BILL ANALYSIS �
SB 616
Page 1
Date of Hearing: July 3, 2012
Counsel: Sandy Uribe
ASSEMBLY COMMITTEE ON PUBLIC SAFETY
Tom Ammiano, Chair
SB 616 (DeSaulnier) - As Amended: June 27, 2012
SUMMARY : Creates a dedicated fund to maintain the Controlled
Substance Utilization Review and Evaluation System (CURES).
Specifically, this bill :
1)Makes legislative findings and declarations about the value
and necessity of the CURES.
2)Establishes the CURES fund in the State Treasury, which shall
consist of contributions collected from organizations for
purposes of funding the CURES program.
3)Provides that monies in the fund shall be allocated to the
Department of Justice (DOJ) to administer the CURES.
EXISTING LAW :
1)Requires DOJ to maintain the CURES for the electronic
monitoring of the prescribing and dispensing of Schedule II,
Schedule III, and Schedule IV controlled substances by all
practitioners authorized to prescribe or dispense these
controlled substances. �Health and Safety Code (HSC) Section
11165(a).]
2)Requires a dispensing pharmacy or clinic to provide specified
prescription data for each prescription for a Schedule II,
Schedule III, or Schedule IV controlled substance to DOJ on a
weekly basis. �HSC Section 11165(d).]
3)Allows a licensed health care practitioner who is eligible to
prescribe Schedule II, Schedule III, or Schedule IV controlled
substances, or a pharmacist to make a written request to DOJ
for the history of controlled substances dispensed to an
individual under his or her care, and allows DOJ to provide
that information to that health care practitioner or
pharmacist. �HSC Section 11165.1(a).]
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4)Provides that the history of controlled substances dispensed
to an individual based on data contained in CURES that is
received by a practitioner or pharmacist from DOJ pursuant to
this section shall be considered medical information subject
to specified confidentiality provisions. �HSC Section
11165.1(d).]
5)Requires every practitioner, other than a pharmacist, who
prescribes or administers a controlled substance classified in
Schedule II, III or IV to record specified information
relating to the transaction. (HSC Section 11190.)
FISCAL EFFECT : Unknown
COMMENTS :
1)Author's Statement : According to the author, "SB 616
establishes a dedicated fund to assist law enforcement and
regulatory agencies in their efforts to control the diversion
and abuse of prescription drugs and increase the frequency
that a pharmacy or clinic reports filled controlled substance
prescriptions. The fund will support the Controlled Substance
Utilization Review and Evaluation System (CURES) Program
administered by the California Department of Justice (DOJ).
In 2099, the DOJ launched its automated Prescription Drug
Monitoring Program (PDMP) within the CURES program. The
program allows licensed health care practitioners eligible to
prescribe controlled substances access to patient controlled
substance prescription information in real-time, 24 hours a
day at the point of care. Prescribers and pharmacists used
the PDMP to make informed decisions about patient care and
detect patients who may be abusing controlled substances by
obtaining multiple prescriptions from various practitioners.
While the automated PDMP within the CURES program is a
valuable investigative, preventative, and educational tool for
law enforcement, regulatory boards, and health care providers,
recent funding reductions have resulted in insufficient funds
to support the CURES. Without dedicated resources, the CURES
program will be suspended."
2)Background : The CURES was established in 1997 by AB 3042
(Takasugi), Chapter 738, Statutes of 1996, in response to
recommendations of the Controlled Substance Prescription
Advisory Council. (SCR 74, 1992.) CURES is a state database
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of dispensed prescription drugs with a high potential for
misuse. The program initially was intended to electronically
monitor the prescribing and dispensing of Schedule II
controlled substances, such as Oxycodone. The CURES provides
for real-time electronic transmission of specified
prescription data to DOJ. Essentially, the data is analyzed
for indications that controlled substances are being
improperly prescribed, or that drug abusers are obtaining
prescriptions from many doctors (doctor shopping).
In September 2009, DOJ launched the Prescription Drug Monitoring
Program (PDMP) system allowing pre-registered users, including
licensed health care prescribers eligible to prescribe
controlled substances, pharmacists authorized to dispense
controlled substances, law enforcement, and regulatory boards,
to access real-time patient controlled substance history
information through a secure Web site. Prior to adoption of
PDMP, doctors and pharmacists had to request information by
fax, mail or phone, and wait days for a response. Under the
system, a registered person authorized to prescribe or
dispense a controlled substance is able to instantly look up a
new patient's controlled substance history to determine
whether the patient legitimately needs medication or is doctor
shopping. The system also assists persons authorized to
prescribe or dispense controlled substances to assure patient
safety.
3)Funding : According to a June 2012 report prepared by the DOJ,
"Currently, there is no permanent funding to support the
CURES/PDMP program. The California Budget Act of 2011
eliminated all General Fund support of CURES/PDMP, which
included funding for system support, staff support and related
operating expenses. To perform the minimum critical functions
and to avoid shutting down the program, the Department opted
to assign five staff to perform temporary dual job assignments
on a part-time basis. Although some tasks are being
performed, the program is faced with a constant backlog (e.g.,
four-week backlog on processing new user applications,
six-week response time on emails, twelve week backlog on
voicemails, etc.) In addition, since January 23, 2012, four
unpaid Regional Occupational Program (ROP) students have been
assigned to assist with the workload. Their assignments ended
at the conclusion of the school year effective May 31, 2012.
DOJ intends on replacing these unpaid students with paid
students to ensure some continuity; however, this is a
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temporary solution and will not resolve the long-term issue of
insufficient staff support.
"The only funding currently available is through renewable
contracts with five separate regulatory boards and one grant.
As a result, funding for CURES/PDMP in state fiscal year (FY)
2011-12 consists of $296,000 that can be used only for PDMP
system data and maintenance. The contracts are renewed every
two to three years (depending on the board) contingent upon
the availability of adequate board funds (Health & Safety Code
11165). In addition, the federal Bureau of Justice Assistance
(BJA) recently authorized the extension of the Fiscal Year
(FY) 2010 Harold Rogers grant to DOJ into state FY 2012-13,
allowing CURES/PDMP to carry over approximately $340,000 in
unspent grant funds specified for outreach and system
development. While DOJ has been able to successfully renew
contracts with the boards and receive grant funding this year,
these sources of funding are not permanent and may not be
available in future years and cannot be used to fund staff
positions. In addition, these two funding sources are
insufficient to operate and maintain the PDMP system, make
necessary enhancements or fully fund a PDMP modernization
effort. The DOJ has once again applied for the current Harold
Rogers grant, however, it will not provide sufficient funding
for the ongoing costs of the program." (See CURES 2.0, An
Integrated Approach to Preventing Prescription Drug Abuse and
Diversion, June 2012.)
4)Controlled Substances : The federal government regulates the
manufacture, distribution, and dispensing of controlled
substances through the Controlled Substances Act of 1970. The
act ranks into five schedules those drugs known to have
potential for physical or psychological harm, based on three
considerations: (a) their potential for abuse; (b) their
accepted medical use; and, (c) their accepted safety under
medical supervision.
Schedule I controlled substances have a high potential for abuse
and no generally accepted medical use such as heroin and LSD.
Schedule II controlled substances have a currently accepted
medical use in treatment, or a currently accepted medical use
with severe restrictions, and have a high potential for abuse
and psychological or physical dependence. Schedule II drugs
can be narcotics or non-narcotic. Examples of Schedule II
controlled substances include morphine, methadone, Ritalin,
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Demerol, Dilaudid, Percocet, Percodan, and Oxycontin.
Schedule III and IV drugs include Vicodin, Zanex, Ambien and
other anti-anxiety drugs that generally have less potential
for abuse than Schedule II drugs, but are known to be mixed in
specific ways to achieve a narcotic-like end product.
Schedule V drugs are available over the counter.
5)Vagueness Concerns : This bill creates a funding mechanism
based on voluntary contributions from "organizations." The
bill does not specify who those organizations are. Moreover,
by making the contributions voluntary, it appears the bill
does not truly create a dedicated funding source, which is
part of the legislative intent. Thus, while the overarching
goals of the bill are clear, the specific language to
accomplish this goal is vague.
6)Argument in Support : According to the Department of Justice ,
"The legislation would memorialize a fee structure to be
agreed upon by entities affected by the PDMP program. This
funding would allow the Attorney General's Office (AGO) to
upgrade and maintain the PDMP and to field teams to
investigate prescription drug diversion.
The AGO uses the PDMP to collect and store data on the
prescription and dispensation of Schedule II through IV
controlled substances. This data allows licensed prescribers
and dispensers to make appropriate treatment decisions and to
prevent and intervene with patients under their care who may
be abusing controlled substances."
7)Related Legislation : SB 360 (DeSaulnier), Chapter 418,
Statutes of 2011, updated the CURES to reflect the new PDMP
and authorized DOJ to initiate administrative enforcement
actions to prevent the misuse of confidential information
collected through the CURES program. SB 360 also provided
additional requirements and sanctions for security
prescription printers and their employees who have direct
contact with, or access to, controlled-substance
prescription-drug forms.
8)Prior Legislation :
a) SB 1071 (DeSaulnier), of the 2009-10 Legislative
Session, imposed a per-pill tax upon every manufacturer and
importer of controlled substances classified as Schedule
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II, III, or IV to be allocated to DOJ for the cost of the
CURES program. SB 1071 failed passage in the Senate
Committee on Health.
b) AB 2968 (Mullin), Chapter 286, Statutes of 2006, added
more information to the requirements for a physician to
prescribe a controlled substance, and required electronic
monitoring of Schedule IV drugs.
c) SB 734 (Torlakson), Chapter 487, Statutes of 2005, made
various technical and clarifying changes to the CURES.
d) SB 151 (Burton), Chapter 406, Statutes of 2004, made the
CURES reporting system permanent
e) AB 3042 (Takasugi), Chapter 738, Statutes of 1996,
established CURES as a three-year pilot program.
REGISTERED SUPPORT / OPPOSITION :
Support
Department of Justice
Opposition
None
Analysis Prepared by : Sandy Uribe / PUB. S. / (916) 319-3744