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AB-1998 Opioids: safe prescribing policy.(2017-2018)

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Date Published: 06/20/2018 04:00 AM
AB1998:v95#DOCUMENT

Amended  IN  Senate  June 19, 2018
Amended  IN  Assembly  May 25, 2018
Amended  IN  Assembly  April 11, 2018
Amended  IN  Assembly  March 12, 2018

CALIFORNIA LEGISLATURE— 2017–2018 REGULAR SESSION

Assembly Bill No. 1998


Introduced by Assembly Member Rodriguez

February 01, 2018


An act to add Section 11153.1 to the Health and Safety Code, relating to controlled substances.


LEGISLATIVE COUNSEL'S DIGEST


AB 1998, as amended, Rodriguez. Opioids: safe prescribing policy.
Existing law, the Uniform Controlled Substances Act, classifies opioids as Schedule II controlled substances and places restrictions on the prescription of those drugs, including prohibiting refills and specifying the requirements of a prescription for these drugs. Violation of these provisions and the Uniform Controlled Substances Act is a misdemeanor.
This bill would require, by July 1, 2019, every health care practitioner who prescribes, orders, administers, or furnishes opioids classified as Schedule II and Schedule III to adopt, review, and periodically update a safe opioid prescribing policy, as specified. The bill would prohibit the safe opioid prescribing policy from placing a limitation on the prescription, ordering, administration, or furnishing of opioids to patients with prescribed conditions. The bill would require a health care practitioner who determines, based on his or her professional judgment, that the safe prescribing policy is not appropriate for a specific patient’s treatment, to provide adequate documentation in the patient’s record to support the treatment decision. The bill would make the failure to establish or adopt a safe opioid prescribing policy to be referred to the appropriate state professional licensing board for administrative sanctions. Because violation of these provisions is also a crime, the bill would create a new crime, thereby imposing a state-mandated local program.
The bill would require the State Department of Public Health, utilizing data from the CURES database, to submit a report detailing progress toward the stated goals of declining opioid prescriptions, as specified.
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.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: YES  

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


SECTION 1.

 The Legislature finds and declares all of the following:
(a) The opioid epidemic is a public health crisis affecting not only the State of California, but the entire country.
(b) According to the federal Centers for Disease Control and Prevention, 66 percent of the drug overdose deaths in the United States involve an opioid.
(c) In 2016, there were almost 2,000 overdose deaths due to opioids alone, and nearly 4,000 emergency room visits due to opioid overdoses.
(d) According to a 2018 University of Southern California study, about 83.45 percent of opioid prescriptions originated from physician offices.
(e) In 2016, there were 23 million opioid prescriptions in California, a state that has nearly 40 million residents.
(f) According to data from the State Department of Public Health, opioid prescriptions declined by an average of three percent between 2014 and 2017.

SEC. 2.

 Section 11153.1 is added to the Health and Safety Code, to read:

11153.1.
 (a) It is the intent of the Legislature that, from July 1, 2019, to July 1, 2023, inclusive, opioid prescriptions in California for Schedule II and Schedule III, as defined in Sections 11055 and 11056 respectively, continue in a year-over-year downward trend consistent with the average trend established between 2014 and 2017.
(b) By July 1, 2019, every health care practitioner who prescribes, orders, administers, or furnishes opioids classified as Schedule II and Schedule III pursuant to Sections 11055 and 11056, respectively, shall establish or adopt a safe opioid prescribing policy, as described in subdivision (d). A group of practitioners practitioners, including a hospital pharmacy and therapeutics committee, may adopt a safe opioid prescribing policy that applies to all parties as part of a business affiliation or contract with an organized provider group.
(c) A health care practitioner or group of practitioners practitioners, including a hospital pharmacy and therapeutics committee, is deemed to have satisfied this section by adopting a nationally or professionally recognized guideline guideline, or a guideline established by the state licensing board or commission that was updated after January 1, 2015, for the use of opioids for managing pain if the guideline meets the criteria specified in subdivision (d).
(d) The safe opioid prescribing policy shall be a written document promoting the appropriate dosage and duration of opioid prescriptions for patients, with the goal of reducing the overall prescription, ordering, administration, or furnishing of opioids to the lowest effective dose and the shortest duration necessary to treat the patient. The policy shall address, but not be limited to, all of the following:
(1) The appropriate dose and duration of prescriptions for adult patients patients, as applicable, experiencing acute pain.
(2) The appropriate dose and duration of prescriptions for pediatric patients patients, as applicable, experiencing acute pain.
(3) Alternatives to opioid treatment, including nonpharmacological treatment options and referral to specialty care, as appropriate.
(4) Recommendations for assessing patients’ continued use of opioids for pain management.

(5)Concurrent prescription of opioid antagonists to at-risk patients, including, but not limited to, patients who meet any of the following criteria:

(A)An opioid dosage of 90 morphine milligrams or more per day.

(B)Patients who are prescribed benzodiazepines.

(C)Patients with a history of substance use disorder.

(6)

(5) Recommendations for counseling patients on overdose and addiction risk and response.
(e) In addition to the requirements in subdivision (d), every policy shall include a requirement that the prescriber offer a prescription for naloxone hydrochloride or another drug approved by the United States Food and Drug Administration for the complete or partial reversal of opioid depression to a patient when one or more of the following conditions are present:
(1) The prescription dosage for the patient is 90 morphine milligrams or more of an opioid medication per day.
(2) An opioid medication is prescribed concurrently with a prescription for benzodiazepine.
(3) The patient presents an increased risk for overdose, including a patient with a history of overdose, a patient with a history of substance use disorder, or a patient at risk of returning to a high dose of opioid medication to which the patient is no longer tolerant.

(e)

(f) The development of a safe opioid prescribing policy shall include review and consideration of evidence-based science, literature, research, and guidelines, including relevant recommendations and research from academia and consideration of existing guidelines and recommendations from groups including, but not limited to, the federal Centers for Disease Control and Prevention, the federal Centers for Medicare and Medicaid Services, the Medical Board of California, and the American Society of Addiction Medicine.

(f)

(g) The safe opioid prescribing policy shall be reviewed periodically and updated according to applicable scientific studies and available data.

(g)

(h) When a prescriber determines, based on his or her professional judgment, that the safe prescribing policy is not appropriate for a specific patient’s treatment, the health care practitioner shall provide adequate documentation in the patient’s record to support the treatment decision.
(i) A health care practitioner who prescribes, orders, administers, or furnishes opioids classified as Schedule II or Schedule III pursuant to Sections 11055 and 11056, respectively, to a hospital patient shall follow the guideline or policy of that hospital’s pharmacy and therapeutics committee adopted pursuant to subdivision (b).

(h)

(j) The safe opioid prescribing policy shall not place limitations on the prescription, ordering, administration, or furnishing of opioids to patients undergoing treatment for chronic pain, cancer, substance use disorder, sickle cell disease with acute intermittent porphyria, hospice, or end-of-life care.

(i)

(k) (1) A health care practitioner who fails to establish or adopt a safe opioid prescribing policy, as required by subdivision (b), shall be referred to the appropriate state professional licensing board solely for administrative sanctions, as deemed appropriate by that board.
(2) This section does not create a private right of action against a health care practitioner. This section does not limit a health care practitioner’s liability for the negligent failure to diagnose or treat a patient.

(j)

(l) (1) By July 1, 2024, the State Department of Public Health shall submit a report to the Legislature and publish to the public, using data from the CURES database, detailing progress toward the goal stated in subdivision (a). The department may, and is encouraged to, contract with an independent academic entity, including the University of California, to prepare the report. The report shall address, but not be limited to, all of the following:
(A) The overall number of opioid prescriptions, rates of opioid prescription per 1,000 persons, and morphine milligram equivalents per year in the years 2019 to 2023, inclusive. This information shall be provided in total, and by prescribing license.
(B) The overall year-by-year change in opioid prescriptions, rates of opioid prescription per 1,000 persons, and morphine milligram equivalents from the years 2019 to 2023, inclusive.
(C) The progress made toward reducing the over-prescription of opioids.
(D) Recommendations for whether further reduction of opioid prescription is needed.
(E) Information, if available, on opioid prescriptions by geographic location.
(2) Before publishing the final report, the department shall provide an opportunity for feedback on the draft report by relevant stakeholders.
(3) The report submitted pursuant to this subdivision shall be submitted in compliance with Section 9795 of the Government Code.
(4) The requirement for submitting a report imposed under this subdivision is inoperative on July 1, 2028, pursuant to Section 10231.5 of the Government Code.

SEC. 3.

 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.