AB 1130: Substance use disorder.
- Session Year: 2023-2024
- House: Assembly
- Latest Version Date: 2023-06-29
Current Status:
Passed
(2023-06-29: Chaptered by Secretary of State - Chapter 21, Statutes of 2023.)
Introduced
In Committee
First Chamber
In Committee
Second Chamber
Enacted
Existing law, the California Uniform Controlled Substances Act, regulates the distribution and use of controlled substances, as defined. Under the act, the State Department of Health Care Services is responsible for the administration of prevention, treatment, and recovery services for alcohol and drug abuse. Existing law, the Medical Practice Act, provides for the licensing and regulation of physicians and surgeons by the Medical Board of California. Existing law authorizes a physician and surgeon to prescribe, dispense, or administer prescription drugs, including prescription controlled substances, to an addict under their treatment for a purpose other than maintenance on, or detoxification from, prescription drugs or controlled substances and under specified conditions to an addict for purposes of maintenance on, or detoxification from, prescription drugs or controlled substances.
This bill would revise and recast these provisions, among others, to delete the reference to an addict and instead replace it with the term a person with substance use disorder, among other technical nonsubstantive changes.
Existing law, the California Uniform Controlled Substances Act, regulates the distribution and use of controlled substances, as defined. Under the act, the State Department of Health Care Services is responsible for the administration of prevention, treatment, and recovery services for alcohol and drug abuse. Existing law, the Medical Practice Act, provides for the licensing and regulation of physicians and surgeons by the Medical Board of California. Existing law authorizes a physician and surgeon to prescribe, dispense, or administer prescription drugs, including prescription controlled substances, to an addict under their treatment for a purpose other than maintenance on, or detoxification from, prescription drugs or controlled substances and under specified conditions to an addict for purposes of maintenance on, or detoxification from, prescription drugs or controlled substances.
This bill would revise and recast these provisions, among others, to delete the reference to an addict and instead replace it with the term a person with substance use disorder, among other technical nonsubstantive changes.
Existing law, the California Uniform Controlled Substances Act, regulates the distribution and use of controlled substances, as defined. Under the act, the State Department of Health Care Services is responsible for the administration of prevention, treatment, and recovery services for alcohol and drug abuse. Existing law, the Medical Practice Act, provides for the licensing and regulation of physicians and surgeons by the Medical Board of California. Existing law authorizes a physician and surgeon to prescribe, dispense, or administer prescription drugs, including prescription controlled substances, to an addict under their treatment for a purpose other than maintenance on, or detoxification from, prescription drugs or controlled substances and under specified conditions to an addict for purposes of maintenance on, or detoxification from, prescription drugs or controlled substances.
This bill would revise and recast these provisions, among others, to delete the reference to an addict and instead replace it with the term a person with substance use disorder, among other technical nonsubstantive changes.
(a)A physician and surgeon may prescribe, dispense, or administer prescription drugs, including prescription controlled substances, to a person with substance use disorder under the physician and surgeons treatment for a purpose other than maintenance on, or detoxification from, prescription drugs or controlled substances.
(b)A physician and surgeon may prescribe, dispense, or administer prescription drugs or prescription controlled substances to a person with substance use disorder for purposes of maintenance on, or detoxification from, prescription drugs or controlled substances only as set forth in subdivision (c) or in Sections 11215, 11217, 11217.5, 11218, 11219, and 11220 of the Health and Safety Code. Nothing in this subdivision shall authorize a physician and surgeon to prescribe, dispense, or administer dangerous drugs or controlled substances to a person they know or reasonably believe is using or will use the drugs or substances for a nonmedical purpose.
(c)Notwithstanding subdivision (a), prescription drugs or controlled substances may also be administered or applied by a physician and surgeon, or by a registered nurse acting under their instruction and supervision, under the following circumstances:
(1)Emergency treatment of a patient whose addiction is complicated by the presence of incurable disease, acute accident, illness, or injury, or the infirmities attendant upon age.
(2)Treatment of persons with substance use disorder in state-licensed institutions where the patient is kept under restraint and control, or in city or county jails or state prisons.
(3)Treatment of persons with substance use disorder as provided for by Section 11217.5 of the Health and Safety Code.
(d)(1)For purposes of this section and Section 2241.5, person with substance use disorder means a person whose actions are characterized by craving in combination with one or more of the following:
(A)Impaired control over drug use.
(B)Compulsive use.
(C)Continued use despite harm.
(2)Notwithstanding paragraph (1), a person whose drug-seeking behavior is primarily due to the inadequate control of pain is not a person with substance use disorder within the meaning of this section or Section 2241.5.
SEC. 2.Section 2241.5 of the Business and Professions Code is amended to read:2241.5.(a)A physician and surgeon may prescribe for, or dispense or administer to, a person under their treatment for a medical condition dangerous drugs or prescription controlled substances for the treatment of pain or a condition causing pain, including, but not limited to, intractable pain.
(b)No physician and surgeon shall be subject to disciplinary action for prescribing, dispensing, or administering dangerous drugs or prescription controlled substances in accordance with this section.
(c)This section shall not affect the power of the board to take any action described in Section 2227 against a physician and surgeon who does any of the following:
(1)Violates subdivision (b), (c), or (d) of Section 2234 regarding gross negligence, repeated negligent acts, or incompetence.
(2)Violates Section 2241 regarding treatment of a person with substance use disorder.
(3)Violates Section 2242 or 2525.3 regarding performing an appropriate prior examination and the existence of a medical indication for prescribing, dispensing, or furnishing dangerous drugs or recommending medical cannabis.
(4)Violates Section 2242.1 regarding prescribing on the Internet.
(5)Fails to keep complete and accurate records of purchases and disposals of substances listed in the California Uniform Controlled Substances Act (Division 10 (commencing with Section 11000) of the Health and Safety Code) or controlled substances scheduled in the federal Comprehensive Drug Abuse Prevention and Control Act of 1970 (21 U.S.C. Sec. 801 et seq.), or pursuant to the federal Comprehensive Drug Abuse Prevention and Control Act of 1970. A physician and surgeon shall keep records of their purchases and disposals of these controlled substances or dangerous drugs, including the date of purchase, the date and records of the sale or disposal of the drugs by the physician and surgeon, the name and address of the person receiving the drugs, and the reason for the disposal or the dispensing of the drugs to the person, and shall otherwise comply with all state recordkeeping requirements for controlled substances.
(6)Writes false or fictitious prescriptions for controlled substances listed in the California Uniform Controlled Substances Act or scheduled in the federal Comprehensive Drug Abuse Prevention and Control Act of 1970.
(7)Prescribes, administers, or dispenses in violation of this chapter, or in violation of Chapter 4 (commencing with Section 11150) or Chapter 5 (commencing with Section 11210) of Division 10 of the Health and Safety Code.
(d)A physician and surgeon shall exercise reasonable care in determining whether a particular patient or condition, or the complexity of a patients treatment, including, but not limited to, a current or recent pattern of drug abuse, requires consultation with, or referral to, a more qualified specialist.
(e)Nothing in this section shall prohibit the governing body of a hospital from taking disciplinary actions against a physician and surgeon pursuant to Sections 809.05, 809.4, and 809.5.
SEC. 3.Section 4301 of the Business and Professions Code is amended to read:4301.The board shall take action against any holder of a license who is guilty of unprofessional conduct or whose license has been issued by mistake. Unprofessional conduct includes, but is not limited to, any of the following:
(a)Procurement of a license by fraud or misrepresentation.
(b)Incompetence.
(c)Gross negligence.
(d)The clearly excessive furnishing of controlled substances in violation of subdivision (a) of Section 11153 of the Health and Safety Code.
(e)The clearly excessive furnishing of controlled substances in violation of subdivision (a) of Section 11153.5 of the Health and Safety Code. Factors to be considered in determining whether the furnishing of controlled substances is clearly excessive shall include, but not be limited to, the amount of controlled substances furnished, the previous ordering pattern of the customer (including size and frequency of orders), the type and size of the customer, and where and to whom the customer distributes its product.
(f)The commission of any act involving moral turpitude, dishonesty, fraud, deceit, or corruption, whether the act is committed in the course of relations as a licensee or otherwise, and whether the act is a felony or misdemeanor or not.
(g)Knowingly making or signing any certificate or other document that falsely represents the existence or nonexistence of a state of facts.
(h)The administering to oneself, of any controlled substance, or the use of any dangerous drug or of alcoholic beverages to the extent or in a manner as to be dangerous or injurious to oneself, to a person holding a license under this chapter, or to any other person or to the public, or to the extent that the use impairs the ability of the person to conduct with safety to the public the practice authorized by the license.
(i)Except as otherwise authorized by law, knowingly selling, furnishing, giving away, or administering, or offering to sell, furnish, give away, or administer, any controlled substance to a person with substance use disorder.
(j)The violation of any of the statutes of this state, of any other state, or of the United States regulating controlled substances and dangerous drugs.
(k)The conviction of more than one misdemeanor or any felony involving the use, consumption, or self-administration of any dangerous drug or alcoholic beverage, or any combination of those substances.
(l)The conviction of a crime substantially related to the qualifications, functions, and duties of a licensee under this chapter. The record of conviction of a violation of Chapter 13 (commencing with Section 801) of Title 21 of the United States Code regulating controlled substances or of a violation of the statutes of this state regulating controlled substances or dangerous drugs shall be conclusive evidence of unprofessional conduct. In all other cases, the record of conviction shall be conclusive evidence only of the fact that the conviction occurred. The board may inquire into the circumstances surrounding the commission of the crime, in order to fix the degree of discipline or, in the case of a conviction not involving controlled substances or dangerous drugs, to determine if the conviction is of an offense substantially related to the qualifications, functions, and duties of a licensee under this chapter. A plea or verdict of guilty or a conviction following a plea of nolo contendere is deemed to be a conviction within the meaning of this provision. The board may take action when the time for appeal has elapsed, or the judgment of conviction has been affirmed on appeal or when an order granting probation is made suspending the imposition of sentence, irrespective of a subsequent order under Section 1203.4 of the Penal Code allowing the person to withdraw their plea of guilty and to enter a plea of not guilty, or setting aside the verdict of guilty, or dismissing the accusation, information, or indictment.
(m)The cash compromise of a charge of violation of Chapter 13 (commencing with Section 801) of Title 21 of the United States Code regulating controlled substances or of Chapter 7 (commencing with Section 14000) of Part 3 of Division 9 of the Welfare and Institutions Code relating to the Medi-Cal program.
(n)The revocation, suspension, or other discipline by another state of a license to practice pharmacy, operate a pharmacy, or do any other act for which a license is required by this chapter that would be grounds for revocation, suspension, or other discipline under this chapter. Any disciplinary action taken by the board pursuant to this section shall be coterminous with action taken by another state, except that the term of any discipline taken by the board may exceed that of another state, consistent with the boards enforcement guidelines. The evidence of discipline by another state is conclusive proof of unprofessional conduct.
(o)Violating or attempting to violate, directly or indirectly, or assisting in or abetting the violation of or conspiring to violate any provision or term of this chapter or of the applicable federal and state laws and regulations governing pharmacy, including regulations established by the board or by any other state or federal regulatory agency.
(p)Actions or conduct that would have warranted denial of a license.
(q)Engaging in any conduct that subverts or attempts to subvert an investigation of the board.
(r)The selling, trading, transferring, or furnishing of drugs obtained pursuant to Section 256b of Title 42 of the United States Code to any person a licensee knows or reasonably should have known, not to be a patient of a covered entity, as defined in paragraph (4) of subsection (a) of Section 256b of Title 42 of the United States Code.
(s)The clearly excessive furnishing of dangerous drugs by a wholesaler to a pharmacy that primarily or solely dispenses prescription drugs to patients of long-term care facilities. Factors to be considered in determining whether the furnishing of dangerous drugs is clearly excessive shall include, but not be limited to, the amount of dangerous drugs furnished to a pharmacy that primarily or solely dispenses prescription drugs to patients of long-term care facilities, the previous ordering pattern of the pharmacy, and the general patient population to whom the pharmacy distributes the dangerous drugs. That a wholesaler has established, and employs, a tracking system that complies with the requirements of subdivision (b) of Section 4164 shall be considered in determining whether there has been a violation of this subdivision. This provision shall not be interpreted to require a wholesaler to obtain personal medical information or be authorized to permit a wholesaler to have access to personal medical information except as otherwise authorized by Section 56 and following of the Civil Code. For purposes of this section, long-term care facility has the same meaning given the term in Section 1418 of the Health and Safety Code.
(t)The acquisition of a nonprescription diabetes test device from a person that the licensee knew or should have known was not the nonprescription diabetes test devices manufacturer or the manufacturers authorized distributor as identified in Section 4160.5.
(u)The submission of a reimbursement claim for a nonprescription diabetes test device to a pharmaceutical benefit manager, health insurer, government agency, or other third-party payor when the licensee knew or reasonably should have known that the diabetes test device was not purchased either directly from the manufacturer or from the nonprescription diabetes test device manufacturers authorized distributors as identified in Section 4160.5.
SEC. 4.Section 11153 of the Health and Safety Code is amended to read:11153.(a) 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 their professional practice. 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. Except as authorized by this division, the following are not legal prescriptions: (1) an order purporting to be a prescription which is issued not in the usual course of professional treatment or in legitimate and authorized research; or (2) an order for a person with substance use disorder or habitual user of controlled substances, which is issued not in the course of professional treatment or as part of an authorized narcotic treatment program, for the purpose of providing the user with controlled substances, sufficient to keep them comfortable by maintaining customary use.
(b) Any person who knowingly violates this section shall be punished by imprisonment pursuant to subdivision (h) of Section 1170 of the Penal Code, or in a county jail not exceeding one year, or by a fine not exceeding twenty thousand dollars ($20,000), or by both that fine and imprisonment.
(c) No provision of the amendments to this section enacted during the second year of the 198182 Regular Session shall be construed as expanding the scope of practice of a pharmacist.
SEC. 5.Section 11156 of the Health and Safety Code is amended to read:11156.(a)Except as provided in Section 2241 of the Business and Professions Code, no person shall prescribe for, or administer, or dispense a controlled substance to, a person with substance use disorder, or to any person representing themselves as such, except as permitted by this division.
(b)(1)For purposes of this section, person with substance use disorder means a person whose actions are characterized by craving in combination with one or more of the following:
(A)Impaired control over drug use.
(B)Compulsive use.
(C)Continued use despite harm.
(2)Notwithstanding paragraph (1), a person whose drug-seeking behavior is primarily due to the inadequate control of pain is not a person with substance use disorder within the meaning of this section.
SEC. 6.Section 11158.1 of the Health and Safety Code is amended 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 persons with substance use disorder, 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. 7.Section 11215 of the Health and Safety Code is amended to read:11215.(a) Except as provided in subdivision (b), any narcotic controlled substance employed in treating a person with substance use disorder for addiction shall be administered by:
(1) A physician and surgeon.
(2) A registered nurse acting under the instruction of a physician and surgeon.
(3) A physician assistant licensed pursuant to Chapter 7.7 (commencing with Section 3500) of Division 2 of the Business and Professions Code acting under the patient-specific authority of their physician and surgeon.
(b) When acting under the direction of a physician and surgeon, the following persons may administer a narcotic controlled substance orally in the treatment of a person with substance use disorder for addiction to a controlled substance:
(1) A psychiatric technician licensed pursuant to Chapter 10 (commencing with Section 4500) of Division 2 of the Business and Professions Code.
(2) A vocational nurse licensed pursuant to Chapter 6.5 (commencing with Section 2840) of Division 2 of the Business and Professions Code.
(3) A pharmacist licensed pursuant to Chapter 9 (commencing with Section 4000) of Division 2 of the Business and Professions Code.
(c) Except as permitted in this section, no person shall order, permit, or direct any other person to administer a narcotic controlled substance to a person being treated for addiction to a controlled substance.
SEC. 8.Section 11217 of the Health and Safety Code is amended to read:11217.Except as provided in Section 11223, no person shall treat a person with substance use disorder for addiction to a narcotic drug except in one of the following:
(a)An institution approved by the State Department of Health Care Services, and where the patient is at all times kept under restraint and control.
(b)A city or county jail.
(c)A state prison.
(d)A facility designated by a county and approved by the State Department of Health Care Services pursuant to Division 5 (commencing with Section 5000) of the Welfare and Institutions Code.
(e)A state hospital.
(f)A county hospital.
(g)A facility licensed by the State Department of Health Care Services pursuant to Division 10.5 (commencing with Section 11750).
(h)A facility as defined in subdivision (a) or (b) of Section 1250 and Section 1250.3.
A narcotic controlled substance in the continuing treatment of addiction to a controlled substance shall be used only in those programs licensed by the State Department of Health Care Services pursuant to Article 1 (commencing with Section 11839) of Chapter 10 of Part 2 of Division 10.5 on either an inpatient or outpatient basis, or both.
This section does not apply during emergency treatment, or where the patients addiction is complicated by the presence of incurable disease, serious accident, or injury, or the infirmities of old age.
Neither this section nor any other provision of this division shall be construed to prohibit the maintenance of a place in which persons seeking to recover from addiction to a controlled substance reside and endeavor to aid one another and receive aid from others in recovering from that addiction, nor does this section or this division prohibit that aid, provided that no person is treated for addiction in a place by means of administering, furnishing, or prescribing of controlled substances. The preceding sentence is declaratory of preexisting law.
Neither this section or any other provision of this division shall be construed to prohibit short-term narcotic detoxification treatment in a controlled setting approved by the director and pursuant to rules and regulations of the director. Facilities and treatment approved by the director under this paragraph shall not be subject to approval or inspection by the Medical Board of California, nor shall persons in those facilities be required to register with, or report the termination of residence with, the police department or sheriffs office.
SEC. 9.Section 11217.5 of the Health and Safety Code is amended to read:11217.5.Notwithstanding the provisions of Section 11217, a licensed physician and surgeon may treat a person with substance use disorder for addiction in any office or medical facility which, in the professional judgment of the physician and surgeon, is medically proper for the rehabilitation and treatment of the person. A licensed physician and surgeon may administer to a person with substance use disorder, under their direct care, those medications and therapeutic agents which, in the judgment of the physician and surgeon, are medically necessary, provided that nothing in this section shall authorize the administration of any narcotic drug.
SEC. 10.Section 11218 of the Health and Safety Code is amended to read:11218.A physician treating a person with substance use disorder for addiction may not prescribe for or furnish to the person with substance use disorder more than any one of the following amounts of controlled substances during each of the first 15 days of that treatment:
(a) Eight grains of opium.
(b) Four grains of morphine.
(c) Six grains of Pantopon.
(d) One grain of Dilaudid.
(e) Four hundred milligrams of isonipecaine (Demerol).
SEC. 11.Section 11219 of the Health and Safety Code is amended to read:11219.After 15 days of treatment, the physician may not prescribe for or furnish to the person with substance use disorder more than any one of the following amounts of controlled substances during each day of the treatment:
(a) Four grains of opium.
(b) Two grains of morphine.
(c) Three grains of Pantopon.
(d) One-half grain of Dilaudid.
(e) Two hundred milligrams of isonipecaine (Demerol).
SEC. 12.Section 11380.7 of the Health and Safety Code is amended to read:11380.7.(a)Notwithstanding any other provision of law, any person who is convicted of trafficking in heroin, cocaine, cocaine base, methamphetamine, or phencyclidine (PCP), or of a conspiracy to commit trafficking in heroin, cocaine, cocaine base, methamphetamine, or phencyclidine (PCP), in addition to the punishment imposed for the conviction, shall be imprisoned pursuant to subdivision (h) of Section 1170 of the Penal Code for an additional one year if the violation occurred upon the grounds of, or within 1,000 feet of, a drug treatment center, detoxification facility, or homeless shelter.
(b)(1)The additional punishment provided in this section shall not be imposed unless the allegation is charged in the accusatory pleading and admitted by the defendant or found to be true by the trier of fact.
(2)The additional punishment provided in this section shall not be imposed if any other additional punishment is imposed pursuant to Section 11353.1, 11353.5, 11353.6, 11353.7, or 11380.1.
(c)Notwithstanding any other provision of law, the court may strike the additional punishment provided for in this section if it determines that there are circumstances in mitigation of the additional punishment and states on the record its reasons for striking the additional punishment. In determining whether or not to strike the additional punishment, the court shall consider the following factors and any relevant factors in aggravation or mitigation in Rules 4.421 and 4.423 of the California Rules of Court.
(1)The following factors indicate that the court should exercise its discretion to strike the additional punishment unless these factors are outweighed by factors in aggravation:
(A)The defendant is homeless, or is in a homeless shelter or transitional housing.
(B)The defendant lacks resources for the necessities of life.
(C)The defendant is addicted to or dependent on controlled substances.
(D)The defendants motive was merely to maintain a steady supply of drugs for personal use.
(E)The defendant was recruited or exploited by a more culpable person to commit the crime.
(2)The following factors indicate that the court should not exercise discretion to strike the additional punishment unless these factors are outweighed by factors in mitigation:
(A)The defendant, in committing the crime, preyed on homeless persons, persons with substance use disorder, or substance abusers who were seeking treatment, shelter or transitional services.
(B)The defendants primary motive was monetary compensation.
(C)The defendant induced others, particularly homeless persons, persons with substance use disorder, and substance abusers, to become involved in trafficking.
(d)For the purposes of this section, the following terms have the following meanings:
(1)Detoxification facility means any premises, place, or building in which 24-hour residential nonmedical services are provided to adults who are recovering from problems related to alcohol, drug, or alcohol and drug misuse or abuse, and who need alcohol, drug, or alcohol and drug recovery treatment or detoxification services.
(2)Drug treatment program or drug treatment has the same meaning set forth in subdivision (b) of Section 1210 of the Penal Code.
(3)Homeless shelter includes, but is not limited to, emergency shelter housing, as well as transitional housing, but does not include domestic violence shelters. Emergency shelter housing is housing with minimal support services for homeless persons in which residency is limited to six months or less and is not related to the persons ability to pay. Transitional housing means housing with supportive services, including self-sufficiency development services, which is exclusively designed and targeted to help recently homeless persons find permanent housing as soon as reasonably possible, limits residency to 24 months, and in which rent and service fees are based on ability to pay.
(4)Trafficking means any of the unlawful activities specified in Sections 11351, 11351.5, 11352, 11353, 11354, 11378, 11379, 11379.6, and 11380. It does not include simple possession or drug use.
SEC. 13.Section 11847 of the Health and Safety Code is amended to read:11847.The Legislature hereby finds and declares that it is essential to the health and welfare of the people of this state that action be taken by state government to effectively and economically utilize federal and state funds for narcotic and alcohol and other drug abuse prevention, care, treatment, and rehabilitation services. To achieve this, it is necessary that all of the following occur:
(a)Existing fragmented, uncoordinated, and duplicative narcotic and alcohol and other drug abuse programs be molded into a comprehensive and integrated statewide program for the prevention of narcotic and alcohol and other drug abuse and for the care, treatment, and rehabilitation of persons with substance use disorder and alcohol and other drug users.
(b)Responsibility and authority for planning programs and activities for prevention, care, treatment, and rehabilitation of persons with substance use disorder be concentrated in the department. It is the intent of the Legislature to assign responsibility and grant authority for planning narcotic and alcoholic and other drug abuse prevention, care, treatment, and rehabilitation programs to the department whose functions shall be subject to periodic review by the Legislature and appropriate federal agencies.
(c)The department succeeds to, and is vested with, all the duties, powers, purposes, responsibilities, and jurisdiction with regard to substance abuse formerly vested in the State Department of Alcohol and Drug Programs.
(a)A physician and surgeon may prescribe, dispense, or administer prescription drugs, including prescription controlled substances, to a person with substance use disorder under the physician and surgeons treatment for a purpose other than maintenance on, or detoxification from, prescription drugs or controlled substances.
(b)A physician and surgeon may prescribe, dispense, or administer prescription drugs or prescription controlled substances to a person with substance use disorder for purposes of maintenance on, or detoxification from, prescription drugs or controlled substances only as set forth in subdivision (c) or in Sections 11215, 11217, 11217.5, 11218, 11219, and 11220 of the Health and Safety Code. Nothing in this subdivision shall authorize a physician and surgeon to prescribe, dispense, or administer dangerous drugs or controlled substances to a person they know or reasonably believe is using or will use the drugs or substances for a nonmedical purpose.
(c)Notwithstanding subdivision (a), prescription drugs or controlled substances may also be administered or applied by a physician and surgeon, or by a registered nurse acting under their instruction and supervision, under the following circumstances:
(1)Emergency treatment of a patient whose addiction is complicated by the presence of incurable disease, acute accident, illness, or injury, or the infirmities attendant upon age.
(2)Treatment of persons with substance use disorder in state-licensed institutions where the patient is kept under restraint and control, or in city or county jails or state prisons.
(3)Treatment of persons with substance use disorder as provided for by Section 11217.5 of the Health and Safety Code.
(d)(1)For purposes of this section and Section 2241.5, person with substance use disorder means a person whose actions are characterized by craving in combination with one or more of the following:
(A)Impaired control over drug use.
(B)Compulsive use.
(C)Continued use despite harm.
(2)Notwithstanding paragraph (1), a person whose drug-seeking behavior is primarily due to the inadequate control of pain is not a person with substance use disorder within the meaning of this section or Section 2241.5.
SEC. 2.Section 2241.5 of the Business and Professions Code is amended to read:2241.5.(a)A physician and surgeon may prescribe for, or dispense or administer to, a person under their treatment for a medical condition dangerous drugs or prescription controlled substances for the treatment of pain or a condition causing pain, including, but not limited to, intractable pain.
(b)No physician and surgeon shall be subject to disciplinary action for prescribing, dispensing, or administering dangerous drugs or prescription controlled substances in accordance with this section.
(c)This section shall not affect the power of the board to take any action described in Section 2227 against a physician and surgeon who does any of the following:
(1)Violates subdivision (b), (c), or (d) of Section 2234 regarding gross negligence, repeated negligent acts, or incompetence.
(2)Violates Section 2241 regarding treatment of a person with substance use disorder.
(3)Violates Section 2242 or 2525.3 regarding performing an appropriate prior examination and the existence of a medical indication for prescribing, dispensing, or furnishing dangerous drugs or recommending medical cannabis.
(4)Violates Section 2242.1 regarding prescribing on the Internet.
(5)Fails to keep complete and accurate records of purchases and disposals of substances listed in the California Uniform Controlled Substances Act (Division 10 (commencing with Section 11000) of the Health and Safety Code) or controlled substances scheduled in the federal Comprehensive Drug Abuse Prevention and Control Act of 1970 (21 U.S.C. Sec. 801 et seq.), or pursuant to the federal Comprehensive Drug Abuse Prevention and Control Act of 1970. A physician and surgeon shall keep records of their purchases and disposals of these controlled substances or dangerous drugs, including the date of purchase, the date and records of the sale or disposal of the drugs by the physician and surgeon, the name and address of the person receiving the drugs, and the reason for the disposal or the dispensing of the drugs to the person, and shall otherwise comply with all state recordkeeping requirements for controlled substances.
(6)Writes false or fictitious prescriptions for controlled substances listed in the California Uniform Controlled Substances Act or scheduled in the federal Comprehensive Drug Abuse Prevention and Control Act of 1970.
(7)Prescribes, administers, or dispenses in violation of this chapter, or in violation of Chapter 4 (commencing with Section 11150) or Chapter 5 (commencing with Section 11210) of Division 10 of the Health and Safety Code.
(d)A physician and surgeon shall exercise reasonable care in determining whether a particular patient or condition, or the complexity of a patients treatment, including, but not limited to, a current or recent pattern of drug abuse, requires consultation with, or referral to, a more qualified specialist.
(e)Nothing in this section shall prohibit the governing body of a hospital from taking disciplinary actions against a physician and surgeon pursuant to Sections 809.05, 809.4, and 809.5.
SEC. 3.Section 4301 of the Business and Professions Code is amended to read:4301.The board shall take action against any holder of a license who is guilty of unprofessional conduct or whose license has been issued by mistake. Unprofessional conduct includes, but is not limited to, any of the following:
(a)Procurement of a license by fraud or misrepresentation.
(b)Incompetence.
(c)Gross negligence.
(d)The clearly excessive furnishing of controlled substances in violation of subdivision (a) of Section 11153 of the Health and Safety Code.
(e)The clearly excessive furnishing of controlled substances in violation of subdivision (a) of Section 11153.5 of the Health and Safety Code. Factors to be considered in determining whether the furnishing of controlled substances is clearly excessive shall include, but not be limited to, the amount of controlled substances furnished, the previous ordering pattern of the customer (including size and frequency of orders), the type and size of the customer, and where and to whom the customer distributes its product.
(f)The commission of any act involving moral turpitude, dishonesty, fraud, deceit, or corruption, whether the act is committed in the course of relations as a licensee or otherwise, and whether the act is a felony or misdemeanor or not.
(g)Knowingly making or signing any certificate or other document that falsely represents the existence or nonexistence of a state of facts.
(h)The administering to oneself, of any controlled substance, or the use of any dangerous drug or of alcoholic beverages to the extent or in a manner as to be dangerous or injurious to oneself, to a person holding a license under this chapter, or to any other person or to the public, or to the extent that the use impairs the ability of the person to conduct with safety to the public the practice authorized by the license.
(i)Except as otherwise authorized by law, knowingly selling, furnishing, giving away, or administering, or offering to sell, furnish, give away, or administer, any controlled substance to a person with substance use disorder.
(j)The violation of any of the statutes of this state, of any other state, or of the United States regulating controlled substances and dangerous drugs.
(k)The conviction of more than one misdemeanor or any felony involving the use, consumption, or self-administration of any dangerous drug or alcoholic beverage, or any combination of those substances.
(l)The conviction of a crime substantially related to the qualifications, functions, and duties of a licensee under this chapter. The record of conviction of a violation of Chapter 13 (commencing with Section 801) of Title 21 of the United States Code regulating controlled substances or of a violation of the statutes of this state regulating controlled substances or dangerous drugs shall be conclusive evidence of unprofessional conduct. In all other cases, the record of conviction shall be conclusive evidence only of the fact that the conviction occurred. The board may inquire into the circumstances surrounding the commission of the crime, in order to fix the degree of discipline or, in the case of a conviction not involving controlled substances or dangerous drugs, to determine if the conviction is of an offense substantially related to the qualifications, functions, and duties of a licensee under this chapter. A plea or verdict of guilty or a conviction following a plea of nolo contendere is deemed to be a conviction within the meaning of this provision. The board may take action when the time for appeal has elapsed, or the judgment of conviction has been affirmed on appeal or when an order granting probation is made suspending the imposition of sentence, irrespective of a subsequent order under Section 1203.4 of the Penal Code allowing the person to withdraw their plea of guilty and to enter a plea of not guilty, or setting aside the verdict of guilty, or dismissing the accusation, information, or indictment.
(m)The cash compromise of a charge of violation of Chapter 13 (commencing with Section 801) of Title 21 of the United States Code regulating controlled substances or of Chapter 7 (commencing with Section 14000) of Part 3 of Division 9 of the Welfare and Institutions Code relating to the Medi-Cal program.
(n)The revocation, suspension, or other discipline by another state of a license to practice pharmacy, operate a pharmacy, or do any other act for which a license is required by this chapter that would be grounds for revocation, suspension, or other discipline under this chapter. Any disciplinary action taken by the board pursuant to this section shall be coterminous with action taken by another state, except that the term of any discipline taken by the board may exceed that of another state, consistent with the boards enforcement guidelines. The evidence of discipline by another state is conclusive proof of unprofessional conduct.
(o)Violating or attempting to violate, directly or indirectly, or assisting in or abetting the violation of or conspiring to violate any provision or term of this chapter or of the applicable federal and state laws and regulations governing pharmacy, including regulations established by the board or by any other state or federal regulatory agency.
(p)Actions or conduct that would have warranted denial of a license.
(q)Engaging in any conduct that subverts or attempts to subvert an investigation of the board.
(r)The selling, trading, transferring, or furnishing of drugs obtained pursuant to Section 256b of Title 42 of the United States Code to any person a licensee knows or reasonably should have known, not to be a patient of a covered entity, as defined in paragraph (4) of subsection (a) of Section 256b of Title 42 of the United States Code.
(s)The clearly excessive furnishing of dangerous drugs by a wholesaler to a pharmacy that primarily or solely dispenses prescription drugs to patients of long-term care facilities. Factors to be considered in determining whether the furnishing of dangerous drugs is clearly excessive shall include, but not be limited to, the amount of dangerous drugs furnished to a pharmacy that primarily or solely dispenses prescription drugs to patients of long-term care facilities, the previous ordering pattern of the pharmacy, and the general patient population to whom the pharmacy distributes the dangerous drugs. That a wholesaler has established, and employs, a tracking system that complies with the requirements of subdivision (b) of Section 4164 shall be considered in determining whether there has been a violation of this subdivision. This provision shall not be interpreted to require a wholesaler to obtain personal medical information or be authorized to permit a wholesaler to have access to personal medical information except as otherwise authorized by Section 56 and following of the Civil Code. For purposes of this section, long-term care facility has the same meaning given the term in Section 1418 of the Health and Safety Code.
(t)The acquisition of a nonprescription diabetes test device from a person that the licensee knew or should have known was not the nonprescription diabetes test devices manufacturer or the manufacturers authorized distributor as identified in Section 4160.5.
(u)The submission of a reimbursement claim for a nonprescription diabetes test device to a pharmaceutical benefit manager, health insurer, government agency, or other third-party payor when the licensee knew or reasonably should have known that the diabetes test device was not purchased either directly from the manufacturer or from the nonprescription diabetes test device manufacturers authorized distributors as identified in Section 4160.5.
SEC. 4.Section 11153 of the Health and Safety Code is amended to read:11153.(a) 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 their professional practice. 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. Except as authorized by this division, the following are not legal prescriptions: (1) an order purporting to be a prescription which is issued not in the usual course of professional treatment or in legitimate and authorized research; or (2) an order for a person with substance use disorder or habitual user of controlled substances, which is issued not in the course of professional treatment or as part of an authorized narcotic treatment program, for the purpose of providing the user with controlled substances, sufficient to keep them comfortable by maintaining customary use.
(b) Any person who knowingly violates this section shall be punished by imprisonment pursuant to subdivision (h) of Section 1170 of the Penal Code, or in a county jail not exceeding one year, or by a fine not exceeding twenty thousand dollars ($20,000), or by both that fine and imprisonment.
(c) No provision of the amendments to this section enacted during the second year of the 198182 Regular Session shall be construed as expanding the scope of practice of a pharmacist.
SEC. 5.Section 11156 of the Health and Safety Code is amended to read:11156.(a)Except as provided in Section 2241 of the Business and Professions Code, no person shall prescribe for, or administer, or dispense a controlled substance to, a person with substance use disorder, or to any person representing themselves as such, except as permitted by this division.
(b)(1)For purposes of this section, person with substance use disorder means a person whose actions are characterized by craving in combination with one or more of the following:
(A)Impaired control over drug use.
(B)Compulsive use.
(C)Continued use despite harm.
(2)Notwithstanding paragraph (1), a person whose drug-seeking behavior is primarily due to the inadequate control of pain is not a person with substance use disorder within the meaning of this section.
SEC. 6.Section 11158.1 of the Health and Safety Code is amended 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 persons with substance use disorder, 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. 7.Section 11215 of the Health and Safety Code is amended to read:11215.(a) Except as provided in subdivision (b), any narcotic controlled substance employed in treating a person with substance use disorder for addiction shall be administered by:
(1) A physician and surgeon.
(2) A registered nurse acting under the instruction of a physician and surgeon.
(3) A physician assistant licensed pursuant to Chapter 7.7 (commencing with Section 3500) of Division 2 of the Business and Professions Code acting under the patient-specific authority of their physician and surgeon.
(b) When acting under the direction of a physician and surgeon, the following persons may administer a narcotic controlled substance orally in the treatment of a person with substance use disorder for addiction to a controlled substance:
(1) A psychiatric technician licensed pursuant to Chapter 10 (commencing with Section 4500) of Division 2 of the Business and Professions Code.
(2) A vocational nurse licensed pursuant to Chapter 6.5 (commencing with Section 2840) of Division 2 of the Business and Professions Code.
(3) A pharmacist licensed pursuant to Chapter 9 (commencing with Section 4000) of Division 2 of the Business and Professions Code.
(c) Except as permitted in this section, no person shall order, permit, or direct any other person to administer a narcotic controlled substance to a person being treated for addiction to a controlled substance.
SEC. 8.Section 11217 of the Health and Safety Code is amended to read:11217.Except as provided in Section 11223, no person shall treat a person with substance use disorder for addiction to a narcotic drug except in one of the following:
(a)An institution approved by the State Department of Health Care Services, and where the patient is at all times kept under restraint and control.
(b)A city or county jail.
(c)A state prison.
(d)A facility designated by a county and approved by the State Department of Health Care Services pursuant to Division 5 (commencing with Section 5000) of the Welfare and Institutions Code.
(e)A state hospital.
(f)A county hospital.
(g)A facility licensed by the State Department of Health Care Services pursuant to Division 10.5 (commencing with Section 11750).
(h)A facility as defined in subdivision (a) or (b) of Section 1250 and Section 1250.3.
A narcotic controlled substance in the continuing treatment of addiction to a controlled substance shall be used only in those programs licensed by the State Department of Health Care Services pursuant to Article 1 (commencing with Section 11839) of Chapter 10 of Part 2 of Division 10.5 on either an inpatient or outpatient basis, or both.
This section does not apply during emergency treatment, or where the patients addiction is complicated by the presence of incurable disease, serious accident, or injury, or the infirmities of old age.
Neither this section nor any other provision of this division shall be construed to prohibit the maintenance of a place in which persons seeking to recover from addiction to a controlled substance reside and endeavor to aid one another and receive aid from others in recovering from that addiction, nor does this section or this division prohibit that aid, provided that no person is treated for addiction in a place by means of administering, furnishing, or prescribing of controlled substances. The preceding sentence is declaratory of preexisting law.
Neither this section or any other provision of this division shall be construed to prohibit short-term narcotic detoxification treatment in a controlled setting approved by the director and pursuant to rules and regulations of the director. Facilities and treatment approved by the director under this paragraph shall not be subject to approval or inspection by the Medical Board of California, nor shall persons in those facilities be required to register with, or report the termination of residence with, the police department or sheriffs office.
SEC. 9.Section 11217.5 of the Health and Safety Code is amended to read:11217.5.Notwithstanding the provisions of Section 11217, a licensed physician and surgeon may treat a person with substance use disorder for addiction in any office or medical facility which, in the professional judgment of the physician and surgeon, is medically proper for the rehabilitation and treatment of the person. A licensed physician and surgeon may administer to a person with substance use disorder, under their direct care, those medications and therapeutic agents which, in the judgment of the physician and surgeon, are medically necessary, provided that nothing in this section shall authorize the administration of any narcotic drug.
SEC. 10.Section 11218 of the Health and Safety Code is amended to read:11218.A physician treating a person with substance use disorder for addiction may not prescribe for or furnish to the person with substance use disorder more than any one of the following amounts of controlled substances during each of the first 15 days of that treatment:
(a) Eight grains of opium.
(b) Four grains of morphine.
(c) Six grains of Pantopon.
(d) One grain of Dilaudid.
(e) Four hundred milligrams of isonipecaine (Demerol).
SEC. 11.Section 11219 of the Health and Safety Code is amended to read:11219.After 15 days of treatment, the physician may not prescribe for or furnish to the person with substance use disorder more than any one of the following amounts of controlled substances during each day of the treatment:
(a) Four grains of opium.
(b) Two grains of morphine.
(c) Three grains of Pantopon.
(d) One-half grain of Dilaudid.
(e) Two hundred milligrams of isonipecaine (Demerol).
SEC. 12.Section 11380.7 of the Health and Safety Code is amended to read:11380.7.(a)Notwithstanding any other provision of law, any person who is convicted of trafficking in heroin, cocaine, cocaine base, methamphetamine, or phencyclidine (PCP), or of a conspiracy to commit trafficking in heroin, cocaine, cocaine base, methamphetamine, or phencyclidine (PCP), in addition to the punishment imposed for the conviction, shall be imprisoned pursuant to subdivision (h) of Section 1170 of the Penal Code for an additional one year if the violation occurred upon the grounds of, or within 1,000 feet of, a drug treatment center, detoxification facility, or homeless shelter.
(b)(1)The additional punishment provided in this section shall not be imposed unless the allegation is charged in the accusatory pleading and admitted by the defendant or found to be true by the trier of fact.
(2)The additional punishment provided in this section shall not be imposed if any other additional punishment is imposed pursuant to Section 11353.1, 11353.5, 11353.6, 11353.7, or 11380.1.
(c)Notwithstanding any other provision of law, the court may strike the additional punishment provided for in this section if it determines that there are circumstances in mitigation of the additional punishment and states on the record its reasons for striking the additional punishment. In determining whether or not to strike the additional punishment, the court shall consider the following factors and any relevant factors in aggravation or mitigation in Rules 4.421 and 4.423 of the California Rules of Court.
(1)The following factors indicate that the court should exercise its discretion to strike the additional punishment unless these factors are outweighed by factors in aggravation:
(A)The defendant is homeless, or is in a homeless shelter or transitional housing.
(B)The defendant lacks resources for the necessities of life.
(C)The defendant is addicted to or dependent on controlled substances.
(D)The defendants motive was merely to maintain a steady supply of drugs for personal use.
(E)The defendant was recruited or exploited by a more culpable person to commit the crime.
(2)The following factors indicate that the court should not exercise discretion to strike the additional punishment unless these factors are outweighed by factors in mitigation:
(A)The defendant, in committing the crime, preyed on homeless persons, persons with substance use disorder, or substance abusers who were seeking treatment, shelter or transitional services.
(B)The defendants primary motive was monetary compensation.
(C)The defendant induced others, particularly homeless persons, persons with substance use disorder, and substance abusers, to become involved in trafficking.
(d)For the purposes of this section, the following terms have the following meanings:
(1)Detoxification facility means any premises, place, or building in which 24-hour residential nonmedical services are provided to adults who are recovering from problems related to alcohol, drug, or alcohol and drug misuse or abuse, and who need alcohol, drug, or alcohol and drug recovery treatment or detoxification services.
(2)Drug treatment program or drug treatment has the same meaning set forth in subdivision (b) of Section 1210 of the Penal Code.
(3)Homeless shelter includes, but is not limited to, emergency shelter housing, as well as transitional housing, but does not include domestic violence shelters. Emergency shelter housing is housing with minimal support services for homeless persons in which residency is limited to six months or less and is not related to the persons ability to pay. Transitional housing means housing with supportive services, including self-sufficiency development services, which is exclusively designed and targeted to help recently homeless persons find permanent housing as soon as reasonably possible, limits residency to 24 months, and in which rent and service fees are based on ability to pay.
(4)Trafficking means any of the unlawful activities specified in Sections 11351, 11351.5, 11352, 11353, 11354, 11378, 11379, 11379.6, and 11380. It does not include simple possession or drug use.
SEC. 13.Section 11847 of the Health and Safety Code is amended to read:11847.The Legislature hereby finds and declares that it is essential to the health and welfare of the people of this state that action be taken by state government to effectively and economically utilize federal and state funds for narcotic and alcohol and other drug abuse prevention, care, treatment, and rehabilitation services. To achieve this, it is necessary that all of the following occur:
(a)Existing fragmented, uncoordinated, and duplicative narcotic and alcohol and other drug abuse programs be molded into a comprehensive and integrated statewide program for the prevention of narcotic and alcohol and other drug abuse and for the care, treatment, and rehabilitation of persons with substance use disorder and alcohol and other drug users.
(b)Responsibility and authority for planning programs and activities for prevention, care, treatment, and rehabilitation of persons with substance use disorder be concentrated in the department. It is the intent of the Legislature to assign responsibility and grant authority for planning narcotic and alcoholic and other drug abuse prevention, care, treatment, and rehabilitation programs to the department whose functions shall be subject to periodic review by the Legislature and appropriate federal agencies.
(c)The department succeeds to, and is vested with, all the duties, powers, purposes, responsibilities, and jurisdiction with regard to substance abuse formerly vested in the State Department of Alcohol and Drug Programs.
(a)A physician and surgeon may prescribe, dispense, or administer prescription drugs, including prescription controlled substances, to an addict a person with substance use disorder under his or her the physician and surgeons treatment for a purpose other than maintenance on, or detoxification from, prescription drugs or controlled substances.
(b)A physician and surgeon may prescribe, dispense, or administer prescription drugs or prescription controlled substances to an addict a person with substance use disorder for purposes of maintenance on, or detoxification from, prescription drugs or controlled substances only as set forth in subdivision (c) or in Sections 11215, 11217, 11217.5, 11218, 11219, and 11220 of the Health and Safety Code. Nothing in this subdivision shall authorize a physician and surgeon to prescribe, dispense, or administer dangerous drugs or controlled substances to a person he or she knows or reasonably believes they know or reasonably believe is using or will use the drugs or substances for a nonmedical purpose.
(c)Notwithstanding subdivision (a), prescription drugs or controlled substances may also be administered or applied by a physician and surgeon, or by a registered nurse acting under his or her their instruction and supervision, under the following circumstances:
(1)Emergency treatment of a patient whose addiction is complicated by the presence of incurable disease, acute accident, illness, or injury, or the infirmities attendant upon age.
(2)Treatment of addicts persons with substance use disorder in state-licensed institutions where the patient is kept under restraint and control, or in city or county jails or state prisons.
(3)Treatment of addicts persons with substance use disorder as provided for by Section 11217.5 of the Health and Safety Code.
(d)(1)For purposes of this section and Section 2241.5, addict person with substance use disorder means a person whose actions are characterized by craving in combination with one or more of the following:
(A)Impaired control over drug use.
(B)Compulsive use.
(C)Continued use despite harm.
(2)Notwithstanding paragraph (1), a person whose drug-seeking behavior is primarily due to the inadequate control of pain is not an addict a person with substance use disorder within the meaning of this section or Section 2241.5.
SEC. 2.Section 2241.5 of the Business and Professions Code is amended to read:2241.5.(a)A physician and surgeon may prescribe for, or dispense or administer to, a person under his or her their treatment for a medical condition dangerous drugs or prescription controlled substances for the treatment of pain or a condition causing pain, including, but not limited to, intractable pain.
(b)No physician and surgeon shall be subject to disciplinary action for prescribing, dispensing, or administering dangerous drugs or prescription controlled substances in accordance with this section.
(c)This section shall not affect the power of the board to take any action described in Section 2227 against a physician and surgeon who does any of the following:
(1)Violates subdivision (b), (c), or (d) of Section 2234 regarding gross negligence, repeated negligent acts, or incompetence.
(2)Violates Section 2241 regarding treatment of an addict. a person with substance use disorder.
(3)Violates Section 2242 or 2525.3 regarding performing an appropriate prior examination and the existence of a medical indication for prescribing, dispensing, or furnishing dangerous drugs or recommending medical cannabis.
(4)Violates Section 2242.1 regarding prescribing on the Internet.
(5)Fails to keep complete and accurate records of purchases and disposals of substances listed in the California Uniform Controlled Substances Act (Division 10 (commencing with Section 11000) of the Health and Safety Code) or controlled substances scheduled in the federal Comprehensive Drug Abuse Prevention and Control Act of 1970 (21 U.S.C. Sec. 801 et seq.), or pursuant to the federal Comprehensive Drug Abuse Prevention and Control Act of 1970. A physician and surgeon shall keep records of his or her their purchases and disposals of these controlled substances or dangerous drugs, including the date of purchase, the date and records of the sale or disposal of the drugs by the physician and surgeon, the name and address of the person receiving the drugs, and the reason for the disposal or the dispensing of the drugs to the person, and shall otherwise comply with all state recordkeeping requirements for controlled substances.
(6)Writes false or fictitious prescriptions for controlled substances listed in the California Uniform Controlled Substances Act or scheduled in the federal Comprehensive Drug Abuse Prevention and Control Act of 1970.
(7)Prescribes, administers, or dispenses in violation of this chapter, or in violation of Chapter 4 (commencing with Section 11150) or Chapter 5 (commencing with Section 11210) of Division 10 of the Health and Safety Code.
(d)A physician and surgeon shall exercise reasonable care in determining whether a particular patient or condition, or the complexity of a patients treatment, including, but not limited to, a current or recent pattern of drug abuse, requires consultation with, or referral to, a more qualified specialist.
(e)Nothing in this section shall prohibit the governing body of a hospital from taking disciplinary actions against a physician and surgeon pursuant to Sections 809.05, 809.4, and 809.5.
SEC. 3.Section 4301 of the Business and Professions Code is amended to read:4301.The board shall take action against any holder of a license who is guilty of unprofessional conduct or whose license has been issued by mistake. Unprofessional conduct includes, but is not limited to, any of the following:
(a)Procurement of a license by fraud or misrepresentation.
(b)Incompetence.
(c)Gross negligence.
(d)The clearly excessive furnishing of controlled substances in violation of subdivision (a) of Section 11153 of the Health and Safety Code.
(e)The clearly excessive furnishing of controlled substances in violation of subdivision (a) of Section 11153.5 of the Health and Safety Code. Factors to be considered in determining whether the furnishing of controlled substances is clearly excessive shall include, but not be limited to, the amount of controlled substances furnished, the previous ordering pattern of the customer (including size and frequency of orders), the type and size of the customer, and where and to whom the customer distributes its product.
(f)The commission of any act involving moral turpitude, dishonesty, fraud, deceit, or corruption, whether the act is committed in the course of relations as a licensee or otherwise, and whether the act is a felony or misdemeanor or not.
(g)Knowingly making or signing any certificate or other document that falsely represents the existence or nonexistence of a state of facts.
(h)The administering to oneself, of any controlled substance, or the use of any dangerous drug or of alcoholic beverages to the extent or in a manner as to be dangerous or injurious to oneself, to a person holding a license under this chapter, or to any other person or to the public, or to the extent that the use impairs the ability of the person to conduct with safety to the public the practice authorized by the license.
(i)Except as otherwise authorized by law, knowingly selling, furnishing, giving away, or administering, or offering to sell, furnish, give away, or administer, any controlled substance to an addict. a person with substance use disorder.
(j)The violation of any of the statutes of this state, of any other state, or of the United States regulating controlled substances and dangerous drugs.
(k)The conviction of more than one misdemeanor or any felony involving the use, consumption, or self-administration of any dangerous drug or alcoholic beverage, or any combination of those substances.
(l)The conviction of a crime substantially related to the qualifications, functions, and duties of a licensee under this chapter. The record of conviction of a violation of Chapter 13 (commencing with Section 801) of Title 21 of the United States Code regulating controlled substances or of a violation of the statutes of this state regulating controlled substances or dangerous drugs shall be conclusive evidence of unprofessional conduct. In all other cases, the record of conviction shall be conclusive evidence only of the fact that the conviction occurred. The board may inquire into the circumstances surrounding the commission of the crime, in order to fix the degree of discipline or, in the case of a conviction not involving controlled substances or dangerous drugs, to determine if the conviction is of an offense substantially related to the qualifications, functions, and duties of a licensee under this chapter. A plea or verdict of guilty or a conviction following a plea of nolo contendere is deemed to be a conviction within the meaning of this provision. The board may take action when the time for appeal has elapsed, or the judgment of conviction has been affirmed on appeal or when an order granting probation is made suspending the imposition of sentence, irrespective of a subsequent order under Section 1203.4 of the Penal Code allowing the person to withdraw his or her their plea of guilty and to enter a plea of not guilty, or setting aside the verdict of guilty, or dismissing the accusation, information, or indictment.
(m)The cash compromise of a charge of violation of Chapter 13 (commencing with Section 801) of Title 21 of the United States Code regulating controlled substances or of Chapter 7 (commencing with Section 14000) of Part 3 of Division 9 of the Welfare and Institutions Code relating to the Medi-Cal program.
(n)The revocation, suspension, or other discipline by another state of a license to practice pharmacy, operate a pharmacy, or do any other act for which a license is required by this chapter that would be grounds for revocation, suspension, or other discipline under this chapter. Any disciplinary action taken by the board pursuant to this section shall be coterminous with action taken by another state, except that the term of any discipline taken by the board may exceed that of another state, consistent with the boards enforcement guidelines. The evidence of discipline by another state is conclusive proof of unprofessional conduct.
(o)Violating or attempting to violate, directly or indirectly, or assisting in or abetting the violation of or conspiring to violate any provision or term of this chapter or of the applicable federal and state laws and regulations governing pharmacy, including regulations established by the board or by any other state or federal regulatory agency.
(p)Actions or conduct that would have warranted denial of a license.
(q)Engaging in any conduct that subverts or attempts to subvert an investigation of the board.
(r)The selling, trading, transferring, or furnishing of drugs obtained pursuant to Section 256b of Title 42 of the United States Code to any person a licensee knows or reasonably should have known, not to be a patient of a covered entity, as defined in paragraph (4) of subsection (a) of Section 256b of Title 42 of the United States Code.
(s)The clearly excessive furnishing of dangerous drugs by a wholesaler to a pharmacy that primarily or solely dispenses prescription drugs to patients of long-term care facilities. Factors to be considered in determining whether the furnishing of dangerous drugs is clearly excessive shall include, but not be limited to, the amount of dangerous drugs furnished to a pharmacy that primarily or solely dispenses prescription drugs to patients of long-term care facilities, the previous ordering pattern of the pharmacy, and the general patient population to whom the pharmacy distributes the dangerous drugs. That a wholesaler has established, and employs, a tracking system that complies with the requirements of subdivision (b) of Section 4164 shall be considered in determining whether there has been a violation of this subdivision. This provision shall not be interpreted to require a wholesaler to obtain personal medical information or be authorized to permit a wholesaler to have access to personal medical information except as otherwise authorized by Section 56 and following of the Civil Code. For purposes of this section, long-term care facility has the same meaning given the term in Section 1418 of the Health and Safety Code.
(t)The acquisition of a nonprescription diabetes test device from a person that the licensee knew or should have known was not the nonprescription diabetes test devices manufacturer or the manufacturers authorized distributor as identified in Section 4160.5.
(u)The submission of a reimbursement claim for a nonprescription diabetes test device to a pharmaceutical benefit manager, health insurer, government agency, or other third-party payor when the licensee knew or reasonably should have known that the diabetes test device was not purchased either directly from the manufacturer or from the nonprescription diabetes test device manufacturers authorized distributors as identified in Section 4160.5.
SEC. 4.Section 11153 of the Health and Safety Code is amended to read:11153.(a) 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 their professional practice. 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. Except as authorized by this division, the following are not legal prescriptions: (1) an order purporting to be a prescription which is issued not in the usual course of professional treatment or in legitimate and authorized research; or (2) an order for an addict a person with substance use disorder or habitual user of controlled substances, which is issued not in the course of professional treatment or as part of an authorized narcotic treatment program, for the purpose of providing the user with controlled substances, sufficient to keep him or her them comfortable by maintaining customary use.
(b) Any person who knowingly violates this section shall be punished by imprisonment pursuant to subdivision (h) of Section 1170 of the Penal Code, or in a county jail not exceeding one year, or by a fine not exceeding twenty thousand dollars ($20,000), or by both that fine and imprisonment.
(c) No provision of the amendments to this section enacted during the second year of the 198182 Regular Session shall be construed as expanding the scope of practice of a pharmacist.
SEC. 5.Section 11156 of the Health and Safety Code is amended to read:11156.(a)Except as provided in Section 2241 of the Business and Professions Code, no person shall prescribe for, or administer, or dispense a controlled substance to, an addict, a person with substance use disorder, or to any person representing himself or herself themselves as such, except as permitted by this division.
(b)(1)For purposes of this section, addict person with substance use disorder means a person whose actions are characterized by craving in combination with one or more of the following:
(A)Impaired control over drug use.
(B)Compulsive use.
(C)Continued use despite harm.
(2)Notwithstanding paragraph (1), a person whose drug-seeking behavior is primarily due to the inadequate control of pain is not an addict a person with substance use disorder within the meaning of this section.
SEC. 6.Section 11158.1 of the Health and Safety Code is amended 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, persons with substance use disorder, 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. 7.Section 11215 of the Health and Safety Code is amended to read:11215.(a) Except as provided in subdivision (b), any narcotic controlled substance employed in treating an addict a person with substance use disorder for addiction shall be administered by:
(1) A physician and surgeon.
(2) A registered nurse acting under the instruction of a physician and surgeon.
(3) A physician assistant licensed pursuant to Chapter 7.7 (commencing with Section 3500) of Division 2 of the Business and Professions Code acting under the patient-specific authority of his or her their physician and surgeon supervisor approved pursuant to Section 3515 of the Business and Professions Code. surgeon.
(b) When acting under the direction of a physician and surgeon, the following persons may administer a narcotic controlled substance orally in the treatment of an addict a person with substance use disorder for addiction to a controlled substance:
(1) A psychiatric technician licensed pursuant to Chapter 10 (commencing with Section 4500) of Division 2 of the Business and Professions Code.
(2) A vocational nurse licensed pursuant to Chapter 6.5 (commencing with Section 2840) of Division 2 of the Business and Professions Code.
(3) A pharmacist licensed pursuant to Chapter 9 (commencing with Section 4000) of Division 2 of the Business and Professions Code.
(c) Except as permitted in this section, no person shall order, permit, or direct any other person to administer a narcotic controlled substance to a person being treated for addiction to a controlled substance.
SEC. 8.Section 11217 of the Health and Safety Code is amended to read:11217.Except as provided in Section 11223, no person shall treat an addict a person with substance use disorder for addiction to a narcotic drug except in one of the following:
(a)An institution approved by the State Department of Health Care Services, and where the patient is at all times kept under restraint and control.
(b)A city or county jail.
(c)A state prison.
(d)A facility designated by a county and approved by the State Department of Health Care Services pursuant to Division 5 (commencing with Section 5000) of the Welfare and Institutions Code.
(e)A state hospital.
(f)A county hospital.
(g)A facility licensed by the State Department of Health Care Services pursuant to Division 10.5 (commencing with Section 11750).
(h)A facility as defined in subdivision (a) or (b) of Section 1250 and Section 1250.3.
A narcotic controlled substance in the continuing treatment of addiction to a controlled substance shall be used only in those programs licensed by the State Department of Health Care Services pursuant to Article 1 (commencing with Section 11839) of Chapter 10 of Part 2 of Division 10.5 on either an inpatient or outpatient basis, or both.
This section does not apply during emergency treatment, or where the patients addiction is complicated by the presence of incurable disease, serious accident, or injury, or the infirmities of old age.
Neither this section nor any other provision of this division shall be construed to prohibit the maintenance of a place in which persons seeking to recover from addiction to a controlled substance reside and endeavor to aid one another and receive aid from others in recovering from that addiction, nor does this section or this division prohibit that aid, provided that no person is treated for addiction in a place by means of administering, furnishing, or prescribing of controlled substances. The preceding sentence is declaratory of preexisting law.
Neither this section or any other provision of this division shall be construed to prohibit short-term narcotic detoxification treatment in a controlled setting approved by the director and pursuant to rules and regulations of the director. Facilities and treatment approved by the director under this paragraph shall not be subject to approval or inspection by the Medical Board of California, nor shall persons in those facilities be required to register with, or report the termination of residence with, the police department or sheriffs office.
SEC. 9.Section 11217.5 of the Health and Safety Code is amended to read:11217.5.Notwithstanding the provisions of Section 11217, a licensed physician and surgeon may treat an addict a person with substance use disorder for addiction in any office or medical facility which, in the professional judgment of such the physician and surgeon, is medically proper for the rehabilitation and treatment of such addict. Such the person. A licensed physician and surgeon may administer to an addict, under his a person with substance use disorder, under their direct care, those medications and therapeutic agents which, in the judgment of such the physician and surgeon, are medically necessary, provided that nothing in this section shall authorize the administration of any narcotic drug.
SEC. 10.Section 11218 of the Health and Safety Code is amended to read:11218.A physician treating an addict a person with substance use disorder for addiction may not prescribe for or furnish to the addict person with substance use disorder more than any one of the following amounts of controlled substances during each of the first 15 days of that treatment:
(a) Eight grains of opium.
(b) Four grains of morphine.
(c) Six grains of Pantopon.
(d) One grain of Dilaudid.
(e) Four hundred milligrams of isonipecaine (Demerol).
SEC. 11.Section 11219 of the Health and Safety Code is amended to read:11219.After 15 days of treatment, the physician may not prescribe for or furnish to the addict person with substance use disorder more than any one of the following amounts of controlled substances during each day of the treatment:
(a) Four grains of opium.
(b) Two grains of morphine.
(c) Three grains of Pantopon.
(d) One-half grain of Dilaudid.
(e) Two hundred milligrams of isonipecaine (Demerol).
SEC. 12.Section 11380.7 of the Health and Safety Code is amended to read:11380.7.(a)Notwithstanding any other provision of law, any person who is convicted of trafficking in heroin, cocaine, cocaine base, methamphetamine, or phencyclidine (PCP), or of a conspiracy to commit trafficking in heroin, cocaine, cocaine base, methamphetamine, or phencyclidine (PCP), in addition to the punishment imposed for the conviction, shall be imprisoned pursuant to subdivision (h) of Section 1170 of the Penal Code for an additional one year if the violation occurred upon the grounds of, or within 1,000 feet of, a drug treatment center, detoxification facility, or homeless shelter.
(b)(1)The additional punishment provided in this section shall not be imposed unless the allegation is charged in the accusatory pleading and admitted by the defendant or found to be true by the trier of fact.
(2)The additional punishment provided in this section shall not be imposed if any other additional punishment is imposed pursuant to Section 11353.1, 11353.5, 11353.6, 11353.7, or 11380.1.
(c)Notwithstanding any other provision of law, the court may strike the additional punishment provided for in this section if it determines that there are circumstances in mitigation of the additional punishment and states on the record its reasons for striking the additional punishment. In determining whether or not to strike the additional punishment, the court shall consider the following factors and any relevant factors in aggravation or mitigation in Rules 4.421 and 4.423 of the California Rules of Court.
(1)The following factors indicate that the court should exercise its discretion to strike the additional punishment unless these factors are outweighed by factors in aggravation:
(A)The defendant is homeless, or is in a homeless shelter or transitional housing.
(B)The defendant lacks resources for the necessities of life.
(C)The defendant is addicted to or dependent on controlled substances.
(D)The defendants motive was merely to maintain a steady supply of drugs for personal use.
(E)The defendant was recruited or exploited by a more culpable person to commit the crime.
(2)The following factors indicate that the court should not exercise discretion to strike the additional punishment unless these factors are outweighed by factors in mitigation:
(A)The defendant, in committing the crime, preyed on homeless persons, drug addicts persons with substance use disorder, or substance abusers who were seeking treatment, shelter or transitional services.
(B)The defendants primary motive was monetary compensation.
(C)The defendant induced others, particularly homeless persons, drug addicts persons with substance use disorder, and substance abusers, to become involved in trafficking.
(d)For the purposes of this section, the following terms have the following meanings:
(1)Detoxification facility means any premises, place, or building in which 24-hour residential nonmedical services are provided to adults who are recovering from problems related to alcohol, drug, or alcohol and drug misuse or abuse, and who need alcohol, drug, or alcohol and drug recovery treatment or detoxification services.
(2)Drug treatment program or drug treatment has the same meaning set forth in subdivision (b) of Section 1210 of the Penal Code.
(3)Homeless shelter includes, but is not limited to, emergency shelter housing, as well as transitional housing, but does not include domestic violence shelters. Emergency shelter housing is housing with minimal support services for homeless persons in which residency is limited to six months or less and is not related to the persons ability to pay. Transitional housing means housing with supportive services, including self-sufficiency development services, which is exclusively designed and targeted to help recently homeless persons find permanent housing as soon as reasonably possible, limits residency to 24 months, and in which rent and service fees are based on ability to pay.
(4)Trafficking means any of the unlawful activities specified in Sections 11351, 11351.5, 11352, 11353, 11354, 11378, 11379, 11379.6, and 11380. It does not include simple possession or drug use.
SEC. 13.Section 11847 of the Health and Safety Code is amended to read:11847.The Legislature hereby finds and declares that it is essential to the health and welfare of the people of this state that action be taken by state government to effectively and economically utilize federal and state funds for narcotic and alcohol and other drug abuse prevention, care, treatment, and rehabilitation services. To achieve this, it is necessary that all of the following occur:
(a)Existing fragmented, uncoordinated, and duplicative narcotic and alcohol and other drug abuse programs be molded into a comprehensive and integrated statewide program for the prevention of narcotic and alcohol and other drug abuse and for the care, treatment, and rehabilitation of narcotic addicts persons with substance use disorder and alcohol and other drug users.
(b)Responsibility and authority for planning programs and activities for prevention, care, treatment, and rehabilitation of narcotic addicts persons with substance use disorder be concentrated in the department. It is the intent of the Legislature to assign responsibility and grant authority for planning narcotic and alcoholic and other drug abuse prevention, care, treatment, and rehabilitation programs to the department whose functions shall be subject to periodic review by the Legislature and appropriate federal agencies.
(c)The department succeeds to, and is vested with, all the duties, powers, purposes, responsibilities, and jurisdiction with regard to substance abuse formerly vested in the State Department of Alcohol and Drug Programs.
|
Date
|
Status
|
|---|---|
| Jun 29, 2023 | Chaptered by Secretary of State - Chapter 21, Statutes of 2023. |
| Jun 29, 2023 | Approved by the Governor. |
| Jun 19, 2023 | Enrolled and presented to the Governor at 1:30 p.m. |
| Jun 8, 2023 | In Assembly. Ordered to Engrossing and Enrolling. |
| Jun 8, 2023 | Read third time. Passed. Ordered to the Assembly. (Ayes 39. Noes 0. Page 1490.). |
| Jun 6, 2023 | Read second time. Ordered to Consent Calendar. |
| Jun 5, 2023 | From committee: Do pass. To Consent Calendar. (Ayes 13. Noes 0.) (June 5). |
| May 17, 2023 | Referred to Com. on B., P. & E. D. |
| May 4, 2023 | In Senate. Read first time. To Com. on RLS. for assignment. |
| May 4, 2023 | Read third time. Passed. Ordered to the Senate. (Ayes 75. Noes 0. Page 1461.) |
| Apr 27, 2023 | Read second time. Ordered to Consent Calendar. |
| Apr 26, 2023 | From committee: Do pass. To Consent Calendar. (Ayes 16. Noes 0.) (April 25). |
| Mar 2, 2023 | Referred to Com. on B. & P. |
| Feb 16, 2023 | From printer. May be heard in committee March 18. |
| Feb 15, 2023 | Read first time. To print. |
|
Date
|
Description
|
Location
|
Votes
|
|
|---|---|---|---|---|
| Jun 8, 2023 | Consent Calendar AB1130 Berman | Senate Floor |
Passed |
|
| Jun 5, 2023 | Do pass and be ordered to the Consent Calendar | Senate Standing Committee on Business, Professions and Economic Development |
Passed |
|
| May 4, 2023 | AB 1130 Berman Consent Calendar Second Day Regular Session | Assembly Floor |
Passed |
|
| Apr 25, 2023 | Do pass. To Consent Calendar. | Assembly Standing Committee on Business and Professions |
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
|
|---|---|---|
| Alcohol Justice | ** Support | |
| National Association Of Social Workers, California Chapter | ** Support |
SENATE RULES COMMITTEE Office of Senate Floor Analyses (916) 651-1520 Fax: (916) 327-4478 | AB 1130 |
CONSENT
Bill No: AB 1130
Author: Berman (D)
Introduced: 2/15/23
Vote: 21
SENATE BUS., PROF. & ECON. DEV. COMMITTEE: 13-0, 6/5/23
AYES: Roth, Nguyen, Alvarado-Gil, Archuleta, Ashby, Becker, Dodd, Eggman, Glazer, Niello, Smallwood-Cuevas, Wahab, Wilk
ASSEMBLY FLOOR: 75-0, 5/4/23 (Consent) - See last page for vote
SUBJECT: Substance use disorder
SOURCE: Author
DIGEST:
This bill replaces the term “addict” with “person with substance use disorder” in various provisions of the Business and Professions (BPC) and Health and Safety (HSC) codes.
ANALYSIS:
Existing law:
- Defines “addict” as a person whose actions are characterized by craving in combination with one or more of the following:
- Impaired control over drug use.
- Compulsive use.
- Continued use despite harm.
(Business and Professions Code (BPC) § 2241)
- Provides for the circumstances under which a physician and surgeon may prescribe, dispense, or administer prescription drugs, including prescription controlled substances, to an addict. (BPC §§ 2241, 2241.5)
- Authorizes the California State Board of Pharmacy to take disciplinary action against a licensee for knowingly selling, furnishing, giving away, or administering any controlled substance to an addict, except for under certain circumstances. (BPC § 4301)
- Provides that a prescription is not legal if it is an order for an addict or habitual user of controlled substances, unless it is issued in the course of professional treatment or as part of an authorized narcotic treatment program, for the purpose of providing the user with controlled substances sufficient to keep them comfortable by maintaining customary use. (Health and Safety Code (HSC) § 11153)
- Prohibits medical professionals from prescribing, administering, or dispensing a controlled substance to an addict, as defined. (HSC § 11156)
- Proscribes requirements for the use of controlled substances in the treatment of an addict for addiction. (HSC §§ 11215 et seq.)
- Includes among the factors indicating that a court should not exercise discretion to strike additional punishments for drug trafficking, whether the defendant, in committing the crime, preyed on drug addicts. (HSC § 11380.7)
- Makes findings and declarations regarding the need to implement a comprehensive and integrated statewide program to address the prevention, care, treatment, and rehabilitation of narcotics addicts. (HSC § 11847)
This bill replaces the term “addict” with “person with substance use disorder” in the BPC and HSC codes above.
Background
Information provided by the author notes that the National Institute on Drug Abuse within the National Institutes of Health (NIH) has published guidance on preferred language for talking about addiction. This guidance urges providers to use person-first language and avoid terms that increase stigma and negative bias when discussing the disease of addiction. The educational resources published by NIH discourage use of the term “addict” and advocate for its replacement with the term “person with substance use disorder,” explaining that shifting to person-first language ‘shows that a person ‘has’ a problem, rather than ‘is’ the problem.’ The NIH guidance is aligned with modern research into the effect of addiction stigma in the treatment of substance use disorder.
One editorial published by a peer-reviewed journal focused on the treatment of addiction treatment made the case as follows: “Appropriate use of language in the field of addiction is important. Inappropriate use of language can negatively impact the way society perceives substance use and the people who are affected by it. Language frames what the public thinks about substance use and recovery, and it can also affect how individuals think about themselves and their own ability to change. But most importantly, language intentionally and unintentionally propagates stigma: the mark of dishonor, disgrace, and difference that depersonalizes people, depriving them of individual or personal qualities and personal identity. Stigma is harmful, distressing, and marginalizing to the individuals, groups, and populations who bear it.” The editorial concluded by “[making] an appeal for the use of language that (1) respects the worth and dignity of all persons (“people-first language”); (2) focuses on the medical nature of substance use disorders and treatment; (3) promotes the recovery process; and (4) avoids perpetuating negative stereotypes and biases through the use of slang and idioms.”
FISCAL EFFECT: Appropriation: No Fiscal Com.: No Local: No
SUPPORT: (Verified 6/6/23)
Alcohol Justice
National Association of Social Workers, California Chapter
OPPOSITION: (Verified 6/6/23)
None received
ARGUMENTS IN SUPPORT: Alcohol Justice writes in support, noting that the term addict is outdated because it is inaccurate and stigmatizing. According to the organization, “As the current Diagnostic and Statistical Manual of Mental Disorders, 5th Addition (DSM-V) seeks to explain, the disorders formerly described as alcohol- or drug addiction are best understood by their consequences to the person experiencing them, as opposed to a mere judgment of substance use patterns. By these standards, someone can be experiencing substance use disorder without habitual use, or someone can exhibit habitual use without experiencing sufficient harm to qualify as disordered. In light of this conception, ‘addiction’ and ‘addict’ lose their definitions and become meaningless.” They also state that “Regardless of one’s personal views of language shifts, much of the time one can find outright, practical needs for them. The move away from ‘addict’ in favor of ‘person with substance use disorder’ is one of them. Addict is frequently use a pejorative, and is laden with assumptions about the value, behavior, and nature of people who use drugs or alcohol that do not stand up to current understandings. By perpetuating that language, we risk a) alienating people seeking treatment and reducing their sense of self-efficacy when engaging in it; b) creating negative perceptions of clinicians and other care providers towards people seeking help, which in turn discourages help-seeking; and c) exacerbating public attitudes that might be hostile to providing avenues of care or other services to individuals who use drugs or alcohol.”
According to the National Association of Social Workers, California Chapter, “Person first language humanizes individuals and shows that the person has a problem rather than is the problem.”
ASSEMBLY FLOOR: 75-0, 5/4/23
AYES: Addis, Aguiar-Curry, Alanis, Alvarez, Arambula, Bains, Bauer-Kahan, Bennett, Berman, Boerner, Bonta, Bryan, Calderon, Juan Carrillo, Wendy Carrillo, Cervantes, Chen, Connolly, Megan Dahle, Davies, Dixon, Essayli, Mike Fong, Vince Fong, Friedman, Gabriel, Gallagher, Garcia, Gipson, Grayson, Haney, Hart, Holden, Hoover, Irwin, Jackson, Jones-Sawyer, Kalra, Lackey, Lee, Low, Lowenthal, Maienschein, Mathis, McCarty, Stephanie Nguyen, Ortega, Pacheco, Papan, Jim Patterson, Joe Patterson, Pellerin, Petrie-Norris, Quirk-Silva, Ramos, Reyes, Luz Rivas, Robert Rivas, Rodriguez, Blanca Rubio, Sanchez, Santiago, Schiavo, Soria, Ta, Ting, Valencia, Villapudua, Waldron, Ward, Weber, Wilson, Wood, Zbur, Rendon
NO VOTE RECORDED: Flora, McKinnor, Muratsuchi, Wallis, Wicks
Prepared by: Sarah Mason / B., P. & E.D. /
6/7/23 15:04:35
**** END ****
SENATE COMMITTEE ON
BUSINESS, PROFESSIONS AND ECONOMIC DEVELOPMENT
Senator Richard Roth, Chair
2023 - 2024 Regular
Bill No: Hearing Date: June 5, 2023
Author: | |||
Version: | February 15, 2023 | ||
Urgency: | No | Fiscal: | No |
Consultant: | Sarah Mason | ||
Subject:
SUMMARY:
Replaces the term “addict” with “person with substance use disorder” in various provisions of the Business and Professions (BPC) and Health and Safety (HSC) codes.
Existing law:
- Defines “addict” as a person whose actions are characterized by craving in combination with one or more of the following:
- Impaired control over drug use.
- Compulsive use.
- Continued use despite harm.
(Business and Professions Code (BPC) § 2241)
- Provides for the circumstances under which a physician and surgeon may prescribe, dispense, or administer prescription drugs, including prescription controlled substances, to an addict. (BPC §§ 2241, 2241.5)
- Authorizes the California State Board of Pharmacy to take disciplinary action against a licensee for knowingly selling, furnishing, giving away, or administering any controlled substance to an addict, except for under certain circumstances. (BPC § 4301)
- Provides that a prescription is not legal if it is an order for an addict or habitual user of controlled substances, unless it is issued in the course of professional treatment or as part of an authorized narcotic treatment program, for the purpose of providing the user with controlled substances sufficient to keep them comfortable by maintaining customary use. (Health and Safety Code (HSC) § 11153)
- Prohibits medical professionals from prescribing, administering, or dispensing a controlled substance to an addict, as defined. (HSC § 11156)
- Proscribes requirements for the use of controlled substances in the treatment of an addict for addiction. (HSC §§ 11215 et seq.)
- Includes among the factors indicating that a court should not exercise discretion to strike additional punishments for drug trafficking, whether the defendant, in committing the crime, preyed on drug addicts. (HSC § 11380.7)
- Makes findings and declarations regarding the need to implement a comprehensive and integrated statewide program to address the prevention, care, treatment, and rehabilitation of narcotics addicts. (HSC § 11847)
This bill replaces the term “addict” with “person with substance use disorder” in the BPC and HSC codes above.
FISCAL EFFECT:
Unknown. This bill is not keyed fiscal by Legislative Counsel.
COMMENTS:
- Purpose. The Author is the Sponsor of this bill. According to the Author, “Over the past several decades, policymakers and public health experts have worked collaboratively to advance laws in California that reflect modern best practices in the treatment of substance use disorder. State policy has undergone a paradigm shift away from criminalizing addiction and toward acknowledging that addiction is first and foremost a health concern. Medication-assisted treatment, harm reduction strategies, and funding for local substance use disorder treatment programs have all played a role in these efforts. Nevertheless, numerous provisions of law currently use the outdated term “addict” to describe individuals suffering from substance use disorder.”
The Author states that “This bill would reflect the expert consensus around the need for person-first, non-pejorative language in the discussion of persons suffering from addiction or substance use disorder. While the immediate effect of the bill would appear to primarily be technical, it represents a substantive shift in the state’s approach to a significant public health problem. Replacing the term “addict” in code will represent a meaningful step in California’s continued progress toward reducing stigma and enhancing treatment of individuals suffering with substance use disorder.”
- Background. Information provided by the Author notes that The National Institute on Drug Abuse within the National Institutes of Health (NIH) has published guidance on preferred language for talking about addiction. This guidance urges providers to use person-first language and avoid terms that increase stigma and negative bias when discussing the disease of addiction. The educational resources published by NIH discourage use of the term “addict” and advocate for its replacement with the term “person with substance use disorder,” explaining that shifting to person-first language ‘shows that a person ‘has’ a problem, rather than ‘is’ the problem.’ The NIH guidance is aligned with modern research into the effect of addiction stigma in the treatment of substance use disorder.
One editorial published by a peer-reviewed journal focused on the treatment of addiction treatment made the case as follows: “Appropriate use of language in the field of addiction is important. Inappropriate use of language can negatively impact the way society perceives substance use and the people who are affected by it. Language frames what the public thinks about substance use and recovery, and it can also affect how individuals think about themselves and their own ability to change. But most importantly, language intentionally and unintentionally propagates stigma: the mark of dishonor, disgrace, and difference that depersonalizes people, depriving them of individual or personal qualities and personal identity. Stigma is harmful, distressing, and marginalizing to the individuals, groups, and populations who bear it.” The editorial concluded by “[making] an appeal for the use of language that (1) respects the worth and dignity of all persons (“people-first language”); (2) focuses on the medical nature of substance use disorders and treatment; (3) promotes the recovery process; and (4) avoids perpetuating negative stereotypes and biases through the use of slang and idioms.”
- Arguments in Support. Alcohol Justice writes in support, noting that the term addict is outdated because it is inaccurate and stigmatizing. According to the organization, “As the current Diagnostic and Statistical Manual of Mental Disorders, 5th Addition (DSM-V) seeks to explain, the disorders formerly described as alcohol- or drug addiction are best understood by their consequences to the person experiencing them, as opposed to a mere judgment of substance use patterns. By these standards, someone can be experiencing substance use disorder without habitual use, or someone can exhibit habitual use without experiencing sufficient harm to qualify as disordered. In light of this conception, “addiction” and “addict” lose their definitions and become meaningless.” They also state that “Regardless of one’s personal views of language shifts, much of the time one can find outright, practical needs for them. The move away from ‘addict’ in favor of ‘person with substance use disorder’ is one of them. Addict is frequently use a pejorative, and is laden with assumptions about the value, behavior, and nature of people who use drugs or alcohol that do not stand up to current understandings. By perpetuating that language, we risk a) alienating people seeking treatment and reducing their sense of self-efficacy when engaging in it; b) creating negative perceptions of clinicians and other care providers towards people seeking help, which in turn discourages help-seeking; and c) exacerbating public attitudes that might be hostile to providing avenues of care or other services to individuals who use drugs or alcohol.”
According to the National Association of Social Workers, California Chapter, “Person first language humanizes individuals and shows that the person has a problem rather than is the problem.”
SUPPORT AND OPPOSITION:
Support:
Alcohol Justice
National Association of Social Workers, California Chapter
Opposition:
None received
-- END --
Date of Hearing:
ASSEMBLY COMMITTEE ON BUSINESS AND PROFESSIONS
Marc Berman, Chair
ABPCA Bill Id:AB 1130
Author:(Berman) – As Introduced Ver:February 15, 2023
SUBJECT: Substance use disorder.
SUMMARY: Updates various provisions of code to replace use of the term “addict” with the term “person with substance use disorder.”
EXISTING LAW:
- Defines “addict” as a person whose actions are characterized by craving in combination with one or more of the following:
- Impaired control over drug use.
- Compulsive use.
- Continued use despite harm.
(Business and Professions Code (BPC § 2241)
- Provides for the circumstances under which a physician and surgeon may prescribe, dispense, or administer prescription drugs, including prescription controlled substances, to an addict. (BPC §§ 2241, 2241.5)
- Authorizes the California State Board of Pharmacy to take disciplinary action against a licensee for knowingly selling, furnishing, giving away, or administering any controlled substance to an addict, except for under certain circumstances. (BPC § 4301)
- Provides that a prescription is not legal if it is an order for an addict or habitual user of controlled substances, unless it is issued in the course of professional treatment or as part of an authorized narcotic treatment program, for the purpose of providing the user with controlled substances sufficient to keep them comfortable by maintaining customary use. (Health and Safety Code (HSC) § 11153)
- Prohibits medical professionals from prescribing, administering, or dispensing a controlled substance to an addict, as defined. (HSC § 11156)
- Proscribes requirements for the use of controlled substances in the treatment of an addict for addiction. (HSC §§ 11215 et seq.)
- Includes among the factors indicating that a court should not exercise discretion to strike additional punishments for drug trafficking, whether the defendant, in committing the crime, preyed on drug addicts. (HSC § 11380.7)
- Makes findings and declarations regarding the need to implement a comprehensive and integrated statewide program to address the prevention, care, treatment, and rehabilitation of narcotics addicts. (HSC § 11847)
THIS BILL:
- Replaces the term “addict” with “person with substance use disorder” in various provisions of the BPC and HSC.
FISCAL EFFECT: This bill is keyed nonfiscal by the Legislative Counsel.
COMMENTS:
Purpose. This bill is sponsored by the author. According to the author:
“As an epidemic of substance use disorder has continued to grow toward a crisis point in California, there is a consensus among experts that vilifying the afflicted is not an effective public health strategy. Use of the term ‘addict’ is outdated and not representative of the terminology we should use to describe those in need of care and support. AB 1130 would modernize our laws to reflect the appropriate use of person-first language in regards to individuals with substance use disorders.”
Background.
To adapt and paraphrase a quote by the late Mitchell Hedberg: “Addiction is a disease, but it is the only disease that you get yelled at for having.” Over the past several decades, policymakers and public health experts have worked collaboratively to advance laws in California that reflect modern best practices in the treatment of substance use disorder. State policy has undergone a paradigm shift away from criminalizing addiction and toward acknowledging that addiction is first and foremost a health concern. Medication-assisted treatment, harm reduction strategies, and funding for local substance use disorder treatment programs have all played a role in these efforts.
Nevertheless, numerous provisions of law currently use the outdated term “addict” to describe individuals suffering from substance use disorder. The National Institute on Drug Abuse within the National Institutes of Health (NIH) has published guidance on preferred language for talking about addiction. This guidance urges providers to use person-first language and avoid terms that increase stigma and negative bias when discussing the disease of addiction. The educational resources published by NIH discourage use of the term “addict” and advocate for its replacement with the term “person with substance use disorder,” explaining that shifting to person-first language “shows that a person ‘has’ a problem, rather than ‘is’ the problem.”[1]
The NIH guidance is aligned with modern research into the effect of addiction stigma in the treatment of substance use disorder. One editorial[2] published by a peer-reviewed journal focused on the treatment of addiction treatment made the case as follows:
“Appropriate use of language in the field of addiction is important. Inappropriate use of language can negatively impact the way society perceives substance use and the people who are affected by it. Language frames what the public thinks about substance use and recovery, and it can also affect how individuals think about themselves and their own ability to change. But most importantly, language intentionally and unintentionally propagates stigma: the mark of dishonor, disgrace, and difference that depersonalizes people, depriving them of individual or personal qualities and personal identity. Stigma is harmful, distressing, and marginalizing to the individuals, groups, and populations who bear it.”
The editorial concluded by “[making] an appeal for the use of language that (1) respects the worth and dignity of all persons (“people-first language”); (2) focuses on the medical nature of substance use disorders and treatment; (3) promotes the recovery process; and (4) avoids perpetuating negative stereotypes and biases through the use of slang and idioms.”
This bill would reflect the expert consensus around the need for person-first, non-pejorative language in the discussion of persons suffering from addiction or substance use disorder. While the immediate effect of the bill would appear to primarily be technical, it represents a substantive shift in the state’s approach to a significant public health problem. Replacing the term “addict” in code will represent a meaningful step in California’s continued progress toward reducing stigma and enhancing treatment of individuals suffering with substance use disorder.
Prior Related Legislation. AB 1055 (Bains) would create an Allied Behavioral Health Board within the Department of Consumer Affairs to license alcohol drug counselors. This bill is pending in this committee.
ARGUMENTS IN SUPPORT:
Alcohol Justice supports this bill, writing: “We strongly support shifting public language to less stigmatic framing. We are in the midst of twin opioid and alcohol crises, and every step we take to providing services that are welcoming, nonjudgmental, and compassionate is desperately needed. Please demonstrate that California understands and accepts the best clinical standards of care, including framing language, and vote ‘yes’ on AB 1130.”
ARGUMENTS IN OPPOSITION:
None on file.
REGISTERED SUPPORT:
Alcohol Justice
REGISTERED OPPOSITION:
None on file.
Analysis Prepared by: Robert Sumner / B. & P. / (916) 319-3301
https://nida.nih.gov/nidamed-medical-health-professionals/health-professions-education/words-matter-terms-to-use-avoid-when-talking-about-addiction ↑
Broyles, Lauren M., et al. “Confronting inadvertent stigma and pejorative language in addiction scholarship: a recognition and response.” Substance Abuse 35.3 (2014). ↑
Bill Author
Bill Co-Author(s):