BILL ANALYSIS
AB 2145
Page 1
ASSEMBLY THIRD READING
AB 2145 (Ammiano)
As Amended May 28, 2010
Majority vote
JUDICIARY 9-0 APPROPRIATIONS 17-0
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|Ayes:|Feuer, Tran, Brownley, |Ayes:|Fuentes, Conway, Ammiano, |
| |Hill, Hagman, Huffman, | |Bradford, Charles |
| |Skinner, Monning, Nava | |Calderon, Coto, Davis, |
| | | |Monning, Ruskin, Harkey, |
| | | |Miller, Nielsen, Norby, |
| | | |Skinner, Solorio, |
| | | |Torlakson, Torrico |
| | | | |
|-----+--------------------------+-----+--------------------------|
| | | | |
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SUMMARY : Seeks to expand parameters of the current pilot
program authorizing opioid antagonist (Naloxone) treatment of
drug overdose with limited immunity from liability.
Specifically, this bill :
1)Provides that a person who is not otherwise licensed to
administer an opioid antidote may administer an opioid
antidote in an emergency without fee, if the person believes
in good faith that the other person is experiencing a drug
overdose, and has received specified training through a
training program operated or registered by the local health
jurisdiction. Further provides that the person shall not, as
a result of his or her acts or omissions, be liable for any
violation of any professional licensing statute, or subject to
any criminal prosecution related to the unauthorized practice
of medicine or possession of an opioid antidote.
2)Deletes the provision that currently restricts application of
the Naloxone treatment pilot program to only seven authorized
counties, thereby expanding application of these provisions
statewide.
3)Deletes the sunset date provision that would repeal authority
for the Naloxone treatment pilot program on January 1, 2011,
thereby extending these provisions indefinitely.
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4)Deletes the requirement that each local health jurisdiction
that operates or registers an opioid overdose prevention and
treatment training program must report specified data by
January 1, 2010 to the Senate and Assembly Judiciary
Committees.
FISCAL EFFECT : According to the Assembly Appropriations
Committee, no direct fiscal impact is created by this bill.
COMMENTS : This bill, co-sponsored by Harm Reduction California
and the Los Angeles Overdose Prevention Task Force, seeks to
expand parameters of the current pilot project that grants
limited immunity from civil and criminal penalties to licensed
health care providers in seven counties who are authorized to
prescribe and distribute opioid antagonists for emergency
treatment of drug overdose. First, the bill would expand
limited immunity from civil and criminal liability to lay
persons who administer an opioid antagonist in an emergency, if
that lay person has received appropriate training through a
program operated or registered by the local health jurisdiction.
In practice, these persons are most likely to be friends or
acquaintances of the person using opioid drugs, present when an
overdose begins and thus in the best position to intervene and
administer the opioid antagonist at a point when it will have
its greatest lifesaving effect. This bill would also expand the
pilot provisions statewide, while simultaneously deleting the
2011 sunset date, thereby extending these provisions
indefinitely.
Opioid overdoses are characterized by central nervous system and
respiratory depression, leading to coma and death. Naloxone,
like other opioid antagonists, has the ability to counteract
depression of the central nervous and respiratory system caused
by an opioid overdose. Naloxone is administered by injection
into vein or muscle, with intravenous injection providing for
the fastest action. Once injected, naloxone takes effect after
around two minutes, with effects lasting around 45 minutes,
potentially saving the person's life.
According to the Harm Reduction Coalition, overdose prevention
programs that dispense naloxone (often referred to as "naloxone
prescription programs", or NPPs) have been operating legally in
California for ten years, with different levels of support from
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city and county public health departments and community-based
organizations.
Proponents of this bill contend, very simply, that naloxone
prescription programs save lives, and that available data from
San Francisco and Los Angeles pilot programs demonstrate that
these programs are actively being used to produce safe and
effective health outcomes. With respect to liability concerns,
the Judiciary Committee has not been made aware of any suits or
prosecutions as a result of the current distribution of opioid
antagonists.
Proponents of this bill contend that accidental drug overdose is
a prevalent problem across the state, and that expansion of the
pilot program would help to address unmet needs in many counties
that currently do not enjoy the protections provided by the SB
767 pilot project. According to the most recent report by
California Alcohol and Drug Programs, the counties with the
highest number of overdose deaths in 2006 were Kern, Orange,
Riverside, Sacramento, San Bernardino, San Diego, Santa Clara,
Alameda, Fresno, San Francisco, and Los Angeles. The author
notes that only the latter four counties are authorized as sites
for pilot programs in SB 767, and asserts that there are a
number of counties that already have NPPs that merit protection,
as well as many high-need counties yet to implement programs
that would stand to benefit from statewide expansion proposed by
this bill.
Supporters contend that because naloxone cannot be
self-administered by the person experiencing the overdose, it is
recommendable to extend protection from liability to third
parties who are trained to administer naloxone, or else they
will simply avoid employing naloxone in an emergency even when
it is available. The author explains:
Opioid overdose is characterized by unconsciousness
caused by failure of the respiratory system.
Therefore, if the person prescribed naloxone is the
one who is at-risk, he will not be able to use it on
himself when actually needed. A companion trained in
naloxone administration must be present to administer
the life-saving drug. Friends, family members, workers
in homeless shelters, residential hotels, and drug
treatment programs are often first responders in an
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overdose crisis, but may be fearful to carry a
naloxone prescription because of the lack of 3rd party
protection. A trained, informed Good Samaritan
deserves to keep naloxone in the first aid kit or
medicine cabinet without needless concern.
Supporters report that county health workers who operate or who
desire to operate a NPP report having difficulty finding health
care providers who are comfortable writing prescriptions for a
medication that will, by necessity, be administered by a third
party, without reasonable liability protection. Furthermore,
supporters assert that even so-called "frontline workers" who
have taken overdose prevention trainings, and who often are in
close contact with drug users at sites like homeless shelters
and drug treatment facilities, nevertheless are reluctant to
keep the naloxone close at hand for emergency response, without
any legal protection for a third party who administrates
naloxone.
Analysis Prepared by : Anthony Lew / JUD. / (916) 319-2334
FN: 0004660