BILL ANALYSIS
SENATE HEALTH
COMMITTEE ANALYSIS
Senator Deborah V. Ortiz, Chair
BILL NO: AB 631
A
AUTHOR: Leno
B
AMENDED: May 26, 2005
HEARING DATE: June 15, 2005
6
FISCAL: Appropriations
3
1
CONSULTANT:
Dunstan / ak
SUBJECT
Narcotic treatment programs: mobile service units
SUMMARY
This measure requires the California Department of Alcohol
and Drug Programs (DADP) to create a licensing category for
mobile narcotic treatment programs.
ABSTRACT
Existing law:
1.Establishes DADP and grants them sole authority in state
government to license adult alcoholism or drug abuse
recovery or treatment facilities.
2.Authorizes that the controlled substances methadone and
levoalphacetylmethadol (LAAM) are authorized for use in
replacement narcotic therapy by licensed narcotic
treatment programs.
3.Prohibits a licensee from operating an alcoholism or drug
abuse recovery or treatment facility beyond the
conditions and limitations specified on the license.
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4.Authorizes the director to grant exceptions to the
licensing regulations for pilot and demonstration
projects.
5.Establishes the drug Medi-Cal program administered by
DADP to provide defined modes of treatment for low-income
persons with a drug or alcohol abuse problem.
This bill:
1.Requires DADP to establish a program for the operation
and regulation of mobile narcotic treatment programs
(MNTP).
2.Requires a MNTP to meet one of the following conditions:
Hold a primary narcotic treatment program license;
or,
Be affiliated and associated with a primary
licensed narcotic treatment program. In this case,
the MNTP will not be required to have a license
separate from its affiliated primary licensed narcotic
treatment program.
1.Provides additional criteria that DADP shall use in
approving a MNTP that is affiliated with a licensed
narcotic treatment program, including eligible patients,
capacity limitation, use of federal Food and Drug
Administration approved treatment and security protocols
to prevent diversion of medication.
2.Requires DADP, in considering a MNTP application, to
independently weigh the treatment needs and concerns of
the county, city, or areas to be served by the program.
3.Specifies that nothing in this bill is intended to expand
the scope of the practice of pharmacy.
4.Requires the MNTPs to be located at predetermined sites
approved by DADP.
FISCAL IMPACT
According to the Assembly Appropriations Committee:
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1.Unknown General Fund cost pressures in the Drug Medi-Cal
program to the extent this bill increases the number of
counties that start MNTPs and the number of clients
served by newly licensed programs. For example, an
increase in 35 patients, served at a rate of $13 per day
would result in more than $160,000 in Drug Medi-Cal
costs, which are shared evenly by the federal and state
government.
2.Unknown and potentially significant savings to the extent
that this bill reduces societal costs in terms of
criminal justice and health care.
BACKGROUND AND DISCUSSION
Purpose of the bill
According to the author, this bill will make services
offered by MNTPs eligible for Drug Medi-Cal and will expand
access to effective treatment services. In illustrating
the need for this bill, the author cites the mobile
narcotic treatment pilot project in San Francisco which
provides narcotic treatment services to various
individuals. Although 21 percent of the patients receiving
services from the pilot project are eligible for Medi-Cal,
the services are currently not reimbursed because the
program is not licensed by DADP.
In addition, the author states that locating traditional
methadone clinics is made difficult by community resistance
to the presence of treatment programs in their
neighborhoods. MNTPs address this issue by providing
services in neighborhoods where the services are needed
without creating a permanent clinic site.
San Francisco pilot project
In May 2002, the San Francisco Board of Supervisors passed
a resolution allowing the San Francisco Department of
Public Health to establish a mobile medication unit pilot
program as an extension to the city's narcotic treatment
program. To support the pilot program, federal funding was
granted by the Substance Abuse and Mental Health Services
Administration (SAMHSA). On September 10, 2002, DADP
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allowed San Francisco to operate a mobile medication unit
pilot program to provide replacement narcotic therapy from
a van. This van provides services daily at two locations
for up to 75 patients in each location. The van provides
dispensing services, urinalysis sample collection and
emergency crisis counseling. Scheduled counseling sessions
are provided in an office space at the community clinics
where the van is securely parked.
Narcotic treatment program (NTP)
In California, individuals who are addicted to heroin or
other opiates may be admitted to a state-approved NTP for
replacement narcotic therapy using the FDA-approved
medications, methadone and levomethadyl. To receive these
medications in a licensed NTP, all patients must
participate in a comprehensive treatment program which
includes a medical evaluation and screening for diseases
that are disproportionately represented in the
opiate-addicted populations. Patients are evaluated and
provided counseling for medical, alcohol, criminal and
psychological problems and are required to undergo regular
urinalysis to ensure that illicit drugs are not being used
during treatment. According to DADP, methadone maintenance
treatment costs an average of $11 per day.
Licensing requirement
The NTP licensing branch at DADP is responsible for
licensing NTPs and regulating the delivery of replacement
narcotic therapy services to patients. DADP ensures that
patients enrolled in NTP programs receive therapeutic care
and ensure the health and safety of each patient is upheld.
Annual inspections monitor NTPs for compliance with state
and federal laws and regulations. In addition, programs
are required to be certified by SAMHSA and to obtain a Drug
Enforcement Administration (DEA) registration prior to
licensure. For purposes of the San Francisco mobile
medication unit pilot program, DEA required the NTP to
equip the van with a Global Positioning System and a
security system that provides security for the safe that
stores the medication, panic buttons throughout the van and
a monitoring device which allows a security company to
monitor the interior of the van in an emergency.
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Drug Medi-Cal
Drug Medi-Cal services provide medically necessary alcohol
and other drug treatment to eligible Medi-Cal recipients.
DADP receives Medi-Cal funding from the Department of
Health Services for Drug Medi-Cal. Drug Medi-Cal benefits
are optional Medi-Cal benefits that the state has chosen to
offer.
Arguments in support
The sponsor, the City and County of San Francisco points
out that at $13 per day, methadone treatment is a
cost-effective alternative to incarceration or
hospitalization. Some studies indicate that savings accrue
at a rate of $7 in the future to every $1 spent on
addiction treatment in the present.
PRIOR ACTIONS
Assembly Floor: 72 - 7 Pass
Assembly Appropriations: 17 - 1 Do Pass as Amended
Assembly Health: 12 - 0 Do Pass
POSITIONS
Support: San Francisco City and County (sponsor)
California Medical Association
California Opioid Maintenance Providers
Drug Policy Alliance Network
Oppose:None received
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