Existing law establishes the State Department of Public Health under the direction of the State Public Health Officer. Existing law requires that each death be registered with the local registrar of births and deaths in the district in which the death was officially pronounced or the body was found. Existing law sets forth the persons responsible for completing the certificate of death and the required contents of the certificate, including, but not limited to, the decedents name, sex, and birthplace. Existing law requires a person completing the certificate of death to record whether the decedent was ever in the Armed Forces of the United States.

Existing law also requires the State Department of Public Health to access data within the electronic death registration system to compile a report on veteran suicide in California and requires the department to annually provide that report to the Legislature and the Department of Veterans Affairs.

This bill would require the State Department of Public Health to access data within the electronic death registration system to compile a report on veteran drug overdose deaths in California and require the department to annually provide that report to the Legislature and the Department of Veteran Affairs on or before March 15 each year. The bill would require the report to include a cross-tabulation of the specified data and compare it to the data from the previous year. The bill would also require the California Overdose Surveillance Dashboard to reflect overdose deaths by veterans.

Existing law establishes the State Department of Public Health under the direction of the State Public Health Officer. Existing law requires that each death be registered with the local registrar of births and deaths in the district in which the death was officially pronounced or the body was found. Existing law sets forth the persons responsible for completing the certificate of death and the required contents of the certificate, including, but not limited to, the decedents name, sex, and birthplace. Existing law requires a person completing the certificate of death to record whether the decedent was ever in the Armed Forces of the United States.

Existing law also requires the State Department of Public Health to access data within the electronic death registration system to compile a report on veteran suicide in California and requires the department to annually provide that report to the Legislature and the Department of Veterans Affairs.

This bill would require the State Department of Public Health to access data within the electronic death registration system to compile a report on veteran drug overdose deaths in California and require the department to annually provide that report to the Legislature and the Department of Veteran Affairs on or before March 15 each year. The bill would require the report to include a cross-tabulation of the specified data and compare it to the data from the previous year. The bill would also require the California Overdose Surveillance Dashboard to reflect overdose deaths by veterans.

Existing law establishes the State Department of Public Health under the direction of the State Public Health Officer. Existing law requires that each death be registered with the local registrar of births and deaths in the district in which the death was officially pronounced or the body was found. Existing law sets forth the persons responsible for completing the certificate of death and the required contents of the certificate, including, but not limited to, the decedents name, sex, and birthplace. Existing law requires a person completing the certificate of death to record whether the decedent was ever in the Armed Forces of the United States.

Existing law also requires the State Department of Public Health to access data within the electronic death registration system to compile a report on veteran suicide in California and requires the department to annually provide that report to the Legislature and the Department of Veterans Affairs.

This bill would require the State Department of Public Health to access data within the electronic death registration system to compile a report on veteran drug overdose deaths in California and require the department to annually provide that report to the Legislature and the Department of Veteran Affairs on or before March 15 each year. The bill would require the report to include a cross-tabulation of the specified data and compare it to the data from the previous year. The bill would also require the California Overdose Surveillance Dashboard to reflect overdose deaths by veterans.

Existing law establishes the State Department of Public Health under the direction of the State Public Health Officer. Existing law requires that each death be registered with the local registrar of births and deaths in the district in which the death was officially pronounced or the body was found. Existing law sets forth the persons responsible for completing the certificate of death and the required contents of the certificate, including, but not limited to, the decedents name, sex, and birthplace. Existing law requires a person completing the certificate of death to record whether the decedent was ever in the Armed Forces of the United States.

Existing law also requires the State Department of Public Health to access data within the electronic death registration system to compile a report on veteran suicide in California and requires the department to annually provide that report to the Legislature and the Department of Veterans Affairs.

This bill would require the State Department of Public Health to access data within the electronic death registration system to compile a report on veteran drug overdose deaths in California and require the department to annually provide that report to the Legislature and the Department of Veteran Affairs on or before March 15 each year. The bill would require the report to include a cross-tabulation of the specified data and compare it to the data from the previous year. The bill would also require the California Overdose Surveillance Dashboard to reflect overdose deaths by veterans.

CONCURRENCE IN SENATE AMENDMENTS

CSA1 Bill Id:AB 1462

Author:(Jim Patterson)

As Amended Ver:September 7, 2023

Majority vote

SUMMARY

Requires the California Department of Public Health (DPH) to access existing data within the electronic death registration system to compile a report on veteran drug overdose deaths in California and to report specified data.

Senate Amendments

Add a coauthor.

COMMENTS

Veteran Overdose Rates. Drug overdose became the leading cause of injury-related death in the United States (U.S.), surpassing deaths from traffic accidents in 2009. According to the U.S. Centers for Disease Control and Preventions (CDC), 107,375 people in the United States died of drug overdoses and drug poisonings in the 12-month period ending in January 2022. A staggering 67% of those deaths involved synthetic opioids like fentanyl. Fentanyl is a synthetic opioid that is 50-100 times stronger than morphine.

An April 2022, cross-sectional study reported in Drug and Alcohol Dependence, entitled "Veteran Drug Overdose Mortality, 2010-2019" details veteran drug overdose mortality from the years 2010 to 2019. The researchers used data cross-referenced from multiple sources – Veterans Administration (VA) medical records, the VA/Department of Defense Mortality Data repository, and the CDC's Wide-ranging Online Data for Epidemiologic Research. The data show that the age-adjusted mortality rate in veteran opioid overdose deaths from 2010-2019 increased 53.2%. Veteran men experienced the largest increase in opioid overdose deaths compared to women, and veterans in the 65+ age group experienced the largest increase compared to other age groups.

The study also analyzed veteran mortality by opioid type. Overall opioid overdose mortality rates for veterans increased from 1,891 in 2010 to 3,197 in 2019. Synthetic opioid overdose deaths, most often linked to fentanyl, account for much of that increase.

The study referenced above is valuable, but presumably very labor intensive, as researchers had to gain access to and merge data sets from multiple federal record sources. Other than this study, there is very little comprehensive data on veteran opioid overdose deaths. Despite efforts to curb opioid and other substance-related mortality among the general population and specifically veterans, the opioid overdose public health crisis persists, with the highest number of overdose fatalities ever reported during 2020-2021 among the general population. Many veterans face difficult challenges combining problems of pain management, substance use, service-related mental and physical health problems, and the day-to-day challenges associated with housing, employment, and relationships, all of which can heighten risk for drug overdose. Tracking trends during this crisis is necessary to inform any initiatives or interventions that may help to prevent veteran opioid deaths.

According to the Author

This bill will require DPH to collect data on accidental veteran overdoses so that the public and the Legislature have a better picture of the reality of overdoses resulting in death for our veteran population.

Arguments in Support

Parents and Addicts in Need (PAIN), in a support position states that California already reports overdoses on the California Overdose Surveillance Dashboard which is creased from data available through a collaboration between the DPH, the Department of Health Care Access and Information, the Department of Justice, and the California HealthCare Foundation. However, there is no data that is specific to veterans. As we already know, veterans are at a higher risk of substance use disorder and overdose than the general population. They may struggle with physical and psychological injuries sustained during their service, which can lead to chronic pain, mental health issues, and addition. PAIN concludes by stating that without accurate data, it is difficult to allocate resources effectively and to make informed decisions about how best to support veterans in need.

Arguments in Opposition

The Department of Finance (DOF) is opposed to this bill because it results in General Fund (GF) costs that should be considered as part of the annual budget process. DPH currently funds the California Overdose Surveillance Dashboard via federal funds received through its Overdose Data to Action cooperative agreement through the CDC. Due to the CDC’s revised federal funding allocation calculation, the most recent national formula adopted for 2023-2028 will result in a reduced funding level for California from 2019-2023 levels, despite California experiencing an increase in overdose deaths (by count). Although the Opioid Settlements Fund (OSF) may be an allowable alternative funding source for DPH’s one-time costs in 2024-25 under existing law, the 2023 Budget includes an OSF spending plan between 2023-24 and 2026-27 which fully allocates projected revenues within that time period. Also, the 2023 Budget authorizes the DOF to augment the Department of Health Care Service’s OSF appropriation to support the Naloxone Distribution Project if additional OSF revenues become available between 2023-24 and 2026-27. As such, it is unclear if any additional revenues would be available to support DPH’s $78,000 costs in 2024-25.

FISCAL COMMENTS

According to the Senate Appropriations Committee, DPH estimates one-time GF costs of $78,000 to enter into a contract with an external vendor to provide consultation and training related to the dashboard modifications to incorporate veteran status in reports of overdose deaths.

VOTES:

ASM HEALTH: 14-0-1

YES: Wood, Waldron, Aguiar-Curry, Arambula, Boerner Horvath, Flora, Vince Fong, Maienschein, McCarty, Joe Patterson, Rodriguez, Santiago, Villapudua, Weber

ABS, ABST OR NV: Wendy Carrillo

ASM MILITARY AND VETERANS AFFAIRS: 11-0-0

YES: Soria, Davies, Addis, Alvarez, Boerner Horvath, Juan Carrillo, Mathis, Muratsuchi, Petrie-Norris, Ta, Valencia

ASM APPROPRIATIONS: 15-0-1

YES: Holden, Megan Dahle, Bryan, Calderon, Wendy Carrillo, Dixon, Mike Fong, Hart, Lowenthal, Mathis, Papan, Pellerin, Sanchez, Weber, Ortega

ABS, ABST OR NV: Robert Rivas

ASSEMBLY FLOOR: 75-0-5

YES: Addis, Alanis, Arambula, Bains, Bauer-Kahan, Berman, Boerner, Bonta, Bryan, Calderon, Juan Carrillo, Wendy Carrillo, Cervantes, Chen, Connolly, Megan Dahle, Davies, Dixon, Essayli, Flora, Mike Fong, Vince Fong, Friedman, Gabriel, Gallagher, Garcia, Gipson, Grayson, Haney, Hart, Holden, Hoover, Irwin, Jackson, Jones-Sawyer, Kalra, Lackey, Lee, Low, Lowenthal, Maienschein, McCarty, McKinnor, Muratsuchi, Stephanie Nguyen, Ortega, Pacheco, 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, Wallis, Ward, Weber, Wicks, Wilson, Wood, Zbur, Rendon

ABS, ABST OR NV: Aguiar-Curry, Alvarez, Bennett, Mathis, Papan

UPDATED

VERSION: September 7, 2023

CONSULTANT: Judith Babcock / HEALTH / (916) 319-2097 FN: 0002037

 THIRD READING  

Bill No: AB 1462

Author: Jim Patterson (R), et al.

Amended: 9/7/23 in Senate

Vote: 21

SENATE HEALTH COMMITTEE: 12-0, 6/14/23

AYES: Eggman, Nguyen, Glazer, Gonzalez, Grove, Hurtado, Limón, Menjivar, Roth, Rubio, Wahab, Wiener

SENATE MILITARY & VETERANS COMMITTEE: 5-0, 7/10/23

AYES: Archuleta, Grove, Alvarado-Gil, Menjivar, Umberg

SENATE APPROPRIATIONS COMMITTEE: 7-0, 9/1/23

AYES: Portantino, Jones, Ashby, Bradford, Seyarto, Wahab, Wiener

ASSEMBLY FLOOR: 75-0, 5/25/23 - See last page for vote

SUBJECT: Veteran overdose deaths

SOURCE: Author

DIGEST:

This bill requires the California Department of Public Health to compile a report for the Legislature and the California Department of Veterans Affairs on veteran drug overdose deaths in the state.

Senate Floor Amendments of 9/7/23 correct phrasing and add Senator Rubio as a coauthor.

ANALYSIS:

Existing law:

1. Requires each live birth, fetal death, death, and marriage that occurs in the state to be registered, as specified. [HSC §102100]
2. Requires a certificate of death to include the decedent’s full name, sex, color or race, marital status, name of spouse, date of birth and age at death, birthplace, usual residence, occupation and industry or business, and whether the decedent was ever in the Armed Forces of the United States. [HSC §102875]
3. Establishes an Internet-based electronic death registration system (EDRS) for the creation, storage, and transfer of death registration information. [HSC §102778]
4. Requires the California Department of Public Health (CDPH) to access data within the EDRS to compile a report on veteran suicide in California. Requires the report to include, but not be limited to, information on the ages, sexes, races or ethnicities, counties of residence, and methods of suicide. Requires the report to include a cross-tabulation of the data specified and to compare the data to the data from the previous year. Requires CDPH, on or before March 15, of each year, to provide the report to the Legislature and the California Department of Veterans Affairs (CalVet). [HSC §102791]

This bill:

1. Requires CDPH to access data within EDRS to compile a report on veteran drug overdose deaths in California. Requires the report to include such information as age, sex, race or ethnicity, counties of residence, and drug or drugs causing overdose deaths of veterans.
2. Requires the report to include cross-tabulation of the data specified in 1) above, and to compare the data to the data from the previous year.
3. Requires CDPH to provide the report annually to the Legislature and CalVet on or before March 15 each year.
4. Requires the California Overdose Surveillance Dashboard, maintained by CDPH on its website, to be updated to reflect veteran status in information reported about deaths.

Background

Drug overdose became the leading cause of injury-related death in the U.S., surpassing deaths from traffic accidents in 2009. According to the U.S. Centers for Disease Control and Preventions (CDC), 107,375 people in the United States died of drug overdoses and drug poisonings in the 12-month period ending in January 2022. Sixty-seven percent of those deaths involved synthetic opioids like fentanyl. An April 2022 study reported in Drug and Alcohol Dependence, entitled “Veteran Drug Overdose Mortality, 2010-2019” details veteran drug overdose mortality from the years 2010 to 2019. The researchers used data cross-referenced from multiple sources: Veterans Administration (VA) medical records, the VA/Department of Defense Mortality Data repository, and the CDC’s Online Data for Epidemiologic Research. The data show that the age-adjusted mortality rate in veteran opioid overdose deaths from 2010-2019 increased 53.2%. Veteran men experienced the largest increase in opioid overdose deaths compared to women, and veterans in the 65+ age group experienced the largest increase compared to other age groups. The study also analyzed veteran mortality by opioid type. Overall opioid overdose mortality rates for veterans increased from 1,891 in 2010 to 3,197 in 2019. Synthetic opioid overdose deaths, most often linked to fentanyl, account for much of that increase. Other than this study, there is very little comprehensive data on veteran opioid overdose deaths. Despite efforts to curb opioid and other substance-related mortality among the general population and specifically veterans, the opioid overdose public health crisis persists, with the highest number of overdose fatalities ever reported during 2020-2021 among the general population. Many veterans face difficult challenges combining problems of pain management, substance use, service-related mental and physical health problems, and the day-to-day challenges associated with housing, employment, and relationships, all of which can heighten risk for drug overdose. Tracking trends during this crisis is necessary to inform any initiatives or interventions that may help to prevent veteran opioid deaths.

Comments

Author’s statement. According to the author, this bill will require CDPH to collect data on accidental veteran overdoses so that the public and the Legislature have a better picture of the reality of overdoses resulting in death for our veteran population.

FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: No

According to the Senate Appropriations Committee, CDPH estimates one-time General Fund costs of $78,000 to enter into a contract with an external vendor to provide consultation and training related to the dashboard modifications to incorporate veteran status in reports of overdose deaths.

SUPPORT: (Verified 9/7/23)

American Legion, Department of California

American Veterans, Department of California

California Association of County Veterans Service Officers

California Association of Veteran Service Agencies

California State University, Fresno, Student Veterans Organization

County Behavioral Health Directors Association of California

County of Fresno Veterans Services Office

Military Officers Association of America, California Council of Chapters

Parents and Addicts in Need

OPPOSITION: (Verified 9/7/23)

Department of Finance

ARGUMENTS IN SUPPORT: Supporters state that California already reports overdoses on the California Overdose Surveillance Dashboard, which is made by data available through the collaboration between CDPH, the California Department of Health Care Access and Information, the Department of Justice, and the California Health Care Foundation. However, there is no data that details the overdose specifics for veterans. Supporters argue veterans are at a higher risk of substance abuse and overdose than the general population. They may struggle with physical and psychological injuries sustained during their service, which can lead to chronic pain, mental health issues, and addiction. Tracking veteran overdoses can help identify patterns and risk factors that can be addressed and prevented. Without accurate data, it is difficult to allocate resources effectively and make informed decisions about how best to support veterans in need.

ARGUMENTS IN OPPOSITION: The Department of Finance is opposed to this bill because it results in General Fund costs that should be considered as part of the annual budget process.

ASSEMBLY FLOOR: 75-0, 5/25/23

AYES: Addis, Alanis, Arambula, Bains, Bauer-Kahan, Berman, Boerner, Bonta, Bryan, Calderon, Juan Carrillo, Wendy Carrillo, Cervantes, Chen, Connolly, Megan Dahle, Davies, Dixon, Essayli, Flora, Mike Fong, Vince Fong, Friedman, Gabriel, Gallagher, Garcia, Gipson, Grayson, Haney, Hart, Holden, Hoover, Irwin, Jackson, Jones-Sawyer, Kalra, Lackey, Lee, Low, Lowenthal, Maienschein, McCarty, McKinnor, Muratsuchi, Stephanie Nguyen, Ortega, Pacheco, 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, Wallis, Ward, Weber, Wicks, Wilson, Wood, Zbur, Rendon

NO VOTE RECORDED: Aguiar-Curry, Alvarez, Bennett, Mathis, Papan

Prepared by: Reyes Diaz / HEALTH / (916) 651-4111

9/8/23 16:27:28

**** END ****

 THIRD READING  

Bill No: AB 1462

Author: Jim Patterson (R)

Introduced: 2/17/23

Vote: 21

SENATE HEALTH COMMITTEE: 12-0, 6/14/23

AYES: Eggman, Nguyen, Glazer, Gonzalez, Grove, Hurtado, Limón, Menjivar, Roth, Rubio, Wahab, Wiener

SENATE MILITARY & VETERANS COMMITTEE: 5-0, 7/10/23

AYES: Archuleta, Grove, Alvarado-Gil, Menjivar, Umberg

SENATE APPROPRIATIONS COMMITTEE: 7-0, 9/1/23

AYES: Portantino, Jones, Ashby, Bradford, Seyarto, Wahab, Wiener

ASSEMBLY FLOOR: 75-0, 5/25/23 - See last page for vote

SUBJECT: Veteran overdose deaths

SOURCE: Author

DIGEST:

This bill requires the California Department of Public Health to compile a report for the Legislature and the California Department of Veterans Affairs on veteran drug overdose deaths in the state.

ANALYSIS:

Existing law:

1. Requires each live birth, fetal death, death, and marriage that occurs in the state to be registered, as specified. [HSC §102100]
2. Requires a certificate of death to include the decedent’s full name, sex, color or race, marital status, name of spouse, date of birth and age at death, birthplace, usual residence, occupation and industry or business, and whether the decedent was ever in the Armed Forces of the United States. [HSC §102875]
3. Establishes an Internet-based electronic death registration system (EDRS) for the creation, storage, and transfer of death registration information. [HSC §102778]
4. Requires the California Department of Public Health (CDPH) to access data within the EDRS to compile a report on veteran suicide in California. Requires the report to include, but not be limited to, information on the ages, sexes, races or ethnicities, counties of residence, and methods of suicide. Requires the report to include a cross-tabulation of the data specified and to compare the data to the data from the previous year. Requires CDPH, on or before March 15, of each year, to provide the report to the Legislature and the California Department of Veterans Affairs (CalVet). [HSC §102791]

This bill:

1. Requires CDPH to access data within EDRS to compile a report on veteran drug overdose deaths in California. Requires the report to include such information as age, sex, race or ethnicity, counties of residence, and drug or drugs causing overdose deaths of veterans.
2. Requires the report to include cross-tabulation of the data specified in 1) above, and to compare the data to the data from the previous year.
3. Requires CDPH to provide the report annually to the Legislature and CalVet on or before March 15 each year.
4. Requires the California Overdose Surveillance Dashboard, maintained by CDPH on its website, to be updated to reflect veteran status in information reported about deaths.

Background

Drug overdose became the leading cause of injury-related death in the U.S., surpassing deaths from traffic accidents in 2009. According to the U.S. Centers for Disease Control and Preventions (CDC), 107,375 people in the United States died of drug overdoses and drug poisonings in the 12-month period ending in January 2022. Sixty-seven percent of those deaths involved synthetic opioids like fentanyl. An April 2022 study reported in Drug and Alcohol Dependence, entitled “Veteran Drug Overdose Mortality, 2010-2019” details veteran drug overdose mortality from the years 2010 to 2019. The researchers used data cross-referenced from multiple sources: Veterans Administration (VA) medical records, the VA/Department of Defense Mortality Data repository, and the CDC’s ONline Data for Epidemiologic Research. The data show that the age-adjusted mortality rate in veteran opioid overdose deaths from 2010-2019 increased 53.2%. Veteran men experienced the largest increase in opioid overdose deaths compared to women, and veterans in the 65+ age group experienced the largest increase compared to other age groups. The study also analyzed veteran mortality by opioid type. Overall opioid overdose mortality rates for veterans increased from 1,891 in 2010 to 3,197 in 2019. Synthetic opioid overdose deaths, most often linked to fentanyl, account for much of that increase. Other than this study, there is very little comprehensive data on veteran opioid overdose deaths. Despite efforts to curb opioid and other substance-related mortality among the general population and specifically veterans, the opioid overdose public health crisis persists, with the highest number of overdose fatalities ever reported during 2020-2021 among the general population. Many veterans face difficult challenges combining problems of pain management, substance use, service-related mental and physical health problems, and the day-to-day challenges associated with housing, employment, and relationships, all of which can heighten risk for drug overdose. Tracking trends during this crisis is necessary to inform any initiatives or interventions that may help to prevent veteran opioid deaths.

Comments

Author’s statement. According to the author, this bill will require CDPH to collect data on accidental veteran overdoses so that the public and the Legislature have a better picture of the reality of overdoses resulting in death for our veteran population.

FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: No

According to the Senate Appropriations Committee, CDPH estimates one-time General Fund costs of $78,000 to enter into a contract with an external vendor to provide consultation and training related to the dashboard modifications to incorporate veteran status in reports of overdose deaths.

SUPPORT: (Verified 8/22/23)

American Legion, Department of California

American Veterans, Department of California

California Association of County Veterans Service Officers

California Association of Veteran Service Agencies

California State University, Fresno, Student Veterans Organization

County Behavioral Health Directors Association of California

County of Fresno Veterans Services Office

Military Officers Association of America, California Council of Chapters

Parents and Addicts in Need

OPPOSITION: (Verified 8/22/23)

Department of Finance

ARGUMENTS IN SUPPORT: Supporters state that California already reports overdoses on the California Overdose Surveillance Dashboard, which is made by data available through the collaboration between CDPH, the California Department of Health Care Access and Information, the Department of Justice, and the California Health Care Foundation. However, there is no data that details the overdose specifics for veterans. Supporters argue veterans are at a higher risk of substance abuse and overdose than the general population. They may struggle with physical and psychological injuries sustained during their service, which can lead to chronic pain, mental health issues, and addiction. Tracking veteran overdoses can help identify patterns and risk factors that can be addressed and prevented. Without accurate data, it is difficult to allocate resources effectively and make informed decisions about how best to support veterans in need.

ARGUMENTS IN OPPOSITION: The Department of Finance is opposed to this bill because it results in General Fund costs that should be considered as part of the annual budget process.

ASSEMBLY FLOOR: 75-0, 5/25/23

AYES: Addis, Alanis, Arambula, Bains, Bauer-Kahan, Berman, Boerner, Bonta, Bryan, Calderon, Juan Carrillo, Wendy Carrillo, Cervantes, Chen, Connolly, Megan Dahle, Davies, Dixon, Essayli, Flora, Mike Fong, Vince Fong, Friedman, Gabriel, Gallagher, Garcia, Gipson, Grayson, Haney, Hart, Holden, Hoover, Irwin, Jackson, Jones-Sawyer, Kalra, Lackey, Lee, Low, Lowenthal, Maienschein, McCarty, McKinnor, Muratsuchi, Stephanie Nguyen, Ortega, Pacheco, 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, Wallis, Ward, Weber, Wicks, Wilson, Wood, Zbur, Rendon

NO VOTE RECORDED: Aguiar-Curry, Alvarez, Bennett, Mathis, Papan

Prepared by: Reyes Diaz / HEALTH / (916) 651-4111

9/2/23 15:01:42

**** END ****

SENATE COMMITTEE ON APPROPRIATIONS

Senator Anthony Portantino, Chair

2023 - 2024 Regular Session

AB 1462 (Jim Patterson) - Veteran overdose deaths

Bill Summary:

AB 1462 would require the California Department of Public Health (CDPH) to compile a report for the Legislature and the California Department of Veterans Affairs (CalVet) on veteran drug overdose deaths in the state.

Fiscal Impact:

The CDPH estimates one-time General Fund costs of $78,000 to enter into a contract with an external vendor to provide consultation and training related to the dashboard modifications to incorporate veteran status in reports of overdose deaths.

Background:

CDPH’s Vital Records Registration Branch is charged with maintaining a uniform, comprehensive, and continuous index for all birth, death, fetal death, and marriage vital events which occur in California. Certified copies of vital records are available from CDPH, 58 county recorders, and 61 local health jurisdictions. Local health officers serve as the local registrars for their respective health jurisdictions, and perform all the related duties. Local registrars either send the original birth or death certificate to the county recorder, who makes a special county record and forwards the original to the State Registrar, or the local registrar sends the county recorder a copy of the certificate at the same time they forward the original to State Registrar.

Current law requires a certificate of death to include the decedent’s full name, sex, color or race, marital status, name of spouse, date of birth and age at death, birthplace, usual residence, occupation and industry or business, and whether the decedent was ever in the Armed Forces of the United States. The electronic death registration system (EDRS) is an Internet-based system established for the creation, storage, and transfer of death registration information.

Current law requires the CDPH to access data within the EDRS to compile a report on veteran suicide in California. The report must include, but not be limited to, information on the ages, sexes, races or ethnicities, counties of residence, and methods of suicide; and must include a cross-tabulation of the data specified and to compare the data to the data from the previous year. Current law requires CDPH, on or before March 15, of each year, to provide the report to the Legislature and to CalVet.

The CDPH also maintains the California Overdose Surveillance Dashboard which provides data on state and local level drug-related overdose outcomes for California, including deaths, emergency department visits, and hospitalizations, as well as opioid and select other drug prescription data.

Proposed Law:

Specific provisions of the bill would:

• Require CDPH to access data within EDRS to compile a report on veteran drug overdose deaths in California, as specified; and annually provide the report to the Legislature and CalVet on or before March 15 each year.
• Require the California Overdose Surveillance Dashboard, maintained by CDPH on its website, to be updated to reflect veteran status in information reported about deaths.

-- END --

SENATE COMMITTEE ON APPROPRIATIONS

Senator Anthony Portantino, Chair

2023 - 2024 Regular Session

AB 1462 (Jim Patterson) - Veteran overdose deaths

Bill Summary:

AB 1462 would require the California Department of Public Health (CDPH) to compile a report for the Legislature and the California Department of Veterans Affairs (CalVet) on veteran drug overdose deaths in the state.

Fiscal Impact:

The CDPH estimates one-time General Fund costs of $78,000 to enter into a contract with an external vendor to provide consultation and training related to the dashboard modifications to incorporate veteran status in reports of overdose deaths.

Background:

CDPH’s Vital Records Registration Branch is charged with maintaining a uniform, comprehensive, and continuous index for all birth, death, fetal death, and marriage vital events which occur in California. Certified copies of vital records are available from CDPH, 58 county recorders, and 61 local health jurisdictions. Local health officers serve as the local registrars for their respective health jurisdictions, and perform all the related duties. Local registrars either send the original birth or death certificate to the county recorder, who makes a special county record and forwards the original to the State Registrar, or the local registrar sends the county recorder a copy of the certificate at the same time they forward the original to State Registrar.

Current law requires a certificate of death to include the decedent’s full name, sex, color or race, marital status, name of spouse, date of birth and age at death, birthplace, usual residence, occupation and industry or business, and whether the decedent was ever in the Armed Forces of the United States. The electronic death registration system (EDRS) is an Internet-based system established for the creation, storage, and transfer of death registration information.

Current law requires the CDPH to access data within the EDRS to compile a report on veteran suicide in California. The report must include, but not be limited to, information on the ages, sexes, races or ethnicities, counties of residence, and methods of suicide; and must include a cross-tabulation of the data specified and to compare the data to the data from the previous year. Current law requires CDPH, on or before March 15, of each year, to provide the report to the Legislature and to CalVet.

The CDPH also maintains the California Overdose Surveillance Dashboard which provides data on state and local level drug-related overdose outcomes for California, including deaths, emergency department visits, and hospitalizations, as well as opioid and select other drug prescription data.

Proposed Law:

Specific provisions of the bill would:

• Require CDPH to access data within EDRS to compile a report on veteran drug overdose deaths in California, as specified; and annually provide the report to the Legislature and CalVet on or before March 15 each year.
• Require the California Overdose Surveillance Dashboard, maintained by CDPH on its website, to be updated to reflect veteran status in information reported about deaths.

-- END --

SENATE COMMITTEE ON MILITARY AND VETERANS AFFAIRS

Senator Bob Archuleta, Chair

2023 - 2024 Regular

Bill No: AB 1462 Hearing Date: 7/10/23

Subject: Veteran overdose deaths

DESCRIPTION

Summary:

Requires the California Department of Public Health (DPH) to access existing data within the electronic death registration system (EDRS) to compile a report on veteran drug overdose deaths in California and to report specified data.

Existing law:

1. Requires each live birth, fetal death, death, and marriage that occurs in the state to be registered, as specified.
2. Provides that all confidential information included in birth, fetal death, death, and marriage certificates that are required to be filed are exempt from the California Public Record Act.
3. Requires a Certificate of Death to include the decedent’s full name, sex, color or race, marital status, name of spouse, date of birth and age at death, birthplace, usual residence, occupation and industry or business, and whether the decedent was ever in the Armed Forces of the United States.
4. Establishes an Internet-based EDRS for the creation, storage, and transfer of death registration information. Requires the EDRS to be subject to limitations placed on the accessibility and release of personally identifying information contained in those death records by any other provision of law or subsequently enacted legislation.
5. Requires DPH to access data within the EDRS to compile a report on veteran suicide in California. Requires the report to include, but not be limited to, information on the ages, sexes, races or ethnicities, counties of residence, and methods of suicide. Requires the report to include a cross-tabulation of the data specified and to compare the data to the data from the previous year. Requires on or before March 15, of each year, DPH provide the report to the Legislature and the CalVet.

This bill:

1. Requires DPH to access data within the EDRS to compile a report on veteran drug overdose deaths in California.
2. Requires the report to include, but not be limited to, information on the ages, sexes, races or ethnicities, counties of residence, and drug or drugs causing overdose deaths of veterans.
3. Requires the report to include a cross-tabulation of the data specified and to compare the data to the data from the previous year.
4. Requires DPH, on or before March 15, of each year, to provide the report to the Legislature and the California Department of Veterans Affairs (CalVet).
5. Requires the California Overdose Surveillance Dashboard, maintained by DPH on its internet website, to be updated to reflect veteran status in information reported about deaths.

BACKGROUND

Drug overdose became the leading cause of injury-related death in the U.S., surpassing deaths from traffic accidents, in 2009. According to the U.S. Centers for Disease Control and Preventions (CDC), 107,375 people in the United States died of drug overdoses and drug poisonings in the 12-month period ending in January 2022. A staggering 67% of those deaths involved synthetic opioids like fentanyl. Fentanyl is a synthetic opioid that is 50-100 times stronger than morphine.

An April 2022, cross-sectional study reported in Drug and Alcohol Dependence, entitled “Veteran Drug Overdose Mortality, 2010-2019” details veteran drug overdose mortality from the years 2010 to 2019. The researchers used data cross-referenced from multiple sources – Veterans Administration (VA) medical records, the VA/Department of Defense Mortality Data repository, and the CDC’s WONDER (Wide-ranging ONline Data for Epidemiologic Research). The data show that the age-adjusted mortality rate in veteran opioid overdose deaths from 2010-2019 increased 53.2%. Veteran men experienced the largest increase in opioid overdose deaths compared to women, and veterans in the 65+ age group experienced the largest increase compared to other age groups.

The study also analyzed veteran mortality by opioid type. Overall opioid overdose mortality rates for veterans increased from 1,891 in 2010 to 3,197 in 2019. Synthetic opioid overdose deaths, most often linked to fentanyl, account for much of that increase.

COMMENT

Other than this study, there is very little comprehensive data on veteran opioid overdose deaths. Despite efforts to curb opioid and other substance-related mortality among the general population and specifically veterans, the opioid overdose public health crisis persists, with the highest number of overdose fatalities ever reported during 2020-2021 among the general population. Many veterans face difficult challenges combining problems of pain management, substance use, service-related mental and physical health problems, and the day-to-day challenges associated with housing, employment, and relationships, all of which can heighten risk for drug overdose. Tracking trends during this crisis is necessary to inform any initiatives or interventions that may help to prevent veteran opioid deaths.

According to the author, “AB 1462 will require the Department of Public Health to collect data on accidental veteran overdoses so that the public and the legislature have a better picture of the reality of overdoses resulting in death for our veteran population.” Related legislation:

AB 3371 (Committee on Veterans Affairs, Chapter 77, Statutes of 2020) expanded the data the State Department of Public Health (CDPH) was required to include in its annual report on veteran suicide in California, and further specified format and detail of reporting.

POSITIONS

Sponsor: Author.

Support:

California Association of Veteran Service Agencies
California State University, Fresno, Student Veterans Organization
Fresno County Veterans Services Office
Pain Parents & Addicts in Need

Oppose: None on File.

-- END --

SENATE COMMITTEE ON HEALTH

Senator Dr. Susan Talamantes Eggman, Chair

BILL NO: AB 1462

SUBJECT: Veteran overdose deaths.

SUMMARY:

Requires the California Department of Public Health to compile a report for the Legislature and the California Department of Veterans Affairs on veteran drug overdose deaths in the state.

Existing law:

1. Requires each live birth, fetal death, death, and marriage that occurs in the state to be registered, as specified. [HSC §102100]
2. Requires a certificate of death to include the decedent’s full name, sex, color or race, marital status, name of spouse, date of birth and age at death, birthplace, usual residence, occupation and industry or business, and whether the decedent was ever in the Armed Forces of the United States. [HSC §102875]
3. Establishes an Internet-based electronic death registration system (EDRS) for the creation, storage, and transfer of death registration information. [HSC §102778]
4. Requires the California Department of Public Health (CDPH) to access data within the EDRS to compile a report on veteran suicide in California. Requires the report to include, but not be limited to, information on the ages, sexes, races or ethnicities, counties of residence, and methods of suicide. Requires the report to include a cross-tabulation of the data specified and to compare the data to the data from the previous year. Requires CDPH, on or before March 15, of each year, to provide the report to the Legislature and the California Department of Veterans Affairs (CalVet). [HSC §102791]

This bill:

1. Requires CDPH to access data within EDRS to compile a report on veteran drug overdose deaths in California. Requires the report to include such information as age, sex, race or ethnicity, counties of residence, and drug or drugs causing overdose deaths of veterans.
2. Requires the report to include cross-tabulation of the data specified in 1) above, and to compare the data to the data from the previous year.
3. Requires CDPH to provide the report annually to the Legislature and CalVet on or before March 15 each year.
4. Requires the California Overdose Surveillance Dashboard, maintained by CDPH on its website, to be updated to reflect veteran status in information reported about deaths.

FISCAL EFFECT:

According to the Assembly Appropriations Committee, CDPH estimates one-time costs of $78,000 to enter into a contract with an external vendor to provide consultation and training on modifications to CDPH's Dashboard to incorporate veteran status in reports of overdose deaths (General Fund, unless the Opioid Settlement Fund is made available). CDPH estimates 400 hours of work with a vendor would be required at a rate of $195 per hour, based on the hourly rate of a vendor CDPH currently contracts for work on the Dashboard. Other costs for annually accessing data within the electronic death registration system, producing and submitting the legislative report, and updating the Dashboard would be minor and absorbable.

PRIOR VOTES:

COMMENTS:

1. Author’s statement. According to the author, this bill will require CDPH to collect data on accidental veteran overdoses so that the public and the Legislature have a better picture of the reality of overdoses resulting in death for our veteran population.
2. Background. Drug overdose became the leading cause of injury-related death in the U.S., surpassing deaths from traffic accidents in 2009. According to the U.S. Centers for Disease Control and Preventions (CDC), 107,375 people in the United States died of drug overdoses and drug poisonings in the 12-month period ending in January 2022. Sixty-seven percent of those deaths involved synthetic opioids like fentanyl. An April 2022 study reported in Drug and Alcohol Dependence, entitled “Veteran Drug Overdose Mortality, 2010-2019” details veteran drug overdose mortality from the years 2010 to 2019. The researchers used data cross-referenced from multiple sources: Veterans Administration (VA) medical records, the VA/Department of Defense Mortality Data repository, and the CDC’s ONline Data for Epidemiologic Research. The data show that the age-adjusted mortality rate in veteran opioid overdose deaths from 2010-2019 increased 53.2%. Veteran men experienced the largest increase in opioid overdose deaths compared to women, and veterans in the 65+ age group experienced the largest increase compared to other age groups. The study also analyzed veteran mortality by opioid type. Overall opioid overdose mortality rates for veterans increased from 1,891 in 2010 to 3,197 in 2019. Synthetic opioid overdose deaths, most often linked to fentanyl, account for much of that increase. Other than this study, there is very little comprehensive data on veteran opioid overdose deaths. Despite efforts to curb opioid and other substance-related mortality among the general population and specifically veterans, the opioid overdose public health crisis persists, with the highest number of overdose fatalities ever reported during 2020-2021 among the general population. Many veterans face difficult challenges combining problems of pain management, substance use, service-related mental and physical health problems, and the day-to-day challenges associated with housing, employment, and relationships, all of which can heighten risk for drug overdose. Tracking trends during this crisis is necessary to inform any initiatives or interventions that may help to prevent veteran opioid deaths.
3. Double referral. This bill is double referred. Should it pass out of this committee, it will be referred to the Senate Committee on Military and Veterans Affairs.
4. Related legislation. SB 783 (Archuleta) permits the Counties of Los Angeles and Nevada to create a veteran suicide prevention training pilot program to offer individuals specialized training and certification in suicide prevention with military-connected populations, as specified. SB 783 is pending in the Assembly Military and Veterans Affairs Committee.

AB 718 (Ta) requires the CalVet, upon appropriation by the Legislature, to establish a program to fund an academic study of mental health among women veterans in California, as specified. AB 718 is pending in the Senate Military and Veterans Affairs Committee.

1. Prior legislation. AB 1935 (Voepel of 2020) was similar to AB 718. AB 1935 was not heard in the Senate Military and Veterans Affairs Committee.

AB 3371 (Committee on Veterans Affairs, Chapter 77, Statutes of 2020) expands the data CDPH is required to include in its annual report on veteran suicide in California.

AB 242 (Arambula, Chapter 222, Statutes of 2017) requires a certificate of death to show if the deceased person was ever a member of the United States Armed Forces, and requires CDPH to access data and compile an annual report.

1. Support. Supporters state that California already reports overdoses on the California Overdose Surveillance Dashboard, which is made by data available through the collaboration between CDPH, the California Department of Health Care Access and Information, the Department of Justice, and the California Health Care Foundation. However, there is no data that details the overdose specifics for veterans. Supporters argue veterans are at a higher risk of substance abuse and overdose than the general population. They may struggle with physical and psychological injuries sustained during their service, which can lead to chronic pain, mental health issues, and addiction. Tracking veteran overdoses can help identify patterns and risk factors that can be addressed and prevented. Without accurate data, it is difficult to allocate resources effectively and make informed decisions about how best to support veterans in need.

SUPPORT AND OPPOSITION:

Support: California Association of Veteran Service Agencies

California State University, Fresno, Student Veterans Organization

Parents and Addicts in Need

Oppose: None received

-- END --

ASSEMBLY THIRD READING

ATR Bill Id:AB 1462

Author:(Jim Patterson)

As Introduced Ver:February 17, 2023

Majority vote

SUMMARY

Requires the California Department of Public Health (DPH) to access existing data within the electronic death registration system to compile a report on veteran drug overdose deaths in California and to report specified data.

Major Provisions

COMMENTS

Veteran Overdose Rates. Drug overdose became the leading cause of injury-related death in the U.S., surpassing deaths from traffic accidents in 2009. According to the U.S. Centers for Disease Control and Preventions (CDC), 107,375 people in the United States died of drug overdoses and drug poisonings in the 12-month period ending in January 2022. A staggering 67% of those deaths involved synthetic opioids like fentanyl. Fentanyl is a synthetic opioid that is 50-100 times stronger than morphine.

An April 2022, cross-sectional study reported in Drug and Alcohol Dependence, entitled "Veteran Drug Overdose Mortality, 2010-2019" details veteran drug overdose mortality from the years 2010 to 2019. The researchers used data cross-referenced from multiple sources – Veterans Administration (VA) medical records, the VA/Department of Defense Mortality Data repository, and the CDC's Wide-ranging Online Data for Epidemiologic Research. The data show that the age-adjusted mortality rate in veteran opioid overdose deaths from 2010-2019 increased 53.2%. Veteran men experienced the largest increase in opioid overdose deaths compared to women, and veterans in the 65+ age group experienced the largest increase compared to other age groups.

The study also analyzed veteran mortality by opioid type. Overall opioid overdose mortality rates for veterans increased from 1,891 in 2010 to 3,197 in 2019. Synthetic opioid overdose deaths, most often linked to fentanyl, account for much of that increase.

The study referenced above is valuable, but presumably very labor intensive, as researchers had to gain access to and merge data sets from multiple federal record sources. Other than this study, there is very little comprehensive data on veteran opioid overdose deaths. Despite efforts to curb opioid and other substance-related mortality among the general population and specifically veterans, the opioid overdose public health crisis persists, with the highest number of overdose fatalities ever reported during 2020-2021 among the general population. Many veterans face difficult challenges combining problems of pain management, substance use, service-related mental and physical health problems, and the day-to-day challenges associated with housing, employment, and relationships, all of which can heighten risk for drug overdose. Tracking trends during this crisis is necessary to inform any initiatives or interventions that may help to prevent veteran opioid deaths.

According to the Author

This bill will require DPH to collect data on accidental veteran overdoses so that the public and the Legislature have a better picture of the reality of overdoses resulting in death for our veteran population.

Arguments in Support

Parents & Addicts in Need (PAIN), in a support position states that California already reports overdoses on the California Overdose Surveillance Dashboard which is creased from data available through a collaboration between the DPH, the Department of Health Care Access and Information, the Department of Justice, and the California HealthCare Foundation. However, there is no data that is specific to veterans. As we already know, veterans are at a higher risk of substance use disorder and overdose than the general population. They may struggle with physical and psychological injuries sustained during their service, which can lead to chronic pain, mental health issues, and addition. PAIN concludes by stating that without accurate data, it is difficult to allocate resources effectively and to make informed decisions about how best to support veterans in need.

Arguments in Opposition

There is no known opposition.

FISCAL COMMENTS

According to the Assembly Appropriations Committee, DPH estimates one-time costs of $78,000 to enter into a contract with an external vendor to provide consultation and training on modifications to DPH's (data) Dashboard to incorporate veteran status in reports of overdose deaths (General Fund, unless the Opioid Settlement Fund is made available). DPH estimates 400 hours of work with a vendor would be required at a rate of $195 per hour, based on the hourly rate of a vendor DPH currently contracts for work on DPH's Dashboard. Other costs for annually accessing data within the electronic death registration system, producing and submitting the legislative report, and updating DPH's Dashboard would be minor and absorbable.

VOTES

ASM HEALTH: 14-0-1

YES: Wood, Waldron, Aguiar-Curry, Arambula, Boerner Horvath, Flora, Vince Fong, Maienschein, McCarty, Joe Patterson, Rodriguez, Santiago, Villapudua, Weber

ABS, ABST OR NV: Wendy Carrillo

ASM MILITARY AND VETERANS AFFAIRS: 11-0-0

YES: Soria, Davies, Addis, Alvarez, Boerner Horvath, Juan Carrillo, Mathis, Muratsuchi, Petrie-Norris, Ta, Valencia

ASM APPROPRIATIONS: 15-0-1

YES: Holden, Megan Dahle, Bryan, Calderon, Wendy Carrillo, Dixon, Mike Fong, Hart, Lowenthal, Mathis, Papan, Pellerin, Sanchez, Weber, Ortega

ABS, ABST OR NV: Robert Rivas

UPDATED

VERSION: February 17, 2023

CONSULTANT: Judith Babcock / HEALTH / (916) 319-2097 FN: 0000549

Date of Hearing: May 10, 2023

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Chris Holden, Chair

ABPCA Bill Id:AB 1462

Author:(Jim Patterson) – As Introduced Ver:February 17, 2023

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

SUMMARY:

This bill requires the California Department of Public Health (CDPH) to access data within the electronic death registration system to compile a report, including specified information, on veteran drug overdose deaths in California. The bill requires CDPH to submit the report to the Legislature and the Department of Veterans Affairs by March 15 of each year. This bill also requires CDPH to update the California Overdose Surveillance Dashboard to reflect veteran status in reports of deaths.

FISCAL EFFECT:

CDPH estimates one-time costs of $78,000 to enter into a contract with an external vendor to provide consultation and training on modifications to CDPH’s (data) Dashboard to incorporate veteran status in reports of overdose deaths (General Fund, unless the Opioid Settlement Fund is made available). CDPH estimates 400 hours of work with a vendor would be required at a rate of $195 per hour, based on the hourly rate of a vendor CDPH currently contracts for work on CDPH’s Dashboard. Other costs for annually accessing data within the electronic death registration system, producing and submitting the legislative report, and updating CDPH’s Dashboard would be minor and absorbable.

It is the policy of this committee to place any bill the committee concludes has the primary purpose of creating a task force, a commission, a work group, a pilot project or a pilot project extension, a report or a study, on the committee’s suspense file, regardless of cost.

COMMENTS:

1. Purpose. According to the author:

The California Veterans Service Agencies annual report highlights that from 2010 to 2019 there was a 93.4% increase in veteran opioid overdose deaths. The report also highlights the difficulty in tracking this data because it requires gaining access, merging, and cross referencing data between State and Federal government.

1. Background. Drug overdose became the leading cause of injury-related death in the U.S., surpassing deaths from traffic accidents, in 2009. According to the U.S. Centers for Disease Control and Prevention (CDC), 107,375 people in the United States died of drug overdoses and drug poisonings in the 12-month period ending in January 2022, and 67% of those deaths involved synthetic opioids such as fentanyl.
   
   The Assembly Committee on Military and Veterans Affairs analysis of this bill cites a 2022 study reported in Drug and Alcohol Dependence, “Veteran Drug Overdose Mortality, 2010-2019.” The study details veteran drug overdose mortality and showed that the age-adjusted opioid overdose mortality rate among veterans increased 53.2% from 2010-2019. Synthetic opioid overdose deaths accounted for much of that increase. The committee analysis notes the study referenced above required that researchers gain access to and merge data sets from multiple federal record sources. Other than this study, there is very little comprehensive data on veteran opioid overdose deaths. Despite efforts to curb opioid and other substance-related mortality among the general population and specifically veterans, the opioid overdose public health crisis persists, with the highest number of overdose fatalities among the general population ever reported during 2020-21. Many veterans face difficult challenges of pain management, substance use, service-related mental and physical health problems, all of which heighten risk for drug overdose.
2. Prior Legislation. AB 3371 (Committee on Veterans Affairs), Chapter 77, Statutes of 2020, expanded the data CDPH was required to include in its annual report on veteran suicide in California, and further specified format and detail of reporting.

Analysis Prepared by: Allegra Kim / APPR. / (916) 319-2081

Date of Hearing: April 18, 2023

ASSEMBLY COMMITTEE ON MILITARY AND VETERANS AFFAIRS

Esmeralda Soria, Chair

ABPCA Bill Id:AB 1462 (

Author:Jim Patterson) – As Introduced Ver:February 17, 2023

SUBJECT: Veteran overdose deaths

SUMMARY: Requires the California Department of Public Health (DPH) to access existing data within the electronic death registration system (EDRS) to compile a report on veteran drug overdose deaths in California and to report specified data. Specifically, this bill:

1. Requires DPH to access data within the EDRS (enacted by AB 2550 (Nation), Chapter 859, Statues of 2002) to compile a report on veteran drug overdose deaths in California.
2. Requires the report to include, but not be limited to, information on the ages, sexes, races or ethnicities, counties of residence, and drug or drugs causing overdose deaths of veterans.
3. Requires the report to include a cross-tabulation of the data specified and to compare the data to the data from the previous year.
4. Requires DPH, on or before March 15, of each year, to provide the report to the Legislature and the California Department of Veterans Affairs (CalVet).
5. Requires the California Overdose Surveillance Dashboard, maintained by DPH on its internet website, to be updated to reflect veteran status in information reported about deaths.

EXISTING LAW:

1. Requires each live birth, fetal death, death, and marriage that occurs in the state to be registered, as specified. (Health and Safety Code (HSC) Section 102100)
2. Provides that all confidential information included in birth, fetal death, death, and marriage certificates that are required to be filed are exempt from the California Public Record Act. (HSC Section 102100)
3. Requires a Certificate of Death to include the decedent’s full name, sex, color or race, marital status, name of spouse, date of birth and age at death, birthplace, usual residence, occupation and industry or business, and whether the decedent was ever in the Armed Forces of the United States. (HSC Section 102875)
4. Establishes an Internet-based EDRS for the creation, storage, and transfer of death registration information. Requires the EDRS to be subject to limitations placed on the accessibility and release of personally identifying information contained in those death records by any other provision of law or subsequently enacted legislation. (HSC Section 102778)
5. Requires DPH to access data within the EDRS to compile a report on veteran suicide in California. Requires the report to include, but not be limited to, information on the ages, sexes, races or ethnicities, counties of residence, and methods of suicide. Requires the report to include a cross-tabulation of the data specified and to compare the data to the data from the previous year. Requires on or before March 15, of each year, DPH provide the report to the Legislature and the CalVet. (HSC Section 102791)

FISCAL EFFECT: This bill has not been analyzed by a fiscal committee.

COMMENTS: Purpose. According to the author, “AB 1462 will require the Department of Public Health to collect data on accidental veteran overdoses so that the public and the legislature have a better picture of the reality of overdoses resulting in death for our veteran population.”

Background

Veteran Overdose Rates. Drug overdose became the leading cause of injury-related death in the U.S., surpassing deaths from traffic accidents in 2009. According to the U.S. Centers for Disease Control and Preventions (CDC), 107,375 people in the United States died of drug overdoses and drug poisonings in the 12-month period ending in January 2022. A staggering 67% of those deaths involved synthetic opioids like fentanyl. Fentanyl is a synthetic opioid that is 50-100 times stronger than morphine.

An April 2022, cross-sectional study reported in Drug and Alcohol Dependence, entitled “Veteran Drug Overdose Mortality, 2010-2019” details veteran drug overdose mortality from the years 2010 to 2019. The researchers used data cross-referenced from multiple sources – Veterans Administration (VA) medical records, the VA/Department of Defense Mortality Data repository, and the CDC’s WONDER (Wide-ranging ONline Data for Epidemiologic Research). The data show that the age-adjusted mortality rate in veteran opioid overdose deaths from 2010-2019 increased 53.2%. Veteran men experienced the largest increase in opioid overdose deaths compared to women, and veterans in the 65+ age group experienced the largest increase compared to other age groups.

The study also analyzed veteran mortality by opioid type. Overall opioid overdose mortality rates for veterans increased from 1,891 in 2010 to 3,197 in 2019. Synthetic opioid overdose deaths, most often linked to fentanyl, account for much of that increase.

The study referenced above required that researchers gain access to and merge data sets from multiple federal record sources. Other than this study, there is very little comprehensive data on veteran opioid overdose deaths. Despite efforts to curb opioid and other substance-related mortality among the general population and specifically veterans, the opioid overdose public health crisis persists, with the highest number of overdose fatalities ever reported during 2020-2021 among the general population. Many veterans face difficult challenges combining problems of pain management, substance use, service-related mental and physical health problems, and the day-to-day challenges associated with housing, employment, and relationships, all of which can heighten risk for drug overdose. Tracking trends during this crisis is necessary to inform any initiatives or interventions that may help to prevent veteran opioid deaths.

Related legislation.

AB 3371 (Committee on Veterans Affairs, Chapter 77, Statutes of 2020) expanded the data the State Department of Public Health (CDPH) was required to include in its annual report on veteran suicide in California, and further specified format and detail of reporting.

REGISTERED SUPPORT / OPPOSITION:

Support

California Association of Veteran Service Agencies
California State University, Fresno, Student Veterans Organization
Pain Parents & Addicts in Need

Opposition

None on file.

Analysis Prepared by: Christian Burkin / M. & V.A. / (916) 319-3550

Date of Hearing: March 21, 2023

ASSEMBLY COMMITTEE ON HEALTH

Jim Wood, Chair

ABPCA Bill Id:AB 1462

Author:(Jim Patterson) – As Introduced Ver:February 17, 2023

SUBJECT: Veteran overdose deaths.

SUMMARY: Requires the California Department of Public Health (DPH) to access existing data within the electronic death registration system (EDRS) to compile a report on veteran drug overdose deaths in California and to report specified data. Specifically, this bill:

1. Requires DPH to access data within the EDRS (enacted by AB 2550 (Nation), Chapter 859, Statues of 2002) to compile a report on veteran drug overdose deaths in California.
2. Requires the report to include, but not be limited to, information on the ages, sexes, races or ethnicities, counties of residence, and drug or drugs causing overdose deaths of veterans.
3. Requires the report to include a cross-tabulation of the data specified and to compare the data to the data from the previous year.
4. Requires DPH, on or before March 15, of each year, to provide the report to the Legislature and the California Department of Veterans Affairs (CalVet).
5. Requires the California Overdose Surveillance Dashboard, maintained by DPH on its internet website, to be updated to reflect veteran status in information reported about deaths.

EXISTING LAW:

1. Requires each live birth, fetal death, death, and marriage that occurs in the state to be registered, as specified. [Health and Safety Code (HSC) §102100]
2. Provides that all confidential information included in birth, fetal death, death, and marriage certificates that are required to be filed are exempt from the California Public Record Act. [HSC §102100]
3. Requires a Certificate of Death to include the decedent’s full name, sex, color or race, marital status, name of spouse, date of birth and age at death, birthplace, usual residence, occupation and industry or business, and whether the decedent was ever in the Armed Forces of the United States. [HSC §102875]
4. Establishes an Internet-based EDRS for the creation, storage, and transfer of death registration information. Requires the EDRS to be subject to limitations placed on the accessibility and release of personally identifying information contained in those death records by any other provision of law or subsequently enacted legislation. [HSC §102778]
5. Requires DPH to access data within the EDRS to compile a report on veteran suicide in California. Requires the report to include, but not be limited to, information on the ages, sexes, races or ethnicities, counties of residence, and methods of suicide. Requires the report to include a cross-tabulation of the data specified and to compare the data to the data from the previous year. Requires on or before March 15, of each year, DPH provide the report to the Legislature and the CalVet. [HSC §102791]

FISCAL EFFECT: Unknown. This bill has not yet been analyzed by a fiscal committee.

COMMENTS:

1. PURPOSE OF THIS BILL. According to the author, this bill will require DPH to collect data on accidental veteran overdoses so that the public and the Legislature have a better picture of the reality of overdoses resulting in death for our veteran population.
2. BACKGROUND. Veteran Overdose Rates. Drug overdose became the leading cause of injury-related death in the U.S., surpassing deaths from traffic accidents in 2009. According to the U.S. Centers for Disease Control and Preventions (CDC), 107,375 people in the United States died of drug overdoses and drug poisonings in the 12-month period ending in January 2022. A staggering 67% of those deaths involved synthetic opioids like fentanyl. Fentanyl is a synthetic opioid that is 50-100 times stronger than morphine.
   
   An April 2022, cross-sectional study reported in Drug and Alcohol Dependence, entitled “Veteran Drug Overdose Mortality, 2010-2019” details veteran drug overdose mortality from the years 2010 to 2019. The researchers used data cross-referenced from multiple sources – Veterans Administration (VA) medical records, the VA/Department of Defense Mortality Data repository, and the CDC’s Wide-ranging ONline Data for Epidemiologic Research. The data show that the age-adjusted mortality rate in veteran opioid overdose deaths from 2010-2019 increased 53.2%. Veteran men experienced the largest increase in opioid overdose deaths compared to women, and veterans in the 65+ age group experienced the largest increase compared to other age groups.
   
   The study also analyzed veteran mortality by opioid type. Overall opioid overdose mortality rates for veterans increased from 1,891 in 2010 to 3,197 in 2019. Synthetic opioid overdose deaths, most often linked to fentanyl, account for much of that increase.
   
   The study referenced above is valuable, but presumably very labor intensive, as researchers had to gain access to and merge data sets from multiple federal record sources. Other than this study, there is very little comprehensive data on veteran opioid overdose deaths. Despite efforts to curb opioid and other substance-related mortality among the general population and specifically veterans, the opioid overdose public health crisis persists, with the highest number of overdose fatalities ever reported during 2020-2021 among the general population. Many veterans face difficult challenges combining problems of pain management, substance use, service-related mental and physical health problems, and the day-to-day challenges associated with housing, employment, and relationships, all of which can heighten risk for drug overdose. Tracking trends during this crisis is necessary to inform any initiatives or interventions that may help to prevent veteran opioid deaths.
3. SUPPORT. Parents & Addicts in Need (PAIN), in a support position states that California already reports overdoses on the California Overdose Surveillance Dashboard which is creased from data available through a collaboration between the DPH, the Department of Health Care Access and Information, the Department of Justice, and the California HealthCare Foundation. However, there is no data that is specific to veterans. As we already know, veterans are at a higher risk of substance use disorder and overdose than the general population. They may struggle with physical and psychological injuries sustained during their service, which can lead to chronic pain, mental health issues, and addition. PAIN concludes by stating that without accurate data, it is difficult to allocate resources effectively and to make informed decisions about how best to support veterans in need.
4. RELATED LEGISLATION.
   1. AB 718 (Ta) requires CalVet to establish a program to fund, upon appropriation by the Legislature, an academic study of mental health among women veterans in California, as specified. Requires CalVet to submit a report summarizing the findings and recommendations of the study to the Legislature no later than July 31, 2025. AB 718 is pending hearing in the Committee on Military and Veterans Affairs.
   2. SB 783 (Archuleta) states that it is the intent of the Legislature to enact legislation to establish a Veteran Suicide Prevention Training Pilot Program, with the purpose of offering each county and city veterans’ service officer specialized training and certification in the prevention of veteran suicide. SB 783 is pending referral in the Senate Rules Committee.
5. PREVIOUS LEGISLATION.
   1. AB 1470 (Mathis) of 2022 would have required DPH to establish the End Military Suicide Task Force to systematically reduce, on an annual basis, military suicides and to provide a plan by June 1, 2023, for the elimination of all military suicides in the state by January 1, 2029. AB 1470 was held on the suspense file in the Assembly Appropriations Committee.
   2. AB 1935 (Voepel) of 2020 would have required CalVet to establish a program to fund an academic study of mental health among women veterans in California and to report findings and recommendations to the Legislature by July 31, 2022. AB 1935 was held in the Senate Committee on Veterans Affairs.
   3. AB 3371 (Patterson), Chapter 77, Statutes of 2020, requires DPH to add additional data to the Veteran Suicide report compiled and released annually to the Legislature and CalVet.
   4. AB 232 (Cervantes) of 2020 would have required DPH’s veteran suicide report to include information on the veterans’ locations of residency and death, length and locations of service, branches of service, and occupations and industries or businesses. Would have established, within CalVet, the Commission on Veteran Suicide Prevention, comprised of five commissioners and require the commission to review each annual report on veteran suicide in California, described above, and make recommendations for preventing veteran suicide from the data collected in each report. AB 232 was held in the Senate Health Committee.
   5. AB 242 (Arambula), Chapter 222, Statutes of 2017, requires that a certificate of death must show if the deceased person was ever a member of the United States Armed Forces, and requires DPH to access data and compile an annual report. Specifies the required data “shall only include information on the ages, sexes, races or ethnicities, and methods of suicide of veterans.”
6. DOUBLE REFERRAL. This bill is double referred, upon passage of this committee; it will be referred to the Assembly Military and Veterans Affairs Committee.

REGISTERED SUPPORT / OPPOSITION:

Support

California Sate University Fresno, Student Veterans Association

Parents and Addicts in Need (PAIN)

Opposition

None on file.

Analysis Prepared by: Judith Babcock / HEALTH / (916) 319-2097