BILL ANALYSIS �
SB 1438
Page 1
Date of Hearing: August 6, 2014
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Mike Gatto, Chair
SB 1438 (Pavley) - As Amended: August 4, 2014
Policy Committee: HealthVote:17-0
Judiciary Vote: 9-0
Urgency: No State Mandated Local Program:
No Reimbursable: No
SUMMARY
This bill establishes standards allowing first responders to
receive and distribute opioid antagonists (naloxone, brand name
Narcan) to reverse overdoses. Specifically, this bill:
1)Clarifies peace officers are among individuals authorized to
receive and distribute opioid antagonists.
2)Requires the Emergency Medical Services Authority (EMSA) to
adopt regulations to include the administration of naloxone
hydrochloride in the training and scope of practice of EMT-I
certification.
3)Requires EMSA to develop standards and regulations for all
prehospital emergency care personnel, as defined, regarding
the use and administration of naloxone hydrochloride and other
opioid antagonists.
4)Allows the Attorney General to authorize hospitals and trauma
centers to share information with local law enforcement
agencies and local emergency medical services agencies about
controlled substances.
FISCAL EFFECT
1)One-time staff costs, not likely to exceed $100,000 for EMSA
to issue regulations.
2)Local and private costs will be incurred as well. Local and
private EMS agencies who have not adopted naloxone
administration on a voluntary basis will incur costs for
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policy development and revising training curriculum. EMT-Is
will incur a cost of $50-80 each for the additional training.
These costs are not state-reimbursable.
COMMENTS
1)Purpose . According to the author, prescription opioid and
heroin abuse have led to an increase in fatal overdoses.
While naloxone, an opiate antidote that reverses opiate
overdoses, has been used by paramedics and advanced EMTs to
save lives for the last few decades, current law is unclear
about the ability of other first emergency responders, such as
law enforcement, to use this medication. This bill clarifies
peace officers can administer naloxone. In addition, EMT-I
level first responders are only authorized in some localities
to administer naloxone; this bill adds this authorization into
their scope of practice on a statewide basis to ensure
consistency.
2)Naloxone . According to the FDA, naloxone rapidly reverses the
effects of opioid overdose and is the standard treatment for
overdose, which is characterized by decreased breathing or
heart rate or loss of consciousness. Within minutes, naloxone
can block opiate receptors to reverse the effects of an
overdose and restore breathing to a victim. It does not cause
any euphoric effect and is not prone to recreational use and
abuse.
In April 2014, the FDA announced the approval of a new
hand-held auto-injector to reverse opioid overdose. The Obama
administration has recently encouraged states and police
departments to equip first responders and peace officers with
naloxone to address a rash of opiate overdoses.
3)Who Can Administer Naloxone? Some first responders, including
EMT-IIs and paramedics, are currently authorized to administer
naloxone. Three local EMS agencies have also adopted an
optional scope of practice for EMT-Is to administer naloxone.
AB 635 (Ammiano), Chapter 707, Statutes of 2013 expanded the
use of naloxone for health care providers, family, friends and
other persons, allowing health care providers to prescribe
naloxone to third parties in a position to assist a person at
risk of an opioid-related overdose. Thus, under current law,
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a lay person can administer naloxone, but there is no clear
authority for a peace officer to do so, nor for an EMT-I in
most California counties. This arguably creates perverse
situations where a first responder could legally procure and
administer naloxone to prevent an overdose as a lay person,
but lacks authority to do so in his/her professional capacity
as a first responder.
4)Opposition . The EMS Administrators Association of California
and the EMS Medical Directors Association of California oppose
provisions of this bill that require all EMT-I's to receive
this training. These local EMS administrators object to the
usurpation of the local medical direction scope of practice of
medical personnel in current law. They also cite significant
costs for training, developing policies, storing the drug, and
general oversight of this requirement.
Analysis Prepared by : Lisa Murawski / APPR. / (916) 319-2081