BILL ANALYSIS
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|SENATE RULES COMMITTEE | AB 2145|
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THIRD READING
Bill No: AB 2145
Author: Ammiano (D)
Amended: 6/29/10 in Senate
Vote: 21
SENATE JUDICIARY COMMITTEE : 4-0, 6/22/10
AYES: Corbett, Harman, Hancock, Leno
NO VOTE RECORDED: Walters
ASSEMBLY FLOOR : 74-1, 6/2/10 - See last page for vote
SUBJECT : Drug overdose treatment: liability
SOURCE : Harm Reduction Coalition
DIGEST : This bill: (1) expands a seven county pilot
program that provides licensed health care providers with a
qualified immunity from civil liability or criminal
prosecution when they prescribed naloxone (a prescription
drug to counteract an opiate overdose), (2) removes the
restriction to only those seven counties, and (3) adds a
new qualified immunity for unlicensed trained persons that
administer an opioid antagonist in emergency situations
where they believe, in good faith, that the other person is
experiencing a drug overdose, and (4) extends the sunset
date from January 1, 2011 to January 1, 2016.
ANALYSIS : Existing law provides that a licensed health
care provider who is permitted by law to prescribe an
opioid antagonist may, if acting with reasonable care,
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prescribe and subsequently dispense or distribute that
antagonist in conjunction with an opioid overdose
prevention and treatment training program, without being
subject to civil liability or criminal prosecution. (Civil
Code Section 1714.22(b).)
Existing law applies the above immunity to a licensed
health care provider even when the opioid antagonist is
administered by and to someone other than the person to
whom it is prescribed. (Civil Code Section 1714.22(b).)
Existing law requires each local health jurisdiction that
operates or registers an opioid overdose prevention and
treatment training program to, by January 1, 2010, collect,
and report to the Senate and Assembly Committees on
Judiciary, all of the following data on programs within the
jurisdiction:
1. Number of training programs operating in the local
health jurisdiction.
2. Number of individuals who have received a prescription
for, and training to administer, an opioid antagonist.
3. Number of opioid antagonist doses prescribed.
4. Number of opioid antagonist doses administered.
5. Number of individuals who received opioid antagonist
injections who were properly revived.
6. Number of individuals who received opioid antagonist
injections who were not revived.
7. Number of adverse events associated with an opioid
antagonist dose that was distributed as part of an
opioid overdose prevention and treatment training
program. (Civil Code Section 1714.22(c).)
Existing law limits the application of the above provisions
to the Counties of Alameda, Fresno, Humboldt, Los Angeles,
Mendocino, San Francisco, and Santa Cruz, and sunsets the
above provisions on January 1, 2011. (Civil Code Section
1714.22(d)(e).)
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Existing law defines "opioid overdose prevention and
treatment training program" as any program operated by a
local health jurisdiction or that is registered by a local
health jurisdiction to train individuals to prevent,
recognize, and respond to an opiate overdose, and that
provides, at a minimum, training in all of the following:
(1) the causes of an opiate overdose; (2) mouth to mouth
resuscitation; (3) how to contact appropriate emergency
medical services; and (4) how to administer an opioid
antagonist. (Civil Code Section 1714.22(a)(2).)
This bill additionally provides that a person who is not
otherwise licensed to administer an opioid antidote may
administer an opioid antidote in an emergency, without a
fee, if the person has been trained by an opioid overdose
prevention and treatment training program and believes in
good faith that the other person is experiencing a drug
overdose. That person would not, as a result of their acts
or omissions, be liable for any violation of any
professional licensing statute, or be subject to any
criminal prosecution arising from or related to the
unauthorized practice of medicine or the possession of an
opioid antidote.
This bill extends the sunset date of January 1, 2011 to
January 1, 2016, removes the report requirement, and
removes the restriction to the above seven counties.
Background
According to the Centers for Disease Control, drug
overdoses are the second leading cause of unintentional
injury death in the United States. Those overdoses
arguably include numerous preventable deaths from opioid
overdose where the victim did not receive prompt medical
treatment.
Opioid overdoses are characterized by central nervous
system and respiratory depression, leading to coma and
death. While there are various opioid antagonists, the
most popular appears to be naloxone, which has the ability
to counteract depression of the central nervous and
respiratory system caused by an opioid overdose. Naloxone
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is administered by either injection into vein or muscle or
via a nasal atomizer. Once administered, naloxone takes
effect after around a minute, with effects lasting around
45 minutes, potentially saving the person's life. The New
York Times August 21, 2005 article entitled The Shot That
Saves , noted: "If given early enough, naloxone can prevent
damage to the brain caused by lack of oxygen and leave the
victim unharmed. According to research . . . at least
75 percent of overdose deaths involve multiple drugs,
usually mixtures of heroin and other depressants like
alcohol. Removing the opioid from the mix with naloxone is
often enough to revive victims.
"Naloxone itself is virtually harmless. Its most common
side effects are withdrawal symptoms like nausea, shakiness
and agitation in those who are physically dependent on
opioids. While uncomfortable, these symptoms are not
dangerous. Rarely, seizures can occur, but this risk is
far lower than the risk to those who are not treated. The
drug has no effect on those who haven't taken opioids.
"According to a study published in the journal Drug and
Alcohol Dependence, 57 percent of 1,184 hard drug users
interviewed had witnessed at least one overdose. Medical
help was sought in only two-thirds of the instances, and
this was usually only after efforts to revive the victim by
hitting him or rubbing him with ice had failed . . . More
than half of the drug users in the study cited fear of
arrest as the main reason for delaying or failing to seek
help."
In order to facilitate the prescription of naloxone to
trained individuals, SB 767 (Ridley-Thomas), Chapter 477,
Statutes of 2007, establishes a seven county pilot program
that provided licensed health care providers with a
qualified immunity from civil liability or criminal
prosecution when they prescribed naloxone. That immunity
only applies where the health care provider dispensed that
drug in connection with an opioid overdose prevention and
training program - those programs, either registered or run
by a local health jurisdiction, trained individuals for how
to recognize and respond to an opiate overdose. The pilot
program sunsets on January 1, 2011, and the seven
participating counties were required to report specified
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information to the Senate and Assembly Committees on
Judiciary by January 1, 2010.
FISCAL EFFECT : Appropriation: No Fiscal Com.: No
Local: No
SUPPORT : (Verified 6/29/10)
Harm Reduction Coalition (source)
AIDS Community Research Consortium
California Association of Alcohol and Drug Program
Executives
California Medical Association
California Public Defenders Association
City and County of San Francisco
Coalition on Homelessness, San Francisco
County Alcohol and Drug Administrators of California
Desert AIDS Project
Drug Policy Alliance
Health Officers Association of California
Homeless Health Care Los Angeles
Los Angeles County Board of Supervisors
San Francisco AIDS Foundation
Street Outreach Supporters
ARGUMENTS IN SUPPORT : According to the author's office,
in 2008, the Overdose Treatment Liability Act established a
three-year pilot project. Scheduled to sunset on January
1, 2011, the act granted limited immunity from civil and
criminal penalties to licensed health care providers in
seven counties - Alameda, Fresno, Humboldt, Los Angeles,
Mendocino, San Francisco, and Santa Cruz. These counties
were designated as pilot counties because they had existing
overdose prevention programs in place already, through
their local syringe access and disposal programs. The Harm
Reduction Coalition is working with health advocates in
Kern, Lake, Sacramento, San Diego, Santa Clara, and Sonoma
counties who are either already doing independent Naloxone
distribution as part of an overdose prevention program or
would like to start.
ASSEMBLY FLOOR :
AYES: Adams, Ammiano, Anderson, Arambula, Bass, Beall,
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Bill Berryhill, Blakeslee, Block, Blumenfield, Bradford,
Brownley, Buchanan, Charles Calderon, Carter, Chesbro,
Conway, Cook, Coto, Davis, De La Torre, De Leon, DeVore,
Emmerson, Eng, Evans, Feuer, Fletcher, Fong, Fuentes,
Fuller, Furutani, Gaines, Galgiani, Garrick, Gilmore,
Hagman, Hall, Harkey, Hayashi, Hernandez, Hill, Huber,
Huffman, Jeffries, Jones, Logue, Bonnie Lowenthal, Ma,
Mendoza, Miller, Monning, Nava, Nestande, Niello,
Nielsen, Norby, V. Manuel Perez, Portantino, Ruskin,
Salas, Saldana, Silva, Skinner, Smyth, Solorio, Swanson,
Torlakson, Torres, Torrico, Tran, Villines, Yamada, John
A. Perez
NOES: Caballero
NO VOTE RECORDED: Tom Berryhill, Knight, Lieu, Audra
Strickland, Vacancy
RJG:do 6/29/10 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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