Existing state law, the Medical Practice Act, establishes the Medical Board of California within the Department of Consumer Affairs. The board is responsible for the licensure and regulation of physicians and surgeons, and is required by the act to adopt and administer standards for the continuing education of those physicians and surgeons. Existing law requires all physicians and surgeons to complete a mandatory continuing education course on pain management and the treatment of terminally ill and dying patients, as provided.

Existing federal law, the Comprehensive Addiction Recovery Act of 2016, requires physicians and surgeons who dispense narcotic drugs for patient treatment to obtain a separate registration from the United States Attorney General. The United States Drug Enforcement Administration, within the federal Office of the Attorney General, administers the registration and requires physicians and surgeons to renew that registration at specified intervals. A physician and surgeon qualifies for a waiver of the registration if he or she is licensed under state law and completes at least one specified training, such as 8 hours of training in the treatment and management of opiate-dependent patients.

This bill would authorize a physician and surgeon to complete a one-time continuing education course on opiate-dependent patient treatment and management, as specified, as an alternative to the mandatory continuing education course on pain management and the treatment of terminally ill and dying patients.

Existing state law, the Medical Practice Act, establishes the Medical Board of California within the Department of Consumer Affairs. The board is responsible for the licensure and regulation of physicians and surgeons, and is required by the act to adopt and administer standards for the continuing education of those physicians and surgeons. Existing law requires all physicians and surgeons to complete a mandatory continuing education course on pain management and the treatment of terminally ill and dying patients, as provided.

Existing federal law, the Comprehensive Addiction Recovery Act of 2016, requires physicians and surgeons who dispense narcotic drugs for patient treatment to obtain a separate registration from the United States Attorney General. The United States Drug Enforcement Administration, within the federal Office of the Attorney General, administers the registration and requires physicians and surgeons to renew that registration at specified intervals. A physician and surgeon qualifies for a waiver of the registration if he or she is licensed under state law and completes at least one specified training, such as 8 hours of training in the treatment and management of opiate-dependent patients.

This bill would authorize a physician and surgeon to complete a one-time continuing education course on opiate-dependent patient treatment and management, as specified, as an alternative to the mandatory continuing education course on pain management and the treatment of terminally ill and dying patients.

Existing state law, the Medical Practice Act, establishes the Medical Board of California within the Department of Consumer Affairs. The board is responsible for the licensure and regulation of physicians and surgeons, and is required by the act to adopt and administer standards for the continuing education of those physicians and surgeons. Existing law requires all physicians and surgeons to complete a mandatory continuing education course on pain management and the treatment of terminally ill and dying patients, as provided.

Existing federal law, the Comprehensive Addiction Recovery Act of 2016, requires physicians and surgeons who dispense narcotic drugs for patient treatment to obtain a separate registration from the United States Attorney General. The United States Drug Enforcement Administration, within the federal Office of the Attorney General, administers the registration and requires physicians and surgeons to renew that registration at specified intervals. A physician and surgeon qualifies for a waiver of the registration if he or she is licensed under state law and completes at least one specified training, such as 8 hours of training in the treatment and management of opiate-dependent patients.

This bill would require authorize a physician and surgeon to complete a one-time continuing education course on either pain management and the treatment of terminally ill and dying patients, or opiate-dependent patient treatment and management, unless the physician and surgeon qualifies for a specified exemption. as specified, as an alternative to the mandatory continuing education course on pain management and the treatment of terminally ill and dying patients.

Existing state law, the Medical Practice Act, establishes the Medical Board of California within the Department of Consumer Affairs. The board is responsible for the licensure and regulation of physicians and surgeons, and is required by the act to adopt and administer standards for the continuing education of those physicians and surgeons. Existing law requires all physicians and surgeons to complete a mandatory continuing education course on pain management and the treatment of terminally ill and dying patients, as provided.

Existing federal law, the Comprehensive Addiction Recovery Act of 2016, requires physicians and surgeons who dispense narcotic drugs for patient treatment to obtain a separate registration from the United States Attorney General. The United States Drug Enforcement Administration, within the federal Office of the Attorney General, administers the registration and requires physicians and surgeons to renew that registration at specified intervals. A physician and surgeon qualifies for a waiver of the registration if he or she is licensed under state law and completes at least one specified training, such as 8 hours of training in the treatment and management of opiate-dependent patients.

This bill would require a physician and surgeon to complete a one-time continuing education course on either pain management and the treatment of terminally ill and dying patients, or opiate-dependent patient treatment and management, as specified, within 6 months of first receiving, or next renewing, a federal Drug Enforcement Administration registration to dispense narcotic drugs for patient treatment, unless the physician and surgeon meets the requirements of a qualifying physician within the federal Comprehensive Addiction Recovery Act of 2016. qualifies for a specified exemption.

Existing state law, the Medical Practice Act, establishes the Medical Board of California within the Department of Consumer Affairs. The board is responsible for the licensure and regulation of physicians and surgeons, and is required by the act to adopt and administer standards for the continuing education of those physicians and surgeons.

Existing federal law, the Comprehensive Addiction Recovery Act of 2016, requires physicians and surgeons who dispense narcotic drugs for patient treatment to obtain a separate registration from the United States Attorney General. The United States Drug Enforcement Administration, within the federal Office of the Attorney General, administers the registration and requires physicians and surgeons to renew that registration at specified intervals. A physician and surgeon qualifies for a waiver of the registration if he or she is licensed under state law and completes at least one specified training, such as 8 hours of training in the treatment and management of opiate-dependent patients.

This bill would require a physician and surgeon to complete a one-time continuing education course on opiate-dependent patient treatment and management, as specified, within 6 months of first receiving, or next renewing, a federal Drug Enforcement Administration registration to dispense narcotic drugs for patient treatment, unless the physician and surgeon meets the requirements of a qualifying physician within the federal Comprehensive Addiction Recovery Act of 2016.

Existing state law, the Medical Practice Act, establishes the Medical Board of California within the Department of Consumer Affairs. The board is responsible for the licensure and regulation of physicians and surgeons, and is required by the act to adopt and administer standards for the continuing education of those physicians and surgeons.

Existing federal law, the Comprehensive Addiction Recovery Act of 2016, requires physicians and surgeons who dispense narcotic drugs for patient treatment to obtain a separate registration from the United States Attorney General. The United States Drug Enforcement Administration, within the federal Office of the Attorney General, administers the registration and requires physicians and surgeons to renew that registration at specified intervals. A physician and surgeon qualifies for a waiver of the registration if he or she is licensed under state law and completes at least one specified training, such as 8 hours of training in the treatment and management of opiate-dependent patients.

This bill would require a physician and surgeon to complete a continuing education course on opiate-dependent patient treatment and management, as specified, within 6 months of first receiving, or next renewing, a federal Drug Enforcement Administration registration to dispense narcotic drugs for patient treatment, unless the physician and surgeon meets the requirements of a qualifying physician within the federal Comprehensive Addiction Recovery Act of 2016.

Existing state law, the Medical Practice Act, establishes the Medical Board of California within the Department of Consumer Affairs. The board is responsible for the licensure and regulation of physicians and surgeons. The act requires each application for a physicians and surgeons certificate to include, among other things, proof of satisfactory completion of specified requirements. The act also requires the board surgeons, and is required by the act to adopt and administer standards for the continuing education of those physicians and surgeons.

Existing federal law, the Comprehensive Addiction Recovery Act of 2016, requires physicians and surgeons who dispense narcotic drugs for patient treatment to obtain a separate registration from the United States Attorney General or qualify for a waiver of that registration. General. The United States Drug Enforcement Administration, within the federal Office of the Attorney General, administers the registration and requires physicians and surgeons to renew that registration at specified intervals. A physician and surgeon qualifies for the a waiver of the registration if he or she is licensed under state law and completes at least one specified training, such as 8 hours of training in the treatment and management of opiate-dependent patients.

This bill would require the application for a physicians and surgeons certificate to include proof of satisfactory completion of a course on opiate-dependent patient treatment and management that meets the requirement, at a minimum, of the federal Comprehensive Addiction Recovery Act of 2016 and also includes at least eight hours of instruction in buprenorphine treatment of opioid use disorders. The This bill would also require a licensed physician and surgeon to complete a continuing education course on opiate-dependent patient treatment and management, as specified, within 6 months of first receiving, or next renewing, a federal Drug Enforcement Administration registration to dispense narcotic drugs for patient treatment, unless the physician and surgeon meets the requirements of a qualifying physician within the federal Comprehensive Addiction Recovery Act of 2016.

Existing state law, the Medical Practice Act, establishes the Medical Board of California within the Department of Consumer Affairs. The board is responsible for the licensure and regulation of physicians and surgeons. The act requires each application for a physicians and surgeons certificate to include, among other things, proof of satisfactory completion of specified requirements. The act also requires the board to adopt and administer standards for the continuing education of physicians and surgeons.

Existing federal law, the Comprehensive Addiction Recovery Act of 2016, requires physicians and surgeons who dispense narcotic drugs for patient treatment to obtain a separate registration from the United States Attorney General or qualify for a waiver of that registration. A physician and surgeon qualifies for the waiver if he or she is licensed under state law and completes at least one specified training, such as 8 hours of training in the treatment and management of opiate-dependent patients.

This bill would require the application for a physicians and surgeons certificate to include proof of satisfactory completion of a course on opiate-dependent patient treatment and management that meets the requirement, at a minimum, of the federal Comprehensive Addiction Recovery Act of 2016 and also includes at least eight hours of instruction in buprenorphine treatment of opioid use disorders. The bill would also require a licensed physician and surgeon to complete a continuing education course on opiate-dependent patient treatment and management, as specified, unless the physician and surgeon meets the requirements of a qualifying physician within the federal Comprehensive Addiction Recovery Act of 2016.

CONCURRENCE IN SENATE AMENDMENTS

CSA1 Bill Id:AB 2487

Author:(McCarty)

As Amended Ver:August 6, 2018

Majority vote

Original Committee Reference: B. & P.

SUMMARY: Authorizes a physician and surgeon to complete a one-time continuing education course on opiate-dependent patient treatment and management as an alternative to the mandatory education course on pain management and the treatment of terminally ill and dying patients.

The Senate amendments strike the requirement that physicians and surgeons authorized to prescribe controlled substances complete a course on opiate-dependent patient treatment and management, and instead allow for that course to be completed in lieu of an existing one-time required course on pain management and the treatment of terminally ill and dying patients.

EXISTING LAW:

1. Establishes the Medical Practice Act, which provides for the state's licensure and regulation of physicians and surgeons by the Medical Board of California (MBC). (Business and Professions Code Section (BPC) 2000 et seq.)
2. Includes among the MBC's responsibilities the administration of a continuing medical education program. (BPC 2004)
3. Requires the MBC to adopt and administer standards for the continuing education of its licensees; authorizes the MBC to set content standards for any education regarding the prevention and treatment of a chronic disease; and mandates that the board shall require each licensed physician and surgeon to demonstrate satisfaction of continuing education requirements at intervals of not less than four nor more than six years. (BPC 2190)
4. Authorizes the MBC's Division of Licensing to establish continuing medical education standards for courses that serve to maintain, develop, or increase the knowledge, skills, and professional performance that a physician and surgeon uses to provide care, or to improve the quality of care provided to patients. (BPC 2190.1)
5. Requires all physicians and surgeons to complete a continuing education course in pain management and the treatment of terminally ill and dying patients. (BPC 2190.5)
6. Prohibits physicians and surgeons from treating opioid dependency with buprenorphine, an opioid antagonist proven effective in medication-assisted treatment, unless they have secured a federal "X-waiver" through the Drug Enforcement Administration (DEA), which requires the physician and surgeon to meet certain training criteria. (United State Code Title 21, Section 823)

FISCAL EFFECT: According to the Senate Appropriations Committee, pursuant to Senate Rule 28.8, negligible state costs.

COMMENTS:

Purpose. This bill is sponsored by the author. According to the author:

AB 2487 equips the medical community to join the fight against the opioid epidemic by learning about the benefits of Medically Assisted Treatment (MAT), and buprenorphine specifically. We have seen the success that MAT brings to the people fighting an opioid addiction and want to ensure there are enough trained physicians to meet the needs of all Californians.

Background. Opioid Abuse and Treatment. In October of 2017, the White House declared the opioid crisis a public health emergency, formally recognizing what had long been understood to be a growing epidemic responsible for devastation in communities across the country. According to the Centers for Disease Control and Prevention, as many as 50,000 Americans died of an opioid overdose in 2016, representing a 28% increase over the previous year. Additionally, the number of Americans who died of an overdose of fentanyl and other opioids more than doubled during that time with nearly 20,000 deaths. These death rates compare to, and potentially exceed, those at the height of the AIDS epidemic.

In response to the rise in opioid abuse and overdose, a number of medication-assisted treatment options have been championed within the medical community. One such treatment is buprenorphine, frequently marketed under the brand name Subutex, as well as Suboxone when combined with naloxone. As an opioid classified as a Schedule III controlled substance, Buprenorphine can only be prescribed or administered by a licensed practitioner in possession of a DEA registration. However, there are additional federal restrictions on Buprenorphine not present for standard prescriptions of opioids. Under the federal Drug Addiction Treatment Act of 2000, only specially trained physicians are authorized to prescribe Buprenorphine through the "X-waiver" process. Absent certain circumstances, physicians may only use Buprenorphine in treatment if they have taken an approved course on the treatment and management of opiate-dependent patients as well as at least eight hours of instruction in buprenorphine treatment. The author's original intention with this bill was to increase the amount of education completed by physicians and surgeons that would count toward meeting the federal X-waiver requirements.

Continuing Medical Education. All physicians and surgeons licensed by the MBC must complete a minimum of 50 hours of approved continuing medical education during each two-year license renewal cycle. This requirement can be met by taking a variety of continuing education courses approved by the MBC. The only specifically required courses are a one-time, 12-hour training in pain management and the treatment of terminally ill patients, and a requirement that general internists and family physicians whose patient populations are over 25% 65 years of age and older must take at least 20% of their continuing education in the field of geriatric medicine. Otherwise, physician and surgeons have the discretion to select what courses to take to meet their education requirements.

As amended, this bill would not add additional continuing education requirements for physicians and surgeons. Instead, this bill would authorize physicians and surgeons to elect to take a course on opiate-dependent patient treatment and management in place of the current requirement for a course in pain management and the treatment of terminally ill patients. Doing so would arguably increase the amount of education taken in opiate-dependent patient treatment without increasing overall education requirements for licensees.

Analysis Prepared by: Robert Sumner / B. & P. / (916) 319-3301 FN: 0003849

 THIRD READING  

Bill No: AB 2487

Author:

:

Vote:

SENATE BUS., PROF. & ECON. DEV. COMMITTEE: 8-0, 6/25/18

AYES: Hill, Fuller, Allen, Dodd, Galgiani, Glazer, Hernandez, Wilk

NO VOTE RECORDED: Pan

SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8

ASSEMBLY FLOOR: 51-18, 5/31/18 - See last page for vote

SUBJECT:

SOURCE: Author

DIGEST:

This bill authorizes a physician and surgeon to complete a one-time continuing education course (CE) of 12 credit hours in the subjects of treatment and management of opiate-dependent patients, including eight hours of training in buprenorphine treatment, or other similar medicinal treatment, for opioid use disorders as an alternative to the required CE course on pain management and the treatment of terminally ill and dying patients.

ANALYSIS:

Existing law:

1. Requires all physicians and surgeons to complete a mandatory CE course in the subjects of pain management and the treatment of terminally ill and dying patients. (BPC § 2190.5)
2. Requires the Medical Board of California (MBC), in determining its CE requirements, to consider including a course in: (BPC § 2191)
3. Human sexuality and nutrition to be taken by those licensees whose practices may require knowledge in those areas.
4. Child abuse detection and treatment to be taken by those licensees whose practices are of a nature that there is a likelihood of contact with abused or neglected children.
5. Acupuncture to be taken by those licensees whose practices may require knowledge in the area of acupuncture and whose education has not included instruction in acupuncture.
6. Nutrition, for every physician and surgeon, as part of his or her CME particularly a physician and surgeon involved in primary care.
7. Elder abuse detection and treatment to be taken by those licensees whose practices are of a nature that there is a likelihood of contact with abused or neglected persons 65 years of age and older.
8. The early detection and treatment of substance abusing pregnant women to be taken by those licensees whose practices are of a nature that there is a likelihood of contact with these women.
9. The special care needs of drug addicted infants to be taken by those licensees whose practices are of a nature that there is a likelihood of contact with these infants.
10. Guidelines on how to routinely screen for signs exhibited by abused women, particularly for physicians and surgeons in emergency, surgical, primary care, pediatric, prenatal, and mental health settings. In the event the MBC establishes a requirement for continuing education coursework in spousal or partner abuse detection or treatment, that requirement shall be met by each licensee within no more than four years from the date the requirement is imposed.
11. Pain management.

This bill authorizes a physician and surgeon to complete a one-time CE course of 12 credit hours in the subjects of treatment and management of opiate-dependent patients, including eight hours of training in buprenorphine treatment, or other similar medicinal treatment, for opioid use disorders as an alternative to the required CE course on pain management and the treatment of terminally ill and dying patients.

Background

Continuing Medical Education (CME) Requirements in California. MBC licensed physicians are required to complete no less than 50 hours of approved CME during each two year period immediately preceding the expiration date of his or her license. The only exception to this requirement is for a physician who takes and passes a certifying or recertifying examination administered by a recognized specialty board; the individual can be granted credit for four consecutive years of CME credit for purposes of licensure renewal. Upon renewal, physicians are required to self-certify under penalty of perjury that they have met each of the CME requirements, that they have met the conditions exempting them from all or part of the requirements, or that they hold a permanent CME waiver.

Prescription Drug Abuse. For the past number of years, abuse of prescription drugs (taking a prescription medication that is not prescribed for you, or taking it for reasons or in dosages other than as prescribed) to get high has become increasingly prevalent. Results from the 2016 National Survey on Drug Use and Health found that 11.8 million people age 12 or older misused opioids in the past year, the vast majority of whom misused prescription pain relievers. Among people 12 or older who misused pain relievers in the past year, about half (53 percent) indicated that they obtained the last pain relievers they misused from a friend or relative. The National Institute on Drug Abuse (NIDA) reports young adults (age 18 to 25) are the biggest abusers of prescription opioid pain relievers, ADHD stimulants, and anti-anxiety drugs. In 2014, more than 1,700 young adults died from prescription drug (mainly opioid) overdoses, more than died from overdoses of any other drug, including heroin and cocaine combined, and many more needed emergency treatment. The nonmedical use of prescription drugs is highest among young adults. Six percent of 12- to 17- year-olds, 12 percent of 18- to 25- year-olds and 5 percent of persons age 26 or older used prescription drugs nonmedically in the past year.

Bupenorphine. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), buprenorphine is used in medication-assisted treatment to help people reduce or quit their use of heroin or other opiates, such as pain relievers like morphine. Unlike methadone treatment, which must be performed in a highly structured clinic, buprenorphine is the first medication to treat opioid dependency that is permitted to be prescribed or dispensed in physician offices, significantly increasing treatment access. Under DATA 2000, qualified physicians can offer buprenorphine for opioid dependency in various settings, including in an office, community hospital, health department, or correctional facility. SAMHSA-certified opioid treatment programs also are allowed to offer buprenorphine, but only are permitted to dispense treatment. Buprenorphine has pharmacological properties that help lower the potential for misuse, diminish the effects of physical dependency to opioids, such as withdrawal symptoms and cravings ad increase safety in cases of overdose. Buprenorphine is an opioid partial agonist that, like opioids, produces effects such as euphoria or respiratory depression but with weaker effects than those of full drugs such as heroin and methadone. The FDA has approved the following buprenorphine products:

• Bunavail (buprenorphine and naloxone) buccal film
• Suboxone (buprenorphine and naloxone) film
• Zubsolv (buprenorphine and naloxone) sublingual tablets
• Buprenorphine-containing transmucosal products for opioid dependency

Qualified physicians are required to acquire and maintain certifications to legally dispense or prescribe opioid dependency medications. SAMHSA’s Division of Pharmacologic Therapies (DPT) makes available required buprenorphine training for physicians, webinars, workshops, and summits, and publications and research.

Comments

According to the author, “Congress passed the Drug Addiction Treatment Act of 2000 (DATA-2000) which allowed physicians to prescribe medication to treat the growing opioid epidemic. One of the flaws with DATA-2000 is that it restricts who can prescribe certain Medical Assisted Treatment (MAT) drugs and the number of patients a physician can treat with through MAT. A licensed physician must have a subspecialty in addiction medicine or have at a minimum eight hours of training for the treatment and management of patients with opioid use disorders. After receiving the minimum of 8 hour training they must apply through the Drug Enforcement Administration to receive what is known as an “X-waiver” that gives folks the opportunity to prescribe buprenorphine. The problem with current law is that because of the specific requirements placed on physicians, there are not enough physicians with an “X- waiver”. Further, those who have such waiver are limited on the amount of patients they can see. On the first year that the physician has this waiver, they are only able to treat 30 patients and on the second year up to 100. On the third year, a physician is able to go up to 275 and is capped at that amount.”

FISCAL EFFECT: Appropriation: Fiscal Com.: Local:

SUPPORT: (Verified 8/8/18)

California Chapter of the American College of Emergency Physicians

OPPOSITION: (Verified 8/8/18)

None received

ASSEMBLY FLOOR: 51-18, 5/31/18

AYES: Acosta, Aguiar-Curry, Travis Allen, Baker, Berman, Bloom, Bonta, Burke, Calderon, Carrillo, Cervantes, Chau, Chiu, Chu, Cooley, Dahle, Daly, Friedman, Gallagher, Cristina Garcia, Eduardo Garcia, Gipson, Gloria, Gonzalez Fletcher, Gray, Grayson, Holden, Irwin, Jones-Sawyer, Kalra, Levine, Limón, Low, McCarty, Medina, Mullin, Nazarian, O'Donnell, Quirk, Reyes, Rodriguez, Salas, Santiago, Mark Stone, Thurmond, Ting, Voepel, Waldron, Weber, Wood, Rendon

NOES: Bigelow, Brough, Caballero, Chávez, Chen, Choi, Cunningham, Frazier, Harper, Kiley, Lackey, Maienschein, Mayes, Melendez, Muratsuchi, Obernolte, Patterson, Quirk-Silva

NO VOTE RECORDED: Arambula, Cooper, Eggman, Flora, Fong, Kamlager-Dove, Mathis, Rubio, Steinorth

Prepared by:

8/8/18 15:52:07

**** END ****

SENATE COMMITTEE ON

BUSINESS, PROFESSIONS AND ECONOMIC DEVELOPMENT

Senator Jerry Hill, Chair

2017 - 2018 Regular

Bill No: Hearing Date: June 25, 2018

Subject:

SUMARY: Updates current continuing education (CE) course requirements for physicians and surgeons to include either 12 hours in the subjects of pain management and the treatment of terminally ill and dying patients, or 12 hours in the subjects of treatment and management of opioid dependent patients.

Existing law:

1. Establishes the Medical Practice Act which provides for the licensing and regulation of physicians and surgeons by the Medial Board of California (MBC). (Business and Professions Code (BPC) § 2000 et seq.)
2. Requires the MBC to adopt and administer standards for the continuing medical education (CME) of its licensees. The MBC may also set content standards for any educational activity concerning a chronic disease that includes appropriate information on prevention of the chronic disease, and on treatment of patients with the chronic disease, by the application of changes in nutrition and lifestyle behavior. The MBC shall require each licensed physician and surgeon to demonstrate satisfaction of the continuing education requirements at intervals of not less than four nor more than six years. (BPC § 2190)
3. Specifies that CME standards may include, but are not limited to, educational activities that meet any of the following criteria: (BPC § 2190.1)
4. Have a scientific or clinical content with a direct bearing on the quality or cost-effective provision of patient care, community or public health, or preventive medicine.
5. Concern quality assurance or improvement, risk management, health facility standards, or the legal aspects of clinical medicine.
6. Concern bioethics or professional ethics.
7. Are designed to improve the physician-patient relationship.
8. Requires all general internists and family physicians who have a patient population of which over 25 percent are 65 years of age or older to complete at least 20 percent of all mandatory CME hours in a course in the field of geriatric medicine or the care of older patients. (BPC § 2190.3)
9. Requires all physicians and surgeons to complete a mandatory CE course in the subjects of pain management and the treatment of terminally ill and dying patients. For the purposes of this section, this course shall be a one-time requirement of
   12 credit hours within the required minimum established by regulation, to be completed by December 31, 2006. All physicians and surgeons licensed on and after January 1, 2002, shall complete this requirement within four years of their initial license or by their second renewal date, whichever occurs first. The MBC may verify completion of this requirement on the renewal application form.
   (BPC § 2190.5)
10. Requires the MBC, in determining its CE requirements, to consider including a course in: (BPC § 2191)
11. Human sexuality and nutrition to be taken by those licensees whose practices may require knowledge in those areas.
12. Child abuse detection and treatment to be taken by those licensees whose practices are of a nature that there is a likelihood of contact with abused or neglected children.
13. Acupuncture to be taken by those licensees whose practices may require knowledge in the area of acupuncture and whose education has not included instruction in acupuncture.
14. Nutrition, for every physician and surgeon, as part of his or her CME particularly a physician and surgeon involved in primary care.
15. Elder abuse detection and treatment to be taken by those licensees whose practices are of a nature that there is a likelihood of contact with abused or neglected persons 65 years of age and older.
16. The early detection and treatment of substance abusing pregnant women to be taken by those licensees whose practices are of a nature that there is a likelihood of contact with these women.
17. The special care needs of drug addicted infants to be taken by those licensees whose practices are of a nature that there is a likelihood of contact with these infants.
18. Guidelines on how to routinely screen for signs exhibited by abused women, particularly for physicians and surgeons in emergency, surgical, primary care, pediatric, prenatal, and mental health settings. In the event the MBC establishes a requirement for continuing education coursework in spousal or partner abuse detection or treatment, that requirement shall be met by each licensee within no more than four years from the date the requirement is imposed.
19. Pain management.
20. Geriatric care for emergency room physicians and surgeons.
21. The special care needs of individuals and their families facing end-of-life issues, including, but not limited to, pain and symptom management, the psycho-social dynamics of death, dying and bereavement and hospice care.
22. Requires MBC, in determining its CE requirements, to also consider including a course in integrating mental and physical health care in primary care settings, especially as it pertains to early identification of mental health issues and exposure to trauma in children and young adults and their appropriate care and treatment. (BPC § 2191.5.)
23. Requires osteopathic physicians and surgeons licensed by the Osteopathic Medical Board of California (OMBC) to complete a minimum of 100 hours of American Osteopathic Association continuing education hours during each two-year cycle. (BPC § 2454.5)
24. Establishes the Uniform Controlled Substances Act which regulates controlled substances and defines opiate as any substance having an addiction-forming or addiction-sustaining liability similar to morphine or being capable of conversion into a drug having addiction-forming or addiction-sustaining liability. (Health and Safety Code (HSC) § 11020)
25. Classifies controlled substances in five schedules according to their danger and potential for abuse. (HSC § 11054-11058)
26. Prohibits any person other than a physician, dentist, podiatrist, veterinarian, naturopathic doctors (according to certain supervision and protocol requirements), pharmacist (according to certain authorizations, policies and procedures), certified nurse-midwife (CNM) (if furnished or ordered incidentally to the provision of family planning services, routine health care or perinatal care, or care rendered consistent with the CNM’s practice; occurs under physician and surgeon supervision; and is in accordance with standardized procedures or protocols as specified), nurse practitioner (NP) (if it is consistent with a NP’s educational preparation or for which clinical competency has been established and maintained; occurs under physician and surgeon supervision; and is in accordance with standardized procedures or protocols as specified); a pharmacist or registered nurse or physician assistant (PA) acting within the scope of an experimental health workforce project authorized by the Office of Statewide Health Planning and Development (HSC § 128125 et seq.); an optometrist licensed under the Optometry Practice Act., or an out-of-state prescriber acting in an emergency situation from writing or issuing a prescription for a controlled substance. (Health and Safety Code (HSC) § 11150)
27. The Comprehensive Addiction and Recovery Act of 2016 (CARA), expanded buprenorphine prescribing privileges to NPs and PAs until October 1, 2021.
    (Public Law (P.L.) 114-198)

This bill updates current CE course requirements for physicians and surgeons to include either 12 hours in the subjects of pain management and the treatment of terminally ill and dying patients or 12 hours in the subjects of treatment and management of opioid dependent patients, 8 hours of which must be in bupenorphone treatment for opioid use disorders.

FISCAL EFFECT: This bill is keyed fiscal by Legislative Counsel. According to the Assembly Committee on Appropriations analysis dated May 2, 2018, this bill will result in minor and absorbable one-time costs for information technology changes and issuance of regulations to the MBC and OMBC as well as minor and absorbable ongoing costs for licensing staff and enforcement to the MBC and OMBC.

COMMENTS:

1. Purpose. The Author is the sponsor of this bill. According to the Author, “Congress passed the Drug Addiction Treatment Act of 2000 (DATA-2000) which allowed physicians to prescribe medication to treat the growing opioid epidemic. One of the flaws with DATA-2000 is that it restricts who can prescribe certain Medical Assisted Treatment (MAT) drugs and the number of patients a physician can treat with through MAT. A licensed physician must have a subspecialty in addiction medicine or have at a minimum eight hours of training for the treatment and management of patients with opioid use disorders. After receiving the minimum of 8 hour training they must apply through the Drug Enforcement Administration to receive what is known as an “X-waiver” that gives folks the opportunity to prescribe buprenorphine. The problem with current law is that because of the specific requirements placed on physicians, there are not enough physicians with an “X- waiver”. Further, those who have such waiver are limited on the amount of patients they can see. On the first year that the physician has this waiver, they are only able to treat 30 patients and on the second year up to 100. On the third year, a physician is able to go up to 275 and is capped at that amount.”
2. Continuing Medical Education (CME) Requirements in California. MBC licensed physicians are required to complete no less than 50 hours of approved CME during each two year period immediately preceding the expiration date of his or her license. The only exception to this requirement is for a physician who takes and passes a certifying or recertifying examination administered by a recognized specialty board; the individual can be granted credit for four consecutive years of CME credit for purposes of licensure renewal. Upon renewal, physicians are required to self-certify under penalty of perjury that they have met each of the CME requirements, that they have met the conditions exempting them from all or part of the requirements, or that they hold a permanent CME waiver.

Approved CME consists of courses or programs designated by the American Medical Association or the Institute for Medical Quality/California Medical Association related to patient care, community health or public health, preventive medicine, quality assurance or improvement, risk management, health facility standards, the legal aspects of clinical medicine, bioethics, professional ethics or improvement of the physician-patient relationship.

D.O.s are required to complete 150 hours of approved CME throughout a three year cycle. OMBC states that it verifies CME compliance by requiring applications for license renewal to be accompanied by certificates of completion of courses attended, thus eliminating any need to audit D.O.s to determine whether CME courses have actually been taken. According to OMBC, licensees who cannot show documentation cannot have their license renewed until CME hours are completed. CME credits can be earned through courses approved by the American Osteopathic Association (AOA) and/or American Medical Association (AMA).

1. Controlled Substances. Through the Controlled Substances Act of 1970, the federal government regulates the manufacture, distribution and dispensing of controlled substances. 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, ecstasy, 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, Demerol, Dilaudid, Percocet, Percodan, and Oxycontin.

Schedule III and IV controlled substances have a currently accepted medical use in treatment, less potential for abuse but are known to be mixed in specific ways to achieve a narcotic-like end product. Examples include drugs include Vicodin, Zanex, Ambien and other anti-anxiety drugs.

Schedule V drugs have a low potential for abuse relative to substances listed in Schedule IV and consist primarily of preparations containing limited quantities of certain narcotics.

The three classes of prescription drugs that are most commonly abused are: opioids, which are most often prescribed to treat pain; central nervous system depressants, which are used to treat anxiety and sleep disorders; and stimulants, which are prescribed to treat the sleep disorder narcolepsy and attention-deficit hyperactivity disorder (ADHD). Each class can induce euphoria, and when administered by routes other than recommended, such as snorting or dissolving into liquid to drink or inject, can intensify that sensation.

Opioids, in particular, act on the same receptors as heroin and, therefore, can be highly addictive. Common opioids are: hydrocodone (Vicodin), oxycodone (OxyContin), propoxyphene (Darvon), hydromorphone (Dilaudid), meperidine (Demerol), and diphenoxylate (Lomotil).

1. Prescription Drug Abuse. For the past number of years, abuse of prescription drugs (taking a prescription medication that is not prescribed for you, or taking it for reasons or in dosages other than as prescribed) to get high has become increasingly prevalent. Results from the 2016 National Survey on Drug Use and Health found that 11.8 million people age 12 or older misused opioids in the past year, the vast majority of whom misused prescription pain relievers. Among people 12 or older who misused pain relievers in the past year, about half (53 percent) indicated that they obtained the last pain relievers they misused from a friend or relative.

The National Institute on Drug Abuse (NIDA) reports young adults (age 18 to 25) are the biggest abusers of prescription opioid pain relievers, ADHD stimulants, and anti-anxiety drugs. In 2014, more than 1,700 young adults died from prescription drug (mainly opioid) overdoses, more than died from overdoses of any other drug, including heroin and cocaine combined, and many more needed emergency treatment. The nonmedical use of prescription drugs is highest among young adults. Six percent of 12- to 17- year-olds, 12 percent of 18- to 25- year-olds and 5 percent of persons age 26 or older used prescription drugs nonmedically in the past year.

Abuse can stem from the fact that prescription drugs are legal and potentially more easily accessible, as they can be found at home in a medicine cabinet. Data shows that individuals who misuse prescription drugs, particularly teens, believe these substances are safer than illicit drugs because they are prescribed by a health care professional and thus are safe to take under any circumstances. NIDA data states that in actuality, prescription drugs act directly or indirectly on the same brain systems affected by illicit drugs, thus, their abuse carries substantial addiction liability and can lead to a variety of other adverse health effects.

1. Bupenorphine. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), buprenorphine is used in medication-assisted treatment (MAT) to help people reduce or quit their use of heroin or other opiates, such as pain relievers like morphine. Unlike methadone treatment, which must be performed in a highly structured clinic, buprenorphine is the first medication to treat opioid dependency that is permitted to be prescribed or dispensed in physician offices, significantly increasing treatment access. Under DATA 2000, qualified physicians can offer buprenorphine for opioid dependency in various settings, including in an office, community hospital, health department, or correctional facility. SAMHSA-certified opioid treatment programs also are allowed to offer buprenorphine, but only are permitted to dispense treatment. Buprenorphine has pharmacological properties that help lower the potential for misuse, diminish the effects of physical dependency to opioids, such as withdrawal symptoms and cravings ad increase safety in cases of overdose. Buprenorphine is an opioid partial agonist that, like opioids, produces effects such as euphoria or respiratory depression but with weaker effects than those of full drugs such as heroin and methadone. The FDA has approved the following buprenorphine products:

• Bunavail (buprenorphine and naloxone) buccal film
• Suboxone (buprenorphine and naloxone) film
• Zubsolv (buprenorphine and naloxone) sublingual tablets
• Buprenorphine-containing transmucosal products for opioid dependency

Qualified physicians are required to acquire and maintain certifications to legally dispense or prescribe opioid dependency medications. SAMHSA’s Division of Pharmacologic Therapies (DPT) makes available required buprenorphine training for physicians, webinars, workshops, and summits, and publications and research.

1. Guidelines for Prescribing Controlled Substances. For certain types of medication, and certain types of medication prescribed to certain types of patients, guidelines on appropriate and safe prescribing practices can serve as a helpful tools for providers, patients and regulatory boards alike. In 1994, MBC unanimously adopted a policy statement entitled “Prescribing Controlled Substances for Pain.” Stemming from studies and discussions about controlled substances, this policy statement was designed to provide guidance to improve prescriber standards for pain management, while simultaneously undermining opportunities for drug diversion and abuse. The guidelines outlined appropriate steps related to a patient’s examination, treatment plan, informed consent, periodic review, consultation, records, and compliance with controlled substances laws. Subsequent to MBC’s 1994 action, legislation that took effect in 2002 (AB 487, Aroner, Chapter 518, Statutes of 2001) created a task force to revisit the 1994 guidelines to develop standards assuring competent review in cases concerning the under-treatment and under-medication of a patient's pain and also required CE courses for physicians in the subjects of pain management and the treatment of terminally ill and dying patients. The passage of AB 2198 in 2006 (Houston, Chapter 350, Statutes of 2006) updated California law governing the use of drugs to treat pain by clarifying that health care professionals with a medical basis, including the treatment of pain, for prescribing, furnishing, dispensing, or administering dangerous drugs or prescription controlled substances, may do so without being subject to disciplinary action or prosecution.

MBC currently encourages all licensees to consult the policy statement and Guidelines for Prescribing Controlled Substances for Pain which were updated in 2014 based on input from a MBC Prescribing Task Force that held multiple meetings to identify best practices. According to the MBC website, “The board strongly urges physicians and surgeons to view effective pain management as a high priority in all patients, including children, the elderly, and patients who are terminally ill. Pain should be assessed and treated promptly, effectively and for as long as pain persists. The medical management of pain should be based on up-to-date knowledge about pain, pain assessment and pain treatment. Pain treatment may involve the use of several medications and non-pharmacological treatment modalities, often in combination. For some types of pain, the use of medications is emphasized and should be pursued vigorously; for other types, the use of medications is better de-emphasized in favor of other therapeutic modalities. Physicians and surgeons should have sufficient knowledge or utilize consultations to make such judgments for their patients. Medications, in particular opioid analgesics, are considered the cornerstone of treatment for pain associated with trauma, surgery, medical procedures, or cancer.” MBC intends for the guidelines to educate physicians on effective pain management in California by avoiding under treatment, overtreatment, or other inappropriate treatment of a patient’s pain. Reduction of prescription overdose deaths is also an objective of the updated guidelines.

In 2015, the Osteopathic Medical Board of California, which licenses and oversees osteopathic physicians and surgeons, adopted the 2014 MBC guidelines.

1. Related Legislation This Year. Prescription medicine used to treat pain has been the focus of ongoing discussions in the Legislature, as California and the nation face an epidemic of prescription drug abuse and related overdose deaths.

SB 1109 (Bates) requires prescribers to take continuing education courses on the risks of addiction associated with the use of Schedule II controlled substances; requires additional warning labeling about the risks of addiction and overdose for opioid prescriptions; requires school districts, charter schools, and private schools that offer athletics programs, as well as youth sports organizations, to provide an information sheet to participants about the risk of opioid addiction that parents have to sign and return; and requires prescribers to discuss risks and dangers of opioids and opioid addiction with minors and their parents or guardians.  (Status:  This bill is pending in the Assembly Committee on Health.)​

AB 1791 (Waldron) requires MBC, in determining its CE requirements for licensed physicians and surgeons, to consider including a course in integrating HIV/AIDS pre-exposure prophylaxis and post-exposure prophylaxis medication maintenance and counseling in primary care settings. (Status: This bill is currently pending in the Senate Committee on Appropriations.)

AB 1998 (Rodriguez) requires every healthcare practitioner authorized to prescribe Schedule II and Schedule III opioids to adopt a safe prescribing policy. (Status: This bill is pending in the Senate Committee on Health.)

AB 2174 (Waldron) requires the Department of Public Health (DPH), upon appropriation by the Legislature or receipt of adequate state or federal grant funding, and in consultation with stakeholders as appropriate, to develop, coordinate, implement and oversee a comprehensive multicultural public awareness campaign, designed to combat the growing heroin and opioid medication epidemic in the state. (Status: The measure is pending in the Assembly Committee on Appropriations.)

AB 2384 (Arambula) requires health care service plans that provide prescription drug benefits and maintain one or more drug formularies to include specified MAT prescription drugs approved by the United States Food and Drug Administration, including buprenorphine in at least one form of administration. (Status: This bill is pending in the Senate Committee on Health.)

AB 2486 (McCarty) would establish the Opioid Prevention and Rehabilitation Program Fund to treat opioid addiction by providing existing programs the additional funding. (Status: The bill is pending in the Senate Committee on Health.)

AB 2741 (Burke) Limits prescriptions of opioid medications to minors to a maximum of a five-day supply, with exceptions; requires practitioners to assess whether a minor has been prescribed treatment for a substance use disorder and discuss the risks and dangers associated with opioids with the minor and the minor's parent or guardian; and requires the prescriber to receive verbal consent from a minor's parent or guardian or authorized adult prior to prescribing a course of treatment with an opioid to a minor. (Status: This bill is being held at the Author’s request in this Committee.)

AB 2760 (Wood) requires certain prescriptions for opioids to also include a co-prescription for naloxone. (Status: This bill in the Senate Committee on Appropriations.)

1. Prior Related Legislation. SB 554 (Stone, Chapter 242, Statutes of 2017) authorized a NP or PA to furnish or order buprenorphine when done in compliance with the provisions of the CARA.

AB 1748 (Mayes, Chapter 557, Statutes of 2016) authorized school nurses and other trained personnel to use NH or another opioid antagonist to provide emergency medical aid to persons suffering, or reasonably believed to be suffering, from an opioid overdose. This bill also authorized pharmacies to furnish NH without a prescription, to a school district, county office of education, or charter school.

AB 1535 (Bloom, Chapter 326, Statutes of 2014) authorized a pharmacist to furnish NH pursuant to standardized procedures and protocols developed and approved jointly by the Board of Pharmacy (BOP) and the Medical Board of California (MBC).

1. Arguments in Support. The California Chapter of the American College of Emergency Physicians (California ACEP) notes that its members see a staggering number of patients with substance use disorder and far too many patients experiencing opioid overdose. California ACEP states that by instead of providing an option for education which includes treatment of patients with substance use disorder and opiate dependence, this bill gives physicians the flexibility to better adapt to the needs of their patients. The organization states, that it wants to do its part in reversing this alarming public health trend and thus supports the important public policy change in this bill.
2. Policy Consideration: Why Impose Additional CE and CME Requirements for Only Certain Health Care Providers Authorized to Prescribe? Current law establishes CE and CME requirements for a number of healing arts licensees who, like physicians and surgeons, also have the authority to prescribe controlled substances, as well as some who also have authority to furnish or order buprenorphine in accordance with federal requirements. As such, the Author may wish to expand buprenorphine CE requirements to NPs and PAs who are authorized to prescribe controlled substances, authorized to furnish buprenorphine and required to complete CE.

SUPPORT AND OPPOSITION:

Support:

California Chapter of the American College of Emergency Physicians

Opposition:

None on file as of June 20, 2018.

-- END --

ASSEMBLY THIRD READING

ATR Bill Id:AB 2487

Author:(McCarty)

As Amended Ver:May 17, 2018

Majority vote

SUMMARY: Requires every physician and surgeon to take one hour of training in medication-assisted treatment for opioid abuse disorders within six months of first receiving a federal Drug Enforcement Administration registration or within six months of their next renewal after January 1, 2019. Specifically, this bill:

1. Requires all licensed physicians and surgeons to complete one hour of one-time mandatory continuing education training in medication-assisted treatment for opioid abuse disorders within six months of first receiving a federal Drug Enforcement Administration (DEA) registration.
2. Requires physicians and surgeons currently or previously in possession, on January 1, 2019, of a federal Drug Enforcement Administration registration to complete the required one hour of one-time training within six months of next renewing his or her registration.
3. Allows the Medical Board of California (MBC) to also require a physician and surgeon to complete additional hours of education when necessary to carry out the board's public protection duties.
4. Provides the MBC with the authority to determine whether a physician and surgeon has met the training requirements.

FISCAL EFFECT: According to the Assembly Committee on Appropriations, minor and absorbable one-time costs for information technology changes and issuance of regulations to the MBC and the Osteopathic MBC, as well as minor and absorbable ongoing costs for licensing staff and enforcement.

COMMENTS:

Purpose. This bill is sponsored by the author. According to the author:

AB 2487 equips the medical community to join the fight against the opioid epidemic by learning about the benefits of Medically Assisted Treatment (MAT), and buprenorphine specifically. We have seen the success that MAT brings to the people fighting an opioid addiction and want to ensure there are enough trained physicians to meet the needs of all Californians.

Background.

Buprenorphine Treatment. Itself a type of opioid, buprenorphine is a Schedule III controlled substance used in medication-assisted treatment of opioid addiction. Buprenorphine is what is referred to as a partial opioid agonist; this essentially means that it provides a much lower degree of euphoria than other opioids like oxycodone and heroin, and is considered to be less prone to abuse or dependence. In medication-assisted treatment of addiction, Buprenorphine is used similarly to methadone, but with reduced side effects. Buprenorphine is frequently marketed under the brand name Subutex, as well as Suboxone when combined with naloxone.

As an opioid classified as a Schedule III controlled substance, Buprenorphine can only be prescribed or administered by a licensed practitioner in possession of a DEA registration. However, there are additional federal restrictions on Buprenorphine not present for standard prescriptions of opioids. Under the federal Drug Addiction Treatment Act of 2000, only specially trained physicians are authorized to prescribe Buprenorphine through the "X-waiver" process. Absent certain circumstances, physicians may only use Buprenorphine in treatment if they have taken an approved course on the treatment and management of opiate-dependent patients as well as at least eight hours of instruction in buprenorphine treatment.

Further restricting the availability of Buprenorphine treatments is federal law limiting the number of patients a physician in receipt of an X-waiver may treat. Upon passage of the Drug Addiction Treatment Act of 2000, the number of patients per physician was capped at ten. This cap was raised under the Obama administration to allow up to 100 patients to be treated with Buprenorphine per approved physicians who have held the waiver for two years, and up to 275 patients at three years. Partially as a result, Buprenorphine prescribing rates have risen significantly in recent years.

Nevertheless, health experts have expressed concerns that Buprenorphine treatment is largely unavailable for patients addicted to opioids. One of the common reasons cited is that most physicians and surgeons in California lack the required training to qualify for the X-waiver. This bill no longer requires physicians and surgeons to take all the training required to obtain an X-waiver. However, it does require physicians and surgeons to take training generally in medication-assisted treatment, which could potentially count toward X-waiver requirements.

Continuing Medical Education. All physicians and surgeons licensed by the MBC must complete a minimum of 50 hours of approved continuing medical education during each two-year license renewal cycle. This requirement can be met by taking a variety of continuing education courses approved by the MBC. The only specifically required courses are a one-time, 12-hour training in pain management and the treatment of terminally ill patients, and a requirement that general internists and family physicians whose patient populations are over 25% 65 years of age and older must take at least 20% of their continuing education in the field of geriatric medicine. Otherwise, physician and surgeons have the discretion to select what courses to take to meet their education requirements.

When determining what continuing education courses to approve, the MBC's Division of Licensing currently considers programs that have been accredited by the American Medical Association, the Institute for Medical Quality/California Medical Association, and the Accreditation Council for Continuing Medical Education (ACCME), as well as programs that qualify for prescribed credit from the American Academy of Family Physicians. The MBC also has broad authority to consider other programs offered by organizations and institutions acceptable to the MBC.

Analysis Prepared by: Robert Sumner / B. & P. / (916) 319-3301 FN: 0002954

Date of Hearing: May 2, 2018

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Lorena Gonzalez Fletcher, Chair

ABPCA Bill Id:AB 2487

Author:(McCarty) – As Amended Ver:April 26, 2018

Urgency: No State Mandated Local Program: No Reimbursable: No

SUMMARY:

This bill mandates a physician, within six months of first receiving a federal Drug Enforcement Administration (DEA) registration for controlled substances, to complete one hour of continuing medical education (CME) on medication-assisted treatments for opioid addiction.

It also applies the same requirement to physicians who already have a DEA registration within six months of next renewing their registration, and exempts physicians already federally authorized to treat opioid dependency with buprenorphine from the CME requirement.

FISCAL EFFECT:

1. Minor and absorbable one-time costs for information technology changes and issuance of regulations to the Medical Board of California (MBC) and the Osteopathic Medical Board of California (OMBC) (fee-supported special funds).
2. Minor and absorbable ongoing costs for licensing staff and enforcement to the MBC and OMBC (fee-supported special funds).

COMMENTS:

1. Purpose. This bill is intended to improve physician training on medication-assisted treatment in order to prepare more physicians to successfully treat opioid addition.
2. Background. Medication-assisted treatment for opioid addiction is the use of medications in combination with counseling and behavioral health therapies. The most well-known such treatment is methadone, which is an opioid replacement therapy, but there are also newer medications. The Department of Health Care Services uses federal grant dollars to implement a "hub-and-spoke" system that pairs substance use treatment providers (hubs) with community physicians (spokes) to improve physicians' comfort with prescribing MAT and to increase the availability of MAT outside of substance use treatment facilities. Current law requires physicians to complete at least 50 hours of approved CME during each two-year license renewal cycle. This bill would mandate one hour of the required CME be spent on medication-assisted treatment for opioid addiction.
3. Support and Opposition. The County Health Executives Association of California, Depression and Bipolar Support Alliance, and National Health Law Program support this bill. Physician groups and Biocom opposed a prior version, which mandated eight hours of on a particular type of opioid addiction treatment medication. Current opposition is unknown.
4. Related Legislation. AB 1791 (Waldron) requires the Medical Board of California to consider including in its continuing education requirements a course in integrating pre-exposure prophylaxis and post-exposure prophylaxis medication maintenance and counseling in primary care settings.

In addition, there is a large number of bills introduced this year addressing various aspects of the opioid epidemic, including improvements to the state prescription drug monitoring program, limits on opioid prescribing, higher reimbursement for drug treatment providers, and improved access to naloxone, which can prevent death from overdose.

Analysis Prepared by: Lisa Murawski / APPR. / (916) 319-2081