BILL ANALYSIS
AB 2268
Page 1
ASSEMBLY THIRD READING
AB 2268 (Chesbro)
As Amended April 20, 2010
Majority vote
HEALTH 18-0
--------------------------------
|Ayes:|Monning, Fletcher, |
| |Ammiano, Carter, |
| |Brownley, De Leon, Adams, |
| |Eng, Gaines, Hayashi, |
| |Hernandez, Jones, Bonnie |
| |Lowenthal, Nava, |
| |V. Manuel Perez, Salas, |
| |Smyth, Audra Strickland |
| | |
--------------------------------
SUMMARY : Authorizes physician and surgeons in California who
are qualified to treat opioid addiction, pursuant to the federal
Data Addiction Treatment Act (DATA) of 2000, to prescribe
buprenorphine in an office-based setting.
EXISTING LAW :
1)Establishes the Department of Alcohol and Drug Program (DADP)
to license treatment facilities that provide a broad range of
services in a supportive environment to adults who are
addicted to alcohol or drugs.
2)Requires DADP to license and inspect narcotic treatment
programs (NTPs), which use replacement narcotic therapy (RNT)
in the treatment of addicted persons whose addiction was
acquired or supported by the use of a narcotic drug or drugs,
not in compliance with a physician and surgeon's legal
prescription.
3)Authorizes the following controlled substances for use in RNT
by licensed NTPs: methadone, Levo-alphacetylmethadol (LAAM),
buprenorphine products or combination products approved by the
federal Food and Drug Administration (FDA) for maintenance or
detoxification of opioid dependence, and any other federally
approved controlled substances used for the purpose of RNT.
AB 2268
Page 2
4)Requires DADP to establish a program for the operation and
regulation of office-based opiate treatment (OBOT) programs
that are required to hold a primary NTP license or be
affiliated and associated with a primary licensed NTP.
5)Defines an OBOT program as a program in which interested and
knowledgeable physicians provide addiction treatment services,
and in which community pharmacies supply necessary medication
both to these physicians for distribution to patients and
through direct administration and dispensing services.
6)Requires physicians in OBOT programs to dispense or administer
pharmacologic treatment for opiate addiction that has been
approved by the FDA.
FISCAL EFFECT : None
COMMENTS : According to the sponsor, DADP, this bill is intended
to ensure California's physicians maintain their key role in the
treatment of addiction. DADP notes that this bill clarifies
that existing law allowing NTPs and OBOT programs to prescribe
buprenorphine does not restrict the ability of other physicians
who are qualified to treat opioid addiction, pursuant to federal
law, and who are not associated with these programs, to provide
this treatment option to their patients.
Buprenorphine is used to treat addiction to opioids by
preventing withdrawal symptoms so that a person can stop taking
the opioid drug to which he or she is addicted. In October
2002, the FDA approved two buprenorphine products, Subutex and
Suboxone, for use in opioid addiction treatment. Subutex and
Suboxone were the first narcotic drugs available for the
treatment of opiate dependence that can be prescribed in an
office setting under the federal DATA of 2000. Prior to DATA,
opiate dependence treatments like methadone could be dispensed
in a limited number of clinics that specialize in addiction
treatment. Under DATA, medications for the treatment of opiate
dependence are subject to less restrictive controls.
Buprenorphine can be prescribed in an office-based setting by
specially qualified physicians, and patients can obtain a 30-day
supply from a pharmacy.
AB 2268
Page 3
Pursuant to DATA, qualified physicians are required to obtain a
waiver from the federal Center for Substance Abuse Treatment to
prescribe buprenorphine. Physicians seeking a waiver must have
a current state medical license and valid Drug Enforcement
Agency number; be certified in specialty or subspecialty
addiction from the American Board of Medical Specialties,
American Society of Addiction Medicine, or American Osteopathic
Association; and, complete appropriate training. Once a
physician obtains the waiver, he or she may treat up to 30
patients for narcotic addiction with buprenorphine. Physicians
may increase their patient limit to 100 if they have had their
waiver for a year or more and request the higher limit in
writing. The federal Substance Abuse and Mental Health Services
Administration Web site indicates that there are 1,121
physicians and 182 treatment programs in California authorized
to treat opioid addiction with buprenorphine. This bill
clarifies that authorized prescribers of buprenorphine in
California include physicians who have obtained prescribing
waivers pursuant to DATA 2000, in addition to physicians who are
associated with NTPs and OBOT programs.
As sponsor of this bill, DADP writes that this bill will
eliminate the legal risk to over 1,200 qualified physicians in
California who are already prescribing buprenorphine in their
offices, not knowing that state law does not conform to DATA.
DADP states that this bill will clarify that qualified
physicians in California are authorized to treat opioid
dependence in their private practices as they would any other
illness, subject to the requirements of DATA, and would
substantially increase access to treatment for underserved
populations in rural areas that do not have NTPs or clients who
use public transit and must travel hours to the nearest NTP.
Supporters, including the California Medical Association, Drug
Policy Alliance and the California Association of Alcoholism and
Drug Counselors, add that this bill will increase access for
patients in need of detoxification and maintenance treatments
and enable physicians to treat their patients with the full
complement of services at their disposal.
Analysis Prepared by : Cassie Rafanan / HEALTH / (916)
319-2097
FN: 0003939