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SB-419 Medical practice: pain management.(2017-2018)

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Date Published: 04/17/2017 02:48 PM
SB419:v97#DOCUMENT

Amended  IN  Senate  April 17, 2017
Amended  IN  Senate  March 20, 2017

CALIFORNIA LEGISLATURE— 2017–2018 REGULAR SESSION

Senate Bill No. 419

Introduced by Senator Portantino

February 15, 2017

An act to add Section 2242.3 to the Business and Professions Code, relating to controlled substances. An act to amend Section 2241.6 of, and to add Section 4075.7 to, the Business and Professions Code, and to add Section 11167.7 to the Health and Safety Code, relating to healing arts.


LEGISLATIVE COUNSEL'S DIGEST


SB 419, as amended, Portantino. Oxycodone: prescriptions. Medical practice: pain management.
Existing law, the Controlled Substances Act, prohibits a person other than a physician, dentist, podiatrist, veterinarian, or certain other health care practitioners, in specified circumstances, from writing or issuing a prescription. That act requires a prescription for specified controlled substances to be made on a specified controlled substance prescription form, to be signed and dated by the prescriber in ink, and to contain specified information. That act requires a health care practitioner authorized to prescribe, order, administer, or furnish a controlled substance to consult the Controlled Substance Utilization Review and Evaluation System database to review a patient’s controlled substance history before prescribing specified controlled substances to the patient for the first time, and at least once every 4 months thereafter if the substance remain part of the treatment of the patient, except as specified. That act prohibits a person from prescribing, administering, or dispensing a controlled substance to an addict or any person representing himself or herself as an addict, except as specified. That act defines “addict” for this purpose, and excludes from the definition a person whose drug-seeking behavior is primarily due to the inadequate control of pain. Existing law, the Pharmacy Law, imposes various requirements on the dispensing by prescription of dangerous drugs, including controlled substances. That law prohibits furnishing a prescription for a controlled substance transmitted by means of an oral or electronically transmitted order to any person unknown and unable to properly establish his or her identity. Existing law makes a violation of these provisions a crime.
This bill would require a specified health care practitioner, before prescribing, ordering, or furnishing specified narcotic pain medications, including controlled substances, to a minor, as defined, to educate the guardian of the minor on all other available medical treatments, specified nonopioid treatment alternatives to be tried before and alongside opioid therapy, the risks and benefits of narcotic medications and alternatives to narcotic medications, the safe storage of opioid medications, the proper disposal of unused medications, and the illegality of sharing or misusing prescribed medications. The bill would also require this discussion and counseling to be memorialized in a document printed on a secure prescription pad and signed by the minor, if he or she was counseled, the guardian, and the prescriber. The bill would require a pharmacist to review and verify the document before dispensing the medication. The bill would prohibit a subsequent prescription of those medications from being made until the minor is reevaluated by a pain management specialist or a pediatrician. By adding these new requirements to the Controlled Substances Act and the Pharmacy Law, the violation of which would be a crime, this bill would impose a state-mandated local program.
Existing law establishes the Medical Board of California within the Department of Consumer Affairs. Existing law, among other things, required the board to develop standards before June 1, 2002, to ensure the competent review in cases concerning the management, including, but not limited to, the undertreatment, undermedication, and overmedication of a patient’s pain.
This bill would require the board, on or before July 1, 2018, to update those standards. The bill would also require the board to update those standards on or before July 1 each 5th year thereafter. The bill would require the board to convene a task force to develop and recommend the updated standards to the board. The bill would require the task force, in developing the updated standards, to consult with specified entities.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.

Existing law, the California Uniform Controlled Substances Act, classifies controlled substances into 5 designated schedules, with the most restrictive limitations generally placed on controlled substances classified in Schedule I, and the least restrictive limitations generally placed on controlled substances classified in Schedule V. Existing law places oxycodone within Schedule II. Existing law requires a prescription for a controlled substance to only be issued for a legitimate medical purpose by an individual practitioner acting in the usual course of his or her professional practice.

Existing law, the Medical Practice Act, provides for the licensing and regulation of physicians and surgeons by the Medical Board of California. Among other things, the act regulates the prescribing, dispensing, or furnishing of dangerous drugs, including oxycodone, by a licensee, and provides, under certain circumstances, for the imposition of an administrative fine pursuant to a citation by the board, or the imposition of a civil penalty for a violation of these provisions. A violation of designated provisions of the act is a crime.

This bill would prohibit a person from prescribing oxycodone, by whatever official, common, usual, chemical, or trade name designated, to a patient under 21 years of age, except as specified. The bill would make a violation of this prohibition subject to a civil penalty, as specified. The bill would also authorize a patient who was prescribed oxycodone in violation of the prohibition, and who sustained economic loss or personal injury as a result of that violation, to bring a civil action to recover compensatory damages, reasonable attorney’s fees, and litigation costs.

Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: NOYES  

The people of the State of California do enact as follows:


SECTION 1.

 Section 2241.6 of the Business and Professions Code is amended to read:
2241.6.

The Division of Medical Quality shall develop standards before June 1, 2002, to assure the competent review in cases concerning the management, including, but not limited to, the undertreatment, undermedication, and overmedication of a patient’s pain. The division

2241.6.
 (a) (1) The board shall develop standards before June 1, 2002, to ensure the competent review in cases concerning the management, including, but not limited to, the undertreatment, undermedication, and overmedication of a patient’s pain.
(2) The board may consult with entities such as the American Pain Society, the American Academy of Pain Medicine, the California Society of Anesthesiologists, the California Chapter of the American College of Emergency Physicians, and any other medical entity specializing in pain control therapies to develop the standards utilizing, to the extent they are applicable, current authoritative clinical practice guidelines.
(b) The board shall update the standards adopted pursuant to subdivision (a) on or before July 1, 2018, and on or before July 1 each fifth year thereafter.
(c) The board shall convene a task force to develop and recommend the updated standards to the board. The task force, in developing the updated standards, shall consult with the entities specified in paragraph (2) of subdivision (a), the American Cancer Society, and specialists in pharmacology and addiction medicine.

SEC. 2.

 Section 4075.7 is added to the Business and Professions Code, to read:

4075.7.
 (a) Before dispensing a prescription for a minor for a pain medication listed in Section 11167.7 of the Health and Safety Code, the pharmacist shall review and verify the disclosure and counseling document described in subdivision (c) of Section 11167.7 of the Health and Safety Code.
(b) For purposes of this section, “minor” shall have the same meaning as in Section 11167.7 of the Health and Safety Code.

SEC. 3.

 Section 11167.7 is added to the Health and Safety Code, to read:

11167.7.
 (a) For purposes of this section, the following definitions shall apply:
(1) “Minor” means a person under 18 years of age who is not any of the following:
(A) A cancer patient.
(B) A patient in hospice or palliative care.
(C) A patient who has been diagnosed with a terminal illness.
(2) “Guardian” means the legal guardian of the minor.
(b) A health care practitioner, except a veterinarian, authorized to prescribe, order, administer, or furnish oxycodone, hydrocodone, hydromorphone, morphine, codeine, oxymorphone, fentanyl, methadone, tramadol, or tapentadol to a minor shall, before prescribing, ordering, administering, or furnishing those medications, educate the guardian on all of the following:
(1) All other available medical treatments, other than the medication to be prescribed.
(2) Nonopioid treatment alternatives to be tried before and alongside opioid therapy, unless there is a specific adverse reaction or contraindication.
(3) The risks and benefits of narcotic medications and alternatives.
(4) The safe storage of opioid medications.
(5) The proper disposal of unused medications.
(6) The illegality of sharing or misusing prescribed medications.
(c) The discussion and counseling provided in subdivision (b) shall be memorialized in a document printed on a secure prescription pad and signed by the minor, if he or she was counseled, the guardian, and the prescriber.
(d) A subsequent prescription for the pain medications listed in subdivision (b) shall not be made until the minor is reevaluated by a pain management specialist or a pediatrician.

SEC. 4.

 No reimbursement is required by this act pursuant to Section 6 of Article XIII B of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIII B of the California Constitution.
SECTION 1.Section 2242.3 is added to the Business and Professions Code, to read:
2242.3.

(a)(1)Notwithstanding any other law, a person shall not prescribe oxycodone, by whatever official, common, usual, chemical, or trade name designated, to a patient under 21 years of age.

(2)Paragraph (1) does not apply with respect to a patient of any age who is any of the following:

(A)A cancer patient.

(B)A patient in hospice or palliative care.

(C)A patient who has been diagnosed with a terminal illness.

(b)(1)Notwithstanding Section 2314 or any other law, a violation of this section may subject the person who has committed the violation to either a fine of up to five thousand dollars ($5,000) per violation pursuant to a citation issued by the board or a civil penalty of up to five thousand dollars ($5,000) per violation.

(2)The Attorney General may bring an action to enforce this section and to collect the fines or civil penalties authorized by paragraph (1).

(c)In addition to the penalties described in paragraph (1) of subdivision (b), a patient who was prescribed oxycodone in violation of subdivision (a), and who sustained economic loss or personal injury as a result of that violation, may bring an action to recover compensatory damages, as well as reasonable attorney’s fees and costs.