SB 1109: Controlled substances: Schedule II drugs: opioids.
- Session Year: 2017-2018
- House: Senate
- Latest Version Date: 2018-09-22
(1)The Medical Practice Act provides for the licensure and regulation of physicians and surgeons by the Medical Board of California. Under that act, the board is required to adopt and administer standards for the continuing education of physicians and surgeons. Existing law requires a physician and surgeon to complete a mandatory continuing education course in the subjects of pain management and the treatment of terminally ill and dying patients. That act requires the board to give its highest priority to considering a course in pain management among its continuing education requirements for licensees, and requires the board to periodically develop and disseminate information and educational material on pain management techniques and procedures to licensees and general acute care hospitals.
This bill would require, for physicians and surgeons licensed on or after January 1, 2019, the mandatory continuing education course to also include the subject of the risks of addiction associated with the use of Schedule II drugs. The bill would require the board to give its highest priority to considering a course in the risks of addiction associated with the use of Schedule II drugs among its continuing education requirements for physicians and surgeons and would require the board to periodically develop and disseminate information and educational material on the risks of addiction associated with the use of Schedule II drugs to physicians and surgeons and general acute care hospitals.
(2)The Nursing Practice Act provides for the licensure and regulation of the practice of nursing by the Board of Registered Nursing and makes a violation of its provisions a crime. Existing law authorizes a certified nurse-midwife to furnish or order drugs or devices under specified circumstances, including board certification that the certified nurse-midwife has completed a course in pharmacology, as specified.
This bill would require the pharmacology course to include the risks of addiction and neonatal abstinence syndrome associated with the use of opioids.
Existing law also authorizes a nurse practitioner to furnish or order drugs or devices under specified circumstances, including board certification that the nurse practitioner has completed a course in pharmacology, as specified. Existing law requires nurse practitioners who are authorized to furnish Schedule II controlled substances to complete a mandatory continuing education course in Schedule II controlled substances.
This bill would require the mandatory continuing education course to include the risks of addiction associated with their use.
By expanding the scope of a crime under the Nursing Practice Act, the bill would impose a state-mandated local program.
(3)The Physician Assistant Practice Act provides for licensure and regulation of physician assistants by the Physician Assistant Board and authorizes a physician assistant to perform medical services as set forth by regulations when those services are rendered under the supervision of a licensed physician and surgeon, as specified. The act prohibits a physician assistant from administering, providing, or issuing a drug order to a patient for Schedule II through Schedule V controlled substances without advance approval by a supervising physician and surgeon for that particular patient unless the physician assistant has completed an education course that meets specific standards.
This bill would require that course to include the risks of addiction associated with the use of Schedule II controlled substances.
(4)The Pharmacy Law provides for the licensure and regulation of pharmacists, pharmacy technicians, and pharmacies by the California State Board of Pharmacy. Existing law requires the board to promulgate regulations that require a standardized, patient-centered, prescription drug label on all prescription medicine dispensed to patients in California. The act makes a violation of its provisions a crime.
This bill would require a pharmacy or practitioner dispensing an opioid to a patient for outpatient use to prominently display on the label or container a notice that warns of the risk of overdose and addiction, as specified. Because a violation of that requirement would be a crime, the bill would impose a state-mandated local program.
(5)The Dental Practice Act provides for the licensure and regulation of persons engaged in the practice of dentistry by the Dental Board of California, which is within the Department of Consumer Affairs. The act authorizes the board, as a condition of license renewal, to require licentiates to successfully complete a portion of required continuing education hours in specific areas, including patient care, health and safety, and law and ethics.
This bill would include the risks of addiction associated with the use of Schedule II drugs in those specific areas of continuing education.
(6)Existing law, the Osteopathic Act, establishes the Osteopathic Medical Board of California, which issues certificates to, and regulates, osteopathic physicians and surgeons. Existing law requires the board to require each licensed osteopathic physician and surgeon to complete a minimum of 100 hours of American Osteopathic Association continuing education hours during each 2-year cycle, of which 40 hours must be completed in American Osteopathic Association Category 1 continuing education hours as a condition for renewal of an active license.
This bill would additionally require licensed osteopathic physician and surgeons to complete a course on the risks of addiction associated with the use of Schedule II drugs.
(7)The Optometry Practice Act provides for the licensure and regulation of the practice of optometry by the State Board of Optometry. The act requires an optometrist certified to use therapeutic pharmaceutical agents to complete a total of 50 hours of continuing education every 2 years in order to renew his or her certificate. Existing law requires 35 of the 50 hours of continuing education to be on the diagnosis, treatment, and management of ocular disease in any combination of specified areas, including pain medication.
This bill would expand the areas of continuing education to include risks of addiction associated with the use of Schedule II drugs.
(8)The California 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. The act makes a violation of its provisions a crime.
This bill would require a prescriber to discuss specified information with the minor, the minors parent or guardian, or other adult authorized to consent to the minors medical treatment before directly dispensing or issuing for a minor the first prescription in a single course of treatment for a controlled substance containing an opioid. This bill would provide that a violation of these requirements is not a criminal offense.
(9)Existing law requires a school district, charter school, or private school that elects to offer an athletic program to take specified actions if an athlete is suspected to have sustained a concussion and to obtain a signed concussion and head injury information sheet from the athlete and athletes parent or guardian before the athlete initiates practice or competition.
This bill would require a youth sports organization, as defined, that elects to offer an athletic program to annually give a specified Opioid Factsheet for Patients to each athlete, and would require each athlete and his or her parent to sign a document acknowledging receipt of that factsheet, as specified.
(10)Existing law requires a youth sports organization, as defined, that elects to offer an athletic program to, among other things, annually give a concussion and head injury information sheet to each athlete and requires that the sheet be signed, as specified.
This bill would also require a youth sports organization that elects to offer an athletic program to annually give a specified Opioid Factsheet for Patients to each athlete, and would require each athlete and his or her parent to sign a document verifying receipt of that factsheet, as specified.
This bill would incorporate additional changes to Section 1645 of the Business and Professions Code proposed by SB 1491 to be operative only if this bill and SB 1491 are enacted and this bill is enacted last.
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.
(1)The Medical Practice Act provides for the licensure and regulation of physicians and surgeons by the Medical Board of California. Under that act, the board is required to adopt and administer standards for the continuing education of physicians and surgeons. Existing law requires a physician and surgeon to complete a mandatory continuing education course in the subjects of pain management and the treatment of terminally ill and dying patients. That act requires the board to give its highest priority to considering a course in pain management among its continuing education requirements for licensees, and requires the board to periodically develop and disseminate information and educational material on pain management techniques and procedures to licensees and general acute care hospitals.
This bill would require, for physicians and surgeons licensed on or after January 1, 2019, the mandatory continuing education course to also include the subject of the risks of addiction associated with the use of Schedule II drugs. The bill would require the board to give its highest priority to considering a course in the risks of addiction associated with the use of Schedule II drugs among its continuing education requirements for physicians and surgeons and would require the board to periodically develop and disseminate information and educational material on the risks of addiction associated with the use of Schedule II drugs to physicians and surgeons and general acute care hospitals.
(2)The Nursing Practice Act provides for the licensure and regulation of the practice of nursing by the Board of Registered Nursing and makes a violation of its provisions a crime. Existing law authorizes a certified nurse-midwife to furnish or order drugs or devices under specified circumstances, including board certification that the certified nurse-midwife has completed a course in pharmacology, as specified.
This bill would require the pharmacology course to include the risks of addiction and neonatal abstinence syndrome associated with the use of opioids.
Existing law also authorizes a nurse practitioner to furnish or order drugs or devices under specified circumstances, including board certification that the nurse practitioner has completed a course in pharmacology, as specified. Existing law requires nurse practitioners who are authorized to furnish Schedule II controlled substances to complete a mandatory continuing education course in Schedule II controlled substances.
This bill would require the mandatory continuing education course to include the risks of addiction associated with their use.
By expanding the scope of a crime under the Nursing Practice Act, the bill would impose a state-mandated local program.
(3)The Physician Assistant Practice Act provides for licensure and regulation of physician assistants by the Physician Assistant Board and authorizes a physician assistant to perform medical services as set forth by regulations when those services are rendered under the supervision of a licensed physician and surgeon, as specified. The act prohibits a physician assistant from administering, providing, or issuing a drug order to a patient for Schedule II through Schedule V controlled substances without advance approval by a supervising physician and surgeon for that particular patient unless the physician assistant has completed an education course that meets specific standards.
This bill would require that course to include the risks of addiction associated with the use of Schedule II controlled substances.
(4)The Pharmacy Law provides for the licensure and regulation of pharmacists, pharmacy technicians, and pharmacies by the California State Board of Pharmacy. Existing law requires the board to promulgate regulations that require a standardized, patient-centered, prescription drug label on all prescription medicine dispensed to patients in California. The act makes a violation of its provisions a crime.
This bill would require a pharmacy or practitioner dispensing an opioid to a patient for outpatient use to prominently display on the label or container a notice that warns of the risk of overdose and addiction, as specified. Because a violation of that requirement would be a crime, the bill would impose a state-mandated local program.
(5)The Dental Practice Act provides for the licensure and regulation of persons engaged in the practice of dentistry by the Dental Board of California, which is within the Department of Consumer Affairs. The act authorizes the board, as a condition of license renewal, to require licentiates to successfully complete a portion of required continuing education hours in specific areas, including patient care, health and safety, and law and ethics.
This bill would include the risks of addiction associated with the use of Schedule II drugs in those specific areas of continuing education.
(6)Existing law, the Osteopathic Act, establishes the Osteopathic Medical Board of California, which issues certificates to, and regulates, osteopathic physicians and surgeons. Existing law requires the board to require each licensed osteopathic physician and surgeon to complete a minimum of 100 hours of American Osteopathic Association continuing education hours during each 2-year cycle, of which 40 hours must be completed in American Osteopathic Association Category 1 continuing education hours as a condition for renewal of an active license.
This bill would additionally require licensed osteopathic physician and surgeons to complete a course on the risks of addiction associated with the use of Schedule II drugs.
(7)The Optometry Practice Act provides for the licensure and regulation of the practice of optometry by the State Board of Optometry. The act requires an optometrist certified to use therapeutic pharmaceutical agents to complete a total of 50 hours of continuing education every 2 years in order to renew his or her certificate. Existing law requires 35 of the 50 hours of continuing education to be on the diagnosis, treatment, and management of ocular disease in any combination of specified areas, including pain medication.
This bill would expand the areas of continuing education to include risks of addiction associated with the use of Schedule II drugs.
(8)The California 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. The act makes a violation of its provisions a crime.
This bill would require a prescriber to discuss specified information with the minor, the minors parent or guardian, or other adult authorized to consent to the minors medical treatment before directly dispensing or issuing for a minor the first prescription in a single course of treatment for a controlled substance containing an opioid. This bill would provide that a violation of these requirements is not a criminal offense.
(9)Existing law requires a school district, charter school, or private school that elects to offer an athletic program to take specified actions if an athlete is suspected to have sustained a concussion and to obtain a signed concussion and head injury information sheet from the athlete and athletes parent or guardian before the athlete initiates practice or competition.
This bill would require a youth sports organization, as defined, that elects to offer an athletic program to annually give a specified Opioid Factsheet for Patients to each athlete, and would require each athlete and his or her parent to sign a document acknowledging receipt of that factsheet, as specified.
(10)Existing law requires a youth sports organization, as defined, that elects to offer an athletic program to, among other things, annually give a concussion and head injury information sheet to each athlete and requires that the sheet be signed, as specified.
This bill would also require a youth sports organization that elects to offer an athletic program to annually give a specified Opioid Factsheet for Patients to each athlete, and would require each athlete and his or her parent to sign a document verifying receipt of that factsheet, as specified.
This bill would incorporate additional changes to Section 1645 of the Business and Professions Code proposed by SB 1491 to be operative only if this bill and SB 1491 are enacted and this bill is enacted last.
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.
(1)The Medical Practice Act provides for the licensure and regulation of physicians and surgeons by the Medical Board of California. Under that act, the board is required to adopt and administer standards for the continuing education of physicians and surgeons. Existing law requires a physician and surgeon to complete a mandatory continuing education course in the subjects of pain management and the treatment of terminally ill and dying patients. That act requires the board to give its highest priority to considering a course in pain management among its continuing education requirements for licensees, and requires the board to periodically develop and disseminate information and educational material on pain management techniques and procedures to licensees and general acute care hospitals.
This bill would require, for physicians and surgeons licensed on or after January 1, 2019, the mandatory continuing education course to also include the subject of the risks of addiction associated with the use of Schedule II drugs. The bill would require the board to give its highest priority to considering a course in the risks of addiction associated with the use of Schedule II drugs among its continuing education requirements for physicians and surgeons and would require the board to periodically develop and disseminate information and educational material on the risks of addiction associated with the use of Schedule II drugs to physicians and surgeons and general acute care hospitals.
(2)The Nursing Practice Act provides for the licensure and regulation of the practice of nursing by the Board of Registered Nursing and makes a violation of its provisions a crime. Existing law authorizes a certified nurse-midwife to furnish or order drugs or devices under specified circumstances, including board certification that the certified nurse-midwife has completed a course in pharmacology, as specified.
This bill would require the pharmacology course to include the risks of addiction and neonatal abstinence syndrome associated with the use of opioids.
Existing law also authorizes a nurse practitioner to furnish or order drugs or devices under specified circumstances, including board certification that the nurse practitioner has completed a course in pharmacology, as specified. Existing law requires nurse practitioners who are authorized to furnish Schedule II controlled substances to complete a mandatory continuing education course in Schedule II controlled substances.
This bill would require the mandatory continuing education course to include the risks of addiction associated with their use.
By expanding the scope of a crime under the Nursing Practice Act, the bill would impose a state-mandated local program.
(3)The Physician Assistant Practice Act provides for licensure and regulation of physician assistants by the Physician Assistant Board and authorizes a physician assistant to perform medical services as set forth by regulations when those services are rendered under the supervision of a licensed physician and surgeon, as specified. The act prohibits a physician assistant from administering, providing, or issuing a drug order to a patient for Schedule II through Schedule V controlled substances without advance approval by a supervising physician and surgeon for that particular patient unless the physician assistant has completed an education course that meets specific standards.
This bill would require that course to include the risks of addiction associated with the use of Schedule II controlled substances.
(4)The Pharmacy Law provides for the licensure and regulation of pharmacists, pharmacy technicians, and pharmacies by the California State Board of Pharmacy. Existing law requires the board to promulgate regulations that require a standardized, patient-centered, prescription drug label on all prescription medicine dispensed to patients in California. The act makes a violation of its provisions a crime.
This bill would require a pharmacy or practitioner dispensing an opioid to a patient for outpatient use to prominently display on the label or container a notice that warns of the risk of overdose and addiction, as specified. Because a violation of that requirement would be a crime, the bill would impose a state-mandated local program.
(5)The Dental Practice Act provides for the licensure and regulation of persons engaged in the practice of dentistry by the Dental Board of California, which is within the Department of Consumer Affairs. The act authorizes the board, as a condition of license renewal, to require licentiates to successfully complete a portion of required continuing education hours in specific areas, including patient care, health and safety, and law and ethics.
This bill would include the risks of addiction associated with the use of Schedule II drugs in those specific areas of continuing education.
(6)Existing law, the Osteopathic Act, establishes the Osteopathic Medical Board of California, which issues certificates to, and regulates, osteopathic physicians and surgeons. Existing law requires the board to require each licensed osteopathic physician and surgeon to complete a minimum of 100 hours of American Osteopathic Association continuing education hours during each 2-year cycle, of which 40 hours must be completed in American Osteopathic Association Category 1 continuing education hours as a condition for renewal of an active license.
This bill would additionally require licensed osteopathic physician and surgeons to complete a course on the risks of addiction associated with the use of Schedule II drugs.
(7)The Optometry Practice Act provides for the licensure and regulation of the practice of optometry by the State Board of Optometry. The act requires an optometrist certified to use therapeutic pharmaceutical agents to complete a total of 50 hours of continuing education every 2 years in order to renew his or her certificate. Existing law requires 35 of the 50 hours of continuing education to be on the diagnosis, treatment, and management of ocular disease in any combination of specified areas, including pain medication.
This bill would expand the areas of continuing education to include risks of addiction associated with the use of Schedule II drugs.
(8)The California 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. The act makes a violation of its provisions a crime.
This bill would require a prescriber to discuss specified information with the minor, the minors parent or guardian, or other adult authorized to consent to the minors medical treatment before directly dispensing or issuing for a minor the first prescription in a single course of treatment for a controlled substance containing an opioid. This bill would provide that a violation of these requirements is not a criminal offense.
(9)Existing law requires a school district, charter school, or private school that elects to offer an athletic program to take specified actions if an athlete is suspected to have sustained a concussion and to obtain a signed concussion and head injury information sheet from the athlete and athletes parent or guardian before the athlete initiates practice or competition.
This bill would require a youth sports organization, as defined, that elects to offer an athletic program to annually give a specified Opioid Factsheet for Patients to each athlete, and would require each athlete and his or her parent to sign a document acknowledging receipt of that factsheet, as specified.
(10)Existing law requires a youth sports organization, as defined, that elects to offer an athletic program to, among other things, annually give a concussion and head injury information sheet to each athlete and requires that the sheet be signed, as specified.
This bill would also require a youth sports organization that elects to offer an athletic program to annually give a specified Opioid Factsheet for Patients to each athlete, and would require each athlete and his or her parent to sign a document verifying receipt of that factsheet, as specified.
This bill would incorporate additional changes to Section 1645 of the Business and Professions Code proposed by SB 1491 to be operative only if this bill and SB 1491 are enacted and this bill is enacted last.
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.
(1)The Medical Practice Act provides for the licensure and regulation of physicians and surgeons by the Medical Board of California. Under that act, the board is required to adopt and administer standards for the continuing education of physicians and surgeons. Existing law requires a physician and surgeon to complete a mandatory continuing education course in the subjects of pain management and the treatment of terminally ill and dying patients. That act requires the board to give its highest priority to considering a course in pain management among its continuing education requirements for licensees, and requires the board to periodically develop and disseminate information and educational material on pain management techniques and procedures to licensees and general acute care hospitals.
This bill would require, for physicians and surgeons licensed on or after January 1, 2019, the mandatory continuing education course to also include the subject of the risks of addiction associated with the use of Schedule II drugs. The bill would require the board to give its highest priority to considering a course in the risks of addiction associated with the use of Schedule II drugs among its continuing education requirements for physicians and surgeons and would require the board to periodically develop and disseminate information and educational material on the risks of addiction associated with the use of Schedule II drugs to physicians and surgeons and general acute care hospitals.
(2)The Nursing Practice Act provides for the licensure and regulation of the practice of nursing by the Board of Registered Nursing and makes a violation of its provisions a crime. Existing law authorizes a certified nurse-midwife to furnish or order drugs or devices under specified circumstances, including board certification that the certified nurse-midwife has completed a course in pharmacology, as specified.
This bill would require the pharmacology course to include the risks of addiction and neonatal abstinence syndrome associated with the use of opioids.
Existing law also authorizes a nurse practitioner to furnish or order drugs or devices under specified circumstances, including board certification that the nurse practitioner has completed a course in pharmacology, as specified. Existing law requires nurse practitioners who are authorized to furnish Schedule II controlled substances to complete a mandatory continuing education course in Schedule II controlled substances.
This bill would require the mandatory continuing education course to include the risks of addiction associated with their use.
By expanding the scope of a crime under the Nursing Practice Act, the bill would impose a state-mandated local program.
(3)The Physician Assistant Practice Act provides for licensure and regulation of physician assistants by the Physician Assistant Board and authorizes a physician assistant to perform medical services as set forth by regulations when those services are rendered under the supervision of a licensed physician and surgeon, as specified. The act prohibits a physician assistant from administering, providing, or issuing a drug order to a patient for Schedule II through Schedule V controlled substances without advance approval by a supervising physician and surgeon for that particular patient unless the physician assistant has completed an education course that meets specific standards.
This bill would require that course to include the risks of addiction associated with the use of Schedule II controlled substances.
(4)The Pharmacy Law provides for the licensure and regulation of pharmacists, pharmacy technicians, and pharmacies by the California State Board of Pharmacy. Existing law requires the board to promulgate regulations that require a standardized, patient-centered, prescription drug label on all prescription medicine dispensed to patients in California. The act makes a violation of its provisions a crime.
This bill would require a pharmacy or practitioner dispensing an opioid to a patient for outpatient use to prominently display on the label or container a notice that warns of the risk of overdose and addiction, as specified. Because a violation of that requirement would be a crime, the bill would impose a state-mandated local program.
(5)The Dental Practice Act provides for the licensure and regulation of persons engaged in the practice of dentistry by the Dental Board of California, which is within the Department of Consumer Affairs. The act authorizes the board, as a condition of license renewal, to require licentiates to successfully complete a portion of required continuing education hours in specific areas, including patient care, health and safety, and law and ethics.
This bill would include the risks of addiction associated with the use of Schedule II drugs in those specific areas of continuing education.
(6)Existing law, the Osteopathic Act, establishes the Osteopathic Medical Board of California, which issues certificates to, and regulates, osteopathic physicians and surgeons. Existing law requires the board to require each licensed osteopathic physician and surgeon to complete a minimum of 100 hours of American Osteopathic Association continuing education hours during each 2-year cycle, of which 40 hours must be completed in American Osteopathic Association Category 1 continuing education hours as a condition for renewal of an active license.
This bill would additionally require licensed osteopathic physician and surgeons to complete a course on the risks of addiction associated with the use of Schedule II drugs.
(7)The Optometry Practice Act provides for the licensure and regulation of the practice of optometry by the State Board of Optometry. The act requires an optometrist certified to use therapeutic pharmaceutical agents to complete a total of 50 hours of continuing education every 2 years in order to renew his or her certificate. Existing law requires 35 of the 50 hours of continuing education to be on the diagnosis, treatment, and management of ocular disease in any combination of specified areas, including pain medication.
This bill would expand the areas of continuing education to include risks of addiction associated with the use of Schedule II drugs.
(8)The California 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. The act makes a violation of its provisions a crime.
This bill would require a prescriber to discuss specified information with the minor, the minors parent or guardian, or other adult authorized to consent to the minors medical treatment before directly dispensing or issuing for a minor the first prescription in a single course of treatment for a controlled substance containing an opioid. This bill would provide that a violation of these requirements is not a criminal offense.
(9)Existing law requires a school district, charter school, or private school that elects to offer an athletic program to take specified actions if an athlete is suspected to have sustained a concussion and to obtain a signed concussion and head injury information sheet from the athlete and athletes parent or guardian before the athlete initiates practice or competition.
This bill would require a youth sports organization, as defined, that elects to offer an athletic program to annually give a specified Opioid Factsheet for Patients to each athlete, and would require each athlete and his or her parent to sign a document acknowledging receipt of that factsheet, as specified.
(10)Existing law requires a youth sports organization, as defined, that elects to offer an athletic program to, among other things, annually give a concussion and head injury information sheet to each athlete and requires that the sheet be signed, as specified.
This bill would also require a youth sports organization that elects to offer an athletic program to annually give a specified Opioid Factsheet for Patients to each athlete, and would require that each athlete and his or her parent to sign a document verifying receipt of that factsheet, 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.
(1)The Medical Practice Act provides for the licensure and regulation of physicians and surgeons by the Medical Board of California. Under that act, the board is required to adopt and administer standards for the continuing education of physicians and surgeons. Existing law requires a physician and surgeon to complete a mandatory continuing education course in the subjects of pain management and the treatment of terminally ill and dying patients. That act requires the board to give its highest priority to considering a course in pain management among its continuing education requirements for licensees, and requires the board to periodically develop and disseminate information and educational material on pain management techniques and procedures to licensees and general acute care hospitals.
This bill would require, for physicians and surgeons licensed on or after January 1, 2019, the mandatory continuing education course to also include the subject of the risks of addiction associated with the use of Schedule II drugs. The bill would require the board to give its highest priority to considering a course in the risks of addiction associated with the use of Schedule II drugs among its continuing education requirements for physicians and surgeons and would require the board to periodically develop and disseminate information and educational material on the risks of addiction associated with the use of Schedule II drugs to physicians and surgeons and general acute care hospitals.
(2)The Nursing Practice Act provides for the licensure and regulation of the practice of nursing by the Board of Registered Nursing and makes a violation of its provisions a crime. Existing law authorizes a certified nurse-midwife to furnish or order drugs or devices under specified circumstances, including board certification that the certified nurse-midwife has completed a course in pharmacology, as specified.
This bill would require the pharmacology course to include the risks of addiction and neonatal abstinence syndrome associated with the use of opioids.
Existing law also authorizes a nurse practitioner to furnish or order drugs or devices under specified circumstances, including board certification that the nurse practitioner has completed a course in pharmacology, as specified. Existing law requires nurse practitioners who are authorized to furnish Schedule II controlled substances to complete a mandatory continuing education course in Schedule II controlled substances.
This bill would require the mandatory continuing education course to include the risks of addiction associated with their use.
By expanding the scope of a crime under the Nursing Practice Act, the bill would impose a state-mandated local program.
(3)The Physician Assistant Practice Act provides for licensure and regulation of physician assistants by the Physician Assistant Board and authorizes a physician assistant to perform medical services as set forth by regulations when those services are rendered under the supervision of a licensed physician and surgeon, as specified. The act prohibits a physician assistant from administering, providing, or issuing a drug order to a patient for Schedule II through Schedule V controlled substances without advance approval by a supervising physician and surgeon for that particular patient unless the physician assistant has completed an education course that meets specific standards.
This bill would require that course to include the risks of addiction associated with the use of Schedule II controlled substances.
(4)The Pharmacy Law provides for the licensure and regulation of pharmacists, pharmacy technicians, and pharmacies by the California State Board of Pharmacy. Existing law requires the board to promulgate regulations that require a standardized, patient-centered, prescription drug label on all prescription medicine dispensed to patients in California. The act makes a violation of its provisions a crime.
This bill would require a pharmacy or practitioner dispensing an opioid to a patient for outpatient use to prominently display on the label or container a notice that warns of the risk of overdose and addiction, as specified. Because a violation of that requirement would be a crime, the bill would impose a state-mandated local program.
(5)The Dental Practice Act provides for the licensure and regulation of persons engaged in the practice of dentistry by the Dental Board of California, which is within the Department of Consumer Affairs. The act authorizes the board, as a condition of license renewal, to require licentiates to successfully complete a portion of required continuing education hours in specific areas, including patient care, health and safety, and law and ethics.
This bill would include the risks of addiction associated with the use of Schedule II drugs in those specific areas of continuing education.
(6)Existing law, the Osteopathic Act, establishes the Osteopathic Medical Board of California, which issues certificates to, and regulates, osteopathic physicians and surgeons. Existing law requires the board to require each licensed osteopathic physician and surgeon to complete a minimum of 100 hours of American Osteopathic Association continuing education hours during each 2-year cycle, of which 40 hours must be completed in American Osteopathic Association Category 1 continuing education hours as a condition for renewal of an active license.
This bill would additionally require licensed osteopathic physician and surgeons to complete a course on the risks of addiction associated with the use of Schedule II drugs.
(7)The Optometry Practice Act provides for the licensure and regulation of the practice of optometry by the State Board of Optometry. The act requires an optometrist certified to use therapeutic pharmaceutical agents to complete a total of 50 hours of continuing education every 2 years in order to renew his or her certificate. Existing law requires 35 of the 50 hours of continuing education to be on the diagnosis, treatment, and management of ocular disease in any combination of specified areas, including pain medication.
This bill would expand the areas of continuing education to include risks of addiction associated with the use of Schedule II drugs.
(8)The California 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. The act makes a violation of its provisions a crime.
This bill would require a prescriber to discuss specified information with the minor, the minors parent or guardian, or other adult authorized to consent to the minors medical treatment before directly dispensing or issuing for a minor the first prescription in a single course of treatment for a controlled substance containing an opioid. This bill would provide that a violation of these requirements is not a criminal offense.
(9)Existing law requires a school district, charter school, or private school that elects to offer an athletic program to take specified actions if an athlete is suspected to have sustained a concussion and to obtain a signed concussion and head injury information sheet from the athlete and athletes parent or guardian before the athlete initiates practice or competition.
This bill would require a school district, charter school, or private school a youth sports organization, as defined, that elects to offer an athletic program to annually give a specified Opioid Factsheet for Patients to each athlete, and would require each athlete and his or her parent to sign a document verifying acknowledging receipt of that factsheet, as specified.
(10)Existing law requires a youth sports organization, as defined, that elects to offer an athletic program to, among other things, annually give a concussion and head injury information sheet to each athlete and requires that the sheet be signed, as specified.
This bill would also require a youth sports organization that elects to offer an athletic program to annually give a specified Opioid Factsheet for Patients to each athlete, and would require that each athlete and his or her parent to sign a document verifying receipt of that factsheet, 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.
(1)The Medical Practice Act provides for the licensure and regulation of physicians and surgeons by the Medical Board of California. Under that act, the board is required to adopt and administer standards for the continuing education of physicians and surgeons. Existing law requires a physician and surgeon to complete a mandatory continuing education course in the subjects of pain management and the treatment of terminally ill and dying patients. That act requires the board to give its highest priority to considering a course in pain management among its continuing education requirements for licensees, and requires the board to periodically develop and disseminate information and educational material on pain management techniques and procedures to licensees and general acute care hospitals.
This bill would require, for physicians and surgeons licensed on or after January 1, 2019, the mandatory continuing education course to also include the subject of the risks of addiction associated with the use of Schedule II drugs. The bill would require the board to give its highest priority to considering a course in the risks of addiction associated with the use of Schedule II drugs among its continuing education requirements for physicians and surgeons and would require the board to periodically develop and disseminate information and educational material on the risks of addiction associated with the use of Schedule II drugs to physicians and surgeons and general acute care hospitals.
(2)The Nursing Practice Act provides for the licensure and regulation of the practice of nursing by the Board of Registered Nursing and makes a violation of its provisions a crime. Existing law authorizes a certified nurse-midwife to furnish or order drugs or devices under specified circumstances, including board certification that the certified nurse-midwife has completed a course in pharmacology, as specified.
This bill would require the pharmacology course to include the risks of addiction and neonatal abstinence syndrome associated with the use of opioids.
Existing law also authorizes a nurse practitioner to furnish or order drugs or devices under specified circumstances, including board certification that the nurse practitioner has completed a course in pharmacology, as specified. Existing law requires nurse practitioners who are authorized to furnish Schedule II controlled substances to complete a mandatory continuing education course in Schedule II controlled substances.
This bill would require the mandatory continuing education course to include the risks of addiction associated with their use.
By expanding the scope of a crime under the Nursing Practice Act, the bill would impose a state-mandated local program.
(3)The Physician Assistant Practice Act provides for licensure and regulation of physician assistants by the Physician Assistant Board and authorizes a physician assistant to perform medical services as set forth by regulations when those services are rendered under the supervision of a licensed physician and surgeon, as specified. The act prohibits a physician assistant from administering, providing, or issuing a drug order to a patient for Schedule II through Schedule V controlled substances without advance approval by a supervising physician and surgeon for that particular patient unless the physician assistant has completed an education course that meets specific standards.
This bill would require that course to include the risks of addiction associated with the use of Schedule II controlled substances.
(4)The Pharmacy Law provides for the licensure and regulation of pharmacists, pharmacy technicians, and pharmacies by the California State Board of Pharmacy. Existing law requires the board to promulgate regulations that require a standardized, patient-centered, prescription drug label on all prescription medicine dispensed to patients in California. The act makes a violation of its provisions a crime.
This bill would require a pharmacy or practitioner dispensing an opioid to a patient for outpatient use to prominently display on the label or container a notice that warns of the risk of overdose and addiction, as specified. Because a violation of that requirement would be a crime, the bill would impose a state-mandated local program.
(5)The Dental Practice Act provides for the licensure and regulation of persons engaged in the practice of dentistry by the Dental Board of California, which is within the Department of Consumer Affairs. The act authorizes the board, as a condition of license renewal, to require licentiates to successfully complete a portion of required continuing education hours in specific areas, including patient care, health and safety, and law and ethics.
This bill would include the risks of addiction associated with the use of Schedule II drugs in those specific areas of continuing education.
(6)Existing law, the Osteopathic Act, establishes the Osteopathic Medical Board of California, which issues certificates to, and regulates, osteopathic physicians and surgeons. Existing law requires the board to require each licensed osteopathic physician and surgeon to complete a minimum of 100 hours of American Osteopathic Association continuing education hours during each 2-year cycle, of which 40 hours must be completed in American Osteopathic Association Category 1 continuing education hours as a condition for renewal of an active license.
This bill would additionally require licensed osteopathic physician and surgeons to complete a course on the risks of addiction associated with the use of Schedule II drugs.
(7)The Optometry Practice Act provides for the licensure and regulation of the practice of optometry by the State Board of Optometry. The act requires an optometrist certified to use therapeutic pharmaceutical agents to complete a total of 50 hours of continuing education every 2 years in order to renew his or her certificate. Existing law requires 35 of the 50 hours of continuing education to be on the diagnosis, treatment, and management of ocular disease in any combination of specified areas, including pain medication.
This bill would expand the areas of continuing education to include risks of addiction associated with the use of Schedule II drugs.
(8)The California 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. The act makes a violation of its provisions a crime.
This bill would require a prescriber to discuss specified information with the minor, the minors parent or guardian, or other adult authorized to consent to the minors medical treatment before directly dispensing or issuing for a minor the first prescription in a single course of treatment for a controlled substance containing an opioid. This bill would provide that a violation of these requirements is not a criminal offense, but would subject the prescriber to disciplinary action for unprofessional conduct under the prescribers respective licensing act. offense.
(9)Existing law requires a school district, charter school, or private school that elects to offer an athletic program to take specified actions if an athlete is suspected to have sustained a concussion and to obtain a signed concussion and head injury information sheet from the athlete and athletes parent or guardian before the athlete initiates practice or competition.
This bill would require a school district, charter school, or private school that elects to offer an athletic program to annually give a specified Opioid Factsheet for Patients to each athlete, and would require each athlete and his or her parent to sign a document verifying receipt of that factsheet, as specified.
(10)Existing law requires a youth sports organization, as defined, that elects to offer an athletic program to, among other things, annually give a concussion and head injury information sheet to each athlete and requires that the sheet be signed, as specified.
This bill would also require a youth sports organization that elects to offer an athletic program to annually give a specified Opioid Factsheet for Patients to each athlete, and would require that each athlete and his or her parent to sign a document verifying receipt of that factsheet, 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.
(1)The Medical Practice Act provides for the licensure and regulation of physicians and surgeons by the Medical Board of California. Under that act, the board is required to adopt and administer standards for the continuing education of physicians and surgeons. Existing law requires a physician and surgeon to complete a mandatory continuing education course in the subjects of pain management and the treatment of terminally ill and dying patients. That act requires the board to give its highest priority to considering a course in pain management among its continuing education requirements for licensees, and requires the board to periodically develop and disseminate information and educational material on pain management techniques and procedures to licensees and general acute care hospitals.
This bill would require, for physicians and surgeons licensed on or after January 1, 2019, the mandatory continuing education course to also include the subject of the risks of addiction associated with the use of Schedule II drugs. The bill would require the board to give its highest priority to considering a course in the risks of addiction associated with the use of Schedule II drugs among its continuing education requirements for physicians and surgeons and would require the board to periodically develop and disseminate information and educational material on the risks of addiction associated with the use of Schedule II drugs to physicians and surgeons and general acute care hospitals.
(2)The Nursing Practice Act provides for the licensure and regulation of the practice of nursing by the Board of Registered Nursing and makes a violation of its provisions a crime. Existing law authorizes a certified nurse-midwife to furnish or order drugs or devices under specified circumstances, including board certification that the certified nurse-midwife has completed a course in pharmacology, as specified.
This bill would require the pharmacology course to include the risks of addiction and neonatal abstinence syndrome associated with the use of opioids.
Existing law also authorizes a nurse practitioner to furnish or order drugs or devices under specified circumstances, including board certification that the nurse practitioner has completed a course in pharmacology, as specified. Existing law requires nurse practitioners who are authorized to furnish Schedule II controlled substances to complete a mandatory continuing education course in Schedule II controlled substances.
This bill would require the mandatory continuing education course to include the risks of addiction associated with their use.
By expanding the scope of a crime under the Nursing Practice Act, the bill would impose a state-mandated local program.
(3)The Physician Assistant Practice Act provides for licensure and regulation of physician assistants by the Physician Assistant Board and authorizes a physician assistant to perform medical services as set forth by regulations when those services are rendered under the supervision of a licensed physician and surgeon, as specified. The act prohibits a physician assistant from administering, providing, or issuing a drug order to a patient for Schedule II through Schedule V controlled substances without advance approval by a supervising physician and surgeon for that particular patient unless the physician assistant has completed an education course that meets specific standards.
This bill would require that course to include the risks of addiction associated with the use of Schedule II controlled substances.
(4)The Pharmacy Law provides for the licensure and regulation of pharmacists, pharmacy technicians, and pharmacies by the California State Board of Pharmacy. Existing law requires the board to promulgate regulations that require a standardized, patient-centered, prescription drug label on all prescription medicine dispensed to patients in California. The act makes a violation of its provisions a crime.
This bill would require a pharmacy or practitioner dispensing an opioid to a patient for outpatient use to prominently display on the label or container a notice that warns of the risk of overdose and addiction, as specified. Because a violation of that requirement would be a crime, the bill would impose a state-mandated local program.
(5)The Dental Practice Act provides for the licensure and regulation of persons engaged in the practice of dentistry by the Dental Board of California, which is within the Department of Consumer Affairs. The act authorizes the board, as a condition of license renewal, to require licentiates to successfully complete a portion of required continuing education hours in specific areas, including patient care, health and safety, and law and ethics.
This bill would include the risks of addiction associated with the use of Schedule II drugs in those specific areas of continuing education.
(6)Existing law, the Osteopathic Act, establishes the Osteopathic Medical Board of California, which issues certificates to, and regulates, osteopathic physicians and surgeons. Existing law requires the board to require each licensed osteopathic physician and surgeon to complete a minimum of 100 hours of American Osteopathic Association continuing education hours during each 2-year cycle, of which 40 hours must be completed in American Osteopathic Association Category 1 continuing education hours as a condition for renewal of an active license.
This bill would additionally require licensed osteopathic physician and surgeons to complete a course on the risks of addiction associated with the use of Schedule II drugs.
(7)The Optometry Practice Act provides for the licensure and regulation of the practice of optometry by the State Board of Optometry. The act requires an optometrist certified to use therapeutic pharmaceutical agents to complete a total of 50 hours of continuing education every 2 years in order to renew his or her certificate. Existing law requires 35 of the 50 hours of continuing education to be on the diagnosis, treatment, and management of ocular disease in any combination of specified areas, including pain medication.
This bill would expand the areas of continuing education to include risks of addiction associated with the use of Schedule II drugs.
(8)The California 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. The act makes a violation of its provisions a crime.
This bill would require a prescriber to discuss specified information with and obtain the consent of the minor, the minors parent or guardian, or other adult authorized to consent to the minors medical treatment before directly dispensing or issuing for a minor the first prescription in a single course of treatment for a controlled substance containing an opioid. This bill would provide that a violation of these requirements is not a criminal offense, but would subject the prescriber to disciplinary action for unprofessional conduct under the prescribers respective licensing act.
(9)Existing law requires a school district, charter school, or private school that elects to offer an athletic program to take specified actions if an athlete is suspected to have sustained a concussion and to obtain a signed concussion and head injury information sheet from the athlete and athletes parent or guardian before the athlete initiates practice or competition.
This bill would require a school district, charter school, or private school that elects to offer an athletic program to annually give a specified Opioid Factsheet for Patients to each athlete, and would require each athlete and his or her parent to sign a document verifying receipt of that factsheet, as specified.
(10)Existing law requires a youth sports organization, as defined, that elects to offer an athletic program to, among other things, annually give a concussion and head injury information sheet to each athlete and requires that the sheet be signed, as specified.
This bill would also require a youth sports organization that elects to offer an athletic program to annually give a specified Opioid Factsheet for Patients to each athlete, and would require that each athlete and his or her parent to sign a document verifying receipt of that factsheet, 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.
(1)The Medical Practice Act provides for the licensure and regulation of physicians and surgeons by the Medical Board of California. Under that act, the board is required to adopt and administer standards for the continuing education of physicians and surgeons. Existing law requires a physician and surgeon to complete a mandatory continuing education course in the subjects of pain management and the treatment of terminally ill and dying patients. That act requires the board to give its highest priority to considering a course in pain management among its continuing education requirements for licensees, and requires the board to periodically develop and disseminate information and educational material on pain management techniques and procedures to licensees and general acute care hospitals.
This bill would require, for physicians and surgeons licensed on or after January 1, 2019, the mandatory continuing education course to also include the subject of the risks of addiction associated with the use of Schedule II drugs. The bill would require the board to give its highest priority to considering a course in the risks of addiction associated with the use of Schedule II drugs among its continuing education requirements for physicians and surgeons and would require the board to periodically develop and disseminate information and educational material on the risks of addiction associated with the use of Schedule II drugs to physicians and surgeons and general acute care hospitals.
(2)The Nursing Practice Act provides for the licensure and regulation of the practice of nursing by the Board of Registered Nursing and makes a violation of its provisions a crime. Existing law authorizes a certified nurse-midwife to furnish or order drugs or devices under specified circumstances, including board certification that the certified nurse-midwife has completed a course in pharmacology, as specified.
This bill would require the pharmacology course to include the risks of addiction and neonatal abstinence syndrome associated with the use of opioids.
Existing law also authorizes a nurse practitioner to furnish or order drugs or devices under specified circumstances, including board certification that the nurse practitioner has completed a course in pharmacology, as specified. Existing law requires nurse practitioners who are authorized to furnish Schedule II controlled substances to complete a mandatory continuing education course in Schedule II controlled substances.
This bill would require the mandatory continuing education course to include the risks of addiction associated with their use.
By expanding the scope of a crime under the Nursing Practice Act, the bill would impose a state-mandated local program.
(3)The Physician Assistant Practice Act provides for licensure and regulation of physician assistants by the Physician Assistant Board and authorizes a physician assistant to perform medical services as set forth by regulations when those services are rendered under the supervision of a licensed physician and surgeon, as specified. The act prohibits a physician assistant from administering, providing, or issuing a drug order to a patient for Schedule II through Schedule V controlled substances without advance approval by a supervising physician and surgeon for that particular patient unless the physician assistant has completed an education course that meets specific standards.
This bill would require that course to include the risks of addiction associated with the use of Schedule II controlled substances.
(4)The Pharmacy Law provides for the licensure and regulation of pharmacists, pharmacy technicians, and pharmacies by the California State Board of Pharmacy. Existing law requires the board to promulgate regulations that require a standardized, patient-centered, prescription drug label on all prescription medicine dispensed to patients in California. The act makes a violation of its provisions a crime.
This bill would require the board to adopt an emergency regulation requiring a warning label on all Schedule II controlled substance vials or prescription bottles that addresses the risk of addiction and overdose when using opioids. a pharmacy or practitioner dispensing an opioid to a patient for outpatient use to prominently display on the label or container a notice that warns of the risk of overdose and addiction, as specified. To the extent that this provision would expand the scope of a crime under the Pharmacy Law, Because a violation of that requirement would be a crime, the bill would impose a state-mandated local program.
(5)The Dental Practice Act provides for the licensure and regulation of persons engaged in the practice of dentistry by the Dental Board of California, which is within the Department of Consumer Affairs. The act authorizes the board, as a condition of license renewal, to require licentiates to successfully complete a portion of required continuing education hours in specific areas, including patient care, health and safety, and law and ethics.
This bill would include the risks of addiction associated with the use of Schedule II drugs in those specific areas of continuing education.
(6)Existing law, the Osteopathic Act, establishes the Osteopathic Medical Board of California, which issues certificates to, and regulates, osteopathic physicians and surgeons. Existing law requires the board to require each licensed osteopathic physician and surgeon to complete a minimum of 100 hours of American Osteopathic Association continuing education hours during each 2-year cycle, of which 40 hours must be completed in American Osteopathic Association Category 1 continuing education hours as a condition for renewal of an active license.
This bill would additionally require licensed osteopathic physician and surgeons to complete a course on the risks of addiction associated with the use of Schedule II drugs.
(7)The Optometry Practice Act provides for the licensure and regulation of the practice of optometry by the State Board of Optometry. The act requires an optometrist certified to use therapeutic pharmaceutical agents to complete a total of 50 hours of continuing education every 2 years in order to renew his or her certificate. Existing law requires 35 of the 50 hours of continuing education to be on the diagnosis, treatment, and management of ocular disease in any combination of specified areas, including pain medication.
This bill would expand the areas of continuing education to include risks of addiction associated with the use of Schedule II drugs.
(5)(8)The California 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. The act makes a violation of its provisions a crime.
This bill would require a prescriber to discuss specified information with and obtain the consent of the minor, the minors parent or guardian, or other adult authorized to consent to the minors medical treatment before directly dispensing or issuing for a minor the first prescription in a single course of treatment for a controlled substance containing an opioid. This bill would provide that a violation of these requirements is not a criminal offense, but would subject the prescriber to disciplinary action for unprofessional conduct under the prescribers respective licensing act.
(6)(9)Existing law requires a school district, charter school, or private school that elects to offer an athletic program to take specified actions if an athlete is suspected to have sustained a concussion and to obtain a signed concussion and head injury information sheet from the athlete and athletes parent or guardian before the athlete initiates practice or competition.
This bill would require a school district, charter school, or private school that elects to offer an athletic program to annually give an information sheet about the risks of opioid addiction to a specified Opioid Factsheet for Patients to each athlete, and would require that sheet to be signed, each athlete and his or her parent to sign a document verifying receipt of that factsheet, as specified.
(7)(10)Existing law requires a youth sports organization, as defined, that elects to offer an athletic program to, among other things, annually give a concussion and head injury information sheet to each athlete and requires that the sheet be signed, as specified.
This bill would also require a youth sports organization that elects to offer an athletic program to annually give an information sheet about the risk of opioid addiction a specified Opioid Factsheet for Patients to each athlete, and would require that sheet to be signed, each athlete and his or her parent to sign a document verifying receipt of that factsheet, 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.
(1)The Medical Practice Act provides for the licensure and regulation of physicians and surgeons by the Medical Board of California. Under that act, the board is required to adopt and administer standards for the continuing education of physicians and surgeons. Existing law requires a physician and surgeon to complete a mandatory continuing education course in the subjects of pain management and the treatment of terminally ill and dying patients. That act requires the board to give its highest priority to considering a course in pain management among its continuing education requirements for licensees, and requires the board to periodically develop and disseminate information and educational material on pain management techniques and procedures to licensees and general acute care hospitals.
This bill would require, for physicians and surgeons licensed on or after January 1, 2019, the mandatory continuing education course to also include the subject of the risks of addiction associated with the use of Schedule II drugs. The bill would require the board to give its highest priority to considering a course in the risks of addiction associated with the use of Schedule II drugs among its continuing education requirements for physicians and surgeons and would require the board to periodically develop and disseminate information and educational material on the risks of addiction associated with the use of Schedule II drugs to physicians and surgeons and general acute care hospitals.
(2)The Nursing Practice Act provides for the licensure and regulation of the practice of nursing by the Board of Registered Nursing and makes a violation of its provisions a crime. Existing law authorizes a certified nurse-midwife to furnish or order drugs or devices under specified circumstances, including board certification that the certified nurse-midwife has completed a course in pharmacology, as specified.
This bill would require the pharmacology course to include the risks of addiction and neonatal abstinence syndrome associated with the use of opioids.
Existing law also authorizes a nurse practitioner to furnish or order drugs or devices under specified circumstances, including board certification that the nurse practitioner has completed a course in pharmacology, as specified. Existing law requires nurse practitioners who are authorized to furnish Schedule II controlled substances to complete a mandatory continuing education course in Schedule II controlled substances.
This bill would require the mandatory continuing education course to include the risks of addiction associated with their use.
By expanding the scope of a crime under the Nursing Practice Act, the bill would impose a state-mandated local program.
(3)The Physician Assistant Practice Act provides for licensure and regulation of physician assistants by the Physician Assistant Board and authorizes a physician assistant to perform medical services as set forth by regulations when those services are rendered under the supervision of a licensed physician and surgeon, as specified. The act prohibits a physician assistant from administering, providing, or issuing a drug order to a patient for Schedule II through Schedule V controlled substances without advance approval by a supervising physician and surgeon for that particular patient unless the physician assistant has completed an education course that meets specific standards.
This bill would require that course to include the risks of addiction associated with the use of Schedule II controlled substances.
(4)The Pharmacy Law provides for the licensure and regulation of pharmacists, pharmacy technicians, and pharmacies by the California State Board of Pharmacy. Existing law requires the board to promulgate regulations that require a standardized, patient-centered, prescription drug label on all prescription medicine dispensed to patients in California. The act makes a violation of its provisions a crime.
This bill would require the board to adopt an emergency regulation requiring a warning label on all Schedule II controlled substance vials or prescription bottles that addresses the risk of addiction and overdose when using opioids. To the extent that this provision would expand the scope of a crime under the Pharmacy Law, the bill would impose a state-mandated local program.
(5)The California 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. The act makes a violation of its provisions a crime.
This bill would require a prescriber to discuss specified information with and obtain the consent of the minor, the minors parent or guardian, or other adult authorized to consent to the minors medical treatment before directly dispensing or issuing for a minor the first prescription in a single course of treatment for a controlled substance containing an opioid. Because a violation of those requirements would be a crime, the bill would expand an existing crime and impose a state-mandated local program. This bill would provide that a violation of these requirements is not a criminal offense, but would subject the prescriber to disciplinary action for unprofessional conduct under the prescribers respective licensing act.
(6)Existing law requires a school district, charter school, or private school that elects to offer an athletic program to take specified actions if an athlete is suspected to have sustained a concussion and to obtain a signed concussion and head injury information sheet from the athlete and athletes parent or guardian before the athlete initiates practice or competition.
This bill would require a school district, charter school, or private school that elects to offer an athletic program to annually give an information sheet about the risks of opioid addiction to each athlete, and would require that sheet to be signed, as specified.
(7)Existing law requires a youth sports organization, as defined, that elects to offer an athletic program to, among other things, annually give a concussion and head injury information sheet to each athlete and requires that the sheet be signed, as specified.
This bill would also require a youth sports organization that elects to offer an athletic program to annually give an information sheet about the risk of opioid addiction to each athlete, and would require that sheet to be signed, 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.
(1)The Medical Practice Act provides for the licensure and regulation of physicians and surgeons by the Medical Board of California. Under that act, the board is required to adopt and administer standards for the continuing education of physicians and surgeons. Existing law requires a physician and surgeon to complete a mandatory continuing education course in the subjects of pain management and the treatment of terminally ill and dying patients. That act requires the board to give its highest priority to considering a course in pain management among its continuing education requirements for licensees, and requires the board to periodically develop and disseminate information and educational material on pain management techniques and procedures to licensees and general acute care hospitals.
This bill would require, for physicians and surgeons licensed on or after January 1, 2019, the mandatory continuing education course to also include the subject of the risks of addiction associated with the use of Schedule II drugs. The bill would require the board to give its highest priority to considering a course in the risks of addiction associated with the use of Schedule II drugs among its continuing education requirements for physicians and surgeons and would require the board to periodically develop and disseminate information and educational material on the risks of addiction associated with the use of Schedule II drugs to physicians and surgeons and general acute care hospitals.
(2)The Nursing Practice Act provides for the licensure and regulation of the practice of nursing by the Board of Registered Nursing and makes a violation of its provisions a crime. Existing law authorizes a certified nurse-midwife to furnish or order drugs or devices under specified circumstances, including board certification that the certified nurse-midwife has completed a course in pharmacology, as specified.
This bill would require the pharmacology course to include the risks of addiction and neonatal abstinence syndrome associated with the use of opioids.
Existing law also authorizes a nurse practitioner to furnish or order drugs or devices under specified circumstances, including board certification that the nurse practitioner has completed a course in pharmacology, as specified. Existing law requires nurse practitioners who are authorized to furnish Schedule II controlled substances to complete a mandatory continuing education course in Schedule II controlled substances.
This bill would require the mandatory continuing education course to include the risks of addiction associated with their use.
By expanding the scope of a crime under the Nursing Practice Act, the bill would impose a state-mandated local program.
(3)The Physician Assistant Practice Act provides for licensure and regulation of physician assistants by the Physician Assistant Board and authorizes a physician assistant to perform medical services as set forth by regulations when those services are rendered under the supervision of a licensed physician and surgeon, as specified. The act prohibits a physician assistant from administering, providing, or issuing a drug order to a patient for Schedule II through Schedule V controlled substances without advance approval by a supervising physician and surgeon for that particular patient unless the physician assistant has completed an education course that meets specific standards.
This bill would require that course to include the risks of addiction associated with the use of Schedule II controlled substances.
(4)The Pharmacy Law provides for the licensure and regulation of pharmacists, pharmacy technicians, and pharmacies by the California State Board of Pharmacy. Existing law requires the board to promulgate regulations that require a standardized, patient-centered, prescription drug label on all prescription medicine dispensed to patients in California. The act makes a violation of its provisions a crime.
This bill would require the board to adopt an emergency regulation requiring a warning label on all Schedule II controlled substance vials or prescription bottles that addresses the risk of addiction and overdose when using opioids. To the extent that this provision would expand the scope of a crime under the Pharmacy Law, the bill would impose a state-mandated local program.
(5)The California 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. The act makes a violation of its provisions a crime.
This bill would require a prescriber to discuss specified information with and obtain the consent of the minor, the minors parent or guardian, or other adult authorized to consent to the minors medical treatment before directly dispensing or issuing for a minor the first prescription in a single course of treatment for a controlled substance containing an opioid. Because a violation of those requirements would be a crime, the bill would expand an existing crime and impose a state-mandated local program.
(6)Existing law requires a school district, charter school, or private school that elects to offer an athletic program to take specified actions if an athlete is suspected to have sustained a concussion and to obtain a signed concussion and head injury information sheet from the athlete and athletes parent or guardian before the athlete initiates practice or competition.
This bill would require a school district, charter school, or private school that elects to offer an athletic program to annually give an information sheet about the risks of opioid addiction to each athlete, and would require that sheet to be signed, as specified.
(7)Existing law requires a youth sports organization, as defined, that elects to offer an athletic program to, among other things, annually give a concussion and head injury information sheet to each athlete and requires that the sheet be signed, as specified.
This bill would also require a youth sports organization that elects to offer an athletic program to annually give an information sheet about the risk of opioid addiction to each athlete, and would require that sheet to be signed, 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.
The Legislature finds and declares all of the following:
(a)Addiction, misuse, and overdose of prescription opioids is a public health crisis affecting both adults and children.
(b)Urgent measures are needed to better inform the public of the risks associated with both the long-term and short-term use of opioids in an effort to address this problem.
(c)Both short-term and long-term prescriptions of opioids to minors fall within situations that require counseling of patients and their parents or guardians by their prescribers.
(d)It is the intent of the Legislature to ensure that health care providers and young athletes receive necessary education on this topic.
SEC. 2.Section 1645 of the Business and Professions Code is amended to read:1645.(a)Effective with the 1974 license renewal period, if the board determines that the public health and safety would be served by requiring all holders of licenses under this chapter to continue their education after receiving a license, it may require, as a condition to the renewal thereof, that they submit assurances satisfactory to the board that they will, during the succeeding two-year period, inform themselves of the developments in the practice of dentistry occurring since the original issuance of their licenses by pursuing one or more courses of study satisfactory to the board or by other means deemed equivalent by the board.
The board shall adopt regulations providing for the suspension of the licenses at the end of the two-year period until compliance with the assurances provided for in this section is accomplished.
(b)The board may also, as a condition of license renewal, require licentiates to successfully complete a portion of the required continuing education hours in specific areas adopted in regulations by the board. The board may prescribe this mandatory coursework within the general areas of patient care, health and safety, law and ethics, and the risks of addiction associated with the use of Schedule II drugs. The mandatory coursework prescribed by the board shall not exceed 15 hours per renewal period for dentists, and 7.5 hours per renewal period for dental auxiliaries. Any mandatory coursework required by the board shall be credited toward the continuing education requirements established by the board pursuant to subdivision (a).
(c)For a retired dentist who provides only uncompensated care, the board shall not require more than 60 percent of the hours of continuing education that are required of other licensed dentists. Notwithstanding subdivision (b), all of the hours of continuing education as described in this subdivision shall be gained through courses related to the actual delivery of dental services to the patient or the community, as determined by the board. Nothing in this subdivision shall be construed to reduce any requirements imposed by the board pursuant to subdivision (b).
(d)The board shall report on the outcome of subdivision (c) pursuant to, and at the time of, its regular sunset review process, as provided in Section 1601.1.
SEC. 2.5.Section 1645 of the Business and Professions Code is amended to read:1645.(a)(1)All holders of licenses under this chapter shall continue their education after receiving a license as a condition to the renewal thereof, and shall obtain evidence satisfactory to the board that they have, during the preceding two-year period, obtained continuing education relevant to developments in the practice of dentistry and dental assisting consistent with the regulations of the board.
The board shall adopt regulations providing for the suspension of the licenses at the end of the two-year period until compliance with this section is accomplished.
(b)The board may also, as a condition of license renewal, require licentiates to successfully complete a portion of the required continuing education hours in specific areas adopted in regulations by the board. The board may prescribe this mandatory coursework within the general areas of patient care, health and safety, law and ethics, and the risks of addiction associated with the use of Schedule II drugs. The mandatory coursework prescribed by the board shall not exceed 15 hours per renewal period for dentists, and 7.5 hours per renewal period for dental auxiliaries. Any mandatory coursework required by the board shall be credited toward the continuing education requirements established by the board pursuant to subdivision (a).
(c)For a retired dentist who provides only uncompensated care, the board shall not require more than 60 percent of the hours of continuing education that are required of other licensed dentists. Notwithstanding subdivision (b), all of the hours of continuing education as described in this subdivision shall be gained through courses related to the actual delivery of dental services to the patient or the community, as determined by the board. Nothing in this subdivision shall be construed to reduce any requirements imposed by the board pursuant to subdivision (b).
(d)The board shall report on the outcome of subdivision (c) pursuant to, and at the time of, its regular sunset review process, as provided in Section 1601.1.
SEC. 3.Section 2190.5 of the Business and Professions Code is amended to read:2190.5.(a)(1)All physicians and surgeons shall complete a mandatory continuing education 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 board may verify completion of this requirement on the renewal application form.
(2)For physicians and surgeons licensed on or after January 1, 2019, the course described in paragraph (1) shall also include the subject of the risks of addiction associated with the use of Schedule II drugs.
(b)By regulatory action, the board may exempt physicians and surgeons by practice status category from the requirement in subdivision (a) if the physician and surgeon does not engage in direct patient care, does not provide patient consultations, or does not reside in the State of California.
(c)This section shall not apply to physicians and surgeons practicing in pathology or radiology specialty areas.
SEC. 4.Section 2191 of the Business and Professions Code is amended to read:2191.(a)In determining its continuing education requirements, the board shall consider including a course in human sexuality, defined as the study of a human being as a sexual being and how he or she functions with respect thereto, and nutrition to be taken by those licensees whose practices may require knowledge in those areas.
(b)The board shall consider including a course in 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.
(c)The board shall consider including a course in 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.
(d)The board shall encourage every physician and surgeon to take nutrition as part of his or her continuing education, particularly a physician and surgeon involved in primary care.
(e)The board shall consider including a course in 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.
(f)In determining its continuing education requirements, the board shall consider including a course in 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.
(g)In determining its continuing education requirements, the board shall consider including a course in 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.
(h)In determining its continuing education requirements, the board shall consider including a course providing training and 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 board 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.
(i)In determining its continuing education requirements, the board shall consider including a course in the special care needs of individuals and their families facing end-of-life issues, including, but not limited to, all of the following:
(1)Pain and symptom management.
(2)The psycho-social dynamics of death.
(3)Dying and bereavement.
(4)Hospice care.
(j)In determining its continuing education requirements, the board shall give its highest priority to considering a course on pain management and the risks of addiction associated with the use of Schedule II drugs.
(k)In determining its continuing education requirements, the board shall consider including a course in geriatric care for emergency room physicians and surgeons.
SEC. 5.Section 2196.2 of the Business and Professions Code is amended to read:2196.2.The board shall periodically develop and disseminate information and educational material regarding pain management techniques and procedures, including the risks of addiction associated with the use of Schedule II drugs, to each licensed physician and surgeon and to each general acute care hospital in this state. The board shall consult with the State Department of Public Health in developing the materials to be distributed pursuant to this section.
SEC. 6.Section 2454.5 of the Business and Professions Code is amended to read:2454.5.In order to ensure the continuing competence of licensed osteopathic physicians and surgeons, the board shall adopt and administer standards for the continuing education of those licensees. The board shall require each licensed osteopathic physician and surgeon to demonstrate satisfaction of the continuing education requirements as a condition for the renewal of a license at intervals of not less than one year nor more than two years. Commencing January 1, 2018, the board shall require each licensed osteopathic physician and surgeon to complete a minimum of 100 hours of American Osteopathic Association continuing education hours during each two-year cycle, of which 40 hours shall be completed in American Osteopathic Association Category 1 continuing education hours and the remaining 60 hours shall be either American Osteopathic Association or American Medical Association accredited as a condition for renewal of an active license. Licensed osteopathic physicians and surgeons shall complete a course on the risks of addiction associated with the use of Schedule II drugs.
For purposes of this section, American Osteopathic Association Category 1 means continuing education activities and programs approved for Category 1 credit by the Committee on Continuing Medical Education of the American Osteopathic Association.
SEC. 7.Section 2746.51 of the Business and Professions Code is amended to read:2746.51.(a)Neither this chapter nor any other provision of law shall be construed to prohibit a certified nurse-midwife from furnishing or ordering drugs or devices, including controlled substances classified in Schedule II, III, IV, or V under the California Uniform Controlled Substances Act (Division 10 (commencing with Section 11000) of the Health and Safety Code), when all of the following apply:
(1)The drugs or devices are furnished or ordered incidentally to the provision of any of the following:
(A)Family planning services, as defined in Section 14503 of the Welfare and Institutions Code.
(B)Routine health care or perinatal care, as defined in subdivision (d) of Section 123485 of the Health and Safety Code.
(C)Care rendered, consistent with the certified nurse-midwifes educational preparation or for which clinical competency has been established and maintained, to persons within a facility specified in subdivision (a), (b), (c), (d), (i), or (j) of Section 1206 of the Health and Safety Code, a clinic as specified in Section 1204 of the Health and Safety Code, a general acute care hospital as defined in subdivision (a) of Section 1250 of the Health and Safety Code, a licensed birth center as defined in Section 1204.3 of the Health and Safety Code, or a special hospital specified as a maternity hospital in subdivision (f) of Section 1250 of the Health and Safety Code.
(2)The drugs or devices are furnished or ordered by a certified nurse-midwife in accordance with standardized procedures or protocols. For purposes of this section, standardized procedure means a document, including protocols, developed and approved by the supervising physician and surgeon, the certified nurse-midwife, and the facility administrator or his or her designee. The standardized procedure covering the furnishing or ordering of drugs or devices shall specify all of the following:
(A)Which certified nurse-midwife may furnish or order drugs or devices.
(B)Which drugs or devices may be furnished or ordered and under what circumstances.
(C)The extent of physician and surgeon supervision.
(D)The method of periodic review of the certified nurse-midwifes competence, including peer review, and review of the provisions of the standardized procedure.
(3)If Schedule II or III controlled substances, as defined in Sections 11055 and 11056 of the Health and Safety Code, are furnished or ordered by a certified nurse-midwife, the controlled substances shall be furnished or ordered in accordance with a patient-specific protocol approved by the treating or supervising physician and surgeon. For Schedule II controlled substance protocols, the provision for furnishing the Schedule II controlled substance shall address the diagnosis of the illness, injury, or condition for which the Schedule II controlled substance is to be furnished.
(4)The furnishing or ordering of drugs or devices by a certified nurse-midwife occurs under physician and surgeon supervision. For purposes of this section, no physician and surgeon shall supervise more than four certified nurse-midwives at one time. Physician and surgeon supervision shall not be construed to require the physical presence of the physician, but does include all of the following:
(A)Collaboration on the development of the standardized procedure or protocol.
(B)Approval of the standardized procedure or protocol.
(C)Availability by telephonic contact at the time of patient examination by the certified nurse-midwife.
(b)(1)The furnishing or ordering of drugs or devices by a certified nurse-midwife is conditional on the issuance by the board of a number to the applicant who has successfully completed the requirements of paragraph (2). The number shall be included on all transmittals of orders for drugs or devices by the certified nurse-midwife. The board shall maintain a list of the certified nurse-midwives that it has certified pursuant to this paragraph and the number it has issued to each one. The board shall make the list available to the California State Board of Pharmacy upon its request. Every certified nurse-midwife who is authorized pursuant to this section to furnish or issue a drug order for a controlled substance shall register with the United States Drug Enforcement Administration.
(2)The board has certified in accordance with paragraph (1) that the certified nurse-midwife has satisfactorily completed a course in pharmacology covering the drugs or devices to be furnished or ordered under this section, including the risks of addiction and neonatal abstinence syndrome associated with the use of opioids. The board shall establish the requirements for satisfactory completion of this paragraph.
(3)A physician and surgeon may determine the extent of supervision necessary pursuant to this section in the furnishing or ordering of drugs and devices.
(4)A copy of the standardized procedure or protocol relating to the furnishing or ordering of controlled substances by a certified nurse-midwife shall be provided upon request to any licensed pharmacist who is uncertain of the authority of the certified nurse-midwife to perform these functions.
(5)Certified nurse-midwives who are certified by the board and hold an active furnishing number, who are currently authorized through standardized procedures or protocols to furnish Schedule II controlled substances, and who are registered with the United States Drug Enforcement Administration shall provide documentation of continuing education specific to the use of Schedule II controlled substances in settings other than a hospital based on standards developed by the board.
(c)Drugs or devices furnished or ordered by a certified nurse-midwife may include Schedule II controlled substances under the California Uniform Controlled Substances Act (Division 10 (commencing with Section 11000) of the Health and Safety Code) under the following conditions:
(1)The drugs and devices are furnished or ordered in accordance with requirements referenced in paragraphs (2) to (4), inclusive, of subdivision (a) and in paragraphs (1) to (3), inclusive, of subdivision (b).
(2)When Schedule II controlled substances, as defined in Section 11055 of the Health and Safety Code, are furnished or ordered by a certified nurse-midwife, the controlled substances shall be furnished or ordered in accordance with a patient-specific protocol approved by the treating or supervising physician and surgeon.
(d)Furnishing of drugs or devices by a certified nurse-midwife means the act of making a pharmaceutical agent or agents available to the patient in strict accordance with a standardized procedure or protocol. Use of the term furnishing in this section shall include the following:
(1)The ordering of a drug or device in accordance with the standardized procedure or protocol.
(2)Transmitting an order of a supervising physician and surgeon.
(e)Drug order or order for purposes of this section means an order for medication or for a drug or device that is dispensed to or for an ultimate user, issued by a certified nurse-midwife as an individual practitioner, within the meaning of Section 1306.03 of Title 21 of the Code of Federal Regulations. Notwithstanding any other provision of law, (1) a drug order issued pursuant to this section shall be treated in the same manner as a prescription of the supervising physician; (2) all references to prescription in this code and the Health and Safety Code shall include drug orders issued by certified nurse-midwives; and (3) the signature of a certified nurse-midwife on a drug order issued in accordance with this section shall be deemed to be the signature of a prescriber for purposes of this code and the Health and Safety Code.
SEC. 8.Section 2836.1 of the Business and Professions Code is amended to read:2836.1.Neither this chapter nor any other provision of law shall be construed to prohibit a nurse practitioner from furnishing or ordering drugs or devices when all of the following apply:
(a)The drugs or devices are furnished or ordered by a nurse practitioner in accordance with standardized procedures or protocols developed by the nurse practitioner and the supervising physician and surgeon when the drugs or devices furnished or ordered are consistent with the practitioners educational preparation or for which clinical competency has been established and maintained.
(b)The nurse practitioner is functioning pursuant to standardized procedure, as defined by Section 2725, or protocol. The standardized procedure or protocol shall be developed and approved by the supervising physician and surgeon, the nurse practitioner, and the facility administrator or the designee.
(c)(1)The standardized procedure or protocol covering the furnishing of drugs or devices shall specify which nurse practitioners may furnish or order drugs or devices, which drugs or devices may be furnished or ordered, under what circumstances, the extent of physician and surgeon supervision, the method of periodic review of the nurse practitioners competence, including peer review, and review of the provisions of the standardized procedure.
(2)In addition to the requirements in paragraph (1), for Schedule II controlled substance protocols, the provision for furnishing Schedule II controlled substances shall address the diagnosis of the illness, injury, or condition for which the Schedule II controlled substance is to be furnished.
(d)The furnishing or ordering of drugs or devices by a nurse practitioner occurs under physician and surgeon supervision. Physician and surgeon supervision shall not be construed to require the physical presence of the physician, but does include (1) collaboration on the development of the standardized procedure, (2) approval of the standardized procedure, and (3) availability by telephonic contact at the time of patient examination by the nurse practitioner.
(e)For purposes of this section, no physician and surgeon shall supervise more than four nurse practitioners at one time.
(f)(1)Drugs or devices furnished or ordered by a nurse practitioner may include Schedule II through Schedule V controlled substances under the California Uniform Controlled Substances Act (Division 10 (commencing with Section 11000) of the Health and Safety Code) and shall be further limited to those drugs agreed upon by the nurse practitioner and physician and surgeon and specified in the standardized procedure.
(2)When Schedule II or III controlled substances, as defined in Sections 11055 and 11056, respectively, of the Health and Safety Code, are furnished or ordered by a nurse practitioner, the controlled substances shall be furnished or ordered in accordance with a patient-specific protocol approved by the treating or supervising physician. A copy of the section of the nurse practitioners standardized procedure relating to controlled substances shall be provided, upon request, to any licensed pharmacist who dispenses drugs or devices, when there is uncertainty about the nurse practitioner furnishing the order.
(g)(1)The board has certified in accordance with Section 2836.3 that the nurse practitioner has satisfactorily completed a course in pharmacology covering the drugs or devices to be furnished or ordered under this section.
(2)A physician and surgeon may determine the extent of supervision necessary pursuant to this section in the furnishing or ordering of drugs and devices.
(3)Nurse practitioners who are certified by the board and hold an active furnishing number, who are authorized through standardized procedures or protocols to furnish Schedule II controlled substances, and who are registered with the United States Drug Enforcement Administration, shall complete, as part of their continuing education requirements, a course including Schedule II controlled substances, and the risks of addiction associated with their use, based on the standards developed by the board. The board shall establish the requirements for satisfactory completion of this subdivision.
(h)Use of the term furnishing in this section, in health facilities defined in Section 1250 of the Health and Safety Code, shall include (1) the ordering of a drug or device in accordance with the standardized procedure and (2) transmitting an order of a supervising physician and surgeon.
(i)Drug order or order for purposes of this section means an order for medication which is dispensed to or for an ultimate user, issued by a nurse practitioner as an individual practitioner, within the meaning of Section 1306.02 of Title 21 of the Code of Federal Regulations. Notwithstanding any other provision of law, (1) a drug order issued pursuant to this section shall be treated in the same manner as a prescription of the supervising physician; (2) all references to prescription in this code and the Health and Safety Code shall include drug orders issued by nurse practitioners; and (3) the signature of a nurse practitioner on a drug order issued in accordance with this section shall be deemed to be the signature of a prescriber for purposes of this code and the Health and Safety Code.
SEC. 9.Section 3059 of the Business and Professions Code is amended to read:3059.(a)It is the intent of the Legislature that the public health and safety would be served by requiring all holders of licenses to practice optometry granted under this chapter to continue their education after receiving their licenses. The board shall adopt regulations that require, as a condition to the renewal thereof, that all holders of licenses submit proof satisfactory to the board that they have informed themselves of the developments in the practice of optometry occurring since the original issuance of their licenses by pursuing one or more courses of study satisfactory to the board or by other means deemed equivalent by the board.
(b)The board may, in accordance with the intent of this section, make exceptions from continuing education requirements for reasons of health, military service, or other good cause.
(c)If for good cause compliance cannot be met for the current year, the board may grant exemption of compliance for that year, provided that a plan of future compliance that includes current requirements as well as makeup of previous requirements is approved by the board.
(d)The board may require that proof of compliance with this section be submitted on an annual or biennial basis as determined by the board.
(e)An optometrist certified to use therapeutic pharmaceutical agents pursuant to Section 3041.3 shall complete a total of 50 hours of continuing education every two years in order to renew his or her certificate. Thirty-five of the required 50 hours of continuing education shall be on the diagnosis, treatment, and management of ocular disease in any combination of the following areas:
(1)Glaucoma.
(2)Ocular infection.
(3)Ocular inflammation.
(4)Topical steroids.
(5)Systemic medication.
(6)Pain medication, including the risks of addiction associated with the use of Schedule II drugs.
(f)The board shall encourage every optometrist to take a course or courses in pharmacology and pharmaceuticals as part of his or her continuing education.
(g)The board shall consider requiring courses in child abuse detection to be taken by those licensees whose practices are such that there is a likelihood of contact with abused or neglected children.
(h)The board shall consider requiring courses in elder abuse detection to be taken by those licensees whose practices are such that there is a likelihood of contact with abused or neglected elder persons.
SEC. 10.Section 3502.1 of the Business and Professions Code is amended to read:3502.1.(a)In addition to the services authorized in the regulations adopted by the Medical Board of California, and except as prohibited by Section 3502, while under the supervision of a licensed physician and surgeon or physicians and surgeons authorized by law to supervise a physician assistant, a physician assistant may administer or provide medication to a patient, or transmit orally, or in writing on a patients record or in a drug order, an order to a person who may lawfully furnish the medication or medical device pursuant to subdivisions (c) and (d).
(1)A supervising physician and surgeon who delegates authority to issue a drug order to a physician assistant may limit this authority by specifying the manner in which the physician assistant may issue delegated prescriptions.
(2)Each supervising physician and surgeon who delegates the authority to issue a drug order to a physician assistant shall first prepare and adopt, or adopt, a written, practice specific, formulary and protocols that specify all criteria for the use of a particular drug or device, and any contraindications for the selection. Protocols for Schedule II controlled substances shall address the diagnosis of illness, injury, or condition for which the Schedule II controlled substance is being administered, provided, or issued. The drugs listed in the protocols shall constitute the formulary and shall include only drugs that are appropriate for use in the type of practice engaged in by the supervising physician and surgeon. When issuing a drug order, the physician assistant is acting on behalf of and as an agent for a supervising physician and surgeon.
(b)Drug order, for purposes of this section, means an order for medication that is dispensed to or for a patient, issued and signed by a physician assistant acting as an individual practitioner within the meaning of Section 1306.02 of Title 21 of the Code of Federal Regulations. Notwithstanding any other provision of law, (1) a drug order issued pursuant to this section shall be treated in the same manner as a prescription or order of the supervising physician, (2) all references to prescription in this code and the Health and Safety Code shall include drug orders issued by physician assistants pursuant to authority granted by their supervising physicians and surgeons, and (3) the signature of a physician assistant on a drug order shall be deemed to be the signature of a prescriber for purposes of this code and the Health and Safety Code.
(c)A drug order for any patient cared for by the physician assistant that is issued by the physician assistant shall either be based on the protocols described in subdivision (a) or shall be approved by the supervising physician and surgeon before it is filled or carried out.
(1)A physician assistant shall not administer or provide a drug or issue a drug order for a drug other than for a drug listed in the formulary without advance approval from a supervising physician and surgeon for the particular patient. At the direction and under the supervision of a physician and surgeon, a physician assistant may hand to a patient of the supervising physician and surgeon a properly labeled prescription drug prepackaged by a physician and surgeon, manufacturer as defined in the Pharmacy Law, or a pharmacist.
(2)A physician assistant shall not administer, provide, or issue a drug order to a patient for Schedule II through Schedule V controlled substances without advance approval by a supervising physician and surgeon for that particular patient unless the physician assistant has completed an education course that covers controlled substances and that meets standards, including pharmacological content, approved by the board. The education course shall be provided either by an accredited continuing education provider or by an approved physician assistant training program. If the physician assistant will administer, provide, or issue a drug order for Schedule II controlled substances, the course shall contain a minimum of three hours exclusively on Schedule II controlled substances, including the risks of addiction associated with their use. Completion of the requirements set forth in this paragraph shall be verified and documented in the manner established by the board prior to the physician assistants use of a registration number issued by the United States Drug Enforcement Administration to the physician assistant to administer, provide, or issue a drug order to a patient for a controlled substance without advance approval by a supervising physician and surgeon for that particular patient.
(3)Any drug order issued by a physician assistant shall be subject to a reasonable quantitative limitation consistent with customary medical practice in the supervising physician and surgeons practice.
(d)A written drug order issued pursuant to subdivision (a), except a written drug order in a patients medical record in a health facility or medical practice, shall contain the printed name, address, and telephone number of the supervising physician and surgeon, the printed or stamped name and license number of the physician assistant, and the signature of the physician assistant. Further, a written drug order for a controlled substance, except a written drug order in a patients medical record in a health facility or a medical practice, shall include the federal controlled substances registration number of the physician assistant and shall otherwise comply with Section 11162.1 of the Health and Safety Code. Except as otherwise required for written drug orders for controlled substances under Section 11162.1 of the Health and Safety Code, the requirements of this subdivision may be met through stamping or otherwise imprinting on the supervising physician and surgeons prescription blank to show the name, license number, and if applicable, the federal controlled substances registration number of the physician assistant, and shall be signed by the physician assistant. When using a drug order, the physician assistant is acting on behalf of and as the agent of a supervising physician and surgeon.
(e)The supervising physician and surgeon shall use either of the following mechanisms to ensure adequate supervision of the administration, provision, or issuance by a physician assistant of a drug order to a patient for Schedule II controlled substances:
(1)The medical record of any patient cared for by a physician assistant for whom the physician assistants Schedule II drug order has been issued or carried out shall be reviewed, countersigned, and dated by a supervising physician and surgeon within seven days.
(2)If the physician assistant has documentation evidencing the successful completion of an education course that covers controlled substances, and that controlled substance education course (A) meets the standards, including pharmacological content, established in Sections 1399.610 and 1399.612 of Title 16 of the California Code of Regulations, and (B) is provided either by an accredited continuing education provider or by an approved physician assistant training program, the supervising physician and surgeon shall review, countersign, and date, within seven days, a sample consisting of the medical records of at least 20 percent of the patients cared for by the physician assistant for whom the physician assistants Schedule II drug order has been issued or carried out. Completion of the requirements set forth in this paragraph shall be verified and documented in the manner established in Section 1399.612 of Title 16 of the California Code of Regulations. Physician assistants who have a certificate of completion of the course described in paragraph (2) of subdivision (c) shall be deemed to have met the education course requirement of this subdivision.
(f)All physician assistants who are authorized by their supervising physicians to issue drug orders for controlled substances shall register with the United States Drug Enforcement Administration (DEA).
(g)The board shall consult with the Medical Board of California and report during its sunset review required by Article 7.5 (commencing with Section 9147.7) of Chapter 1.5 of Part 1 of Division 2 of Title 2 of the Government Code the impacts of exempting Schedule III and Schedule IV drug orders from the requirement for a physician and surgeon to review and countersign the affected medical record of a patient.
SEC. 11.Section 4076.7 is added to the Business and Professions Code, to read:4076.7.In addition to the requirements of Sections 4076 and 4076.5, whenever a prescription drug containing an opioid is dispensed to a patient for outpatient use, the pharmacy or practitioner dispensing the drug shall prominently display on the label or container, by means of a flag or other notification mechanism attached to the container, a notice that states Caution: Opioid. Risk of overdose and addiction.
SEC. 12.Section 49476 is added to the Education Code, to read:49476.(a)If a school district, charter school, or private school elects to offer an athletic program, the school district, charter school, or private school shall annually give the Opioid Factsheet for Patients published by the Centers for Disease Control and Prevention to each athlete. The athlete and, if the athlete is 17 years of age or younger, the athletes parent or guardian shall sign a document acknowledging receipt of the Opioid Factsheet for Patients and return that document to the school district, charter school, or private school before the athlete initiates practice or competition. The Opioid Factsheet for Patients may be sent and returned through an electronic medium, including, but not limited to, fax or email.
(b)This section does not apply to an athlete engaging in an athletic activity during the regular schoolday or as part of a physical education course required pursuant to subdivision (d) of Section 51220.
SEC. 13.Section 11158.1 is added to the Health and Safety Code, to read:11158.1.(a)Except when a patient is being treated as set forth in Sections 11159, 11159.2, and 11167.5, and Article 2 (commencing with Section 11215) of Chapter 5, pertaining to the treatment of addicts, or for a diagnosis of chronic intractable pain as used in Section 124960 of this code and Section 2241.5 of the Business and Professions Code, a prescriber shall discuss all of the following with the minor, the minors parent or guardian, or another adult authorized to consent to the minors medical treatment before directly dispensing or issuing for a minor the first prescription in a single course of treatment for a controlled substance containing an opioid:
(1)The risks of addiction and overdose associated with the use of opioids.
(2)The increased risk of addiction to an opioid to an individual who is suffering from both mental and substance abuse disorders.
(3)The danger of taking an opioid with a benzodiazepine, alcohol, or another central nervous system depressant.
(4)Any other information required by law.
(b)This section does not apply in any of the following circumstances:
(1)If the minors treatment includes emergency services and care as defined in Section 1317.1.
(2)If the minors treatment is associated with or incident to an emergency surgery, regardless of whether the surgery is performed on an inpatient or outpatient basis.
(3)If, in the prescribers professional judgment, fulfilling the requirements of subdivision (a) would be detrimental to the minors health or safety, or in violation of the minors legal rights regarding confidentiality.
(c)Notwithstanding any other law, including Section 11374, failure to comply with this section shall not constitute a criminal offense.
SEC. 14.Section 124236 is added to the Health and Safety Code, to read:124236.(a)A youth sports organization, as defined in paragraph (3) of subdivision (b) of Section 124235, that elects to offer an athletic program shall annually give the Opioid Factsheet for Patients published by the Centers for Disease Control and Prevention to each athlete. The athlete and, if the athlete is 17 years of age or younger, the athletes parent or guardian shall sign a document acknowledging receipt of the Opioid Factsheet for Patients and return that document to the youth sports organization before the athlete initiates practice or competition. The Opioid Factsheet for Patients may be sent and returned through an electronic medium, including, but not limited to, fax or email.
(b)This section shall apply to all athletes participating in the activities of a youth sports organization, irrespective of their ages. This section shall not be construed to prohibit a youth sports organization, or any other appropriate entity, from adopting and enforcing rules intended to provide a higher standard of safety for athletes than the standard established under this section.
SEC. 15.Section 2.5 of this bill incorporates amendments to Section 1645 of the Business and Professions Code proposed by both this bill and Senate Bill 1491. That section of this bill shall only become operative if (1) both bills are enacted and become effective on or before January 1, 2019, (2) each bill amends Section 1645 of the Business and Professions Code, and (3) this bill is enacted after Senate Bill 1491, in which case Section 2 of this bill shall not become operative.
SEC. 16.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB 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 XIIIB of the California Constitution.
The Legislature finds and declares all of the following:
(a)Addiction, misuse, and overdose of prescription opioids is a public health crisis affecting both adults and children.
(b)Urgent measures are needed to better inform the public of the risks associated with both the long-term and short-term use of opioids in an effort to address this problem.
(c)Both short-term and long-term prescriptions of opioids to minors fall within situations that require counseling of patients and their parents or guardians by their prescribers.
(d)It is the intent of the Legislature to ensure that health care providers and young athletes receive necessary education on this topic.
SEC. 2.Section 1645 of the Business and Professions Code is amended to read:1645.(a)Effective with the 1974 license renewal period, if the board determines that the public health and safety would be served by requiring all holders of licenses under this chapter to continue their education after receiving a license, it may require, as a condition to the renewal thereof, that they submit assurances satisfactory to the board that they will, during the succeeding two-year period, inform themselves of the developments in the practice of dentistry occurring since the original issuance of their licenses by pursuing one or more courses of study satisfactory to the board or by other means deemed equivalent by the board.
The board shall adopt regulations providing for the suspension of the licenses at the end of the two-year period until compliance with the assurances provided for in this section is accomplished.
(b)The board may also, as a condition of license renewal, require licentiates to successfully complete a portion of the required continuing education hours in specific areas adopted in regulations by the board. The board may prescribe this mandatory coursework within the general areas of patient care, health and safety, law and ethics, and the risks of addiction associated with the use of Schedule II drugs. The mandatory coursework prescribed by the board shall not exceed 15 hours per renewal period for dentists, and 7.5 hours per renewal period for dental auxiliaries. Any mandatory coursework required by the board shall be credited toward the continuing education requirements established by the board pursuant to subdivision (a).
(c)For a retired dentist who provides only uncompensated care, the board shall not require more than 60 percent of the hours of continuing education that are required of other licensed dentists. Notwithstanding subdivision (b), all of the hours of continuing education as described in this subdivision shall be gained through courses related to the actual delivery of dental services to the patient or the community, as determined by the board. Nothing in this subdivision shall be construed to reduce any requirements imposed by the board pursuant to subdivision (b).
(d)The board shall report on the outcome of subdivision (c) pursuant to, and at the time of, its regular sunset review process, as provided in Section 1601.1.
SEC. 2.5.Section 1645 of the Business and Professions Code is amended to read:1645.(a)(1)All holders of licenses under this chapter shall continue their education after receiving a license as a condition to the renewal thereof, and shall obtain evidence satisfactory to the board that they have, during the preceding two-year period, obtained continuing education relevant to developments in the practice of dentistry and dental assisting consistent with the regulations of the board.
The board shall adopt regulations providing for the suspension of the licenses at the end of the two-year period until compliance with this section is accomplished.
(b)The board may also, as a condition of license renewal, require licentiates to successfully complete a portion of the required continuing education hours in specific areas adopted in regulations by the board. The board may prescribe this mandatory coursework within the general areas of patient care, health and safety, law and ethics, and the risks of addiction associated with the use of Schedule II drugs. The mandatory coursework prescribed by the board shall not exceed 15 hours per renewal period for dentists, and 7.5 hours per renewal period for dental auxiliaries. Any mandatory coursework required by the board shall be credited toward the continuing education requirements established by the board pursuant to subdivision (a).
(c)For a retired dentist who provides only uncompensated care, the board shall not require more than 60 percent of the hours of continuing education that are required of other licensed dentists. Notwithstanding subdivision (b), all of the hours of continuing education as described in this subdivision shall be gained through courses related to the actual delivery of dental services to the patient or the community, as determined by the board. Nothing in this subdivision shall be construed to reduce any requirements imposed by the board pursuant to subdivision (b).
(d)The board shall report on the outcome of subdivision (c) pursuant to, and at the time of, its regular sunset review process, as provided in Section 1601.1.
SEC. 3.Section 2190.5 of the Business and Professions Code is amended to read:2190.5.(a)(1)All physicians and surgeons shall complete a mandatory continuing education 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 board may verify completion of this requirement on the renewal application form.
(2)For physicians and surgeons licensed on or after January 1, 2019, the course described in paragraph (1) shall also include the subject of the risks of addiction associated with the use of Schedule II drugs.
(b)By regulatory action, the board may exempt physicians and surgeons by practice status category from the requirement in subdivision (a) if the physician and surgeon does not engage in direct patient care, does not provide patient consultations, or does not reside in the State of California.
(c)This section shall not apply to physicians and surgeons practicing in pathology or radiology specialty areas.
SEC. 4.Section 2191 of the Business and Professions Code is amended to read:2191.(a)In determining its continuing education requirements, the board shall consider including a course in human sexuality, defined as the study of a human being as a sexual being and how he or she functions with respect thereto, and nutrition to be taken by those licensees whose practices may require knowledge in those areas.
(b)The board shall consider including a course in 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.
(c)The board shall consider including a course in 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.
(d)The board shall encourage every physician and surgeon to take nutrition as part of his or her continuing education, particularly a physician and surgeon involved in primary care.
(e)The board shall consider including a course in 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.
(f)In determining its continuing education requirements, the board shall consider including a course in 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.
(g)In determining its continuing education requirements, the board shall consider including a course in 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.
(h)In determining its continuing education requirements, the board shall consider including a course providing training and 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 board 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.
(i)In determining its continuing education requirements, the board shall consider including a course in the special care needs of individuals and their families facing end-of-life issues, including, but not limited to, all of the following:
(1)Pain and symptom management.
(2)The psycho-social dynamics of death.
(3)Dying and bereavement.
(4)Hospice care.
(j)In determining its continuing education requirements, the board shall give its highest priority to considering a course on pain management and the risks of addiction associated with the use of Schedule II drugs.
(k)In determining its continuing education requirements, the board shall consider including a course in geriatric care for emergency room physicians and surgeons.
SEC. 5.Section 2196.2 of the Business and Professions Code is amended to read:2196.2.The board shall periodically develop and disseminate information and educational material regarding pain management techniques and procedures, including the risks of addiction associated with the use of Schedule II drugs, to each licensed physician and surgeon and to each general acute care hospital in this state. The board shall consult with the State Department of Public Health in developing the materials to be distributed pursuant to this section.
SEC. 6.Section 2454.5 of the Business and Professions Code is amended to read:2454.5.In order to ensure the continuing competence of licensed osteopathic physicians and surgeons, the board shall adopt and administer standards for the continuing education of those licensees. The board shall require each licensed osteopathic physician and surgeon to demonstrate satisfaction of the continuing education requirements as a condition for the renewal of a license at intervals of not less than one year nor more than two years. Commencing January 1, 2018, the board shall require each licensed osteopathic physician and surgeon to complete a minimum of 100 hours of American Osteopathic Association continuing education hours during each two-year cycle, of which 40 hours shall be completed in American Osteopathic Association Category 1 continuing education hours and the remaining 60 hours shall be either American Osteopathic Association or American Medical Association accredited as a condition for renewal of an active license. Licensed osteopathic physicians and surgeons shall complete a course on the risks of addiction associated with the use of Schedule II drugs.
For purposes of this section, American Osteopathic Association Category 1 means continuing education activities and programs approved for Category 1 credit by the Committee on Continuing Medical Education of the American Osteopathic Association.
SEC. 7.Section 2746.51 of the Business and Professions Code is amended to read:2746.51.(a)Neither this chapter nor any other provision of law shall be construed to prohibit a certified nurse-midwife from furnishing or ordering drugs or devices, including controlled substances classified in Schedule II, III, IV, or V under the California Uniform Controlled Substances Act (Division 10 (commencing with Section 11000) of the Health and Safety Code), when all of the following apply:
(1)The drugs or devices are furnished or ordered incidentally to the provision of any of the following:
(A)Family planning services, as defined in Section 14503 of the Welfare and Institutions Code.
(B)Routine health care or perinatal care, as defined in subdivision (d) of Section 123485 of the Health and Safety Code.
(C)Care rendered, consistent with the certified nurse-midwifes educational preparation or for which clinical competency has been established and maintained, to persons within a facility specified in subdivision (a), (b), (c), (d), (i), or (j) of Section 1206 of the Health and Safety Code, a clinic as specified in Section 1204 of the Health and Safety Code, a general acute care hospital as defined in subdivision (a) of Section 1250 of the Health and Safety Code, a licensed birth center as defined in Section 1204.3 of the Health and Safety Code, or a special hospital specified as a maternity hospital in subdivision (f) of Section 1250 of the Health and Safety Code.
(2)The drugs or devices are furnished or ordered by a certified nurse-midwife in accordance with standardized procedures or protocols. For purposes of this section, standardized procedure means a document, including protocols, developed and approved by the supervising physician and surgeon, the certified nurse-midwife, and the facility administrator or his or her designee. The standardized procedure covering the furnishing or ordering of drugs or devices shall specify all of the following:
(A)Which certified nurse-midwife may furnish or order drugs or devices.
(B)Which drugs or devices may be furnished or ordered and under what circumstances.
(C)The extent of physician and surgeon supervision.
(D)The method of periodic review of the certified nurse-midwifes competence, including peer review, and review of the provisions of the standardized procedure.
(3)If Schedule II or III controlled substances, as defined in Sections 11055 and 11056 of the Health and Safety Code, are furnished or ordered by a certified nurse-midwife, the controlled substances shall be furnished or ordered in accordance with a patient-specific protocol approved by the treating or supervising physician and surgeon. For Schedule II controlled substance protocols, the provision for furnishing the Schedule II controlled substance shall address the diagnosis of the illness, injury, or condition for which the Schedule II controlled substance is to be furnished.
(4)The furnishing or ordering of drugs or devices by a certified nurse-midwife occurs under physician and surgeon supervision. For purposes of this section, no physician and surgeon shall supervise more than four certified nurse-midwives at one time. Physician and surgeon supervision shall not be construed to require the physical presence of the physician, but does include all of the following:
(A)Collaboration on the development of the standardized procedure or protocol.
(B)Approval of the standardized procedure or protocol.
(C)Availability by telephonic contact at the time of patient examination by the certified nurse-midwife.
(b)(1)The furnishing or ordering of drugs or devices by a certified nurse-midwife is conditional on the issuance by the board of a number to the applicant who has successfully completed the requirements of paragraph (2). The number shall be included on all transmittals of orders for drugs or devices by the certified nurse-midwife. The board shall maintain a list of the certified nurse-midwives that it has certified pursuant to this paragraph and the number it has issued to each one. The board shall make the list available to the California State Board of Pharmacy upon its request. Every certified nurse-midwife who is authorized pursuant to this section to furnish or issue a drug order for a controlled substance shall register with the United States Drug Enforcement Administration.
(2)The board has certified in accordance with paragraph (1) that the certified nurse-midwife has satisfactorily completed a course in pharmacology covering the drugs or devices to be furnished or ordered under this section, including the risks of addiction and neonatal abstinence syndrome associated with the use of opioids. The board shall establish the requirements for satisfactory completion of this paragraph.
(3)A physician and surgeon may determine the extent of supervision necessary pursuant to this section in the furnishing or ordering of drugs and devices.
(4)A copy of the standardized procedure or protocol relating to the furnishing or ordering of controlled substances by a certified nurse-midwife shall be provided upon request to any licensed pharmacist who is uncertain of the authority of the certified nurse-midwife to perform these functions.
(5)Certified nurse-midwives who are certified by the board and hold an active furnishing number, who are currently authorized through standardized procedures or protocols to furnish Schedule II controlled substances, and who are registered with the United States Drug Enforcement Administration shall provide documentation of continuing education specific to the use of Schedule II controlled substances in settings other than a hospital based on standards developed by the board.
(c)Drugs or devices furnished or ordered by a certified nurse-midwife may include Schedule II controlled substances under the California Uniform Controlled Substances Act (Division 10 (commencing with Section 11000) of the Health and Safety Code) under the following conditions:
(1)The drugs and devices are furnished or ordered in accordance with requirements referenced in paragraphs (2) to (4), inclusive, of subdivision (a) and in paragraphs (1) to (3), inclusive, of subdivision (b).
(2)When Schedule II controlled substances, as defined in Section 11055 of the Health and Safety Code, are furnished or ordered by a certified nurse-midwife, the controlled substances shall be furnished or ordered in accordance with a patient-specific protocol approved by the treating or supervising physician and surgeon.
(d)Furnishing of drugs or devices by a certified nurse-midwife means the act of making a pharmaceutical agent or agents available to the patient in strict accordance with a standardized procedure or protocol. Use of the term furnishing in this section shall include the following:
(1)The ordering of a drug or device in accordance with the standardized procedure or protocol.
(2)Transmitting an order of a supervising physician and surgeon.
(e)Drug order or order for purposes of this section means an order for medication or for a drug or device that is dispensed to or for an ultimate user, issued by a certified nurse-midwife as an individual practitioner, within the meaning of Section 1306.03 of Title 21 of the Code of Federal Regulations. Notwithstanding any other provision of law, (1) a drug order issued pursuant to this section shall be treated in the same manner as a prescription of the supervising physician; (2) all references to prescription in this code and the Health and Safety Code shall include drug orders issued by certified nurse-midwives; and (3) the signature of a certified nurse-midwife on a drug order issued in accordance with this section shall be deemed to be the signature of a prescriber for purposes of this code and the Health and Safety Code.
SEC. 8.Section 2836.1 of the Business and Professions Code is amended to read:2836.1.Neither this chapter nor any other provision of law shall be construed to prohibit a nurse practitioner from furnishing or ordering drugs or devices when all of the following apply:
(a)The drugs or devices are furnished or ordered by a nurse practitioner in accordance with standardized procedures or protocols developed by the nurse practitioner and the supervising physician and surgeon when the drugs or devices furnished or ordered are consistent with the practitioners educational preparation or for which clinical competency has been established and maintained.
(b)The nurse practitioner is functioning pursuant to standardized procedure, as defined by Section 2725, or protocol. The standardized procedure or protocol shall be developed and approved by the supervising physician and surgeon, the nurse practitioner, and the facility administrator or the designee.
(c)(1)The standardized procedure or protocol covering the furnishing of drugs or devices shall specify which nurse practitioners may furnish or order drugs or devices, which drugs or devices may be furnished or ordered, under what circumstances, the extent of physician and surgeon supervision, the method of periodic review of the nurse practitioners competence, including peer review, and review of the provisions of the standardized procedure.
(2)In addition to the requirements in paragraph (1), for Schedule II controlled substance protocols, the provision for furnishing Schedule II controlled substances shall address the diagnosis of the illness, injury, or condition for which the Schedule II controlled substance is to be furnished.
(d)The furnishing or ordering of drugs or devices by a nurse practitioner occurs under physician and surgeon supervision. Physician and surgeon supervision shall not be construed to require the physical presence of the physician, but does include (1) collaboration on the development of the standardized procedure, (2) approval of the standardized procedure, and (3) availability by telephonic contact at the time of patient examination by the nurse practitioner.
(e)For purposes of this section, no physician and surgeon shall supervise more than four nurse practitioners at one time.
(f)(1)Drugs or devices furnished or ordered by a nurse practitioner may include Schedule II through Schedule V controlled substances under the California Uniform Controlled Substances Act (Division 10 (commencing with Section 11000) of the Health and Safety Code) and shall be further limited to those drugs agreed upon by the nurse practitioner and physician and surgeon and specified in the standardized procedure.
(2)When Schedule II or III controlled substances, as defined in Sections 11055 and 11056, respectively, of the Health and Safety Code, are furnished or ordered by a nurse practitioner, the controlled substances shall be furnished or ordered in accordance with a patient-specific protocol approved by the treating or supervising physician. A copy of the section of the nurse practitioners standardized procedure relating to controlled substances shall be provided, upon request, to any licensed pharmacist who dispenses drugs or devices, when there is uncertainty about the nurse practitioner furnishing the order.
(g)(1)The board has certified in accordance with Section 2836.3 that the nurse practitioner has satisfactorily completed a course in pharmacology covering the drugs or devices to be furnished or ordered under this section.
(2)A physician and surgeon may determine the extent of supervision necessary pursuant to this section in the furnishing or ordering of drugs and devices.
(3)Nurse practitioners who are certified by the board and hold an active furnishing number, who are authorized through standardized procedures or protocols to furnish Schedule II controlled substances, and who are registered with the United States Drug Enforcement Administration, shall complete, as part of their continuing education requirements, a course including Schedule II controlled substances, and the risks of addiction associated with their use, based on the standards developed by the board. The board shall establish the requirements for satisfactory completion of this subdivision.
(h)Use of the term furnishing in this section, in health facilities defined in Section 1250 of the Health and Safety Code, shall include (1) the ordering of a drug or device in accordance with the standardized procedure and (2) transmitting an order of a supervising physician and surgeon.
(i)Drug order or order for purposes of this section means an order for medication which is dispensed to or for an ultimate user, issued by a nurse practitioner as an individual practitioner, within the meaning of Section 1306.02 of Title 21 of the Code of Federal Regulations. Notwithstanding any other provision of law, (1) a drug order issued pursuant to this section shall be treated in the same manner as a prescription of the supervising physician; (2) all references to prescription in this code and the Health and Safety Code shall include drug orders issued by nurse practitioners; and (3) the signature of a nurse practitioner on a drug order issued in accordance with this section shall be deemed to be the signature of a prescriber for purposes of this code and the Health and Safety Code.
SEC. 9.Section 3059 of the Business and Professions Code is amended to read:3059.(a)It is the intent of the Legislature that the public health and safety would be served by requiring all holders of licenses to practice optometry granted under this chapter to continue their education after receiving their licenses. The board shall adopt regulations that require, as a condition to the renewal thereof, that all holders of licenses submit proof satisfactory to the board that they have informed themselves of the developments in the practice of optometry occurring since the original issuance of their licenses by pursuing one or more courses of study satisfactory to the board or by other means deemed equivalent by the board.
(b)The board may, in accordance with the intent of this section, make exceptions from continuing education requirements for reasons of health, military service, or other good cause.
(c)If for good cause compliance cannot be met for the current year, the board may grant exemption of compliance for that year, provided that a plan of future compliance that includes current requirements as well as makeup of previous requirements is approved by the board.
(d)The board may require that proof of compliance with this section be submitted on an annual or biennial basis as determined by the board.
(e)An optometrist certified to use therapeutic pharmaceutical agents pursuant to Section 3041.3 shall complete a total of 50 hours of continuing education every two years in order to renew his or her certificate. Thirty-five of the required 50 hours of continuing education shall be on the diagnosis, treatment, and management of ocular disease in any combination of the following areas:
(1)Glaucoma.
(2)Ocular infection.
(3)Ocular inflammation.
(4)Topical steroids.
(5)Systemic medication.
(6)Pain medication, including the risks of addiction associated with the use of Schedule II drugs.
(f)The board shall encourage every optometrist to take a course or courses in pharmacology and pharmaceuticals as part of his or her continuing education.
(g)The board shall consider requiring courses in child abuse detection to be taken by those licensees whose practices are such that there is a likelihood of contact with abused or neglected children.
(h)The board shall consider requiring courses in elder abuse detection to be taken by those licensees whose practices are such that there is a likelihood of contact with abused or neglected elder persons.
SEC. 10.Section 3502.1 of the Business and Professions Code is amended to read:3502.1.(a)In addition to the services authorized in the regulations adopted by the Medical Board of California, and except as prohibited by Section 3502, while under the supervision of a licensed physician and surgeon or physicians and surgeons authorized by law to supervise a physician assistant, a physician assistant may administer or provide medication to a patient, or transmit orally, or in writing on a patients record or in a drug order, an order to a person who may lawfully furnish the medication or medical device pursuant to subdivisions (c) and (d).
(1)A supervising physician and surgeon who delegates authority to issue a drug order to a physician assistant may limit this authority by specifying the manner in which the physician assistant may issue delegated prescriptions.
(2)Each supervising physician and surgeon who delegates the authority to issue a drug order to a physician assistant shall first prepare and adopt, or adopt, a written, practice specific, formulary and protocols that specify all criteria for the use of a particular drug or device, and any contraindications for the selection. Protocols for Schedule II controlled substances shall address the diagnosis of illness, injury, or condition for which the Schedule II controlled substance is being administered, provided, or issued. The drugs listed in the protocols shall constitute the formulary and shall include only drugs that are appropriate for use in the type of practice engaged in by the supervising physician and surgeon. When issuing a drug order, the physician assistant is acting on behalf of and as an agent for a supervising physician and surgeon.
(b)Drug order, for purposes of this section, means an order for medication that is dispensed to or for a patient, issued and signed by a physician assistant acting as an individual practitioner within the meaning of Section 1306.02 of Title 21 of the Code of Federal Regulations. Notwithstanding any other provision of law, (1) a drug order issued pursuant to this section shall be treated in the same manner as a prescription or order of the supervising physician, (2) all references to prescription in this code and the Health and Safety Code shall include drug orders issued by physician assistants pursuant to authority granted by their supervising physicians and surgeons, and (3) the signature of a physician assistant on a drug order shall be deemed to be the signature of a prescriber for purposes of this code and the Health and Safety Code.
(c)A drug order for any patient cared for by the physician assistant that is issued by the physician assistant shall either be based on the protocols described in subdivision (a) or shall be approved by the supervising physician and surgeon before it is filled or carried out.
(1)A physician assistant shall not administer or provide a drug or issue a drug order for a drug other than for a drug listed in the formulary without advance approval from a supervising physician and surgeon for the particular patient. At the direction and under the supervision of a physician and surgeon, a physician assistant may hand to a patient of the supervising physician and surgeon a properly labeled prescription drug prepackaged by a physician and surgeon, manufacturer as defined in the Pharmacy Law, or a pharmacist.
(2)A physician assistant shall not administer, provide, or issue a drug order to a patient for Schedule II through Schedule V controlled substances without advance approval by a supervising physician and surgeon for that particular patient unless the physician assistant has completed an education course that covers controlled substances and that meets standards, including pharmacological content, approved by the board. The education course shall be provided either by an accredited continuing education provider or by an approved physician assistant training program. If the physician assistant will administer, provide, or issue a drug order for Schedule II controlled substances, the course shall contain a minimum of three hours exclusively on Schedule II controlled substances, including the risks of addiction associated with their use. Completion of the requirements set forth in this paragraph shall be verified and documented in the manner established by the board prior to the physician assistants use of a registration number issued by the United States Drug Enforcement Administration to the physician assistant to administer, provide, or issue a drug order to a patient for a controlled substance without advance approval by a supervising physician and surgeon for that particular patient.
(3)Any drug order issued by a physician assistant shall be subject to a reasonable quantitative limitation consistent with customary medical practice in the supervising physician and surgeons practice.
(d)A written drug order issued pursuant to subdivision (a), except a written drug order in a patients medical record in a health facility or medical practice, shall contain the printed name, address, and telephone number of the supervising physician and surgeon, the printed or stamped name and license number of the physician assistant, and the signature of the physician assistant. Further, a written drug order for a controlled substance, except a written drug order in a patients medical record in a health facility or a medical practice, shall include the federal controlled substances registration number of the physician assistant and shall otherwise comply with Section 11162.1 of the Health and Safety Code. Except as otherwise required for written drug orders for controlled substances under Section 11162.1 of the Health and Safety Code, the requirements of this subdivision may be met through stamping or otherwise imprinting on the supervising physician and surgeons prescription blank to show the name, license number, and if applicable, the federal controlled substances registration number of the physician assistant, and shall be signed by the physician assistant. When using a drug order, the physician assistant is acting on behalf of and as the agent of a supervising physician and surgeon.
(e)The supervising physician and surgeon shall use either of the following mechanisms to ensure adequate supervision of the administration, provision, or issuance by a physician assistant of a drug order to a patient for Schedule II controlled substances:
(1)The medical record of any patient cared for by a physician assistant for whom the physician assistants Schedule II drug order has been issued or carried out shall be reviewed, countersigned, and dated by a supervising physician and surgeon within seven days.
(2)If the physician assistant has documentation evidencing the successful completion of an education course that covers controlled substances, and that controlled substance education course (A) meets the standards, including pharmacological content, established in Sections 1399.610 and 1399.612 of Title 16 of the California Code of Regulations, and (B) is provided either by an accredited continuing education provider or by an approved physician assistant training program, the supervising physician and surgeon shall review, countersign, and date, within seven days, a sample consisting of the medical records of at least 20 percent of the patients cared for by the physician assistant for whom the physician assistants Schedule II drug order has been issued or carried out. Completion of the requirements set forth in this paragraph shall be verified and documented in the manner established in Section 1399.612 of Title 16 of the California Code of Regulations. Physician assistants who have a certificate of completion of the course described in paragraph (2) of subdivision (c) shall be deemed to have met the education course requirement of this subdivision.
(f)All physician assistants who are authorized by their supervising physicians to issue drug orders for controlled substances shall register with the United States Drug Enforcement Administration (DEA).
(g)The board shall consult with the Medical Board of California and report during its sunset review required by Article 7.5 (commencing with Section 9147.7) of Chapter 1.5 of Part 1 of Division 2 of Title 2 of the Government Code the impacts of exempting Schedule III and Schedule IV drug orders from the requirement for a physician and surgeon to review and countersign the affected medical record of a patient.
SEC. 11.Section 4076.7 is added to the Business and Professions Code, to read:4076.7.In addition to the requirements of Sections 4076 and 4076.5, whenever a prescription drug containing an opioid is dispensed to a patient for outpatient use, the pharmacy or practitioner dispensing the drug shall prominently display on the label or container, by means of a flag or other notification mechanism attached to the container, a notice that states Caution: Opioid. Risk of overdose and addiction.
SEC. 12.Section 49476 is added to the Education Code, to read:49476.(a)If a school district, charter school, or private school elects to offer an athletic program, the school district, charter school, or private school shall annually give the Opioid Factsheet for Patients published by the Centers for Disease Control and Prevention to each athlete. The athlete and, if the athlete is 17 years of age or younger, the athletes parent or guardian shall sign a document acknowledging receipt of the Opioid Factsheet for Patients and return that document to the school district, charter school, or private school before the athlete initiates practice or competition. The Opioid Factsheet for Patients may be sent and returned through an electronic medium, including, but not limited to, fax or email.
(b)This section does not apply to an athlete engaging in an athletic activity during the regular schoolday or as part of a physical education course required pursuant to subdivision (d) of Section 51220.
SEC. 13.Section 11158.1 is added to the Health and Safety Code, to read:11158.1.(a)Except when a patient is being treated as set forth in Sections 11159, 11159.2, and 11167.5, and Article 2 (commencing with Section 11215) of Chapter 5, pertaining to the treatment of addicts, or for a diagnosis of chronic intractable pain as used in Section 124960 of this code and Section 2241.5 of the Business and Professions Code, a prescriber shall discuss all of the following with the minor, the minors parent or guardian, or another adult authorized to consent to the minors medical treatment before directly dispensing or issuing for a minor the first prescription in a single course of treatment for a controlled substance containing an opioid:
(1)The risks of addiction and overdose associated with the use of opioids.
(2)The increased risk of addiction to an opioid to an individual who is suffering from both mental and substance abuse disorders.
(3)The danger of taking an opioid with a benzodiazepine, alcohol, or another central nervous system depressant.
(4)Any other information required by law.
(b)This section does not apply in any of the following circumstances:
(1)If the minors treatment includes emergency services and care as defined in Section 1317.1.
(2)If the minors treatment is associated with or incident to an emergency surgery, regardless of whether the surgery is performed on an inpatient or outpatient basis.
(3)If, in the prescribers professional judgment, fulfilling the requirements of subdivision (a) would be detrimental to the minors health or safety, or in violation of the minors legal rights regarding confidentiality.
(c)Notwithstanding any other law, including Section 11374, failure to comply with this section shall not constitute a criminal offense.
SEC. 14.Section 124236 is added to the Health and Safety Code, to read:124236.(a)A youth sports organization, as defined in paragraph (3) of subdivision (b) of Section 124235, that elects to offer an athletic program shall annually give the Opioid Factsheet for Patients published by the Centers for Disease Control and Prevention to each athlete. The athlete and, if the athlete is 17 years of age or younger, the athletes parent or guardian shall sign a document acknowledging receipt of the Opioid Factsheet for Patients and return that document to the youth sports organization before the athlete initiates practice or competition. The Opioid Factsheet for Patients may be sent and returned through an electronic medium, including, but not limited to, fax or email.
(b)This section shall apply to all athletes participating in the activities of a youth sports organization, irrespective of their ages. This section shall not be construed to prohibit a youth sports organization, or any other appropriate entity, from adopting and enforcing rules intended to provide a higher standard of safety for athletes than the standard established under this section.
SEC. 15.Section 2.5 of this bill incorporates amendments to Section 1645 of the Business and Professions Code proposed by both this bill and Senate Bill 1491. That section of this bill shall only become operative if (1) both bills are enacted and become effective on or before January 1, 2019, (2) each bill amends Section 1645 of the Business and Professions Code, and (3) this bill is enacted after Senate Bill 1491, in which case Section 2 of this bill shall not become operative.
SEC. 16.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB 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 XIIIB of the California Constitution.
The Legislature finds and declares all of the following:
(a)Addiction, misuse, and overdose of prescription opioids is a public health crisis affecting both adults and children.
(b)Urgent measures are needed to better inform the public of the risks associated with both the long-term and short-term use of opioids in an effort to address this problem.
(c)Both short-term and long-term prescriptions of opioids to minors fall within situations that require counseling of patients and their parents or guardians by their prescribers.
(d)It is the intent of the Legislature to ensure that health care providers and young athletes receive necessary education on this topic.
SEC. 2.Section 1645 of the Business and Professions Code is amended to read:1645.(a)Effective with the 1974 license renewal period, if the board determines that the public health and safety would be served by requiring all holders of licenses under this chapter to continue their education after receiving a license, it may require, as a condition to the renewal thereof, that they submit assurances satisfactory to the board that they will, during the succeeding two-year period, inform themselves of the developments in the practice of dentistry occurring since the original issuance of their licenses by pursuing one or more courses of study satisfactory to the board or by other means deemed equivalent by the board.
The board shall adopt regulations providing for the suspension of the licenses at the end of the two-year period until compliance with the assurances provided for in this section is accomplished.
(b)The board may also, as a condition of license renewal, require licentiates to successfully complete a portion of the required continuing education hours in specific areas adopted in regulations by the board. The board may prescribe this mandatory coursework within the general areas of patient care, health and safety, law and ethics, and the risks of addiction associated with the use of Schedule II drugs. The mandatory coursework prescribed by the board shall not exceed 15 hours per renewal period for dentists, and 7.5 hours per renewal period for dental auxiliaries. Any mandatory coursework required by the board shall be credited toward the continuing education requirements established by the board pursuant to subdivision (a).
(c)For a retired dentist who provides only uncompensated care, the board shall not require more than 60 percent of the hours of continuing education that are required of other licensed dentists. Notwithstanding subdivision (b), all of the hours of continuing education as described in this subdivision shall be gained through courses related to the actual delivery of dental services to the patient or the community, as determined by the board. Nothing in this subdivision shall be construed to reduce any requirements imposed by the board pursuant to subdivision (b).
(d)The board shall report on the outcome of subdivision (c) pursuant to, and at the time of, its regular sunset review process, as provided in Section 1601.1.
SEC. 2.5.Section 1645 of the Business and Professions Code is amended to read:1645.(a)Effective with the 1974 license renewal period, if the board determines that the public health and safety would be served by requiring all (1)All holders of licenses under this chapter to shall continue their education after receiving a license, it may require, license as a condition to the renewal thereof, that they submit assurances and shall obtain evidence satisfactory to the board that they will, have, during the succeeding preceding two-year period, inform themselves of the obtained continuing education relevant to developments in the practice of dentistry occurring since the original issuance of their licenses by pursuing one or more courses of study satisfactory to the board or by other means deemed equivalent by the and dental assisting consistent with the regulations of the board.
The board shall adopt regulations providing for the suspension of the licenses at the end of the two-year period until compliance with the assurances provided for in this section is accomplished.
(b)The board may also, as a condition of license renewal, require licentiates to successfully complete a portion of the required continuing education hours in specific areas adopted in regulations by the board. The board may prescribe this mandatory coursework within the general areas of patient care, health and safety, and law and ethics. law and ethics, and the risks of addiction associated with the use of Schedule II drugs. The mandatory coursework prescribed by the board shall not exceed fifteen 15 hours per renewal period for dentists, and seven and one-half 7.5 hours per renewal period for dental auxiliaries. Any mandatory coursework required by the board shall be credited toward the continuing education requirements established by the board pursuant to subdivision (a).
(c)For a retired dentist who provides only uncompensated care, the board shall not require more than 60 percent of the hours of continuing education that are required of other licensed dentists. Notwithstanding subdivision (b), all of the hours of continuing education as described in this subdivision shall be gained through courses related to the actual delivery of dental services to the patient or the community, as determined by the board. Nothing in this subdivision shall be construed to reduce any requirements imposed by the board pursuant to subdivision (b).
(d)The board shall report on the outcome of subdivision (c) pursuant to, and at the time of, its regular sunset review process, as provided in Section 1601.1.
SEC. 3.Section 2190.5 of the Business and Professions Code is amended to read:2190.5.(a)(1)All physicians and surgeons shall complete a mandatory continuing education 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 board may verify completion of this requirement on the renewal application form.
(2)For physicians and surgeons licensed on or after January 1, 2019, the course described in paragraph (1) shall also include the subject of the risks of addiction associated with the use of Schedule II drugs.
(b)By regulatory action, the board may exempt physicians and surgeons by practice status category from the requirement in subdivision (a) if the physician and surgeon does not engage in direct patient care, does not provide patient consultations, or does not reside in the State of California.
(c)This section shall not apply to physicians and surgeons practicing in pathology or radiology specialty areas.
SEC. 4.Section 2191 of the Business and Professions Code is amended to read:2191.(a)In determining its continuing education requirements, the board shall consider including a course in human sexuality, defined as the study of a human being as a sexual being and how he or she functions with respect thereto, and nutrition to be taken by those licensees whose practices may require knowledge in those areas.
(b)The board shall consider including a course in 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.
(c)The board shall consider including a course in 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.
(d)The board shall encourage every physician and surgeon to take nutrition as part of his or her continuing education, particularly a physician and surgeon involved in primary care.
(e)The board shall consider including a course in 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.
(f)In determining its continuing education requirements, the board shall consider including a course in 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.
(g)In determining its continuing education requirements, the board shall consider including a course in 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.
(h)In determining its continuing education requirements, the board shall consider including a course providing training and 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 board 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.
(i)In determining its continuing education requirements, the board shall consider including a course in the special care needs of individuals and their families facing end-of-life issues, including, but not limited to, all of the following:
(1)Pain and symptom management.
(2)The psycho-social dynamics of death.
(3)Dying and bereavement.
(4)Hospice care.
(j)In determining its continuing education requirements, the board shall give its highest priority to considering a course on pain management and the risks of addiction associated with the use of Schedule II drugs.
(k)In determining its continuing education requirements, the board shall consider including a course in geriatric care for emergency room physicians and surgeons.
SEC. 5.Section 2196.2 of the Business and Professions Code is amended to read:2196.2.The board shall periodically develop and disseminate information and educational material regarding pain management techniques and procedures, including the risks of addiction associated with the use of Schedule II drugs, to each licensed physician and surgeon and to each general acute care hospital in this state. The board shall consult with the State Department of Public Health in developing the materials to be distributed pursuant to this section.
SEC. 6.Section 2454.5 of the Business and Professions Code is amended to read:2454.5.In order to ensure the continuing competence of licensed osteopathic physicians and surgeons, the board shall adopt and administer standards for the continuing education of those licensees. The board shall require each licensed osteopathic physician and surgeon to demonstrate satisfaction of the continuing education requirements as a condition for the renewal of a license at intervals of not less than one year nor more than two years. Commencing January 1, 2018, the board shall require each licensed osteopathic physician and surgeon to complete a minimum of 100 hours of American Osteopathic Association continuing education hours during each two-year cycle, of which 40 hours shall be completed in American Osteopathic Association Category 1 continuing education hours and the remaining 60 hours shall be either American Osteopathic Association or American Medical Association accredited as a condition for renewal of an active license. Licensed osteopathic physicians and surgeons shall complete a course on the risks of addiction associated with the use of Schedule II drugs.
For purposes of this section, American Osteopathic Association Category 1 means continuing education activities and programs approved for Category 1 credit by the Committee on Continuing Medical Education of the American Osteopathic Association.
SEC. 7.Section 2746.51 of the Business and Professions Code is amended to read:2746.51.(a)Neither this chapter nor any other provision of law shall be construed to prohibit a certified nurse-midwife from furnishing or ordering drugs or devices, including controlled substances classified in Schedule II, III, IV, or V under the California Uniform Controlled Substances Act (Division 10 (commencing with Section 11000) of the Health and Safety Code), when all of the following apply:
(1)The drugs or devices are furnished or ordered incidentally to the provision of any of the following:
(A)Family planning services, as defined in Section 14503 of the Welfare and Institutions Code.
(B)Routine health care or perinatal care, as defined in subdivision (d) of Section 123485 of the Health and Safety Code.
(C)Care rendered, consistent with the certified nurse-midwifes educational preparation or for which clinical competency has been established and maintained, to persons within a facility specified in subdivision (a), (b), (c), (d), (i), or (j) of Section 1206 of the Health and Safety Code, a clinic as specified in Section 1204 of the Health and Safety Code, a general acute care hospital as defined in subdivision (a) of Section 1250 of the Health and Safety Code, a licensed birth center as defined in Section 1204.3 of the Health and Safety Code, or a special hospital specified as a maternity hospital in subdivision (f) of Section 1250 of the Health and Safety Code.
(2)The drugs or devices are furnished or ordered by a certified nurse-midwife in accordance with standardized procedures or protocols. For purposes of this section, standardized procedure means a document, including protocols, developed and approved by the supervising physician and surgeon, the certified nurse-midwife, and the facility administrator or his or her designee. The standardized procedure covering the furnishing or ordering of drugs or devices shall specify all of the following:
(A)Which certified nurse-midwife may furnish or order drugs or devices.
(B)Which drugs or devices may be furnished or ordered and under what circumstances.
(C)The extent of physician and surgeon supervision.
(D)The method of periodic review of the certified nurse-midwifes competence, including peer review, and review of the provisions of the standardized procedure.
(3)If Schedule II or III controlled substances, as defined in Sections 11055 and 11056 of the Health and Safety Code, are furnished or ordered by a certified nurse-midwife, the controlled substances shall be furnished or ordered in accordance with a patient-specific protocol approved by the treating or supervising physician and surgeon. For Schedule II controlled substance protocols, the provision for furnishing the Schedule II controlled substance shall address the diagnosis of the illness, injury, or condition for which the Schedule II controlled substance is to be furnished.
(4)The furnishing or ordering of drugs or devices by a certified nurse-midwife occurs under physician and surgeon supervision. For purposes of this section, no physician and surgeon shall supervise more than four certified nurse-midwives at one time. Physician and surgeon supervision shall not be construed to require the physical presence of the physician, but does include all of the following:
(A)Collaboration on the development of the standardized procedure or protocol.
(B)Approval of the standardized procedure or protocol.
(C)Availability by telephonic contact at the time of patient examination by the certified nurse-midwife.
(b)(1)The furnishing or ordering of drugs or devices by a certified nurse-midwife is conditional on the issuance by the board of a number to the applicant who has successfully completed the requirements of paragraph (2). The number shall be included on all transmittals of orders for drugs or devices by the certified nurse-midwife. The board shall maintain a list of the certified nurse-midwives that it has certified pursuant to this paragraph and the number it has issued to each one. The board shall make the list available to the California State Board of Pharmacy upon its request. Every certified nurse-midwife who is authorized pursuant to this section to furnish or issue a drug order for a controlled substance shall register with the United States Drug Enforcement Administration.
(2)The board has certified in accordance with paragraph (1) that the certified nurse-midwife has satisfactorily completed a course in pharmacology covering the drugs or devices to be furnished or ordered under this section, including the risks of addiction and neonatal abstinence syndrome associated with the use of opioids. The board shall establish the requirements for satisfactory completion of this paragraph.
(3)A physician and surgeon may determine the extent of supervision necessary pursuant to this section in the furnishing or ordering of drugs and devices.
(4)A copy of the standardized procedure or protocol relating to the furnishing or ordering of controlled substances by a certified nurse-midwife shall be provided upon request to any licensed pharmacist who is uncertain of the authority of the certified nurse-midwife to perform these functions.
(5)Certified nurse-midwives who are certified by the board and hold an active furnishing number, who are currently authorized through standardized procedures or protocols to furnish Schedule II controlled substances, and who are registered with the United States Drug Enforcement Administration shall provide documentation of continuing education specific to the use of Schedule II controlled substances in settings other than a hospital based on standards developed by the board.
(c)Drugs or devices furnished or ordered by a certified nurse-midwife may include Schedule II controlled substances under the California Uniform Controlled Substances Act (Division 10 (commencing with Section 11000) of the Health and Safety Code) under the following conditions:
(1)The drugs and devices are furnished or ordered in accordance with requirements referenced in paragraphs (2) to (4), inclusive, of subdivision (a) and in paragraphs (1) to (3), inclusive, of subdivision (b).
(2)When Schedule II controlled substances, as defined in Section 11055 of the Health and Safety Code, are furnished or ordered by a certified nurse-midwife, the controlled substances shall be furnished or ordered in accordance with a patient-specific protocol approved by the treating or supervising physician and surgeon.
(d)Furnishing of drugs or devices by a certified nurse-midwife means the act of making a pharmaceutical agent or agents available to the patient in strict accordance with a standardized procedure or protocol. Use of the term furnishing in this section shall include the following:
(1)The ordering of a drug or device in accordance with the standardized procedure or protocol.
(2)Transmitting an order of a supervising physician and surgeon.
(e)Drug order or order for purposes of this section means an order for medication or for a drug or device that is dispensed to or for an ultimate user, issued by a certified nurse-midwife as an individual practitioner, within the meaning of Section 1306.03 of Title 21 of the Code of Federal Regulations. Notwithstanding any other provision of law, (1) a drug order issued pursuant to this section shall be treated in the same manner as a prescription of the supervising physician; (2) all references to prescription in this code and the Health and Safety Code shall include drug orders issued by certified nurse-midwives; and (3) the signature of a certified nurse-midwife on a drug order issued in accordance with this section shall be deemed to be the signature of a prescriber for purposes of this code and the Health and Safety Code.
SEC. 8.Section 2836.1 of the Business and Professions Code is amended to read:2836.1.Neither this chapter nor any other provision of law shall be construed to prohibit a nurse practitioner from furnishing or ordering drugs or devices when all of the following apply:
(a)The drugs or devices are furnished or ordered by a nurse practitioner in accordance with standardized procedures or protocols developed by the nurse practitioner and the supervising physician and surgeon when the drugs or devices furnished or ordered are consistent with the practitioners educational preparation or for which clinical competency has been established and maintained.
(b)The nurse practitioner is functioning pursuant to standardized procedure, as defined by Section 2725, or protocol. The standardized procedure or protocol shall be developed and approved by the supervising physician and surgeon, the nurse practitioner, and the facility administrator or the designee.
(c)(1)The standardized procedure or protocol covering the furnishing of drugs or devices shall specify which nurse practitioners may furnish or order drugs or devices, which drugs or devices may be furnished or ordered, under what circumstances, the extent of physician and surgeon supervision, the method of periodic review of the nurse practitioners competence, including peer review, and review of the provisions of the standardized procedure.
(2)In addition to the requirements in paragraph (1), for Schedule II controlled substance protocols, the provision for furnishing Schedule II controlled substances shall address the diagnosis of the illness, injury, or condition for which the Schedule II controlled substance is to be furnished.
(d)The furnishing or ordering of drugs or devices by a nurse practitioner occurs under physician and surgeon supervision. Physician and surgeon supervision shall not be construed to require the physical presence of the physician, but does include (1) collaboration on the development of the standardized procedure, (2) approval of the standardized procedure, and (3) availability by telephonic contact at the time of patient examination by the nurse practitioner.
(e)For purposes of this section, no physician and surgeon shall supervise more than four nurse practitioners at one time.
(f)(1)Drugs or devices furnished or ordered by a nurse practitioner may include Schedule II through Schedule V controlled substances under the California Uniform Controlled Substances Act (Division 10 (commencing with Section 11000) of the Health and Safety Code) and shall be further limited to those drugs agreed upon by the nurse practitioner and physician and surgeon and specified in the standardized procedure.
(2)When Schedule II or III controlled substances, as defined in Sections 11055 and 11056, respectively, of the Health and Safety Code, are furnished or ordered by a nurse practitioner, the controlled substances shall be furnished or ordered in accordance with a patient-specific protocol approved by the treating or supervising physician. A copy of the section of the nurse practitioners standardized procedure relating to controlled substances shall be provided, upon request, to any licensed pharmacist who dispenses drugs or devices, when there is uncertainty about the nurse practitioner furnishing the order.
(g)(1)The board has certified in accordance with Section 2836.3 that the nurse practitioner has satisfactorily completed a course in pharmacology covering the drugs or devices to be furnished or ordered under this section.
(2)A physician and surgeon may determine the extent of supervision necessary pursuant to this section in the furnishing or ordering of drugs and devices.
(3)Nurse practitioners who are certified by the board and hold an active furnishing number, who are authorized through standardized procedures or protocols to furnish Schedule II controlled substances, and who are registered with the United States Drug Enforcement Administration, shall complete, as part of their continuing education requirements, a course including Schedule II controlled substances, and the risks of addiction associated with their use, based on the standards developed by the board. The board shall establish the requirements for satisfactory completion of this subdivision.
(h)Use of the term furnishing in this section, in health facilities defined in Section 1250 of the Health and Safety Code, shall include (1) the ordering of a drug or device in accordance with the standardized procedure and (2) transmitting an order of a supervising physician and surgeon.
(i)Drug order or order for purposes of this section means an order for medication which is dispensed to or for an ultimate user, issued by a nurse practitioner as an individual practitioner, within the meaning of Section 1306.02 of Title 21 of the Code of Federal Regulations. Notwithstanding any other provision of law, (1) a drug order issued pursuant to this section shall be treated in the same manner as a prescription of the supervising physician; (2) all references to prescription in this code and the Health and Safety Code shall include drug orders issued by nurse practitioners; and (3) the signature of a nurse practitioner on a drug order issued in accordance with this section shall be deemed to be the signature of a prescriber for purposes of this code and the Health and Safety Code.
SEC. 9.Section 3059 of the Business and Professions Code is amended to read:3059.(a)It is the intent of the Legislature that the public health and safety would be served by requiring all holders of licenses to practice optometry granted under this chapter to continue their education after receiving their licenses. The board shall adopt regulations that require, as a condition to the renewal thereof, that all holders of licenses submit proof satisfactory to the board that they have informed themselves of the developments in the practice of optometry occurring since the original issuance of their licenses by pursuing one or more courses of study satisfactory to the board or by other means deemed equivalent by the board.
(b)The board may, in accordance with the intent of this section, make exceptions from continuing education requirements for reasons of health, military service, or other good cause.
(c)If for good cause compliance cannot be met for the current year, the board may grant exemption of compliance for that year, provided that a plan of future compliance that includes current requirements as well as makeup of previous requirements is approved by the board.
(d)The board may require that proof of compliance with this section be submitted on an annual or biennial basis as determined by the board.
(e)An optometrist certified to use therapeutic pharmaceutical agents pursuant to Section 3041.3 shall complete a total of 50 hours of continuing education every two years in order to renew his or her certificate. Thirty-five of the required 50 hours of continuing education shall be on the diagnosis, treatment, and management of ocular disease in any combination of the following areas:
(1)Glaucoma.
(2)Ocular infection.
(3)Ocular inflammation.
(4)Topical steroids.
(5)Systemic medication.
(6)Pain medication, including the risks of addiction associated with the use of Schedule II drugs.
(f)The board shall encourage every optometrist to take a course or courses in pharmacology and pharmaceuticals as part of his or her continuing education.
(g)The board shall consider requiring courses in child abuse detection to be taken by those licensees whose practices are such that there is a likelihood of contact with abused or neglected children.
(h)The board shall consider requiring courses in elder abuse detection to be taken by those licensees whose practices are such that there is a likelihood of contact with abused or neglected elder persons.
SEC. 10.Section 3502.1 of the Business and Professions Code is amended to read:3502.1.(a)In addition to the services authorized in the regulations adopted by the Medical Board of California, and except as prohibited by Section 3502, while under the supervision of a licensed physician and surgeon or physicians and surgeons authorized by law to supervise a physician assistant, a physician assistant may administer or provide medication to a patient, or transmit orally, or in writing on a patients record or in a drug order, an order to a person who may lawfully furnish the medication or medical device pursuant to subdivisions (c) and (d).
(1)A supervising physician and surgeon who delegates authority to issue a drug order to a physician assistant may limit this authority by specifying the manner in which the physician assistant may issue delegated prescriptions.
(2)Each supervising physician and surgeon who delegates the authority to issue a drug order to a physician assistant shall first prepare and adopt, or adopt, a written, practice specific, formulary and protocols that specify all criteria for the use of a particular drug or device, and any contraindications for the selection. Protocols for Schedule II controlled substances shall address the diagnosis of illness, injury, or condition for which the Schedule II controlled substance is being administered, provided, or issued. The drugs listed in the protocols shall constitute the formulary and shall include only drugs that are appropriate for use in the type of practice engaged in by the supervising physician and surgeon. When issuing a drug order, the physician assistant is acting on behalf of and as an agent for a supervising physician and surgeon.
(b)Drug order, for purposes of this section, means an order for medication that is dispensed to or for a patient, issued and signed by a physician assistant acting as an individual practitioner within the meaning of Section 1306.02 of Title 21 of the Code of Federal Regulations. Notwithstanding any other provision of law, (1) a drug order issued pursuant to this section shall be treated in the same manner as a prescription or order of the supervising physician, (2) all references to prescription in this code and the Health and Safety Code shall include drug orders issued by physician assistants pursuant to authority granted by their supervising physicians and surgeons, and (3) the signature of a physician assistant on a drug order shall be deemed to be the signature of a prescriber for purposes of this code and the Health and Safety Code.
(c)A drug order for any patient cared for by the physician assistant that is issued by the physician assistant shall either be based on the protocols described in subdivision (a) or shall be approved by the supervising physician and surgeon before it is filled or carried out.
(1)A physician assistant shall not administer or provide a drug or issue a drug order for a drug other than for a drug listed in the formulary without advance approval from a supervising physician and surgeon for the particular patient. At the direction and under the supervision of a physician and surgeon, a physician assistant may hand to a patient of the supervising physician and surgeon a properly labeled prescription drug prepackaged by a physician and surgeon, manufacturer as defined in the Pharmacy Law, or a pharmacist.
(2)A physician assistant shall not administer, provide, or issue a drug order to a patient for Schedule II through Schedule V controlled substances without advance approval by a supervising physician and surgeon for that particular patient unless the physician assistant has completed an education course that covers controlled substances and that meets standards, including pharmacological content, approved by the board. The education course shall be provided either by an accredited continuing education provider or by an approved physician assistant training program. If the physician assistant will administer, provide, or issue a drug order for Schedule II controlled substances, the course shall contain a minimum of three hours exclusively on Schedule II controlled substances, including the risks of addiction associated with their use. Completion of the requirements set forth in this paragraph shall be verified and documented in the manner established by the board prior to the physician assistants use of a registration number issued by the United States Drug Enforcement Administration to the physician assistant to administer, provide, or issue a drug order to a patient for a controlled substance without advance approval by a supervising physician and surgeon for that particular patient.
(3)Any drug order issued by a physician assistant shall be subject to a reasonable quantitative limitation consistent with customary medical practice in the supervising physician and surgeons practice.
(d)A written drug order issued pursuant to subdivision (a), except a written drug order in a patients medical record in a health facility or medical practice, shall contain the printed name, address, and telephone number of the supervising physician and surgeon, the printed or stamped name and license number of the physician assistant, and the signature of the physician assistant. Further, a written drug order for a controlled substance, except a written drug order in a patients medical record in a health facility or a medical practice, shall include the federal controlled substances registration number of the physician assistant and shall otherwise comply with Section 11162.1 of the Health and Safety Code. Except as otherwise required for written drug orders for controlled substances under Section 11162.1 of the Health and Safety Code, the requirements of this subdivision may be met through stamping or otherwise imprinting on the supervising physician and surgeons prescription blank to show the name, license number, and if applicable, the federal controlled substances registration number of the physician assistant, and shall be signed by the physician assistant. When using a drug order, the physician assistant is acting on behalf of and as the agent of a supervising physician and surgeon.
(e)The supervising physician and surgeon shall use either of the following mechanisms to ensure adequate supervision of the administration, provision, or issuance by a physician assistant of a drug order to a patient for Schedule II controlled substances:
(1)The medical record of any patient cared for by a physician assistant for whom the physician assistants Schedule II drug order has been issued or carried out shall be reviewed, countersigned, and dated by a supervising physician and surgeon within seven days.
(2)If the physician assistant has documentation evidencing the successful completion of an education course that covers controlled substances, and that controlled substance education course (A) meets the standards, including pharmacological content, established in Sections 1399.610 and 1399.612 of Title 16 of the California Code of Regulations, and (B) is provided either by an accredited continuing education provider or by an approved physician assistant training program, the supervising physician and surgeon shall review, countersign, and date, within seven days, a sample consisting of the medical records of at least 20 percent of the patients cared for by the physician assistant for whom the physician assistants Schedule II drug order has been issued or carried out. Completion of the requirements set forth in this paragraph shall be verified and documented in the manner established in Section 1399.612 of Title 16 of the California Code of Regulations. Physician assistants who have a certificate of completion of the course described in paragraph (2) of subdivision (c) shall be deemed to have met the education course requirement of this subdivision.
(f)All physician assistants who are authorized by their supervising physicians to issue drug orders for controlled substances shall register with the United States Drug Enforcement Administration (DEA).
(g)The board shall consult with the Medical Board of California and report during its sunset review required by Article 7.5 (commencing with Section 9147.7) of Chapter 1.5 of Part 1 of Division 2 of Title 2 of the Government Code the impacts of exempting Schedule III and Schedule IV drug orders from the requirement for a physician and surgeon to review and countersign the affected medical record of a patient.
SEC. 11.Section 4076.7 is added to the Business and Professions Code, to read:4076.7.In addition to the requirements of Sections 4076 and 4076.5, whenever a prescription drug containing an opioid is dispensed to a patient for outpatient use, the pharmacy or practitioner dispensing the drug shall prominently display on the label or container, by means of a flag or other notification mechanism attached to the container, a notice that states Caution: Opioid. Risk of overdose and addiction.
SEC. 12.Section 49476 is added to the Education Code, to read:49476.(a)If a school district, charter school, or private school elects to offer an athletic program, the school district, charter school, or private school shall annually give the Opioid Factsheet for Patients published by the Centers for Disease Control and Prevention to each athlete. The athlete and, if the athlete is 17 years of age or younger, the athletes parent or guardian shall sign a document acknowledging receipt of the Opioid Factsheet for Patients and return that document to the school district, charter school, or private school before the athlete initiates practice or competition. The Opioid Factsheet for Patients may be sent and returned through an electronic medium, including, but not limited to, fax or email.
(b)This section does not apply to an athlete engaging in an athletic activity during the regular schoolday or as part of a physical education course required pursuant to subdivision (d) of Section 51220.
SEC. 13.Section 11158.1 is added to the Health and Safety Code, to read:11158.1.(a)Except when a patient is being treated as set forth in Sections 11159, 11159.2, and 11167.5, and Article 2 (commencing with Section 11215) of Chapter 5, pertaining to the treatment of addicts, or for a diagnosis of chronic intractable pain as used in Section 124960 of this code and Section 2241.5 of the Business and Professions Code, a prescriber shall discuss all of the following with the minor, the minors parent or guardian, or another adult authorized to consent to the minors medical treatment before directly dispensing or issuing for a minor the first prescription in a single course of treatment for a controlled substance containing an opioid:
(1)The risks of addiction and overdose associated with the use of opioids.
(2)The increased risk of addiction to an opioid to an individual who is suffering from both mental and substance abuse disorders.
(3)The danger of taking an opioid with a benzodiazepine, alcohol, or another central nervous system depressant.
(4)Any other information required by law.
(b)This section does not apply in any of the following circumstances:
(1)If the minors treatment includes emergency services and care as defined in Section 1317.1.
(2)If the minors treatment is associated with or incident to an emergency surgery, regardless of whether the surgery is performed on an inpatient or outpatient basis.
(3)If, in the prescribers professional judgment, fulfilling the requirements of subdivision (a) would be detrimental to the minors health or safety, or in violation of the minors legal rights regarding confidentiality.
(c)Notwithstanding any other law, including Section 11374, failure to comply with this section shall not constitute a criminal offense.
SEC. 14.Section 124236 is added to the Health and Safety Code, to read:124236.(a)A youth sports organization, as defined in paragraph (3) of subdivision (b) of Section 124235, that elects to offer an athletic program shall annually give the Opioid Factsheet for Patients published by the Centers for Disease Control and Prevention to each athlete. The athlete and, if the athlete is 17 years of age or younger, the athletes parent or guardian shall sign a document acknowledging receipt of the Opioid Factsheet for Patients and return that document to the youth sports organization before the athlete initiates practice or competition. The Opioid Factsheet for Patients may be sent and returned through an electronic medium, including, but not limited to, fax or email.
(b)This section shall apply to all athletes participating in the activities of a youth sports organization, irrespective of their ages. This section shall not be construed to prohibit a youth sports organization, or any other appropriate entity, from adopting and enforcing rules intended to provide a higher standard of safety for athletes than the standard established under this section.
SEC. 15.Section 2.5 of this bill incorporates amendments to Section 1645 of the Business and Professions Code proposed by both this bill and Senate Bill 1491. That section of this bill shall only become operative if (1) both bills are enacted and become effective on or before January 1, 2019, (2) each bill amends Section 1645 of the Business and Professions Code, and (3) this bill is enacted after Senate Bill 1491, in which case Section 2 of this bill shall not become operative.
SEC. 15.SEC. 16.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB 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 XIIIB of the California Constitution.
The Legislature finds and declares all of the following:
(a)Addiction, misuse, and overdose of prescription opioids is a public health crisis affecting both adults and children.
(b)Urgent measures are needed to better inform the public of the risks associated with both the long-term and short-term use of opioids in an effort to address this problem.
(c)Both short-term and long-term prescriptions of opioids to minors fall within situations that require counseling of patients and their parents or guardians by their prescribers.
(d)It is the intent of the Legislature to ensure that health care providers and young athletes receive necessary education on this topic.
SEC. 2.Section 1645 of the Business and Professions Code is amended to read:1645.(a)Effective with the 1974 license renewal period, if the board determines that the public health and safety would be served by requiring all holders of licenses under this chapter to continue their education after receiving a license, it may require, as a condition to the renewal thereof, that they submit assurances satisfactory to the board that they will, during the succeeding two-year period, inform themselves of the developments in the practice of dentistry occurring since the original issuance of their licenses by pursuing one or more courses of study satisfactory to the board or by other means deemed equivalent by the board.
The board shall adopt regulations providing for the suspension of the licenses at the end of the two-year period until compliance with the assurances provided for in this section is accomplished.
(b)The board may also, as a condition of license renewal, require licentiates to successfully complete a portion of the required continuing education hours in specific areas adopted in regulations by the board. The board may prescribe this mandatory coursework within the general areas of patient care, health and safety, law and ethics, and the risks of addiction associated with the use of Schedule II drugs. The mandatory coursework prescribed by the board shall not exceed fifteen 15 hours per renewal period for dentists, and seven and one-half 7.5 hours per renewal period for dental auxiliaries. Any mandatory coursework required by the board shall be credited toward the continuing education requirements established by the board pursuant to subdivision (a).
(c)For a retired dentist who provides only uncompensated care, the board shall not require more than 60 percent of the hours of continuing education that are required of other licensed dentists. Notwithstanding subdivision (b), all of the hours of continuing education as described in this subdivision shall be gained through courses related to the actual delivery of dental services to the patient or the community, as determined by the board. Nothing in this subdivision shall be construed to reduce any requirements imposed by the board pursuant to subdivision (b).
(d)The board shall report on the outcome of subdivision (c) pursuant to, and at the time of, its regular sunset review process, as provided in Section 1601.1.
SEC. 3.Section 2190.5 of the Business and Professions Code is amended to read:2190.5.(a)(1)All physicians and surgeons shall complete a mandatory continuing education 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 board may verify completion of this requirement on the renewal application form.
(2)For physicians and surgeons licensed on or after January 1, 2019, the course described in paragraph (1) shall also include the subject of the risks of addiction associated with the use of Schedule II drugs.
(b)By regulatory action, the board may exempt physicians and surgeons by practice status category from the requirement in subdivision (a) if the physician and surgeon does not engage in direct patient care, does not provide patient consultations, or does not reside in the State of California.
(c)This section shall not apply to physicians and surgeons practicing in pathology or radiology specialty areas.
SEC. 4.Section 2191 of the Business and Professions Code is amended to read:2191.(a)In determining its continuing education requirements, the board shall consider including a course in human sexuality, defined as the study of a human being as a sexual being and how he or she functions with respect thereto, and nutrition to be taken by those licensees whose practices may require knowledge in those areas.
(b)The board shall consider including a course in 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.
(c)The board shall consider including a course in 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.
(d)The board shall encourage every physician and surgeon to take nutrition as part of his or her continuing education, particularly a physician and surgeon involved in primary care.
(e)The board shall consider including a course in 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.
(f)In determining its continuing education requirements, the board shall consider including a course in 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.
(g)In determining its continuing education requirements, the board shall consider including a course in 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.
(h)In determining its continuing education requirements, the board shall consider including a course providing training and 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 board 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.
(i)In determining its continuing education requirements, the board shall consider including a course in the special care needs of individuals and their families facing end-of-life issues, including, but not limited to, all of the following:
(1)Pain and symptom management.
(2)The psycho-social dynamics of death.
(3)Dying and bereavement.
(4)Hospice care.
(j)In determining its continuing education requirements, the board shall give its highest priority to considering a course on pain management and the risks of addiction associated with the use of Schedule II drugs.
(k)In determining its continuing education requirements, the board shall consider including a course in geriatric care for emergency room physicians and surgeons.
SEC. 5.Section 2196.2 of the Business and Professions Code is amended to read:2196.2.The board shall periodically develop and disseminate information and educational material regarding pain management techniques and procedures, including the risks of addiction associated with the use of Schedule II drugs, to each licensed physician and surgeon and to each general acute care hospital in this state. The board shall consult with the State Department of Public Health in developing the materials to be distributed pursuant to this section.
SEC. 6.Section 2454.5 of the Business and Professions Code is amended to read:2454.5.In order to ensure the continuing competence of licensed osteopathic physicians and surgeons, the board shall adopt and administer standards for the continuing education of those licensees. The board shall require each licensed osteopathic physician and surgeon to demonstrate satisfaction of the continuing education requirements as a condition for the renewal of a license at intervals of not less than one year nor more than two years. Commencing January 1, 2018, the board shall require each licensed osteopathic physician and surgeon to complete a minimum of 100 hours of American Osteopathic Association continuing education hours during each two-year cycle, of which 40 hours shall be completed in American Osteopathic Association Category 1 continuing education hours and the remaining 60 hours shall be either American Osteopathic Association or American Medical Association accredited as a condition for renewal of an active license. Licensed osteopathic physicians and surgeons shall complete a course on the risks of addiction associated with the use of Schedule II drugs.
For purposes of this section, American Osteopathic Association Category 1 means continuing education activities and programs approved for Category 1 credit by the Committee on Continuing Medical Education of the American Osteopathic Association.
SEC. 7.Section 2746.51 of the Business and Professions Code is amended to read:2746.51.(a)Neither this chapter nor any other provision of law shall be construed to prohibit a certified nurse-midwife from furnishing or ordering drugs or devices, including controlled substances classified in Schedule II, III, IV, or V under the California Uniform Controlled Substances Act (Division 10 (commencing with Section 11000) of the Health and Safety Code), when all of the following apply:
(1)The drugs or devices are furnished or ordered incidentally to the provision of any of the following:
(A)Family planning services, as defined in Section 14503 of the Welfare and Institutions Code.
(B)Routine health care or perinatal care, as defined in subdivision (d) of Section 123485 of the Health and Safety Code.
(C)Care rendered, consistent with the certified nurse-midwifes educational preparation or for which clinical competency has been established and maintained, to persons within a facility specified in subdivision (a), (b), (c), (d), (i), or (j) of Section 1206 of the Health and Safety Code, a clinic as specified in Section 1204 of the Health and Safety Code, a general acute care hospital as defined in subdivision (a) of Section 1250 of the Health and Safety Code, a licensed birth center as defined in Section 1204.3 of the Health and Safety Code, or a special hospital specified as a maternity hospital in subdivision (f) of Section 1250 of the Health and Safety Code.
(2)The drugs or devices are furnished or ordered by a certified nurse-midwife in accordance with standardized procedures or protocols. For purposes of this section, standardized procedure means a document, including protocols, developed and approved by the supervising physician and surgeon, the certified nurse-midwife, and the facility administrator or his or her designee. The standardized procedure covering the furnishing or ordering of drugs or devices shall specify all of the following:
(A)Which certified nurse-midwife may furnish or order drugs or devices.
(B)Which drugs or devices may be furnished or ordered and under what circumstances.
(C)The extent of physician and surgeon supervision.
(D)The method of periodic review of the certified nurse-midwifes competence, including peer review, and review of the provisions of the standardized procedure.
(3)If Schedule II or III controlled substances, as defined in Sections 11055 and 11056 of the Health and Safety Code, are furnished or ordered by a certified nurse-midwife, the controlled substances shall be furnished or ordered in accordance with a patient-specific protocol approved by the treating or supervising physician and surgeon. For Schedule II controlled substance protocols, the provision for furnishing the Schedule II controlled substance shall address the diagnosis of the illness, injury, or condition for which the Schedule II controlled substance is to be furnished.
(4)The furnishing or ordering of drugs or devices by a certified nurse-midwife occurs under physician and surgeon supervision. For purposes of this section, no physician and surgeon shall supervise more than four certified nurse-midwives at one time. Physician and surgeon supervision shall not be construed to require the physical presence of the physician, but does include all of the following:
(A)Collaboration on the development of the standardized procedure or protocol.
(B)Approval of the standardized procedure or protocol.
(C)Availability by telephonic contact at the time of patient examination by the certified nurse-midwife.
(b)(1)The furnishing or ordering of drugs or devices by a certified nurse-midwife is conditional on the issuance by the board of a number to the applicant who has successfully completed the requirements of paragraph (2). The number shall be included on all transmittals of orders for drugs or devices by the certified nurse-midwife. The board shall maintain a list of the certified nurse-midwives that it has certified pursuant to this paragraph and the number it has issued to each one. The board shall make the list available to the California State Board of Pharmacy upon its request. Every certified nurse-midwife who is authorized pursuant to this section to furnish or issue a drug order for a controlled substance shall register with the United States Drug Enforcement Administration.
(2)The board has certified in accordance with paragraph (1) that the certified nurse-midwife has satisfactorily completed a course in pharmacology covering the drugs or devices to be furnished or ordered under this section, including the risks of addiction and neonatal abstinence syndrome associated with the use of opioids. The board shall establish the requirements for satisfactory completion of this paragraph.
(3)A physician and surgeon may determine the extent of supervision necessary pursuant to this section in the furnishing or ordering of drugs and devices.
(4)A copy of the standardized procedure or protocol relating to the furnishing or ordering of controlled substances by a certified nurse-midwife shall be provided upon request to any licensed pharmacist who is uncertain of the authority of the certified nurse-midwife to perform these functions.
(5)Certified nurse-midwives who are certified by the board and hold an active furnishing number, who are currently authorized through standardized procedures or protocols to furnish Schedule II controlled substances, and who are registered with the United States Drug Enforcement Administration shall provide documentation of continuing education specific to the use of Schedule II controlled substances in settings other than a hospital based on standards developed by the board.
(c)Drugs or devices furnished or ordered by a certified nurse-midwife may include Schedule II controlled substances under the California Uniform Controlled Substances Act (Division 10 (commencing with Section 11000) of the Health and Safety Code) under the following conditions:
(1)The drugs and devices are furnished or ordered in accordance with requirements referenced in paragraphs (2) to (4), inclusive, of subdivision (a) and in paragraphs (1) to (3), inclusive, of subdivision (b).
(2)When Schedule II controlled substances, as defined in Section 11055 of the Health and Safety Code, are furnished or ordered by a certified nurse-midwife, the controlled substances shall be furnished or ordered in accordance with a patient-specific protocol approved by the treating or supervising physician and surgeon.
(d)Furnishing of drugs or devices by a certified nurse-midwife means the act of making a pharmaceutical agent or agents available to the patient in strict accordance with a standardized procedure or protocol. Use of the term furnishing in this section shall include the following:
(1)The ordering of a drug or device in accordance with the standardized procedure or protocol.
(2)Transmitting an order of a supervising physician and surgeon.
(e)Drug order or order for purposes of this section means an order for medication or for a drug or device that is dispensed to or for an ultimate user, issued by a certified nurse-midwife as an individual practitioner, within the meaning of Section 1306.03 of Title 21 of the Code of Federal Regulations. Notwithstanding any other provision of law, (1) a drug order issued pursuant to this section shall be treated in the same manner as a prescription of the supervising physician; (2) all references to prescription in this code and the Health and Safety Code shall include drug orders issued by certified nurse-midwives; and (3) the signature of a certified nurse-midwife on a drug order issued in accordance with this section shall be deemed to be the signature of a prescriber for purposes of this code and the Health and Safety Code.
SEC. 8.Section 2836.1 of the Business and Professions Code is amended to read:2836.1.Neither this chapter nor any other provision of law shall be construed to prohibit a nurse practitioner from furnishing or ordering drugs or devices when all of the following apply:
(a)The drugs or devices are furnished or ordered by a nurse practitioner in accordance with standardized procedures or protocols developed by the nurse practitioner and the supervising physician and surgeon when the drugs or devices furnished or ordered are consistent with the practitioners educational preparation or for which clinical competency has been established and maintained.
(b)The nurse practitioner is functioning pursuant to standardized procedure, as defined by Section 2725, or protocol. The standardized procedure or protocol shall be developed and approved by the supervising physician and surgeon, the nurse practitioner, and the facility administrator or the designee.
(c)(1)The standardized procedure or protocol covering the furnishing of drugs or devices shall specify which nurse practitioners may furnish or order drugs or devices, which drugs or devices may be furnished or ordered, under what circumstances, the extent of physician and surgeon supervision, the method of periodic review of the nurse practitioners competence, including peer review, and review of the provisions of the standardized procedure.
(2)In addition to the requirements in paragraph (1), for Schedule II controlled substance protocols, the provision for furnishing Schedule II controlled substances shall address the diagnosis of the illness, injury, or condition for which the Schedule II controlled substance is to be furnished.
(d)The furnishing or ordering of drugs or devices by a nurse practitioner occurs under physician and surgeon supervision. Physician and surgeon supervision shall not be construed to require the physical presence of the physician, but does include (1) collaboration on the development of the standardized procedure, (2) approval of the standardized procedure, and (3) availability by telephonic contact at the time of patient examination by the nurse practitioner.
(e)For purposes of this section, no physician and surgeon shall supervise more than four nurse practitioners at one time.
(f)(1)Drugs or devices furnished or ordered by a nurse practitioner may include Schedule II through Schedule V controlled substances under the California Uniform Controlled Substances Act (Division 10 (commencing with Section 11000) of the Health and Safety Code) and shall be further limited to those drugs agreed upon by the nurse practitioner and physician and surgeon and specified in the standardized procedure.
(2)When Schedule II or III controlled substances, as defined in Sections 11055 and 11056, respectively, of the Health and Safety Code, are furnished or ordered by a nurse practitioner, the controlled substances shall be furnished or ordered in accordance with a patient-specific protocol approved by the treating or supervising physician. A copy of the section of the nurse practitioners standardized procedure relating to controlled substances shall be provided, upon request, to any licensed pharmacist who dispenses drugs or devices, when there is uncertainty about the nurse practitioner furnishing the order.
(g)(1)The board has certified in accordance with Section 2836.3 that the nurse practitioner has satisfactorily completed a course in pharmacology covering the drugs or devices to be furnished or ordered under this section.
(2)A physician and surgeon may determine the extent of supervision necessary pursuant to this section in the furnishing or ordering of drugs and devices.
(3)Nurse practitioners who are certified by the board and hold an active furnishing number, who are authorized through standardized procedures or protocols to furnish Schedule II controlled substances, and who are registered with the United States Drug Enforcement Administration, shall complete, as part of their continuing education requirements, a course including Schedule II controlled substances, and the risks of addiction associated with their use, based on the standards developed by the board. The board shall establish the requirements for satisfactory completion of this subdivision.
(h)Use of the term furnishing in this section, in health facilities defined in Section 1250 of the Health and Safety Code, shall include (1) the ordering of a drug or device in accordance with the standardized procedure and (2) transmitting an order of a supervising physician and surgeon.
(i)Drug order or order for purposes of this section means an order for medication which is dispensed to or for an ultimate user, issued by a nurse practitioner as an individual practitioner, within the meaning of Section 1306.02 of Title 21 of the Code of Federal Regulations. Notwithstanding any other provision of law, (1) a drug order issued pursuant to this section shall be treated in the same manner as a prescription of the supervising physician; (2) all references to prescription in this code and the Health and Safety Code shall include drug orders issued by nurse practitioners; and (3) the signature of a nurse practitioner on a drug order issued in accordance with this section shall be deemed to be the signature of a prescriber for purposes of this code and the Health and Safety Code.
SEC. 9.Section 3059 of the Business and Professions Code is amended to read:3059.(a)It is the intent of the Legislature that the public health and safety would be served by requiring all holders of licenses to practice optometry granted under this chapter to continue their education after receiving their licenses. The board shall adopt regulations that require, as a condition to the renewal thereof, that all holders of licenses submit proof satisfactory to the board that they have informed themselves of the developments in the practice of optometry occurring since the original issuance of their licenses by pursuing one or more courses of study satisfactory to the board or by other means deemed equivalent by the board.
(b)The board may, in accordance with the intent of this section, make exceptions from continuing education requirements for reasons of health, military service, or other good cause.
(c)If for good cause compliance cannot be met for the current year, the board may grant exemption of compliance for that year, provided that a plan of future compliance that includes current requirements as well as makeup of previous requirements is approved by the board.
(d)The board may require that proof of compliance with this section be submitted on an annual or biennial basis as determined by the board.
(e)An optometrist certified to use therapeutic pharmaceutical agents pursuant to Section 3041.3 shall complete a total of 50 hours of continuing education every two years in order to renew his or her certificate. Thirty-five of the required 50 hours of continuing education shall be on the diagnosis, treatment, and management of ocular disease in any combination of the following areas:
(1)Glaucoma.
(2)Ocular infection.
(3)Ocular inflammation.
(4)Topical steroids.
(5)Systemic medication.
(6)Pain medication, including the risks of addiction associated with the use of Schedule II drugs.
(f)The board shall encourage every optometrist to take a course or courses in pharmacology and pharmaceuticals as part of his or her continuing education.
(g)The board shall consider requiring courses in child abuse detection to be taken by those licensees whose practices are such that there is a likelihood of contact with abused or neglected children.
(h)The board shall consider requiring courses in elder abuse detection to be taken by those licensees whose practices are such that there is a likelihood of contact with abused or neglected elder persons.
SEC. 10.Section 3502.1 of the Business and Professions Code is amended to read:3502.1.(a)In addition to the services authorized in the regulations adopted by the Medical Board of California, and except as prohibited by Section 3502, while under the supervision of a licensed physician and surgeon or physicians and surgeons authorized by law to supervise a physician assistant, a physician assistant may administer or provide medication to a patient, or transmit orally, or in writing on a patients record or in a drug order, an order to a person who may lawfully furnish the medication or medical device pursuant to subdivisions (c) and (d).
(1)A supervising physician and surgeon who delegates authority to issue a drug order to a physician assistant may limit this authority by specifying the manner in which the physician assistant may issue delegated prescriptions.
(2)Each supervising physician and surgeon who delegates the authority to issue a drug order to a physician assistant shall first prepare and adopt, or adopt, a written, practice specific, formulary and protocols that specify all criteria for the use of a particular drug or device, and any contraindications for the selection. Protocols for Schedule II controlled substances shall address the diagnosis of illness, injury, or condition for which the Schedule II controlled substance is being administered, provided, or issued. The drugs listed in the protocols shall constitute the formulary and shall include only drugs that are appropriate for use in the type of practice engaged in by the supervising physician and surgeon. When issuing a drug order, the physician assistant is acting on behalf of and as an agent for a supervising physician and surgeon.
(b)Drug order, for purposes of this section, means an order for medication that is dispensed to or for a patient, issued and signed by a physician assistant acting as an individual practitioner within the meaning of Section 1306.02 of Title 21 of the Code of Federal Regulations. Notwithstanding any other provision of law, (1) a drug order issued pursuant to this section shall be treated in the same manner as a prescription or order of the supervising physician, (2) all references to prescription in this code and the Health and Safety Code shall include drug orders issued by physician assistants pursuant to authority granted by their supervising physicians and surgeons, and (3) the signature of a physician assistant on a drug order shall be deemed to be the signature of a prescriber for purposes of this code and the Health and Safety Code.
(c)A drug order for any patient cared for by the physician assistant that is issued by the physician assistant shall either be based on the protocols described in subdivision (a) or shall be approved by the supervising physician and surgeon before it is filled or carried out.
(1)A physician assistant shall not administer or provide a drug or issue a drug order for a drug other than for a drug listed in the formulary without advance approval from a supervising physician and surgeon for the particular patient. At the direction and under the supervision of a physician and surgeon, a physician assistant may hand to a patient of the supervising physician and surgeon a properly labeled prescription drug prepackaged by a physician and surgeon, manufacturer as defined in the Pharmacy Law, or a pharmacist.
(2)A physician assistant shall not administer, provide, or issue a drug order to a patient for Schedule II through Schedule V controlled substances without advance approval by a supervising physician and surgeon for that particular patient unless the physician assistant has completed an education course that covers controlled substances and that meets standards, including pharmacological content, approved by the board. The education course shall be provided either by an accredited continuing education provider or by an approved physician assistant training program. If the physician assistant will administer, provide, or issue a drug order for Schedule II controlled substances, the course shall contain a minimum of three hours exclusively on Schedule II controlled substances, including the risks of addiction associated with their use. Completion of the requirements set forth in this paragraph shall be verified and documented in the manner established by the board prior to the physician assistants use of a registration number issued by the United States Drug Enforcement Administration to the physician assistant to administer, provide, or issue a drug order to a patient for a controlled substance without advance approval by a supervising physician and surgeon for that particular patient.
(3)Any drug order issued by a physician assistant shall be subject to a reasonable quantitative limitation consistent with customary medical practice in the supervising physician and surgeons practice.
(d)A written drug order issued pursuant to subdivision (a), except a written drug order in a patients medical record in a health facility or medical practice, shall contain the printed name, address, and telephone number of the supervising physician and surgeon, the printed or stamped name and license number of the physician assistant, and the signature of the physician assistant. Further, a written drug order for a controlled substance, except a written drug order in a patients medical record in a health facility or a medical practice, shall include the federal controlled substances registration number of the physician assistant and shall otherwise comply with Section 11162.1 of the Health and Safety Code. Except as otherwise required for written drug orders for controlled substances under Section 11162.1 of the Health and Safety Code, the requirements of this subdivision may be met through stamping or otherwise imprinting on the supervising physician and surgeons prescription blank to show the name, license number, and if applicable, the federal controlled substances registration number of the physician assistant, and shall be signed by the physician assistant. When using a drug order, the physician assistant is acting on behalf of and as the agent of a supervising physician and surgeon.
(e)The supervising physician and surgeon shall use either of the following mechanisms to ensure adequate supervision of the administration, provision, or issuance by a physician assistant of a drug order to a patient for Schedule II controlled substances:
(1)The medical record of any patient cared for by a physician assistant for whom the physician assistants Schedule II drug order has been issued or carried out shall be reviewed, countersigned, and dated by a supervising physician and surgeon within seven days.
(2)If the physician assistant has documentation evidencing the successful completion of an education course that covers controlled substances, and that controlled substance education course (A) meets the standards, including pharmacological content, established in Sections 1399.610 and 1399.612 of Title 16 of the California Code of Regulations, and (B) is provided either by an accredited continuing education provider or by an approved physician assistant training program, the supervising physician and surgeon shall review, countersign, and date, within seven days, a sample consisting of the medical records of at least 20 percent of the patients cared for by the physician assistant for whom the physician assistants Schedule II drug order has been issued or carried out. Completion of the requirements set forth in this paragraph shall be verified and documented in the manner established in Section 1399.612 of Title 16 of the California Code of Regulations. Physician assistants who have a certificate of completion of the course described in paragraph (2) of subdivision (c) shall be deemed to have met the education course requirement of this subdivision.
(f)All physician assistants who are authorized by their supervising physicians to issue drug orders for controlled substances shall register with the United States Drug Enforcement Administration (DEA).
(g)The board shall consult with the Medical Board of California and report during its sunset review required by Article 7.5 (commencing with Section 9147.7) of Chapter 1.5 of Part 1 of Division 2 of Title 2 of the Government Code the impacts of exempting Schedule III and Schedule IV drug orders from the requirement for a physician and surgeon to review and countersign the affected medical record of a patient.
SEC. 11.Section 4076.7 is added to the Business and Professions Code, to read:4076.7.In addition to the requirements of Sections 4076 and 4076.5, whenever a prescription drug containing an opioid is dispensed to a patient for outpatient use, the pharmacy or practitioner dispensing the drug shall prominently display on the label or container, by means of a flag or other notification mechanism attached to the container, a notice that states Caution: Opioid. Risk of overdose and addiction.
SEC. 12.Section 49476 is added to the Education Code, to read:49476.(a)If a school district, charter school, or private school elects to offer an athletic program, the school district, charter school, or private school shall annually give the Opioid Factsheet for Patients published by the Centers for Disease Control and Prevention to each athlete. The athlete and, if the athlete is 17 years of age or younger, the athletes parent or guardian shall sign a document acknowledging receipt of the Opioid Factsheet for Patients and return that document to the school district, charter school, or private school before the athlete initiates practice or competition. The Opioid Factsheet for Patients may be sent and returned through an electronic medium, including, but not limited to, fax or email.
(b)This section does not apply to an athlete engaging in an athletic activity during the regular schoolday or as part of a physical education course required pursuant to subdivision (d) of Section 51220.
SEC. 13.Section 11158.1 is added to the Health and Safety Code, to read:11158.1.(a)Except when a patient is being treated as set forth in Sections 11159, 11159.2, and 11167.5, and Article 2 (commencing with Section 11215) of Chapter 5, pertaining to the treatment of addicts, or for a diagnosis of chronic intractable pain as used in Section 124960 of this code and Section 2241.5 of the Business and Professions Code, a prescriber shall discuss all of the following with the minor, the minors parent or guardian, or another adult authorized to consent to the minors medical treatment before directly dispensing or issuing for a minor the first prescription in a single course of treatment for a controlled substance containing an opioid:
(1)The risks of addiction and overdose associated with the use of opioids.
(2)The increased risk of addiction to an opioid to an individual who is suffering from both mental and substance abuse disorders.
(3)The danger of taking an opioid with a benzodiazepine, alcohol, or another central nervous system depressant.
(4)Any other information required by law.
(b)This section does not apply in any of the following circumstances:
(1)If the minors treatment includes emergency services and care as defined in Section 1317.1.
(2)If the minors treatment is associated with or incident to an emergency surgery, regardless of whether the surgery is performed on an inpatient or outpatient basis.
(3)If, in the prescribers professional judgment, fulfilling the requirements of subdivision (a) would be detrimental to the minors health or safety. safety, or in violation of the minors legal rights regarding confidentiality.
(c)Notwithstanding any other law, including Section 11374, failure to comply with this section shall not constitute a criminal offense.
SEC. 14.Section 124236 is added to the Health and Safety Code, to read:124236.(a)A youth sports organization, as defined in paragraph (3) of subdivision (b) of Section 124235, that elects to offer an athletic program shall annually give the Opioid Factsheet for Patients published by the Centers for Disease Control and Prevention to each athlete. The athlete and, if the athlete is 17 years of age or younger, the athletes parent or guardian shall sign a document acknowledging receipt of the Opioid Factsheet for Patients and return that document to the youth sports organization before the athlete initiates practice or competition. The Opioid Factsheet for Patients may be sent and returned through an electronic medium, including, but not limited to, fax or email.
(b)This section shall apply to all athletes participating in the activities of a youth sports organization, irrespective of their ages. This section shall not be construed to prohibit a youth sports organization, or any other appropriate entity, from adopting and enforcing rules intended to provide a higher standard of safety for athletes than the standard established under this section.
SEC. 15.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB 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 XIIIB of the California Constitution.
The Legislature finds and declares all of the following:
(a)Addiction, misuse, and overdose of prescription opioids is a public health crisis affecting both adults and children.
(b)Urgent measures are needed to better inform the public of the risks associated with both the long-term and short-term use of opioids in an effort to address this problem.
(c)Both short-term and long-term prescriptions of opioids to minors fall within situations that require counseling of patients and their parents or guardians by their prescribers.
(d)It is the intent of the Legislature to ensure that health care providers and young athletes receive necessary education on this topic.
SEC. 2.Section 1645 of the Business and Professions Code is amended to read:1645.(a)Effective with the 1974 license renewal period, if the board determines that the public health and safety would be served by requiring all holders of licenses under this chapter to continue their education after receiving a license, it may require, as a condition to the renewal thereof, that they submit assurances satisfactory to the board that they will, during the succeeding two-year period, inform themselves of the developments in the practice of dentistry occurring since the original issuance of their licenses by pursuing one or more courses of study satisfactory to the board or by other means deemed equivalent by the board.
The board shall adopt regulations providing for the suspension of the licenses at the end of the two-year period until compliance with the assurances provided for in this section is accomplished.
(b)The board may also, as a condition of license renewal, require licentiates to successfully complete a portion of the required continuing education hours in specific areas adopted in regulations by the board. The board may prescribe this mandatory coursework within the general areas of patient care, health and safety, law and ethics, and the risks of addiction associated with the use of Schedule II drugs. The mandatory coursework prescribed by the board shall not exceed fifteen hours per renewal period for dentists, and seven and one-half hours per renewal period for dental auxiliaries. Any mandatory coursework required by the board shall be credited toward the continuing education requirements established by the board pursuant to subdivision (a).
(c)For a retired dentist who provides only uncompensated care, the board shall not require more than 60 percent of the hours of continuing education that are required of other licensed dentists. Notwithstanding subdivision (b), all of the hours of continuing education as described in this subdivision shall be gained through courses related to the actual delivery of dental services to the patient or the community, as determined by the board. Nothing in this subdivision shall be construed to reduce any requirements imposed by the board pursuant to subdivision (b).
(d)The board shall report on the outcome of subdivision (c) pursuant to, and at the time of, its regular sunset review process, as provided in Section 1601.1.
SEC. 3.Section 2190.5 of the Business and Professions Code is amended to read:2190.5.(a)(1)All physicians and surgeons shall complete a mandatory continuing education 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 board may verify completion of this requirement on the renewal application form.
(2)For physicians and surgeons licensed on or after January 1, 2019, the course described in paragraph (1) shall also include the subject of the risks of addiction associated with the use of Schedule II drugs.
(b)By regulatory action, the board may exempt physicians and surgeons by practice status category from the requirement in subdivision (a) if the physician and surgeon does not engage in direct patient care, does not provide patient consultations, or does not reside in the State of California.
(c)This section shall not apply to physicians and surgeons practicing in pathology or radiology specialty areas.
SEC. 4.Section 2191 of the Business and Professions Code is amended to read:2191.(a)In determining its continuing education requirements, the board shall consider including a course in human sexuality, defined as the study of a human being as a sexual being and how he or she functions with respect thereto, and nutrition to be taken by those licensees whose practices may require knowledge in those areas.
(b)The board shall consider including a course in 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.
(c)The board shall consider including a course in 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.
(d)The board shall encourage every physician and surgeon to take nutrition as part of his or her continuing education, particularly a physician and surgeon involved in primary care.
(e)The board shall consider including a course in 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.
(f)In determining its continuing education requirements, the board shall consider including a course in 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.
(g)In determining its continuing education requirements, the board shall consider including a course in 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.
(h)In determining its continuing education requirements, the board shall consider including a course providing training and 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 board 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.
(i)In determining its continuing education requirements, the board shall consider including a course in the special care needs of individuals and their families facing end-of-life issues, including, but not limited to, all of the following:
(1)Pain and symptom management.
(2)The psycho-social dynamics of death.
(3)Dying and bereavement.
(4)Hospice care.
(j)In determining its continuing education requirements, the board shall give its highest priority to considering a course on pain management and the risks of addiction associated with the use of Schedule II drugs.
(k)In determining its continuing education requirements, the board shall consider including a course in geriatric care for emergency room physicians and surgeons.
SEC. 5.Section 2196.2 of the Business and Professions Code is amended to read:2196.2.The board shall periodically develop and disseminate information and educational material regarding pain management techniques and procedures, including the risks of addiction associated with the use of Schedule II drugs, to each licensed physician and surgeon and to each general acute care hospital in this state. The board shall consult with the State Department of Public Health in developing the materials to be distributed pursuant to this section.
SEC. 6.Section 2454.5 of the Business and Professions Code is amended to read:2454.5.In order to ensure the continuing competence of licensed osteopathic physicians and surgeons, the board shall adopt and administer standards for the continuing education of those licensees. The board shall require each licensed osteopathic physician and surgeon to demonstrate satisfaction of the continuing education requirements as a condition for the renewal of a license at intervals of not less than one year nor more than two years. Commencing January 1, 2018, the board shall require each licensed osteopathic physician and surgeon to complete a minimum of 100 hours of American Osteopathic Association continuing education hours during each two-year cycle, of which 40 hours shall be completed in American Osteopathic Association Category 1 continuing education hours and the remaining 60 hours shall be either American Osteopathic Association or American Medical Association accredited as a condition for renewal of an active license. Licensed osteopathic physicians and surgeons shall complete a course on the risks of addiction associated with the use of Schedule II drugs.
For purposes of this section, American Osteopathic Association Category 1 means continuing education activities and programs approved for Category 1 credit by the Committee on Continuing Medical Education of the American Osteopathic Association.
SEC. 7.Section 2746.51 of the Business and Professions Code is amended to read:2746.51.(a)Neither this chapter nor any other provision of law shall be construed to prohibit a certified nurse-midwife from furnishing or ordering drugs or devices, including controlled substances classified in Schedule II, III, IV, or V under the California Uniform Controlled Substances Act (Division 10 (commencing with Section 11000) of the Health and Safety Code), when all of the following apply:
(1)The drugs or devices are furnished or ordered incidentally to the provision of any of the following:
(A)Family planning services, as defined in Section 14503 of the Welfare and Institutions Code.
(B)Routine health care or perinatal care, as defined in subdivision (d) of Section 123485 of the Health and Safety Code.
(C)Care rendered, consistent with the certified nurse-midwifes educational preparation or for which clinical competency has been established and maintained, to persons within a facility specified in subdivision (a), (b), (c), (d), (i), or (j) of Section 1206 of the Health and Safety Code, a clinic as specified in Section 1204 of the Health and Safety Code, a general acute care hospital as defined in subdivision (a) of Section 1250 of the Health and Safety Code, a licensed birth center as defined in Section 1204.3 of the Health and Safety Code, or a special hospital specified as a maternity hospital in subdivision (f) of Section 1250 of the Health and Safety Code.
(2)The drugs or devices are furnished or ordered by a certified nurse-midwife in accordance with standardized procedures or protocols. For purposes of this section, standardized procedure means a document, including protocols, developed and approved by the supervising physician and surgeon, the certified nurse-midwife, and the facility administrator or his or her designee. The standardized procedure covering the furnishing or ordering of drugs or devices shall specify all of the following:
(A)Which certified nurse-midwife may furnish or order drugs or devices.
(B)Which drugs or devices may be furnished or ordered and under what circumstances.
(C)The extent of physician and surgeon supervision.
(D)The method of periodic review of the certified nurse-midwifes competence, including peer review, and review of the provisions of the standardized procedure.
(3)If Schedule II or III controlled substances, as defined in Sections 11055 and 11056 of the Health and Safety Code, are furnished or ordered by a certified nurse-midwife, the controlled substances shall be furnished or ordered in accordance with a patient-specific protocol approved by the treating or supervising physician and surgeon. For Schedule II controlled substance protocols, the provision for furnishing the Schedule II controlled substance shall address the diagnosis of the illness, injury, or condition for which the Schedule II controlled substance is to be furnished.
(4)The furnishing or ordering of drugs or devices by a certified nurse-midwife occurs under physician and surgeon supervision. For purposes of this section, no physician and surgeon shall supervise more than four certified nurse-midwives at one time. Physician and surgeon supervision shall not be construed to require the physical presence of the physician, but does include all of the following:
(A)Collaboration on the development of the standardized procedure or protocol.
(B)Approval of the standardized procedure or protocol.
(C)Availability by telephonic contact at the time of patient examination by the certified nurse-midwife.
(b)(1)The furnishing or ordering of drugs or devices by a certified nurse-midwife is conditional on the issuance by the board of a number to the applicant who has successfully completed the requirements of paragraph (2). The number shall be included on all transmittals of orders for drugs or devices by the certified nurse-midwife. The board shall maintain a list of the certified nurse-midwives that it has certified pursuant to this paragraph and the number it has issued to each one. The board shall make the list available to the California State Board of Pharmacy upon its request. Every certified nurse-midwife who is authorized pursuant to this section to furnish or issue a drug order for a controlled substance shall register with the United States Drug Enforcement Administration.
(2)The board has certified in accordance with paragraph (1) that the certified nurse-midwife has satisfactorily completed a course in pharmacology covering the drugs or devices to be furnished or ordered under this section, including the risks of addiction and neonatal abstinence syndrome associated with the use of opioids. The board shall establish the requirements for satisfactory completion of this paragraph.
(3)A physician and surgeon may determine the extent of supervision necessary pursuant to this section in the furnishing or ordering of drugs and devices.
(4)A copy of the standardized procedure or protocol relating to the furnishing or ordering of controlled substances by a certified nurse-midwife shall be provided upon request to any licensed pharmacist who is uncertain of the authority of the certified nurse-midwife to perform these functions.
(5)Certified nurse-midwives who are certified by the board and hold an active furnishing number, who are currently authorized through standardized procedures or protocols to furnish Schedule II controlled substances, and who are registered with the United States Drug Enforcement Administration shall provide documentation of continuing education specific to the use of Schedule II controlled substances in settings other than a hospital based on standards developed by the board.
(c)Drugs or devices furnished or ordered by a certified nurse-midwife may include Schedule II controlled substances under the California Uniform Controlled Substances Act (Division 10 (commencing with Section 11000) of the Health and Safety Code) under the following conditions:
(1)The drugs and devices are furnished or ordered in accordance with requirements referenced in paragraphs (2) to (4), inclusive, of subdivision (a) and in paragraphs (1) to (3), inclusive, of subdivision (b).
(2)When Schedule II controlled substances, as defined in Section 11055 of the Health and Safety Code, are furnished or ordered by a certified nurse-midwife, the controlled substances shall be furnished or ordered in accordance with a patient-specific protocol approved by the treating or supervising physician and surgeon.
(d)Furnishing of drugs or devices by a certified nurse-midwife means the act of making a pharmaceutical agent or agents available to the patient in strict accordance with a standardized procedure or protocol. Use of the term furnishing in this section shall include the following:
(1)The ordering of a drug or device in accordance with the standardized procedure or protocol.
(2)Transmitting an order of a supervising physician and surgeon.
(e)Drug order or order for purposes of this section means an order for medication or for a drug or device that is dispensed to or for an ultimate user, issued by a certified nurse-midwife as an individual practitioner, within the meaning of Section 1306.03 of Title 21 of the Code of Federal Regulations. Notwithstanding any other provision of law, (1) a drug order issued pursuant to this section shall be treated in the same manner as a prescription of the supervising physician; (2) all references to prescription in this code and the Health and Safety Code shall include drug orders issued by certified nurse-midwives; and (3) the signature of a certified nurse-midwife on a drug order issued in accordance with this section shall be deemed to be the signature of a prescriber for purposes of this code and the Health and Safety Code.
SEC. 8.Section 2836.1 of the Business and Professions Code is amended to read:2836.1.Neither this chapter nor any other provision of law shall be construed to prohibit a nurse practitioner from furnishing or ordering drugs or devices when all of the following apply:
(a)The drugs or devices are furnished or ordered by a nurse practitioner in accordance with standardized procedures or protocols developed by the nurse practitioner and the supervising physician and surgeon when the drugs or devices furnished or ordered are consistent with the practitioners educational preparation or for which clinical competency has been established and maintained.
(b)The nurse practitioner is functioning pursuant to standardized procedure, as defined by Section 2725, or protocol. The standardized procedure or protocol shall be developed and approved by the supervising physician and surgeon, the nurse practitioner, and the facility administrator or the designee.
(c)(1)The standardized procedure or protocol covering the furnishing of drugs or devices shall specify which nurse practitioners may furnish or order drugs or devices, which drugs or devices may be furnished or ordered, under what circumstances, the extent of physician and surgeon supervision, the method of periodic review of the nurse practitioners competence, including peer review, and review of the provisions of the standardized procedure.
(2)In addition to the requirements in paragraph (1), for Schedule II controlled substance protocols, the provision for furnishing Schedule II controlled substances shall address the diagnosis of the illness, injury, or condition for which the Schedule II controlled substance is to be furnished.
(d)The furnishing or ordering of drugs or devices by a nurse practitioner occurs under physician and surgeon supervision. Physician and surgeon supervision shall not be construed to require the physical presence of the physician, but does include (1) collaboration on the development of the standardized procedure, (2) approval of the standardized procedure, and (3) availability by telephonic contact at the time of patient examination by the nurse practitioner.
(e)For purposes of this section, no physician and surgeon shall supervise more than four nurse practitioners at one time.
(f)(1)Drugs or devices furnished or ordered by a nurse practitioner may include Schedule II through Schedule V controlled substances under the California Uniform Controlled Substances Act (Division 10 (commencing with Section 11000) of the Health and Safety Code) and shall be further limited to those drugs agreed upon by the nurse practitioner and physician and surgeon and specified in the standardized procedure.
(2)When Schedule II or III controlled substances, as defined in Sections 11055 and 11056, respectively, of the Health and Safety Code, are furnished or ordered by a nurse practitioner, the controlled substances shall be furnished or ordered in accordance with a patient-specific protocol approved by the treating or supervising physician. A copy of the section of the nurse practitioners standardized procedure relating to controlled substances shall be provided, upon request, to any licensed pharmacist who dispenses drugs or devices, when there is uncertainty about the nurse practitioner furnishing the order.
(g)(1)The board has certified in accordance with Section 2836.3 that the nurse practitioner has satisfactorily completed a course in pharmacology covering the drugs or devices to be furnished or ordered under this section.
(2)A physician and surgeon may determine the extent of supervision necessary pursuant to this section in the furnishing or ordering of drugs and devices.
(3)Nurse practitioners who are certified by the board and hold an active furnishing number, who are authorized through standardized procedures or protocols to furnish Schedule II controlled substances, and who are registered with the United States Drug Enforcement Administration, shall complete, as part of their continuing education requirements, a course including Schedule II controlled substances, and the risks of addiction associated with their use, based on the standards developed by the board. The board shall establish the requirements for satisfactory completion of this subdivision.
(h)Use of the term furnishing in this section, in health facilities defined in Section 1250 of the Health and Safety Code, shall include (1) the ordering of a drug or device in accordance with the standardized procedure and (2) transmitting an order of a supervising physician and surgeon.
(i)Drug order or order for purposes of this section means an order for medication which is dispensed to or for an ultimate user, issued by a nurse practitioner as an individual practitioner, within the meaning of Section 1306.02 of Title 21 of the Code of Federal Regulations. Notwithstanding any other provision of law, (1) a drug order issued pursuant to this section shall be treated in the same manner as a prescription of the supervising physician; (2) all references to prescription in this code and the Health and Safety Code shall include drug orders issued by nurse practitioners; and (3) the signature of a nurse practitioner on a drug order issued in accordance with this section shall be deemed to be the signature of a prescriber for purposes of this code and the Health and Safety Code.
SEC. 9.Section 3059 of the Business and Professions Code is amended to read:3059.(a)It is the intent of the Legislature that the public health and safety would be served by requiring all holders of licenses to practice optometry granted under this chapter to continue their education after receiving their licenses. The board shall adopt regulations that require, as a condition to the renewal thereof, that all holders of licenses submit proof satisfactory to the board that they have informed themselves of the developments in the practice of optometry occurring since the original issuance of their licenses by pursuing one or more courses of study satisfactory to the board or by other means deemed equivalent by the board.
(b)The board may, in accordance with the intent of this section, make exceptions from continuing education requirements for reasons of health, military service, or other good cause.
(c)If for good cause compliance cannot be met for the current year, the board may grant exemption of compliance for that year, provided that a plan of future compliance that includes current requirements as well as makeup of previous requirements is approved by the board.
(d)The board may require that proof of compliance with this section be submitted on an annual or biennial basis as determined by the board.
(e)An optometrist certified to use therapeutic pharmaceutical agents pursuant to Section 3041.3 shall complete a total of 50 hours of continuing education every two years in order to renew his or her certificate. Thirty-five of the required 50 hours of continuing education shall be on the diagnosis, treatment, and management of ocular disease in any combination of the following areas:
(1)Glaucoma.
(2)Ocular infection.
(3)Ocular inflammation.
(4)Topical steroids.
(5)Systemic medication.
(6)Pain medication, including the risks of addiction associated with the use of Schedule II drugs.
(f)The board shall encourage every optometrist to take a course or courses in pharmacology and pharmaceuticals as part of his or her continuing education.
(g)The board shall consider requiring courses in child abuse detection to be taken by those licensees whose practices are such that there is a likelihood of contact with abused or neglected children.
(h)The board shall consider requiring courses in elder abuse detection to be taken by those licensees whose practices are such that there is a likelihood of contact with abused or neglected elder persons.
SEC. 10.Section 3502.1 of the Business and Professions Code is amended to read:3502.1.(a)In addition to the services authorized in the regulations adopted by the Medical Board of California, and except as prohibited by Section 3502, while under the supervision of a licensed physician and surgeon or physicians and surgeons authorized by law to supervise a physician assistant, a physician assistant may administer or provide medication to a patient, or transmit orally, or in writing on a patients record or in a drug order, an order to a person who may lawfully furnish the medication or medical device pursuant to subdivisions (c) and (d).
(1)A supervising physician and surgeon who delegates authority to issue a drug order to a physician assistant may limit this authority by specifying the manner in which the physician assistant may issue delegated prescriptions.
(2)Each supervising physician and surgeon who delegates the authority to issue a drug order to a physician assistant shall first prepare and adopt, or adopt, a written, practice specific, formulary and protocols that specify all criteria for the use of a particular drug or device, and any contraindications for the selection. Protocols for Schedule II controlled substances shall address the diagnosis of illness, injury, or condition for which the Schedule II controlled substance is being administered, provided, or issued. The drugs listed in the protocols shall constitute the formulary and shall include only drugs that are appropriate for use in the type of practice engaged in by the supervising physician and surgeon. When issuing a drug order, the physician assistant is acting on behalf of and as an agent for a supervising physician and surgeon.
(b)Drug order, for purposes of this section, means an order for medication that is dispensed to or for a patient, issued and signed by a physician assistant acting as an individual practitioner within the meaning of Section 1306.02 of Title 21 of the Code of Federal Regulations. Notwithstanding any other provision of law, (1) a drug order issued pursuant to this section shall be treated in the same manner as a prescription or order of the supervising physician, (2) all references to prescription in this code and the Health and Safety Code shall include drug orders issued by physician assistants pursuant to authority granted by their supervising physicians and surgeons, and (3) the signature of a physician assistant on a drug order shall be deemed to be the signature of a prescriber for purposes of this code and the Health and Safety Code.
(c)A drug order for any patient cared for by the physician assistant that is issued by the physician assistant shall either be based on the protocols described in subdivision (a) or shall be approved by the supervising physician and surgeon before it is filled or carried out.
(1)A physician assistant shall not administer or provide a drug or issue a drug order for a drug other than for a drug listed in the formulary without advance approval from a supervising physician and surgeon for the particular patient. At the direction and under the supervision of a physician and surgeon, a physician assistant may hand to a patient of the supervising physician and surgeon a properly labeled prescription drug prepackaged by a physician and surgeon, manufacturer as defined in the Pharmacy Law, or a pharmacist.
(2)A physician assistant shall not administer, provide, or issue a drug order to a patient for Schedule II through Schedule V controlled substances without advance approval by a supervising physician and surgeon for that particular patient unless the physician assistant has completed an education course that covers controlled substances and that meets standards, including pharmacological content, approved by the board. The education course shall be provided either by an accredited continuing education provider or by an approved physician assistant training program. If the physician assistant will administer, provide, or issue a drug order for Schedule II controlled substances, the course shall contain a minimum of three hours exclusively on Schedule II controlled substances, including the risks of addiction associated with their use. Completion of the requirements set forth in this paragraph shall be verified and documented in the manner established by the board prior to the physician assistants use of a registration number issued by the United States Drug Enforcement Administration to the physician assistant to administer, provide, or issue a drug order to a patient for a controlled substance without advance approval by a supervising physician and surgeon for that particular patient.
(3)Any drug order issued by a physician assistant shall be subject to a reasonable quantitative limitation consistent with customary medical practice in the supervising physician and surgeons practice.
(d)A written drug order issued pursuant to subdivision (a), except a written drug order in a patients medical record in a health facility or medical practice, shall contain the printed name, address, and telephone number of the supervising physician and surgeon, the printed or stamped name and license number of the physician assistant, and the signature of the physician assistant. Further, a written drug order for a controlled substance, except a written drug order in a patients medical record in a health facility or a medical practice, shall include the federal controlled substances registration number of the physician assistant and shall otherwise comply with Section 11162.1 of the Health and Safety Code. Except as otherwise required for written drug orders for controlled substances under Section 11162.1 of the Health and Safety Code, the requirements of this subdivision may be met through stamping or otherwise imprinting on the supervising physician and surgeons prescription blank to show the name, license number, and if applicable, the federal controlled substances registration number of the physician assistant, and shall be signed by the physician assistant. When using a drug order, the physician assistant is acting on behalf of and as the agent of a supervising physician and surgeon.
(e)The supervising physician and surgeon shall use either of the following mechanisms to ensure adequate supervision of the administration, provision, or issuance by a physician assistant of a drug order to a patient for Schedule II controlled substances:
(1)The medical record of any patient cared for by a physician assistant for whom the physician assistants Schedule II drug order has been issued or carried out shall be reviewed, countersigned, and dated by a supervising physician and surgeon within seven days.
(2)If the physician assistant has documentation evidencing the successful completion of an education course that covers controlled substances, and that controlled substance education course (A) meets the standards, including pharmacological content, established in Sections 1399.610 and 1399.612 of Title 16 of the California Code of Regulations, and (B) is provided either by an accredited continuing education provider or by an approved physician assistant training program, the supervising physician and surgeon shall review, countersign, and date, within seven days, a sample consisting of the medical records of at least 20 percent of the patients cared for by the physician assistant for whom the physician assistants Schedule II drug order has been issued or carried out. Completion of the requirements set forth in this paragraph shall be verified and documented in the manner established in Section 1399.612 of Title 16 of the California Code of Regulations. Physician assistants who have a certificate of completion of the course described in paragraph (2) of subdivision (c) shall be deemed to have met the education course requirement of this subdivision.
(f)All physician assistants who are authorized by their supervising physicians to issue drug orders for controlled substances shall register with the United States Drug Enforcement Administration (DEA).
(g)The board shall consult with the Medical Board of California and report during its sunset review required by Article 7.5 (commencing with Section 9147.7) of Chapter 1.5 of Part 1 of Division 2 of Title 2 of the Government Code the impacts of exempting Schedule III and Schedule IV drug orders from the requirement for a physician and surgeon to review and countersign the affected medical record of a patient.
SEC. 11.Section 4076.7 is added to the Business and Professions Code, to read:4076.7.In addition to the requirements of Sections 4076 and 4076.5, whenever a prescription drug containing an opioid is dispensed to a patient for outpatient use, the pharmacy or practitioner dispensing the drug shall prominently display on the label or container container, by means of a flag or other notification mechanism attached to the container, a notice that states Caution: Opioid. Risk of overdose and addiction.
SEC. 12.Section 49476 is added to the Education Code, to read:49476.(a)If a school district, charter school, or private school elects to offer an athletic program, the school district, charter school, or private school shall annually give the Opioid Factsheet for Patients published by the Centers for Disease Control and Prevention to each athlete. The athlete and, if the athlete is 17 years of age or younger, the athletes parent or guardian shall sign a document acknowledging receipt of the Opioid Factsheet for Patients and return that document to the school district, charter school, or private school before the athlete initiates practice or competition. The Opioid Factsheet for Patients may be sent and returned through an electronic medium, including, but not limited to, fax or email.
(b)This section does not apply to an athlete engaging in an athletic activity during the regular schoolday or as part of a physical education course required pursuant to subdivision (d) of Section 51220.
SEC. 13.Section 11158.1 is added to the Health and Safety Code, to read:11158.1.(a)Except when a patient is being treated as set forth in Sections 11159, 11159.2, and 11167.5, and Article 2 (commencing with Section 11215) of Chapter 5, pertaining to the treatment of addicts, or for a diagnosis of chronic intractable pain as used in Section 124960 of this code and Section 2241.5 of the Business and Professions Code, a prescriber shall discuss all of the following with the minor, the minors parent or guardian, or another adult authorized to consent to the minors medical treatment before directly dispensing or issuing for a minor the first prescription in a single course of treatment for a controlled substance containing an opioid:
(1)The risks of addiction and overdose associated with the use of opioids.
(2)The increased risk of addiction to an opioid to an individual who is suffering from both mental and substance abuse disorders.
(3)The danger of taking an opioid with a benzodiazepine, alcohol, or another central nervous system depressant.
(4)Any other information required by law.
(b)Subdivision (a) This section does not apply in any of the following circumstances:
(1)If the minors treatment is associated with or incident to a medical emergency. includes emergency services and care as defined in Section 1317.1.
(2)If the minors treatment is associated with or incident to an emergency surgery, regardless of whether the surgery is performed on an inpatient or outpatient basis.
(3)If, in the prescribers professional judgment, fulfilling the requirements of subdivision (a) would be detrimental to the minors health or safety.
(c)Notwithstanding any other law, including Section 11374, failure to comply with this section shall not constitute a criminal offense.
SEC. 14.Section 124236 is added to the Health and Safety Code, to read:124236.(a)A youth sports organization, as defined in paragraph (3) of subdivision (b) of Section 124235, that elects to offer an athletic program shall annually give the Opioid Factsheet for Patients published by the Centers for Disease Control and Prevention to each athlete. The athlete and, if the athlete is 17 years of age or younger, the athletes parent or guardian shall sign a document acknowledging receipt of the Opioid Factsheet for Patients and return that document to the school district, charter school, or private school youth sports organization before the athlete initiates practice or competition. The Opioid Factsheet for Patients may be sent and returned through an electronic medium, including, but not limited to, fax or email.
(b)This section shall apply to all athletes participating in the activities of a youth sports organization, irrespective of their ages. This section shall not be construed to prohibit a youth sports organization, or any other appropriate entity, from adopting and enforcing rules intended to provide a higher standard of safety for athletes than the standard established under this section.
SEC. 15.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB 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 XIIIB of the California Constitution.
The Legislature finds and declares all of the following:
(a)Addiction, misuse, and overdose of prescription opioids is a public health crisis affecting both adults and children.
(b)Urgent measures are needed to better inform the public of the risks associated with both the long-term and short-term use of opioids in an effort to address this problem.
(c)Both short-term and long-term prescriptions of opioids to minors fall within situations that require counseling and written consent under the Guidelines for Prescribing Controlled Substances for Pain issued by the Medical Board of California. of patients and their parents or guardians by their prescribers.
(d)It is the intent of the Legislature to codify the Medical Board of Californias Guidelines for Prescribing Controlled Substances for Pain, as it relates to patient counseling, consent, and pain management agreements, and to ensure that health care providers and young athletes receive necessary education on this topic.
SEC. 2.Section 1645 of the Business and Professions Code is amended to read:1645.(a)Effective with the 1974 license renewal period, if the board determines that the public health and safety would be served by requiring all holders of licenses under this chapter to continue their education after receiving a license, it may require, as a condition to the renewal thereof, that they submit assurances satisfactory to the board that they will, during the succeeding two-year period, inform themselves of the developments in the practice of dentistry occurring since the original issuance of their licenses by pursuing one or more courses of study satisfactory to the board or by other means deemed equivalent by the board.
The board shall adopt regulations providing for the suspension of the licenses at the end of the two-year period until compliance with the assurances provided for in this section is accomplished.
(b)The board may also, as a condition of license renewal, require licentiates to successfully complete a portion of the required continuing education hours in specific areas adopted in regulations by the board. The board may prescribe this mandatory coursework within the general areas of patient care, health and safety, law and ethics, and the risks of addiction associated with the use of Schedule II drugs. The mandatory coursework prescribed by the board shall not exceed fifteen hours per renewal period for dentists, and seven and one-half hours per renewal period for dental auxiliaries. Any mandatory coursework required by the board shall be credited toward the continuing education requirements established by the board pursuant to subdivision (a).
(c)For a retired dentist who provides only uncompensated care, the board shall not require more than 60 percent of the hours of continuing education that are required of other licensed dentists. Notwithstanding subdivision (b), all of the hours of continuing education as described in this subdivision shall be gained through courses related to the actual delivery of dental services to the patient or the community, as determined by the board. Nothing in this subdivision shall be construed to reduce any requirements imposed by the board pursuant to subdivision (b).
(d)The board shall report on the outcome of subdivision (c) pursuant to, and at the time of, its regular sunset review process, as provided in Section 1601.1.
SEC. 3.Section 2190.5 of the Business and Professions Code is amended to read:2190.5.(a)(1)All physicians and surgeons shall complete a mandatory continuing education 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 board may verify completion of this requirement on the renewal application form.
(2)For physicians and surgeons licensed on or after January 1, 2019, the course described in paragraph (1) shall also include the subject of the risks of addiction associated with the use of Schedule II drugs.
(b)By regulatory action, the board may exempt physicians and surgeons by practice status category from the requirement in subdivision (a) if the physician and surgeon does not engage in direct patient care, does not provide patient consultations, or does not reside in the State of California.
(c)This section shall not apply to physicians and surgeons practicing in pathology or radiology specialty areas.
SEC. 4.Section 2191 of the Business and Professions Code is amended to read:2191.(a)In determining its continuing education requirements, the board shall consider including a course in human sexuality, defined as the study of a human being as a sexual being and how he or she functions with respect thereto, and nutrition to be taken by those licensees whose practices may require knowledge in those areas.
(b)The board shall consider including a course in 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.
(c)The board shall consider including a course in 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.
(d)The board shall encourage every physician and surgeon to take nutrition as part of his or her continuing education, particularly a physician and surgeon involved in primary care.
(e)The board shall consider including a course in 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.
(f)In determining its continuing education requirements, the board shall consider including a course in 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.
(g)In determining its continuing education requirements, the board shall consider including a course in 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.
(h)In determining its continuing education requirements, the board shall consider including a course providing training and 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 board 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.
(i)In determining its continuing education requirements, the board shall consider including a course in the special care needs of individuals and their families facing end-of-life issues, including, but not limited to, all of the following:
(1)Pain and symptom management.
(2)The psycho-social dynamics of death.
(3)Dying and bereavement.
(4)Hospice care.
(j)In determining its continuing education requirements, the board shall give its highest priority to considering a course on pain management and the risks of addiction associated with the use of Schedule II drugs.
(k)In determining its continuing education requirements, the board shall consider including a course in geriatric care for emergency room physicians and surgeons.
SEC. 5.Section 2196.2 of the Business and Professions Code is amended to read:2196.2.The board shall periodically develop and disseminate information and educational material regarding pain management techniques and procedures, including the risks of addiction associated with the use of Schedule II drugs, to each licensed physician and surgeon and to each general acute care hospital in this state. The board shall consult with the State Department of Public Health in developing the materials to be distributed pursuant to this section.
SEC. 6.Section 2454.5 of the Business and Professions Code is amended to read:2454.5.In order to ensure the continuing competence of licensed osteopathic physicians and surgeons, the board shall adopt and administer standards for the continuing education of those licensees. The board shall require each licensed osteopathic physician and surgeon to demonstrate satisfaction of the continuing education requirements as a condition for the renewal of a license at intervals of not less than one year nor more than two years. Commencing January 1, 2018, the board shall require each licensed osteopathic physician and surgeon to complete a minimum of 100 hours of American Osteopathic Association continuing education hours during each two-year cycle, of which 40 hours shall be completed in American Osteopathic Association Category 1 continuing education hours and the remaining 60 hours shall be either American Osteopathic Association or American Medical Association accredited as a condition for renewal of an active license. Licensed osteopathic physicians and surgeons shall complete a course on the risks of addiction associated with the use of Schedule II drugs.
For purposes of this section, American Osteopathic Association Category 1 means continuing education activities and programs approved for Category 1 credit by the Committee on Continuing Medical Education of the American Osteopathic Association.
SEC. 7.Section 2746.51 of the Business and Professions Code is amended to read:2746.51.(a)Neither this chapter nor any other provision of law shall be construed to prohibit a certified nurse-midwife from furnishing or ordering drugs or devices, including controlled substances classified in Schedule II, III, IV, or V under the California Uniform Controlled Substances Act (Division 10 (commencing with Section 11000) of the Health and Safety Code), when all of the following apply:
(1)The drugs or devices are furnished or ordered incidentally to the provision of any of the following:
(A)Family planning services, as defined in Section 14503 of the Welfare and Institutions Code.
(B)Routine health care or perinatal care, as defined in subdivision (d) of Section 123485 of the Health and Safety Code.
(C)Care rendered, consistent with the certified nurse-midwifes educational preparation or for which clinical competency has been established and maintained, to persons within a facility specified in subdivision (a), (b), (c), (d), (i), or (j) of Section 1206 of the Health and Safety Code, a clinic as specified in Section 1204 of the Health and Safety Code, a general acute care hospital as defined in subdivision (a) of Section 1250 of the Health and Safety Code, a licensed birth center as defined in Section 1204.3 of the Health and Safety Code, or a special hospital specified as a maternity hospital in subdivision (f) of Section 1250 of the Health and Safety Code.
(2)The drugs or devices are furnished or ordered by a certified nurse-midwife in accordance with standardized procedures or protocols. For purposes of this section, standardized procedure means a document, including protocols, developed and approved by the supervising physician and surgeon, the certified nurse-midwife, and the facility administrator or his or her designee. The standardized procedure covering the furnishing or ordering of drugs or devices shall specify all of the following:
(A)Which certified nurse-midwife may furnish or order drugs or devices.
(B)Which drugs or devices may be furnished or ordered and under what circumstances.
(C)The extent of physician and surgeon supervision.
(D)The method of periodic review of the certified nurse-midwifes competence, including peer review, and review of the provisions of the standardized procedure.
(3)If Schedule II or III controlled substances, as defined in Sections 11055 and 11056 of the Health and Safety Code, are furnished or ordered by a certified nurse-midwife, the controlled substances shall be furnished or ordered in accordance with a patient-specific protocol approved by the treating or supervising physician and surgeon. For Schedule II controlled substance protocols, the provision for furnishing the Schedule II controlled substance shall address the diagnosis of the illness, injury, or condition for which the Schedule II controlled substance is to be furnished.
(4)The furnishing or ordering of drugs or devices by a certified nurse-midwife occurs under physician and surgeon supervision. For purposes of this section, no physician and surgeon shall supervise more than four certified nurse-midwives at one time. Physician and surgeon supervision shall not be construed to require the physical presence of the physician, but does include all of the following:
(A)Collaboration on the development of the standardized procedure or protocol.
(B)Approval of the standardized procedure or protocol.
(C)Availability by telephonic contact at the time of patient examination by the certified nurse-midwife.
(b)(1)The furnishing or ordering of drugs or devices by a certified nurse-midwife is conditional on the issuance by the board of a number to the applicant who has successfully completed the requirements of paragraph (2). The number shall be included on all transmittals of orders for drugs or devices by the certified nurse-midwife. The board shall maintain a list of the certified nurse-midwives that it has certified pursuant to this paragraph and the number it has issued to each one. The board shall make the list available to the California State Board of Pharmacy upon its request. Every certified nurse-midwife who is authorized pursuant to this section to furnish or issue a drug order for a controlled substance shall register with the United States Drug Enforcement Administration.
(2)The board has certified in accordance with paragraph (1) that the certified nurse-midwife has satisfactorily completed a course in pharmacology covering the drugs or devices to be furnished or ordered under this section, including the risks of addiction and neonatal abstinence syndrome associated with the use of opioids. The board shall establish the requirements for satisfactory completion of this paragraph.
(3)A physician and surgeon may determine the extent of supervision necessary pursuant to this section in the furnishing or ordering of drugs and devices.
(4)A copy of the standardized procedure or protocol relating to the furnishing or ordering of controlled substances by a certified nurse-midwife shall be provided upon request to any licensed pharmacist who is uncertain of the authority of the certified nurse-midwife to perform these functions.
(5)Certified nurse-midwives who are certified by the board and hold an active furnishing number, who are currently authorized through standardized procedures or protocols to furnish Schedule II controlled substances, and who are registered with the United States Drug Enforcement Administration shall provide documentation of continuing education specific to the use of Schedule II controlled substances in settings other than a hospital based on standards developed by the board.
(c)Drugs or devices furnished or ordered by a certified nurse-midwife may include Schedule II controlled substances under the California Uniform Controlled Substances Act (Division 10 (commencing with Section 11000) of the Health and Safety Code) under the following conditions:
(1)The drugs and devices are furnished or ordered in accordance with requirements referenced in paragraphs (2) to (4), inclusive, of subdivision (a) and in paragraphs (1) to (3), inclusive, of subdivision (b).
(2)When Schedule II controlled substances, as defined in Section 11055 of the Health and Safety Code, are furnished or ordered by a certified nurse-midwife, the controlled substances shall be furnished or ordered in accordance with a patient-specific protocol approved by the treating or supervising physician and surgeon.
(d)Furnishing of drugs or devices by a certified nurse-midwife means the act of making a pharmaceutical agent or agents available to the patient in strict accordance with a standardized procedure or protocol. Use of the term furnishing in this section shall include the following:
(1)The ordering of a drug or device in accordance with the standardized procedure or protocol.
(2)Transmitting an order of a supervising physician and surgeon.
(e)Drug order or order for purposes of this section means an order for medication or for a drug or device that is dispensed to or for an ultimate user, issued by a certified nurse-midwife as an individual practitioner, within the meaning of Section 1306.03 of Title 21 of the Code of Federal Regulations. Notwithstanding any other provision of law, (1) a drug order issued pursuant to this section shall be treated in the same manner as a prescription of the supervising physician; (2) all references to prescription in this code and the Health and Safety Code shall include drug orders issued by certified nurse-midwives; and (3) the signature of a certified nurse-midwife on a drug order issued in accordance with this section shall be deemed to be the signature of a prescriber for purposes of this code and the Health and Safety Code.
SEC. 8.Section 2836.1 of the Business and Professions Code is amended to read:2836.1.Neither this chapter nor any other provision of law shall be construed to prohibit a nurse practitioner from furnishing or ordering drugs or devices when all of the following apply:
(a)The drugs or devices are furnished or ordered by a nurse practitioner in accordance with standardized procedures or protocols developed by the nurse practitioner and the supervising physician and surgeon when the drugs or devices furnished or ordered are consistent with the practitioners educational preparation or for which clinical competency has been established and maintained.
(b)The nurse practitioner is functioning pursuant to standardized procedure, as defined by Section 2725, or protocol. The standardized procedure or protocol shall be developed and approved by the supervising physician and surgeon, the nurse practitioner, and the facility administrator or the designee.
(c)(1)The standardized procedure or protocol covering the furnishing of drugs or devices shall specify which nurse practitioners may furnish or order drugs or devices, which drugs or devices may be furnished or ordered, under what circumstances, the extent of physician and surgeon supervision, the method of periodic review of the nurse practitioners competence, including peer review, and review of the provisions of the standardized procedure.
(2)In addition to the requirements in paragraph (1), for Schedule II controlled substance protocols, the provision for furnishing Schedule II controlled substances shall address the diagnosis of the illness, injury, or condition for which the Schedule II controlled substance is to be furnished.
(d)The furnishing or ordering of drugs or devices by a nurse practitioner occurs under physician and surgeon supervision. Physician and surgeon supervision shall not be construed to require the physical presence of the physician, but does include (1) collaboration on the development of the standardized procedure, (2) approval of the standardized procedure, and (3) availability by telephonic contact at the time of patient examination by the nurse practitioner.
(e)For purposes of this section, no physician and surgeon shall supervise more than four nurse practitioners at one time.
(f)(1)Drugs or devices furnished or ordered by a nurse practitioner may include Schedule II through Schedule V controlled substances under the California Uniform Controlled Substances Act (Division 10 (commencing with Section 11000) of the Health and Safety Code) and shall be further limited to those drugs agreed upon by the nurse practitioner and physician and surgeon and specified in the standardized procedure.
(2)When Schedule II or III controlled substances, as defined in Sections 11055 and 11056, respectively, of the Health and Safety Code, are furnished or ordered by a nurse practitioner, the controlled substances shall be furnished or ordered in accordance with a patient-specific protocol approved by the treating or supervising physician. A copy of the section of the nurse practitioners standardized procedure relating to controlled substances shall be provided, upon request, to any licensed pharmacist who dispenses drugs or devices, when there is uncertainty about the nurse practitioner furnishing the order.
(g)(1)The board has certified in accordance with Section 2836.3 that the nurse practitioner has satisfactorily completed a course in pharmacology covering the drugs or devices to be furnished or ordered under this section.
(2)A physician and surgeon may determine the extent of supervision necessary pursuant to this section in the furnishing or ordering of drugs and devices.
(3)Nurse practitioners who are certified by the board and hold an active furnishing number, who are authorized through standardized procedures or protocols to furnish Schedule II controlled substances, and who are registered with the United States Drug Enforcement Administration, shall complete, as part of their continuing education requirements, a course including Schedule II controlled substances, and the risks of addiction associated with their use, based on the standards developed by the board. The board shall establish the requirements for satisfactory completion of this subdivision.
(h)Use of the term furnishing in this section, in health facilities defined in Section 1250 of the Health and Safety Code, shall include (1) the ordering of a drug or device in accordance with the standardized procedure and (2) transmitting an order of a supervising physician and surgeon.
(i)Drug order or order for purposes of this section means an order for medication which is dispensed to or for an ultimate user, issued by a nurse practitioner as an individual practitioner, within the meaning of Section 1306.02 of Title 21 of the Code of Federal Regulations. Notwithstanding any other provision of law, (1) a drug order issued pursuant to this section shall be treated in the same manner as a prescription of the supervising physician; (2) all references to prescription in this code and the Health and Safety Code shall include drug orders issued by nurse practitioners; and (3) the signature of a nurse practitioner on a drug order issued in accordance with this section shall be deemed to be the signature of a prescriber for purposes of this code and the Health and Safety Code.
SEC. 9.Section 3059 of the Business and Professions Code is amended to read:3059.(a)It is the intent of the Legislature that the public health and safety would be served by requiring all holders of licenses to practice optometry granted under this chapter to continue their education after receiving their licenses. The board shall adopt regulations that require, as a condition to the renewal thereof, that all holders of licenses submit proof satisfactory to the board that they have informed themselves of the developments in the practice of optometry occurring since the original issuance of their licenses by pursuing one or more courses of study satisfactory to the board or by other means deemed equivalent by the board.
(b)The board may, in accordance with the intent of this section, make exceptions from continuing education requirements for reasons of health, military service, or other good cause.
(c)If for good cause compliance cannot be met for the current year, the board may grant exemption of compliance for that year, provided that a plan of future compliance that includes current requirements as well as makeup of previous requirements is approved by the board.
(d)The board may require that proof of compliance with this section be submitted on an annual or biennial basis as determined by the board.
(e)An optometrist certified to use therapeutic pharmaceutical agents pursuant to Section 3041.3 shall complete a total of 50 hours of continuing education every two years in order to renew his or her certificate. Thirty-five of the required 50 hours of continuing education shall be on the diagnosis, treatment, and management of ocular disease in any combination of the following areas:
(1)Glaucoma.
(2)Ocular infection.
(3)Ocular inflammation.
(4)Topical steroids.
(5)Systemic medication.
(6)Pain medication, including the risks of addiction associated with the use of Schedule II drugs.
(f)The board shall encourage every optometrist to take a course or courses in pharmacology and pharmaceuticals as part of his or her continuing education.
(g)The board shall consider requiring courses in child abuse detection to be taken by those licensees whose practices are such that there is a likelihood of contact with abused or neglected children.
(h)The board shall consider requiring courses in elder abuse detection to be taken by those licensees whose practices are such that there is a likelihood of contact with abused or neglected elder persons.
SEC. 10.Section 3502.1 of the Business and Professions Code is amended to read:3502.1.(a)In addition to the services authorized in the regulations adopted by the Medical Board of California, and except as prohibited by Section 3502, while under the supervision of a licensed physician and surgeon or physicians and surgeons authorized by law to supervise a physician assistant, a physician assistant may administer or provide medication to a patient, or transmit orally, or in writing on a patients record or in a drug order, an order to a person who may lawfully furnish the medication or medical device pursuant to subdivisions (c) and (d).
(1)A supervising physician and surgeon who delegates authority to issue a drug order to a physician assistant may limit this authority by specifying the manner in which the physician assistant may issue delegated prescriptions.
(2)Each supervising physician and surgeon who delegates the authority to issue a drug order to a physician assistant shall first prepare and adopt, or adopt, a written, practice specific, formulary and protocols that specify all criteria for the use of a particular drug or device, and any contraindications for the selection. Protocols for Schedule II controlled substances shall address the diagnosis of illness, injury, or condition for which the Schedule II controlled substance is being administered, provided, or issued. The drugs listed in the protocols shall constitute the formulary and shall include only drugs that are appropriate for use in the type of practice engaged in by the supervising physician and surgeon. When issuing a drug order, the physician assistant is acting on behalf of and as an agent for a supervising physician and surgeon.
(b)Drug order, for purposes of this section, means an order for medication that is dispensed to or for a patient, issued and signed by a physician assistant acting as an individual practitioner within the meaning of Section 1306.02 of Title 21 of the Code of Federal Regulations. Notwithstanding any other provision of law, (1) a drug order issued pursuant to this section shall be treated in the same manner as a prescription or order of the supervising physician, (2) all references to prescription in this code and the Health and Safety Code shall include drug orders issued by physician assistants pursuant to authority granted by their supervising physicians and surgeons, and (3) the signature of a physician assistant on a drug order shall be deemed to be the signature of a prescriber for purposes of this code and the Health and Safety Code.
(c)A drug order for any patient cared for by the physician assistant that is issued by the physician assistant shall either be based on the protocols described in subdivision (a) or shall be approved by the supervising physician and surgeon before it is filled or carried out.
(1)A physician assistant shall not administer or provide a drug or issue a drug order for a drug other than for a drug listed in the formulary without advance approval from a supervising physician and surgeon for the particular patient. At the direction and under the supervision of a physician and surgeon, a physician assistant may hand to a patient of the supervising physician and surgeon a properly labeled prescription drug prepackaged by a physician and surgeon, manufacturer as defined in the Pharmacy Law, or a pharmacist.
(2)A physician assistant shall not administer, provide, or issue a drug order to a patient for Schedule II through Schedule V controlled substances without advance approval by a supervising physician and surgeon for that particular patient unless the physician assistant has completed an education course that covers controlled substances and that meets standards, including pharmacological content, approved by the board. The education course shall be provided either by an accredited continuing education provider or by an approved physician assistant training program. If the physician assistant will administer, provide, or issue a drug order for Schedule II controlled substances, the course shall contain a minimum of three hours exclusively on Schedule II controlled substances, including the risks of addiction associated with their use. Completion of the requirements set forth in this paragraph shall be verified and documented in the manner established by the board prior to the physician assistants use of a registration number issued by the United States Drug Enforcement Administration to the physician assistant to administer, provide, or issue a drug order to a patient for a controlled substance without advance approval by a supervising physician and surgeon for that particular patient.
(3)Any drug order issued by a physician assistant shall be subject to a reasonable quantitative limitation consistent with customary medical practice in the supervising physician and surgeons practice.
(d)A written drug order issued pursuant to subdivision (a), except a written drug order in a patients medical record in a health facility or medical practice, shall contain the printed name, address, and telephone number of the supervising physician and surgeon, the printed or stamped name and license number of the physician assistant, and the signature of the physician assistant. Further, a written drug order for a controlled substance, except a written drug order in a patients medical record in a health facility or a medical practice, shall include the federal controlled substances registration number of the physician assistant and shall otherwise comply with Section 11162.1 of the Health and Safety Code. Except as otherwise required for written drug orders for controlled substances under Section 11162.1 of the Health and Safety Code, the requirements of this subdivision may be met through stamping or otherwise imprinting on the supervising physician and surgeons prescription blank to show the name, license number, and if applicable, the federal controlled substances registration number of the physician assistant, and shall be signed by the physician assistant. When using a drug order, the physician assistant is acting on behalf of and as the agent of a supervising physician and surgeon.
(e)The supervising physician and surgeon shall use either of the following mechanisms to ensure adequate supervision of the administration, provision, or issuance by a physician assistant of a drug order to a patient for Schedule II controlled substances:
(1)The medical record of any patient cared for by a physician assistant for whom the physician assistants Schedule II drug order has been issued or carried out shall be reviewed, countersigned, and dated by a supervising physician and surgeon within seven days.
(2)If the physician assistant has documentation evidencing the successful completion of an education course that covers controlled substances, and that controlled substance education course (A) meets the standards, including pharmacological content, established in Sections 1399.610 and 1399.612 of Title 16 of the California Code of Regulations, and (B) is provided either by an accredited continuing education provider or by an approved physician assistant training program, the supervising physician and surgeon shall review, countersign, and date, within seven days, a sample consisting of the medical records of at least 20 percent of the patients cared for by the physician assistant for whom the physician assistants Schedule II drug order has been issued or carried out. Completion of the requirements set forth in this paragraph shall be verified and documented in the manner established in Section 1399.612 of Title 16 of the California Code of Regulations. Physician assistants who have a certificate of completion of the course described in paragraph (2) of subdivision (c) shall be deemed to have met the education course requirement of this subdivision.
(f)All physician assistants who are authorized by their supervising physicians to issue drug orders for controlled substances shall register with the United States Drug Enforcement Administration (DEA).
(g)The board shall consult with the Medical Board of California and report during its sunset review required by Article 7.5 (commencing with Section 9147.7) of Chapter 1.5 of Part 1 of Division 2 of Title 2 of the Government Code the impacts of exempting Schedule III and Schedule IV drug orders from the requirement for a physician and surgeon to review and countersign the affected medical record of a patient.
SEC. 11.Section 4076.7 is added to the Business and Professions Code, to read:4076.7.In addition to the requirements of Sections 4076 and 4076.5, whenever a prescription drug containing an opioid is dispensed to a patient for outpatient use, the pharmacy or practitioner dispensing the drug shall prominently display on the label or container a notice that states Caution: Opioid. Risk of overdose and addiction.
SEC. 12.Section 49476 is added to the Education Code, to read:49476.(a)If a school district, charter school, or private school elects to offer an athletic program, the school district, charter school, or private school shall annually give the Opioid Factsheet for Patients published by the Centers for Disease Control and Prevention to each athlete. The athlete and, if the athlete is 17 years of age or younger, the athletes parent or guardian shall sign a document acknowledging receipt of the Opioid Factsheet for Patients and return that document to the school district, charter school, or private school before the athlete initiates practice or competition. The Opioid Factsheet for Patients may be sent and returned through an electronic medium, including, but not limited to, fax or email.
(b)This section does not apply to an athlete engaging in an athletic activity during the regular schoolday or as part of a physical education course required pursuant to subdivision (d) of Section 51220.
SEC. 13.Section 11158.1 is added to the Health and Safety Code, to read:11158.1.(a)Except when a patient is being treated as set forth in Sections 11159, 11159.2, and 11167.5, and Article 2 (commencing with Section 11215) of Chapter 5, pertaining to the treatment of addicts, or for a diagnosis of chronic intractable pain as used in Section 124960 of this code and Section 2241.5 of the Business and Professions Code, a prescriber shall discuss all of the following with the minor, the minors parent or guardian, or another adult authorized to consent to the minors medical treatment before directly dispensing or issuing for a minor the first prescription in a single course of treatment for a controlled substance containing an opioid:
(1)The risks of addiction and overdose associated with the use of opioids.
(2)The increased risk of addiction to an opioid to an individual who is suffering from both mental and substance abuse disorders.
(3)The danger of taking an opioid with a benzodiazepine, alcohol, or another central nervous system depressant.
(4)Any other information required by law.
(b)Subdivision (a) does not apply in any of the following circumstances:
(1)If the minors treatment is associated with or incident to a medical emergency.
(2)If the minors treatment is associated with or incident to an emergency surgery, regardless of whether the surgery is performed on an inpatient or outpatient basis.
(3)If, in the prescribers professional judgment, fulfilling the requirements of subdivision (a) would be detrimental to the minors health or safety.
(c)Notwithstanding any other law, including Section 11374, failure to comply with this section shall not constitute a criminal offense, but may subject the prescriber to disciplinary action for unprofessional conduct under the prescribers respective licensing act under Division 2 (commencing with Section 500) of the Business and Professions Code. offense.
SEC. 14.Section 124236 is added to the Health and Safety Code, to read:124236.(a)A youth sports organization, as defined in paragraph (3) of subdivision (b) of Section 124235, that elects to offer an athletic program shall annually give the Opioid Factsheet for Patients published by the Centers for Disease Control and Prevention to each athlete. The athlete and, if the athlete is 17 years of age or younger, the athletes parent or guardian shall sign a document acknowledging receipt of the Opioid Factsheet for Patients and return that document to the school district, charter school, or private school before the athlete initiates practice or competition. The Opioid Factsheet for Patients may be sent and returned through an electronic medium, including, but not limited to, fax or email.
(b)This section shall apply to all athletes participating in the activities of a youth sports organization, irrespective of their ages. This section shall not be construed to prohibit a youth sports organization, or any other appropriate entity, from adopting and enforcing rules intended to provide a higher standard of safety for athletes than the standard established under this section.
SEC. 15.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB 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 XIIIB of the California Constitution.
The Legislature finds and declares all of the following:
(a)Addiction, misuse, and overdose of prescription opioids is a public health crisis affecting both adults and children.
(b)Urgent measures are needed to better inform the public of the risks associated with both the long-term and short-term use of opioids in an effort to address this problem.
(c)Both short-term and long-term prescriptions of opioids to minors fall within situations that require counseling and written consent under the Guidelines for Prescribing Controlled Substances for Pain issued by the Medical Board of California.
(d)It is the intent of the Legislature to codify the Medical Board of Californias Guidelines for Prescribing Controlled Substances for Pain, as it relates to patient counseling, consent, and pain management agreements, and to ensure that health care providers and young athletes receive necessary education on this topic.
SEC. 2.Section 1645 of the Business and Professions Code is amended to read:1645.(a)Effective with the 1974 license renewal period, if the board determines that the public health and safety would be served by requiring all holders of licenses under this chapter to continue their education after receiving a license, it may require, as a condition to the renewal thereof, that they submit assurances satisfactory to the board that they will, during the succeeding two-year period, inform themselves of the developments in the practice of dentistry occurring since the original issuance of their licenses by pursuing one or more courses of study satisfactory to the board or by other means deemed equivalent by the board.
The board shall adopt regulations providing for the suspension of the licenses at the end of the two-year period until compliance with the assurances provided for in this section is accomplished.
(b)The board may also, as a condition of license renewal, require licentiates to successfully complete a portion of the required continuing education hours in specific areas adopted in regulations by the board. The board may prescribe this mandatory coursework within the general areas of patient care, health and safety, law and ethics, and the risks of addiction associated with the use of Schedule II drugs. The mandatory coursework prescribed by the board shall not exceed fifteen hours per renewal period for dentists, and seven and one-half hours per renewal period for dental auxiliaries. Any mandatory coursework required by the board shall be credited toward the continuing education requirements established by the board pursuant to subdivision (a).
(c)For a retired dentist who provides only uncompensated care, the board shall not require more than 60 percent of the hours of continuing education that are required of other licensed dentists. Notwithstanding subdivision (b), all of the hours of continuing education as described in this subdivision shall be gained through courses related to the actual delivery of dental services to the patient or the community, as determined by the board. Nothing in this subdivision shall be construed to reduce any requirements imposed by the board pursuant to subdivision (b).
(d)The board shall report on the outcome of subdivision (c) pursuant to, and at the time of, its regular sunset review process, as provided in Section 1601.1.
SEC. 3.Section 2190.5 of the Business and Professions Code is amended to read:2190.5.(a)(1)All physicians and surgeons shall complete a mandatory continuing education 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 board may verify completion of this requirement on the renewal application form.
(2)For physicians and surgeons licensed on or after January 1, 2019, the course described in paragraph (1) shall also include the subject of the risks of addiction associated with the use of Schedule II drugs.
(b)By regulatory action, the board may exempt physicians and surgeons by practice status category from the requirement in subdivision (a) if the physician and surgeon does not engage in direct patient care, does not provide patient consultations, or does not reside in the State of California.
(c)This section shall not apply to physicians and surgeons practicing in pathology or radiology specialty areas.
SEC. 4.Section 2191 of the Business and Professions Code is amended to read:2191.(a)In determining its continuing education requirements, the board shall consider including a course in human sexuality, defined as the study of a human being as a sexual being and how he or she functions with respect thereto, and nutrition to be taken by those licensees whose practices may require knowledge in those areas.
(b)The board shall consider including a course in 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.
(c)The board shall consider including a course in 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.
(d)The board shall encourage every physician and surgeon to take nutrition as part of his or her continuing education, particularly a physician and surgeon involved in primary care.
(e)The board shall consider including a course in 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.
(f)In determining its continuing education requirements, the board shall consider including a course in 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.
(g)In determining its continuing education requirements, the board shall consider including a course in 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.
(h)In determining its continuing education requirements, the board shall consider including a course providing training and 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 board 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.
(i)In determining its continuing education requirements, the board shall consider including a course in the special care needs of individuals and their families facing end-of-life issues, including, but not limited to, all of the following:
(1)Pain and symptom management.
(2)The psycho-social dynamics of death.
(3)Dying and bereavement.
(4)Hospice care.
(j)In determining its continuing education requirements, the board shall give its highest priority to considering a course on pain management and the risks of addiction associated with the use of Schedule II drugs.
(k)In determining its continuing education requirements, the board shall consider including a course in geriatric care for emergency room physicians and surgeons.
SEC. 5.Section 2196.2 of the Business and Professions Code is amended to read:2196.2.The board shall periodically develop and disseminate information and educational material regarding pain management techniques and procedures, including the risks of addiction associated with the use of Schedule II drugs, to each licensed physician and surgeon and to each general acute care hospital in this state. The board shall consult with the State Department of Public Health in developing the materials to be distributed pursuant to this section.
SEC. 6.Section 2454.5 of the Business and Professions Code is amended to read:2454.5.In order to ensure the continuing competence of licensed osteopathic physicians and surgeons, the board shall adopt and administer standards for the continuing education of those licensees. The board shall require each licensed osteopathic physician and surgeon to demonstrate satisfaction of the continuing education requirements as a condition for the renewal of a license at intervals of not less than one year nor more than two years. Commencing January 1, 2018, the board shall require each licensed osteopathic physician and surgeon to complete a minimum of 100 hours of American Osteopathic Association continuing education hours during each two-year cycle, of which 40 hours shall be completed in American Osteopathic Association Category 1 continuing education hours and the remaining 60 hours shall be either American Osteopathic Association or American Medical Association accredited as a condition for renewal of an active license. Licensed osteopathic physicians and surgeons shall complete a course on the risks of addiction associated with the use of Schedule II drugs.
For purposes of this section, American Osteopathic Association Category 1 means continuing education activities and programs approved for Category 1 credit by the Committee on Continuing Medical Education of the American Osteopathic Association.
SEC. 7.Section 2746.51 of the Business and Professions Code is amended to read:2746.51.(a)Neither this chapter nor any other provision of law shall be construed to prohibit a certified nurse-midwife from furnishing or ordering drugs or devices, including controlled substances classified in Schedule II, III, IV, or V under the California Uniform Controlled Substances Act (Division 10 (commencing with Section 11000) of the Health and Safety Code), when all of the following apply:
(1)The drugs or devices are furnished or ordered incidentally to the provision of any of the following:
(A)Family planning services, as defined in Section 14503 of the Welfare and Institutions Code.
(B)Routine health care or perinatal care, as defined in subdivision (d) of Section 123485 of the Health and Safety Code.
(C)Care rendered, consistent with the certified nurse-midwifes educational preparation or for which clinical competency has been established and maintained, to persons within a facility specified in subdivision (a), (b), (c), (d), (i), or (j) of Section 1206 of the Health and Safety Code, a clinic as specified in Section 1204 of the Health and Safety Code, a general acute care hospital as defined in subdivision (a) of Section 1250 of the Health and Safety Code, a licensed birth center as defined in Section 1204.3 of the Health and Safety Code, or a special hospital specified as a maternity hospital in subdivision (f) of Section 1250 of the Health and Safety Code.
(2)The drugs or devices are furnished or ordered by a certified nurse-midwife in accordance with standardized procedures or protocols. For purposes of this section, standardized procedure means a document, including protocols, developed and approved by the supervising physician and surgeon, the certified nurse-midwife, and the facility administrator or his or her designee. The standardized procedure covering the furnishing or ordering of drugs or devices shall specify all of the following:
(A)Which certified nurse-midwife may furnish or order drugs or devices.
(B)Which drugs or devices may be furnished or ordered and under what circumstances.
(C)The extent of physician and surgeon supervision.
(D)The method of periodic review of the certified nurse-midwifes competence, including peer review, and review of the provisions of the standardized procedure.
(3)If Schedule II or III controlled substances, as defined in Sections 11055 and 11056 of the Health and Safety Code, are furnished or ordered by a certified nurse-midwife, the controlled substances shall be furnished or ordered in accordance with a patient-specific protocol approved by the treating or supervising physician and surgeon. For Schedule II controlled substance protocols, the provision for furnishing the Schedule II controlled substance shall address the diagnosis of the illness, injury, or condition for which the Schedule II controlled substance is to be furnished.
(4)The furnishing or ordering of drugs or devices by a certified nurse-midwife occurs under physician and surgeon supervision. For purposes of this section, no physician and surgeon shall supervise more than four certified nurse-midwives at one time. Physician and surgeon supervision shall not be construed to require the physical presence of the physician, but does include all of the following:
(A)Collaboration on the development of the standardized procedure or protocol.
(B)Approval of the standardized procedure or protocol.
(C)Availability by telephonic contact at the time of patient examination by the certified nurse-midwife.
(b)(1)The furnishing or ordering of drugs or devices by a certified nurse-midwife is conditional on the issuance by the board of a number to the applicant who has successfully completed the requirements of paragraph (2). The number shall be included on all transmittals of orders for drugs or devices by the certified nurse-midwife. The board shall maintain a list of the certified nurse-midwives that it has certified pursuant to this paragraph and the number it has issued to each one. The board shall make the list available to the California State Board of Pharmacy upon its request. Every certified nurse-midwife who is authorized pursuant to this section to furnish or issue a drug order for a controlled substance shall register with the United States Drug Enforcement Administration.
(2)The board has certified in accordance with paragraph (1) that the certified nurse-midwife has satisfactorily completed a course in pharmacology covering the drugs or devices to be furnished or ordered under this section, including the risks of addiction and neonatal abstinence syndrome associated with the use of opioids. The board shall establish the requirements for satisfactory completion of this paragraph.
(3)A physician and surgeon may determine the extent of supervision necessary pursuant to this section in the furnishing or ordering of drugs and devices.
(4)A copy of the standardized procedure or protocol relating to the furnishing or ordering of controlled substances by a certified nurse-midwife shall be provided upon request to any licensed pharmacist who is uncertain of the authority of the certified nurse-midwife to perform these functions.
(5)Certified nurse-midwives who are certified by the board and hold an active furnishing number, who are currently authorized through standardized procedures or protocols to furnish Schedule II controlled substances, and who are registered with the United States Drug Enforcement Administration shall provide documentation of continuing education specific to the use of Schedule II controlled substances in settings other than a hospital based on standards developed by the board.
(c)Drugs or devices furnished or ordered by a certified nurse-midwife may include Schedule II controlled substances under the California Uniform Controlled Substances Act (Division 10 (commencing with Section 11000) of the Health and Safety Code) under the following conditions:
(1)The drugs and devices are furnished or ordered in accordance with requirements referenced in paragraphs (2) to (4), inclusive, of subdivision (a) and in paragraphs (1) to (3), inclusive, of subdivision (b).
(2)When Schedule II controlled substances, as defined in Section 11055 of the Health and Safety Code, are furnished or ordered by a certified nurse-midwife, the controlled substances shall be furnished or ordered in accordance with a patient-specific protocol approved by the treating or supervising physician and surgeon.
(d)Furnishing of drugs or devices by a certified nurse-midwife means the act of making a pharmaceutical agent or agents available to the patient in strict accordance with a standardized procedure or protocol. Use of the term furnishing in this section shall include the following:
(1)The ordering of a drug or device in accordance with the standardized procedure or protocol.
(2)Transmitting an order of a supervising physician and surgeon.
(e)Drug order or order for purposes of this section means an order for medication or for a drug or device that is dispensed to or for an ultimate user, issued by a certified nurse-midwife as an individual practitioner, within the meaning of Section 1306.03 of Title 21 of the Code of Federal Regulations. Notwithstanding any other provision of law, (1) a drug order issued pursuant to this section shall be treated in the same manner as a prescription of the supervising physician; (2) all references to prescription in this code and the Health and Safety Code shall include drug orders issued by certified nurse-midwives; and (3) the signature of a certified nurse-midwife on a drug order issued in accordance with this section shall be deemed to be the signature of a prescriber for purposes of this code and the Health and Safety Code.
SEC. 8.Section 2836.1 of the Business and Professions Code is amended to read:2836.1.Neither this chapter nor any other provision of law shall be construed to prohibit a nurse practitioner from furnishing or ordering drugs or devices when all of the following apply:
(a)The drugs or devices are furnished or ordered by a nurse practitioner in accordance with standardized procedures or protocols developed by the nurse practitioner and the supervising physician and surgeon when the drugs or devices furnished or ordered are consistent with the practitioners educational preparation or for which clinical competency has been established and maintained.
(b)The nurse practitioner is functioning pursuant to standardized procedure, as defined by Section 2725, or protocol. The standardized procedure or protocol shall be developed and approved by the supervising physician and surgeon, the nurse practitioner, and the facility administrator or the designee.
(c)(1)The standardized procedure or protocol covering the furnishing of drugs or devices shall specify which nurse practitioners may furnish or order drugs or devices, which drugs or devices may be furnished or ordered, under what circumstances, the extent of physician and surgeon supervision, the method of periodic review of the nurse practitioners competence, including peer review, and review of the provisions of the standardized procedure.
(2)In addition to the requirements in paragraph (1), for Schedule II controlled substance protocols, the provision for furnishing Schedule II controlled substances shall address the diagnosis of the illness, injury, or condition for which the Schedule II controlled substance is to be furnished.
(d)The furnishing or ordering of drugs or devices by a nurse practitioner occurs under physician and surgeon supervision. Physician and surgeon supervision shall not be construed to require the physical presence of the physician, but does include (1) collaboration on the development of the standardized procedure, (2) approval of the standardized procedure, and (3) availability by telephonic contact at the time of patient examination by the nurse practitioner.
(e)For purposes of this section, no physician and surgeon shall supervise more than four nurse practitioners at one time.
(f)(1)Drugs or devices furnished or ordered by a nurse practitioner may include Schedule II through Schedule V controlled substances under the California Uniform Controlled Substances Act (Division 10 (commencing with Section 11000) of the Health and Safety Code) and shall be further limited to those drugs agreed upon by the nurse practitioner and physician and surgeon and specified in the standardized procedure.
(2)When Schedule II or III controlled substances, as defined in Sections 11055 and 11056, respectively, of the Health and Safety Code, are furnished or ordered by a nurse practitioner, the controlled substances shall be furnished or ordered in accordance with a patient-specific protocol approved by the treating or supervising physician. A copy of the section of the nurse practitioners standardized procedure relating to controlled substances shall be provided, upon request, to any licensed pharmacist who dispenses drugs or devices, when there is uncertainty about the nurse practitioner furnishing the order.
(g)(1)The board has certified in accordance with Section 2836.3 that the nurse practitioner has satisfactorily completed a course in pharmacology covering the drugs or devices to be furnished or ordered under this section.
(2)A physician and surgeon may determine the extent of supervision necessary pursuant to this section in the furnishing or ordering of drugs and devices.
(3)Nurse practitioners who are certified by the board and hold an active furnishing number, who are authorized through standardized procedures or protocols to furnish Schedule II controlled substances, and who are registered with the United States Drug Enforcement Administration, shall complete, as part of their continuing education requirements, a course including Schedule II controlled substances, and the risks of addiction associated with their use, based on the standards developed by the board. The board shall establish the requirements for satisfactory completion of this subdivision.
(h)Use of the term furnishing in this section, in health facilities defined in Section 1250 of the Health and Safety Code, shall include (1) the ordering of a drug or device in accordance with the standardized procedure and (2) transmitting an order of a supervising physician and surgeon.
(i)Drug order or order for purposes of this section means an order for medication which is dispensed to or for an ultimate user, issued by a nurse practitioner as an individual practitioner, within the meaning of Section 1306.02 of Title 21 of the Code of Federal Regulations. Notwithstanding any other provision of law, (1) a drug order issued pursuant to this section shall be treated in the same manner as a prescription of the supervising physician; (2) all references to prescription in this code and the Health and Safety Code shall include drug orders issued by nurse practitioners; and (3) the signature of a nurse practitioner on a drug order issued in accordance with this section shall be deemed to be the signature of a prescriber for purposes of this code and the Health and Safety Code.
SEC. 9.Section 3059 of the Business and Professions Code is amended to read:3059.(a)It is the intent of the Legislature that the public health and safety would be served by requiring all holders of licenses to practice optometry granted under this chapter to continue their education after receiving their licenses. The board shall adopt regulations that require, as a condition to the renewal thereof, that all holders of licenses submit proof satisfactory to the board that they have informed themselves of the developments in the practice of optometry occurring since the original issuance of their licenses by pursuing one or more courses of study satisfactory to the board or by other means deemed equivalent by the board.
(b)The board may, in accordance with the intent of this section, make exceptions from continuing education requirements for reasons of health, military service, or other good cause.
(c)If for good cause compliance cannot be met for the current year, the board may grant exemption of compliance for that year, provided that a plan of future compliance that includes current requirements as well as makeup of previous requirements is approved by the board.
(d)The board may require that proof of compliance with this section be submitted on an annual or biennial basis as determined by the board.
(e)An optometrist certified to use therapeutic pharmaceutical agents pursuant to Section 3041.3 shall complete a total of 50 hours of continuing education every two years in order to renew his or her certificate. Thirty-five of the required 50 hours of continuing education shall be on the diagnosis, treatment, and management of ocular disease in any combination of the following areas:
(1)Glaucoma.
(2)Ocular infection.
(3)Ocular inflammation.
(4)Topical steroids.
(5)Systemic medication.
(6)Pain medication, including the risks of addiction associated with the use of Schedule II drugs.
(f)The board shall encourage every optometrist to take a course or courses in pharmacology and pharmaceuticals as part of his or her continuing education.
(g)The board shall consider requiring courses in child abuse detection to be taken by those licensees whose practices are such that there is a likelihood of contact with abused or neglected children.
(h)The board shall consider requiring courses in elder abuse detection to be taken by those licensees whose practices are such that there is a likelihood of contact with abused or neglected elder persons.
SEC. 10.Section 3502.1 of the Business and Professions Code is amended to read:3502.1.(a)In addition to the services authorized in the regulations adopted by the Medical Board of California, and except as prohibited by Section 3502, while under the supervision of a licensed physician and surgeon or physicians and surgeons authorized by law to supervise a physician assistant, a physician assistant may administer or provide medication to a patient, or transmit orally, or in writing on a patients record or in a drug order, an order to a person who may lawfully furnish the medication or medical device pursuant to subdivisions (c) and (d).
(1)A supervising physician and surgeon who delegates authority to issue a drug order to a physician assistant may limit this authority by specifying the manner in which the physician assistant may issue delegated prescriptions.
(2)Each supervising physician and surgeon who delegates the authority to issue a drug order to a physician assistant shall first prepare and adopt, or adopt, a written, practice specific, formulary and protocols that specify all criteria for the use of a particular drug or device, and any contraindications for the selection. Protocols for Schedule II controlled substances shall address the diagnosis of illness, injury, or condition for which the Schedule II controlled substance is being administered, provided, or issued. The drugs listed in the protocols shall constitute the formulary and shall include only drugs that are appropriate for use in the type of practice engaged in by the supervising physician and surgeon. When issuing a drug order, the physician assistant is acting on behalf of and as an agent for a supervising physician and surgeon.
(b)Drug order, for purposes of this section, means an order for medication that is dispensed to or for a patient, issued and signed by a physician assistant acting as an individual practitioner within the meaning of Section 1306.02 of Title 21 of the Code of Federal Regulations. Notwithstanding any other provision of law, (1) a drug order issued pursuant to this section shall be treated in the same manner as a prescription or order of the supervising physician, (2) all references to prescription in this code and the Health and Safety Code shall include drug orders issued by physician assistants pursuant to authority granted by their supervising physicians and surgeons, and (3) the signature of a physician assistant on a drug order shall be deemed to be the signature of a prescriber for purposes of this code and the Health and Safety Code.
(c)A drug order for any patient cared for by the physician assistant that is issued by the physician assistant shall either be based on the protocols described in subdivision (a) or shall be approved by the supervising physician and surgeon before it is filled or carried out.
(1)A physician assistant shall not administer or provide a drug or issue a drug order for a drug other than for a drug listed in the formulary without advance approval from a supervising physician and surgeon for the particular patient. At the direction and under the supervision of a physician and surgeon, a physician assistant may hand to a patient of the supervising physician and surgeon a properly labeled prescription drug prepackaged by a physician and surgeon, manufacturer as defined in the Pharmacy Law, or a pharmacist.
(2)A physician assistant shall not administer, provide, or issue a drug order to a patient for Schedule II through Schedule V controlled substances without advance approval by a supervising physician and surgeon for that particular patient unless the physician assistant has completed an education course that covers controlled substances and that meets standards, including pharmacological content, approved by the board. The education course shall be provided either by an accredited continuing education provider or by an approved physician assistant training program. If the physician assistant will administer, provide, or issue a drug order for Schedule II controlled substances, the course shall contain a minimum of three hours exclusively on Schedule II controlled substances, including the risks of addiction associated with their use. Completion of the requirements set forth in this paragraph shall be verified and documented in the manner established by the board prior to the physician assistants use of a registration number issued by the United States Drug Enforcement Administration to the physician assistant to administer, provide, or issue a drug order to a patient for a controlled substance without advance approval by a supervising physician and surgeon for that particular patient.
(3)Any drug order issued by a physician assistant shall be subject to a reasonable quantitative limitation consistent with customary medical practice in the supervising physician and surgeons practice.
(d)A written drug order issued pursuant to subdivision (a), except a written drug order in a patients medical record in a health facility or medical practice, shall contain the printed name, address, and telephone number of the supervising physician and surgeon, the printed or stamped name and license number of the physician assistant, and the signature of the physician assistant. Further, a written drug order for a controlled substance, except a written drug order in a patients medical record in a health facility or a medical practice, shall include the federal controlled substances registration number of the physician assistant and shall otherwise comply with Section 11162.1 of the Health and Safety Code. Except as otherwise required for written drug orders for controlled substances under Section 11162.1 of the Health and Safety Code, the requirements of this subdivision may be met through stamping or otherwise imprinting on the supervising physician and surgeons prescription blank to show the name, license number, and if applicable, the federal controlled substances registration number of the physician assistant, and shall be signed by the physician assistant. When using a drug order, the physician assistant is acting on behalf of and as the agent of a supervising physician and surgeon.
(e)The supervising physician and surgeon shall use either of the following mechanisms to ensure adequate supervision of the administration, provision, or issuance by a physician assistant of a drug order to a patient for Schedule II controlled substances:
(1)The medical record of any patient cared for by a physician assistant for whom the physician assistants Schedule II drug order has been issued or carried out shall be reviewed, countersigned, and dated by a supervising physician and surgeon within seven days.
(2)If the physician assistant has documentation evidencing the successful completion of an education course that covers controlled substances, and that controlled substance education course (A) meets the standards, including pharmacological content, established in Sections 1399.610 and 1399.612 of Title 16 of the California Code of Regulations, and (B) is provided either by an accredited continuing education provider or by an approved physician assistant training program, the supervising physician and surgeon shall review, countersign, and date, within seven days, a sample consisting of the medical records of at least 20 percent of the patients cared for by the physician assistant for whom the physician assistants Schedule II drug order has been issued or carried out. Completion of the requirements set forth in this paragraph shall be verified and documented in the manner established in Section 1399.612 of Title 16 of the California Code of Regulations. Physician assistants who have a certificate of completion of the course described in paragraph (2) of subdivision (c) shall be deemed to have met the education course requirement of this subdivision.
(f)All physician assistants who are authorized by their supervising physicians to issue drug orders for controlled substances shall register with the United States Drug Enforcement Administration (DEA).
(g)The board shall consult with the Medical Board of California and report during its sunset review required by Article 7.5 (commencing with Section 9147.7) of Chapter 1.5 of Part 1 of Division 2 of Title 2 of the Government Code the impacts of exempting Schedule III and Schedule IV drug orders from the requirement for a physician and surgeon to review and countersign the affected medical record of a patient.
SEC. 11.Section 4076.7 is added to the Business and Professions Code, to read:4076.7.In addition to the requirements of Sections 4076 and 4076.5, whenever a prescription drug containing an opioid is dispensed to a patient for outpatient use, the pharmacy or practitioner dispensing the drug shall prominently display on the label or container a notice that states Caution: Opioid. Risk of overdose and addition. addiction.
SEC. 12.Section 49476 is added to the Education Code, to read:49476.(a)If a school district, charter school, or private school elects to offer an athletic program, the school district, charter school, or private school shall annually give the Opioid Factsheet for Patients published by the Centers for Disease Control and Prevention to each athlete. The athlete and, if the athlete is 17 years of age or younger, the athletes parent or guardian shall sign a document acknowledging receipt of the Opioid Factsheet for Patients and return that document to the school district, charter school, or private school before the athlete initiates practice or competition. The Opioid Factsheet for Patients may be sent and returned through an electronic medium, including, but not limited to, fax or email.
(b)This section does not apply to an athlete engaging in an athletic activity during the regular schoolday or as part of a physical education course required pursuant to subdivision (d) of Section 51220.
SEC. 13.Section 11158.1 is added to the Health and Safety Code, to read:11158.1.(a)Except when a patient is being treated as set forth in Sections 11159, 11159.2, and 11167.5, and Article 2 (commencing with Section 11215) of Chapter 5, pertaining to the treatment of addicts, or for a diagnosis of chronic intractable pain as used in Section 124960 of this code and Section 2241.5 of the Business and Professions Code, a prescriber shall do all of the following discuss all of the following with the minor, the minors parent or guardian, or another adult authorized to consent to the minors medical treatment before directly dispensing or issuing for a minor the first prescription in a single course of treatment for a controlled substance containing an opioid:
(1)Discuss all of the following with the minor, with the minors parent or guardian, or with another adult authorized to consent to the minors medical treatment:(A)(1)The risks of addiction and overdose associated with the use of opioids.
(B)(2)The increased risk of addiction to an opioid to an individual who is suffering from both mental and substance abuse disorders.
(C)(3)The danger of taking an opioid with a benzodiazepine, alcohol, or another central nervous system depressant.
(D)(4)Any other information required by law.
(2)Obtain the signature of the minor, and the minors parent or guardian or other adult authorized to consent to the minors medical treatment. The prescriber shall include the signed consent form in the minors medical record.(b)Paragraph (1) of subdivision Subdivision (a) does not apply in any of the following circumstances:
(1)If the minors treatment is associated with or incident to a medical emergency.
(2)If the minors treatment is associated with or incident to an emergency surgery, regardless of whether the surgery is performed on an inpatient or outpatient basis.
(3)If, in the prescribers professional judgment, fulfilling the requirements of paragraph (1) of subdivision (a) would be detrimental to the minors health or safety.
(c)The consent described in paragraph (2) of subdivision (a) shall be obtained in a form that is separate from any other document that a prescriber uses to obtain the informed consent for the treatment of a minor and shall contain all of the following:(1)The name and quantity of the controlled substance being prescribed for the minor and the amount of the initial dose.(2)A statement indicating that a controlled substance is a drug or other substance that has been identified as having a potential for abuse.(3)A statement certifying that the prescriber discussed with the minor, and with the minors parent or guardian or with another adult authorized to consent to the minors medical treatment, the topics described in paragraph (1) of subdivision (a), unless the exemption in subdivision (b) applies.(4)A space for the signature of the minors parent or guardian or other adult authorized to consent to the minors medical treatment, and a space to indicate the date that the minors parent or guardian or other adult authorized to consent to the minors medical treatment signed the form.(d)(c)Notwithstanding any other law, including Section 11374, failure to comply with this section shall not constitute a criminal offense, but may subject the prescriber to disciplinary action for unprofessional conduct under the prescribers respective licensing act under Division 2 (commencing with Section 500) of the Business and Professions Code.
SEC. 14.Section 124236 is added to the Health and Safety Code, to read:124236.(a)A youth sports organization, as defined in paragraph (3) of subdivision (b) of Section 124235, that elects to offer an athletic program shall annually give the Opioid Factsheet for Patients published by the Centers for Disease Control and Prevention to each athlete. The athlete and, if the athlete is 17 years of age or younger, the athletes parent or guardian shall sign a document acknowledging receipt of the Opioid Factsheet for Patients and return that document to the school district, charter school, or private school before the athlete initiates practice or competition. The Opioid Factsheet for Patients may be sent and returned through an electronic medium, including, but not limited to, fax or email.
(b)This section shall apply to all athletes participating in the activities of a youth sports organization, irrespective of their ages. This section shall not be construed to prohibit a youth sports organization, or any other appropriate entity, from adopting and enforcing rules intended to provide a higher standard of safety for athletes than the standard established under this section.
SEC. 15.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB 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 XIIIB of the California Constitution.
The Legislature finds and declares all of the following:
(a)Addiction, misuse, and overdose of prescription opioids is a public health crisis affecting both adults and children.
(b)Urgent measures are needed to better inform the public of the risks associated with both the long-term and short-term use of opioids in an effort to address this problem.
(c)Both short-term and long-term prescriptions of opioids to minors fall within situations that require counseling and written consent under the Guidelines for Prescribing Controlled Substances for Pain issued by the Medical Board of California.
(d)It is the intent of the Legislature to codify the Medical Board of Californias Guidelines for Prescribing Controlled Substances for Pain, as it relates to patient counseling, consent, and pain management agreements, and to ensure that health care providers and young athletes receive necessary education on this topic.
SEC. 2.Section 1645 of the Business and Professions Code is amended to read:1645.(a)Effective with the 1974 license renewal period, if the board determines that the public health and safety would be served by requiring all holders of licenses under this chapter to continue their education after receiving a license, it may require, as a condition to the renewal thereof, that they submit assurances satisfactory to the board that they will, during the succeeding two-year period, inform themselves of the developments in the practice of dentistry occurring since the original issuance of their licenses by pursuing one or more courses of study satisfactory to the board or by other means deemed equivalent by the board.
The board shall adopt regulations providing for the suspension of the licenses at the end of the two-year period until compliance with the assurances provided for in this section is accomplished.
(b)The board may also, as a condition of license renewal, require licentiates to successfully complete a portion of the required continuing education hours in specific areas adopted in regulations by the board. The board may prescribe this mandatory coursework within the general areas of patient care, health and safety, and law and ethics. ethics, and the risks of addiction associated with the use of Schedule II drugs. The mandatory coursework prescribed by the board shall not exceed fifteen hours per renewal period for dentists, and seven and one-half hours per renewal period for dental auxiliaries. Any mandatory coursework required by the board shall be credited toward the continuing education requirements established by the board pursuant to subdivision (a).
(c)For a retired dentist who provides only uncompensated care, the board shall not require more than 60 percent of the hours of continuing education that are required of other licensed dentists. Notwithstanding subdivision (b), all of the hours of continuing education as described in this subdivision shall be gained through courses related to the actual delivery of dental services to the patient or the community, as determined by the board. Nothing in this subdivision shall be construed to reduce any requirements imposed by the board pursuant to subdivision (b).
(d)The board shall report on the outcome of subdivision (c) pursuant to, and at the time of, its regular sunset review process, as provided in Section 1601.1.
SEC. 2.SEC. 3.Section 2190.5 of the Business and Professions Code is amended to read:2190.5.(a)(1)All physicians and surgeons shall complete a mandatory continuing education 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 board may verify completion of this requirement on the renewal application form.
(2)For physicians and surgeons licensed on or after January 1, 2019, the course described in paragraph (1) shall also include the subject of the risks of addiction associated with the use of Schedule II drugs.
(b)By regulatory action, the board may exempt physicians and surgeons by practice status category from the requirement in subdivision (a) if the physician and surgeon does not engage in direct patient care, does not provide patient consultations, or does not reside in the State of California.
(c)This section shall not apply to physicians and surgeons practicing in pathology or radiology specialty areas.
SEC. 3.SEC. 4.Section 2191 of the Business and Professions Code is amended to read:2191.(a)In determining its continuing education requirements, the board shall consider including a course in human sexuality, defined as the study of a human being as a sexual being and how he or she functions with respect thereto, and nutrition to be taken by those licensees whose practices may require knowledge in those areas.
(b)The board shall consider including a course in 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.
(c)The board shall consider including a course in 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.
(d)The board shall encourage every physician and surgeon to take nutrition as part of his or her continuing education, particularly a physician and surgeon involved in primary care.
(e)The board shall consider including a course in 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.
(f)In determining its continuing education requirements, the board shall consider including a course in 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.
(g)In determining its continuing education requirements, the board shall consider including a course in 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.
(h)In determining its continuing education requirements, the board shall consider including a course providing training and 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 board 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.
(i)In determining its continuing education requirements, the board shall consider including a course in the special care needs of individuals and their families facing end-of-life issues, including, but not limited to, all of the following:
(1)Pain and symptom management.
(2)The psycho-social dynamics of death.
(3)Dying and bereavement.
(4)Hospice care.
(j)In determining its continuing education requirements, the board shall give its highest priority to considering a course on pain management and the risks of addiction associated with the use of Schedule II drugs.
(k)In determining its continuing education requirements, the board shall consider including a course in geriatric care for emergency room physicians and surgeons.
SEC. 4.SEC. 5.Section 2196.2 of the Business and Professions Code is amended to read:2196.2.The board shall periodically develop and disseminate information and educational material regarding pain management techniques and procedures, including the risks of addiction associated with the use of Schedule II drugs, to each licensed physician and surgeon and to each general acute care hospital in this state. The board shall consult with the State Department of Public Health in developing the materials to be distributed pursuant to this section.
SEC. 6.Section 2454.5 of the Business and Professions Code is amended to read:2454.5.In order to ensure the continuing competence of licensed osteopathic physicians and surgeons, the board shall adopt and administer standards for the continuing education of those licensees. The board shall require each licensed osteopathic physician and surgeon to demonstrate satisfaction of the continuing education requirements as a condition for the renewal of a license at intervals of not less than one year nor more than two years. Commencing January 1, 2018, the board shall require each licensed osteopathic physician and surgeon to complete a minimum of 100 hours of American Osteopathic Association continuing education hours during each two-year cycle, of which 40 hours shall be completed in American Osteopathic Association Category 1 continuing education hours and the remaining 60 hours shall be either American Osteopathic Association or American Medical Association accredited as a condition for renewal of an active license. Licensed osteopathic physicians and surgeons shall complete a course on the risks of addiction associated with the use of Schedule II drugs.
For purposes of this section, American Osteopathic Association Category 1 means continuing education activities and programs approved for Category 1 credit by the Committee on Continuing Medical Education of the American Osteopathic Association.
SEC. 5.SEC. 7.Section 2746.51 of the Business and Professions Code is amended to read:2746.51.(a)Neither this chapter nor any other provision of law shall be construed to prohibit a certified nurse-midwife from furnishing or ordering drugs or devices, including controlled substances classified in Schedule II, III, IV, or V under the California Uniform Controlled Substances Act (Division 10 (commencing with Section 11000) of the Health and Safety Code), when all of the following apply:
(1)The drugs or devices are furnished or ordered incidentally to the provision of any of the following:
(A)Family planning services, as defined in Section 14503 of the Welfare and Institutions Code.
(B)Routine health care or perinatal care, as defined in subdivision (d) of Section 123485 of the Health and Safety Code.
(C)Care rendered, consistent with the certified nurse-midwifes educational preparation or for which clinical competency has been established and maintained, to persons within a facility specified in subdivision (a), (b), (c), (d), (i), or (j) of Section 1206 of the Health and Safety Code, a clinic as specified in Section 1204 of the Health and Safety Code, a general acute care hospital as defined in subdivision (a) of Section 1250 of the Health and Safety Code, a licensed birth center as defined in Section 1204.3 of the Health and Safety Code, or a special hospital specified as a maternity hospital in subdivision (f) of Section 1250 of the Health and Safety Code.
(2)The drugs or devices are furnished or ordered by a certified nurse-midwife in accordance with standardized procedures or protocols. For purposes of this section, standardized procedure means a document, including protocols, developed and approved by the supervising physician and surgeon, the certified nurse-midwife, and the facility administrator or his or her designee. The standardized procedure covering the furnishing or ordering of drugs or devices shall specify all of the following:
(A)Which certified nurse-midwife may furnish or order drugs or devices.
(B)Which drugs or devices may be furnished or ordered and under what circumstances.
(C)The extent of physician and surgeon supervision.
(D)The method of periodic review of the certified nurse-midwifes competence, including peer review, and review of the provisions of the standardized procedure.
(3)If Schedule II or III controlled substances, as defined in Sections 11055 and 11056 of the Health and Safety Code, are furnished or ordered by a certified nurse-midwife, the controlled substances shall be furnished or ordered in accordance with a patient-specific protocol approved by the treating or supervising physician and surgeon. For Schedule II controlled substance protocols, the provision for furnishing the Schedule II controlled substance shall address the diagnosis of the illness, injury, or condition for which the Schedule II controlled substance is to be furnished.
(4)The furnishing or ordering of drugs or devices by a certified nurse-midwife occurs under physician and surgeon supervision. For purposes of this section, no physician and surgeon shall supervise more than four certified nurse-midwives at one time. Physician and surgeon supervision shall not be construed to require the physical presence of the physician, but does include all of the following:
(A)Collaboration on the development of the standardized procedure or protocol.
(B)Approval of the standardized procedure or protocol.
(C)Availability by telephonic contact at the time of patient examination by the certified nurse-midwife.
(b)(1)The furnishing or ordering of drugs or devices by a certified nurse-midwife is conditional on the issuance by the board of a number to the applicant who has successfully completed the requirements of paragraph (2). The number shall be included on all transmittals of orders for drugs or devices by the certified nurse-midwife. The board shall maintain a list of the certified nurse-midwives that it has certified pursuant to this paragraph and the number it has issued to each one. The board shall make the list available to the California State Board of Pharmacy upon its request. Every certified nurse-midwife who is authorized pursuant to this section to furnish or issue a drug order for a controlled substance shall register with the United States Drug Enforcement Administration.
(2)The board has certified in accordance with paragraph (1) that the certified nurse-midwife has satisfactorily completed a course in pharmacology covering the drugs or devices to be furnished or ordered under this section, including the risks of addiction and neonatal abstinence syndrome associated with the use of opioids. The board shall establish the requirements for satisfactory completion of this paragraph.
(3)A physician and surgeon may determine the extent of supervision necessary pursuant to this section in the furnishing or ordering of drugs and devices.
(4)A copy of the standardized procedure or protocol relating to the furnishing or ordering of controlled substances by a certified nurse-midwife shall be provided upon request to any licensed pharmacist who is uncertain of the authority of the certified nurse-midwife to perform these functions.
(5)Certified nurse-midwives who are certified by the board and hold an active furnishing number, who are currently authorized through standardized procedures or protocols to furnish Schedule II controlled substances, and who are registered with the United States Drug Enforcement Administration shall provide documentation of continuing education specific to the use of Schedule II controlled substances in settings other than a hospital based on standards developed by the board.
(c)Drugs or devices furnished or ordered by a certified nurse-midwife may include Schedule II controlled substances under the California Uniform Controlled Substances Act (Division 10 (commencing with Section 11000) of the Health and Safety Code) under the following conditions:
(1)The drugs and devices are furnished or ordered in accordance with requirements referenced in paragraphs (2) to (4), inclusive, of subdivision (a) and in paragraphs (1) to (3), inclusive, of subdivision (b).
(2)When Schedule II controlled substances, as defined in Section 11055 of the Health and Safety Code, are furnished or ordered by a certified nurse-midwife, the controlled substances shall be furnished or ordered in accordance with a patient-specific protocol approved by the treating or supervising physician and surgeon.
(d)Furnishing of drugs or devices by a certified nurse-midwife means the act of making a pharmaceutical agent or agents available to the patient in strict accordance with a standardized procedure or protocol. Use of the term furnishing in this section shall include the following:
(1)The ordering of a drug or device in accordance with the standardized procedure or protocol.
(2)Transmitting an order of a supervising physician and surgeon.
(e)Drug order or order for purposes of this section means an order for medication or for a drug or device that is dispensed to or for an ultimate user, issued by a certified nurse-midwife as an individual practitioner, within the meaning of Section 1306.03 of Title 21 of the Code of Federal Regulations. Notwithstanding any other provision of law, (1) a drug order issued pursuant to this section shall be treated in the same manner as a prescription of the supervising physician; (2) all references to prescription in this code and the Health and Safety Code shall include drug orders issued by certified nurse-midwives; and (3) the signature of a certified nurse-midwife on a drug order issued in accordance with this section shall be deemed to be the signature of a prescriber for purposes of this code and the Health and Safety Code.
SEC. 6.SEC. 8.Section 2836.1 of the Business and Professions Code is amended to read:2836.1.Neither this chapter nor any other provision of law shall be construed to prohibit a nurse practitioner from furnishing or ordering drugs or devices when all of the following apply:
(a)The drugs or devices are furnished or ordered by a nurse practitioner in accordance with standardized procedures or protocols developed by the nurse practitioner and the supervising physician and surgeon when the drugs or devices furnished or ordered are consistent with the practitioners educational preparation or for which clinical competency has been established and maintained.
(b)The nurse practitioner is functioning pursuant to standardized procedure, as defined by Section 2725, or protocol. The standardized procedure or protocol shall be developed and approved by the supervising physician and surgeon, the nurse practitioner, and the facility administrator or the designee.
(c)(1)The standardized procedure or protocol covering the furnishing of drugs or devices shall specify which nurse practitioners may furnish or order drugs or devices, which drugs or devices may be furnished or ordered, under what circumstances, the extent of physician and surgeon supervision, the method of periodic review of the nurse practitioners competence, including peer review, and review of the provisions of the standardized procedure.
(2)In addition to the requirements in paragraph (1), for Schedule II controlled substance protocols, the provision for furnishing Schedule II controlled substances shall address the diagnosis of the illness, injury, or condition for which the Schedule II controlled substance is to be furnished.
(d)The furnishing or ordering of drugs or devices by a nurse practitioner occurs under physician and surgeon supervision. Physician and surgeon supervision shall not be construed to require the physical presence of the physician, but does include (1) collaboration on the development of the standardized procedure, (2) approval of the standardized procedure, and (3) availability by telephonic contact at the time of patient examination by the nurse practitioner.
(e)For purposes of this section, no physician and surgeon shall supervise more than four nurse practitioners at one time.
(f)(1)Drugs or devices furnished or ordered by a nurse practitioner may include Schedule II through Schedule V controlled substances under the California Uniform Controlled Substances Act (Division 10 (commencing with Section 11000) of the Health and Safety Code) and shall be further limited to those drugs agreed upon by the nurse practitioner and physician and surgeon and specified in the standardized procedure.
(2)When Schedule II or III controlled substances, as defined in Sections 11055 and 11056, respectively, of the Health and Safety Code, are furnished or ordered by a nurse practitioner, the controlled substances shall be furnished or ordered in accordance with a patient-specific protocol approved by the treating or supervising physician. A copy of the section of the nurse practitioners standardized procedure relating to controlled substances shall be provided, upon request, to any licensed pharmacist who dispenses drugs or devices, when there is uncertainty about the nurse practitioner furnishing the order.
(g)(1)The board has certified in accordance with Section 2836.3 that the nurse practitioner has satisfactorily completed a course in pharmacology covering the drugs or devices to be furnished or ordered under this section.
(2)A physician and surgeon may determine the extent of supervision necessary pursuant to this section in the furnishing or ordering of drugs and devices.
(3)Nurse practitioners who are certified by the board and hold an active furnishing number, who are authorized through standardized procedures or protocols to furnish Schedule II controlled substances, and who are registered with the United States Drug Enforcement Administration, shall complete, as part of their continuing education requirements, a course including Schedule II controlled substances, and the risks of addiction associated with their use, based on the standards developed by the board. The board shall establish the requirements for satisfactory completion of this subdivision.
(h)Use of the term furnishing in this section, in health facilities defined in Section 1250 of the Health and Safety Code, shall include (1) the ordering of a drug or device in accordance with the standardized procedure and (2) transmitting an order of a supervising physician and surgeon.
(i)Drug order or order for purposes of this section means an order for medication which is dispensed to or for an ultimate user, issued by a nurse practitioner as an individual practitioner, within the meaning of Section 1306.02 of Title 21 of the Code of Federal Regulations. Notwithstanding any other provision of law, (1) a drug order issued pursuant to this section shall be treated in the same manner as a prescription of the supervising physician; (2) all references to prescription in this code and the Health and Safety Code shall include drug orders issued by nurse practitioners; and (3) the signature of a nurse practitioner on a drug order issued in accordance with this section shall be deemed to be the signature of a prescriber for purposes of this code and the Health and Safety Code.
SEC. 9.Section 3059 of the Business and Professions Code is amended to read:3059.(a)It is the intent of the Legislature that the public health and safety would be served by requiring all holders of licenses to practice optometry granted under this chapter to continue their education after receiving their licenses. The board shall adopt regulations that require, as a condition to the renewal thereof, that all holders of licenses submit proof satisfactory to the board that they have informed themselves of the developments in the practice of optometry occurring since the original issuance of their licenses by pursuing one or more courses of study satisfactory to the board or by other means deemed equivalent by the board.
(b)The board may, in accordance with the intent of this section, make exceptions from continuing education requirements for reasons of health, military service, or other good cause.
(c)If for good cause compliance cannot be met for the current year, the board may grant exemption of compliance for that year, provided that a plan of future compliance that includes current requirements as well as makeup of previous requirements is approved by the board.
(d)The board may require that proof of compliance with this section be submitted on an annual or biennial basis as determined by the board.
(e)An optometrist certified to use therapeutic pharmaceutical agents pursuant to Section 3041.3 shall complete a total of 50 hours of continuing education every two years in order to renew his or her certificate. Thirty-five of the required 50 hours of continuing education shall be on the diagnosis, treatment, and management of ocular disease in any combination of the following areas:
(1)Glaucoma.
(2)Ocular infection.
(3)Ocular inflammation.
(4)Topical steroids.
(5)Systemic medication.
(6)Pain medication. medication, including the risks of addiction associated with the use of Schedule II drugs.
(f)The board shall encourage every optometrist to take a course or courses in pharmacology and pharmaceuticals as part of his or her continuing education.
(g)The board shall consider requiring courses in child abuse detection to be taken by those licensees whose practices are such that there is a likelihood of contact with abused or neglected children.
(h)The board shall consider requiring courses in elder abuse detection to be taken by those licensees whose practices are such that there is a likelihood of contact with abused or neglected elder persons.
SEC. 7.SEC. 10.Section 3502.1 of the Business and Professions Code is amended to read:3502.1.(a)In addition to the services authorized in the regulations adopted by the Medical Board of California, and except as prohibited by Section 3502, while under the supervision of a licensed physician and surgeon or physicians and surgeons authorized by law to supervise a physician assistant, a physician assistant may administer or provide medication to a patient, or transmit orally, or in writing on a patients record or in a drug order, an order to a person who may lawfully furnish the medication or medical device pursuant to subdivisions (c) and (d).
(1)A supervising physician and surgeon who delegates authority to issue a drug order to a physician assistant may limit this authority by specifying the manner in which the physician assistant may issue delegated prescriptions.
(2)Each supervising physician and surgeon who delegates the authority to issue a drug order to a physician assistant shall first prepare and adopt, or adopt, a written, practice specific, formulary and protocols that specify all criteria for the use of a particular drug or device, and any contraindications for the selection. Protocols for Schedule II controlled substances shall address the diagnosis of illness, injury, or condition for which the Schedule II controlled substance is being administered, provided, or issued. The drugs listed in the protocols shall constitute the formulary and shall include only drugs that are appropriate for use in the type of practice engaged in by the supervising physician and surgeon. When issuing a drug order, the physician assistant is acting on behalf of and as an agent for a supervising physician and surgeon.
(b)Drug order, for purposes of this section, means an order for medication that is dispensed to or for a patient, issued and signed by a physician assistant acting as an individual practitioner within the meaning of Section 1306.02 of Title 21 of the Code of Federal Regulations. Notwithstanding any other provision of law, (1) a drug order issued pursuant to this section shall be treated in the same manner as a prescription or order of the supervising physician, (2) all references to prescription in this code and the Health and Safety Code shall include drug orders issued by physician assistants pursuant to authority granted by their supervising physicians and surgeons, and (3) the signature of a physician assistant on a drug order shall be deemed to be the signature of a prescriber for purposes of this code and the Health and Safety Code.
(c)A drug order for any patient cared for by the physician assistant that is issued by the physician assistant shall either be based on the protocols described in subdivision (a) or shall be approved by the supervising physician and surgeon before it is filled or carried out.
(1)A physician assistant shall not administer or provide a drug or issue a drug order for a drug other than for a drug listed in the formulary without advance approval from a supervising physician and surgeon for the particular patient. At the direction and under the supervision of a physician and surgeon, a physician assistant may hand to a patient of the supervising physician and surgeon a properly labeled prescription drug prepackaged by a physician and surgeon, manufacturer as defined in the Pharmacy Law, or a pharmacist.
(2)A physician assistant shall not administer, provide, or issue a drug order to a patient for Schedule II through Schedule V controlled substances without advance approval by a supervising physician and surgeon for that particular patient unless the physician assistant has completed an education course that covers controlled substances and that meets standards, including pharmacological content, approved by the board. The education course shall be provided either by an accredited continuing education provider or by an approved physician assistant training program. If the physician assistant will administer, provide, or issue a drug order for Schedule II controlled substances, the course shall contain a minimum of three hours exclusively on Schedule II controlled substances, including the risks of addiction associated with their use. Completion of the requirements set forth in this paragraph shall be verified and documented in the manner established by the board prior to the physician assistants use of a registration number issued by the United States Drug Enforcement Administration to the physician assistant to administer, provide, or issue a drug order to a patient for a controlled substance without advance approval by a supervising physician and surgeon for that particular patient.
(3)Any drug order issued by a physician assistant shall be subject to a reasonable quantitative limitation consistent with customary medical practice in the supervising physician and surgeons practice.
(d)A written drug order issued pursuant to subdivision (a), except a written drug order in a patients medical record in a health facility or medical practice, shall contain the printed name, address, and telephone number of the supervising physician and surgeon, the printed or stamped name and license number of the physician assistant, and the signature of the physician assistant. Further, a written drug order for a controlled substance, except a written drug order in a patients medical record in a health facility or a medical practice, shall include the federal controlled substances registration number of the physician assistant and shall otherwise comply with Section 11162.1 of the Health and Safety Code. Except as otherwise required for written drug orders for controlled substances under Section 11162.1 of the Health and Safety Code, the requirements of this subdivision may be met through stamping or otherwise imprinting on the supervising physician and surgeons prescription blank to show the name, license number, and if applicable, the federal controlled substances registration number of the physician assistant, and shall be signed by the physician assistant. When using a drug order, the physician assistant is acting on behalf of and as the agent of a supervising physician and surgeon.
(e)The supervising physician and surgeon shall use either of the following mechanisms to ensure adequate supervision of the administration, provision, or issuance by a physician assistant of a drug order to a patient for Schedule II controlled substances:
(1)The medical record of any patient cared for by a physician assistant for whom the physician assistants Schedule II drug order has been issued or carried out shall be reviewed, countersigned, and dated by a supervising physician and surgeon within seven days.
(2)If the physician assistant has documentation evidencing the successful completion of an education course that covers controlled substances, and that controlled substance education course (A) meets the standards, including pharmacological content, established in Sections 1399.610 and 1399.612 of Title 16 of the California Code of Regulations, and (B) is provided either by an accredited continuing education provider or by an approved physician assistant training program, the supervising physician and surgeon shall review, countersign, and date, within seven days, a sample consisting of the medical records of at least 20 percent of the patients cared for by the physician assistant for whom the physician assistants Schedule II drug order has been issued or carried out. Completion of the requirements set forth in this paragraph shall be verified and documented in the manner established in Section 1399.612 of Title 16 of the California Code of Regulations. Physician assistants who have a certificate of completion of the course described in paragraph (2) of subdivision (c) shall be deemed to have met the education course requirement of this subdivision.
(f)All physician assistants who are authorized by their supervising physicians to issue drug orders for controlled substances shall register with the United States Drug Enforcement Administration (DEA).
(g)The board shall consult with the Medical Board of California and report during its sunset review required by Article 7.5 (commencing with Section 9147.7) of Chapter 1.5 of Part 1 of Division 2 of Title 2 of the Government Code the impacts of exempting Schedule III and Schedule IV drug orders from the requirement for a physician and surgeon to review and countersign the affected medical record of a patient.
SEC. 8.Section 4079 is added to the Business and Professions Code, to read:4079.The board shall adopt an emergency regulation that requires a warning label on all Schedule II controlled substance vials or prescription bottles that addresses the risks of addiction and overdose when using opioids.SEC. 11.Section 4076.7 is added to the Business and Professions Code, to read:4076.7.In addition to the requirements of Sections 4076 and 4076.5, whenever a prescription drug containing an opioid is dispensed to a patient for outpatient use, the pharmacy or practitioner dispensing the drug shall prominently display on the label or container a notice that states Caution: Opioid. Risk of overdose and addition.
SEC. 9.SEC. 12.Section 49476 is added to the Education Code, to read:49476.(a)If a school district, charter school, or private school elects to offer an athletic program, the school district, charter school, or private school shall annually give an information sheet about the risk of opioid addiction the Opioid Factsheet for Patients published by the Centers for Disease Control and Prevention to each athlete. The information sheet shall be signed and returned by the The athlete before the athlete initiates practice or competition. If and, if the athlete is 17 years of age or younger, the information sheet the athletes parent or guardian shall also be signed by the athletes parent or guardian sign a document acknowledging receipt of the Opioid Factsheet for Patients and return that document to the school district, charter school, or private school before the athlete initiates practice or competition. The information sheet Opioid Factsheet for Patients may be sent and returned through an electronic medium, including, but not limited to, fax or email.
(b)This section does not apply to an athlete engaging in an athletic activity during the regular schoolday or as part of a physical education course required pursuant to subdivision (d) of Section 51220.
SEC. 10.SEC. 13.Section 11158.1 is added to the Health and Safety Code, to read:11158.1.(a)Except when a patient is being treated as set forth in Sections 11159, 11159.2, and 11167.5, and Article 2 (commencing with Section 11215) of Chapter 5, pertaining to the treatment of addicts, or for a diagnosis of chronic intractable pain as used in Section 124960 of this code and Section 2241.5 of the Business and Professions Code, a prescriber shall do all of the following before directly dispensing or issuing for a minor the first prescription in a single course of treatment for a controlled substance containing an opioid:
(1)Discuss all of the following with the minor, with the minors parent or guardian, or with another adult authorized to consent to the minors medical treatment:
(A)The risks of addiction and overdose associated with the use of opioids.
(B)The increased risk of addiction to an opioid to an individual who is suffering from both mental and substance abuse disorders.
(C)The danger of taking an opioid with a benzodiazepine, alcohol, or another central nervous system depressant.
(D)Any other information required by law.
(2)Obtain the signature of the minor, and the minors parent or guardian or other adult authorized to consent to the minors medical treatment. The prescriber shall include the signed consent form in the minors medical record.
(b)Paragraph (1) of subdivision (a) does not apply in any of the following circumstances:
(1)If the minors treatment is associated with or incident to a medical emergency.
(2)If the minors treatment is associated with or incident to an emergency surgery, regardless of whether the surgery is performed on an inpatient or outpatient basis.
(3)If, in the prescribers professional judgment, fulfilling the requirements of paragraph (1) of subdivision (a) would be detrimental to the minors health or safety.
(c)The consent described in paragraph (2) of subdivision (a) shall be obtained in a form that is separate from any other document that a prescriber uses to obtain the informed consent for the treatment of a minor and shall contain all of the following:
(1)The name and quantity of the controlled substance being prescribed for the minor and the amount of the initial dose.
(2)A statement indicating that a controlled substance is a drug or other substance that has been identified as having a potential for abuse.
(3)A statement certifying that the prescriber discussed with the minor, and with the minors parent or guardian or with another adult authorized to consent to the minors medical treatment, the topics described in paragraph (1) of subdivision (a), unless the exemption in subdivision (b) applies.
(4)A space for the signature of the minors parent or guardian or other adult authorized to consent to the minors medical treatment, and a space to indicate the date that the minors parent or guardian or other adult authorized to consent to the minors medical treatment signed the form.
(d)Notwithstanding any other law, including Section 11374, failure to comply with this section shall not constitute a criminal offense, but may subject the prescriber to disciplinary action for unprofessional conduct under the prescribers respective licensing act under Division 2 (commencing with Section 500) of the Business and Professions Code.
SEC. 11.SEC. 14.Section 124236 is added to the Health and Safety Code, to read:124236.(a)A youth sports organization, as defined in paragraph (3) of subdivision (b) of Section 124235, that elects to offer an athletic program shall annually give an information sheet about the risk of opioid addiction the Opioid Factsheet for Patients published by the Centers for Disease Control and Prevention to each athlete. The information sheet shall be signed and returned by the athlete before the athlete initiates practice or competition. If and, if the athlete is 17 years of age or younger, the athletes parent or guardian the information sheet shall also be signed by the athletes parent or guardian sign a document acknowledging receipt of the Opioid Factsheet for Patients and return that document to the school district, charter school, or private school before the athlete initiates practice or competition. The information sheet Opioid Factsheet for Patients may be sent and returned through an electronic medium, including, but not limited to, fax or email.
(b)This section shall apply to all athletes participating in the activities of a youth sports organization, irrespective of their ages. This section shall not be construed to prohibit a youth sports organization, or any other appropriate entity, from adopting and enforcing rules intended to provide a higher standard of safety for athletes than the standard established under this section.
SEC. 12.SEC. 15.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB 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 XIIIB of the California Constitution.
The Legislature finds and declares all of the following:
(a)Addiction, misuse, and overdose of prescription opioids is a public health crisis affecting both adults and children.
(b)Urgent measures are needed to better inform the public of the risks associated with both the long-term and short-term use of opioids in an effort to address this problem.
(c)Both short-term and long-term prescriptions of opioids to minors fall within situations that require counseling and written consent under the Guidelines for Prescribing Controlled Substances for Pain issued by the Medical Board of California.
(d)It is the intent of the Legislature to codify the Medical Board of Californias Guidelines for Prescribing Controlled Substances for Pain, as it relates to patient counseling, consent, and pain management agreements, and to ensure that health care providers and young athletes receive necessary education on this topic.
SEC. 2.Section 2190.5 of the Business and Professions Code is amended to read:2190.5.(a)(1)All physicians and surgeons shall complete a mandatory continuing education 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 board may verify completion of this requirement on the renewal application form.
(2)For physicians and surgeons licensed on or after January 1, 2019, the course described in paragraph (1) shall also include the subject of the risks of addiction associated with the use of Schedule II drugs.
(b)By regulatory action, the board may exempt physicians and surgeons by practice status category from the requirement in subdivision (a) if the physician and surgeon does not engage in direct patient care, does not provide patient consultations, or does not reside in the State of California.
(c)This section shall not apply to physicians and surgeons practicing in pathology or radiology specialty areas.
SEC. 3.Section 2191 of the Business and Professions Code is amended to read:2191.(a)In determining its continuing education requirements, the board shall consider including a course in human sexuality, defined as the study of a human being as a sexual being and how he or she functions with respect thereto, and nutrition to be taken by those licensees whose practices may require knowledge in those areas.
(b)The board shall consider including a course in 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.
(c)The board shall consider including a course in 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.
(d)The board shall encourage every physician and surgeon to take nutrition as part of his or her continuing education, particularly a physician and surgeon involved in primary care.
(e)The board shall consider including a course in 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.
(f)In determining its continuing education requirements, the board shall consider including a course in 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.
(g)In determining its continuing education requirements, the board shall consider including a course in 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.
(h)In determining its continuing education requirements, the board shall consider including a course providing training and 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 board 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.
(i)In determining its continuing education requirements, the board shall consider including a course in the special care needs of individuals and their families facing end-of-life issues, including, but not limited to, all of the following:
(1)Pain and symptom management.
(2)The psycho-social dynamics of death.
(3)Dying and bereavement.
(4)Hospice care.
(j)In determining its continuing education requirements, the board shall give its highest priority to considering a course on pain management and the risks of addiction associated with the use of Schedule II drugs.
(k)In determining its continuing education requirements, the board shall consider including a course in geriatric care for emergency room physicians and surgeons.
SEC. 4.Section 2196.2 of the Business and Professions Code is amended to read:2196.2.The board shall periodically develop and disseminate information and educational material regarding pain management techniques and procedures, including the risks of addiction associated with the use of Schedule II drugs, to each licensed physician and surgeon and to each general acute care hospital in this state. The board shall consult with the State Department of Public Health in developing the materials to be distributed pursuant to this section.
SEC. 5.Section 2746.51 of the Business and Professions Code is amended to read:2746.51.(a)Neither this chapter nor any other provision of law shall be construed to prohibit a certified nurse-midwife from furnishing or ordering drugs or devices, including controlled substances classified in Schedule II, III, IV, or V under the California Uniform Controlled Substances Act (Division 10 (commencing with Section 11000) of the Health and Safety Code), when all of the following apply:
(1)The drugs or devices are furnished or ordered incidentally to the provision of any of the following:
(A)Family planning services, as defined in Section 14503 of the Welfare and Institutions Code.
(B)Routine health care or perinatal care, as defined in subdivision (d) of Section 123485 of the Health and Safety Code.
(C)Care rendered, consistent with the certified nurse-midwifes educational preparation or for which clinical competency has been established and maintained, to persons within a facility specified in subdivision (a), (b), (c), (d), (i), or (j) of Section 1206 of the Health and Safety Code, a clinic as specified in Section 1204 of the Health and Safety Code, a general acute care hospital as defined in subdivision (a) of Section 1250 of the Health and Safety Code, a licensed birth center as defined in Section 1204.3 of the Health and Safety Code, or a special hospital specified as a maternity hospital in subdivision (f) of Section 1250 of the Health and Safety Code.
(2)The drugs or devices are furnished or ordered by a certified nurse-midwife in accordance with standardized procedures or protocols. For purposes of this section, standardized procedure means a document, including protocols, developed and approved by the supervising physician and surgeon, the certified nurse-midwife, and the facility administrator or his or her designee. The standardized procedure covering the furnishing or ordering of drugs or devices shall specify all of the following:
(A)Which certified nurse-midwife may furnish or order drugs or devices.
(B)Which drugs or devices may be furnished or ordered and under what circumstances.
(C)The extent of physician and surgeon supervision.
(D)The method of periodic review of the certified nurse-midwifes competence, including peer review, and review of the provisions of the standardized procedure.
(3)If Schedule II or III controlled substances, as defined in Sections 11055 and 11056 of the Health and Safety Code, are furnished or ordered by a certified nurse-midwife, the controlled substances shall be furnished or ordered in accordance with a patient-specific protocol approved by the treating or supervising physician and surgeon. For Schedule II controlled substance protocols, the provision for furnishing the Schedule II controlled substance shall address the diagnosis of the illness, injury, or condition for which the Schedule II controlled substance is to be furnished.
(4)The furnishing or ordering of drugs or devices by a certified nurse-midwife occurs under physician and surgeon supervision. For purposes of this section, no physician and surgeon shall supervise more than four certified nurse-midwives at one time. Physician and surgeon supervision shall not be construed to require the physical presence of the physician, but does include all of the following:
(A)Collaboration on the development of the standardized procedure or protocol.
(B)Approval of the standardized procedure or protocol.
(C)Availability by telephonic contact at the time of patient examination by the certified nurse-midwife.
(b)(1)The furnishing or ordering of drugs or devices by a certified nurse-midwife is conditional on the issuance by the board of a number to the applicant who has successfully completed the requirements of paragraph (2). The number shall be included on all transmittals of orders for drugs or devices by the certified nurse-midwife. The board shall maintain a list of the certified nurse-midwives that it has certified pursuant to this paragraph and the number it has issued to each one. The board shall make the list available to the California State Board of Pharmacy upon its request. Every certified nurse-midwife who is authorized pursuant to this section to furnish or issue a drug order for a controlled substance shall register with the United States Drug Enforcement Administration.
(2)The board has certified in accordance with paragraph (1) that the certified nurse-midwife has satisfactorily completed a course in pharmacology covering the drugs or devices to be furnished or ordered under this section, including the risks of addiction and neonatal abstinence syndrome associated with the use of opioids. The board shall establish the requirements for satisfactory completion of this paragraph.
(3)A physician and surgeon may determine the extent of supervision necessary pursuant to this section in the furnishing or ordering of drugs and devices.
(4)A copy of the standardized procedure or protocol relating to the furnishing or ordering of controlled substances by a certified nurse-midwife shall be provided upon request to any licensed pharmacist who is uncertain of the authority of the certified nurse-midwife to perform these functions.
(5)Certified nurse-midwives who are certified by the board and hold an active furnishing number, who are currently authorized through standardized procedures or protocols to furnish Schedule II controlled substances, and who are registered with the United States Drug Enforcement Administration shall provide documentation of continuing education specific to the use of Schedule II controlled substances in settings other than a hospital based on standards developed by the board.
(c)Drugs or devices furnished or ordered by a certified nurse-midwife may include Schedule II controlled substances under the California Uniform Controlled Substances Act (Division 10 (commencing with Section 11000) of the Health and Safety Code) under the following conditions:
(1)The drugs and devices are furnished or ordered in accordance with requirements referenced in paragraphs (2) to (4), inclusive, of subdivision (a) and in paragraphs (1) to (3), inclusive, of subdivision (b).
(2)When Schedule II controlled substances, as defined in Section 11055 of the Health and Safety Code, are furnished or ordered by a certified nurse-midwife, the controlled substances shall be furnished or ordered in accordance with a patient-specific protocol approved by the treating or supervising physician and surgeon.
(d)Furnishing of drugs or devices by a certified nurse-midwife means the act of making a pharmaceutical agent or agents available to the patient in strict accordance with a standardized procedure or protocol. Use of the term furnishing in this section shall include the following:
(1)The ordering of a drug or device in accordance with the standardized procedure or protocol.
(2)Transmitting an order of a supervising physician and surgeon.
(e)Drug order or order for purposes of this section means an order for medication or for a drug or device that is dispensed to or for an ultimate user, issued by a certified nurse-midwife as an individual practitioner, within the meaning of Section 1306.03 of Title 21 of the Code of Federal Regulations. Notwithstanding any other provision of law, (1) a drug order issued pursuant to this section shall be treated in the same manner as a prescription of the supervising physician; (2) all references to prescription in this code and the Health and Safety Code shall include drug orders issued by certified nurse-midwives; and (3) the signature of a certified nurse-midwife on a drug order issued in accordance with this section shall be deemed to be the signature of a prescriber for purposes of this code and the Health and Safety Code.
SEC. 6.Section 2836.1 of the Business and Professions Code is amended to read:2836.1.Neither this chapter nor any other provision of law shall be construed to prohibit a nurse practitioner from furnishing or ordering drugs or devices when all of the following apply:
(a)The drugs or devices are furnished or ordered by a nurse practitioner in accordance with standardized procedures or protocols developed by the nurse practitioner and the supervising physician and surgeon when the drugs or devices furnished or ordered are consistent with the practitioners educational preparation or for which clinical competency has been established and maintained.
(b)The nurse practitioner is functioning pursuant to standardized procedure, as defined by Section 2725, or protocol. The standardized procedure or protocol shall be developed and approved by the supervising physician and surgeon, the nurse practitioner, and the facility administrator or the designee.
(c)(1)The standardized procedure or protocol covering the furnishing of drugs or devices shall specify which nurse practitioners may furnish or order drugs or devices, which drugs or devices may be furnished or ordered, under what circumstances, the extent of physician and surgeon supervision, the method of periodic review of the nurse practitioners competence, including peer review, and review of the provisions of the standardized procedure.
(2)In addition to the requirements in paragraph (1), for Schedule II controlled substance protocols, the provision for furnishing Schedule II controlled substances shall address the diagnosis of the illness, injury, or condition for which the Schedule II controlled substance is to be furnished.
(d)The furnishing or ordering of drugs or devices by a nurse practitioner occurs under physician and surgeon supervision. Physician and surgeon supervision shall not be construed to require the physical presence of the physician, but does include (1) collaboration on the development of the standardized procedure, (2) approval of the standardized procedure, and (3) availability by telephonic contact at the time of patient examination by the nurse practitioner.
(e)For purposes of this section, no physician and surgeon shall supervise more than four nurse practitioners at one time.
(f)(1)Drugs or devices furnished or ordered by a nurse practitioner may include Schedule II through Schedule V controlled substances under the California Uniform Controlled Substances Act (Division 10 (commencing with Section 11000) of the Health and Safety Code) and shall be further limited to those drugs agreed upon by the nurse practitioner and physician and surgeon and specified in the standardized procedure.
(2)When Schedule II or III controlled substances, as defined in Sections 11055 and 11056, respectively, of the Health and Safety Code, are furnished or ordered by a nurse practitioner, the controlled substances shall be furnished or ordered in accordance with a patient-specific protocol approved by the treating or supervising physician. A copy of the section of the nurse practitioners standardized procedure relating to controlled substances shall be provided, upon request, to any licensed pharmacist who dispenses drugs or devices, when there is uncertainty about the nurse practitioner furnishing the order.
(g)(1)The board has certified in accordance with Section 2836.3 that the nurse practitioner has satisfactorily completed a course in pharmacology covering the drugs or devices to be furnished or ordered under this section.
(2)A physician and surgeon may determine the extent of supervision necessary pursuant to this section in the furnishing or ordering of drugs and devices.
(3)Nurse practitioners who are certified by the board and hold an active furnishing number, who are authorized through standardized procedures or protocols to furnish Schedule II controlled substances, and who are registered with the United States Drug Enforcement Administration, shall complete, as part of their continuing education requirements, a course including Schedule II controlled substances, and the risks of addiction associated with their use, based on the standards developed by the board. The board shall establish the requirements for satisfactory completion of this subdivision.
(h)Use of the term furnishing in this section, in health facilities defined in Section 1250 of the Health and Safety Code, shall include (1) the ordering of a drug or device in accordance with the standardized procedure and (2) transmitting an order of a supervising physician and surgeon.
(i)Drug order or order for purposes of this section means an order for medication which is dispensed to or for an ultimate user, issued by a nurse practitioner as an individual practitioner, within the meaning of Section 1306.02 of Title 21 of the Code of Federal Regulations. Notwithstanding any other provision of law, (1) a drug order issued pursuant to this section shall be treated in the same manner as a prescription of the supervising physician; (2) all references to prescription in this code and the Health and Safety Code shall include drug orders issued by nurse practitioners; and (3) the signature of a nurse practitioner on a drug order issued in accordance with this section shall be deemed to be the signature of a prescriber for purposes of this code and the Health and Safety Code.
SEC. 7.Section 3502.1 of the Business and Professions Code is amended to read:3502.1.(a)In addition to the services authorized in the regulations adopted by the Medical Board of California, and except as prohibited by Section 3502, while under the supervision of a licensed physician and surgeon or physicians and surgeons authorized by law to supervise a physician assistant, a physician assistant may administer or provide medication to a patient, or transmit orally, or in writing on a patients record or in a drug order, an order to a person who may lawfully furnish the medication or medical device pursuant to subdivisions (c) and (d).
(1)A supervising physician and surgeon who delegates authority to issue a drug order to a physician assistant may limit this authority by specifying the manner in which the physician assistant may issue delegated prescriptions.
(2)Each supervising physician and surgeon who delegates the authority to issue a drug order to a physician assistant shall first prepare and adopt, or adopt, a written, practice specific, formulary and protocols that specify all criteria for the use of a particular drug or device, and any contraindications for the selection. Protocols for Schedule II controlled substances shall address the diagnosis of illness, injury, or condition for which the Schedule II controlled substance is being administered, provided, or issued. The drugs listed in the protocols shall constitute the formulary and shall include only drugs that are appropriate for use in the type of practice engaged in by the supervising physician and surgeon. When issuing a drug order, the physician assistant is acting on behalf of and as an agent for a supervising physician and surgeon.
(b)Drug order, for purposes of this section, means an order for medication that is dispensed to or for a patient, issued and signed by a physician assistant acting as an individual practitioner within the meaning of Section 1306.02 of Title 21 of the Code of Federal Regulations. Notwithstanding any other provision of law, (1) a drug order issued pursuant to this section shall be treated in the same manner as a prescription or order of the supervising physician, (2) all references to prescription in this code and the Health and Safety Code shall include drug orders issued by physician assistants pursuant to authority granted by their supervising physicians and surgeons, and (3) the signature of a physician assistant on a drug order shall be deemed to be the signature of a prescriber for purposes of this code and the Health and Safety Code.
(c)A drug order for any patient cared for by the physician assistant that is issued by the physician assistant shall either be based on the protocols described in subdivision (a) or shall be approved by the supervising physician and surgeon before it is filled or carried out.
(1)A physician assistant shall not administer or provide a drug or issue a drug order for a drug other than for a drug listed in the formulary without advance approval from a supervising physician and surgeon for the particular patient. At the direction and under the supervision of a physician and surgeon, a physician assistant may hand to a patient of the supervising physician and surgeon a properly labeled prescription drug prepackaged by a physician and surgeon, manufacturer as defined in the Pharmacy Law, or a pharmacist.
(2)A physician assistant shall not administer, provide, or issue a drug order to a patient for Schedule II through Schedule V controlled substances without advance approval by a supervising physician and surgeon for that particular patient unless the physician assistant has completed an education course that covers controlled substances and that meets standards, including pharmacological content, approved by the board. The education course shall be provided either by an accredited continuing education provider or by an approved physician assistant training program. If the physician assistant will administer, provide, or issue a drug order for Schedule II controlled substances, the course shall contain a minimum of three hours exclusively on Schedule II controlled substances, including the risks of addiction associated with their use. Completion of the requirements set forth in this paragraph shall be verified and documented in the manner established by the board prior to the physician assistants use of a registration number issued by the United States Drug Enforcement Administration to the physician assistant to administer, provide, or issue a drug order to a patient for a controlled substance without advance approval by a supervising physician and surgeon for that particular patient.
(3)Any drug order issued by a physician assistant shall be subject to a reasonable quantitative limitation consistent with customary medical practice in the supervising physician and surgeons practice.
(d)A written drug order issued pursuant to subdivision (a), except a written drug order in a patients medical record in a health facility or medical practice, shall contain the printed name, address, and telephone number of the supervising physician and surgeon, the printed or stamped name and license number of the physician assistant, and the signature of the physician assistant. Further, a written drug order for a controlled substance, except a written drug order in a patients medical record in a health facility or a medical practice, shall include the federal controlled substances registration number of the physician assistant and shall otherwise comply with Section 11162.1 of the Health and Safety Code. Except as otherwise required for written drug orders for controlled substances under Section 11162.1 of the Health and Safety Code, the requirements of this subdivision may be met through stamping or otherwise imprinting on the supervising physician and surgeons prescription blank to show the name, license number, and if applicable, the federal controlled substances registration number of the physician assistant, and shall be signed by the physician assistant. When using a drug order, the physician assistant is acting on behalf of and as the agent of a supervising physician and surgeon.
(e)The supervising physician and surgeon shall use either of the following mechanisms to ensure adequate supervision of the administration, provision, or issuance by a physician assistant of a drug order to a patient for Schedule II controlled substances:
(1)The medical record of any patient cared for by a physician assistant for whom the physician assistants Schedule II drug order has been issued or carried out shall be reviewed, countersigned, and dated by a supervising physician and surgeon within seven days.
(2)If the physician assistant has documentation evidencing the successful completion of an education course that covers controlled substances, and that controlled substance education course (A) meets the standards, including pharmacological content, established in Sections 1399.610 and 1399.612 of Title 16 of the California Code of Regulations, and (B) is provided either by an accredited continuing education provider or by an approved physician assistant training program, the supervising physician and surgeon shall review, countersign, and date, within seven days, a sample consisting of the medical records of at least 20 percent of the patients cared for by the physician assistant for whom the physician assistants Schedule II drug order has been issued or carried out. Completion of the requirements set forth in this paragraph shall be verified and documented in the manner established in Section 1399.612 of Title 16 of the California Code of Regulations. Physician assistants who have a certificate of completion of the course described in paragraph (2) of subdivision (c) shall be deemed to have met the education course requirement of this subdivision.
(f)All physician assistants who are authorized by their supervising physicians to issue drug orders for controlled substances shall register with the United States Drug Enforcement Administration (DEA).
(g)The board shall consult with the Medical Board of California and report during its sunset review required by Article 7.5 (commencing with Section 9147.7) of Chapter 1.5 of Part 1 of Division 2 of Title 2 of the Government Code the impacts of exempting Schedule III and Schedule IV drug orders from the requirement for a physician and surgeon to review and countersign the affected medical record of a patient.
SEC. 8.Section 4079 is added to the Business and Professions Code, to read:4079.The board shall adopt an emergency regulation that requires a warning label on all Schedule II controlled substance vials or prescription bottles that addresses the risks of addiction and overdose when using opioids.
SEC. 9.Section 49476 is added to the Education Code, to read:49476.(a)If a school district, charter school, or private school elects to offer an athletic program, the school district, charter school, or private school shall annually give an information sheet about the risk of opioid addiction to each athlete. The information sheet shall be signed and returned by the athlete before the athlete initiates practice or competition. If the athlete is 17 years of age or younger, the information sheet shall also be signed by the athletes parent or guardian before the athlete initiates practice or competition. The information sheet may be sent and returned through an electronic medium, including, but not limited to, fax or email.
(b)This section does not apply to an athlete engaging in an athletic activity during the regular schoolday or as part of a physical education course required pursuant to subdivision (d) of Section 51220.
SEC. 10.Section 11158.1 is added to the Health and Safety Code, to read:11158.1.(a)Except when a patient is being treated as set forth in Sections 11159, 11159.2, and 11167.5, and Article 2 (commencing with Section 11215) of Chapter 5, pertaining to the treatment of addicts, or for a diagnosis of chronic intractable pain as used in Section 124960 of this code and Section 2241.5 of the Business and Professions Code, a prescriber shall do all of the following before directly dispensing or issuing for a minor the first prescription in a single course of treatment for a controlled substance containing an opioid:
(1)Discuss all of the following with the minor, with the minors parent or guardian, or with another adult authorized to consent to the minors medical treatment:
(A)The risks of addiction and overdose associated with the use of opioids.
(B)The increased risk of addiction to an opioid to an individual who is suffering from both mental and substance abuse disorders.
(C)The danger of taking an opioid with a benzodiazepine, alcohol, or another central nervous system depressant.
(D)Any other information required by law.
(2)Obtain the signature of the minor, and the minors parent or guardian or other adult authorized to consent to the minors medical treatment. The prescriber shall include the signed consent form in the minors medical record.
(b)Paragraph (1) of subdivision (a) does not apply in any of the following circumstances:
(1)If the minors treatment is associated with or incident to a medical emergency.
(2)If the minors treatment is associated with or incident to an emergency surgery, regardless of whether the surgery is performed on an inpatient or outpatient basis.
(3)If, in the prescribers professional judgment, fulfilling the requirements of paragraph (1) of subdivision (a) would be detrimental to the minors health or safety.
(c)The consent described in paragraph (2) of subdivision (a) shall be obtained in a form that is separate from any other document that a prescriber uses to obtain the informed consent for the treatment of a minor and shall contain all of the following:
(1)The name and quantity of the controlled substance being prescribed for the minor and the amount of the initial dose.
(2)A statement indicating that a controlled substance is a drug or other substance that has been identified as having a potential for abuse.
(3)A statement certifying that the prescriber discussed with the minor, and with the minors parent or guardian or with another adult authorized to consent to the minors medical treatment, the topics described in paragraph (1) of subdivision (a), unless the exemption in subdivision (b) applies.
(4)A space for the signature of the minors parent or guardian or other adult authorized to consent to the minors medical treatment, and a space to indicate the date that the minors parent or guardian or other adult authorized to consent to the minors medical treatment signed the form.
(d)Notwithstanding any other law, including Section 11374, failure to comply with this section shall not constitute a criminal offense, but may subject the prescriber to disciplinary action for unprofessional conduct under the prescribers respective licensing act under Division 2 (commencing with Section 500) of the Business and Professions Code.
SEC. 11.Section 124236 is added to the Health and Safety Code, to read:124236.(a)A youth sports organization, as defined in paragraph (3) of subdivision (b) of Section 124235, that elects to offer an athletic program shall annually give an information sheet about the risk of opioid addiction to each athlete. The information sheet shall be signed and returned by the athlete before the athlete initiates practice or competition. If the athlete is 17 years of age or younger, the information sheet shall also be signed by the athletes parent or guardian before the athlete initiates practice or competition. The information sheet may be sent and returned through an electronic medium, including, but not limited to, fax or email.
(b)This section shall apply to all athletes participating in the activities of a youth sports organization, irrespective of their ages. This section shall not be construed to prohibit a youth sports organization, or any other appropriate entity, from adopting and enforcing rules intended to provide a higher standard of safety for athletes than the standard established under this section.
SEC. 12.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB 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 XIIIB of the California Constitution.
The Legislature finds and declares all of the following:
(a)Addiction, misuse, and overdose of prescription opioids is a public health crisis affecting both adults and children.
(b)Urgent measures are needed to better inform the public of the risks associated with both the long-term and short-term use of opioids in an effort to address this problem.
(c)Both short-term and long-term prescriptions of opioids to minors fall within situations that require counseling and written consent under the Guidelines for Prescribing Controlled Substances for Pain issued by the Medical Board of California.
(d)It is the intent of the Legislature to codify the Medical Board of Californias Guidelines for Prescribing Controlled Substances for Pain, as it relates to patient counseling, consent, and pain management agreements, and to ensure that health care providers and young athletes receive necessary education on this topic.
SEC. 2.Section 2190.5 of the Business and Professions Code is amended to read:2190.5.(a)(1)All physicians and surgeons shall complete a mandatory continuing education 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 board may verify completion of this requirement on the renewal application form.
(2)For physicians and surgeons licensed on or after January 1, 2019, the course described in paragraph (1) shall also include the subject of the risks of addiction associated with the use of Schedule II drugs.
(b)By regulatory action, the board may exempt physicians and surgeons by practice status category from the requirement in subdivision (a) if the physician and surgeon does not engage in direct patient care, does not provide patient consultations, or does not reside in the State of California.
(c)This section shall not apply to physicians and surgeons practicing in pathology or radiology specialty areas.
SEC. 3.Section 2191 of the Business and Professions Code is amended to read:2191.(a)In determining its continuing education requirements, the board shall consider including a course in human sexuality, defined as the study of a human being as a sexual being and how he or she functions with respect thereto, and nutrition to be taken by those licensees whose practices may require knowledge in those areas.
(b)The board shall consider including a course in 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.
(c)The board shall consider including a course in 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.
(d)The board shall encourage every physician and surgeon to take nutrition as part of his or her continuing education, particularly a physician and surgeon involved in primary care.
(e)The board shall consider including a course in 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.
(f)In determining its continuing education requirements, the board shall consider including a course in 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.
(g)In determining its continuing education requirements, the board shall consider including a course in 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.
(h)In determining its continuing education requirements, the board shall consider including a course providing training and 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 board 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.
(i)In determining its continuing education requirements, the board shall consider including a course in the special care needs of individuals and their families facing end-of-life issues, including, but not limited to, all of the following:
(1)Pain and symptom management.
(2)The psycho-social dynamics of death.
(3)Dying and bereavement.
(4)Hospice care.
(j)In determining its continuing education requirements, the board shall give its highest priority to considering a course on pain management. management and the risks of addiction associated with the use of Schedule II drugs.
(k)In determining its continuing education requirements, the board shall consider including a course in geriatric care for emergency room physicians and surgeons.
SEC. 4.Section 2196.2 of the Business and Professions Code is amended to read:2196.2.The board shall periodically develop and disseminate information and educational material regarding pain management techniques and procedures procedures, including the risks of addiction associated with the use of Schedule II drugs, to each licensed physician and surgeon and to each general acute care hospital in this state. The board shall consult with the State Department of Health Services Public Health in developing the materials to be distributed pursuant to this section.
SEC. 5.Section 2746.51 of the Business and Professions Code is amended to read:2746.51.(a)Neither this chapter nor any other provision of law shall be construed to prohibit a certified nurse-midwife from furnishing or ordering drugs or devices, including controlled substances classified in Schedule II, III, IV, or V under the California Uniform Controlled Substances Act (Division 10 (commencing with Section 11000) of the Health and Safety Code), when all of the following apply:
(1)The drugs or devices are furnished or ordered incidentally to the provision of any of the following:
(A)Family planning services, as defined in Section 14503 of the Welfare and Institutions Code.
(B)Routine health care or perinatal care, as defined in subdivision (d) of Section 123485 of the Health and Safety Code.
(C)Care rendered, consistent with the certified nurse-midwifes educational preparation or for which clinical competency has been established and maintained, to persons within a facility specified in subdivision (a), (b), (c), (d), (i), or (j) of Section 1206 of the Health and Safety Code, a clinic as specified in Section 1204 of the Health and Safety Code, a general acute care hospital as defined in subdivision (a) of Section 1250 of the Health and Safety Code, a licensed birth center as defined in Section 1204.3 of the Health and Safety Code, or a special hospital specified as a maternity hospital in subdivision (f) of Section 1250 of the Health and Safety Code.
(2)The drugs or devices are furnished or ordered by a certified nurse-midwife in accordance with standardized procedures or protocols. For purposes of this section, standardized procedure means a document, including protocols, developed and approved by the supervising physician and surgeon, the certified nurse-midwife, and the facility administrator or his or her designee. The standardized procedure covering the furnishing or ordering of drugs or devices shall specify all of the following:
(A)Which certified nurse-midwife may furnish or order drugs or devices.
(B)Which drugs or devices may be furnished or ordered and under what circumstances.
(C)The extent of physician and surgeon supervision.
(D)The method of periodic review of the certified nurse-midwifes competence, including peer review, and review of the provisions of the standardized procedure.
(3)If Schedule II or III controlled substances, as defined in Sections 11055 and 11056 of the Health and Safety Code, are furnished or ordered by a certified nurse-midwife, the controlled substances shall be furnished or ordered in accordance with a patient-specific protocol approved by the treating or supervising physician and surgeon. For Schedule II controlled substance protocols, the provision for furnishing the Schedule II controlled substance shall address the diagnosis of the illness, injury, or condition for which the Schedule II controlled substance is to be furnished.
(4)The furnishing or ordering of drugs or devices by a certified nurse-midwife occurs under physician and surgeon supervision. For purposes of this section, no physician and surgeon shall supervise more than four certified nurse-midwives at one time. Physician and surgeon supervision shall not be construed to require the physical presence of the physician, but does include all of the following:
(A)Collaboration on the development of the standardized procedure or protocol.
(B)Approval of the standardized procedure or protocol.
(C)Availability by telephonic contact at the time of patient examination by the certified nurse-midwife.
(b)(1)The furnishing or ordering of drugs or devices by a certified nurse-midwife is conditional on the issuance by the board of a number to the applicant who has successfully completed the requirements of paragraph (2). The number shall be included on all transmittals of orders for drugs or devices by the certified nurse-midwife. The board shall maintain a list of the certified nurse-midwives that it has certified pursuant to this paragraph and the number it has issued to each one. The board shall make the list available to the California State Board of Pharmacy upon its request. Every certified nurse-midwife who is authorized pursuant to this section to furnish or issue a drug order for a controlled substance shall register with the United States Drug Enforcement Administration.
(2)The board has certified in accordance with paragraph (1) that the certified nurse-midwife has satisfactorily completed a course in pharmacology covering the drugs or devices to be furnished or ordered under this section. section, including the risks of addiction and neonatal abstinence syndrome associated with the use of opioids. The board shall establish the requirements for satisfactory completion of this paragraph.
(3)A physician and surgeon may determine the extent of supervision necessary pursuant to this section in the furnishing or ordering of drugs and devices.
(4)A copy of the standardized procedure or protocol relating to the furnishing or ordering of controlled substances by a certified nurse-midwife shall be provided upon request to any licensed pharmacist who is uncertain of the authority of the certified nurse-midwife to perform these functions.
(5)Certified nurse-midwives who are certified by the board and hold an active furnishing number, who are currently authorized through standardized procedures or protocols to furnish Schedule II controlled substances, and who are registered with the United States Drug Enforcement Administration shall provide documentation of continuing education specific to the use of Schedule II controlled substances in settings other than a hospital based on standards developed by the board.
(c)Drugs or devices furnished or ordered by a certified nurse-midwife may include Schedule II controlled substances under the California Uniform Controlled Substances Act (Division 10 (commencing with Section 11000) of the Health and Safety Code) under the following conditions:
(1)The drugs and devices are furnished or ordered in accordance with requirements referenced in paragraphs (2) to (4), inclusive, of subdivision (a) and in paragraphs (1) to (3), inclusive, of subdivision (b).
(2)When Schedule II controlled substances, as defined in Section 11055 of the Health and Safety Code, are furnished or ordered by a certified nurse-midwife, the controlled substances shall be furnished or ordered in accordance with a patient-specific protocol approved by the treating or supervising physician and surgeon.
(d)Furnishing of drugs or devices by a certified nurse-midwife means the act of making a pharmaceutical agent or agents available to the patient in strict accordance with a standardized procedure or protocol. Use of the term furnishing in this section shall include the following:
(1)The ordering of a drug or device in accordance with the standardized procedure or protocol.
(2)Transmitting an order of a supervising physician and surgeon.
(e)Drug order or order for purposes of this section means an order for medication or for a drug or device that is dispensed to or for an ultimate user, issued by a certified nurse-midwife as an individual practitioner, within the meaning of Section 1306.03 of Title 21 of the Code of Federal Regulations. Notwithstanding any other provision of law, (1) a drug order issued pursuant to this section shall be treated in the same manner as a prescription of the supervising physician; (2) all references to prescription in this code and the Health and Safety Code shall include drug orders issued by certified nurse-midwives; and (3) the signature of a certified nurse-midwife on a drug order issued in accordance with this section shall be deemed to be the signature of a prescriber for purposes of this code and the Health and Safety Code.
SEC. 6.Section 2836.1 of the Business and Professions Code is amended to read:2836.1.Neither this chapter nor any other provision of law shall be construed to prohibit a nurse practitioner from furnishing or ordering drugs or devices when all of the following apply:
(a)The drugs or devices are furnished or ordered by a nurse practitioner in accordance with standardized procedures or protocols developed by the nurse practitioner and the supervising physician and surgeon when the drugs or devices furnished or ordered are consistent with the practitioners educational preparation or for which clinical competency has been established and maintained.
(b)The nurse practitioner is functioning pursuant to standardized procedure, as defined by Section 2725, or protocol. The standardized procedure or protocol shall be developed and approved by the supervising physician and surgeon, the nurse practitioner, and the facility administrator or the designee.
(c)(1)The standardized procedure or protocol covering the furnishing of drugs or devices shall specify which nurse practitioners may furnish or order drugs or devices, which drugs or devices may be furnished or ordered, under what circumstances, the extent of physician and surgeon supervision, the method of periodic review of the nurse practitioners competence, including peer review, and review of the provisions of the standardized procedure.
(2)In addition to the requirements in paragraph (1), for Schedule II controlled substance protocols, the provision for furnishing Schedule II controlled substances shall address the diagnosis of the illness, injury, or condition for which the Schedule II controlled substance is to be furnished.
(d)The furnishing or ordering of drugs or devices by a nurse practitioner occurs under physician and surgeon supervision. Physician and surgeon supervision shall not be construed to require the physical presence of the physician, but does include (1) collaboration on the development of the standardized procedure, (2) approval of the standardized procedure, and (3) availability by telephonic contact at the time of patient examination by the nurse practitioner.
(e)For purposes of this section, no physician and surgeon shall supervise more than four nurse practitioners at one time.
(f)(1)Drugs or devices furnished or ordered by a nurse practitioner may include Schedule II through Schedule V controlled substances under the California Uniform Controlled Substances Act (Division 10 (commencing with Section 11000) of the Health and Safety Code) and shall be further limited to those drugs agreed upon by the nurse practitioner and physician and surgeon and specified in the standardized procedure.
(2)When Schedule II or III controlled substances, as defined in Sections 11055 and 11056, respectively, of the Health and Safety Code, are furnished or ordered by a nurse practitioner, the controlled substances shall be furnished or ordered in accordance with a patient-specific protocol approved by the treating or supervising physician. A copy of the section of the nurse practitioners standardized procedure relating to controlled substances shall be provided, upon request, to any licensed pharmacist who dispenses drugs or devices, when there is uncertainty about the nurse practitioner furnishing the order.
(g)(1)The board has certified in accordance with Section 2836.3 that the nurse practitioner has satisfactorily completed a course in pharmacology covering the drugs or devices to be furnished or ordered under this section.
(2)A physician and surgeon may determine the extent of supervision necessary pursuant to this section in the furnishing or ordering of drugs and devices.
(3)Nurse practitioners who are certified by the board and hold an active furnishing number, who are authorized through standardized procedures or protocols to furnish Schedule II controlled substances, and who are registered with the United States Drug Enforcement Administration, shall complete, as part of their continuing education requirements, a course including Schedule II controlled substances substances, and the risks of addiction associated with their use, based on the standards developed by the board. The board shall establish the requirements for satisfactory completion of this subdivision.
(h)Use of the term furnishing in this section, in health facilities defined in Section 1250 of the Health and Safety Code, shall include (1) the ordering of a drug or device in accordance with the standardized procedure and (2) transmitting an order of a supervising physician and surgeon.
(i)Drug order or order for purposes of this section means an order for medication which is dispensed to or for an ultimate user, issued by a nurse practitioner as an individual practitioner, within the meaning of Section 1306.02 of Title 21 of the Code of Federal Regulations. Notwithstanding any other provision of law, (1) a drug order issued pursuant to this section shall be treated in the same manner as a prescription of the supervising physician; (2) all references to prescription in this code and the Health and Safety Code shall include drug orders issued by nurse practitioners; and (3) the signature of a nurse practitioner on a drug order issued in accordance with this section shall be deemed to be the signature of a prescriber for purposes of this code and the Health and Safety Code.
SEC. 7.Section 3502.1 of the Business and Professions Code is amended to read:3502.1.(a)In addition to the services authorized in the regulations adopted by the Medical Board of California, and except as prohibited by Section 3502, while under the supervision of a licensed physician and surgeon or physicians and surgeons authorized by law to supervise a physician assistant, a physician assistant may administer or provide medication to a patient, or transmit orally, or in writing on a patients record or in a drug order, an order to a person who may lawfully furnish the medication or medical device pursuant to subdivisions (c) and (d).
(1)A supervising physician and surgeon who delegates authority to issue a drug order to a physician assistant may limit this authority by specifying the manner in which the physician assistant may issue delegated prescriptions.
(2)Each supervising physician and surgeon who delegates the authority to issue a drug order to a physician assistant shall first prepare and adopt, or adopt, a written, practice specific, formulary and protocols that specify all criteria for the use of a particular drug or device, and any contraindications for the selection. Protocols for Schedule II controlled substances shall address the diagnosis of illness, injury, or condition for which the Schedule II controlled substance is being administered, provided, or issued. The drugs listed in the protocols shall constitute the formulary and shall include only drugs that are appropriate for use in the type of practice engaged in by the supervising physician and surgeon. When issuing a drug order, the physician assistant is acting on behalf of and as an agent for a supervising physician and surgeon.
(b)Drug order, for purposes of this section, means an order for medication that is dispensed to or for a patient, issued and signed by a physician assistant acting as an individual practitioner within the meaning of Section 1306.02 of Title 21 of the Code of Federal Regulations. Notwithstanding any other provision of law, (1) a drug order issued pursuant to this section shall be treated in the same manner as a prescription or order of the supervising physician, (2) all references to prescription in this code and the Health and Safety Code shall include drug orders issued by physician assistants pursuant to authority granted by their supervising physicians and surgeons, and (3) the signature of a physician assistant on a drug order shall be deemed to be the signature of a prescriber for purposes of this code and the Health and Safety Code.
(c)A drug order for any patient cared for by the physician assistant that is issued by the physician assistant shall either be based on the protocols described in subdivision (a) or shall be approved by the supervising physician and surgeon before it is filled or carried out.
(1)A physician assistant shall not administer or provide a drug or issue a drug order for a drug other than for a drug listed in the formulary without advance approval from a supervising physician and surgeon for the particular patient. At the direction and under the supervision of a physician and surgeon, a physician assistant may hand to a patient of the supervising physician and surgeon a properly labeled prescription drug prepackaged by a physician and surgeon, manufacturer as defined in the Pharmacy Law, or a pharmacist.
(2)A physician assistant shall not administer, provide, or issue a drug order to a patient for Schedule II through Schedule V controlled substances without advance approval by a supervising physician and surgeon for that particular patient unless the physician assistant has completed an education course that covers controlled substances and that meets standards, including pharmacological content, approved by the board. The education course shall be provided either by an accredited continuing education provider or by an approved physician assistant training program. If the physician assistant will administer, provide, or issue a drug order for Schedule II controlled substances, the course shall contain a minimum of three hours exclusively on Schedule II controlled substances. substances, including the risks of addiction associated with their use. Completion of the requirements set forth in this paragraph shall be verified and documented in the manner established by the board prior to the physician assistants use of a registration number issued by the United States Drug Enforcement Administration to the physician assistant to administer, provide, or issue a drug order to a patient for a controlled substance without advance approval by a supervising physician and surgeon for that particular patient.
(3)Any drug order issued by a physician assistant shall be subject to a reasonable quantitative limitation consistent with customary medical practice in the supervising physician and surgeons practice.
(d)A written drug order issued pursuant to subdivision (a), except a written drug order in a patients medical record in a health facility or medical practice, shall contain the printed name, address, and telephone number of the supervising physician and surgeon, the printed or stamped name and license number of the physician assistant, and the signature of the physician assistant. Further, a written drug order for a controlled substance, except a written drug order in a patients medical record in a health facility or a medical practice, shall include the federal controlled substances registration number of the physician assistant and shall otherwise comply with Section 11162.1 of the Health and Safety Code. Except as otherwise required for written drug orders for controlled substances under Section 11162.1 of the Health and Safety Code, the requirements of this subdivision may be met through stamping or otherwise imprinting on the supervising physician and surgeons prescription blank to show the name, license number, and if applicable, the federal controlled substances registration number of the physician assistant, and shall be signed by the physician assistant. When using a drug order, the physician assistant is acting on behalf of and as the agent of a supervising physician and surgeon.
(e)The supervising physician and surgeon shall use either of the following mechanisms to ensure adequate supervision of the administration, provision, or issuance by a physician assistant of a drug order to a patient for Schedule II controlled substances:
(1)The medical record of any patient cared for by a physician assistant for whom the physician assistants Schedule II drug order has been issued or carried out shall be reviewed, countersigned, and dated by a supervising physician and surgeon within seven days.
(2)If the physician assistant has documentation evidencing the successful completion of an education course that covers controlled substances, and that controlled substance education course (A) meets the standards, including pharmacological content, established in Sections 1399.610 and 1399.612 of Title 16 of the California Code of Regulations, and (B) is provided either by an accredited continuing education provider or by an approved physician assistant training program, the supervising physician and surgeon shall review, countersign, and date, within seven days, a sample consisting of the medical records of at least 20 percent of the patients cared for by the physician assistant for whom the physician assistants Schedule II drug order has been issued or carried out. Completion of the requirements set forth in this paragraph shall be verified and documented in the manner established in Section 1399.612 of Title 16 of the California Code of Regulations. Physician assistants who have a certificate of completion of the course described in paragraph (2) of subdivision (c) shall be deemed to have met the education course requirement of this subdivision.
(f)All physician assistants who are authorized by their supervising physicians to issue drug orders for controlled substances shall register with the United States Drug Enforcement Administration (DEA).
(g)The board shall consult with the Medical Board of California and report during its sunset review required by Article 7.5 (commencing with Section 9147.7) of Chapter 1.5 of Part 1 of Division 2 of Title 2 of the Government Code the impacts of exempting Schedule III and Schedule IV drug orders from the requirement for a physician and surgeon to review and countersign the affected medical record of a patient.
SEC. 8.Section 4079 is added to the Business and Professions Code, to read:4079.The board shall adopt an emergency regulation that requires a warning label on all Schedule II controlled substance vials or prescription bottles that addresses the risks of addiction and overdose when using opioids.
SEC. 9.Section 49476 is added to the Education Code, to read:49476.(a)If a school district, charter school, or private school elects to offer an athletic program, the school district, charter school, or private school shall annually give an information sheet about the risk of opioid addiction to each athlete. The information sheet shall be signed and returned by the athlete before the athlete initiates practice or competition. If the athlete is 17 years of age or younger, the information sheet shall also be signed by the athletes parent or guardian before the athlete initiates practice or competition. The information sheet may be sent and returned through an electronic medium, including, but not limited to, fax or email.
(b)This section does not apply to an athlete engaging in an athletic activity during the regular schoolday or as part of a physical education course required pursuant to subdivision (d) of Section 51220.
SEC. 10.Section 11158.1 is added to the Health and Safety Code, to read:11158.1.(a)Except when a patient is being treated as set forth in Sections 11159, 11159.2, and 11167.5, and Article 2 (commencing with Section 11215) of Chapter 5, pertaining to the treatment of addicts, or for a diagnosis of chronic intractable pain as used in Section 124960 of this code and Section 2241.5 of the Business and Professions Code, a prescriber shall do all of the following before directly dispensing or issuing for a minor the first prescription in a single course of treatment for a controlled substance containing an opioid:
(1)Discuss all of the following with the minor, with the minors parent or guardian, or with another adult authorized to consent to the minors medical treatment:
(A)The risks of addiction and overdose associated with the use of opioids.
(B)The increased risk of addiction to an opioid to an individual who is suffering from both mental and substance abuse disorders.
(C)The danger of taking an opioid with a benzodiazepine, alcohol, or another central nervous system depressant.
(D)Any other information required by law.
(2)Obtain the signature of the minor, and the minors parent or guardian or other adult authorized to consent to the minors medical treatment. The prescriber shall include the signed consent form in the minors medical record.
(b)Paragraph (1) of subdivision (a) does not apply in any of the following circumstances:
(1)If the minors treatment is associated with or incident to a medical emergency.
(2)If the minors treatment is associated with or incident to an emergency surgery, regardless of whether the surgery is performed on an inpatient or outpatient basis.
(3)If, in the prescribers professional judgment, fulfilling the requirements of paragraph (1) of subdivision (a) would be detrimental to the minors health or safety.
(c)The consent described in paragraph (2) of subdivision (a) shall be obtained in a form that is separate from any other document that a prescriber uses to obtain the informed consent for the treatment of a minor and shall contain all of the following:
(1)The name and quantity of the controlled substance being prescribed for the minor and the amount of the initial dose.
(2)A statement indicating that a controlled substance is a drug or other substance that has been identified as having a potential for abuse.
(3)A statement certifying that the prescriber discussed with the minor, and with the minors parent or guardian or with another adult authorized to consent to the minors medical treatment, the topics described in paragraph (1) of subdivision (a), unless the exemption in subdivision (b) applies.
(4)A space for the signature of the minors parent or guardian or other adult authorized to consent to the minors medical treatment, and a space to indicate the date that the minors parent or guardian or other adult authorized to consent to the minors medical treatment signed the form.
SEC. 11.Section 124236 is added to the Health and Safety Code, to read:124236.(a)A youth sports organization, as defined in paragraph (3) of subdivision (b) of Section 124235, that elects to offer an athletic program shall annually give an information sheet about the risk of opioid addiction to each athlete. The information sheet shall be signed and returned by the athlete before the athlete initiates practice or competition. If the athlete is 17 years of age or younger, the information sheet shall also be signed by the athletes parent or guardian before the athlete initiates practice or competition. The information sheet may be sent and returned through an electronic medium, including, but not limited to, fax or email.
(b)This section shall apply to all athletes participating in the activities of a youth sports organization, irrespective of their ages. This section shall not be construed to prohibit a youth sports organization, or any other appropriate entity, from adopting and enforcing rules intended to provide a higher standard of safety for athletes than the standard established under this section.
SEC. 12.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB 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 XIIIB of the California Constitution.
|
Date
|
Status
|
|---|---|
| Sep 22, 2018 | Chaptered by Secretary of State. Chapter 693, Statutes of 2018. |
| Sep 22, 2018 | Approved by the Governor. |
| Sep 12, 2018 | Enrolled and presented to the Governor at 5 p.m. |
| Aug 31, 2018 | Assembly amendments concurred in. (Ayes 38. Noes 0.) Ordered to engrossing and enrolling. |
| Aug 31, 2018 | Ordered to special consent calendar. |
| Aug 31, 2018 | In Senate. Concurrence in Assembly amendments pending. |
| Aug 31, 2018 | Read third time. Passed. Ordered to the Senate. |
| Aug 24, 2018 | Read third time and amended. |
| Aug 20, 2018 | From consent calendar. |
| Aug 16, 2018 | Read second time. Ordered to consent calendar. |
| Aug 15, 2018 | From committee: Do pass. Ordered to consent calendar. (Ayes 17. Noes 0.) (August 15). |
| Jun 27, 2018 | From committee: Do pass and re-refer to Com. on APPR. with recommendation: To consent calendar. (Ayes 15. Noes 0.) (June 26). Re-referred to Com. on APPR. |
| Jun 19, 2018 | From committee with author's amendments. Read second time and amended. Re-referred to Com. on HEALTH. |
| Jun 12, 2018 | From committee: Do pass and re-refer to Com. on HEALTH. (Ayes 18. Noes 0.) (June 12). Re-referred to Com. on HEALTH. |
| Jun 6, 2018 | From committee with author's amendments. Read second time and amended. Re-referred to Com. on B. & P. |
| May 31, 2018 | Referred to Coms. on B. & P. and HEALTH. |
| May 21, 2018 | In Assembly. Read first time. Held at Desk. |
| May 21, 2018 | Read third time. Passed. (Ayes 39. Noes 0.) Ordered to the Assembly. |
| May 15, 2018 | Read second time. Ordered to third reading. |
| May 14, 2018 | From committee: Do pass. (Ayes 7. Noes 0.) (May 14). |
| May 9, 2018 | Set for hearing May 14. |
| May 8, 2018 | From committee with author's amendments. Read second time and amended. Re-referred to Com. on APPR. |
| May 2, 2018 | Read second time and amended. Re-referred to Com. on APPR. |
| May 1, 2018 | From committee: Do pass as amended and re-refer to Com. on APPR. (Ayes 9. Noes 0.) (April 25). |
| Apr 18, 2018 | From committee with author's amendments. Read second time and amended. Re-referred to Com. on HEALTH. |
| Apr 18, 2018 | Set for hearing April 25. |
| Apr 17, 2018 | From committee: Do pass and re-refer to Com. on HEALTH. (Ayes 8. Noes 0.) (April 16). Re-referred to Com. on HEALTH. |
| Apr 4, 2018 | From committee with author's amendments. Read second time and amended. Re-referred to Com. on B., P. & E.D. |
| Mar 28, 2018 | April 9 set for first hearing canceled at the request of author. |
| Mar 20, 2018 | Set for hearing April 9. |
| Feb 22, 2018 | Referred to Coms. on B., P. & E.D. and HEALTH. |
| Feb 14, 2018 | From printer. May be acted upon on or after March 16. |
| Feb 13, 2018 | Introduced. Read first time. To Com. on RLS. for assignment. To print. |
|
Date
|
Description
|
Location
|
Votes
|
|
|---|---|---|---|---|
| Aug 31, 2018 | SB 1109 Bates Senate Third Reading By ARAMBULA | Assembly Floor |
Passed |
|
| Aug 31, 2018 | Unfinished Business SB1109 Bates et al. Concurrence | Senate Floor |
Passed |
|
| Aug 15, 2018 | Do pass. To Consent Calendar. | Assembly Standing Committee on Appropriations |
Passed |
|
| Jun 26, 2018 | Do pass and be re-referred to the Committee on [Appropriations] with recommendation: To Consent Calendar | Assembly Standing Committee on Health |
Passed |
|
| Jun 12, 2018 | Do pass and be re-referred to the Committee on [Health] | Assembly Standing Committee on Business and Professions |
Passed |
|
| May 21, 2018 | Senate 3rd Reading SB1109 Bates et al. | Senate Floor |
Passed |
|
| May 14, 2018 | Do pass | Senate Standing Committee on Appropriations |
Passed |
|
| Apr 25, 2018 | Do pass as amended, but first amend, and re-refer to the Committee on [Appropriations] | Senate Standing Committee on Health |
Passed |
|
| Apr 16, 2018 | Do pass, but first be re-referred to the Committee on [Health] | Senate Standing Committee on Business, Professions and Economic Development |
Passed |
This list shows positions taken on this bill by organizations on the date displayed, which is linked to the original source.
Positions by individuals are not included.
|
Organization
|
Position
|
Date
|
|---|---|---|
| American Academy of Pediatrics | * Against Unless Amend | Apr 25, 2018 |
| And Overdose When Using Opioids. | ** Support | Apr 12, 2018 |
| Association Of California Life & Health Insurance Companies | ** Support | Aug 31, 2018 |
| California Dental Association | ** Support | Aug 31, 2018 |
| California District Attorneys Association | ** Support | Aug 31, 2018 |
| California Medical Association | ** Support | Aug 31, 2018 |
| California Narcotic Officers Association | * Support | May 14, 2018 |
| California Pharmacists Association | * Against Unless Amend | Apr 25, 2018 |
| California Retailers Association | * Neutral | Apr 16, 2018 |
| Code, To Read: | ** Support | Apr 12, 2018 |
| Dental Board of California | ** Support | Aug 31, 2018 |
| District Attorney San Diego | * Support | May 14, 2018 |
| Double-Referral To Senate Committee On Health, Second. | ** Support | Apr 12, 2018 |
| Laguna Niguel | * Support | Apr 25, 2018 |
| McHesson | * Support | Apr 25, 2018 |
| McKesson Corporation | ** Support | Aug 31, 2018 |
| Medical Board of California | ** Support | Aug 31, 2018 |
| Note: | ** Support | Apr 12, 2018 |
| Office of the San Diego County District Attorney | ** Support | Aug 31, 2018 |
| Orange County Sheriff Sandra Hutchens | ** Support | Aug 31, 2018 |
| San Diego District Attorney | * Support | Apr 25, 2018 |
| Summer Stephan District Attorney, San Diego County | ** Support | Jun 22, 2018 |
| Support And Opposition: | ** Support | Apr 12, 2018 |
Office of Senate Floor Analyses (916) 651-1520 Fax: (916) 327-4478 | SB |
UNFINISHED BUSINESS
Bill No: SB 1109
:
SENATE BUS., PROF. & ECON. DEV. COMMITTEE: 8-0, 4/16/18
AYES: Hill, Fuller, Dodd, Galgiani, Glazer, Hernandez, Newman, Wilk
NO VOTE RECORDED: Pan
SENATE HEALTH COMMITTEE: 9-0, 4/25/18
AYES: Hernandez, Nguyen, Leyva, Mitchell, Monning, Newman, Nielsen, Pan, Roth
SENATE APPROPRIATIONS COMMITTEE: 7-0, 5/14/18
AYES: Lara, Bates, Beall, Bradford, Hill, Nielsen, Wiener
SENATE FLOOR: 39-0, 5/21/18
AYES: Allen, Anderson, Atkins, Bates, Beall, Berryhill, Bradford, Cannella, De León, Dodd, Fuller, Gaines, Galgiani, Glazer, Hernandez, Hertzberg, Hill, Hueso, Jackson, Lara, Leyva, McGuire, Mitchell, Monning, Moorlach, Morrell, Newman, Nguyen, Nielsen, Pan, Portantino, Roth, Skinner, Stern, Stone, Vidak, Wieckowski, Wiener, Wilk
ASSEMBLY FLOOR: Not available
SOURCE: Office of the San Diego County District Attorney
DIGEST:
This bill (1) requires that existing trainings for prescribers related to pain management include addiction risks associated with Schedule II drugs; (2) requires additional warning labeling about the risks of addiction and overdose for opioid prescriptions; (3) 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 (4) requires prescribers to discuss risks and dangers of opioids and opioid addiction with minors and their parents or guardians.
Assembly Amendments add double jointing language to avoid chaptering conflicts with SB 1491 (Committee on Business, Professions and Economic Development), add coauthors and made technical changes.
Existing law:
- Requires that each prescription dispensed by a pharmacist must be in a container complying with state and federal law and correctly labeled including certain information and requires the Board of Pharmacy to promulgate regulations for a standardized, patient-centered, prescription drug label on all prescription medication dispensed in the state. (BPC §§ 4076 and 4076.5 (a))
- Establishes continuing education (CE) and continuing medical education (CME) requirements for health care providers, including, but not limited to:
- Dentists must complete not less than 50 hours of approved CE during the two-year period immediately preceding the expiration of their license. (BPC § 1645)
- Physicians and surgeons licensed by the Medical Board of California (MBC) must complete a one-time CME course of 12 hours in the subjects of pain management and the treatment of terminally ill and dying patients, among other requirements and other considerations MBC must make for required CME established through regulations. (BPC § 2190.5)
- Osteopathic physicians and surgeons licensed by the Osteopathic Medical Board of California (OMBC) must complete a minimum of 100 hours of American Osteopathic Association CE hours during each two-year cycle. (BPC § 2454.5)
- Certified nurse-midwives certified by the Board of Registered Nursing (BRN) who hold an active furnishing number, who are currently authorized through standardized procedures or protocols to furnish Schedule II controlled substances, and who are registered with the United States Drug Enforcement Administration (DEA) must provide documentation of CE specific to the use of Schedule II controlled substances in settings other than a hospital based on standards developed by the BRN. (BPC § 2746.51)
- Nurse practitioners certified by the BRN who hold an active furnishing number, who are authorized through standardized procedures or protocols to furnish Schedule II controlled substances, and who are registered with DEA must complete a course including Schedule II controlled substances based on standards developed by BRN. (BPC § 2836.1)
- Optometrists certified to use therapeutic pharmaceutical agents must complete a total of 50 hours of CE every two years in order to renew his or her certificate 35 of which must be on the diagnosis, treatment, and management of ocular disease, including pain medication. Requires the Board of Optometry to encourage every optometrist to take a course or courses in pharmacology and pharmaceuticals as part of his or her CE. (BPC § 3059)
- Physician assistants licensed by the Physician Assistant Board (PAB) must complete no more than 50 hours of CE every two years. The PAB shall, as it deems appropriate, accept certification by the National Commission on Certification of Physician Assistants, or another qualified certifying body, as determined by the PAB, as evidence of compliance with CE requirements. (BPC § 3524.5)
- Requires, at the beginning of the first semester or quarter of the regular school term, the governing board of each school district to provide notification to the parent or guardian of a minor pupil about various rights and responsibilities; the availability of individualized instruction; the schedule of minimum days and pupil-free staff development days; the district’s fingerprinting program if it provides one; the district’s sexual harassment policy; all existing statutory attendance options and local attendance options available in the school district; information about grades and academic credits in the event of absences; for pupils enrolled in grades 9-12, information about college admission requirements, career technical education and how to meet with school counselors to help choose courses to meet admission requirements; the availability of state funds for advanced placement fees and; authorizes the notification to also advise the parent or guardian of the importance of investing for future college or university education for their children and of considering appropriate investment options, including, but not limited to, United States savings bonds. (Education Code (EDC) § 48980)
- Establishes requirements for a school district, charter school, or private school that offers an athletic program to take certain actions for an athlete suspected of sustaining a concussion or head injury. Requires, on a yearly basis, a concussion and head injury information sheet to be signed and returned by the athlete and the athlete’s parent or guardian before the athlete initiates practice or competition. (EDC § 49475)
This bill:
- Makes findings and declarations about addiction, misuse and overdose of prescription opioids. States the intent of the Legislature to ensure that health care providers and young athletes receive necessary education on this topic.
- Requires a warning label on all containers for dispensed prescriptions of opioids that reads: "Caution: Opioid. Risk of overdose and addiction."
- Requires a prescriber to discuss the following with a minor, or the minor's parent, guardian, or other adult authorized to consent to the minor's medical treatment, prior to dispensing or issuing a prescription of opioids to a minor for the first time:
- The risks of addiction and overdose associated with the use of opioids.
- The increased risk of addiction to an opioid to an individual who is suffering from both mental and substance abuse disorders.
- The danger of taking an opioid with a benzodiazepine, alcohol, or another central nervous system depressant.
- Any other information required by law.
- Exempts all treatments of addiction, chronic intractable pain, medical emergencies, or any situation where the prescriber believes the discussion would be detrimental to the minor's health or safety or in violation of the minor's legal rights regarding confidentiality from the discussion requirements in 3) above.
- Requires a school district, charter school, or private school offering an athletic program, other than as part of the regular school day or as part of physical education, to annually give the Centers for Disease Control and Prevention’s (CDC) Opioid Factsheet for Patients each athlete, which may be sent and returned electronically. Requires the information sheet to be signed and returned before the athlete initiates practice or competition.
- Requires a youth sports organization that elects to offer an athletic program to comply with the Factsheet requirements outlined above.
- Makes technical changes.
Background
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: (1) their potential for abuse; (2) their accepted medical use; and, (3) their accepted safety under medical supervision. 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).
Prescription drug abuse and related deaths. 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. 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% of persons age 26 or older used prescription drugs nonmedically in the past year.
Prescription opioids continue to be involved in more overdose deaths than any other drug. NIDA reports that more than 1,700 young adults died from prescription drug overdose in 2014, a four-fold increase from 1999, nearly 5 persons per day. According to the CDC, overdose deaths involving prescription opioids have quadrupled since 1999.
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. Physician and surgeons licensed by the MBC have the discretion to select what courses to take to meet the majority of their education requirements. One of the only courses required in statute is a one-time, 12-hour training in pain management and the treatment of terminally ill patients. This bill would amend this existing requirement to specify that the course must also include the risks of addiction associated with Schedule II controlled substances.
Similar provisions exist for other licensed professions engaged in prescribing controlled substances to patients. Dentists, optometrists, osteopathic physicians and surgeons, certified nurse-midwives, nurse practitioners, and physician assistants must all fulfill certain continuing education requirements to renew an active license. This bill amends the practice acts for these professions to include the same language regarding the risks of Schedule II drug addiction.
FISCAL EFFECT: Appropriation: Fiscal Com.: Local:
According to the Assembly Appropriations Committee, this bill will result in minor and absorbable costs for regulatory boards to update course criteria; one-time minor and absorbable information technology costs to the Department of Consumer Affairs; and minor and absorbable costs to the Board of Pharmacy to promulgate regulations.
Office of the San Diego County District Attorney (source)
Association of California Life & Health Insurance Companies
California Dental Association
California District Attorneys Association
California Medical Association
Dental Board of California
McKesson Corporation
Medical Board of California
Orange County Sheriff Sandra Hutchens
OPPOSITION: (Verified 8/28/18)
None received
ARGUMENTS IN SUPPORT: Supporters state that this bill brings common sense solutions that protect consumers by telling them the truth about the real risks of addiction and overdose from prescription opiates. Supporters believe that this bill takes positive steps to address the potential harm to youth when they misuse opioids, and appropriately educates parents and physicians in effective, non-burdensome ways.
8/31/18 17:45:42
**** END ****
SENATE THIRD READING
STR Bill Id:SB 1109
Author:(Bates)
As Amended Ver:August 24, 2018
Majority vote
SENATE VOTE: 39-0
Committee | Votes | Ayes | Noes |
Business & Professions | 18-0 | Low, Brough, Arambula, Baker, Bloom, Chen, Chiu, Cunningham, Eggman, Fong, Gipson, Grayson, Irwin, McCarty, Medina, Mullin, Obernolte, Ting |
|
Health | 15-0 | Wood, Mayes, Aguiar-Curry, Bigelow, Bonta, Burke, Carrillo, Flora, Limón, McCarty, Nazarian, Rodriguez, Santiago, Thurmond, Waldron |
|
Appropriations | 17-0 | Gonzalez Fletcher, Bigelow, Bloom, Bonta, Brough, Calderon, Carrillo, Chau, Eggman, Fong, Friedman, Gallagher, Eduardo Garcia, Nazarian, Obernolte, Quirk, Reyes |
|
SUMMARY: Requires warning labels for opioid prescription drug containers; requires that the Opioid Factsheet for Patients be provided to athletes engaged in after-school youth sports; requires that prescribers discuss the dangers of opioid abuse and addiction with a minor patient or their parent or guardian prior to prescribing an opioid; and requires that existing trainings for prescribers related to pain management include addiction risks associated with Schedule II drugs. Specifically, this bill:
- Requires a warning label on all containers for dispensed prescriptions of opioids that reads: "Caution: Opioid. Risk of overdose and addiction."
- Requires schools and youth sports organizations to annually provide all athletes, as well as the parents or guardians of athletes 17 years of age or younger, with a copy of the Opioid Factsheet for Patients published by the Centers for Disease Control and Prevention, and requires that a signed document acknowledging receipt of the factsheet be returned prior to the athlete's participation in the sport.
- Requires a prescriber to discuss the following with a minor, or the minor's parent, guardian, or other adult authorized to consent to the minor's medical treatment, prior to dispensing or issuing a prescription of opioids to a minor for the first time:
- The risks of addiction and overdose associated with the use of opioids.
- The increased risk of addiction to an opioid to an individual who is suffering from both mental and substance abuse disorders.
- The danger of taking an opioid with a benzodiazepine, alcohol, or another central nervous system depressant.
- Any other information required by law.
- Exempts from a prescriber's discussion requirements, as described above, all treatments of addiction, chronic intractable pain, medical emergencies, or any situation where the prescriber believes the discussion would be detrimental to the minor's health or safety or in violation of the minor's legal rights regarding confidentiality.
- Amends various provisions regarding continuing education related to pain medication or pain management for prescribers, including physicians, dentists, optometrists, and certified nurse-midwives, to including the risks of addiction associated with Schedule II drugs.
- Incorporates additional changes for purposes of chaptering.
EXISTING LAW:
- Establishes the Medical Practice Act, which provides for the state's licensure and regulation of physicians and surgeons. (Business and Professions Code (BPC) Sections 2000 et seq.)
- Establishes the Medical Board of California (MBC), a regulatory board within the Department of Consumer Affairs comprised of 15 appointed members, including 7 public members. (BPC Section 2001)
- Includes among the MBC's responsibilities the administration of a continuing medical education program. (BPC Section 2004)
- Requires all physicians and surgeons to complete a continuing education course in pain management and the treatment of terminally ill and dying patients. (BPC Section 2190.5)
- Requires labeling of all containers of prescription drugs stating information about the drug, directions for use, the names of the patient and the prescriber, and other information. (BPC Section 4076)
- Typically defines "minor" as a person under 18 years of age. (BPC Section 22580)
- Defines "youth sports organization" as an organization, business, nonprofit entity, or a local governmental agency that sponsors or conducts amateur sports competitions, training, camps, or clubs in which persons 17 years of age or younger participate in one of an enumerated list of sports including but not limited to football, martial arts, surfing, rodeo, and cheerleading. (Health and Safety Code Section 124235)
FISCAL EFFECT: According to the Assembly Committee on Appropriations, minor and absorbable costs for regulatory boards to update course criteria; one-time minor and absorbable information technology costs to the Department of Consumer Affairs; and minor and absorbable costs to the Board of Pharmacy to promulgate regulations.
COMMENTS:
Purpose. This bill is sponsored by San Diego County District Attorney Summer Stephan. According to the author:
Senate Bill 1109 addresses the opioid epidemic by educating everyone who comes in contact with these necessary and yet potentially harmful opioid prescriptions. Ensuring patients, minors, parents, and prescribers have the necessary information before taking these medications will help prevent future addictions and overdoses with the drugs.
Proper drug education for all patients regardless of their age or status will help empower people to make the right decision. Education is a key component in understanding the very addictive nature of Schedule II controlled substances. It is necessary to warn consumers who receive opioid prescriptions that they can be addictive and can cause drug overdoses if not used carefully.
More needs to be done to combat a crisis that has taken so many lives. SB 1109 is a step in the right direction, providing additional tools for patients, minors, parents, and prescribers to have more information on hand when making decisions with what prescriptions they elect to take. In the midst of the worst drug epidemic in American history, SB 1109 will prevent more lives from being lost.
Background. Overview of the Opioid Crisis. 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 addition to providing pain relief, opioids can be used as a cough suppressant, an antidiarrheal, a method of sedation, and a treatment for shortness of breath. The majority of pharmaceutical opioids are Schedule II drugs under the federal Controlled Substances Act, considered by the federal Drug Enforcement Agency (DEA) to have a high potential for abuse that may lead to severe psychological or physical dependence. However, combination drugs containing lower doses of opioids combined with other active ingredients are typically less restricted; for example, cough syrups containing low doses of codeine are frequently classified Schedule V medications.
Prescription Drug Container Labeling. Current law prohibits a pharmacist from dispensing a prescription unless he or she does so with a container that meets certain labeling requirements. Absent a small number of exemptions, every prescription drug container must be labeled with an array of information about the drug, the patient, the prescriber, and the condition or purpose for which the drug was prescribed, if indicated. In addition, the California Patient Medication Safety Act directed the State Board of Pharmacy to promulgate regulations to require a "standardized, patient-centered, prescription drug label on all prescription medicine dispensed to patients in California." The resulting language enacted in 16 C.C.R. Section 1707.5 specifies that drug container label information must be clustered into one area of the label comprising at least 50% of the label, and that each item must be printed in at least a 12-point sans serif typeface.
This bill would add to these labeling requirements by including a warning for prescriptions of opioids reading: "Caution: Opioid. Risk of overdose and addiction." This bill requires that the information be displayed through a flag or other notification mechanism attached to the container. It is the author's intent that this warning will contribute to consumer awareness around the dangers of opioid addiction and complement current labeling standards.
Education for Youth Athletes. A commonly recognized vulnerable population that is often at risk of falling into opioid abuse and addiction is minors who receive opioid painkillers during the course of a youth sports program. In response, numerous states have enacted laws aimed at improving education about the dangers of prescription drug abuse. SB 1109 is intended to enact an education requirement for all athletes who participate in sports programs through a school or a youth sports organization.
Athletes participating in these sports, as well as the parents or guardians of athletes who are 17 years of age or younger, would be required under this bill to receive and acknowledge a copy of the Opioid Factsheet for Patients published by the Centers for Disease Control and Prevention. This two-page information guide explains the risks of opioids and provides recommendations to avoid addiction. The author believes that providing youth and parents with this information will significantly reduce the incidents of minor drug addiction in California.
Discussions with Minor Patients. In addition to the information required to be provided to student athletes, this bill would also address concerns about minors becoming addicted to prescription pain medication by adding new discussion requirements for prescribers who wish to treat a minor patient with opioids. Under this bill, a prescriber would be required to discuss the risks and dangers associated with opioids with the minor, the minor's parent or guardian, or another adult authorized to consent to the minor's medical treatment before directly dispensing or issuing for a minor the first prescription in a single course of treatment.
Several exceptions are accommodated in this requirement. Treatments of addiction, chronic intractable pain, medical emergencies, or any situation where the prescriber believes the discussion would be detrimental to the minor's health or safety are exempted. This bill would not impact the ability of a practitioner to prescribe opioids to a minor and would not limit the strength or quantity of the prescription; however, it would seek to increase awareness of opioid risks for minor patients who receive prescriptions for opioids.
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. Physician and surgeons licensed by the MBC have the discretion to select what courses to take to meet the majority of their education requirements. One of the only courses required in statute is a one-time, 12-hour training in pain management and the treatment of terminally ill patients. This bill would amend this existing requirement to specify that the course must also include the risks of addiction associated with Schedule II controlled substances.
Similar provisions exist for other licensed professions engaged in prescribing controlled substances to patients. Dentists, optometrists, osteopathic physicians and surgeons, certified nurse-midwives, nurse practitioners, and physician assistants must all fulfill certain continuing education requirements to renew an active license. This bill amends the practice acts for these professions to include the same language regarding the risks of Schedule II drug addiction.
Analysis Prepared by: Robert Sumner / B. & P. / (916) 319-3301 FN: 0004469
SENATE THIRD READING
STR Bill Id:SB 1109
Author:(Bates)
As Amended Ver:June 19, 2018
Majority vote
SENATE VOTE: 39-0
Committee | Votes | Ayes | Noes |
Business & Professions | 18-0 | Low, Brough, Arambula, Baker, Bloom, Chen, Chiu, Cunningham, Eggman, Fong, Gipson, Grayson, Irwin, McCarty, Medina, Mullin, Obernolte, Ting | |
Health | 15-0 | Wood, Mayes, Aguiar-Curry, Bigelow, Bonta, Burke, Carrillo, Flora, Limón, McCarty, Nazarian, Rodriguez, Santiago, Thurmond, Waldron | |
Appropriations | 17-0 | Gonzalez Fletcher, Bigelow, Bloom, Bonta, Brough, Calderon, Carrillo, Chau, Eggman, Fong, Friedman, Gallagher, Eduardo Garcia, Nazarian, Obernolte, Quirk, Reyes |
SUMMARY: Requires warning labels for opioid prescription drug containers; requires that the Opioid Factsheet for Patients be provided to athletes engaged in after-school youth sports; requires that prescribers discuss the dangers of opioid abuse and addiction with a minor patient or their parent or guardian prior to prescribing an opioid; and requires that existing trainings for prescribers related to pain management include addiction risks associated with Schedule II drugs. Specifically, this bill:
- Requires a warning label on all containers for dispensed prescriptions of opioids that reads: "Caution: Opioid. Risk of overdose and addiction."
- Requires schools and youth sports organizations to annually provide all athletes, as well as the parents or guardians of athletes 17 years of age or younger, with a copy of the Opioid Factsheet for Patients published by the Centers for Disease Control and Prevention, and requires that a signed document acknowledging receipt of the factsheet be returned prior to the athlete's participation in the sport.
- Requires a prescriber to discuss the following with a minor, or the minor's parent, guardian, or other adult authorized to consent to the minor's medical treatment, prior to dispensing or issuing a prescription of opioids to a minor for the first time:
- The risks of addiction and overdose associated with the use of opioids.
- The increased risk of addiction to an opioid to an individual who is suffering from both mental and substance abuse disorders.
- The danger of taking an opioid with a benzodiazepine, alcohol, or another central nervous system depressant.
- Any other information required by law.
- Exempts from a prescriber's discussion requirements, as described above, all treatments of addiction, chronic intractable pain, medical emergencies, or any situation where the prescriber believes the discussion would be detrimental to the minor's health or safety or in violation of the minor's legal rights regarding confidentiality.
- Amends various provisions regarding continuing education related to pain medication or pain management for prescribers, including physicians, dentists, optometrists, and certified nurse-midwives, to including the risks of addiction associated with Schedule II drugs.
EXISTING LAW:
- Establishes the Medical Practice Act, which provides for the state's licensure and regulation of physicians and surgeons. (Business and Professions Code (BPC) Sections 2000 et seq.)
- Establishes the Medical Board of California (MBC), a regulatory board within the Department of Consumer Affairs comprised of 15 appointed members, including 7 public members. (BPC Section 2001)
- Includes among the MBC's responsibilities the administration of a continuing medical education program. (BPC Section 2004)
- Requires all physicians and surgeons to complete a continuing education course in pain management and the treatment of terminally ill and dying patients. (BPC Section 2190.5)
- Requires labeling of all containers of prescription drugs stating information about the drug, directions for use, the names of the patient and the prescriber, and other information. (BPC Section 4076)
- Typically defines "minor" as a person under 18 years of age. (BPC Section 22580)
- Defines "youth sports organization" as an organization, business, nonprofit entity, or a local governmental agency that sponsors or conducts amateur sports competitions, training, camps, or clubs in which persons 17 years of age or younger participate in one of an enumerated list of sports including but not limited to football, martial arts, surfing, rodeo, and cheerleading. (Health and Safety Code Section 124235)
FISCAL EFFECT: According to the Assembly Committee on Appropriations, minor and absorbable costs for regulatory boards to update course criteria; one-time minor and absorbable information technology costs to the Department of Consumer Affairs; and minor and absorbable costs to the Board of Pharmacy to promulgate regulations.
COMMENTS:
Purpose. This bill is sponsored by San Diego County District Attorney Summer Stephan. According to the author:
Senate Bill 1109 addresses the opioid epidemic by educating everyone who comes in contact with these necessary and yet potentially harmful opioid prescriptions. Ensuring patients, minors, parents, and prescribers have the necessary information before taking these medications will help prevent future addictions and overdoses with the drugs.
Proper drug education for all patients regardless of their age or status will help empower people to make the right decision. Education is a key component in understanding the very addictive nature of Schedule II controlled substances. It is necessary to warn consumers who receive opioid prescriptions that they can be addictive and can cause drug overdoses if not used carefully.
More needs to be done to combat a crisis that has taken so many lives. SB 1109 is a step in the right direction, providing additional tools for patients, minors, parents, and prescribers to have more information on hand when making decisions with what prescriptions they elect to take. In the midst of the worst drug epidemic in American history, SB 1109 will prevent more lives from being lost.
Background. Overview of the Opioid Crisis. 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 percent 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 addition to providing pain relief, opioids can be used as a cough suppressant, an antidiarrheal, a method of sedation, and a treatment for shortness of breath. The majority of pharmaceutical opioids are Schedule II drugs under the federal Controlled Substances Act, considered by the federal Drug Enforcement Agency (DEA) to have a high potential for abuse that may lead to severe psychological or physical dependence. However, combination drugs containing lower doses of opioids combined with other active ingredients are typically less restricted; for example, cough syrups containing low doses of codeine are frequently classified Schedule V medications.
Prescription Drug Container Labeling. Current law prohibits a pharmacist from dispensing a prescription unless he or she does so with a container that meets certain labeling requirements. Absent a small number of exemptions, every prescription drug container must be labeled with an array of information about the drug, the patient, the prescriber, and the condition or purpose for which the drug was prescribed, if indicated. In addition, the California Patient Medication Safety Act directed the State Board of Pharmacy to promulgate regulations to require a "standardized, patient-centered, prescription drug label on all prescription medicine dispensed to patients in California." The resulting language enacted in 16 C.C.R. Section 1707.5 specifies that drug container label information must be clustered into one area of the label comprising at least 50 percent of the label, and that each item must be printed in at least a 12-point sans serif typeface.
This bill would add to these labeling requirements by including a warning for prescriptions of opioids reading: "Caution: Opioid. Risk of overdose and addiction." The bill requires that the information be displayed through a flag or other notification mechanism attached to the container. It is the author's intent that this warning will contribute to consumer awareness around the dangers of opioid addiction and complement current labeling standards.
Education for Youth Athletes. A commonly recognized vulnerable population that is often at risk of falling into opioid abuse and addiction is minors who receive opioid painkillers during the course of a youth sports program. In response, numerous states have enacted laws aimed at improving education about the dangers of prescription drug abuse. SB 1109 is intended to enact an education requirement for all athletes who participate in sports programs through a school or a youth sports organization.
Athletes participating in these sports, as well as the parents or guardians of athletes who are 17 years of age or younger, would be required under this bill to receive and acknowledge a copy of the Opioid Factsheet for Patients published by the Centers for Disease Control and Prevention. This two-page information guide explains the risks of opioids and provides recommendations to avoid addiction. The author believes that providing youth and parents with this information will significantly reduce the incidents of minor drug addiction in California.
Discussions with Minor Patients. In addition to the information required to be provided to student athletes, this bill would also address concerns about minors becoming addicted to prescription pain medication by adding new discussion requirements for prescribers who wish to treat a minor patient with opioids. Under the bill, a prescriber would be required to discuss the risks and dangers associated with opioids with the minor, the minor's parent or guardian, or another adult authorized to consent to the minor's medical treatment before directly dispensing or issuing for a minor the first prescription in a single course of treatment.
Several exceptions are accommodated in this requirement. Treatments of addiction, chronic intractable pain, medical emergencies, or any situation where the prescriber believes the discussion would be detrimental to the minor's health or safety are exempted. The bill would not impact the ability of a practitioner to prescribe opioids to a minor and would not limit the strength or quantity of the prescription; however, it would seek to increase awareness of opioid risks for minor patients who receive prescriptions for opioids.
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. Physician and surgeons licensed by the MBC have the discretion to select what courses to take to meet the majority of their education requirements. One of the only courses required in statute is a one-time, 12-hour training in pain management and the treatment of terminally ill patients. This bill would amend this existing requirement to specify that the course must also include the risks of addiction associated with Schedule II controlled substances.
Similar provisions exist for other licensed professions engaged in prescribing controlled substances to patients. Dentists, optometrists, osteopathic physicians and surgeons, certified nurse-midwives, nurse practitioners, and physician assistants must all fulfill certain continuing education requirements to renew an active license. This bill amends the practice acts for these professions to include the same language regarding the risks of Schedule II drug addiction.
Analysis Prepared by: Robert Sumner / B. & P. / (916) 319-3301 FN: 0004467
Date of Hearing: August 15, 2018
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Lorena Gonzalez Fletcher, Chair
SBPCA Bill Id:SB 1109
Author:(Bates) – As Amended Ver:June 19, 2018
Policy Committee: | Business and Professions | Vote: | 18 - 0 |
Health | 15 - 0 | ||
|
|
Urgency: No State Mandated Local Program: Yes Reimbursable: No
SUMMARY:
This bill enhances education and awareness for opioid prescribers and patients. Specifically, this bill:
- Amends various provisions of law regarding continuing education related to pain medication or pain management for prescribers, including physicians, dentists, optometrists, and certified nurse-midwives, to newly include the risks of addiction associated with Schedule II drugs.
- Requires all prescription drugs containing an opioid to prominently display on the label or container a notice that states “Caution: Opioid. Risk of overdose and addiction.”
- Requires schools and youth sports organizations to annually provide all athletes, as well as the parents or guardians of athletes 17 years of age or younger, with a copy of the Opioid Factsheet for Patients published by the Centers for Disease Control and Prevention, and requires that a signed document acknowledging receipt of the factsheet be returned prior to the athlete’s participation in the sport.
- Requires a prescriber to discuss with a minor, the minor’s parent or guardian, or other adult authorized to consent to the minor’s medical treatment, prior to dispensing or issuing a prescription of opioids to a minor for the first time, risks of addiction and overdose associated with the use of opioids as specified.
FISCAL EFFECT:
- Minor and absorbable costs to various prescribing boards to update course criteria (various special funds).
- One-time minor and absorbable information technology costs to the Department of Consumer Affairs for the creation of new enforcement codes (Pharmacy Board Contingent Fund).
- Minor and absorbable costs to the Board of Pharmacy to promulgate regulations (Pharmacy Board Contingent Fund).
COMMENTS:
- Purpose. This bill seeks to decrease the incidence of opioid addiction and overdose by increasing awareness and education among prescribers and patients, including minor athletes and their parents. According to the author, education is a key component in understanding the very addictive nature of Schedule II controlled substances.
- Background. Opioids are a class of narcotic drugs prescribed by health professionals to manage pain. Most opioid analgesics are classified as Schedule II drugs in the California Uniform Controlled Substances Act, in that they have a recognized medical use but also have a high potential for abuse that may lead to severe psychological or physical dependence.
In 2017, the Department of Public Health (DPH) reported 1,882 (preliminary death data) opioid deaths in California with 4,281 emergency department visits for all opioids (excluding heroin). Deaths as a result of fentanyl increased to 373 (a 57% increase) in 2017 and there were nearly 22 million opioid prescriptions issued in the State of California.
All doctors licensed by the Medical Board of California (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. Physician and surgeons have discretion to select what courses to take to meet the majority of their education requirements. One of the only courses required in statute is a one-time, 12-hour training in pain management and the treatment of terminally ill patients. This bill amends this existing requirement to specify the course must also include the risks of addiction associated with Schedule II controlled substances.
Similar provisions exist for other licensed professions engaged in prescribing controlled substances to patients. Dentists, optometrists, osteopathic physicians and surgeons, certified nurse-midwives, nurse practitioners, and physician assistants must all fulfill certain continuing education requirements to renew an active license. This bill amends the practice acts for these professions to include the same language regarding the risks of addiction associated with Schedule II drugs.
Existing law prohibits a pharmacist from dispensing a prescription unless they do so with a container that meets certain labeling requirements. This bill adds to existing prescription drug container labeling requirements by including a warning for prescriptions of opioids.
Minors who receive opioid painkillers during the course of a youth sports program are a commonly recognized population at risk of falling into opioid abuse and addiction. Numerous states have enacted laws aimed at improving education about the dangers of prescription drug abuse. Introduced in the United States Congress, the Student and Student Athlete Opioid Misuse Prevention Act would provide grants for youth education programs. This bill enacts an education requirement for all athletes who participate in sports programs through a school or a youth sports organization.
- Related Legislation. There is a large number of bills introduced this year addressing various aspects of the opioid epidemic, including improvements to CURES, 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
Date of Hearing: June 26, 2018
ASSEMBLY COMMITTEE ON HEALTH
Jim Wood, Chair
SBPCA Bill Id:SB 1109
Author:(Bates) – As Amended Ver:June 19, 2018
SENATE VOTE: 39-0
SUBJECT: Controlled substances: Schedule II drugs: opioids.
SUMMARY: Requires specific health care professionals authorized to prescribe Schedule II drugs to fulfill continuing education courses that address the risks of addiction associated with the use of Schedule II controlled substances; requires providers to discuss the dangers of opioid abuse and addiction with a minor patient or the parent or guardian prior to prescribing an opioid for the first time; requires a warning label on all opioid prescription containers; requires all youth sports organizations, school districts, charter schools, and private schools that offer athletic programs to provide the federal Centers for Disease Control and Prevention’s (CDC) Opioid Factsheet for Patients (Factsheet) to all athletes engaged in after-school or youth sports programs annually and for athletes 17 or younger, to their parent or guardian and receive written acknowledgment. Specifically, this bill:
- Authorizes the healing arts boards that regulate the following healing arts professionals to include in the continuing education requirements the risks of addiction associated with the use of Schedule II drugs:
- Dentists;
- Physicians and Surgeons;
- Osteopathic Physicians and Surgeons;
- Optometrists;
- Nurse Practitioners; and,
- Certified Nurse-Midwives.
- Requires all prescription drugs containing an opioid to prominently display on the label or container a notice that states “Caution: Opioid. Risk of overdose and addiction.”
- Requires, if a school district, charter school, or private school elects to offer an athletic program to give the Factsheet to each athlete annually. Requires the athlete, and if the athlete is 17 years of age or younger, the athlete’s parent or guardian, to sign and return a document acknowledging receipt of the Factsheet prior to the athlete initiating practice or competition. Exempts an athlete engaging in an athletic activity during the regular school day or as part of a required physical education course. Permits the Factsheet to be sent and returned via electronic medium, including, but not limited to, fax or email.
- Requires a youth sports organization offering an athletic program to give the Factsheet to each athlete annually. Requires the athlete, and if the athlete is 17 years of age or younger, the athlete’s parent or guardian to sign and return a document acknowledging receipt of the Factsheet prior to the athlete initiating practice or competition. Permits the Factsheet to be sent and returned via electronic medium, including, but not limited to, fax or email.
- Requires a prescriber to discuss the following with a minor, or the minor’s parent, guardian, or other adult authorized to consent to the minor’s medical treatment, prior to dispensing or issuing a prescription of opioids to a minor for the first time:
- The risks of addiction and overdose associated with the use of opioids;
- The increased risk of addiction to an opioid to an individual who is suffering from both mental and substance abuse disorders;
- The danger of taking an opioid with a benzodiazepine, alcohol, or another central nervous system depressant; and,
- Any other information required by law.
- Exempts from 5) above in the following circumstances:
- If the minor’s treatment includes emergency services and care;
- If the minor’s treatment is associated with or incident to an emergency surgery, regardless of whether the surgery is performed on an inpatient or outpatient basis; and,
- If, in the prescriber’s professional judgment, fulfilling the requirements of 5) above would be detrimental to the minor’s health, safety, or in violation of the minor’s legal rights regarding confidentiality.
- Provides that failure to comply with 5) above does not constitute a criminal offense.
- Provides that 5) does not apply to treatment of addicts, or for a diagnosis of chronic intractable pain.
EXISTING LAW:
- Establishes various healing arts practice acts and regulatory boards within the Department of Consumer Affairs (DCA) to provide for the licensure and regulation of, but not limited to, physicians and surgeons, dentists, osteopathic physicians and surgeons, certified nurse-midwives, nurse practitioners, and optometrists.
- Requires the DCA boards to adopt and administer standards for the continuing education of its licensees; authorizes the board to establish continuing education standards for courses that serve to maintain, develop, or increase the knowledge, skills, and professional performance of their licentiates.
- Allows a physician, dentist, podiatrist, veterinarian, naturopathic doctor, registered nurse, certified nurse-midwife, optometrist, and nurse practitioners, and physician assistants pursuant to specified procedures and protocols, to write or issue a prescription.
- 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 their professional practice.
- Requires labeling of all containers of prescription drugs to include information about the drug, directions for use, the names of the patient and the prescriber and other information.
- Defines “youth sports organization” as an organization, business, nonprofit entity, or a local governmental agency that sponsors or conducts amateur sports competitions, training, camps, or clubs in which persons 17 years of age or younger participate in one of a delineated list of sports including but not limited to football, baseball, volleyball, martial arts, surfing, rodeo, diving, and cheerleading.
FISCAL EFFECT: According to the Senate Appropriations Committee, minor and absorbable costs for the DCA to draft notices and post on its Website the changes pertaining to the bill, so respective Boards and Bureaus can implement the bill’s provisions.
COMMENTS:
- PURPOSE OF THIS BILL. According to the author, this bill is needed to continue educating everyone who comes in contact with these necessary and yet potentially harmful opioid prescriptions. Ensuring, patients, minors, parents, and prescribers have the necessary information before taking these medications will help prevent future addictions and overdoses with the drugs. The author believes that proper drug education for all patients regardless of their age or status will help empower patients to make the right decision. Education is a key component in understanding the very addictive nature of Schedule II controlled substances. It is necessary to warn consumers who receive opioid prescriptions that they can be addictive and can cause drug overdoses if not used carefully. The author concludes by stating that more needs to be done to combat a crisis that has taken so many lives. This bill is a step in the right direction, providing additional tools for patients, parents and prescribers to have more information on hand when making decisions with what prescriptions they elect to take, in the midst of the worst drug epidemic in American history.
- BACKGROUND.
- Opioid Epidemic. California and the nation are experiencing an opioid epidemic. For the 24 month period July 2015 through July 2017, 9,490 Californians lost their lives as a result of drug overdoses, a trend primarily driven by opioids including heroin and fentanyl. California ranks in the top five states when it comes to the raw number of drug-overdose deaths. Enough prescription opioids are prescribed every year to kill every Californian more than twice.
Some California counties have overdose drug rates three to five times higher than the national average. After alcohol, prescription drugs are the most commonly abused substance by Americans over 12 years of age. Most alarming is that driven by the continued surge in drug deaths, life expectancy in the United States dropped for the second year in a row in 2016, resulting in the first consecutive decline in national life expectancy since 1963 - and the annual overdose death toll is still rising.
While our nation and state are firmly ensconced in an epidemic, there is some good news in that California did experience a decline in overdose deaths between 2016 and 2017. A likely reason for a tapering in death counts is growing use of the overdose antidote naloxone hydrochloride (naloxone), stricter adherence to safe prescribing guidelines and enhanced public awareness of the issue. Of significant concern to public health officials and those combatting the opioid epidemic is the alarming increase in deaths as a result of Fentanyl overdoses.
In 2017 the Department of Public Health (DPH) reported 1,882 (preliminary death data) opioid deaths in California with 4,281 emergency department visits for all opioids (excluding heroin). Deaths as a result of Fentanyl increased to 373 (a 57% increase) in 2017 and there were nearly 22 million opioid prescriptions issued in the State of California.
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 those who 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% of 18- to 25-year-olds and 5% of persons age 26 or older used prescription drugs nonmedically in the past year.
- Opioids. Opioids are a class of narcotic drugs that include medications such as hydrocodone, oxycodone, morphine, codeine, and other related drugs. Most opioid analgesics are classified at Schedule II drugs in the California Uniform Controlled Substances Act, in that they have a recognized medical use, but also have a high potential for abuse that may lead to severe psychological dependence or severe physical dependence. According to DPH in the past, prescription opioids were prescribed for relieving short-tem (acute) pain. Today, they are increasingly being used for long-term (chronic) pain management. As a result, sales of opioid pain relievers have quadrupled in the past 10 years. Taken as prescribed, opioids can be used to manage pain safely and effectively. However, opioids may also produce other effects including euphoric response since these drugs affect the regions of the brain involving reward response. The NIDA states that those who abuse opioids may seek to intensify their experience by taking the drug in ways other than those prescribed such as snorting or injecting, thereby increasing their risk for serious medical complications, including overdose. Prescription opioid misuse can lead to long-term health problems, trouble breathing overdose and death.
- Heroin. Heroin, also an opioid, is most commonly used as a recreational drug for its euphoric effects. Heroin is an illegal substance in California and is classified as a Schedule I narcotic. Substances in this schedule have no currently accepted medical use in the United States, a lack of accepted safety for use under medical supervision and a high potential for abuse.
- Opioids. Opioids are a class of narcotic drugs that include medications such as hydrocodone, oxycodone, morphine, codeine, and other related drugs. Most opioid analgesics are classified at Schedule II drugs in the California Uniform Controlled Substances Act, in that they have a recognized medical use, but also have a high potential for abuse that may lead to severe psychological dependence or severe physical dependence. According to DPH in the past, prescription opioids were prescribed for relieving short-tem (acute) pain. Today, they are increasingly being used for long-term (chronic) pain management. As a result, sales of opioid pain relievers have quadrupled in the past 10 years. Taken as prescribed, opioids can be used to manage pain safely and effectively. However, opioids may also produce other effects including euphoric response since these drugs affect the regions of the brain involving reward response. The NIDA states that those who abuse opioids may seek to intensify their experience by taking the drug in ways other than those prescribed such as snorting or injecting, thereby increasing their risk for serious medical complications, including overdose. Prescription opioid misuse can lead to long-term health problems, trouble breathing overdose and death.
- Controlled Substances. Certain drugs are classified under the federal Controlled Substances Act of 1970 (CSA) into one of five schedules. Placement in a given schedule depends on whether a drug has a currently accepted medical use, its relative abuse potential, and its likelihood of causing either addiction or physical dependency when abused. Most opioid analgesics are schedule II drugs, in that they have a recognized medical use, but also have a high potential for abuse that may lead to severe psychological dependence or severe physical dependence. The CSA places a number of restrictions on prescribers and pharmacies that dispense controlled substances like opioids. For example, refills are not permitted and a new written prescription must be presented each time the drug is dispensed.
- Drug Prescription Labelling Requirements. Current law prohibits a pharmacist from dispensing a prescription unless the container meets certain labeling requirements. Absent a small number of exemptions, every prescription drug container must be labeled with the following information:
- The drug’s trade name, or its generic name and manufacturer;
- Directions for the use of the drug;
- The patient’s name;
- The name of the prescriber or other practitioner operating under a prescribing protocol;
- The date of issue;
- The name and address of the pharmacy and the prescription number or other means of identifying the prescription;
- The strength and quantity of the drug or drugs dispensed;
- The expiration date of the effectiveness of the drug dispensed;
- The condition or purpose for which the drug was prescribed, if indicated; and,
- A physical description of the dispensed medication, including its color, shape, and any identification code that appears on the tablets or capsules, except in certain cases.
In addition, the California Patient Medication Safety Act directed the State Board of Pharmacy to promulgate regulations to require a “standardized, patient-centered, prescription drug label on all prescription medicine dispensed to patients in California.” The resulting language specifies that drug container label information must be clustered into one area of the label comprising at least 50% of the label, and that each item must be printed in at least a 12-point sans serif typeface. Further regulations passed by the board additionally require on a prescription drug container label the following information:
- The pharmacy’s telephone number, with the exception of drugs dispensed within hospitals;
- Instructions for storage, handling, and administration; and,
- For all hazardous agents, a special label which states “Chemotherapy - Dispose of Properly” or “Hazardous - Dispose of Properly.”
This bill would add to this existing prescription drug container labeling requirements by including a warning for prescriptions of opioids reading: “Caution: Opioid. Risk of overdose and addiction.” As amended, this bill specifically requires that the information be displayed through a flag or other notification mechanism attached to the container.
d) Youth Sports Education. A commonly recognized vulnerable population that is often at
risk of falling into opioid abuse and addiction is minors who receive opioid painkillers during the course of a youth sports program. The Journal of Child and Adolescent Substance Abuse has published a survey finding that high school athletes are in particular danger of becoming addicted to prescription drugs. In a June 22, 2015 issue of Sports Illustrated, a special report entitled “Smack Epidemic: How Painkillers Are Turning Young Athletes Into Heroin Addicts” provided specific case studies of high school student athletes who received opioid prescriptions following an injury, resulting in spiraling drug addiction.
In response, numerous states have enacted laws aimed at improving education about the dangers of prescription drug abuse. Senate and House of Representatives companion bill have been introduced in the United States Congress, entitled the Student and Student Athlete Opioid Misuse Prevention Act that proposes to provide grants for these kinds of education programs.
- SUPPORT. Summer Stephan, District Attorney for San Diego County, sponsor of the bill, states that this bill is a multi-faceted educational approach to opioid overuse and addiction. This bill brings common sense solutions that protect consumers by telling them the truth about the real risk of addiction and overdose from prescription opiates. It also focuses on the duty of medical professionals and athletic school based programs on educating and informing minors and their parents about the risks of opiate based pain medication. The Medical Board of California (MBC) states that the growing opioid abuse epidemic remains a matter of concern for MBC and that this bill will increase education for physicians and patients which furthers MBC’s mission of consumer protection.
- RELATED LEGISLATION.
- AB 1751 (Low) would authorize the Department of Justice (DOJ) to share prescription records between its Controlled Substance Utilization Review and Evaluation System (CURES) prescription drug monitoring program (PDMP) and other databases across state lines, with a requirement that other states meet California's patient privacy and data security standards. AB 1751 is pending in the Senate Committee on Public Safety.
- AB 1752 (Low) would add Schedule V drugs to CURES, the state's PDMP; changes the required timeframe in which pharmacists are required to report prescriptions from seven days to the following business day; and makes technical changes. AB 1752 is pending in the Senate Committee on Public Safety.
- AB 1753 (Low) of 2018, would authorize the DOJ to cap the number of security printers approved to manufacture regulated prescription pads to three and allows DOJ to reduce or limit the number of printers to no fewer than three through regulation; requires that all prescription forms be uniquely serialized; and requires that the DOJ link prescription pad serial numbers to corresponding records in the state's PDMP. AB 1753 is pending in the Senate Committee on Public Safety.
- AB 1963 (Waldron) would have required the Department of Health Care Services (DHCS) to increase Medi-Cal provider reimbursement rates for opioid addiction treatment by an unspecified percentage of the corresponding average rates established in the 2017-18 fiscal year. Specifically, this bill specifies rate increases for "medication-assisted treatments (MAT), buprenorphine/naloxone combination treatment, methadone treatment, and naltrexone treatments provided by certified providers for opioid addiction. AB 1963 was held on suspense in the Assembly Appropriations Committee.
- AB 1998 (Rodriguez) would require every healthcare practitioner authorized to prescribe opioids classified as Schedule II and Schedule III to adopt a safe prescribing policy (SPP), as specified. AB 1998 is pending in the Senate Health Committee.
- AB 2086 (Gallagher) of 2018, allows prescribers of controlled substances to review a list of patients for whom they are listed as the prescriber in the DOJ’s PDMP, also known as CURES. AB 2086 is pending in the Senate Appropriations Committee.
- AB 2384 (Arambula) would require, until January 1, 2030, a drug formulary maintained by a health care service plan (excluding Medi-Cal managed care plans), or a health insurer to include, at a minimum, the following (MAT) drugs approved by the United States Food and Drug Administration (FDA), as specified. AB 2384 is pending in the Senate Committee on Health.
- AB 2486 (McCarty) would require a manufacturer or wholesaler that sells or distributes opioid drugs to submit to the DHCS a report, that details all opioid drugs sold or distributed during the preceding fiscal year and to calculate the ratable share of a manufacturer or wholesaler, which is the individual portion of the collective sum of $100 million to be paid by the manufacturers and wholesalers, based on the information reported. Would have required the deposit of the payments, less refunds and DHCS’s administrative costs, into the continuously appropriated Opioid Prevention and Rehabilitation Program Fund, established by AB 2486. Require the DHCS to distribute moneys in the fund to counties for purposes of opioid prevention and rehabilitation programs. AB 2486 is pending in the Senate Committee on Health.
- AB 2487 (McCarty) would require every physician and surgeon to take one hour of training in MAT for opioid abuse disorders within the six months of first receiving a FDA registration or within six months of their next renewal after January 1, 2019. AB 2487 is pending in the Senate Committee on Business, Professions and Economic Development.
- AB 2741 (Burke) would limit 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. AB 2741 is pending in the Senate Committee on Business, Professions and Economic Development.
- AB 2760 (Wood) would require a prescriber to prescribe naloxone hydrochloride for patients when certain conditions are present and to provide education to patients. AB 2760 is pending in the Senate Appropriations Committee.
- AB 2783 (O’Donnell) would reschedule hydrocodone combination products from a Schedule III drug to a Schedule II drug. AB 2783 is pending in the Senate Appropriations Committee.
- AB 2789 (Wood) would require that all health care practitioners authorized to issue prescriptions to be capable of electronically prescribing by January 1, 2020, and would require that all prescriptions for controlled substances be transmitted electronically beginning January 1, 2021, with exceptions. AB 2789 is pending in the Senate Appropriations Committee.
- AB 2859 (Caballero) would require a chain community pharmacy that dispenses Schedule II, III, or IV controlled substances to display safe storage products in a place on the building premises that is located close to the pharmacy, unless the chain community pharmacy meets two requirements related to the ownership and management of the pharmacy. AB 2859 is pending in the Senate Business, Professions and Economic Development Committee.
- PREVIOUS LEGISLATION.
- SB 419 (Portantino) of 2017 would have prohibited the prescribing of opioids to persons under 21. SB 419 was subsequently amended to address a different subject.
- AB 715 (Wood) of 2017 would have required DPH to convene a workgroup to review existing prescription guidelines and develop a recommended statewide guideline addressing best practices for prescribing opioid pain relievers. AB 715 was vetoed by the Governor, who indicated that AB 715 was unnecessary because DPH has led the Prescription Opioid Misuse and Overdose Prevention Workgroup comprised of state and local agencies as well as medical and patient organizations committed to reducing opioid overdose rates in California.
- SB 482 (Lara), Chapter 708, Statutes of 2016, requires a health care provider authorized to prescribe, order, administer, or furnish a controlled substance to consult the CURES database prior to prescribing a Schedule II, III or IV drug to a patient for the first time and at least once every four months thereafter if the substance remains part of the patient’s treatment. Exempts from this requirement if a patient is admitted to a certain type of facility, if a patient receives a non-refillable five-day supply or less prescription in conjunction with a surgery, and in the event of a technological failure or inability to access the CURES system.
- AB 623 (Wood) of 2015 would have prohibited a health plan or health insurer from requiring the use of opioid drug products that have no abuse-deterrent properties in order to access abuse-deterrent opioid drug products; would have required pharmacists to provide a patient receiving an opioid drug product information about proper storage and disposal of the drug; and, would have mandated that a plan and insurer may not prevent a provider from prescribing a less than 30-day supply of opioids analgesic drugs and to provide coverage, if otherwise covered, for the less than 30-day prescription. AB 623 was held on the Assembly Appropriations Committee suspense file.
- AB 831 (Bloom) of 2013 would have required the California Health and Human Services Agency (CHHSA) to convene a temporary working group to develop a state plan to reduce the rate of fatal drug overdoses and appropriated $500,000 from the General Fund to CHHSA to provide grants to local agencies to implement drug overdose prevention and response programs. AB 831 was held on the Assembly Appropriations Committee suspense file.
- DOUBLE REFERRAL. This bill is double referred; it was heard in the Assembly Committee on Business and professions on June 12, 2018 and passed on a vote of 18-0.
REGISTERED SUPPORT / OPPOSITION:
Support
Summer Stephan District Attorney, San Diego County (sponsor)
Association of California Life & Health Insurance Companies
California Dental Association
California District Attorneys Association
California Medical Association
Dental Board of California
McKesson Corporation
Medical Board of California
Opposition
None on file.
Analysis Prepared by: Judith Babcock / HEALTH / (916) 319-2097
Date of Hearing:
ASSEMBLY COMMITTEE ON BUSINESS AND PROFESSIONS
Evan Low, Chair
SBPCA Bill Id:
Author:() – As Ver:June 6, 2018
SENATE VOTE:
SUBJECT:
SUMMARY: Requires warning labels for opioid prescription drug containers; requires that the Opioid Factsheet for Patients be provided to athletes engaged in after-school youth sports; requires that prescribers discuss the dangers of opioid abuse and addiction with a minor patient or their parent or guardian prior to prescribing an opioid; and requires that existing trainings for prescribers related to pain management include addiction risks associated with Schedule II drugs.
EXISTING LAW:
- Establishes the Medical Practice Act, which provides for the state’s licensure and regulation of physicians and surgeons. (Business and Professions Code (BPC) §§ 2000 et seq.)
- Establishes the Medical Board of California (MBC), a regulatory board within the Department of Consumer Affairs comprised of 15 appointed members, including 7 public members. (BPC § 2001)
- Includes among the MBC’s responsibilities the administration of a continuing medical education program. (BPC § 2004)
- 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)
- 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)
- 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)
- Allows only a physician, dentist, podiatrist, veterinarian, naturopathic doctor, registered nurse, certified nurse-midwife, optometrist, or out-of-state prescriber to write or issue a prescription. (Health and Safety Code (HSC) § 11150)
- States that a prescription for a controlled substance shall only be issued for a legitimate medical purpose by an individual practitioner acting in the usual course of his or her professional practice, and that the responsibility for the proper prescribing and dispensing of controlled substances is upon the prescribing practitioner, but a corresponding responsibility rests with the pharmacist who fills the prescription. (HSC § 11153)
- Prohibits medical professionals from prescribing, administering, or dispensing a controlled substance to an addict, as defined. (HSC § 11156)
- Establishes the Controlled Substance Utilization Review and Evaluation System (CURES), a database maintained by the California Department of Justice for the purposes of collecting records of dispensed controlled substances for review by licensed prescribers and dispensers, regulatory investigators, law enforcement, and statistical researchers. (HSC § 11165(a))
- Beginning October 2, 2018, requires certain health care practitioners to consult the CURES database to review a patient’s controlled substance history before prescribing a Schedule II, Schedule III, or Schedule IV controlled substance to the patient for the first time and at least once every four months thereafter if the substance remains part of the treatment of the patient, with certain exceptions. (HSC § 11165.4)
- Prohibits any person from obtaining or attempting to obtain a prescription for controlled substances by fraud, deceit, misrepresentation, subterfuge, or the concealment of a material fact. (HSC § 11173)
- Requires labeling of all containers of prescription drugs stating information about the drug, directions for use, the names of the patient and the prescriber, and other information. (BPC § 4076)
- Typically defines “minor” as a person under 18 years of age. (BPC § 22580)
- Defines “youth sports organization” as an organization, business, nonprofit entity, or a local governmental agency that sponsors or conducts amateur sports competitions, training, camps, or clubs in which persons 17 years of age or younger participate in one of an enumerated list of sports including but not limited to football, martial arts, surfing, rodeo, and cheerleading. (HSC § 124235)
THIS BILL:
- Requires a warning label on all containers for dispensed prescriptions of opioids that reads: “Caution: Opioid. Risk of overdose and addiction.”
- Requires schools and youth sports organizations to annually provide all athletes, as well as the parents or guardians of athletes 17 years of age or younger, with a copy of the Opioid Factsheet for Patients published by the Centers for Disease Control and Prevention, and requires that a signed document acknowledging receipt of the factsheet be returned prior to the athlete’s participation in the sport.
- Requires a prescriber to discuss the following with a minor, or the minor’s parent, guardian, or other adult authorized to consent to the minor’s medical treatment, prior to dispensing or issuing a prescription of opioids to a minor for the first time:
- The risks of addiction and overdose associated with the use of opioids.
- The increased risk of addiction to an opioid to an individual who is suffering from both mental and substance abuse disorders.
- The danger of taking an opioid with a benzodiazepine, alcohol, or another central nervous system depressant.
- Any other information required by law.
- Exempts from a prescriber’s discussion requirements, as described above, all treatments of addiction, chronic intractable pain, medical emergencies, or any situation where the prescriber believes the discussion would be detrimental to the minor’s health or safety.
- Amends various provisions regarding continuing education related to pain medication or pain management for prescribers, including physicians, dentists, optometrists, and certified nurse-midwives, to including the risks of addiction associated with Schedule II drugs.
FISCAL EFFECT: According to the Senate Committee on Appropriations, minor and absorbable costs for the Department of Consumer Affairs to draft notices and post on its website the changes pertaining to the bill, so respective Boards and Bureaus can implement the bill’s provisions.
COMMENTS:
Purpose. This bill is sponsored by San Diego County District Attorney Summer Stephan. According to the author:
Senate Bill 1109 addresses the opioid epidemic by educating everyone who comes in contact with these necessary and yet potentially harmful opioid prescriptions. Ensuring patients, minors, parents, and prescribers have the necessary information before taking these medications will help prevent future addictions and overdoses with the drugs.
Proper drug education for all patients regardless of their age or status will help empower people to make the right decision. Education is a key component in understanding the very addictive nature of Schedule II controlled substances. It is necessary to warn consumers who receive opioid prescriptions that they can be addictive and can cause drug overdoses if not used carefully.
More needs to be done to combat a crisis that has taken so many lives. SB 1109 is a step in the right direction, providing additional tools for patients, minors, parents, and prescribers to have more information on hand when making decisions with what prescriptions they elect to take. In the midst of the worst drug epidemic in American history, SB 1109 will prevent more lives from being lost.
Background.
Overview of the Opioid Crisis. 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 percent 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.
Opioids are a class of drugs prescribed and administered by health professionals to manage pain. Modern use of the term “opioid” typically describes both naturally occurring opiates derived from the opium poppy as well as their manufactured synthetics. Common examples of prescription opioids include oxycodone (OxyContin, Percocet); hydrocodone (Vicodin, Norco, Lorcet); codeine; morphine; and fentanyl. Heroin is also an opioid.
In addition to providing pain relief, opioids can be used as a cough suppressant, an antidiarrheal, a method of sedation, and a treatment for shortness of breath. The majority of pharmaceutical opioids are Schedule II drugs under the federal Controlled Substances Act, considered by the federal Drug Enforcement Agency (DEA) to have a high potential for abuse that may lead to severe psychological or physical dependence. However, combination drugs containing lower doses of opioids combined with other active ingredients are typically less restricted; for example, cough syrups containing low doses of codeine are frequently classified Schedule V medications.
The abuse of prescription drugs was historically viewed as a criminal concern analogous to street narcotics cases regularly investigated by law enforcement. In recent years, however, an expert consensus has evolved around the opinion that the opioid crisis must be addressed through the lens of public health policy. This belief is supported by research demonstrating how health professionals may have inadvertently contributed to the origins of the crisis. It is widely accepted that health professionals will play a necessarily critical role in any meaningful solutions.
In the opioid crisis’s broader national context, there has been a persistent perception that California represents a relatively minor segment of an epidemic more typically identified with states like New Hampshire and West Virginia. However, there is substantial evidence that communities in California have been much harder hit than may be generally believed. For example, in 2015, several rural counties in California saw as many or more drug overdose deaths per 100,000 residents than some Midwestern states. It has been reported that some small counties had more opioid prescriptions than residents. In total, the California Department of Public Health estimates that nearly 2,000 Californians died of an opioid overdose in 2016.
Prescription Drug Container Labeling. Current law prohibits a pharmacist from dispensing a prescription unless he or she does so with a container that meets certain labeling requirements. Absent a small number of exemptions, every prescription drug container must be labeled with the following information:
- The drug’s trade name, or its generic name and manufacturer;
- Directions for the use of the drug;
- The patient’s name;
- The name of the prescriber or other practitioner operating under a prescribing protocol;
- The date of issue;
- The name and address of the pharmacy and the prescription number or other means of identifying the prescription;
- The strength and quantity of the drug or drugs dispensed;
- The expiration date of the effectiveness of the drug dispensed;
- The condition or purpose for which the drug was prescribed, if indicated;
- A physical description of the dispensed medication, including its color, shape, and any identification code that appears on the tablets or capsules, except in certain cases.
In addition, the California Patient Medication Safety Act directed the State Board of Pharmacy to promulgate regulations to require a “standardized, patient-centered, prescription drug label on all prescription medicine dispensed to patients in California.” The resulting language enacted in 16 C.C.R. § 1707.5 specifies that drug container label information must be clustered into one area of the label comprising at least 50 percent of the label, and that each item must be printed in at least a 12-point sans serif typeface. The regulations provide template language and recommend formatting to provide added emphasis.
Further regulations passed by the board additionally require on a prescription drug container label the following information:
- The pharmacy’s telephone number, with the exception of drugs dispensed within hospitals.
- Instructions for storage, handling, and administration.
- For all hazardous agents, a special label which states “Chemotherapy - Dispose of Properly” or “Hazardous - Dispose of Properly.”
This bill would add to these existing prescription drug container labeling requirements by including a warning for prescriptions of opioids reading: “Caution: Opioid. Risk of overdose and addiction.” As amended, the bill specifically requires that the information be displayed through a flag or other notification mechanism attached to the container. It is the author’s intent that this warning will further contribute to consumer awareness around the dangers of opioid addiction and will complement current labeling standards already in effect.
Education for Youth Athletes. A commonly recognized vulnerable population that is often at risk of falling into opioid abuse and addiction is minors who receive opioid painkillers during the course of a youth sports program. The Journal of Child and Adolescent Substance Abuse has published a survey finding that high school athletes are in particularized danger of becoming addicted to prescription drugs. In a June 22, 2015 issue of Sports Illustrated, a special report entitled “Smack Epidemic: How Painkillers Are Turning Young Athletes Into Heroin Addicts” provided specific case studies of high school student athletes who received opioid prescriptions following an injury, resulting in spiraling drug addiction.
In response, numerous states have enacted laws aimed at improving education about the dangers of prescription drug abuse. A bill has been introduced in the United States Congress, entitled the Student and Student Athlete Opioid Misuse Prevention Act, that proposes to provide grants for these kinds of education programs. SB 1109 is intended to enact an education requirement for all athletes who participate in sports programs through a school or a youth sports organization.
Statute defines “youth sports organization” as either a private or public entity that sponsors or conducts amateur sports competitions, training, camps, or clubs in which persons 17 years of age or younger participate in any of the following sports:
- Baseball;
- Basketball;
- Bicycle motocross (BMX);
- Boxing;
- Competitive cheerleading;
- Diving;
- Equestrian activities;
- Field hockey;
- Football;
- Full contact martial arts;
- Gymnastics;
- Ice hockey;
- Lacrosse;
- Parkour;
- Rodeo;
- Roller derby;
- Rugby;
- Skateboarding;
- Skiing;
- Soccer;
- Softball;
- Surfing;
- Swimming;
- Synchronized
swimming; - Volleyball;
- Water polo;
- Wrestling.
Athletes participating in these sports, as well as the parents or guardians of athletes who are 17 years of age or younger, would be required under this bill to receive and acknowledge a copy of the Opioid Factsheet for Patients published by the Centers for Disease Control and Prevention.[1] This two-page information guide explains the risks of opioids and provides recommendations to avoid addiction. The author believes that providing youth and parents with this information will significantly reduce the incidents of minor drug addiction in California.
Discussions with Minor Patients. In addition to the information required to be provided to student athletes, this bill would also address concerns about minors becoming addicted to prescription pain medication by adding new discussion requirements for prescribers who wish to treat a minor patient with opioids. Under the bill, a prescriber would be required to discuss all of the following with the minor, the minor’s parent or guardian, or another adult authorized to consent to the minor’s medical treatment before directly dispensing or issuing for a minor the first prescription in a single course of treatment for a controlled substance containing an opioid:
- The risks of addiction and overdose associated with the use of opioids;
- The increased risk of addiction to an opioid to an individual who is suffering from both mental and substance abuse disorders; and
- The danger of taking an opioid with a benzodiazepine, alcohol, or another central nervous system depressant.
Several exceptions are accommodated in this requirement. Treatments of addiction, chronic intractable pain, medical emergencies, or any situation where the prescriber believes the discussion would be detrimental to the minor’s health or safety are exempted. The bill would not impact the ability of a practitioner to prescribe opioids to a minor and would not limit the strength or quantity of the prescription; however, it would seek to increase awareness of opioid risks for minor patients who receive prescriptions for opioids.
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. 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.
Physician and surgeons licensed by the MBC have the discretion to select what courses to take to meet the majority of their education requirements. One of the only courses required in statute is a one-time, 12-hour training in pain management and the treatment of terminally ill patients. This bill would amend this existing requirement to specify that the course must also include the risks of addiction associated with Schedule II controlled substances. In doing so, the author hopes to increase awareness among prescribers as to the dangers of prescribing certain controlled substances to patients.
Similar provisions exist for other licensed professions engaged in prescribing controlled substances to patients. Dentists, optometrists, osteopathic physicians and surgeons, certified nurse-midwives, nurse practitioners, and physician assistants must all fulfill certain continuing education requirements to renew an active license. This bill amends the practice acts for these professions to include the same language regarding the risks of addiction associated with Schedule II drugs.
Current Related Legislation. AB 1751 (Low) would provide a framework for the CURES database to connect with other states that comply with California’s patient privacy and data security standards. This bill is pending in the Senate Business, Professions and Economic Development Committee.
AB 1752 (Low) would add Schedule V drugs to the CURES database and change the requirement for pharmacists to report dispensed prescriptions from seven days to the following business day. This bill is pending in the Senate Business, Professions and Economic Development Committee.
AB 1753 (Low) would regulate the number of security printers authorized to manufacture prescription pads and linking uniquely serialized pads with CURES. This bill is pending in the Senate Business, Professions and Economic Development Committee.
AB 2384 (Arambula) would remove barriers to medication-assisted treatment, such as prior authorization requirements and limits on coverage. This bill is pending in the Senate.
AB 2859 (Caballero) would increase safe storage practices among parents to prevent access to prescription drugs in the home by children and adolescents. This bill is pending in the Senate Business, Professions and Economic Development Committee.
AB 2086 (Gallagher) would allow prescribers of controlled substances to review a list of patients for whom they are listed as being the prescriber. This bill is pending in the Senate Business, Professions and Economic Development Committee.
AB 2487 (McCarty) would add opioid addiction training as a continuing medical education requirement for certain physicians to increase the availability of buprenorphine treatment. This bill is pending in the Senate.
AB 2486 (McCarty) would establish the Opioid Prevention and Rehabilitation Program Fund to treat opioid addiction by providing existing programs the additional funding. This bill is pending in the Senate.
AB 2783 (O’Donnell) would reconcile discrepancies between California’s controlled substance schedules and the corresponding federal controlled substance schedules. This bill is pending in the Senate Public Safety Committee.
AB 1963 (Waldron) would incentivize medical providers to become certified prescribers of medication-assisted treatment by increasing the reimbursement rates for providers who prescribe these drug treatments. This bill was held on suspense in the Assembly Appropriations Committee.
AB 2789 (Wood) would require that prescriptions be submitted electronically, with limited exceptions. This bill is pending in the Senate Business, Professions and Economic Development Committee.
AB 2760 (Wood) would require certain prescriptions for opioids to also include a co-prescription for naloxone. This bill is pending in the Senate Business, Professions and Economic Development Committee.
AB 1998 (Rodriguez) would prohibit a prescriber from prescribing an opioid in an amount greater that the patient needs for a 3-day period unless the prescriber believes that a larger prescription is needed to treat a medical condition or that a larger prescription is necessary. This bill is pending in the Senate.
AB 2741 (Burke) would limit prescriptions of opioid medications to minors to a maximum of a five-day supply, with exceptions, and require prescribers to discuss with minor patients and their parents the same risks and dangers associated with opioids contained in this bill and receive verbal acknowledgement of the discussion. This bill is pending in the Senate Business, Professions and Economic Development Committee.
Prior Related Legislation. AB 1748 (Mayes, Chapter 557, Statutes of 2016) authorized school nurses and other trained personnel to use naloxone or another opioid antagonist to provide emergency medical aid to persons suffering, or reasonably believed to be suffering, from an opioid overdose. Also authorized pharmacies to furnish naloxone without a prescription to a school district, county office of education, or charter school.
SB 419 (Portantino) contained similar language to provisions of this bill related to prescriber notification of and discussions with minor patients about opioid use. This bill was subsequently amended to deal with a different subject.
ARGUMENTS IN SUPPORT:
San Diego County District Attorney Summer Stephan is the sponsor of this legislation. District Attorney Stephan states that the bill “brings common sense solutions that protect consumers by telling them the truth about the real risk of addiction and overdose from prescription opiates. It also focuses on the duty of medical professionals and athletic school based programs on educating and informing minors and their parents about the risks of opiate based pain medications.” District Attorney Stephan cites the seriousness of the opioid crisis, particularly among minors, and argues that requirements for greater education “are in the furtherance of safety for all.”
The California Medical Association (CMA) supports the bill. CMA writes that the legislation “will not place undue burden on patients and physicians, while effectively instituting measures that will provide outreach and education on opioid use disorders and the potential for addiction in youth.” The California Dental Association (CDA) also supports, writing that “prescribers, pharmacists and patients must have the information necessary to make appropriate pain management choices and understand the risks of opioid abuse.”
The Medical Board of California (MBC) is also in support. The MBC explains that “the growing opioid abuse epidemic remains a matter of concern for the Board” and that the provisions of the bill “will further the Board’s mission of consumer protection.” The Dental Board of California (DBC) is additionally in support, writing that “SB 1109 would address the addiction, misuse, and overdose of prescription opioids as a public health crisis by putting educational tools in place for patients, parents, minors and prescribers to assist them in making decisions regarding prescriptions.”
ARGUMENTS IN OPPOSITION:
None on file.
POLICY ISSUES:
While this bill would substantially increase the amount of education provided to minors and other at-risk patients regarding the dangers of opioid abuse and addiction, the provisions of the bill would not directly curb the overprescribing of opioids to children and young adults. Minor patients and their parents or guardians should be made aware of the risks associated with certain pain medications; however, the prescribing of excessive quantities of opioids could nevertheless lead to drug abuse. While the contents of this bill contribute valuably to the state’s efforts to combat opioid addiction among young people, the Legislature should additionally consider further measures to limit some prescriptions of opioids to younger patients as part of a more comprehensive solution to the crisis.
REGISTERED SUPPORT:
San Diego County District Attorney Summer Stephan (Sponsor)
Association of California Life and Health Insurance Companies
California Dental Association
California District Attorneys Association
California Medical Association
Dental Board of California
McKesson Corporation
Medical Board of California
REGISTERED OPPOSITION:
None on file.
Analysis Prepared by: Robert Sumner / B. & P. / (916) 319-3301
Available here: https://www.cdc.gov/drugoverdose/pdf/AHA-Patient-Opioid-Factsheet-a.pdf ↑
Office of Senate Floor Analyses (916) 651-1520 Fax: (916) 327-4478 | SB |
THIRD READING
Bill No: SB 1109
:
SENATE BUS., PROF. & ECON. DEV. COMMITTEE: 8-0, 4/16/18
AYES: Hill, Fuller, Dodd, Galgiani, Glazer, Hernandez, Newman, Wilk
NO VOTE RECORDED: Pan
SENATE HEALTH COMMITTEE: 9-0, 4/25/18
AYES: Hernandez, Nguyen, Leyva, Mitchell, Monning, Newman, Nielsen, Pan, Roth
SENATE APPROPRIATIONS COMMITTEE: 7-0, 5/14/18
AYES: Lara, Bates, Beall, Bradford, Hill, Nielsen, Wiener
SOURCE: Office of the San Diego County District Attorney
DIGEST:
This bill (1) requires prescribers to take continuing education courses on the risks of addiction associated with the use of Schedule II controlled substances; (2) requires additional warning labeling about the risks of addiction and overdose for opioid prescriptions; (3) 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 (4) requires prescribers to discuss risks and dangers of opioids and opioid addiction with minors and their parents or guardians.
Existing law:
- Requires that each prescription dispensed by a pharmacist must be in a container complying with state and federal law and correctly labeled including certain information and requires the Board of Pharmacy to promulgate regulations for a standardized, patient-centered, prescription drug label on all prescription medication dispensed in the state. (BPC §§ 4076 and 4076.5 (a))
- Establishes continuing education (CE) and continuing medical education (CME) requirements for health care providers, including, but not limited to:
- Dentists must complete not less than 50 hours of approved CE during the two-year period immediately preceding the expiration of their license. (BPC § 1645)
- Physicians and surgeons licensed by the Medical Board of California (MBC) must complete a one-time CME course of 12 hours in the subjects of pain management and the treatment of terminally ill and dying patients, among other requirements and other considerations MBC must make for required CME established through regulations. (BPC § 2190.5)
- Osteopathic physicians and surgeons licensed by the Osteopathic Medical Board of California (OMBC) must complete a minimum of 100 hours of American Osteopathic Association CE hours during each two-year cycle. (BPC § 2454.5)
- Certified nurse-midwives certified by the Board of Registered Nursing (BRN) who hold an active furnishing number, who are currently authorized through standardized procedures or protocols to furnish Schedule II controlled substances, and who are registered with the United States Drug Enforcement Administration (DEA) must provide documentation of CE specific to the use of Schedule II controlled substances in settings other than a hospital based on standards developed by the BRN. (BPC § 2746.51)
- Nurse practitioners certified by the BRN who hold an active furnishing number, who are authorized through standardized procedures or protocols to furnish Schedule II controlled substances, and who are registered with DEA must complete a course including Schedule II controlled substances based on standards developed by BRN. (BPC § 2836.1)
- Optometrists certified to use therapeutic pharmaceutical agents must complete a total of 50 hours of CE every two years in order to renew his or her certificate 35 of which must be on the diagnosis, treatment, and management of ocular disease, including pain medication. Requires the Board of Optometry to encourage every optometrist to take a course or courses in pharmacology and pharmaceuticals as part of his or her CE. (BPC § 3059)
- Physician assistants licensed by the Physician Assistant Board (PAB) must complete no more than 50 hours of CE every two years. The PAB shall, as it deems appropriate, accept certification by the National Commission on Certification of Physician Assistants, or another qualified certifying body, as determined by the PAB, as evidence of compliance with CE requirements. (BPC § 3524.5)
- Requires, at the beginning of the first semester or quarter of the regular school term, the governing board of each school district to provide notification to the parent or guardian of a minor pupil about various rights and responsibilities; the availability of individualized instruction; the schedule of minimum days and pupil-free staff development days; the district’s fingerprinting program if it provides one; the district’s sexual harassment policy; all existing statutory attendance options and local attendance options available in the school district; information about grades and academic credits in the event of absences; for pupils enrolled in grades 9-12, information about college admission requirements, career technical education and how to meet with school counselors to help choose courses to meet admission requirements; the availability of state funds for advanced placement fees and; authorizes the notification to also advise the parent or guardian of the importance of investing for future college or university education for their children and of considering appropriate investment options, including, but not limited to, United States savings bonds. (Education Code (EDC) § 48980)
- Establishes requirements for a school district, charter school, or private school that offers an athletic program to take certain actions for an athlete suspected of sustaining a concussion or head injury. Requires, on a yearly basis, a concussion and head injury information sheet to be signed and returned by the athlete and the athlete’s parent or guardian before the athlete initiates practice or competition. (EDC § 49475)
This bill:
- Makes findings and declarations about addiction, misuse and overdose of prescription opioids. States the intent of the Legislature to ensure that health care providers and young athletes receive necessary education on this topic.
- Adds the risks of addiction associated with the use of Schedule II drugs to CE and CME requirements for dentists, physicians and surgeons, osteopathic physicians and surgeons, doctors of podiatric medicine, certified nurse midwives, nurse practitioners, physician assistants and optometrists.
- Requires a pharmacy or practitioner to prominently display a notice on the label or container that states “Caution: Opioid. Risk of overdose and addiction” when dispensing a prescription drug containing an opioid to a patient for outpatient use.
- Requires a prescriber to discuss the risks and dangers of addiction and overdoes associated with the use of opioids with a minor, with the minor’s parent or guardian, or with another adult authorized to consent to the minor’s medical treatment, except when the minor is being treated for addiction, chronic intractable pain or in an emergency situation, or if the prescriber feels it would be detrimental to the minor’s health or safety. Specifies that failure to comply with these discussion provisions shall not constitute a criminal offense.
- Requires a school district, charter school, or private school offering an athletic program, other than as part of the regular school day or as part of physical education, to annually give the Centers for Disease Control and Prevention’s (CDC) Opioid Factsheet for Patients each athlete, which may be sent and returned electronically. Requires the information sheet to be signed and returned by the athlete before the athlete initiates practice or competition and also signed by the athlete’s parent or guardian before the athlete initiates practice or competition if they are under 17.
- Requires a youth sports organization that elects to offer an athletic program to comply with the Factsheet requirements outlined above.
Background
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: (1) their potential for abuse; (2) their accepted medical use; and, (3) their accepted safety under medical supervision. 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).
Prescription drug abuse and related deaths. 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. 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% of persons age 26 or older used prescription drugs nonmedically in the past year.
Prescription opioids continue to be involved in more overdose deaths than any other drug. NIDA reports that more than 1,700 young adults died from prescription drug overdose in 2014, a four-fold increase from 1999, nearly 5 persons per day. According to the CDC, overdose deaths involving prescription opioids have quadrupled since 1999.
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. 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. 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, OMBC, which licenses and oversees osteopathic physicians and surgeons, adopted the 2014 MBC guidelines.
According to the author, “it is imperative that California act to curb future deaths and prevent addiction. SB 1109 is needed to continue educating everyone who comes in contact with these necessary and yet potentially harmful opioid prescriptions. Ensuring patients, minors, parents, and prescribers have the necessary information before taking these medications will help prevent future addictions and overdoses with the drugs.”
FISCAL EFFECT: Appropriation: Fiscal Com.: Local:
According to the Senate Appropriations Committee, minor and absorbable costs for the Department of Consumer Affairs to draft notices and post on its Web site the changes pertaining to this bill, so respective boards and bureaus can implement this bill’s provisions.
Office of the San Diego County District Attorney (source)
California District Attorneys Association
California Medical Association
McKesson Corporation
Medical Board of California
OPPOSITION: (Verified 5/16/18)
None received
ARGUMENTS IN SUPPORT: Supporters state that this bill brings common sense solutions that protect consumers by telling them the truth about the real risks of addiction and overdose from prescription opiates. Supporters believe that this bill takes positive steps to address the potential harm to youth when they misuse opioids, and appropriately educates parents and physicians in effective, non-burdensome ways.
MBC has a support if amended position. MBC writes that “This bill will increase education for physicians and patients, which will further the Board’s mission of consumer protection. AB 2741 (Burke) also requires verbal and written informed consent for any minor receiving an opioid prescription. The informed consent requirements in both bills should be aligned as they move through the legislative process.”
5/16/18 15:57:54
**** END ****
SENATE COMMITTEE ON
Senator Ricardo Lara, Chair
2017 - 2018 Regular Session
SB 1109 (Bates) - Controlled substances: Schedule II drugs: opioids
Version: | Policy Vote: |
Urgency: | Mandate: |
Hearing Date: | Consultant: |
This bill does not meet the criteria for referral to the Suspense File.
Bill Summary:
- Senate Bill 1109 requires prescribers to take continuing education courses on the risks of addiction associated with the use of Schedule II controlled substances; requires a warning label on all opiate-containing drugs; requires youth sports organizations, school districts, charter schools, and private schools that offer athletic programs to give the Opioid Factsheet for Patients published by the Centers for Disease Control and Prevention to each athlete; and requires prescribers to discuss the risks and dangers of opioids and opioid addiction prior to prescribing minors controlled substances for the first time, unless the treatment is in an emergency, emergency surgery, addiction treatment, or treatment for intractable pain.
Fiscal Impact:
- Minor and absorbable costs for the Department of Consumer Affairs to draft notices and post on its website the changes pertaining to the bill, so respective Boards and Bureaus can implement the bill’s provisions.
Background:
- The Business and Professions Code establishes various boards within the Department of Consumer Affairs (DCA), which licenses and regulates health care professionals including: physicians and surgeons (under the Medical Practice Act), dentists (under the Dental Practice Act), veterinarians (under the Veterinary Medicine Practice Act); registered nurses, nurse practitioners (NP) and certified nurse-midwives (CNM) (under the Nursing Practice Act); physician assistants (PA) (under the Physician Assistant Practice Act); osteopathic physicians and surgeons (under the Osteopathic Medical Practice Act); naturopathic doctors (ND) (under the Naturopathic Doctors Act); optometrists (under the Optometry Practice Act); doctors of podiatric medicine (under the Podiatric Act) and; pharmacies, pharmacists and wholesalers of dangerous drugs or devices (under the Pharmacy Law). Health care providers must meet specified continuing education and continuing medical education to maintain licensure.
The Controlled Substances Utilization Review and Evaluation System (CURES), which was established, among other reasons, to assist law enforcement and regulatory agencies in controlling diversion and abuse of Schedule II, III and IV controlled substances, provides for the electronic transmission of Schedule II, III and IV controlled substance prescription information to the Department of Justice (DOJ) at the time prescriptions are dispensed.
Existing law requires each school district, charter school, or private school that offers an athletic program to take certain actions for an athlete suspected of sustaining a concussion or head injury, including a concussion and head injury information sheet, to be signed by the athlete’s parent or guardian.
Proposed Law:
The bill requires continuing education for several licensees, including nurse practitioners, physician assistants, optometrists, osteopathic physicians and surgeons, regarding the risks of addiction associated with Schedule II controlled substances. In addition, the bill requires mandatory coursework that the Dental Board may prescribe as a condition of licensure, related to the risks of addiction to Schedule II drugs; and requires physicians and surgeons licensed after January 1, 2019, to take a mandatory continuing education course that includes the risks of addiction related to Schedule II drugs.
The bill requires that whenever a prescription drug, containing an opioid is dispensed for outpatient use, the pharmacy or practitioner must include a specified display/notice regarding the contents of the container.
The bill requires any school district, charter school, or private school, with an athletic program, or a youth sports organization, to issue the Centers for Disease Control and Prevention Opioid Factsheet for Patients to each athlete, as well as require the parent or guardian of an athlete aged 17 years old or younger, to sign a document, confirming receipt of the fact sheet.
The bill requires a prescriber, unless otherwise provided in law, prior to issuing a minor the first prescription in a single course for a controlled substance containing an opioid, to discuss specified topics with the minor, minor’s guardian and parent, including: risks of addiction, danger of taking an opioid with alcohol or other depressants, and any other information.
Related Legislation:
The Legislature will consider several bills pertaining to opioids, including, but not limited to:
- SB 1229 (Stone) requires pharmacists dispensing any opioid medication to a patient or the patient’s agent for the first time to provide oral consultation before dispensing the medication and prohibits a pharmacist from dispensing the medication if the patient or the patient’s agent declines the consultation. The bill is pending in the Senate Appropriations Committee.
- AB 1998 (Rodriguez) requires every health care practitioner authorized to prescribe Schedule II and III opioids to adopt a safe prescribing protocol with the goal of reducing the misuse of opioids. The bill is pending in Assembly Appropriations Committee.
- AB 2487 (McCarty) would require physicians to complete a mandatory CE course on the treatment and management of opiate-dependent patients which includes eight hours of training in buprenorphine treatment of opioid use disorder within six months of first receiving federal Drug Enforcement Agency registration. The bill is on the Assembly Floor.
- AB 2741 (Burke) would limit all opioid prescriptions for minors to a maximum of five days, with exceptions, and require a prescriber to discuss risks related to opioid medication with the minor and the minor’s parent or guardian and obtain written consent prior to writing the prescription. The bill is pending referral in the Senate Rules Committee.
- AB 2760 (Wood) would require certain prescriptions for opioids to also include a co-prescription for naloxone or another opioid antagonist. The bill is pending in Assembly Appropriations Committee.
- 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. The bill is pending in Assembly Appropriations Committee.
-- END --
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: SB 1109
AUTHOR: | Bates | ||
VERSION: | April 18, 2018 | ||
HEARING DATE: | April 25, 2018 | ||
CONSULTANT: | Scott Bain | ||
SUBJECT: Controlled substances: Schedule II drugs: opioids
SUMMARY:
- Requires prescribers to take continuing education courses on the risks of addiction associated with the use of Schedule II controlled substances; requires a warning label on all opiate-containing drugs; requires youth sports organizations, school districts, charter schools, and private schools that offer athletic programs to give the Opioid Factsheet for Patients published by the Centers for Disease Control and Prevention to each athlete; and requires prescribers to discuss the risks and dangers of opioids and opioid addiction prior to prescribing minors controlled substances for the first time, unless the treatment is in an emergency, emergency surgery, addiction treatment, or treatment for intractable pain.
Existing law:
- Establishes various practice acts in the Business and Professions Code (BPC) governed by various boards within the Department of Consumer Affairs (DCA), which provide for the licensing and regulation of health care professionals including: physicians (under the Medical Practice Act), dentists (under the Dental Practice Act), veterinarians (under the Veterinary Medicine Practice Act); registered nurses, nurse practitioners (NP) and certified nurse-midwives (CNM) (under the Nursing Practice Act); physician assistants (PA) (under the Physician Assistant Practice Act); osteopathic physicians and surgeons (under the Osteopathic Medical Practice Act); naturopathic doctors (ND) (under the Naturopathic Doctors Act); optometrists (under the Optometry Practice Act); doctors of podiatric medicine (under the Podiatric Act) and; pharmacies, pharmacists and wholesalers of dangerous drugs or devices (under the Pharmacy Law). [BPC §500 et seq.]
- Requires that each prescription dispensed by a pharmacist to be in a container complying with state and federal law and correctly labeled including certain information and requires the Board of Pharmacy (BOP) to promulgate regulations for a standardized, patient-centered, prescription drug label on all prescription medication dispensed in the state. [BPC §4076 and 4076.5]
- Establishes continuing education (CE) and continuing medical education (CME) requirements for health care providers, including, but not limited to:
- Dentists must complete not less than 50 hours of approved CE during the two-year period immediately preceding the expiration of their license. The Dental Board of California (DBC) is authorized to require, as a condition of licensure renewal, to require licentiates to complete CE within the general areas of patient care, health and safety and law and ethics. [BPC §1645]
- Physicians and surgeons licensed by the Medical Board of California (MBC) must complete a one-time CME course of 12 hours in the subjects of pain management and the treatment of terminally ill and dying patients, among other requirements and other considerations MBC must make for required CME established through regulations. [BPC §2190.5]
- Osteopathic physicians and surgeons licensed by the Osteopathic Medical Board of California (OMBC) must complete a minimum of 100 hours of American Osteopathic Association continuing education hours during each two-year cycle. [BPC §2454.5]
- CNMs certified by the Board of Registered Nursing (BRN) who hold an active furnishing number, who are currently authorized through standardized procedures or protocols to furnish Schedule II controlled substances, and who are registered with the United States Drug Enforcement Administration (DEA) must provide documentation of continuing education specific to the use of Schedule II controlled substances in settings other than a hospital based on standards developed by the BRN. [BPC §2746.51]
- NPs certified by the BRN who hold an active furnishing number, who are authorized through standardized procedures or protocols to furnish Schedule II controlled substances, and who are registered with DEA must complete a course including Schedule II controlled substances based on standards developed by the BRN. [BPC §2836.1]
- Optometrists certified to use therapeutic pharmaceutical agents must complete a total of 50 hours of CE every two years in order to renew his or her certificate, 35 of which must be on the diagnosis, treatment, and management of ocular disease, including pain medication. Requires the Board of Optometry to encourage every optometrist to take a course or courses in pharmacology and pharmaceuticals as part of his or her CE. [BPC § 3059]
- PAs licensed by the Physician Assistant Board (PAB) must complete no more than 50 hours of CE every two years. Requires the PAB, as it deems appropriate, to accept certification by the National Commission on Certification of Physician Assistants (NCCPA), or another qualified certifying body, as determined by the PAB, as evidence of compliance with CE requirements. [BPC §3524.5]
- Prohibits, under the Uniform Controlled Substances Act, any person other than a physician, dentist, podiatrist, veterinarian, and other specified health care providers from writing or issuing a prescription. [HSC §11150]
- Defines a controlled substance as any substance listed in the Uniform Controlled Substances Act in California law. [BPC §4021]
- Establishes schedules of drugs, from I – V, under the Uniform Controlled Substances Act, in descending order of the potential for abuse. [HSC §11053 et seq]
- Requires, at the beginning of the first semester or quarter of the regular school term, the governing board of each school district to provide notification to the parent or guardian of a minor pupil about various rights and responsibilities; the availability of individualized instruction; the schedule of minimum days and pupil-free staff development days; the district’s fingerprinting program if it provides one; the district’s sexual harassment policy; all existing statutory attendance options and local attendance options available in the school district; information about grades and academic credits in the event of absences; for pupils enrolled in grades 9-12, information about college admission requirements, career technical education and how to meet with school counselors to help choose courses to meet admission requirements; the availability of state funds for advanced placement fees and; authorizes the notification to also advise the parent or guardian of the importance of investing for future college or university education for their children and of considering appropriate investment options, including, but not limited to, United States savings bonds. [EDC § 48980]
- Establishes requirements for a school district, charter school, or private school that offers an athletic program to take certain actions for an athlete suspected of sustaining a concussion or head injury. Requires, on a yearly basis, a concussion and head injury information sheet to be signed and returned by the athlete and the athlete’s parent or guardian before the athlete initiates practice or competition. [EDC §49475]
This bill:
Continuing Education
- Adds to the mandatory CE coursework the Dental Board of California may prescribe as a condition of licensure renewal the risks of addiction associated with use of Schedule II drugs.
- Requires, for MBC licensees licensed after January 1, 2019, the mandatory CE course on the subjects of pain management and the treatment of terminally ill and dying patients, to also include the risks of addiction associated with the use of Schedule II drugs.
- Broadens the existing requirement on the MBC, in determining its continuing CE requirement, to give its highest priority to considering a course on pain to also require that course to include management and the risks of addiction associated with the use of Schedule II drugs.
- Requires the MBC, in addition to periodically developing and disseminating information and educational material regarding pain management techniques and procedures, to also include the risks of addiction associated with the use of Schedule II drugs in this information and educational material.
- Requires licensed osteopathic physicians to complete a course on the risks of addiction associated with the use of Schedule II drugs.
- Requires the course in pharmacology a CNM is required to complete in order to furnish controlled substances to also include the risks of addiction and neonatal abstinence syndrome associated with the use of opioids.
- Requires, for NP licensees who hold an active furnishing number and who are authorized to furnish Schedule II controlled substances, the existing mandatory CE course on Schedule II controlled substances to also include the risk of addiction associated with their use.
- Requires, for PAs who administer, provide, or issue a drug order for Schedule II controlled substances, the existing CE course on Schedule II controlled substances, to also include the risks of addiction associated with their use.
- Expands the scope of CE optometrists certified to use therapeutic pharmaceutical agents must take as part of the requirement on pain medication to also include the risk of addiction associated with the use of Schedule II drugs.
Prescribing and Dispensing Opioids
- Requires, whenever a prescription drug containing an opiate is dispensed to a patient for outpatient use, the pharmacy or practitioner dispensing the drug to prominently display on the label or container a notice that states "Caution: Opioid. Risk of overdose and addiction.”
- Requires a prescriber to discuss all of the following with a minor, the minor’s parent or guardian, or with another adult authorized to consent to the minor’s medical treatment, before directly dispensing or issuing for a minor the first prescription in a single course of treatment for a controlled substance containing an opioid:
- The risks of addiction and overdose associated with the use of opioids;
- The increased risk of opioid addiction to an individual who is suffering from both mental and substance abuse disorders;
- The danger of taking an opioid with a benzodiazepine, alcohol, or another central nervous system depressant; and,
- Any other information required by law.
- Requires the prescriber to obtain the signature of the minor, and the minor’s parent or guardian or other adult authorized to consent to the minor’s medical treatment. Requires the prescriber to include the signed consent form in the minor’s medical record.
- Requires the consent to be obtained in a form that is separate from any other document that a prescriber uses to obtain the informed consent for the treatment of a minor and to contain all of the following:
- The name and quantity of the controlled substance being prescribed for the minor and the amount of the initial dose;
- A statement indicating that a controlled substance is a drug or other substance that has been identified as having a potential for abuse;
- A statement certifying that the prescriber discussed with the minor, and with the minor’s parent or guardian or with another adult authorized to consent to the minor’s medical treatment, the topics described above, unless the exemption in 14) below applies; and,
- A space for the signature of the minor’s parent or guardian or other adult authorized to consent to the minor’s medical treatment, and a space to indicate the date that the minor’s parent or guardian or other adult authorized to consent to the minor’s medical treatment signed the form.
- Exempts prescribers from the above-described requirement in any of the following circumstances:
- If the minor’s treatment is associated with or incident to a medical emergency;
- If the minor’s treatment is associated with or incident to an emergency surgery, regardless of whether the surgery is performed on an inpatient or outpatient basis;
- If, in the prescriber’s professional judgment, fulfilling the requirement would be detrimental to the minor’s health or safety; or,
- When a minor patient is being treated in a hospital, when the patient is terminally ill, is a patient of a licensed skilled nursing facility, a licensed intermediate care facility, a licensed home health agency, or a licensed hospice, or for a terminally ill patient, when a patient is being treated for addiction or for a diagnosis of chronic intractable pain.
- Prohibits a failure to comply with the above requirements from constituting a criminal offense, but permits the prescriber to be subject to disciplinary action for unprofessional conduct under the prescriber’s respective licensing law.
Youth sports
- Requires a youth sports organization, a school district, charter school, or private school that elects to offer an athletic program to annually give the Opioid Factsheet for Patients published by the Centers for Disease Control and Prevention (CDC) to each athlete.
- Requires, if the athlete is 17 years of age or younger, the athlete’s parent or guardian to sign a document acknowledging receipt of the Opioid Factsheet for Patients, and to return that document to the school district, charter school or private school before the athlete initiates practice or competition. Permits the Opioid Factsheet for Patients to be sent and returned through an electronic medium, including, but not limited to, fax or email.
- Exempts school districts, charter schools or private schools from the requirements above for an athlete engaging in an athletic activity during the regular school day or as part of a physical education course required under existing law.
- Requires, for youth sports organization, the Opioid Factsheet for Patients-related requirements to apply to all athletes participating in the activities of a youth sports organization, irrespective of their ages. Prohibits this provision from being construed to prohibit a youth sports organization, or any other appropriate entity, from adopting and enforcing rules intended to provide a higher standard of safety for athletes than the standard established under this bill.
Legislative findings and intent
- Makes legislative findings and declarations that addiction, misuse, and overdose of prescription opioids is a public health crisis affecting both adults and children; urgent measures are needed to better inform the public of the risks associated with both the long-term and short-term use of opioids in an effort to address this problem, and both short-term and long-term prescriptions of opioids to minors fall within situations that require counseling and written consent under the Guidelines for Prescribing Controlled Substances for Pain issued by the MBC.
- States legislative intent to codify the MBC’s Guidelines for Prescribing Controlled Substances for Pain, as it relates to patient counseling, consent, and pain management agreements, and to ensure that health care providers and young athletes receive necessary education on this topic.
FISCAL EFFECT:
This bill has not been analyzed by a fiscal committee.
COMMENTS:
- Author’s statement. According to the author, this bill will not, on its own, solve this national crisis, but it will put preventative measures in place to educate the general public before being prescribed or electing to take these potentially harmful medications. Proper drug education for all patients regardless of their age or status will help empower people to make the right decision. Education is a key component in understanding the very addictive nature of Schedule II controlled substances. It is necessary to warn consumers who receive opioid prescriptions that they can be addictive and can cause drug overdoses if not used carefully. Parents should also be made aware of the dangers of their minor children receiving such prescriptions. Lastly, ensuring that all prescribers of Schedule II controlled substances have the necessary education on the risks of addiction associated with these substances will help communicate these same risks to their patients. SB 1109 is a step in the right direction, providing additional tools for patients, minors, parents, and prescribers to have more information on hand when making decisions with what prescriptions they elect to take. In the midst of the worst drug epidemic in American history, SB 1109 will prevent more lives from being lost.
- 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.
Existing law requires the Department of Justice (DOJ) to maintain the Controlled Substance Utilization Review and Evaluation System (CURES) for the electronic monitoring of the prescribing and dispensing of Schedule II - IV controlled substances by all practitioners authorized to prescribe, administer, furnish, or dispense these controlled substances. Existing law requires dispensing pharmacies and clinics to report specified information for each prescription of a Schedule II, Schedule III, or Schedule IV controlled substance to DOJ. The purpose of CURES is to assist law enforcement and regulatory agencies in controlling diversion and abuse of Schedule II, III and IV controlled substances and for statistical analysis, education and research. In addition, California law requires prescription forms for controlled substance prescriptions to be written on tamper-proof forms.
- Opioid use and substance use disorders. Nearly 22 million Americans are thought to have some kind of substance use disorder; of these, 1.9 million are addicted to prescription painkillers, and an estimated 586,000 are addicted to heroin. Since 2008, more than 115,000 Americans have died from overdoses of prescription painkillers (7,400 deaths in California over the last five years), and nearly 39,000 have died from heroin overdoses: an overall death rate of nine per 100,000 in 2014.
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%) 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% of 18- to 25- year-olds and five percent of persons age 26 or older used prescription drugs nonmedically in the past year.
Prescription opioids continue to be involved in more overdose deaths than any other drug. NIDA reports that more than 1,700 young adults died from prescription drug overdose in 2014, a four-fold increase from 1999, nearly five persons per day. According to the CDC, overdose deaths involving prescription opioids have quadrupled since 1999. CDC found that from 1999 to 2015, more than 183,000 people died in the U.S. from overdoses related to prescription opioids. The CDC notes that the most common drugs involved in prescription opioid overdose deaths are methadone, oxycodone, and hydrocodone. According to the CDC, among those who died from prescription opioid overdose between 1999 and 2014, overdose rates were highest among people aged 25 to 54, overdose rates were higher among non-Hispanic whites and American Indian or Alaskan Natives, compared to non-Hispanic blacks and Hispanics and men were more likely to die from overdose, but the mortality gap between men and women is closing.
Prescription opioid usage in the United States increased considerably from the mid-1990s to its peak in 2011. It is now declining rapidly with the largest single year change in 2017 with a decline or 12%. Decreases in prescription opioid volume have been driven by changes in clinical usage, which have been influenced by regulatory and reimbursement policies and legislation that have been increasingly restricting prescription opioid use since 2012. Opioid prescriptions declined by 10.2% per month from January to December 2017.
- 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. AB 2198 (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.
This measure states Legislative intent to codify MBC’s guidelines.
- Double referral. This bill was heard in the Senate Business and Professions Committee on April 16, 2018 and passed with an 8-0 vote.
- Related legislation. SB 641 (Lara of 2017) prohibits the DOJ from releasing data in CURES to a law enforcement agency except pursuant to a warrant. SB 641 is in the Assembly Public Safety Committee.
SB 1229 (Stone) requires pharmacists dispensing any opioid medication to a patient or the patient’s agent for the first time to provide oral consultation before dispensing the medication and prohibits a pharmacist from dispensing the medication if the patient or the patient’s agent declines the consultation. SB 1299 is set for hearing on April 23, 2018 in the Senate Business, Professions, and Economic Development Committee.
AB 1998 (Rodriguez) requires every health care practitioner authorized to prescribe Schedule II and III opioids to adopt a safe prescribing protocol with the goal of reducing the misuse of opioids. AB 1998 passed the Assembly Health Committee on a 10-1 vote on April 17, 2018.
AB 2486 (McCarty) would require a contract entered into by the Department of Health Care Services and a drug manufacturer under the Medi-Cal program that includes a prescription drug that contains an active opioid ingredient, to provide for a state rebate, in addition to other existing rebates, which would be proportional to the utilization of prescription drugs containing active opioid ingredients pursuant to a specified formula. AB 2486 is scheduled for hearing in the Assembly Health Committee on April 24, 2018.
AB 2487 (McCarty) would require physicians to complete a mandatory CE course on the treatment and management of opiate-dependent patients which includes eight hours of training in buprenorphine treatment of opioid use disorder within six months of first receiving federal Drug Enforcement Agency registration. AB 2487 passed the Assembly Business and Professions Committee on a 9-2 vote on April 10, 2018.
AB 2741 (Burke) would limit all opioid prescriptions for minors to a maximum of five days, with exceptions, and require a prescriber to discuss risks related to opioid medication with the minor and the minor’s parent or guardian and obtain written consent prior to writing the prescription. AB 2741 passed the Assembly Health Committee on a 12-0 vote on April 17, 2018.
AB 2760 (Wood) would require certain prescriptions for opioids to also include a co-prescription for naloxone or another opioid antagonist. AB 2760 passed the Assembly Health Committee on a 15-0 vote on April 17, 2018.
AB 2859 (Caballero) requires a pharmacy that dispenses Schedule II, III, or IV controlled substances to display safe storage products, as defined, for sale within the pharmacy department. AB 2859 passed the Assembly Business and Professions Committee on a 10-0 vote on April 10, 2018.
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. AB 2741 passed the Assembly Health Committee on a 12-0 vote on April 17, 2018.
- Prior legislation. SB 419 (Portantino of 2017) contained similar language to provisions of this bill related to prescriber notification of and discussions with minor patients about opioid use. SB 419 was amended to deal with a different subject.
AB 40 (Santiago, Chapter 607, Statutes of 2017) authorized an entity that operates a health information technology system to establish integration with, and submit queries to CURES on either a user-initiated basis or automated basis, according to certain requirements.
AB 182 (Waldron of 2017) was substantially similar to the AB 2174 (Waldron) above. AB 182 was held on the Senate Appropriations Committee suspense file.
AB 715 (Wood of 2017) would have required DPH to convene a workgroup to review existing prescription guidelines and develop a recommended statewide guideline addressing best practices for prescribing opioid pain relievers. AB 715 was vetoed by the Governor, who referenced the CDC and MBC guidelines in stating the bill was unnecessary.
SB 482 (Lara, Chapter 708, Statutes of 2016) required a health care provider authorized to prescribe, order, administer, or furnish a controlled substance to consult the Controlled Substances Utilization Review and Evaluation System (CURES) prior to prescribing a Schedule II, III or IV drug to a patient for the first and at least once every four months thereafter if the substance remains part of the patient’s treatment. Provides exemptions from the responsibility to consult the CURES system, including while a patient is admitted to a certain type of facility, if a patient receives a non-refillable five-day supply or less prescription in conjunction with a surgery, and in the event of a technological failure or inability to access the CURES system.
AB 623 (Wood of 2015) would have prohibited a health plan or health insurer from requiring the use of opioid drug products that have no abuse-deterrent properties in order to access abuse-deterrent opioid drug products; would have required pharmacists to provide a patient receiving an opioid drug product information about proper storage and disposal of the drug; and, would have mandated that a plan and insurer may not prevent a provider from prescribing a less than 30-day supply of opioids analgesic drugs and to provide coverage, if otherwise covered, for the less than 30-day prescription. AB 623 was held on the Assembly Appropriations Committee suspense file.
SB 500 (Lieu of 2014) would have required the MBC to update prescriber standards for controlled substances once every five years and add the American Cancer Society, specialists in workers compensation, specialists in pharmacology and specialists in addiction medicine to the entities the MBC may consult with in developing the standards. SB 500 was amended to deal with another subject.
SB 1258 (DeSaulnier of 2014) would have made several changes to the ways that controlled substances are prescribed and tracked in the CURES and would have required medical providers to use electronic prescribing systems, would have required additional reporting of controlled substance prescribing, and would have placed additional restrictions on the prescribing of controlled substances. SB 1258 was held on the Senate Appropriations Committee suspense file.
AB 831 (Bloom of 2013) would have required the California Health and Human Services Agency (CHHSA) to convene a temporary working group to develop a state plan to reduce the rate of fatal drug overdoses and appropriated $500,000 from the General Fund to CHHSA to provide grants to local agencies to implement drug overdose prevention and response programs. AB 831 was held on the Assembly Appropriations Committee suspense file.
- Support. This bill is sponsored by the Office of the San Diego County District Attorney (SD DA), which states this bill focuses on the duty of medical professionals and athletic school-based programs to educate and inform minors and their parents about the risks of opiate-based pain medications. The SD DA argues the nation is in the midst of a serious opioid addiction epidemic driven largely by an explosion of prescribed pain medications, and has resulted in a dramatic rise in addiction and deaths from overdoses that are quadruple what they were in 1999. The SD DA argues this bill is a multi-faceted approach to opioid overuse and addiction through a warning label on prescription bottles, an educational form for students and athletes and their parents about opioid misuse and addiction, requiring physicians to discuss the dangers of opioid misuse and addiction with minor patients and their parents, and by requiring the inclusion of the risks of opioid overuse and addiction in existing CE courses.
- Opposition. The California Pharmacists Association (CPhA) writes in opposition that requiring additional information to be included on prescription labels. CPhA points, in trying to make sure labeling requirements are “patient-centered,” California has multiple labeling requirements including directions for use, name of the pharmacy, prescription number, drug strength, pharmacy name and address, quantity of drug dispensed, expiration date of drugs, condition or purpose for which the drug was dispensed, and the physical description of the dispensed medication, including its color, shape and any identification code that appears on the capsules. CPhA argues the existing label is too crowded with information, and there will be significant difficulty finding space for this additional requirement.
- Oppose unless amended. The California Medical Association (CMA) writes this bill is unnecessary and places the government between a patient, and their parent/guardian, and his or her physician. CMA states this bill makes positive changes in its physician education requirement, by ensuring that the MBC add relevant curriculum on addiction to the current pain management CE requirement for physicians, and by requiring a warning on opioid prescription labels and by ensuring that minors who play recreational sports are aware of the dangers of opioid pain medications. However, CMA objects to the requirement that a physician, prior to prescribing an opioid, inform the patient of all the risks of opioid abuse. CMA states physicians must already inform patients of all relevant information regarding their course of treatment, which is patient-specific requirement, and the codification of generic informed consent language is unnecessary. CMA argues this provision attempts to legislate the practice of medicine with regard to informed consent, and asks that this provision be removed from this bill.
SUPPORT AND OPPOSITION:
Support: Office of the San Diego County District Attorney (sponsor)
California District Attorneys Association
McKesson Corporation
Oppose: California Medical Association
California Pharmacists Association
-- END --
SENATE COMMITTEE ON
BUSINESS, PROFESSIONS AND ECONOMIC DEVELOPMENT
Senator Jerry Hill, Chair
2017 - 2018 Regular
Bill No: Hearing Date: April 16, 2018
Author: | |||
Version: | April 4, 2018 | ||
Urgency: | No | Fiscal: | Yes |
Consultant: | Sarah Mason | ||
Subject:
SUMMARY: 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 on all Schedule II controlled substance vials or prescription bottles about the risks of addiction and overdose when using opioids; 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 prior to prescribing minors controlled substances for the first time, unless the treatment is in an emergency or emergency surgery or the minor is undergoing addiction treatment or treatment for intractable pain.
Existing law:
- Establishes various practice acts in the Business and Professions Code (BPC) governed by various boards within the Department of Consumer Affairs (DCA) which provide for the licensing and regulation of health care professionals including: physicians and surgeons (under the Medical Practice Act), dentists (under the Dental Practice Act), veterinarians (under the Veterinary Medicine Practice Act); registered nurses, nurse practitioners (NP) and certified nurse-midwives (CNM) (under the Nursing Practice Act); physician assistants (PA) (under the Physician Assistant Practice Act); osteopathic physicians and surgeons (under the Osteopathic Medical Practice Act); naturopathic doctors (ND) (under the Naturopathic Doctors Act); optometrists (under the Optometry Practice Act); doctors of podiatric medicine (under the Podiatric Act) and; pharmacies, pharmacists and wholesalers of dangerous drugs or devices (under the Pharmacy Law).
(Business and Professions Code (BPC) §§ 500 et seq.) - Defines “dispense” as the furnishing of drugs or devices upon a prescription from a physician, dentist, optometrist, podiatrist, veterinarian, or ND or upon an order to furnish drugs or transmit a prescription from a CNM, NP, PA, ND, or pharmacist acting within the scope of his or her practice. Dispense also means and refers to the furnishing of drugs or devices directly to a patient by a physician, dentist, optometrist, podiatrist, or veterinarian, or by a CNM, NP, ND, PA or pharmacist acting within the scope of his or her practice. (BPC § 4024)
- Requires that each prescription dispensed by a pharmacist must be in a container complying with state and federal law and correctly labeled including certain information and requires the Board of Pharmacy (BOP) to promulgate regulations for a standardized, patient-centered, prescription drug label on all prescription medication dispensed in the state. (BPC §§ 4076 and 4076.5 (a))
- Establishes continuing education (CE) and continuing medical education (CME) requirements for health care providers, including, but not limited to:
- Dentists must complete not less than 50 hours of approved CE during the two-year period immediately preceding the expiration of their license. (BPC § 1645)
- Physicians and surgeons licensed by the Medical Board of California (MBC) must complete a one-time CME course of 12 hours in the subjects of pain management and the treatment of terminally ill and dying patients, among other requirements and other considerations MBC must make for required CME established through regulations. (BPC § 2190.5)
- Osteopathic physicians and surgeons licensed by the Osteopathic Medical Board of California (OMBC) must complete a minimum of 100 hours of American Osteopathic Association continuing education hours during each two-year cycle. (BPC § 2454.5)
- CNMs certified by the Board of Registered Nursing (BRN) who hold an active furnishing number, who are currently authorized through standardized procedures or protocols to furnish Schedule II controlled substances, and who are registered with the United States Drug Enforcement Administration (DEA) must provide documentation of continuing education specific to the use of Schedule II controlled substances in settings other than a hospital based on standards developed by the BRN. (BPC § 2746.51)
- NPs certified by the BRN who hold an active furnishing number, who are authorized through standardized procedures or protocols to furnish Schedule II controlled substances, and who are registered with DEA must complete a course including Schedule II controlled substances based on standards developed by BRN. (BPC § 2836.1)
- Optometrists certified to use therapeutic pharmaceutical agents must complete a total of 50 hours of CE every two years in order to renew his or her certificate 35 of which must be on the diagnosis, treatment, and management of ocular disease, including pain medication. Requires the Board of Optometry to encourage every optometrist to take a course or courses in pharmacology and pharmaceuticals as part of his or her CE. (BPC § 3059)
- PAs licensed by the Physician Assistant Board (PAB) must complete no more than 50 hours of CE every two years. The PAB shall, as it deems appropriate, accept certification by the National Commission on Certification of Physician Assistants (NCCPA), or another qualified certifying body, as determined by the PAB, as evidence of compliance with CE requirements. (BPC § 3524.5)
- Prohibits any person other than a physician, dentist, podiatrist, veterinarian, ND (according to certain supervision and protocol requirements), pharmacist (according to certain authorizations, policies and procedures), 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), 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 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)
- Defines a controlled substance as any substance listed in Uniform Controlled Substances Act. (BPC § 4021)
- Establishes schedules of drugs, from I – V, under the Uniform Controlled Substances Act, in descending order of the potential for abuse. (HSC §§ 11053 et seq)
- Specifies that a prescription for a controlled substance shall only be issued for a legitimate medical purpose and establishes responsibility for proper prescribing on the prescribing practitioner. States that a violation shall result in imprisonment for up to one year or a fine of up to $20,000, or both. (HSC § 11153)
- Establishes the Controlled Substances Utilization Review and Evaluation System (CURES) for electronic monitoring of Schedule II, III and IV controlled substance prescriptions. CURES provides for the electronic transmission of Schedule II, III and IV controlled substance prescription information to the Department of Justice (DOJ) at the time prescriptions are dispensed. (HSC § 11165)
- States that the purpose of CURES is to assist law enforcement and regulatory agencies in controlling diversion and abuse of Schedule II, III and IV controlled substances and for statistical analysis, education and research. (HSC § 11165 (a))
- Requires, at the beginning of the first semester or quarter of the regular school term, the governing board of each school district to provide notification to the parent or guardian of a minor pupil about various rights and responsibilities; the availability of individualized instruction; the schedule of minimum days and pupil-free staff development days; the district’s fingerprinting program if it provides one; the district’s sexual harassment policy; all existing statutory attendance options and local attendance options available in the school district; information about grades and academic credits in the event of absences; for pupils enrolled in grades 9-12, information about college admission requirements, career technical education and how to meet with school counselors to help choose courses to meet admission requirements; the availability of state funds for advanced placement fees and; authorizes the notification to also advise the parent or guardian of the importance of investing for future college or university education for their children and of considering appropriate investment options, including, but not limited to, United States savings bonds. (Education Code (EDC) § 48980)
- Establishes requirements for a school district, charter school, or private school that offers an athletic program to take certain actions for an athlete suspected of sustaining a concussion or head injury. Requires, on a yearly basis, a concussion and head injury information sheet to be signed and returned by the athlete and the athlete’s parent or guardian before the athlete initiates practice or competition. (EDC § 49475)
This bill:
- Makes findings and declarations that addiction, misuse, and overdose of prescription opioids is a public health crisis affecting both adults and children; that urgent measures are needed to better inform the public of the risks associated with both the long-term and short-term use of opioids in an effort to address this problem; that both short-term and long-term prescriptions of opioids to minors fall within situations that require counseling and written consent under the Guidelines for Prescribing Controlled Substances for Pain issued by the MBC.
- States the intent of the Legislature to codify the MBC’s Guidelines for Prescribing Controlled Substances for Pain, as it relates to patient counseling, consent, and pain management agreements, and to ensure that health care providers and young athletes receive necessary education on this topic.
- For MBC licensees licensed after January 1, 2019, adds to course requirements the risks of addiction associated with the use of Schedule II drugs to the current pain management CME requirement. Adds the risks of addiction associated with the use of Schedule II drugs to the list of subjects MBC shall consider in determining its CE requirements. Adds the risks of addiction associated with the use of Schedule II drugs to the information and educational materials regarding pain management techniques MBC is required to develop and disseminate.
- Requires the course in pharmacology a CNM is required to complete in order to furnish controlled substances to include the risks of addiction and neonatal abstinence syndrome associated with the use of opioids.
- Adds the risks of addiction associated with the use of Schedule II drugs to the required CE course on Schedule II drugs NPs must complete.
- Requires the course PAs must complete in order to prescribe Schedule II drugs to include the risks of addiction associated with the use of Schedule II drugs
- Requires the BOP to adopt an emergency regulation that requires a warning label on all Schedule II controlled substance vials or prescription bottles that addresses the risks of addiction and overdose when using opioids.
- Requires a prescriber, prior to directly dispensing or issuing a minor the first prescription in a single course of treatment for a controlled substance containing an opioid, to discuss all of the following with the minor, with the minor’s parent or guardian, or with another adult authorized to consent to the minor’s medical treatment, except when the minor is being treated for addiction, chronic intractable pain or in an emergency situation, or if the prescriber feels it would be detrimental to the minor’s health or safety:
- The risks of addiction and overdose associated with the use of opioids.
- The increased risk of addiction to an opioid to an individual who is suffering from both mental and substance abuse disorders.
- The danger of taking an opioid with a benzodiazepine, alcohol, or another central nervous system depressant.
- Any other information required by law.
- Requires the prescriber to obtain the signature of the minor and the minor’s parent or guardian or other adult authorized to consent to the minor’s medical treatment on a consent form to be retained in the minor’s medical record that includes all of the following:
- The name and quantity of the controlled substance being prescribed for the minor and the amount of the initial dose.
- A statement indicating that a controlled substance is a drug or other substance that has been identified as having a potential for abuse.
- A statement certifying that the prescriber discussed the information in Item # 8) above.
- A space for the signature of the minor’s parent or guardian or other adult authorized to consent to the minor’s medical treatment, and a space to indicate the date that the minor’s parent or guardian or other adult authorized to consent to the minor’s medical treatment signed the form.
- Specifies that failure to comply with the notification and consent provisions above shall not constitute a criminal offense but may subject the prescriber to disciplinary action for unprofessional conduct under the prescriber’s respective licensing act.
- Requires a school district, charter school, or private school offering an athletic program, other than as part of the regular school day or as part of physical education, to annually give an information sheet about the risk of opioid addiction to each athlete, which may be sent and returned electronically. Requires the information sheet to be signed and returned by the athlete before the athlete initiates practice or competition and also signed by the athlete’s parent or guardian before the athlete initiates practice or competition if they are under 17.
- Requires a youth sports organization that elects to offer an athletic program to comply with the requirements outlined in Item # 33) above.
FISCAL EFFECT:
Unknown. This bill is keyed “fiscal” by Legislative Counsel.
COMMENTS:
- Purpose. The Office of the San Diego County District Attorney is the Sponsor of this bill. According to the Author, the “United States’ opioid epidemic has become a very serious public health problem. Drug overdose deaths are the leading cause of injury death in the United States. Additionally, the Center for Disease Control and Prevention recently reported that 91 people die every day in the United States from an opioid overdose. In late October 2017, the President declared the opioid crisis a national public health emergency.”
The Author notes that “not everyone who takes opioids becomes addicted, but there is a very high risk for becoming drug dependent when using opioids. The amount of time it might take for one to become addicted to the drug can vary from person to person. Addiction is a disease that results when the drug has made changes to the brain; this can be on one who is using the medication properly or for someone who is misusing the drug. There are many impacts of the opioid epidemic in California; the death toll alone is staggering: 1,925 deaths in 2016. Sadly, there were even 3,630 infants born in California addicted to drugs in 2015. Even more astonishing is the fact that California spends 19.5% of its budget on addiction, substance use and abuse.”
The Author cites a San Diego-Union Tribune article which noted that in late 2016, San Diego County saw 239 deaths that were specifically caused by opioids (12 percent of the 1,925 deaths in California alone).
According to the Author, “it is imperative that California act to curb future deaths and prevent addiction. SB 1109 is needed to continue educating everyone who comes in contact with these necessary and yet potentially harmful opioid prescriptions. Ensuring patients, minors, parents, and prescribers have the necessary information before taking these medications will help prevent future addictions and overdoses with the drugs.”
- 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).
- 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.
- Prescription Drug Deaths. Prescription opioids continue to be involved in more overdose deaths than any other drug. NIDA reports that more than 1,700 young adults died from prescription drug overdose in 2014, a 4-fold increase from 1999, nearly 5 persons per day. According to the Centers for Disease Control (CDC), overdose deaths involving prescription opioids have quadrupled since 1999. CDC found that from 1999 to 2015, more than 183,000 people died in the U.S. from overdoses related to prescription opioids. CDC notes that the most common drugs involved in prescription opioid overdose deaths are methadone, oxycodone and hydrocodone. According to the CDC, among those who died from prescription opioid overdose between 1999 and 2014, overdose rates were highest among people aged 25 to 54, overdose rates were higher among non-Hispanic whites and American Indian or Alaskan Natives, compared to non-Hispanic blacks and Hispanics and men were more likely to die from overdose, but the mortality gap between men and women is closing.
- 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.
This measure states Legislative intent to codify MBC’s guidelines.
- Prescription Labels in California. In response to concerns about medication errors, SCR 49 (Speier, Resolution Chapter 123, Statutes of 2005) established the Medication Errors Panel (Panel) which published a report in March 2007 entitled, "Prescription for Improving Patient Safety: Addressing Medication Errors." SB 472, The California Patient Medication Safety Act, (Corbett, Chapter 470, Statutes 2007) was pursued after the Panel’s report and sought to deal with the lack of uniformity in prescription drug labels throughout the state which can result in confusion and potential medication errors. Much of the conversation during the SB 472 debate focused on the fact that individual pharmacies design and format their own labels, resulting in a lack of standards across all pharmacies which adversely affects medication users who are elderly, suffer from poor vision, have difficulty reading and understanding instructions on labels or have limited English proficiency.
The bill required the BOP to promulgate regulations on or before January 1, 2011, that require a standardized, patient-centered, prescription drug label on all prescription medicine dispensed to patients. California became the first state to require redesigned prescription container labels to emphasize information most important to consumers, offering an element of safety and consistency since prescription labels are the key source of patients’ reference for information when taking medications in their homes. BOP approved a regulation per the requirements set forth in SB 472 after engaging in a lengthy process. The regulation outlined that certain items (patient name, drug name and strength, directions for use, purpose or condition if entered onto the prescription or otherwise known to the pharmacy and the patient requests it to be included on the label) must be clustered into one area of the label that comprises at least 50 percent of the label, using at least 10-point font using sans serif typeface. In April 2014, BOP initiated a new rulemaking request to change the font size to a minimum of 12-point, rather than 10-point. Additionally, the new rulemaking request required only four items to be clustered into one area of the label that comprises at least 50 percent of the label. BOP continues to discuss the components of the standardized label at its Public Education subcommittee meetings.
This bill requires BOP to adopt an emergency regulation that requires a warning label on all Schedule II controlled substance vials or prescription bottles that addresses the risks of addiction and overdose when using opioids.
- 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 1229 (Stone) requires pharmacist dispensing any opioid medication to a patient or the patient’s agent for the first time to provide oral consultation before dispensing the medication and prohibits a pharmacist from dispensing the medication if the patient or the patient’s agent declines the consultation. (Status: This bill is also pending in this committee.)
AB 1998 (Rodriguez) prohibits a prescriber from prescribing certain opioids in an amount greater that the patient needs for a three-day period unless the prescriber believes, in his or her professional judgment, that a larger prescription is needed to treat a medical condition or that a larger prescription is necessary for the treatment of chronic pain. (Status: The bill is pending in the Assembly 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 Assembly Committee on Health.)
AB 2487 (McCarty) would add opioid addiction training as a CME requirement for certain physicians to increase the availability of buprenorphine treatment. (Status: The bill is pending in the Assembly Committee on Appropriations.)
AB 2741 (Burke) would limit all opioid prescriptions for minors to a maximum of 5 days, with exceptions, and require a prescriber to discuss risks related to opioid medication with the minor and the minor’s parent or guardian and obtain written consent prior to writing the prescription. (Status: The bill is pending in the Assembly Committee on Health.)
AB 2760 (Wood) would require certain prescriptions for opioids to also include a co-prescription for naloxone. (Status: The bill is pending in the Assembly Committee on Health.)
AB 2859 (Caballero) requires a community pharmacy that dispenses Schedule II, III, or IV controlled substances to display safe storage products, as defined, for sale within the pharmacy department. (Status: The bill is pending in the Assembly Committee on Appropriations.)
AB 2741 (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.)
- Prior Related Legislation. SB 419 (Portantino) contained similar language to provisions of this bill related to prescriber notification of and discussions with minor patients about opioid use when it was heard in this committee in 2017. (Status: The measure was amended to deal with a different subject.)
AB 40 (Santiago, Chapter 607, Statutes of 2017) authorized an entity that operates a health information technology system to establish an integration with, and submit queries to CURES on either a user-initiated basis or automated basis, according to certain requirements.
AB 182 (Waldron) of 2017 was substantially similar to the Author’s AB 2741 above. (Status: The measure was held under submission in the Senate Committee on Appropriations.)
AB 715 (Wood) of 2017 would have required DPH to convene a workgroup to review existing prescription guidelines and develop a recommended statewide guideline addressing best practices for prescribing opioid pain relievers. (Status: The bill was vetoed by the Governor who referenced the CDC and MBC guidelines in stating the bill was unnecessary.)
SB 641 (Lara) of 2016 would have prohibited the DOJ from releasing data in CURES to a law enforcement agency except pursuant to a warrant. (Status: The measure did not move from the Assembly Committee on Public Safety.)
SB 482 (Lara, Chapter 708, Statutes of 2016) required a health care provider authorized to prescribe, order, administer, or furnish a controlled substance to consult the Controlled Substances Utilization Review and Evaluation System (CURES) prior to prescribing a Schedule II, III or IV drug to a patient for the first and at least once every four months thereafter if the substance remains part of the patient’s treatment. The bill provided exemptions from the responsibility to consult the CURES system, including while a patient is admitted to a certain type of facility, if a patient receives a non-refillable five-day supply or less prescription in conjunction with a surgery, and in the event of a technological failure or inability to access the CURES system.
AB 623 (Wood) of 2015 would have prohibited a health care service plan or health insurer from requiring the use of opioid drug products that have no abuse-deterrent properties in order to access abuse-deterrent opioid drug products; would have required pharmacists to provide a patient receiving an opioid drug product information about proper storage and disposal of the drug; and, would have mandated that a plan and insurer may not prevent a provider from prescribing a less than 30-day supply of opioids analgesic drugs and to provide coverage, if otherwise covered, for the less than 30-day prescription. (Status: The bill was held under submission in the Assembly Committee on Appropriations.)
SB 500 (Lieu) of 2014 would have required the MBC to update prescriber standards for controlled substances once every five years and add the American Cancer Society, specialists in workers compensation, specialists in pharmacology and specialists in addiction medicine to the entities the MBC may consult with in developing the standards. (Status: The bill was amended to deal with a different subject.)
SB 1258 (DeSaulnier) of 2014 would have made several changes to the ways that controlled substances are prescribed and tracked in the CURES and would have required medical providers to use electronic prescribing systems, would have required additional reporting of controlled substance prescribing, and would have placed additional restrictions on the prescribing of controlled substances.
(Status: The bill was held in the Senate Committee on Appropriations.)
AB 831 (Bloom) of 2013 would have required the California Health and Human Services Agency (CHHSA) to convene a temporary working group to develop a state plan to reduce the rate of fatal drug overdoses and appropriated $500,000 from the General Fund to CHHSA to provide grants to local agencies to implement drug overdose prevention and response programs. (Status: The bill was held under submission in the Assembly Committee on Appropriations.)
- Arguments in Support. The Office of the San Diego County District Attorney (Office) writes that this bill brings common sense solutions that protect consumers by telling them the truth about the real risks of addiction and overdose from prescription opiates. The Office also adds that this bill focuses on the duty of medical professionals and athletic school based programs to educate and inform minors and their parents about the risks of opiate based pain medications.
- Arguments in Opposition. The California Pharmacists Association (CPhA) writes that while the organization appreciates the Author’s desire to address the opioid abuse epidemic, requiring additional information to be included in prescription labels may have the opposite effect. CPhA notes that California has done a great deal of work to ensure prescription labeling requirements are patient-centered and that in addition to California’s requirements, the FDA requires patient package inserts (PPI), medication guides and instructions for use to be included with many prescription medicines. According to CPhA, the guidelines address issues that are specific to particular drugs and drug classes and contain FDA-approved information that can help patients use the medicine safety and effectively while trying to avoid serious adverse events. CPhA specifically cites the FDA’s PPI for oxycodone hydrochloride which states that “a long-acting (extended-release) opioid pain medicine that can put you at risk for overdose and death. Even if you take your dose correctly as prescribed you are at risk for opioid addiction, abuse, and misuse that can lead to death.” CPhA notes that pharmacists use their professional judgment and provide counseling to patients around the addictive nature of opioid medications.
- Proposed Author’s Amendments. In response to concerns raised about promulgating regulations to update California’s patient-centered label standard and in order to provide flexibility to dispensers, the Author has proposed amendments to update the Pharmacy Law and requirements for the label.
Specifically, on page 16, replace the current Section 8 (in line 21) with the following:
SEC. 8. Section 4079 is added to the Business and Professions
Code, to read:
4079. The board shall adopt an emergency regulation that
requires a warning label on all Schedule II controlled substance
vials or prescription bottles that addresses the risks of addiction
and overdose when using opioids.
SEC.8. Section 4076.7 is added to the Business and Professions Code, to read:
4076.7. In addition to the requirements of Sections 4076 and 4076.5, whenever a prescription drug containing an opiate is dispensed to a patient for outpatient use, the pharmacy or practitioner dispensing the drug must prominently display on the label or container a notice that states "Caution: Opioid. Risk of overdose and addiction.”
- Drafting Questions and Suggested Committee Amendments.
Why does this bill impose additional CE and CME requirements for only certain health care providers authorized to prescribe? It is unclear why health care providers like osteopathic physicians and surgeons, who are subject to CME requirements and have the exact same privileges as MBC licensed physicians, including prescribing, are not included in the list of prescribers the bill requires enhanced CE and CME for. To ensure that all prescribers receive the intended additional CE or CME course focus, the bill should be amended to include the other health care providers subject to CE and CME authorized to prescribe or furnish controlled substances.
Should schools and youth sports organizations obtain information about the risk of opioid addiction to include in a fact sheet from a legitimate source, rather than be required to generate this information? While this bill requires information about opioid addiction risks to be provided to school athletes and youth sports participants, it does not specify where the information for a fact sheet should come from, implying that potentially schools and youth sports organizations would have to generate this information on their own. To ensure consistency in the information provided young people in this state, the bill should be amended to require schools and youth sports organizations to obtain a fact sheet from an entity like the CDC, which has readily available information about the risks of opioid addiction.
- Policy Question: Why should only young athletes receive information about the risks of opioid addiction? Opioid misuse by and addiction risks for young people do not appear to be limited to athletes. It is unclear why only young athletes should receive an information sheet containing facts about the dangers and risks of opioids. Particularly since school districts are already required to provide information to the parents and guardians of all pupils, the Author may wish to consider adding an opioid risk fact sheet to the information required by EDC § 48980. The Author may wish to include county offices of education to the list of entities required to provide information, as they also provide pupil instruction services.
NOTE:
Double-referral to Senate Committee on Health, second.
SUPPORT AND OPPOSITION:
Support:
Office of the San Diego County District Attorney
Opposition:
California Pharmacists Association
-- END --
Discussed in Hearing
2MIN
Assembly Floor
9MIN
Assembly Standing Committee on Business and Professions
2MIN
Senate Floor
4MIN
Senate Standing Committee on Appropriations
19MIN
Senate Standing Committee on Health
24MIN
Senate Standing Committee on Business, Professions and Economic Development
Bill Author
Bill Co-Author(s):
