BILL ANALYSIS                                                                                                                                                                                                    �



                                                                  SB 835
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          Date of Hearing:   June 18, 2014

                          ASSEMBLY COMMITTEE ON AGRICULTURE
                           Susan Talamantes Eggman, Chair
                      SB 835 (Hill) - As Amended:  June 4, 2014

           SENATE VOTE  :   35-1
           
          SUBJECT  :  Food animals: medically important antimicrobial drugs.

           SUMMARY  :  This bill would codify the Food and Drug  
          Administration's (FDA) Guidance for Industry (GIF) #213 dated  
          December 2013, by requiring the Secretary (Secretary) of the  
          California Department of Food and Agriculture (CDFA) to refuse  
          to register a livestock drug administered in the feed or  
          drinking water of food animals if such drug is a medically  
          important antimicrobial (MIAM) drug.  Specifically,  this bill  :    


          1)Codifies the FDA Guidance for Industry #213 dated December  
            2013. 

          2)Defines "medically important antimicrobial drug" to mean a  
            drug listed in the FDA Guidance for Industry #152 which  
            categorizes these drugs as critically important, highly  
            important, or important antimicrobial drugs.

          3)Requires the Secretary of DFA to refuse to register a MIAM  
            drug administered to food animals through feed or drinking  
            water unless the drug complies with the specified requirements  
            below:

             a)   Requires drug manufacturers to remove from the label of  
               said drugs the approved use for growth promotion or feed  
               efficiency;

             b)   Requires drug manufacturers to change the  
               over-the-counter availability of said drugs to:

               i)     requiring a veterinary feed directive (VFD) if the  
                 drug is administered in animal feed or;

               ii)    requiring a veterinary prescription if the drug is  
                 administered in drinking water; and,









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             c)   Requires that MIAM drugs administered through feed or  
               water may only be used under the supervision of a  
               veterinarian to treat, prevent, or control disease.

          4)Requires a veterinarian-client-patient relationship to ensure  
            that medically important antimicrobial drugs are used  
            according to professionally accepted best practices.

          5)Requires drug manufacturers to comply with these provisions by  
            January 1, 2017, and reregister MIAM drugs with the Secretary  
            of CDFA.

          6)Authorizes the Secretary to continue registering a drug during  
            FDA's GFI #213 review period should the review be delayed  
            beyond January 1, 2017.

          7)Authorizes the Secretary to extend the implementation date if  
            revisions to the VFD cause FDA to delay implementation of GFI  
            #213.

          8)Authorizes the Secretary to promulgate regulations to ensure  
            that California regulations are consistent with GFI #213  
            should revisions to the VFD cause the FDA to revise GFI #213.

           EXISTING LAW  requires CDFA to register over-the-counter  
          livestock drugs and regulate their use for safety and efficacy.   
          Retail sales of restricted livestock drugs require a license.   
          Each licensee shall keep a record of each sale of a restricted  
          drug, including the kind and quantity of the drug; sale date;  
          purchaser's name, address and signature; and, any other  
          information deemed necessary by the Secretary.  

           FISCAL EFFECT  :  Unknown.

           COMMENTS  :  Antimicrobial drugs have been widely used in human  
          medicine since the 1940s.  Antimicrobial drugs have significant  
          health benefits in both human and animal medicine, and are  
          important and valuable tools used to treat and prevent illness  
          and infection.  Incidences of antimicrobial resistance have been  
          recorded over time and, if left unchecked, pose a threat to  
          public health.

          The Centers for Disease Control (CDC) estimates that in the  
          United States, more than two million people are sickened every  
          year with antibiotic-resistant infections, with at least 23,000  








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          infections resulting in death.  In a recent report, CDC lists  
          four core actions that fight the spread of antibiotic  
          resistance:  1) preventing infections from occurring and  
          preventing resistant bacteria from spreading; 2) tracking  
          resistant bacteria; 3) improving the use of antibiotics; and, 4)  
          promoting the development of new antibiotic and new diagnostic  
          tests for resistant bacteria.  

          CDC notes that the use of antibiotics is the single most  
          important factor leading to antibiotic resistance around the  
          world.  Up to 50% of all antibiotics prescribed for people are  
          either not needed or not optimally effective as prescribed.   
          Antibiotics are also used in food-producing animals for the  
          purpose of promoting growth, which CDC recommends phasing out.  

          In the past decade, FDA has worked on creating GFIs regarding  
          the judicious use of MIAM drugs in food producing animals.  In  
          three GFIs, FDA has: 1) GFI #152, compiled a list of MIAM drugs  
          categorized by their importance to human health; 2) GFI #219,  
          developed principals that determine the appropriate or judicious  
          use of such drugs, by limiting use to only when necessary to  
          maintain animal health, and with veterinary oversight or  
          consultation; and, 3) GFI #213), provided recommendations as to  
          the implementation of the guidelines.  The FDA concludes that  
          using MIAM drugs for animal growth promotion or feed efficiency  
          is not a judicious use, and that veterinary oversight or  
          consultation is necessary when using these drugs.

          In December 2013, FDA released the final draft of GFI #213.  GFI  
          #213 contains nonbinding recommendations to industry regarding  
          the use of MIAM drugs in the feed and drinking water of  
          food-producing animals.  The FDA intends to work with drug  
          companies to help them voluntarily implement the  
          recommendations, which include:  1) phasing out the use of MIAM  
          drugs in food-producing animals for production purposes (growth  
          promotion and feed efficiency); and, 2) include veterinary  
          oversight of these drugs when used in the feed or water of  
          food-producing animals.

          Denmark is a case study for the banning of nontherapeutic use of  
          antibiotics on food production animals.  In 1995, Denmark banned  
          the use of antimicrobial drugs for growth promotion in livestock  
          and has continually recorded antimicrobial drug use and impacts  
          on animal health.  Denmark reports that overall use of  
          antimicrobials in livestock has decreased by 46% since 1994 and  








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          has not compromised animal health or has had a significant cost  
          increase in swine production.  

          According to the author, this bill is necessary to preserve the  
          effectiveness of MIAM by putting into California law the  
          voluntary guidelines issued by FDA to phase out the  
          nontherapeutic use of MIAM in food-producing animals and to  
          require veterinary oversight of these drugs.  

          Supporters state this bill would prohibit the registration of  
          MIAM in livestock and poultry for purposes of growth promotion  
          and feed efficiency, or other uses without veterinary oversight.  
          Furthermore, producers would no longer be able to acquire  
          antibiotics over the counter, but would have to get a  
          veterinarian's prescription or VFD for MIAM use in feed or  
          water. Supporters state this oversight will help ensure  
          antibiotics are used to treat sick animals, to control the  
          spread of diseases present in the flock or herd, and under  
          well-defined circumstances, to prevent disease when necessary.   
          This will in turn help ensure that MIAMs are used in a more  
          judicious manner.  

          Opponents state because the recent FDA guidelines only recommend  
          an end to antibiotic use for growth promotion, the guidelines  
          will do little to curb the inappropriate use of antibiotics on  
          livestock.  Opponents point out that most antibiotics that are  
          used for growth promotion in livestock are also used for disease  
          prevention.  As this will only require a label change in many  
          cases, a Businessweek article published in May, 2014, suggested  
          that the guidelines will not have a significant impact on the  
          companies that sell antibiotics for animal health.  According to  
          opponents, the most effective way to lower MIAM use is to  
          prohibit all antibiotic use in livestock production except for  
          the treatment of sick animals.

          Some supporters and opponents to this bill expressed the desire  
          to collect data in-state on veterinary prescriptions for  
          antibiotics administered in feed.  This information could shed  
          substantial light on the use of MIAM in food animal production.   
          Without some form of tracking, there isn't a way to gauge the  
          success of federal and state policies aimed at reducing  
          antibiotic overuse and curbing the spread of drug-resistant  
          bacteria.  Furthermore, the data may enable both producers and  
          public health officials to spot and remedy problematic overuse  
          that raise human health concerns.








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           RELATED LEGISLATION  :

          AB 1437 (Mullin) of 2014, would have banned the sale, in  
          California, of a livestock or poultry product if the livestock  
          or poultry was given a MIAM for nontherapeutic use.  In the  
          Assembly Committee on Agriculture, the hearing was canceled at  
          the request of author.

          SB 416 (Florez) of 2009, would have authorized a school district  
          to make every effort to purchase poultry and meat products that  
          have not been treated with nontherapeutic antibiotics. SB 416  
          failed passage in the Senate.

          SB 532 (Florez), of 2009 would have required a warning label on  
          any commercial product derived from animals produced with  
          non-therapeutic antibiotics sold for human consumption, and  
          defines antibiotics and nontherapeutics as they pertain to  
          animals raised for the production of commercial human food  
          products beginning January 1, 2011.  In the Assembly Committee  
          on Agriculture, the hearing was canceled at the request of  
          author.

           REGISTERED SUPPORT / OPPOSITION  :

           Support 
           
          California Cattlemen's Association
          California Veterinary Medical Association
          Health Care without Harm
          Health Officers Association of California
          Infectious Disease Association of California
          Pew Charitable Trusts
           
            Opposition 
           
          California State Grange
          CALPIRG
          Center for Food Safety
          Environmental Working Group
          Food and Water Watch
          Consumers Union 
          Natural Defense Resource Council










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           Analysis Prepared by  :    Victor Francovich / AGRI. / (916)  
          319-2084