AB 915: Pupil health: drug education: opioid overdose training program.
- Session Year: 2023-2024
- House: Assembly
- Latest Version Date: 2023-07-10
Current Status:
Failed
(2023-09-01: In committee: Held under submission.)
Introduced
In Committee
First Chamber
In Committee
Second Chamber
Enacted
What does this bill do?
The bill requires schools that choose to keep naloxone (an opioid overdose reversal medicine) on campus to place it in clear, widely known, and easily reached spots—like the nurse’s office, front office, library, gym, cafeteria, auditorium, or athletic trainer’s office—and lets school nurses or trained volunteers use it in an overdose emergency. It also directs the State Department of Public Health to create a training program and toolkit for public high schools to teach students how to spot and respond to opioid overdoses, including using an approved reversal medication, and to collect yearly data on student participation.
The summary is provided by generative AI which can make mistakes. For original language, please view the details in the table below.
Existing law requires instruction to be given in the elementary and secondary schools by appropriately trained instructors on drug education and the effects of the use of tobacco, alcohol, narcotics, dangerous drugs, as defined, and other dangerous substances. Existing law authorizes a public or private elementary or secondary school to determine whether or not to make emergency naloxone hydrochloride or another opioid antagonist and trained personnel available at its school, and to designate one or more volunteers to receive related training to address an opioid overdose, as specified.
This bill would require those school districts, county offices of education, and charter schools, serving pupils in any of grades 9 to 12, inclusive, schools that voluntarily determine to make naloxone hydrochloride or another opioid antagonist available on campus to ensure that the naloxone hydrochloride or another opioid antagonist is placed in an appropriate location that is widely known and easily accessible, both during school hours and after school hours. The bill would require the naloxone hydrochloride or another opioid antagonist to be located on campus grounds in at least one of several specified locations.
This bill would require the State Department of Public Health to establish, by April 1, 2025, a certification develop an opioid overdose training program for and program toolkit, as defined, to be made available to public high school schools for public high school pupils in grades 9 to 12, inclusive, to gain skills in to be trained on how to identify and respond to an opioid overdose, including by administering naloxone hydrochloride nasal spray, as defined. The bill would authorize public high schools serving pupils in any of grades 9 to 12, inclusive, to voluntarily determine whether or not to host the program on their campuses. a federally approved opioid overdose reversal medication, as provided. The bill would require the department, by April 1, 2025, to notify public high schools of the availability of the program toolkit. The bill would require the department to provide the program toolkit upon request to those public high schools that opt to host the program on their campuses and to consider making its representatives available to provide the training onsite at public schools upon request. The bill would require the department to collaborate with local, state, and national organizations, as provided, to provide pupils with integrated, comprehensive, accurate, and unbiased educational materials on opioid and drug overdose prevention, opioid and drug safety, and stigma reduction. The bill would authorize program trainings to include instruction from appropriately trained instructors, as provided, and include informational videos, graphics, or in-person training on what to do and how to respond during a drug or opioid overdose, as well as information on how to recognize signs of a drug or opioid overdose and how to respond in an emergency involving a drug or opioid overdose. The bill would require the department to collect, on an annual basis, data on the number of pupils participating in the program and to share this information with the Legislature and the Senate and Assembly Budget Subcommittees on Education, Health, and Human Services, as provided.
Existing law requires instruction to be given in the elementary and secondary schools by appropriately trained instructors on drug education and the effects of the use of tobacco, alcohol, narcotics, dangerous drugs, as defined, and other dangerous substances. Existing law authorizes a public or private elementary or secondary school to determine whether or not to make emergency naloxone hydrochloride or another opioid antagonist and trained personnel available at its school, and to designate one or more volunteers to receive related training to address an opioid overdose, as specified.
This bill would require those school districts, county offices of education, and charter schools, serving pupils in any of grades 9 to 12, inclusive, that voluntarily determine to make naloxone hydrochloride or another opioid antagonist available on campus to ensure that the naloxone hydrochloride or another opioid antagonist is placed in an appropriate location that is widely known and easily accessible, both during school hours and after school hours. The bill would require the naloxone hydrochloride or another opioid antagonist to be located on campus grounds in at least one of several specified locations.
This bill would require the State Department of Public Health to establish, by March April 1, 2025, a certification training program for public high school pupils in grades 9 to 12, inclusive, to gain skills in how to identify and respond to an opioid overdose, including by administering naloxone hydrochloride nasal spray, as defined. The bill would authorize public high schools serving pupils in any of grades 9 to 12, inclusive, to voluntarily determine whether or not to host the program on their campuses. The bill would require the department to collaborate with local, state, and national organizations, as provided, to provide pupils with integrated, comprehensive, accurate, and unbiased educational materials on opioid and drug overdose prevention, opioid and drug safety, and stigma reduction. The bill would authorize program trainings to include instruction from appropriately trained instructors, as provided, and include informational videos, graphics, or in-person training on what to do and how to respond during a drug or opioid overdose, as well as information on how to recognize signs of a drug or opioid overdose and how to respond in an emergency involving a drug or opioid overdose. The bill would require the department to collect, on an annual basis, data on the number of pupils participating in the program and to share this information with the Legislature and the Senate and Assembly Budget Subcommittees on Education, Health, and Human Services, as provided.
Existing law requires instruction to be given in the elementary and secondary schools by appropriately trained instructors on drug education and the effects of the use of tobacco, alcohol, narcotics, dangerous drugs, as defined, and other dangerous substances. Existing law authorizes a public or private elementary or secondary school to determine whether or not to make emergency naloxone hydrochloride or another opioid antagonist and trained personnel available at its school, and to designate one or more volunteers to receive related training to address an opioid overdose, as specified.
This bill would require those school districts, county offices of education, and charter schools, serving pupils in any of grades 9 to 12, inclusive, that voluntarily determine to make naloxone hydrochloride or another opioid antagonist available on campus to ensure that the naloxone hydrochloride or another opioid antagonist is placed in an appropriate location that is widely known and easily accessible, both during school hours and after school hours. The bill would require the naloxone hydrochloride or another opioid antagonist to be located on campus grounds in at least one of several specified locations.
This bill would require the State Department of Public Health to establish, by March 1, 2025, a certification training program for public high school pupils in grades 9 to 12, inclusive, to gain skills in how to identify and respond to an opioid overdose, including by administering naloxone hydrochloride nasal spray, as defined. The bill would authorize public high schools serving pupils in any of grades 9 to 12, inclusive, to voluntarily determine whether or not to host the program on their campuses. The bill would require the department to collaborate with local, state, and national organizations, as provided, to provide pupils with integrated, comprehensive, accurate, and unbiased educational materials on opioid and drug overdose prevention, opioid and drug safety, and stigma reduction. The bill would authorize program trainings to include instruction from appropriately trained instructors, as provided, and include informational videos, graphics, or in-person training on what to do and how to respond during a drug or opioid overdose, as well as information on how to recognize signs of a drug or opioid overdose and how to respond in an emergency involving a drug or opioid overdose. The bill would require the department to collect, on an annual basis, data on the number of pupils participating in the program and to share this information with the Legislature and the Senate and Assembly Budget Subcommittees on Education, Health, and Human Services, as provided.
Existing law requires instruction to be given in the elementary and secondary schools by appropriately trained instructors on drug education and the effects of the use of tobacco, alcohol, narcotics, dangerous drugs, as defined, and other dangerous substances. Existing law authorizes a public or private elementary or secondary school to determine whether or not to make emergency naloxone hydrochloride or another opioid antagonist and trained personnel available at its school, and to designate one or more volunteers to receive related training to address an opioid overdose, as specified.
This bill would require those school districts, county offices of education, and charter schools schools, serving pupils in any of grades 9 to 12, inclusive, that voluntarily determine to make naloxone hydrochloride or another opioid antagonist available on campus to ensure that the naloxone hydrochloride or another opioid antagonist is placed in an appropriate location that is widely known and easily accessible, both during school hours and after school hours. The bill would require the naloxone hydrochloride or another opioid antagonist to be located on campus grounds in at least one of several specified locations.
This bill would require the State Department of Public Health to establish, by March 1, 2025, a certification training program for public high school pupils in grades 9 to 12, inclusive, to gain skills in how to identify and respond to an opioid overdose, including by administering naloxone hydrochloride nasal spray, as defined. The bill would authorize public high schools serving pupils in any of grades 9 to 12, inclusive, to voluntarily determine whether or not to host the program on their campuses. The bill would require the department to collaborate with community health centers, community health experts, and nonprofits with related expertise local, state, and national organizations, as provided, to provide pupils with integrated, comprehensive, accurate, and unbiased educational materials on opioid and drug overdose prevention, opioid and drug safety, and stigma reduction. The bill would authorize program trainings to include instruction from appropriately trained instructors, as provided, and include informational videos, graphics, or in-person training on what to do and how to respond during a drug or opioid overdose, as well as information on how to recognize signs of a drug or opioid overdose and how to respond in an emergency involving a drug or opioid overdose. The bill would require the department to collect, on an annual basis, data on the number of pupils participating in the program and to share this information with the Legislature and the Senate and Assembly Budget Subcommittees on Health Education, Health, and Human Services, as provided.
Existing law requires instruction to be given in the elementary and secondary schools by appropriately trained instructors on drug education and the effects of the use of tobacco, alcohol, narcotics, dangerous drugs, as defined, and other dangerous substances. Existing law authorizes a public or private elementary or secondary school to determine whether or not to make emergency naloxone hydrochloride or another opioid antagonist and trained personnel available at its school, and to designate one or more volunteers to receive related training to address an opioid overdose, as specified.
This bill would require those public or private elementary schools school districts, county offices of education, and charter schools serving pupils in any of grades 9 to 12, inclusive, that voluntarily determine to make naloxone hydrochloride or another opioid antagonist available on campus to ensure that the naloxone hydrochloride or another opioid antagonist is placed in a an appropriate location that is widely known and easily accessible, both during school hours and after school hours. The bill would require the naloxone hydrochloride or another opioid antagonist to be located on campus grounds in at least one of several specified locations.
This bill would require the State Department of Public Health to establish, by March 1, 2025, a certification training program for public middle school and public high school pupils in grades 5 9 to 12, inclusive, to gain skills in how to administer Narcan identify and respond to an opioid overdose, including by administering naloxone hydrochloride nasal spray, as defined, during an opioid overdose, and how to store and dispose of Narcan nasal spray. defined. The bill would authorize public middle and high schools serving pupils in any of grades 5 9 to 12, inclusive, to voluntarily determine whether or not to host the program on their campuses. The bill would require the department to collaborate with drug prevention organizations, community health centers and experts, centers, community health experts, and nonprofits with related expertise to provide pupils with integrated, comprehensive, accurate, and unbiased educational materials on opioid and drug overdose prevention, opioid and drug safety, and stigma reduction. The bill would require authorize program trainings to include instruction from appropriately trained instructors, as provided, and include informational videos, graphics, and or in-person training on what to do and how to respond during a drug or opioid overdose, as well as information on how to recognize signs of a drug or opioid overdose and how to respond in an emergency involving a drug or opioid overdose. The bill would require the department to collect, on an annual basis, data on the number of pupils participating in the program and to share this information with the Legislature and the Senate and Assembly Budget Subcommittees on Health and Human Services, as provided.
Existing law requires instruction to be given in the elementary and secondary schools by appropriately trained instructors on drug education and the effects of the use of tobacco, alcohol, narcotics, dangerous drugs, as defined, and other dangerous substances. Existing law authorizes a public or private elementary or secondary school to determine whether or not to make emergency naloxone hydrochloride or another opioid antagonist and trained personnel available at its school, and to designate one or more volunteers to receive related training to address an opioid overdose, as specified.
This bill would express the intent of the Legislature to enact subsequent legislation to direct middle and high schools to provide drug education curriculum on efforts to help someone who experiences an overdose.This bill would require those public or private elementary schools that voluntarily determine to make naloxone hydrochloride or another opioid antagonist available on campus to ensure that the naloxone hydrochloride or another opioid antagonist is placed in a location that is widely known and easily accessible, both during school hours and after school hours. The bill would require the naloxone hydrochloride or another opioid antagonist to be located on campus grounds in at least one of several specified locations.
This bill would require the State Department of Public Health to establish, by March 1, 2025, a certification training program for public middle school and public high school pupils in grades 5 to 12, inclusive, to gain skills in how to administer Narcan nasal spray, as defined, during an opioid overdose, and how to store and dispose of Narcan nasal spray. The bill would authorize public middle and high schools serving pupils in any of grades 5 to 12, inclusive, to voluntarily determine whether or not to host the program on their campuses. The bill would require the department to collaborate with drug prevention organizations, community health centers and experts, and nonprofits with related expertise to provide pupils with integrated, comprehensive, accurate, and unbiased educational materials on opioid and drug overdose prevention, opioid and drug safety, and stigma reduction. The bill would require program trainings to include instruction from appropriately trained instructors, as provided, and include informational videos, graphics, and in-person training on what to do and how to respond during a drug or opioid overdose, as well as information on how to recognize signs of a drug or opioid overdose and how to respond in an emergency involving a drug or opioid overdose. The bill would require the department to collect, on an annual basis, data on the number of pupils participating in the program and to share this information with the Legislature and the Senate and Assembly Budget Subcommittees on Health and Human Services, as provided.
Existing law requires instruction to be given in the elementary and secondary schools by appropriately trained instructors on drug education and the effects of the use of tobacco, alcohol, narcotics, dangerous drugs, as defined, and other dangerous substances.
This bill would express the intent of the Legislature to enact subsequent legislation to direct middle and high schools to provide drug education curriculum on efforts to help someone who experiences an overdose.
The Legislature finds and declares all of the following:
(a)The fentanyl crisis among California youth is an urgent public health emergency. Youth overdose rates continue to rise in California, corresponding with the increasing presence of the potent synthetic opioid, Fentanyl, and other related analogs. Fentanyl contributes to more than 80 percent of all drug-related overdose deaths among young people.
(b)The opioid antagonist medication, naloxone hydrochloride, is designed to rapidly reverse an opioid overdose. This medication is available in a safe, easy-to-use nasal spray and in an injectable form. These are used to reduce preventable overdose fatalities. It is imperative that all pupils, faculty, and staff are aware of the location of naloxone hydrochloride on school campuses and understand how to identify the signs of an overdose and respond using an opioid antagonist medication.
(c)The Governors 202324 fiscal year budget proposal prioritizes opioid overdose prevention strategies for high schools across the state.
SEC. 2.Section 49414.3 of the Education Code is amended to read:49414.3.(a)School districts, county offices of education, and charter schools may provide emergency naloxone hydrochloride or another opioid antagonist to school nurses or trained personnel who have volunteered pursuant to subdivision (d), and school nurses or trained personnel may use naloxone hydrochloride or another opioid antagonist to provide emergency medical aid to persons suffering, or reasonably believed to be suffering, from an opioid overdose.
(b)For purposes of this section, the following terms have the following meanings:
(1)Authorizing physician and surgeon may include, but is not limited to, a physician and surgeon employed by, or contracting with, a local educational agency, a medical director of the local health department, or a local emergency medical services director.
(2)Auto-injector means a disposable delivery device designed for the automatic injection of a premeasured dose of an opioid antagonist into the human body and approved by the United States Food and Drug Administration for layperson use.
(3)Opioid antagonist means naloxone hydrochloride or another drug approved by the United States Food and Drug Administration that, when administered, negates or neutralizes in whole or in part the pharmacological effects of an opioid in the body, and has been approved for the treatment of an opioid overdose.
(4)Qualified supervisor of health may include, but is not limited to, a school nurse.
(5)Volunteer or trained personnel means an employee who has volunteered to administer naloxone hydrochloride or another opioid antagonist to a person if the person is suffering, or is reasonably believed to be suffering, from an opioid overdose, has been designated by a school, and has received training pursuant to subdivision (d).
(c)Each public and private elementary and secondary school in the state may voluntarily determine whether or not to make emergency naloxone hydrochloride or another opioid antagonist and trained personnel available at its school. In making this determination, a school shall evaluate the emergency medical response time to the school and determine whether initiating emergency medical services is an acceptable alternative to naloxone hydrochloride or another opioid antagonist and trained personnel. A private elementary or secondary school choosing to exercise the authority provided under this subdivision shall not receive state funds specifically for purposes of this subdivision.
(d)(1)Each public and private elementary and secondary school in the state may designate one or more volunteers to receive initial and annual refresher training, based on the standards developed pursuant to subdivision (e), regarding the storage and emergency use of naloxone hydrochloride or another opioid antagonist from the school nurse or other qualified person designated by an authorizing physician and surgeon. A benefit shall not be granted to or withheld from any individual based on their offer to volunteer, and there shall be no retaliation against any individual for rescinding their offer to volunteer, including after receiving training. Any school district, county office of education, or charter school choosing to exercise the authority provided under this subdivision shall provide the training for the volunteers at no cost to the volunteer and during the volunteers regular working hours or schoolday.
(2)An employee who volunteers pursuant to this section may rescind their offer to administer emergency naloxone hydrochloride or another opioid antagonist at any time, including after receipt of training.
(e)(1)The Superintendent shall establish minimum standards of training for the administration of naloxone hydrochloride or another opioid antagonist that satisfies the requirements of paragraph (2). Every five years, or sooner as deemed necessary by the Superintendent, the Superintendent shall review minimum standards of training for the administration of naloxone hydrochloride or other opioid antagonists that satisfy the requirements of paragraph (2). For purposes of this subdivision, the Superintendent shall consult with organizations and providers with expertise in administering naloxone hydrochloride or another opioid antagonist and administering medication in a school environment, including, but not limited to, the California Society of Addiction Medicine, the Emergency Medical Services Authority, the California School Nurses Organization, the California Medical Association, the American Academy of Pediatrics, and others.
(2)Training established pursuant to this subdivision shall include all of the following:
(A)Techniques for recognizing symptoms of an opioid overdose.
(B)Standards and procedures for the storage, restocking, and emergency use of naloxone hydrochloride or another opioid antagonist.
(C)Basic emergency followup procedures, including, but not limited to, a requirement for the school or charter school administrator or, if the administrator is not available, another school staff member to call the emergency 911 telephone number and to contact the pupils parent or guardian.
(D)Recommendations on the necessity of instruction and certification in cardiopulmonary resuscitation.
(E)Written materials covering the information required under this subdivision.
(3)Training established pursuant to this subdivision shall be consistent with the most recent guidelines for medication administration issued by the department.
(4)A school shall retain for reference the written materials prepared under subparagraph (E) of paragraph (2).
(5)The department shall include on its internet website a clearinghouse for best practices in training nonmedical personnel to administer naloxone hydrochloride or another opioid antagonist to individuals.
(f)Any school district, county office of education, or charter school electing to utilize naloxone hydrochloride or another opioid antagonist for emergency aid shall distribute a notice at least once per school year to all staff that contains the following information:
(1)A description of the volunteer request stating that the request is for volunteers to be trained to administer naloxone hydrochloride or another opioid antagonist to a person if the person is suffering, or reasonably believed to be suffering, from an opioid overdose.
(2)A description of the training that the volunteer will receive pursuant to subdivision (d).
(3)The right of an employee to rescind their offer to volunteer pursuant to this section.
(4)A statement that no benefit will be granted to or withheld from any individual based on their offer to volunteer and that there will be no retaliation against any individual for rescinding their offer to volunteer, including after receiving training.
(g)(1)A qualified supervisor of health at a school district, county office of education, or charter school electing to utilize naloxone hydrochloride or another opioid antagonist for emergency aid shall obtain from an authorizing physician and surgeon a prescription for each school for naloxone hydrochloride or another opioid antagonist. A qualified supervisor of health at a school district, county office of education, or charter school shall be responsible for stocking the naloxone hydrochloride or another opioid antagonist and restocking it if it is used.
(2)If a school district, county office of education, or charter school does not have a qualified supervisor of health, an administrator at the school district, county office of education, or charter school shall carry out the duties specified in paragraph (1).
(3)A prescription pursuant to this subdivision may be filled by local or mail order pharmacies or opioid antagonist manufacturers.
(4)An authorizing physician and surgeon shall not be subject to professional review, be liable in a civil action, or be subject to criminal prosecution for the issuance of a prescription or order pursuant to this section, unless the physician and surgeons issuance of the prescription or order constitutes gross negligence or willful or malicious conduct.
(h)(1)A school nurse or, if the school does not have a school nurse or the school nurse is not onsite or available, a volunteer may administer naloxone hydrochloride or another opioid antagonist to a person exhibiting potentially life-threatening symptoms of an opioid overdose at school or a school activity when a physician is not immediately available. If the naloxone hydrochloride or another opioid antagonist is used it shall be restocked as soon as reasonably possible, but no later than two weeks after it is used. Naloxone hydrochloride or another opioid antagonist shall be restocked before its expiration date.
(2)Volunteers may administer naloxone hydrochloride or another opioid antagonist only by nasal spray or by auto-injector.
(3)A volunteer shall be allowed to administer naloxone hydrochloride or another opioid antagonist in a form listed in paragraph (2) that the volunteer is most comfortable with.
(i)A school district, county office of education, or charter school electing to utilize naloxone hydrochloride or another opioid antagonist for emergency aid shall ensure that each employee who volunteers under this section will be provided defense and indemnification by the school district, county office of education, or charter school for any and all civil liability, in accordance with, but not limited to, that provided in Division 3.6 (commencing with Section 810) of Title 1 of the Government Code. This information shall be reduced to writing, provided to the volunteer, and retained in the volunteers personnel file.
(j)(1)Notwithstanding any other law, a person trained as required under subdivision (d), who administers naloxone hydrochloride or another opioid antagonist, in good faith and not for compensation, to a person who appears to be experiencing an opioid overdose shall not be subject to professional review, be liable in a civil action, or be subject to criminal prosecution for their acts or omissions in administering the naloxone hydrochloride or another opioid antagonist.
(2)The protection specified in paragraph (1) shall not apply in a case of gross negligence or willful and wanton misconduct of the person who renders emergency care treatment by the use of naloxone hydrochloride or another opioid antagonist.
(3)Any public employee who volunteers to administer naloxone hydrochloride or another opioid antagonist pursuant to subdivision (d) is not providing emergency medical care for compensation, notwithstanding the fact that they are a paid public employee.
(k)A state agency, the department, or a public school may accept gifts, grants, and donations from any source for the support of the public school carrying out the provisions of this section, including, but not limited to, the acceptance of naloxone hydrochloride or another opioid antagonist from a manufacturer or wholesaler.
(l)Any school district, county office of education, or charter school, serving pupils in any of grades 9 to 12, inclusive, school that voluntarily determines to make naloxone hydrochloride or another opioid antagonist available on campus shall ensure that the naloxone hydrochloride or another opioid antagonist is placed in an appropriate location, as determined by the governing board or body, that is widely known and easily accessible, both during school hours and after school hours. The naloxone hydrochloride or another opioid antagonist shall be located in at least one of the following locations on campus:
(1)School nurses office.
(2)Athletic trainers office.
(3)Front office.
(4)Performing arts auditorium.
(5)Library.
(6)Cafeteria.
(7)Athletic gym.
SEC. 3.Article 5.5 (commencing with Section 49478) is added to Chapter 9 of Part 27 of Division 4 of Title 2 of the Education Code, to read:5.5.Opioid Overdose Prevention Certification andTraining Program49478.(a)For purposes of this article, the following definitions apply:
(1)Naloxone hydrochloride nasal spray means a nasal spray version of naloxone hydrochloride designed to rapidly reverse an opioid overdose that is approved by the United States Food and Drug Administration.(2)(1)Program means the opioid overdose prevention certification and training program established pursuant to subdivision (b).
(2)Program toolkit means the opioid overdose prevention training program materials necessary for a public high school to self-administer the program.
(3)Public high school means a public school serving pupils in grades 9 to 12, inclusive.
(b)(1)The State Department of Public Health shall establish, by April 1, 2025, a certification develop an opioid overdose training program and program toolkit to be made available to public high schools for public high school pupils in grades 9 to 12, inclusive, to gain skills in be trained on how to identify and respond to an opioid overdose, including by administering naloxone hydrochloride nasal spray. a federally approved opioid overdose reversal medication.
(2)Public high schools serving pupils in any of grades 9 to 12, inclusive, may voluntarily determine whether or not to host the program on their campuses.(2)The program may include, but is not limited to, all of the following:
(A)Informational videos, graphics, and in-person training on what to do and how to respond during a drug or opioid overdose. The State Department of Public Health may use any existing content or other relevant materials already developed, or develop new materials.
(B)Information on how to recognize signs of a drug or opioid overdose.
(C)Information on how to respond in an emergency involving a drug or opioid overdose.
(3)The program toolkit shall encourage and support opioid overdose training instruction in person at public high schools from appropriately trained instructors from local, state, and national organizations, which may include community health centers, community health experts, nonprofit organizations with related expertise, and school staff. Instructors who are not employed by the school shall undergo state-approved background checks.
(4)The program toolkit shall provide resource materials related to drug and opioid use or prevention, for appropriate use with pupils of all races, genders, sexual orientations, and ethnic and cultural backgrounds, pupils with disabilities, and English learners.
(5)The State Department of Public Health shall, by April 1, 2025, notify public high schools of the availability of the program toolkit.
(6)The State Department of Public Health shall provide the program toolkit upon request to those public high schools that opt to host the program on their campuses.
(7)The State Department of Public Health shall consider making its representatives available to provide the training onsite at public high schools upon request.
(c)In establishing the program, the The State Department of Public Health shall collaborate with local, state, and national organizations, which may include community health centers, community health experts, and nonprofits nonprofit organizations with related expertise, to provide pupils working toward their certificate with integrated, comprehensive, accurate, and unbiased educational materials on opioid and drug overdose prevention, opioid and drug safety, and stigma reduction.
(d)Program training shall include instruction from appropriately trained instructors from local, state, and national organizations, which may include community health centers, community health experts, nonprofits with related expertise, and school staff. Instructors who are not employed by the school shall undergo state-approved background checks.(e)(1)Program training related to administering naloxone hydrochloride nasal spray may include, but is not limited to, all of the following:(A)Informational videos, graphics, or in-person training on what to do and how to respond during a drug or opioid overdose.(B)Information on how to recognize signs of a drug or opioid overdose.(C)Information on how to respond in an emergency involving a drug or opioid overdose.(2)The program shall provide resource materials related to drug and opioid use or prevention, for appropriate use with pupils of all races, genders, sexual orientations, and ethnic and cultural backgrounds, pupils with disabilities, and English learners.(f)(d)In order to determine the efficacy of program training resources and program drug and opioid prevention informational efforts, the State Department of Public Health shall, on an annual basis, collect data on the number of pupils participating in the program and share this information with the Legislature, in compliance with Section 9795 of the Government Code, and with the Senate and Assembly Budget Subcommittees on Education, Health, and Human Services.
The Legislature finds and declares all of the following:
(a)The fentanyl crisis among California youth is an urgent public health emergency. Youth overdose rates continue to rise in California, corresponding with the increasing presence of the potent synthetic opioid, Fentanyl, and other related analogs. Fentanyl contributes to more than 80 percent of all drug-related overdose deaths among young people.
(b)The opioid antagonist medication, naloxone hydrochloride, is designed to rapidly reverse an opioid overdose. This medication is available in a safe, easy-to-use nasal spray and in an injectable form. These are used to reduce preventable overdose fatalities. It is imperative that all pupils, faculty, and staff are aware of the location of naloxone hydrochloride on school campuses and understand how to identify the signs of an overdose and respond using an opioid antagonist medication.
(c)The Governors 202324 fiscal year budget proposal prioritizes opioid overdose prevention strategies for high schools across the state.
SEC. 2.Section 49414.3 of the Education Code is amended to read:49414.3.(a)School districts, county offices of education, and charter schools may provide emergency naloxone hydrochloride or another opioid antagonist to school nurses or trained personnel who have volunteered pursuant to subdivision (d), and school nurses or trained personnel may use naloxone hydrochloride or another opioid antagonist to provide emergency medical aid to persons suffering, or reasonably believed to be suffering, from an opioid overdose.
(b)For purposes of this section, the following terms have the following meanings:
(1)Authorizing physician and surgeon may include, but is not limited to, a physician and surgeon employed by, or contracting with, a local educational agency, a medical director of the local health department, or a local emergency medical services director.
(2)Auto-injector means a disposable delivery device designed for the automatic injection of a premeasured dose of an opioid antagonist into the human body and approved by the United States Food and Drug Administration for layperson use.
(3)Opioid antagonist means naloxone hydrochloride or another drug approved by the United States Food and Drug Administration that, when administered, negates or neutralizes in whole or in part the pharmacological effects of an opioid in the body, and has been approved for the treatment of an opioid overdose.
(4)Qualified supervisor of health may include, but is not limited to, a school nurse.
(5)Volunteer or trained personnel means an employee who has volunteered to administer naloxone hydrochloride or another opioid antagonist to a person if the person is suffering, or is reasonably believed to be suffering, from an opioid overdose, has been designated by a school, and has received training pursuant to subdivision (d).
(c)Each public and private elementary and secondary school in the state may voluntarily determine whether or not to make emergency naloxone hydrochloride or another opioid antagonist and trained personnel available at its school. In making this determination, a school shall evaluate the emergency medical response time to the school and determine whether initiating emergency medical services is an acceptable alternative to naloxone hydrochloride or another opioid antagonist and trained personnel. A private elementary or secondary school choosing to exercise the authority provided under this subdivision shall not receive state funds specifically for purposes of this subdivision.
(d)(1)Each public and private elementary and secondary school in the state may designate one or more volunteers to receive initial and annual refresher training, based on the standards developed pursuant to subdivision (e), regarding the storage and emergency use of naloxone hydrochloride or another opioid antagonist from the school nurse or other qualified person designated by an authorizing physician and surgeon. A benefit shall not be granted to or withheld from any individual based on their offer to volunteer, and there shall be no retaliation against any individual for rescinding their offer to volunteer, including after receiving training. Any school district, county office of education, or charter school choosing to exercise the authority provided under this subdivision shall provide the training for the volunteers at no cost to the volunteer and during the volunteers regular working hours or schoolday.
(2)An employee who volunteers pursuant to this section may rescind their offer to administer emergency naloxone hydrochloride or another opioid antagonist at any time, including after receipt of training.
(e)(1)The Superintendent shall establish minimum standards of training for the administration of naloxone hydrochloride or another opioid antagonist that satisfies the requirements of paragraph (2). Every five years, or sooner as deemed necessary by the Superintendent, the Superintendent shall review minimum standards of training for the administration of naloxone hydrochloride or other opioid antagonists that satisfy the requirements of paragraph (2). For purposes of this subdivision, the Superintendent shall consult with organizations and providers with expertise in administering naloxone hydrochloride or another opioid antagonist and administering medication in a school environment, including, but not limited to, the California Society of Addiction Medicine, the Emergency Medical Services Authority, the California School Nurses Organization, the California Medical Association, the American Academy of Pediatrics, and others.
(2)Training established pursuant to this subdivision shall include all of the following:
(A)Techniques for recognizing symptoms of an opioid overdose.
(B)Standards and procedures for the storage, restocking, and emergency use of naloxone hydrochloride or another opioid antagonist.
(C)Basic emergency followup procedures, including, but not limited to, a requirement for the school or charter school administrator or, if the administrator is not available, another school staff member to call the emergency 911 telephone number and to contact the pupils parent or guardian.
(D)Recommendations on the necessity of instruction and certification in cardiopulmonary resuscitation.
(E)Written materials covering the information required under this subdivision.
(3)Training established pursuant to this subdivision shall be consistent with the most recent guidelines for medication administration issued by the department.
(4)A school shall retain for reference the written materials prepared under subparagraph (E) of paragraph (2).
(5)The department shall include on its internet website a clearinghouse for best practices in training nonmedical personnel to administer naloxone hydrochloride or another opioid antagonist to individuals.
(f)Any school district, county office of education, or charter school electing to utilize naloxone hydrochloride or another opioid antagonist for emergency aid shall distribute a notice at least once per school year to all staff that contains the following information:
(1)A description of the volunteer request stating that the request is for volunteers to be trained to administer naloxone hydrochloride or another opioid antagonist to a person if the person is suffering, or reasonably believed to be suffering, from an opioid overdose.
(2)A description of the training that the volunteer will receive pursuant to subdivision (d).
(3)The right of an employee to rescind their offer to volunteer pursuant to this section.
(4)A statement that no benefit will be granted to or withheld from any individual based on their offer to volunteer and that there will be no retaliation against any individual for rescinding their offer to volunteer, including after receiving training.
(g)(1)A qualified supervisor of health at a school district, county office of education, or charter school electing to utilize naloxone hydrochloride or another opioid antagonist for emergency aid shall obtain from an authorizing physician and surgeon a prescription for each school for naloxone hydrochloride or another opioid antagonist. A qualified supervisor of health at a school district, county office of education, or charter school shall be responsible for stocking the naloxone hydrochloride or another opioid antagonist and restocking it if it is used.
(2)If a school district, county office of education, or charter school does not have a qualified supervisor of health, an administrator at the school district, county office of education, or charter school shall carry out the duties specified in paragraph (1).
(3)A prescription pursuant to this subdivision may be filled by local or mail order pharmacies or opioid antagonist manufacturers.
(4)An authorizing physician and surgeon shall not be subject to professional review, be liable in a civil action, or be subject to criminal prosecution for the issuance of a prescription or order pursuant to this section, unless the physician and surgeons issuance of the prescription or order constitutes gross negligence or willful or malicious conduct.
(h)(1)A school nurse or, if the school does not have a school nurse or the school nurse is not onsite or available, a volunteer may administer naloxone hydrochloride or another opioid antagonist to a person exhibiting potentially life-threatening symptoms of an opioid overdose at school or a school activity when a physician is not immediately available. If the naloxone hydrochloride or another opioid antagonist is used it shall be restocked as soon as reasonably possible, but no later than two weeks after it is used. Naloxone hydrochloride or another opioid antagonist shall be restocked before its expiration date.
(2)Volunteers may administer naloxone hydrochloride or another opioid antagonist only by nasal spray or by auto-injector.
(3)A volunteer shall be allowed to administer naloxone hydrochloride or another opioid antagonist in a form listed in paragraph (2) that the volunteer is most comfortable with.
(i)A school district, county office of education, or charter school electing to utilize naloxone hydrochloride or another opioid antagonist for emergency aid shall ensure that each employee who volunteers under this section will be provided defense and indemnification by the school district, county office of education, or charter school for any and all civil liability, in accordance with, but not limited to, that provided in Division 3.6 (commencing with Section 810) of Title 1 of the Government Code. This information shall be reduced to writing, provided to the volunteer, and retained in the volunteers personnel file.
(j)(1)Notwithstanding any other law, a person trained as required under subdivision (d), who administers naloxone hydrochloride or another opioid antagonist, in good faith and not for compensation, to a person who appears to be experiencing an opioid overdose shall not be subject to professional review, be liable in a civil action, or be subject to criminal prosecution for their acts or omissions in administering the naloxone hydrochloride or another opioid antagonist.
(2)The protection specified in paragraph (1) shall not apply in a case of gross negligence or willful and wanton misconduct of the person who renders emergency care treatment by the use of naloxone hydrochloride or another opioid antagonist.
(3)Any public employee who volunteers to administer naloxone hydrochloride or another opioid antagonist pursuant to subdivision (d) is not providing emergency medical care for compensation, notwithstanding the fact that they are a paid public employee.
(k)A state agency, the department, or a public school may accept gifts, grants, and donations from any source for the support of the public school carrying out the provisions of this section, including, but not limited to, the acceptance of naloxone hydrochloride or another opioid antagonist from a manufacturer or wholesaler.
(l)Any school district, county office of education, or charter school, serving pupils in any of grades 9 to 12, inclusive, that voluntarily determines to make naloxone hydrochloride or another opioid antagonist available on campus shall ensure that the naloxone hydrochloride or another opioid antagonist is placed in an appropriate location, as determined by the governing board or body, that is widely known and easily accessible, both during school hours and after school hours. The naloxone hydrochloride or another opioid antagonist shall be located in at least one of the following locations on campus:
(1)School nurses office.
(2)Athletic trainers office.
(3)Front office.
(4)Performing arts auditorium.
(5)Library.
(6)Cafeteria.
(7)Athletic gym.
SEC. 3.Article 5.5 (commencing with Section 49478) is added to Chapter 9 of Part 27 of Division 4 of Title 2 of the Education Code, to read:5.5.Opioid Overdose Prevention Certification and Training Program49478.(a)For purposes of this article, the following definitions apply:
(1)Naloxone hydrochloride nasal spray means a nasal spray version of naloxone hydrochloride designed to rapidly reverse an opioid overdose that is approved by the United States Food and Drug Administration.
(2)Program means the opioid overdose prevention certification and training program established pursuant to subdivision (b).
(b)(1)The State Department of Public Health shall establish, by March April 1, 2025, a certification training program for public high school pupils in grades 9 to 12, inclusive, to gain skills in how to identify and respond to an opioid overdose, including by administering naloxone hydrochloride nasal spray.
(2)Public high schools serving pupils in any of grades 9 to 12, inclusive, may voluntarily determine whether or not to host the program on their campuses.
(c)In establishing the program, the State Department of Public Health shall collaborate with local, state, and national organizations, which may include community health centers, community health experts, and nonprofits with related expertise, to provide pupils working toward their certificate with integrated, comprehensive, accurate, and unbiased educational materials on opioid and drug overdose prevention, opioid and drug safety, and stigma reduction.
(d)Program training shall include instruction from appropriately trained instructors from local, state, and national organizations, which may include community health centers, community health experts, nonprofits with related expertise, and school staff. Instructors who are not employed by the school shall undergo state-approved background checks.
(e)(1)Program training related to administering naloxone hydrochloride nasal spray may include, but is not limited to, all of the following:
(A)Informational videos, graphics, or in-person training on what to do and how to respond during a drug or opioid overdose.
(B)Information on how to recognize signs of a drug or opioid overdose.
(C)Information on how to respond in an emergency involving a drug or opioid overdose.
(2)The program shall provide resource materials related to drug and opioid use or prevention, for appropriate use with pupils of all races, genders, sexual orientations, and ethnic and cultural backgrounds, pupils with disabilities, and English learners.
(f)In order to determine the efficacy of program training resources and program drug and opioid prevention informational efforts, the State Department of Public Health shall, on an annual basis, collect data on the number of pupils participating in the program and share this information with the Legislature, in compliance with Section 9795 of the Government Code, and with the Senate and Assembly Budget Subcommittees on Education, Health, and Human Services.
The Legislature finds and declares all of the following:
(a)The fentanyl crisis among California youth is an urgent public health emergency. Youth overdose rates continue to rise in California, corresponding with the increasing presence of the potent synthetic opioid, Fentanyl, and other related analogs. Fentanyl contributes to more than 80 percent of all drug-related overdose deaths among young people.
(b)The opioid antagonist medication, naloxone hydrochloride, is designed to rapidly reverse an opioid overdose. This medication is available in a safe, easy-to-use nasal spray and in an injectable form. These are used to reduce preventable overdose fatalities. It is imperative that all pupils, faculty, and staff are aware of the location of naloxone hydrochloride on school campuses and understand how to identify the signs of an overdose and respond using an opioid antagonist medication.
(c)The Governors 202324 fiscal year budget proposal prioritizes opioid overdose prevention strategies for high schools across the state.
SEC. 2.Section 49414.3 of the Education Code is amended to read:49414.3.(a)School districts, county offices of education, and charter schools may provide emergency naloxone hydrochloride or another opioid antagonist to school nurses or trained personnel who have volunteered pursuant to subdivision (d), and school nurses or trained personnel may use naloxone hydrochloride or another opioid antagonist to provide emergency medical aid to persons suffering, or reasonably believed to be suffering, from an opioid overdose.
(b)For purposes of this section, the following terms have the following meanings:
(1)Authorizing physician and surgeon may include, but is not limited to, a physician and surgeon employed by, or contracting with, a local educational agency, a medical director of the local health department, or a local emergency medical services director.
(2)Auto-injector means a disposable delivery device designed for the automatic injection of a premeasured dose of an opioid antagonist into the human body and approved by the United States Food and Drug Administration for layperson use.
(3)Opioid antagonist means naloxone hydrochloride or another drug approved by the United States Food and Drug Administration that, when administered, negates or neutralizes in whole or in part the pharmacological effects of an opioid in the body, and has been approved for the treatment of an opioid overdose.
(4)Qualified supervisor of health may include, but is not limited to, a school nurse.
(5)Volunteer or trained personnel means an employee who has volunteered to administer naloxone hydrochloride or another opioid antagonist to a person if the person is suffering, or is reasonably believed to be suffering, from an opioid overdose, has been designated by a school, and has received training pursuant to subdivision (d).
(c)Each public and private elementary and secondary school in the state may voluntarily determine whether or not to make emergency naloxone hydrochloride or another opioid antagonist and trained personnel available at its school. In making this determination, a school shall evaluate the emergency medical response time to the school and determine whether initiating emergency medical services is an acceptable alternative to naloxone hydrochloride or another opioid antagonist and trained personnel. A private elementary or secondary school choosing to exercise the authority provided under this subdivision shall not receive state funds specifically for purposes of this subdivision.
(d)(1)Each public and private elementary and secondary school in the state may designate one or more volunteers to receive initial and annual refresher training, based on the standards developed pursuant to subdivision (e), regarding the storage and emergency use of naloxone hydrochloride or another opioid antagonist from the school nurse or other qualified person designated by an authorizing physician and surgeon. A benefit shall not be granted to or withheld from any individual based on their offer to volunteer, and there shall be no retaliation against any individual for rescinding their offer to volunteer, including after receiving training. Any school district, county office of education, or charter school choosing to exercise the authority provided under this subdivision shall provide the training for the volunteers at no cost to the volunteer and during the volunteers regular working hours or schoolday.
(2)An employee who volunteers pursuant to this section may rescind their offer to administer emergency naloxone hydrochloride or another opioid antagonist at any time, including after receipt of training.
(e)(1)The Superintendent shall establish minimum standards of training for the administration of naloxone hydrochloride or another opioid antagonist that satisfies the requirements of paragraph (2). Every five years, or sooner as deemed necessary by the Superintendent, the Superintendent shall review minimum standards of training for the administration of naloxone hydrochloride or other opioid antagonists that satisfy the requirements of paragraph (2). For purposes of this subdivision, the Superintendent shall consult with organizations and providers with expertise in administering naloxone hydrochloride or another opioid antagonist and administering medication in a school environment, including, but not limited to, the California Society of Addiction Medicine, the Emergency Medical Services Authority, the California School Nurses Organization, the California Medical Association, the American Academy of Pediatrics, and others.
(2)Training established pursuant to this subdivision shall include all of the following:
(A)Techniques for recognizing symptoms of an opioid overdose.
(B)Standards and procedures for the storage, restocking, and emergency use of naloxone hydrochloride or another opioid antagonist.
(C)Basic emergency followup procedures, including, but not limited to, a requirement for the school or charter school administrator or, if the administrator is not available, another school staff member to call the emergency 911 telephone number and to contact the pupils parent or guardian.
(D)Recommendations on the necessity of instruction and certification in cardiopulmonary resuscitation.
(E)Written materials covering the information required under this subdivision.
(3)Training established pursuant to this subdivision shall be consistent with the most recent guidelines for medication administration issued by the department.
(4)A school shall retain for reference the written materials prepared under subparagraph (E) of paragraph (2).
(5)The department shall include on its internet website a clearinghouse for best practices in training nonmedical personnel to administer naloxone hydrochloride or another opioid antagonist to individuals.
(f)Any school district, county office of education, or charter school electing to utilize naloxone hydrochloride or another opioid antagonist for emergency aid shall distribute a notice at least once per school year to all staff that contains the following information:
(1)A description of the volunteer request stating that the request is for volunteers to be trained to administer naloxone hydrochloride or another opioid antagonist to a person if the person is suffering, or reasonably believed to be suffering, from an opioid overdose.
(2)A description of the training that the volunteer will receive pursuant to subdivision (d).
(3)The right of an employee to rescind their offer to volunteer pursuant to this section.
(4)A statement that no benefit will be granted to or withheld from any individual based on their offer to volunteer and that there will be no retaliation against any individual for rescinding their offer to volunteer, including after receiving training.
(g)(1)A qualified supervisor of health at a school district, county office of education, or charter school electing to utilize naloxone hydrochloride or another opioid antagonist for emergency aid shall obtain from an authorizing physician and surgeon a prescription for each school for naloxone hydrochloride or another opioid antagonist. A qualified supervisor of health at a school district, county office of education, or charter school shall be responsible for stocking the naloxone hydrochloride or another opioid antagonist and restocking it if it is used.
(2)If a school district, county office of education, or charter school does not have a qualified supervisor of health, an administrator at the school district, county office of education, or charter school shall carry out the duties specified in paragraph (1).
(3)A prescription pursuant to this subdivision may be filled by local or mail order pharmacies or opioid antagonist manufacturers.
(4)An authorizing physician and surgeon shall not be subject to professional review, be liable in a civil action, or be subject to criminal prosecution for the issuance of a prescription or order pursuant to this section, unless the physician and surgeons issuance of the prescription or order constitutes gross negligence or willful or malicious conduct.
(h)(1)A school nurse or, if the school does not have a school nurse or the school nurse is not onsite or available, a volunteer may administer naloxone hydrochloride or another opioid antagonist to a person exhibiting potentially life-threatening symptoms of an opioid overdose at school or a school activity when a physician is not immediately available. If the naloxone hydrochloride or another opioid antagonist is used it shall be restocked as soon as reasonably possible, but no later than two weeks after it is used. Naloxone hydrochloride or another opioid antagonist shall be restocked before its expiration date.
(2)Volunteers may administer naloxone hydrochloride or another opioid antagonist only by nasal spray or by auto-injector.
(3)A volunteer shall be allowed to administer naloxone hydrochloride or another opioid antagonist in a form listed in paragraph (2) that the volunteer is most comfortable with.
(i)A school district, county office of education, or charter school electing to utilize naloxone hydrochloride or another opioid antagonist for emergency aid shall ensure that each employee who volunteers under this section will be provided defense and indemnification by the school district, county office of education, or charter school for any and all civil liability, in accordance with, but not limited to, that provided in Division 3.6 (commencing with Section 810) of Title 1 of the Government Code. This information shall be reduced to writing, provided to the volunteer, and retained in the volunteers personnel file.
(j)(1)Notwithstanding any other law, a person trained as required under subdivision (d), who administers naloxone hydrochloride or another opioid antagonist, in good faith and not for compensation, to a person who appears to be experiencing an opioid overdose shall not be subject to professional review, be liable in a civil action, or be subject to criminal prosecution for their acts or omissions in administering the naloxone hydrochloride or another opioid antagonist.
(2)The protection specified in paragraph (1) shall not apply in a case of gross negligence or willful and wanton misconduct of the person who renders emergency care treatment by the use of naloxone hydrochloride or another opioid antagonist.
(3)Any public employee who volunteers to administer naloxone hydrochloride or another opioid antagonist pursuant to subdivision (d) is not providing emergency medical care for compensation, notwithstanding the fact that they are a paid public employee.
(k)A state agency, the department, or a public school may accept gifts, grants, and donations from any source for the support of the public school carrying out the provisions of this section, including, but not limited to, the acceptance of naloxone hydrochloride or another opioid antagonist from a manufacturer or wholesaler.
(l)Any school district, county office of education, or charter school, serving pupils in any of grades 9 to 12, inclusive, that voluntarily determines to make naloxone hydrochloride or another opioid antagonist available on campus shall ensure that the naloxone hydrochloride or another opioid antagonist is placed in an appropriate location, as determined by the governing board or body, that is widely known and easily accessible, both during school hours and after school hours. The naloxone hydrochloride or another opioid antagonist shall be located in at least one of the following locations on campus:
(1)School nurses office.
(2)Athletic trainers office.
(3)Front office.
(4)Performing arts auditorium.
(5)Library.
(6)Cafeteria.
(7)Athletic gym.
SEC. 3.Article 5.5 (commencing with Section 49478) is added to Chapter 9 of Part 27 of Division 4 of Title 2 of the Education Code, to read:5.5.Naloxone Hydrochloride Spray Certification Opioid Overdose Prevention Certification and Training Program49478.(a)For purposes of this article, the following definitions apply:
(1)Naloxone hydrochloride nasal spray means a nasal spray version of naloxone hydrochloride designed to rapidly reverse an opioid overdose that is approved by the United States Food and Drug Administration.
(2)Program means the naloxone hydrochloride nasal spray certification training program opioid overdose prevention certification and training program established pursuant to subdivision (b).
(b)(1)The State Department of Public Health shall establish, by March 1, 2025, a certification training program for public high school pupils in grades 9 to 12, inclusive, to gain skills in how to identify and respond to an opioid overdose, including by administering naloxone hydrochloride nasal spray.
(2)Public high schools serving pupils in any of grades 9 to 12, inclusive, may voluntarily determine whether or not to host the program on their campuses.
(c)In establishing the program, the State Department of Public Health shall collaborate with local, state, and national organizations, which may include community health centers, community health experts, and nonprofits with related expertise, to provide pupils working toward their certificate with integrated, comprehensive, accurate, and unbiased educational materials on opioid and drug overdose prevention, opioid and drug safety, and stigma reduction.
(d)Program training shall include instruction from appropriately trained instructors from local, state, and national organizations, which may include community health centers, community health experts, nonprofits with related expertise, and school staff. Instructors who are not employed by the school shall undergo state-approved background checks.
(e)(1)Program training related to administering naloxone hydrochloride nasal spray may include, but is not limited to, all of the following:
(A)Informational videos, graphics, or in-person training on what to do and how to respond during a drug or opioid overdose.
(B)Information on how to recognize signs of a drug or opioid overdose.
(C)Information on how to respond in an emergency involving a drug or opioid overdose.
(2)The program shall provide resource materials related to drug and opioid use or prevention, for appropriate use with pupils of all races, genders, sexual orientations, and ethnic and cultural backgrounds, pupils with disabilities, and English learners.
(f)In order to determine the efficacy of program training resources and program drug and opioid prevention informational efforts, the State Department of Public Health shall, on an annual basis, collect data on the number of pupils participating in the program and share this information with the Legislature, in compliance with Section 9795 of the Government Code, and with the Senate and Assembly Budget Subcommittees on Education, Health, and Human Services.
The Legislature finds and declares all of the following:
(a)The fentanyl crisis among California youth is an urgent public health emergency. Youth overdose rates continue to rise in California, corresponding with the increasing presence of the potent synthetic opioid, Fentanyl, and other related analogs. Fentanyl contributes to more than 80 percent of all drug-related overdose deaths among young people.
(b)The opioid antagonist medication, naloxone hydrochloride, is designed to rapidly reverse an opioid overdose. This medication is available in a safe, easy-to-use nasal spray and in an injectable form. These are used to reduce preventable overdose fatalities. It is imperative that all pupils, faculty, and staff are aware of the location of naloxone hydrochloride on school campuses and understand how to identify the signs of an overdose and respond using an opioid antagonist medication.
(c)The Governors 202324 fiscal year budget proposal prioritizes opioid overdose prevention strategies for high schools across the state.
SEC. 2.Section 49414.3 of the Education Code is amended to read:49414.3.(a)School districts, county offices of education, and charter schools may provide emergency naloxone hydrochloride or another opioid antagonist to school nurses or trained personnel who have volunteered pursuant to subdivision (d), and school nurses or trained personnel may use naloxone hydrochloride or another opioid antagonist to provide emergency medical aid to persons suffering, or reasonably believed to be suffering, from an opioid overdose.
(b)For purposes of this section, the following terms have the following meanings:
(1)Authorizing physician and surgeon may include, but is not limited to, a physician and surgeon employed by, or contracting with, a local educational agency, a medical director of the local health department, or a local emergency medical services director.
(2)Auto-injector means a disposable delivery device designed for the automatic injection of a premeasured dose of an opioid antagonist into the human body and approved by the United States Food and Drug Administration for layperson use.
(3)Opioid antagonist means naloxone hydrochloride or another drug approved by the United States Food and Drug Administration that, when administered, negates or neutralizes in whole or in part the pharmacological effects of an opioid in the body, and has been approved for the treatment of an opioid overdose.
(4)Qualified supervisor of health may include, but is not limited to, a school nurse.
(5)Volunteer or trained personnel means an employee who has volunteered to administer naloxone hydrochloride or another opioid antagonist to a person if the person is suffering, or is reasonably believed to be suffering, from an opioid overdose, has been designated by a school, and has received training pursuant to subdivision (d).
(c)Each public and private elementary and secondary school in the state may voluntarily determine whether or not to make emergency naloxone hydrochloride or another opioid antagonist and trained personnel available at its school. In making this determination, a school shall evaluate the emergency medical response time to the school and determine whether initiating emergency medical services is an acceptable alternative to naloxone hydrochloride or another opioid antagonist and trained personnel. A private elementary or secondary school choosing to exercise the authority provided under this subdivision shall not receive state funds specifically for purposes of this subdivision.
(d)(1)Each public and private elementary and secondary school in the state may designate one or more volunteers to receive initial and annual refresher training, based on the standards developed pursuant to subdivision (e), regarding the storage and emergency use of naloxone hydrochloride or another opioid antagonist from the school nurse or other qualified person designated by an authorizing physician and surgeon. A benefit shall not be granted to or withheld from any individual based on their offer to volunteer, and there shall be no retaliation against any individual for rescinding their offer to volunteer, including after receiving training. Any school district, county office of education, or charter school choosing to exercise the authority provided under this subdivision shall provide the training for the volunteers at no cost to the volunteer and during the volunteers regular working hours or schoolday.
(2)An employee who volunteers pursuant to this section may rescind their offer to administer emergency naloxone hydrochloride or another opioid antagonist at any time, including after receipt of training.
(e)(1)The Superintendent shall establish minimum standards of training for the administration of naloxone hydrochloride or another opioid antagonist that satisfies the requirements of paragraph (2). Every five years, or sooner as deemed necessary by the Superintendent, the Superintendent shall review minimum standards of training for the administration of naloxone hydrochloride or other opioid antagonists that satisfy the requirements of paragraph (2). For purposes of this subdivision, the Superintendent shall consult with organizations and providers with expertise in administering naloxone hydrochloride or another opioid antagonist and administering medication in a school environment, including, but not limited to, the California Society of Addiction Medicine, the Emergency Medical Services Authority, the California School Nurses Organization, the California Medical Association, the American Academy of Pediatrics, and others.
(2)Training established pursuant to this subdivision shall include all of the following:
(A)Techniques for recognizing symptoms of an opioid overdose.
(B)Standards and procedures for the storage, restocking, and emergency use of naloxone hydrochloride or another opioid antagonist.
(C)Basic emergency followup procedures, including, but not limited to, a requirement for the school or charter school administrator or, if the administrator is not available, another school staff member to call the emergency 911 telephone number and to contact the pupils parent or guardian.
(D)Recommendations on the necessity of instruction and certification in cardiopulmonary resuscitation.
(E)Written materials covering the information required under this subdivision.
(3)Training established pursuant to this subdivision shall be consistent with the most recent guidelines for medication administration issued by the department.
(4)A school shall retain for reference the written materials prepared under subparagraph (E) of paragraph (2).
(5)The department shall include on its internet website a clearinghouse for best practices in training nonmedical personnel to administer naloxone hydrochloride or another opioid antagonist to individuals.
(f)Any school district, county office of education, or charter school electing to utilize naloxone hydrochloride or another opioid antagonist for emergency aid shall distribute a notice at least once per school year to all staff that contains the following information:
(1)A description of the volunteer request stating that the request is for volunteers to be trained to administer naloxone hydrochloride or another opioid antagonist to a person if the person is suffering, or reasonably believed to be suffering, from an opioid overdose.
(2)A description of the training that the volunteer will receive pursuant to subdivision (d).
(3)The right of an employee to rescind their offer to volunteer pursuant to this section.
(4)A statement that no benefit will be granted to or withheld from any individual based on their offer to volunteer and that there will be no retaliation against any individual for rescinding their offer to volunteer, including after receiving training.
(g)(1)A qualified supervisor of health at a school district, county office of education, or charter school electing to utilize naloxone hydrochloride or another opioid antagonist for emergency aid shall obtain from an authorizing physician and surgeon a prescription for each school for naloxone hydrochloride or another opioid antagonist. A qualified supervisor of health at a school district, county office of education, or charter school shall be responsible for stocking the naloxone hydrochloride or another opioid antagonist and restocking it if it is used.
(2)If a school district, county office of education, or charter school does not have a qualified supervisor of health, an administrator at the school district, county office of education, or charter school shall carry out the duties specified in paragraph (1).
(3)A prescription pursuant to this subdivision may be filled by local or mail order pharmacies or opioid antagonist manufacturers.
(4)An authorizing physician and surgeon shall not be subject to professional review, be liable in a civil action, or be subject to criminal prosecution for the issuance of a prescription or order pursuant to this section, unless the physician and surgeons issuance of the prescription or order constitutes gross negligence or willful or malicious conduct.
(h)(1)A school nurse or, if the school does not have a school nurse or the school nurse is not onsite or available, a volunteer may administer naloxone hydrochloride or another opioid antagonist to a person exhibiting potentially life-threatening symptoms of an opioid overdose at school or a school activity when a physician is not immediately available. If the naloxone hydrochloride or another opioid antagonist is used it shall be restocked as soon as reasonably possible, but no later than two weeks after it is used. Naloxone hydrochloride or another opioid antagonist shall be restocked before its expiration date.
(2)Volunteers may administer naloxone hydrochloride or another opioid antagonist only by nasal spray or by auto-injector.
(3)A volunteer shall be allowed to administer naloxone hydrochloride or another opioid antagonist in a form listed in paragraph (2) that the volunteer is most comfortable with.
(i)A school district, county office of education, or charter school electing to utilize naloxone hydrochloride or another opioid antagonist for emergency aid shall ensure that each employee who volunteers under this section will be provided defense and indemnification by the school district, county office of education, or charter school for any and all civil liability, in accordance with, but not limited to, that provided in Division 3.6 (commencing with Section 810) of Title 1 of the Government Code. This information shall be reduced to writing, provided to the volunteer, and retained in the volunteers personnel file.
(j)(1)Notwithstanding any other law, a person trained as required under subdivision (d), who administers naloxone hydrochloride or another opioid antagonist, in good faith and not for compensation, to a person who appears to be experiencing an opioid overdose shall not be subject to professional review, be liable in a civil action, or be subject to criminal prosecution for their acts or omissions in administering the naloxone hydrochloride or another opioid antagonist.
(2)The protection specified in paragraph (1) shall not apply in a case of gross negligence or willful and wanton misconduct of the person who renders emergency care treatment by the use of naloxone hydrochloride or another opioid antagonist.
(3)Any public employee who volunteers to administer naloxone hydrochloride or another opioid antagonist pursuant to subdivision (d) is not providing emergency medical care for compensation, notwithstanding the fact that they are a paid public employee.
(k)A state agency, the department, or a public school may accept gifts, grants, and donations from any source for the support of the public school carrying out the provisions of this section, including, but not limited to, the acceptance of naloxone hydrochloride or another opioid antagonist from a manufacturer or wholesaler.
(l)Any school district, county office of education, or charter school school, serving pupils in any of grades 9 to 12, inclusive, that voluntarily determines to make naloxone hydrochloride or another opioid antagonist available on campus shall ensure that the naloxone hydrochloride or another opioid antagonist is placed in an appropriate location, as determined by the governing board or body, that is widely known and easily accessible, both during school hours and after school hours. The naloxone hydrochloride or another opioid antagonist shall be located in at least one of the following locations on campus:
(1)School nurses office.
(2)Athletic trainers office.
(3)Front office.
(4)Performing arts auditorium.
(5)Library.
(6)Cafeteria.
(7)Athletic gym.
SEC. 3.Article 5.5 (commencing with Section 49478) is added to Chapter 9 of Part 27 of Division 4 of Title 2 of the Education Code, to read:5.5.Naloxone Hydrochloride Spray Certification Training Program49478.(a)For purposes of this article, the following definitions apply:
(1)Naloxone hydrochloride nasal spray means a nasal spray version of naloxone hydrochloride designed to rapidly reverse an opioid overdose that is approved by the United States Food and Drug Administration.
(2)Program means the naloxone hydrochloride nasal spray certification training program established pursuant to subdivision (b).
(b)(1)The State Department of Public Health shall establish, by March 1, 2025, a certification training program for public high school pupils in grades 9 to 12, inclusive, to gain skills in how to identify and respond to an opioid overdose, including by administering naloxone hydrochloride nasal spray.
(2)Public high schools serving pupils in any of grades 9 to 12, inclusive, may voluntarily determine whether or not to host the program on their campuses.
(c)In establishing the program, the State Department of Public Health shall collaborate with local, state, and national organizations, which may include community health centers, community health experts, and nonprofits with related expertise expertise, to provide pupils working toward their certificate with integrated, comprehensive, accurate, and unbiased educational materials on opioid and drug overdose prevention, opioid and drug safety, and stigma reduction.
(d)Program training shall include instruction from appropriately trained instructors from local, state, and national organizations, which may include community health centers, community health experts, and nonprofits with related expertise. expertise, and school staff. Instructors who are not employed by the school shall undergo state-approved background checks.
(e)(1)Program training related to administering naloxone hydrochloride nasal spray may include, but is not limited to, all of the following:
(A)Informational videos, graphics, or in-person training on what to do and how to respond during a drug or opioid overdose.
(B)Information on how to recognize signs of a drug or opioid overdose.
(C)Information on how to respond in an emergency involving a drug or opioid overdose.
(2)The program shall provide resource materials related to drug and opioid use or prevention, for appropriate use with pupils of all races, genders, sexual orientations, and ethnic and cultural backgrounds, pupils with disabilities, and English learners.
(f)In order to determine the efficacy of program training resources and program drug and opioid prevention informational efforts, the State Department of Public Health shall, on an annual basis, collect data on the number of pupils participating in the program and share this information with the Legislature, in compliance with Section 9795 of the Government Code, and with the Senate and Assembly Budget Subcommittees on Health Education, Health, and Human Services.
The Legislature finds and declares all of the following:
(a)The fentanyl crisis among California youth is an urgent public health emergency. Young people are struggling with addiction, leading to countless preventable deaths in the state. Fentanyl, a potent opioid, Youth overdose rates continue to rise in California, corresponding with the increasing presence of the potent synthetic opioid, Fentanyl, and other related analogs. Fentanyl contributes to more than 80 percent of all drug-related overdose deaths among young people.
(b)Awareness of Narcan, a naloxone nasal spray that can reverse an opioid overdose, is a lifesaving form of protection. It is imperative that pupils, faculty, and staff are aware of the location of naloxone on campus.(c)Knowledge of the location of installed, easily accessible, and secured naloxone on campuses can reduce opioid fatalities in cases of emergencies.(b)The opioid antagonist medication, naloxone hydrochloride, is designed to rapidly reverse an opioid overdose. This medication is available in a safe, easy-to-use nasal spray and in an injectable form. These are used to reduce preventable overdose fatalities. It is imperative that all pupils, faculty, and staff are aware of the location of naloxone hydrochloride on school campuses and understand how to identify the signs of an overdose and respond using an opioid antagonist medication.
(d)(c)The Governors 202324 fiscal year budget proposal prioritizes opioid overdose prevention strategies for middle and high schools across the state.
SEC. 2.Section 49414.3 of the Education Code is amended to read:49414.3.(a)School districts, county offices of education, and charter schools may provide emergency naloxone hydrochloride or another opioid antagonist to school nurses or trained personnel who have volunteered pursuant to subdivision (d), and school nurses or trained personnel may use naloxone hydrochloride or another opioid antagonist to provide emergency medical aid to persons suffering, or reasonably believed to be suffering, from an opioid overdose.
(b)For purposes of this section, the following terms have the following meanings:
(1)Authorizing physician and surgeon may include, but is not limited to, a physician and surgeon employed by, or contracting with, a local educational agency, a medical director of the local health department, or a local emergency medical services director.
(2)Auto-injector means a disposable delivery device designed for the automatic injection of a premeasured dose of an opioid antagonist into the human body and approved by the United States Food and Drug Administration for layperson use.
(3)Opioid antagonist means naloxone hydrochloride or another drug approved by the United States Food and Drug Administration that, when administered, negates or neutralizes in whole or in part the pharmacological effects of an opioid in the body, and has been approved for the treatment of an opioid overdose.
(4)Qualified supervisor of health may include, but is not limited to, a school nurse.
(5)Volunteer or trained personnel means an employee who has volunteered to administer naloxone hydrochloride or another opioid antagonist to a person if the person is suffering, or is reasonably believed to be suffering, from an opioid overdose, has been designated by a school, and has received training pursuant to subdivision (d).
(c)Each public and private elementary and secondary school in the state may voluntarily determine whether or not to make emergency naloxone hydrochloride or another opioid antagonist and trained personnel available at its school. In making this determination, a school shall evaluate the emergency medical response time to the school and determine whether initiating emergency medical services is an acceptable alternative to naloxone hydrochloride or another opioid antagonist and trained personnel. A private elementary or secondary school choosing to exercise the authority provided under this subdivision shall not receive state funds specifically for purposes of this subdivision.
(d)(1)Each public and private elementary and secondary school in the state may designate one or more volunteers to receive initial and annual refresher training, based on the standards developed pursuant to subdivision (e), regarding the storage and emergency use of naloxone hydrochloride or another opioid antagonist from the school nurse or other qualified person designated by an authorizing physician and surgeon. A benefit shall not be granted to or withheld from any individual based on their offer to volunteer, and there shall be no retaliation against any individual for rescinding their offer to volunteer, including after receiving training. Any school district, county office of education, or charter school choosing to exercise the authority provided under this subdivision shall provide the training for the volunteers at no cost to the volunteer and during the volunteers regular working hours. hours or schoolday.
(2)An employee who volunteers pursuant to this section may rescind their offer to administer emergency naloxone hydrochloride or another opioid antagonist at any time, including after receipt of training.
(e)(1)The Superintendent shall establish minimum standards of training for the administration of naloxone hydrochloride or another opioid antagonist that satisfies the requirements of paragraph (2). Every five years, or sooner as deemed necessary by the Superintendent, the Superintendent shall review minimum standards of training for the administration of naloxone hydrochloride or other opioid antagonists that satisfy the requirements of paragraph (2). For purposes of this subdivision, the Superintendent shall consult with organizations and providers with expertise in administering naloxone hydrochloride or another opioid antagonist and administering medication in a school environment, including, but not limited to, the California Society of Addiction Medicine, the Emergency Medical Services Authority, the California School Nurses Organization, the California Medical Association, the American Academy of Pediatrics, and others.
(2)Training established pursuant to this subdivision shall include all of the following:
(A)Techniques for recognizing symptoms of an opioid overdose.
(B)Standards and procedures for the storage, restocking, and emergency use of naloxone hydrochloride or another opioid antagonist.
(C)Basic emergency followup procedures, including, but not limited to, a requirement for the school or charter school administrator or, if the administrator is not available, another school staff member to call the emergency 911 telephone number and to contact the pupils parent or guardian.
(D)Recommendations on the necessity of instruction and certification in cardiopulmonary resuscitation.
(E)Written materials covering the information required under this subdivision.
(3)Training established pursuant to this subdivision shall be consistent with the most recent guidelines for medication administration issued by the department.
(4)A school shall retain for reference the written materials prepared under subparagraph (E) of paragraph (2).
(5)The department shall include on its internet website a clearinghouse for best practices in training nonmedical personnel to administer naloxone hydrochloride or another opioid antagonist to pupils. individuals.
(f)Any school district, county office of education, or charter school electing to utilize naloxone hydrochloride or another opioid antagonist for emergency aid shall distribute a notice at least once per school year to all staff that contains the following information:
(1)A description of the volunteer request stating that the request is for volunteers to be trained to administer naloxone hydrochloride or another opioid antagonist to a person if the person is suffering, or reasonably believed to be suffering, from an opioid overdose.
(2)A description of the training that the volunteer will receive pursuant to subdivision (d).
(3)The right of an employee to rescind their offer to volunteer pursuant to this section.
(4)A statement that no benefit will be granted to or withheld from any individual based on their offer to volunteer and that there will be no retaliation against any individual for rescinding their offer to volunteer, including after receiving training.
(g)(1)A qualified supervisor of health at a school district, county office of education, or charter school electing to utilize naloxone hydrochloride or another opioid antagonist for emergency aid shall obtain from an authorizing physician and surgeon a prescription for each school for naloxone hydrochloride or another opioid antagonist. A qualified supervisor of health at a school district, county office of education, or charter school shall be responsible for stocking the naloxone hydrochloride or another opioid antagonist and restocking it if it is used.
(2)If a school district, county office of education, or charter school does not have a qualified supervisor of health, an administrator at the school district, county office of education, or charter school shall carry out the duties specified in paragraph (1).
(3)A prescription pursuant to this subdivision may be filled by local or mail order pharmacies or naloxone hydrochloride or another opioid antagonist manufacturers.
(4)An authorizing physician and surgeon shall not be subject to professional review, be liable in a civil action, or be subject to criminal prosecution for the issuance of a prescription or order pursuant to this section, unless the physician and surgeons issuance of the prescription or order constitutes gross negligence or willful or malicious conduct.
(h)(1)A school nurse or, if the school does not have a school nurse or the school nurse is not onsite or available, a volunteer may administer naloxone hydrochloride or another opioid antagonist to a person exhibiting potentially life-threatening symptoms of an opioid overdose at school or a school activity when a physician is not immediately available. If the naloxone hydrochloride or another opioid antagonist is used it shall be restocked as soon as reasonably possible, but no later than two weeks after it is used. Naloxone hydrochloride or another opioid antagonist shall be restocked before its expiration date.
(2)Volunteers may administer naloxone hydrochloride or another opioid antagonist only by nasal spray or by auto-injector.
(3)A volunteer shall be allowed to administer naloxone hydrochloride or another opioid antagonist in a form listed in paragraph (2) that the volunteer is most comfortable with.
(i)A school district, county office of education, or charter school electing to utilize naloxone hydrochloride or another opioid antagonist for emergency aid shall ensure that each employee who volunteers under this section will be provided defense and indemnification by the school district, county office of education, or charter school for any and all civil liability, in accordance with, but not limited to, that provided in Division 3.6 (commencing with Section 810) of Title 1 of the Government Code. This information shall be reduced to writing, provided to the volunteer, and retained in the volunteers personnel file.
(j)(1)Notwithstanding any other law, a person trained as required under subdivision (d), who administers naloxone hydrochloride or another opioid antagonist, in good faith and not for compensation, to a person who appears to be experiencing an opioid overdose shall not be subject to professional review, be liable in a civil action, or be subject to criminal prosecution for their acts or omissions in administering the naloxone hydrochloride or another opioid antagonist.
(2)The protection specified in paragraph (1) shall not apply in a case of gross negligence or willful and wanton misconduct of the person who renders emergency care treatment by the use of naloxone hydrochloride or another opioid antagonist.
(3)Any public employee who volunteers to administer naloxone hydrochloride or another opioid antagonist pursuant to subdivision (d) is not providing emergency medical care for compensation, notwithstanding the fact that they are a paid public employee.
(k)A state agency, the department, or a public school may accept gifts, grants, and donations from any source for the support of the public school carrying out the provisions of this section, including, but not limited to, the acceptance of naloxone hydrochloride or another opioid antagonist from a manufacturer or wholesaler.
(l)Any public or private elementary school district, county office of education, or charter school serving pupils in any of grades 9 to 12, inclusive, that voluntarily determines to make naloxone hydrochloride or another opioid antagonist available on campus shall ensure that the naloxone hydrochloride or another opioid antagonist is placed in a location an appropriate location, as determined by the governing board or body, that is widely known and easily accessible, both during school hours and after school hours. The naloxone hydrochloride or another opioid antagonist shall be located in at least one of the following locations on campus:
(1)School nurses office.
(2)Athletic trainers office.
(3)Front office.
(4)Performing arts auditorium.
(5)Library.
(6)Cafeteria.
(7)Athletic gym.
SEC. 3.Article 5.5 (commencing with Section 49478) is added to Chapter 9 of Part 27 of Division 4 of Title 2 of the Education Code, to read:5.5.Narcan Nasal Naloxone Hydrochloride Spray Certification Training Program49478.(a)For purposes of this article, the following definitions apply:
(1)Narcan Naloxone hydrochloride nasal spray means a nasal spray version of naloxone hydrochloride used designed to temporarily stop or rapidly reverse the effects of an opioid overdose that is approved by the United States Food and Drug Administration.
(2)Program means the Narcan naloxone hydrochloride nasal spray certification training program established pursuant to subdivision (b).
(b)(1)The State Department of Public Health shall establish, by March 1, 2025, a certification training program for public middle school and public high school pupils in grades 5 9 to 12, inclusive, to gain skills in how to administer Narcan nasal spray during an opioid overdose, and how to store and dispose of Narcan nasal spray. identify and respond to an opioid overdose, including by administering naloxone hydrochloride nasal spray.
(2)Public middle and high schools serving pupils in any of grades 5 9 to 12, inclusive, may voluntarily determine whether or not to host the program on their campuses.
(c)In establishing the program, the State Department of Public Health shall collaborate with local, state, and national drug prevention organizations, community health centers, community health experts, and nonprofits with related expertise to provide pupils working toward their certificate with integrated, comprehensive, accurate, and unbiased educational materials on opioid and drug overdose prevention, opioid and drug safety, and stigma reduction.
(d)Program trainings training shall include instruction from appropriately trained instructors from local, state, and national drug and opioid use and prevention organizations, community health centers, community health experts, and nonprofits with related expertise. Instructors shall undergo state-approved background checks.
(e)(1)Program training related to administering Narcan naloxone hydrochloride nasal spray shall include may include, but is not limited to, all of the following:
(A)Informational videos, graphics, and or in-person training on what to do and how to respond during a drug or opioid overdose.
(B)Information on how to recognize signs of a drug or opioid overdose.
(C)Information on how to respond in an emergency involving a drug or opioid overdose.
(2)The program shall provide resource materials related to drug and opioid use and or prevention, for appropriate use with pupils of all races, genders, sexual orientations, and ethnic and cultural backgrounds, pupils with disabilities, and English learners.
(f)In order to determine the efficacy of program training resources and program drug and opioid prevention informational efforts, the State Department of Public Health shall, on an annual basis, collect data on the number of pupils participating in the program and share this information with the Legislature, in compliance with Section 9795 of the Government Code, and with the Senate and Assembly Budget Subcommittees on Health and Human Services.
The Legislature finds and declares all of the following:
(a)The fentanyl crisis among California youth is an urgent public health emergency. Young people are struggling with addiction, leading to countless preventable deaths in the state. Fentanyl, a potent opioid, contributes to more than 80 percent of all drug-related overdose deaths among young people.
(b)Awareness of Narcan, a naloxone nasal spray that can reverse an opioid overdose, is a lifesaving form of protection. It is imperative that pupils, faculty, and staff are aware of the location of naloxone on campus.
(c)Knowledge of the location of installed, easily accessible, and secured naloxone on campuses can reduce opioid fatalities in cases of emergencies.
(d)The Governors 202324 fiscal year budget proposal prioritizes opioid overdose prevention strategies for middle and high schools across the state.
SEC. 2.Section 49414.3 of the Education Code is amended to read:49414.3.(a)School districts, county offices of education, and charter schools may provide emergency naloxone hydrochloride or another opioid antagonist to school nurses or trained personnel who have volunteered pursuant to subdivision (d), and school nurses or trained personnel may use naloxone hydrochloride or another opioid antagonist to provide emergency medical aid to persons suffering, or reasonably believed to be suffering, from an opioid overdose.
(b)For purposes of this section, the following terms have the following meanings:
(1)Authorizing physician and surgeon may include, but is not limited to, a physician and surgeon employed by, or contracting with, a local educational agency, a medical director of the local health department, or a local emergency medical services director.
(2)Auto-injector means a disposable delivery device designed for the automatic injection of a premeasured dose of an opioid antagonist into the human body and approved by the federal United States Food and Drug Administration for layperson use.
(3)Opioid antagonist means naloxone hydrochloride or another drug approved by the federal United States Food and Drug Administration that, when administered, negates or neutralizes in whole or in part the pharmacological effects of an opioid in the body, and has been approved for the treatment of an opioid overdose.
(4)Qualified supervisor of health may include, but is not limited to, a school nurse.
(5)Volunteer or trained personnel means an employee who has volunteered to administer naloxone hydrochloride or another opioid antagonist to a person if the person is suffering, or reasonably believed to be suffering, from an opioid overdose, has been designated by a school, and has received training pursuant to subdivision (d).
(c)Each public and private elementary and secondary school in the state may voluntarily determine whether or not to make emergency naloxone hydrochloride or another opioid antagonist and trained personnel available at its school. In making this determination, a school shall evaluate the emergency medical response time to the school and determine whether initiating emergency medical services is an acceptable alternative to naloxone hydrochloride or another opioid antagonist and trained personnel. A private elementary or secondary school choosing to exercise the authority provided under this subdivision shall not receive state funds specifically for purposes of this subdivision.
(d)(1)Each public and private elementary and secondary school in the state may designate one or more volunteers to receive initial and annual refresher training, based on the standards developed pursuant to subdivision (e), regarding the storage and emergency use of naloxone hydrochloride or another opioid antagonist from the school nurse or other qualified person designated by an authorizing physician and surgeon. A benefit shall not be granted to or withheld from any individual based on his or her their offer to volunteer, and there shall be no retaliation against any individual for rescinding his or her their offer to volunteer, including after receiving training. Any school district, county office of education, or charter school choosing to exercise the authority provided under this subdivision shall provide the training for the volunteers at no cost to the volunteer and during the volunteers regular working hours.
(2)An employee who volunteers pursuant to this section may rescind his or her their offer to administer emergency naloxone hydrochloride or another opioid antagonist at any time, including after receipt of training.
(e)(1)The Superintendent shall establish minimum standards of training for the administration of naloxone hydrochloride or another opioid antagonist that satisfies the requirements of paragraph (2). Every five years, or sooner as deemed necessary by the Superintendent, the Superintendent shall review minimum standards of training for the administration of naloxone hydrochloride or other opioid antagonists that satisfy the requirements of paragraph (2). For purposes of this subdivision, the Superintendent shall consult with organizations and providers with expertise in administering naloxone hydrochloride or another opioid antagonist and administering medication in a school environment, including, but not limited to, the California Society of Addiction Medicine, the Emergency Medical Services Authority, the California School Nurses Organization, the California Medical Association, the American Academy of Pediatrics, and others.
(2)Training established pursuant to this subdivision shall include all of the following:
(A)Techniques for recognizing symptoms of an opioid overdose.
(B)Standards and procedures for the storage, restocking, and emergency use of naloxone hydrochloride or another opioid antagonist.
(C)Basic emergency followup procedures, including, but not limited to, a requirement for the school or charter school administrator or, if the administrator is not available, another school staff member to call the emergency 911 telephone number and to contact the pupils parent or guardian.
(D)Recommendations on the necessity of instruction and certification in cardiopulmonary resuscitation.
(E)Written materials covering the information required under this subdivision.
(3)Training established pursuant to this subdivision shall be consistent with the most recent guidelines for medication administration issued by the department.
(4)A school shall retain for reference the written materials prepared under subparagraph (E) of paragraph (2).
(5)The department shall include on its Internet Web site internet website a clearinghouse for best practices in training nonmedical personnel to administer naloxone hydrochloride or another opioid antagonist to pupils.
(f)Any school district, county office of education, or charter school electing to utilize naloxone hydrochloride or another opioid antagonist for emergency aid shall distribute a notice at least once per school year to all staff that contains the following information:
(1)A description of the volunteer request stating that the request is for volunteers to be trained to administer naloxone hydrochloride or another opioid antagonist to a person if the person is suffering, or reasonably believed to be suffering, from an opioid overdose.
(2)A description of the training that the volunteer will receive pursuant to subdivision (d).
(3)The right of an employee to rescind his or her their offer to volunteer pursuant to this section.
(4)A statement that no benefit will be granted to or withheld from any individual based on his or her their offer to volunteer and that there will be no retaliation against any individual for rescinding his or her their offer to volunteer, including after receiving training.
(g)(1)A qualified supervisor of health at a school district, county office of education, or charter school electing to utilize naloxone hydrochloride or another opioid antagonist for emergency aid shall obtain from an authorizing physician and surgeon a prescription for each school for naloxone hydrochloride or another opioid antagonist. A qualified supervisor of health at a school district, county office of education, or charter school shall be responsible for stocking the naloxone hydrochloride or another opioid antagonist and restocking it if it is used.
(2)If a school district, county office of education, or charter school does not have a qualified supervisor of health, an administrator at the school district, county office of education, or charter school shall carry out the duties specified in paragraph (1).
(3)A prescription pursuant to this subdivision may be filled by local or mail order pharmacies or naloxone hydrochloride or another opioid antagonist manufacturers.
(4)An authorizing physician and surgeon shall not be subject to professional review, be liable in a civil action, or be subject to criminal prosecution for the issuance of a prescription or order pursuant to this section, unless the physician and surgeons issuance of the prescription or order constitutes gross negligence or willful or malicious conduct.
(h)(1)A school nurse or, if the school does not have a school nurse or the school nurse is not onsite or available, a volunteer may administer naloxone hydrochloride or another opioid antagonist to a person exhibiting potentially life-threatening symptoms of an opioid overdose at school or a school activity when a physician is not immediately available. If the naloxone hydrochloride or another opioid antagonist is used it shall be restocked as soon as reasonably possible, but no later than two weeks after it is used. Naloxone hydrochloride or another opioid antagonist shall be restocked before its expiration date.
(2)Volunteers may administer naloxone hydrochloride or another opioid antagonist only by nasal spray or by auto-injector.
(3)A volunteer shall be allowed to administer naloxone hydrochloride or another opioid antagonist in a form listed in paragraph (2) that the volunteer is most comfortable with.
(i)A school district, county office of education, or charter school electing to utilize naloxone hydrochloride or another opioid antagonist for emergency aid shall ensure that each employee who volunteers under this section will be provided defense and indemnification by the school district, county office of education, or charter school for any and all civil liability, in accordance with, but not limited to, that provided in Division 3.6 (commencing with Section 810) of Title 1 of the Government Code. This information shall be reduced to writing, provided to the volunteer, and retained in the volunteers personnel file.
(j)(1)Notwithstanding any other law, a person trained as required under subdivision (d), who administers naloxone hydrochloride or another opioid antagonist, in good faith and not for compensation, to a person who appears to be experiencing an opioid overdose shall not be subject to professional review, be liable in a civil action, or be subject to criminal prosecution for his or her their acts or omissions in administering the naloxone hydrochloride or another opioid antagonist.
(2)The protection specified in paragraph (1) shall not apply in a case of gross negligence or willful and wanton misconduct of the person who renders emergency care treatment by the use of naloxone hydrochloride or another opioid antagonist.
(3)Any public employee who volunteers to administer naloxone hydrochloride or another opioid antagonist pursuant to subdivision (d) is not providing emergency medical care for compensation, notwithstanding the fact that he or she is they are a paid public employee.
(k)A state agency, the department, or a public school may accept gifts, grants, and donations from any source for the support of the public school carrying out the provisions of this section, including, but not limited to, the acceptance of naloxone hydrochloride or another opioid antagonist from a manufacturer or wholesaler.
(l)Any public or private elementary school that voluntarily determines to make naloxone hydrochloride or another opioid antagonist available on campus shall ensure that the naloxone hydrochloride or another opioid antagonist is placed in a location that is widely known and easily accessible, both during school hours and after school hours. The naloxone hydrochloride or another opioid antagonist shall be located in at least one of the following locations on campus:
(1)School nurses office.
(2)Athletic trainers office.
(3)Front office.
(4)Performing arts auditorium.
(5)Library.
(6)Cafeteria.
(7)Athletic gym.
SEC. 3.Article 5.5 (commencing with Section 49478) is added to Chapter 9 of Part 27 of Division 4 of Title 2 of the Education Code, to read:5.5.Narcan Nasal Spray Certification Training Program49478.(a)For purposes of this article, the following definitions apply:
(1)Narcan nasal spray means a nasal spray version of naloxone hydrochloride used to temporarily stop or reverse the effects of an opioid overdose that is approved by the United States Food and Drug Administration.
(2)Program means the Narcan nasal spray certification training program established pursuant to subdivision (b).
(b)(1)The State Department of Public Health shall establish, by March 1, 2025, a certification training program for public middle school and public high school pupils in grades 5 to 12, inclusive, to gain skills in how to administer Narcan nasal spray during an opioid overdose, and how to store and dispose of Narcan nasal spray.
(2)Public middle and high schools serving pupils in any of grades 5 to 12, inclusive, may voluntarily determine whether or not to host the program on their campuses.
(c)In establishing the program, the State Department of Public Health shall collaborate with local, state, and national drug prevention organizations, community health centers, community health experts, and nonprofits with related expertise to provide pupils working toward their certificate with integrated, comprehensive, accurate, and unbiased educational materials on opioid and drug overdose prevention, opioid and drug safety, and stigma reduction.
(d)Program trainings shall include instruction from appropriately trained instructors from local, state, and national drug and opioid use and prevention organizations, community health centers, community health experts, and nonprofits with related expertise.
(e)(1)Program training related to administering Narcan nasal spray shall include all of the following:
(A)Informational videos, graphics, and in-person training on what to do and how to respond during a drug or opioid overdose.
(B)Information on how to recognize signs of a drug or opioid overdose.
(C)Information on how to respond in an emergency involving a drug or opioid overdose.
(2)The program shall provide resource materials related to drug and opioid use and prevention, for appropriate use with pupils of all races, genders, sexual orientations, and ethnic and cultural backgrounds, pupils with disabilities, and English learners.
(f)In order to determine the efficacy of program training resources and program drug and opioid prevention informational efforts, the State Department of Public Health shall, on an annual basis, collect data on the number of pupils participating in the program and share this information with the Legislature, in compliance with Section 9795 of the Government Code, and with the Senate and Assembly Budget Subcommittees on Health and Human Services.
SECTION 1.It is the intent of the Legislature to enact subsequent legislation to direct middle and high schools to provide drug education curriculum on efforts to help someone who experiences an overdose.It is the intent of the Legislature to enact subsequent legislation to direct middle and high schools to provide drug education curriculum on efforts to help someone who experiences an overdose.
|
Date
|
Status
|
|---|---|
| Sep 1, 2023 | In committee: Held under submission. |
| Aug 14, 2023 | In committee: Referred to APPR suspense file. |
| Jul 10, 2023 | Read second time and amended. Re-referred to Com. on APPR. |
| Jul 6, 2023 | From committee: Amend, and do pass as amended and re-refer to Com. on APPR with recommendation: To Consent Calendar. (Ayes 12. Noes 0.) (July 5). |
| Jun 28, 2023 | From committee: Do pass and re-refer to Com. on HEALTH. (Ayes 7. Noes 0.) (June 28). Re-referred to Com. on HEALTH. |
| Jun 19, 2023 | From committee chair, with author's amendments: Amend, and re-refer to committee. Read second time, amended, and re-referred to Com. on ED. |
| Jun 7, 2023 | Referred to Coms. on ED. and HEALTH. |
| May 26, 2023 | In Senate. Read first time. To Com. on RLS. for assignment. |
| May 25, 2023 | Read third time. Passed. Ordered to the Senate. (Ayes 78. Noes 0. Page 1756.) |
| May 18, 2023 | Read second time. Ordered to third reading. |
| May 18, 2023 | From committee: Do pass. (Ayes 15. Noes 0.) (May 18). |
| May 10, 2023 | In committee: Set, first hearing. Referred to APPR. suspense file. |
| May 1, 2023 | Re-referred to Com. on APPR. |
| Apr 27, 2023 | Read second time and amended. |
| Apr 26, 2023 | From committee: Amend, and do pass as amended and re-refer to Com. on APPR. with recommendation: To Consent Calendar. (Ayes 15. Noes 0.) (April 25). |
| Apr 19, 2023 | Re-referred to Com. on HEALTH. |
| Apr 18, 2023 | Read second time and amended. |
| Apr 17, 2023 | From committee: Amend, and do pass as amended and re-refer to Com. on HEALTH. (Ayes 7. Noes 0.) (April 12). |
| Apr 4, 2023 | Re-referred to Com. on ED. |
| Apr 3, 2023 | From committee chair, with author's amendments: Amend, and re-refer to Com. on ED. Read second time and amended. |
| Mar 27, 2023 | Re-referred to Com. on ED. |
| Mar 23, 2023 | Referred to Coms. on ED. and HEALTH. |
| Mar 23, 2023 | From committee chair, with author's amendments: Amend, and re-refer to Com. on ED. Read second time and amended. |
| Feb 15, 2023 | From printer. May be heard in committee March 17. |
| Feb 14, 2023 | Read first time. To print. |
|
Date
|
Description
|
Location
|
Votes
|
|
|---|---|---|---|---|
| Aug 14, 2023 | Placed on suspense file | Senate Standing Committee on Appropriations |
Passed |
|
| Jul 5, 2023 | Do pass as amended, but first amend, and re-refer to the Committee on [Appropriations] with the recommendation: To Consent Calendar | Senate Standing Committee on Health |
Passed |
|
| Jun 28, 2023 | Do pass, but first be re-referred to the Committee on [Health] | Senate Standing Committee on Education |
Passed |
|
| May 25, 2023 | AB 915 Arambula Assembly Third Reading | Assembly Floor |
Passed |
|
| May 18, 2023 | Do pass. | Assembly Standing Committee on Appropriations |
Passed |
|
| Apr 25, 2023 | Do pass as amended, and be re-referred to the Committee on [Appropriations] with recommendation: To Consent Calendar | Assembly Standing Committee on Health |
Passed |
|
| Apr 12, 2023 | Do pass as amended and be re-referred to the Committee on [Health] | Assembly Standing Committee on Education |
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
|
|---|---|---|
| Alameda County Office Of Education | ** Support | |
| County Health Executives Association Of California | ** Support | |
| Ella Baker Center For Human Rights | ** Support | |
| Fresno State College of Health & Human Services | ** Support | |
| Fresno State University | * Support | Apr 12, 2023 |
| Generation Up | ** Support | |
| HealthRight 360 | ** Support | |
| Initiate Justice | ** Support | |
| Sister Warriors Freedom Coalition | ** Support | |
| Zachary Horton Foundation | ** Support | |
| Zachary Horton Foundation | * Support | Apr 12, 2023 |
SENATE COMMITTEE ON
Senator Anthony Portantino, Chair
2023 - 2024 Regular Session
AB 915 (Arambula) - Pupil health: drug education: opioid overdose training program
Version: | Policy Vote: |
Urgency: | Mandate: |
Hearing Date: | Consultant: |
Bill Summary:
This bill requires any local educational agency (LEA), county office of education, and charter school that voluntarily determines to make naloxone hydrochloride or another opioid antagonist available on campus to be placed in an appropriate location, as specified. This bill also requires the California Department of Public Health (CDPH) to create an opioid overdose training program and program toolkit to train high school students on how to identify and respond to an opioid overdose.
Fiscal Impact:
The CDPH estimates General Fund costs of $549,000 for the 2024-25 fiscal year, $849,000 for the 2025-26 fiscal year, and about $624,000 thereafter to support 2.0 two positions and two external contractors. The positions would be necessary to support the development of regulations, collaborate with stakeholders, establish and monitor the curriculum development contract, collect data, and develop the report. CDPH indicates that these costs could be less to the extent that Opioid Settlements Funds are available.
This bill could also result in additional, unknown Proposition 98 General Fund costs for LEAs that elect to provide the training. The related costs would depend on the design, scope, and amount of time that would be necessary to deliver the training.
Background:
Existing law permits school nurses or trained personnel who have volunteered to provide emergency naloxone or another opioid antagonist, by nasal spray or by auto-injector, to persons suffering, or reasonably believed to be suffering, from an opioid overdose.
Existing law requires the Superintendent of Public Instruction (SPI) to establish and revise, every five years or sooner, minimum training standards for administering naloxone or another opioid antagonist as specified. The California Department of Education (CDE) shall maintain a clearinghouse for best practices in training nonmedical personnel to administer naloxone or another opioid antagonist to pupils.
Existing law requires an LEA, COE, or charter school electing to utilize naloxone or another opioid antagonist for emergency aid to ensure that each employee who volunteers is provided defense and indemnification by the LEA, COE, or charter school for any civil liability. This information shall be reduced to writing, provided to the volunteer, and retained in the volunteer’s personnel file.
Proposed Law:
This bill requires any LEA, COE, and charter school serving pupils in any of grades 9 to 12 that voluntarily determines to make naloxone or another opioid antagonist available on campus to be placed in at least one of specified locations on campus that is widely known and easily accessible, both during school hours and after school hours, including the school nurse’s office and the athletic trainer’s office.
This bill requires the CDPH to establish by April 1, 2025, an opioid overdose training program and program toolkit to be made available for public high school pupils to be trained on how to identify and respond to an opioid overdose, including by administering a federally approved opioid overdose reversal medication. The bill requires the training program to include instruction from appropriately trained instructors from local, state, and national organizations, which may include community health centers, community health experts, nonprofits with related expertise, and school staff. It also requires the instructors whom the school does not employ shall undergo state-approved background checks.
This bill requires the CDPH to collaborate with local, state, and national organizations, which may include community health centers, community health experts, and nonprofits with related expertise, to provide pupils with integrated, comprehensive, accurate, and unbiased educational materials on opioid and drug overdose prevention, opioid and drug safety, and stigma reduction.
This bill specifies the training program to include, but is not limited to:
- Informational videos, graphics, or in-person training on what to do and how to respond during a drug or opioid overdose.
- Information on recognizing signs of a drug or opioid overdose.
- Information on how to respond in an emergency involving a drug or opioid overdose.
This bill requires the CDPH, on an annual basis, to determine the efficacy of program training resources and program drug and opioid prevention informational efforts, collect data on the number of pupils participating in the program and share this information with the Legislature.
Related Legislation:
AB 19 (Patterson, 2023) would require each public school operated by an LEA, COE, or charter school to maintain at least two doses of naloxone hydrochloride or another opioid antagonist for purposes of those authorizations. This bill is currently on the Suspense File in this committee.
SB 10 (Cortese, 2023) would require LEAs and COEs to include strategies for the prevention and treatment of an opioid overdose in their school safety plans and requires CDE to develop training materials on the use of emergency opioid antagonists for school personnel, and safety materials for parents, guardians, and. This bill is pending in the Assembly Appropriations Committee.
SB 472 (Hurtado, 2023) would require each campus of a public school operated by an LEA, COE, or charter school to maintain at least two doses on its campus, and distribute, naloxone hydrochloride or another opioid antagonist pursuant to the standing order for naloxone. This bill was held on the Suspense File in this committee.
SB 234 (Portantino, 2023) would require schools kindergarten to 12 grade, institutions of higher education, stadiums, concert venues, and amusement parks, at all times, to maintain unexpired doses of naloxone or any other opioid antagonist on its premise, ensure that at least two employees are aware of the location of the naloxone or other opioid antagonist, and expand community colleges ability to administer naloxone. This bill is pending in the Assembly Appropriations Committee.
Staff Comments:
The CDPH indicates it would hire a contractor with expertise in youth curriculum development, trauma-informed training, and substance misuse/substance use disorder prevention experience. The contractor would ensure that the curriculum is age-appropriate, trauma-informed, and accessible and inclusive and also work with CDPH to establish evaluation metrics for the ongoing annual report. The costs for the contractor are estimated at $225,000 annually for two years and are based on recent quotes for a similar curriculum development and program at CDPH. After the initial two years, the type of contractual service will change from curriculum development to contractual support for training of trainers.
-- END --
SENATE COMMITTEE ON
Senator Anthony Portantino, Chair
2023 - 2024 Regular Session
AB 915 (Arambula) - Pupil health: drug education: opioid overdose training program
Version: | Policy Vote: |
Urgency: | Mandate: |
Hearing Date: | Consultant: |
Bill Summary:
This bill requires any local educational agency (LEA), county office of education, and charter school that voluntarily determines to make naloxone hydrochloride or another opioid antagonist available on campus to be placed in an appropriate location, as specified. This bill also requires the California Department of Public Health (CDPH) to create an opioid overdose training program and program toolkit to train high school students on how to identify and respond to an opioid overdose.
Fiscal Impact:
The CDPH estimates General Fund costs of $549,000 for the 2024-25 fiscal year, $849,000 for the 2025-26 fiscal year, and about $624,000 thereafter to support 2.0 two positions and two external contractors. The positions would be necessary to support the development of regulations, collaborate with stakeholders, establish and monitor the curriculum development contract, collect data, and develop the report. CDPH indicates that these costs could be less to the extent that Opioid Settlements Funds are available.
This bill could also result in additional, unknown Proposition 98 General Fund costs for LEAs that elect to provide the training. The related costs would depend on the design, scope, and amount of time that would be necessary to deliver the training.
Background:
Existing law permits school nurses or trained personnel who have volunteered to provide emergency naloxone or another opioid antagonist, by nasal spray or by auto-injector, to persons suffering, or reasonably believed to be suffering, from an opioid overdose.
Existing law requires the Superintendent of Public Instruction (SPI) to establish and revise, every five years or sooner, minimum training standards for administering naloxone or another opioid antagonist as specified. The California Department of Education (CDE) shall maintain a clearinghouse for best practices in training nonmedical personnel to administer naloxone or another opioid antagonist to pupils.
Existing law requires an LEA, COE, or charter school electing to utilize naloxone or another opioid antagonist for emergency aid to ensure that each employee who volunteers is provided defense and indemnification by the LEA, COE, or charter school for any civil liability. This information shall be reduced to writing, provided to the volunteer, and retained in the volunteer’s personnel file.
Proposed Law:
This bill requires any LEA, COE, and charter school serving pupils in any of grades 9 to 12 that voluntarily determines to make naloxone or another opioid antagonist available on campus to be placed in at least one of specified locations on campus that is widely known and easily accessible, both during school hours and after school hours, including the school nurse’s office and the athletic trainer’s office.
This bill requires the CDPH to establish by April 1, 2025, an opioid overdose training program and program toolkit to be made available for public high school pupils to be trained on how to identify and respond to an opioid overdose, including by administering a federally approved opioid overdose reversal medication. The bill requires the training program to include instruction from appropriately trained instructors from local, state, and national organizations, which may include community health centers, community health experts, nonprofits with related expertise, and school staff. It also requires the instructors whom the school does not employ shall undergo state-approved background checks.
This bill requires the CDPH to collaborate with local, state, and national organizations, which may include community health centers, community health experts, and nonprofits with related expertise, to provide pupils with integrated, comprehensive, accurate, and unbiased educational materials on opioid and drug overdose prevention, opioid and drug safety, and stigma reduction.
This bill specifies the training program to include, but is not limited to:
- Informational videos, graphics, or in-person training on what to do and how to respond during a drug or opioid overdose.
- Information on recognizing signs of a drug or opioid overdose.
- Information on how to respond in an emergency involving a drug or opioid overdose.
This bill requires the CDPH, on an annual basis, to determine the efficacy of program training resources and program drug and opioid prevention informational efforts, collect data on the number of pupils participating in the program and share this information with the Legislature.
Related Legislation:
AB 19 (Patterson, 2023) would require each public school operated by an LEA, COE, or charter school to maintain at least two doses of naloxone hydrochloride or another opioid antagonist for purposes of those authorizations. This bill is currently on the Suspense File in this committee.
SB 10 (Cortese, 2023) would require LEAs and COEs to include strategies for the prevention and treatment of an opioid overdose in their school safety plans and requires CDE to develop training materials on the use of emergency opioid antagonists for school personnel, and safety materials for parents, guardians, and. This bill is pending in the Assembly Appropriations Committee.
SB 472 (Hurtado, 2023) would require each campus of a public school operated by an LEA, COE, or charter school to maintain at least two doses on its campus, and distribute, naloxone hydrochloride or another opioid antagonist pursuant to the standing order for naloxone. This bill was held on the Suspense File in this committee.
SB 234 (Portantino, 2023) would require schools kindergarten to 12 grade, institutions of higher education, stadiums, concert venues, and amusement parks, at all times, to maintain unexpired doses of naloxone or any other opioid antagonist on its premise, ensure that at least two employees are aware of the location of the naloxone or other opioid antagonist, and expand community colleges ability to administer naloxone. This bill is pending in the Assembly Appropriations Committee.
Staff Comments:
The CDPH indicates it would hire a contractor with expertise in youth curriculum development, trauma-informed training, and substance misuse/substance use disorder prevention experience. The contractor would ensure that the curriculum is age-appropriate, trauma-informed, and accessible and inclusive and also work with CDPH to establish evaluation metrics for the ongoing annual report. The costs for the contractor are estimated at $225,000 annually for two years and are based on recent quotes for a similar curriculum development and program at CDPH. After the initial two years, the type of contractual service will change from curriculum development to contractual support for training of trainers.
-- END --
SENATE COMMITTEE ON HEALTH
Senator Dr. Susan Talamantes Eggman, Chair
BILL NO: AB 915
AUTHOR: | Arambula and Ramos | ||
VERSION: | June 19, 2023 | ||
HEARING DATE: | July 5, 2023 | ||
CONSULTANT: | Reyes Diaz | ||
SUBJECT: Pupil health: drug education: opioid overdose certification and training program
SUMMARY:
Requires the California Department of Public Health, by April 1, 2025, to establish a certification training program for public high school pupils in grades 9-12 to gain skills in how to identify and respond to an opioid overdose, including by administering naloxone hydrochloride nasal spray. Permits high schools to voluntarily determine whether or not to host the program at their campuses. Requires high schools that voluntarily determine to make naloxone hydrochloride or another opioid antagonist available on campus to make it available in specified location that are easily accessible, as specified.
Existing law:
- Establishes the Department of Health Care Services (DHCS) as the sole authority for all substance use disorder (SUD) functions and programs in the state. [HSC §11750 et seq.]
- Establishes the California Department of Public Health (CDPH) to be vested with all the duties, powers, purposes, functions, responsibilities, and jurisdiction as they relate to public health, as specified. [HSC §131050]
- Authorizes licensed health care providers to issue a standing order for the distribution or the administration of naloxone to a person at risk of overdose, or family members, friends, or other persons in a position to assist a person at risk of an opioid-related overdose. Requires a person who is prescribed or possesses naloxone pursuant to a standing order to receive training, as specified. [CIV §1714.22, et seq.]
- Permits a school nurse or trained personnel who have volunteered to provide emergency naloxone or another opioid antagonist, by nasal spray or by auto-injector, to persons suffering, or reasonably believed to be suffering, from an opioid overdose. [EDC §49414.3]
- Permits each public and private elementary and secondary school in the state to voluntarily determine whether or not to make emergency naloxone or another opioid antagonist and trained personnel available at its school. [EDC §49414.3]
- Requires any school district, county office of education (COE), or charter school electing to utilize naloxone or another opioid antagonist for emergency aid to distribute a notice at least once per school year to all staff that contains specified information related to volunteers to administer naloxone and specified training. [EDC §49414.3]
- Requires a qualified supervisor of health at a school, COE, or charter school electing to utilize naloxone or another opioid antagonist for emergency aid to obtain from an authorizing physician a prescription for each school for naloxone or another opioid antagonist, and to stock the naloxone, as specified. [EDC §49414.3]
- Requires a school district, COE, or charter school electing to utilize naloxone or another opioid antagonist for emergency aid to ensure that each employee who volunteers is provided defense and indemnification by the school district, COE, or charter school for any and all civil liability. Requires the information to be reduced to writing, provided to the volunteer, and retained in the volunteer’s personnel file. [EDC §49414.3]
This bill:
- Requires CDPH, by April 1, 2025, to establish a certification training program for public high school pupils in grades 9-12, inclusive, to gain skills in how to identify and respond to an opioid overdose, including by administering naloxone hydrochloride nasal spray. Permits high schools to voluntarily determine whether or not to host the program at their campuses.
- Requires CDPH, in establish the program, collaborate with local, state, and national organizations, such as community health centers, health experts, and nonprofits with expertise, to provide pupils working toward their certification with integrated, comprehensive, accurate, and unbiased educational materials on opioid and drug overdose prevention, opioid drug safety, and stigma reduction.
- Requires program training to include instruction from appropriately trained instructors from entities specified in 2) above, and school staff. Requires instructors who are not employed by the school to undergo state-approved background checks.
- Permits program training related to administering naloxone hydrochloride nasal spray to include, but not be limited to:
- Informational videos, graphics, or in-person training on what to do and how to respond during a drug or opioid overdose;
- Information on how to recognize signs of a drug or opioid overdose; and,
- Information on how to respond in an emergency involving a drug or opioid overdose.
- Requires the program to provide resource materials related to drug and opioid use or prevention, for appropriate use with pupils of all races, genders, sexual orientations, and ethnic and cultural backgrounds, pupils with disabilities, and English learners.
- Requires CDPH to collect data on the number of pupils participating in the program, on an annual basis, in order to determine the efficacy of program training resources and program drug and opioid prevention informational efforts, and to share this information with the Legislature and with the Senate and Assembly Budget Subcommittees on Education, Health, and Human Services.
- Requires any school district, COE, or charter school serving pupils in grades 9-12 that voluntarily determine to make naloxone hydrochloride or another opioid antagonist available on campus to ensure that the naloxone hydrochloride or another opioid antagonist is placed in an appropriate location, as determined by the governing board or body, that is widely known and easily accessible, both during school hours and after school hours. Requires the naloxone hydrochloride or another opioid antagonist to be located in at least one of the following locations on campus:
- School nurse’s office;
- Athletic trainer’s office;
- Front office;
- Performing arts auditorium;
- Library;
- Cafeteria; or,
- Athletic gym.
FISCAL EFFECT:
According to the Assembly Appropriations Committee:
One-time and ongoing General Fund costs of about $480,000 for the 2024-25 fiscal year and $700,000 for the 2025-26 fiscal year and thereafter to CDPH for two positions, an external contractor, and the development and promulgation of regulations to establish the criteria of the certification, and approve curriculum instructors. CDPH notes General Fund costs could be less to the extent Opioid Settlements Funds are available. The two positions at CDPH are needed to support regulations development, establish the curriculum-development contract through a request for proposals or interagency agreement, monitor the external contract, collect data, and develop the legislative report. Following the first year of regulation development, CDPH indicates it would hire a contractor with expertise in youth curriculum development, trauma-informed training, and substance misuse/SUD prevention experience. The contractor would ensure that the curriculum is age-appropriate, trauma-informed, and accessible and inclusive, and work with CDPH to establish evaluation metrics for the ongoing annual report. Costs for the contractor are estimated at $225,000 annually for two years and are based on recent quotes for a similar curriculum development and program at CDPH. After the initial two years, the type of contractual service will change from curriculum development to contractual support for training of trainers.
Ongoing Proposition 98 General Fund costs to a Local Education Agency (LEA) to provide the training, should a LEA opt to provide the training. Costs to conduct the training will depend on how LEAs deliver the training and how CDPH designs the training.
PRIOR VOTES:
Assembly Floor: | 78 - 0 |
Assembly Appropriations Committee: | 15 - 0 |
Assembly Health Committee: | 15 - 0 |
Assembly Education Committee: | 7 - 0 |
COMMENTS:
- Author’s statement. According to the author, the fentanyl and opioid crisis is a state and nationwide public health emergency that has taken the lives of so many young people. Fentanyl prevention, education, and training on how to assist someone who is experiencing an opioid overdose is lifesaving. According to CDPH, in 2021 there were 7,175 deaths because of an opioid overdose. The state can take a leadership role to better inform people of how to treat those who undergo a potentially fatal overdose. This bill will establish a certification training program for young people in grades 9-12. It will outline key methods on how to support a peer experiencing an opioid overdose, with the use of naloxone hydrochloride nasal sprays. Through comprehensive and evidence-based certification training, students can prepare and learn ways to support their peers experiencing a drug-related overdose.
- Naloxone. According to the U.S. Surgeon General, naloxone is an opioid antagonist that is used to temporarily reverse the effects of an opioid overdose, namely slowed or stopped breathing. Expanding the awareness and availability of this medication is a key part of the public health response to the opioid epidemic. Naloxone is a safe antidote to a suspected overdose and, when given in time, can save a life. Research shows that when naloxone and overdose education are available to community members, overdose deaths decrease in those communities. Therefore, increasing the availability and targeted distribution of naloxone is a critical component of our efforts to reduce opioid-related overdose deaths and, when combined with the availability of effective treatment, to ending the opioid epidemic. In most states, including California, people who are or who know someone at risk for opioid overdose can go to a pharmacy or community-based program, to get trained on naloxone administration, and receive naloxone by “standing order,” i.e., without a patient-specific prescription. Most states have laws designed to protect health care professionals for prescribing and dispensing naloxone from civil and criminal liabilities, as well as Good Samaritan laws to protect people who administer naloxone or call for help during an opioid overdose emergency. Naloxone is increasingly being used by police officers, emergency medical technicians, and non-emergency first responders to reverse opioid overdoses. There are two U.S. Food and Drug Administration (FDA)-approved naloxone products for community use that are available by prescription, but too few community members are aware of the important role they can play to save lives. The Surgeon General advises patients and the public to talk with their doctor or pharmacist about obtaining naloxone; learn the signs of opioid overdose, like pinpoint pupils, slowed breathing or loss of consciousness; and, get trained to administer naloxone in the case of a suspected emergency.
- Statewide standing order for naloxone distribution. CDPH issued a statewide standing order for naloxone in June 2018. The order allows organizations and entities, including k-12 schools, colleges, and universities, to distribute naloxone to a person who is at risk of experiencing an overdose or an individual in a position to assist an at-risk person. Staff of community organizations and other entities distributing naloxone under the statewide standing order are required to receive training, and are also required to provide training to individuals who receive naloxone from them. Organizations may apply to use the statewide standing order and meet certain terms and conditions. A separate distribution program administered through DHCS makes use of the statewide standing order and allows various entities to apply for and obtain naloxone at no cost.
In addition to the standing order, CDPH hosts a comprehensive webpage[1] through its Substance and Addiction Prevention Branch that contains comprehensive information for the public related to naloxone, including a questions and answers format discussing who should carry naloxone and why it should be carried; where it could be obtained; how to store and dispose of it; resources for being trained on its administration; and information on pertinent laws, like the Good Samaritan law, which gives people indemnification for administering it.
- Naloxone Distribution Project (NDP). The NDP aims to reduce opioid overdose deaths through the provision of free naloxone. Entities can apply to DHCS to have naloxone shipped directly to their address. Eligible entities include:
- Law enforcement such as police departments, county jails, and probation;
- Fire, emergency medical services (EMS), and first responders;
- Schools and universities;
- County public health and behavioral health departments; and,
- Community organizations, such as harm reduction organizations or community opioid coalitions.
Since it began in October 2018, the NDP has distributed more than 2,200,000 kits of naloxone, which have been used to reverse more than 140,000 overdoses. The NDP requires entities who receive naloxone to receive training and to subsequently train those to whom they distribute it. The NDP receives State General Funds and opioid settlement funds from the Janssen and Distributors (J&D) Settlement Agreements.
- Recent FDA approval. On March 29, 2023, the FDA approved four-milligram naloxone nasal spray for over-the-counter (OTC), nonprescription, use—the first naloxone product approved for use without a prescription. This action, according to the FDA, paves the way for the life-saving medication to reverse an opioid overdose to be sold directly to consumers in places like drug stores, convenience stores, grocery stores, and gas stations, as well as online. The timeline for availability and price of this OTC product is determined by the manufacturer. The FDA will work with all stakeholders to help facilitate the continued availability of naloxone nasal spray products during the time needed to implement the switch from prescription to OTC status, which may take months. Other formulations and dosages of naloxone will remain available by prescription only. In its November 15, 2022, announcement related to the preliminary assessment for the OTC approval, the FDA specified it was assessing whether certain naloxone drug products—up to four milligrams nasal spray and up to two milligrams auto-injector for intramuscular or subcutaneous use—would be approved as safe and effective for nonprescription use.
- Double referral. This bill was heard in the Senate Education Committee on June 28, 2023, and passed with a 7-0 vote.
- Related legislation. SB 10 (Cortese) requires LEAs and county offices of education to include strategies for the prevention and treatment of an opioid overdose in their school safety plans. SB 10 is set to be heard in the Assembly Health Committee on July 11, 2023.
SB 19 (Seyarto) establishes, upon appropriation by the Legislature, the Anti-Fentanyl Abuse Task Force to evaluate the nature and extent of fentanyl abuse in the state and to develop policy recommendations for addressing it. SB 19 is set to be heard in the Assembly Public Safety Committee on July 11, 2023.
SB 234 (Portantino, Hurtado, and Umberg) requires each campus of a K-12 public school and colleges, and each stadium, concert venue, and amusement park, to maintain unexpired opioid antagonist doses on its premises and ensure that at least two employees are aware of their location. SB 234 is set to be heard in the Assembly Health Committee on July 11, 2023.
AB 33 (Bains) is substantially similar to SB 19 (Seyarto) and establishes the Fentanyl Addiction and Overdose Prevention Task Force to undertake specified duties relating to fentanyl abuse. AB 33 is pending in the Senate Appropriations Committee.
AB 461 (Ramos) requires the governing board of each community college district and the Trustees of the California State University to provide information about the use and location of fentanyl test strips as part of established campus orientations, to notify students of the presence and location of fentanyl test strips, and would require that each campus health center stock and distribute fentanyl test strips, as specified. AB 461 is set to be heard in this Committee on July 5, 2023.
AB 1510 (Jones-Sawyer) establishes the Fighting Fentanyl Bond Act (FFBA) of 2024, in the sum of an unspecified amount, to be distributed to various state entities for the purpose of addressing the issues caused by the growing fentanyl and synthetic opioid overdose and death crisis. Requires the FFBA to be submitted to the voters at the November 5, 2024, statewide general election. AB 1510 is set to be heard in this Committee on July 5, 2023.
- Prior legislation. AB 1748 (Mayes, Chapter 557, Statues of 2016) authorizes school districts to provide an emergency opioid antagonist to school nurses or trained personnel and authorizes a school nurse or trained personnel to administer an opioid antagonist to a person suffering from an opioid overdose.
- Support. The sponsor and other supporters of this bill state that there is currently no type of certification training for young people on how to reverse an opioid overdose. Fentanyl, a synthetic opioid more potent than morphine, is FDA-approved to treat severe pain related to surgery or complex pain conditions. However, illicitly manufactured fentanyl and other illegally produced opioids are increasingly found in the drug supply and contribute to a dramatic rise in drug overdose deaths in the United States. In California, fentanyl has attributed to more than 80% of all drug-related deaths in 2021 due to overdose among young people. Across the state, 7,000 people died from a fentanyl overdose in 2021. Data from the 2020 National Survey of Children’s Health indicates that 282 deaths occurred among adolescents in 2019 and 546 deaths occurred in 2020 from a drug overdose. Supporters state this bill will support the training and development of young people and their peers to learn how to respond safely to an opioid overdose crisis.
- Policy concerns.
- CDPH currently host a comprehensive webpage related to naloxone with resources on training for administering it. Committee staff also notes that a simple Internet search for naloxone administration training results in many links to training programs, including on the Centers for Disease Control and Prevention website. It is unclear why CDPH would be tasked with establishing a training and certification program for naloxone administration for high school campuses only.
- Current law permits each public and private elementary and secondary school in the state to determine whether or not to make emergency naloxone or another opioid antagonist and trained personnel available at its school. This bill requires only high schools that determine to make it available to ensure it’s in specified locations and readily and easily accessible. It is unclear why only high schools are required to make it available in specified locations and why other schools that determine to make it available on campus would not be subject to this requirement.
- Amendments. To address the policy concerns, the author may wish to amend this bill to:
- Require CDPH to provide training toolkits for in-person trainings at high schools that volunteer to host trainings for administering opioid overdose reversal medications and recognizing signs of an overdose.
- Require all schools that determine to make emergency naloxone or another opioid antagonist available on their campuses to place them at the locations specified in this bill.
The author may also wish to include a technical amendment as follows:
- Require CDPH to share information with the Legislature and with the Senate and Assembly Budget Subcommittees on Education and Health and Human Services.
SUPPORT AND OPPOSITION:
Support: Zachary Horton Foundation (sponsor)
Alameda County Office of Education
County Health Executives Association of California
Ella Baker Center for Human Rights
Generation Up
HealthRIGHT 360
Initiate Justice
Sister Warriors Freedom Coalition
One individual
Oppose: None received
-- END --
SENATE COMMITTEE ON EDUCATION
Senator Josh Newman, Chair
2023 - 2024 Regular
Bill No: AB 915 Hearing Date: June 28, 2023
Author: | |||
Version: | June 19, 2023 | ||
Urgency: | No | Fiscal: | Yes |
Consultant: | Kordell Hampton | ||
Subject: Pupil health: drug education: opioid overdose certification and training program.
Note: This bill has been referred to the Committees on Education and Health. A "do pass" motion should include a referral to the Committee on Health.
SUMMARY
This bill requires any local education agency (LEA), county office of education (COE), and charter school that voluntarily determines to make naloxone hydrochloride (naloxone) or another opioid antagonist available on campus to be placed in appropriate location, as specified, and requires the California Department of Public Health (CDPH) to create a certificate training program for students in grades 9-12 to gain skills in how to identify and respond to an opioid overdose.
BACKGROUND
Existing Law:
Education Code (EC)
- Permits school nurses or trained personnel who have volunteered to provide emergency naloxone or another opioid antagonist, by nasal spray or by auto-injector, to persons suffering, or reasonably believed to be suffering, from an opioid overdose. (EC § 49414.3(a))
- Requires the Superintendent of Public Instruction (SPI) to establish and revise, every five years or sooner, minimum training standards for administering naloxone or another opioid antagonist as specified. The California Department of Education (CDE) shall maintain a clearinghouse for best practices in training nonmedical personnel to administer naloxone or another opioid antagonist to pupils. (EC § 49414.3(e))
- Requires an LEA, COE, or charter school electing to utilize naloxone or another opioid antagonist for emergency aid to ensure that each employee who volunteers is provided defense and indemnification by the LEA, COE, or charter school for any civil liability. This information shall be reduced to writing, provided to the volunteer, and retained in the volunteer’s personnel file. (EC 49414.3(i))
Civil Code (CIV)
- Permits a licensed health care provider who is authorized by law to prescribe an opioid antagonist may issue standing orders for the distribution of an opioid antagonist to a person at risk of an opioid-related overdose or to a family member, friend, or other person in a position to assist a person at risk of an opioid-related overdose. (CIV § 1747.22(c))
- A person who is prescribed or possesses an opioid antagonist pursuant to a standing order shall receive the training provided by an opioid overdose prevention and treatment training program. (CIV § 1747.22(d))
- An opioid overdose prevention and treatment training program is any program operated by a local health jurisdiction or that is registered by a local health jurisdiction to train individuals to prevent, recognize, and respond to an opiate overdose, and that provides, at a minimum, training as specified. (CIV 1714.22(a)(2))
ANALYSIS
This bill requires any LEA, COE, and charter school that voluntarily determines to make naloxone or another opioid antagonist available on campus to be placed in appropriate location, as specified, and requires the CDPH to create a certificate training program for students in grades 9-12 to gain skills in how to identify and respond to an opioid overdose. Specifically, this bill:
Naloxone: Widely Known and Easily Accessible Locations On School Campuses
- Requires any LEA, COE, and charter school serving pupils in any of grades 9 to 12 that voluntarily determines to make naloxone or another opioid antagonist available on campus to be placed in at least one of the following locations on campus that is widely known and easily accessible, both during school hours and after school hours:
- School nurse’s office.
- Athletic trainer’s office.
- Front office.
- Performing arts auditorium.
- Library.
- Cafeteria.
- Athletic gym.
- Makes findings and declarations related to the importance of having all pupils, faculty, and staff aware of the location of naloxone on school campuses and understand how to identify the signs of an overdose and respond using an opioid antagonist medication.
CDPH Certification Training Program
- Requires the CDPH to establish by April 1, 2025, a certification training program for public high school pupils in grades 9 to 12, inclusive, to gain skills in how to identify and respond to an opioid overdose, including by administering naloxone and allows high school to voluntarily determine whether or not to host the program on their campuses.
- Requires the CDPH to collaborate with local, state, and national organizations, which may include community health centers, community health experts, and nonprofits with related expertise, to provide pupils working toward their certificate with integrated, comprehensive, accurate, and unbiased educational materials on opioid and drug overdose prevention, opioid and drug safety, and stigma reduction.
- Requires the training program to include instruction from appropriately trained instructors from local, state, and national organizations, which may include community health centers, community health experts, nonprofits with related expertise, and school staff. Instructors whom the school does not employ shall undergo state-approved background checks.
- Specifies the training program related to administering naloxone to include, but is not limited to:
- Informational videos, graphics, or in-person training on what to do and how to respond during a drug or opioid overdose.
- Information on recognizing signs of a drug or opioid overdose.
- Information on how to respond in an emergency involving a drug or opioid overdose.
- Resource materials related to drug and opioid use or prevention for appropriate use with pupils of all races, genders, sexual orientations, ethnic and cultural backgrounds, pupils with disabilities, and English learners.
- Requires the CDPH, on an annual basis, to determine the efficacy of program training resources and program drug and opioid prevention informational efforts, collect data on the number of pupils participating in the program and share this information with the Legislature.
STAFF COMMENTS
- Need for the bill. According to the author,” The fentanyl and opioid crisis is a state and nationwide public health emergency that has taken the lives of so many young people. Fentanyl prevention, education, and training on how to assist someone who is experiencing an opioid overdose is lifesaving. According to CDPH, in 2021 there were 7,175 deaths because of an opioid overdose. The state can take a leadership role to better inform people of how to treat those who undergo a potentially fatal overdose. AB 915 will establish a certification-training program for young people in grades 9-12. It will outline key methods on how to support a peer experiencing an opioid overdose, with the use of Naloxone nasal sprays. Through comprehensive and evidence-based certification training, students can prepare and learn ways to support their peers experiencing a drug-related overdose.”
- Statewide Standing Order for Naloxone. Naloxone can help reduce opioid overdose deaths in California, but many organizations find it challenging to obtain the required standing order to get naloxone from healthcare providers. According to CDPH, of the 6,843 opioid-related overdose deaths in 2021, 5,722 were related to fentanyl. CDPH issued the standing order in 2017 to address this need and support equitable naloxone access. The standing order:
- Allow community organizations and other entities in California that are not currently working with a physician to distribute naloxone to a person at risk of an opioid-related overdose or to a family member, friend, or another person in a position to assist; and
- Allow for the administration of naloxone by a family member, friend, or other person to a person experiencing or reasonably suspected of experiencing an opioid overdose.
Among the organizations and entities that can distribute naloxone under the order are colleges and universities. An individual at risk of experiencing an overdose or someone who can assist an individual at risk is allowed to do so. Under the statewide standing order, staff of community organizations and other entities distributing naloxone must be trained. They are also required to provide training to individuals who receive naloxone from them. Colleges and other organizations may apply to use the statewide standing order if they meet certain conditions.
A separate distribution program administered through The Department of Health Care Services (DHCS) allows universities and colleges to apply for and obtain naloxone at no cost to the institution. According to the CDPH website, since October 2018, their Naloxone Distribution Project (NDP) has distributed over 1 million units of naloxone and recorded over 57,000 overdose reversals.
- Addressing Fentanyl Among California Youth. According to the CDPH, fentanyl-related overdose deaths increased 625 percent among ages 10-19 from 2018 to 2020. In 2021, there were 224 fentanyl-related overdose deaths among teens ages 15–19 in California. According to AB 1748 (Mayes) Chapter 557, Statutes of 2016, among other things, the SPI must establish minimum training standards for school employees who volunteer to administer naloxone or another opioid antagonist. In addition to setting minimum training standards, the CDE must maintain on its website a clearinghouse for best practices in training nonmedical personnel to administer naloxone or another opioid antagonist to pupils.
In conjunction with the CDPH, the CDE provides LEAs with resources and information that they can readily share with parents and students to help keep them safe. The shareable Fentanyl Awareness and Prevention toolkit page offer information about the risks of fentanyl and how to prevent teen use and overdoses. In addition to the toolkit, the CDPH’s Substance and Addiction Prevention branch provides resources for parents, guardians, caretakers, educators, schools, and youth-serving providers.
- Local Action to Address Fentanyl. LEAs and COEs have also adjusted to address this growing crisis. For example, the Lake County Office of Education and Washington Unified School District in West Sacramento recently implemented a local school naloxone policy consistent with state statutes. San Diego Unified School District created its naloxone toolkit to aid other LEAs and inform parents and guardians.
Some California school districts have opted to make Naloxone available. Several incidents of overdoses have occurred in the state's largest school district, Los Angeles Unified, including at least one death in 2022. In response, the district plans to stock naloxone in over 1,400 elementary, middle, and high schools. Throughout the San Diego Unified School District, which is the second-largest school system in the state, naloxone is available in classrooms grades six through 12. Since 2020, Elk Grove Unified School District, a large district in Northern California, has provided naloxone to school security officers and their supervisors. Naloxone was made available at all county high schools in Los Angeles County by the Palos Verdes Peninsula Unified School District, which trained all its registered nurses to administer it.
There is no precedent in state law to allow students to administer medication. Students could administer naloxone under these circumstances, which represents a significant departure from the current practice. There is no precedent in state law to allow students to administer medication to other students. The committee may wish to consider whether it is appropriate to have young people trained to administer naloxone.
- Health Education Framework. The health education standards shape the direction of health education instruction for children and youths in California’s public schools: they provide LEAs with fundamental tools for developing health education curricula and improving student attainment in this area, and they help ensure that all students in kindergarten through high school receive high-quality health education instruction, providing students with the knowledge, skills, and confidence to lead healthy lives. Health education has undergone a paradigm shift over the last 15 years. Data from national and state surveys, including the California Healthy Kids Survey, indicated that although youths knew what was harmful to their health, they did not have the skills to avoid risky behaviors. To ensure students not only knew about the harms of drugs, alcohol, and tobacco but also learned how to prevent and recognize these behaviors, the State Board of Education adopted a revised health education curriculum in 2019. The framework aims to achieve the following goals through different grades.
- Kindergarten
- Ability to explain why medicines are used and why they can be helpful or harmful.
- Recognize medicines should be taken only under the supervision of a trusted adult; that some household products are harmful if ingested or inhaled; and that tobacco smoke is harmful to health and should be avoided.
- Grade 2
- Distinguish between helpful and harmful substances (including alcohol, tobacco, and other drugs).
- Explain why household products are harmful if ingested or inhaled; that a drug is a chemical that changes how the body and brain work; why it is dangerous to taste, swallow, sniff, or play with unknown substances; why it is important to follow the medical recommendations for prescription and nonprescription medicines.
- Identify rules for taking medicine at school and at home and refusal skills when confronted or pressured to use alcohol, tobacco, or other drugs.
- Grade 4
- Describe the harmful short- and long-term effects of alcohol, tobacco, and other drugs, including inhalants.
- Explain the differences between medicines and illicit drugs and why individual reactions to alcohol and drug use may vary.
- Identify family and school rules about alcohol, tobacco, and drug use; ways to cope with situations involving alcohol, tobacco, and other drugs.
- Grade 6
- Explain short- and long-term effects of alcohol, tobacco, inhalant, and other drug use, including social, legal, and economic implications; the dangers of secondhand smoke; the stages of drug dependence and addiction and the effects of drugs on the adolescent brain.
- Identify positive alternatives to alcohol, tobacco, and other drug use; the benefits of a tobacco-free environment; and the effects of alcohol, tobacco, and other drug use on physical activity, including athletic performance.
- Differentiate between the use and misuse of prescription and nonprescription medicines.
- Grades 7-8
- Describe the harmful short- and long-term effects of alcohol, tobacco, and other drugs, including steroids, performance-enhancing drugs and inhalants; the relationship between using alcohol, tobacco, and other drugs and engaging in other risky behaviors; the consequences of using alcohol, tobacco, and other drugs during pregnancy, including fetal alcohol spectrum disorders.
- Explain the dangers of drug dependence and addiction; the short- and long-term consequences of using alcohol and other drugs to cope with problems; why most youths do not use alcohol, tobacco, or other drugs; school policies and community laws related to the use, possession, and sale of alcohol, tobacco, and illegal drugs.
- Analyze the harmful effects of using diet pills without physician supervision.
- Grades 9-12
- Describe the health benefits of abstaining from or discontinuing use of alcohol, tobacco, and other drugs; the use and abuse of prescription and nonprescription medicines and illegal substances.
- Explain the impact of alcohol, tobacco, and other drug use on brain chemistry, brain function, and behavior; the connection between alcohol and tobacco use and the risk of oral cancer; the impact of alcohol and other drug use on vehicle crashes, injuries, violence, and risky sexual behavior.
- Identify the social and legal implications of using and abusing alcohol, tobacco, and other drugs.
- Analyze the consequences for the mother and child of using alcohol, tobacco, and other drugs during pregnancy—including fetal alcohol spectrum disorders and other birth defects; the consequences of binge drinking and its relationship to cancer; to liver, pancreatic, and cardiovascular diseases; and to a variety of gastrointestinal problems, neurological disorders, and reproductive system disorders.
- Clarify myths regarding the scope of alcohol, tobacco, and other drug use among adolescents.
- Related Legislation
AB 19 (Patterson, 2023) would require each public school operated by an LEA, COE, or charter school to maintain at least two doses of naloxone hydrochloride or another opioid antagonist for purposes of those authorizations. This bill is currently in Senate Appropriations Committee.
SB 10 (Cortese, 2023) would require LEAs and COEs to include strategies for the prevention and treatment of an opioid overdose in their school safety plans and requires the California Department of Education (CDE) to develop training materials on the use of emergency opioid antagonists for school personnel, and safety materials for parents, guardians, and pupils in conjunction with the California Health and Human Services Agency (CalHHS). This bill is currently in Assembly Education Committee.
SB 472 (Hurtado, 2023) would require each campus of a public school operated by an LEA, COE, or charter school to maintain at least two doses on its campus, and distribute, naloxone hydrochloride or another opioid antagonist pursuant to the standing order for naloxone and requires LEAs, COEs, and charter school to report to the DHCS for failure to distribute naloxone. This bill was held in Senate Appropriations.
SB 234 (Portantino, 2023) would require schools kindergarten to 12 grade, institutions of higher education, stadiums, concert venues, and amusement parks, at all times, to maintain unexpired doses of naloxone or any other opioid antagonist on its premise, ensure that at least two employees are aware of the location of the naloxone or other opioid antagonist, and expand community colleges ability to administer naloxone. SB 234 also provides civil protections to a person who helps administer naloxone or another opioid antagonist on a college campus stadium, concert venue, or amusement park to a person who appears to be experiencing an opioid overdose. This bill is currently in Assembly Education Committee.
AB 1748 (Mayes) Chapter 557, Statutes of 2016, authorizes LEAs to provide an emergency opioid antagonist to school nurses or trained personnel and authorizes a school nurse or trained personnel to administer an opioid antagonist to a person suffering from an opioid overdose.
SUPPORT
Generation Up (Co-Sponsor)
Alameda County Office of Education
County Health Executives Association of California
OPPOSITION
None received
-- END --
ASSEMBLY THIRD READING
ATR Bill Id:AB 915
Author:(Arambula and Ramos)
As Amended Ver:April 27, 2023
Majority vote
SUMMARY
Establishes a voluntary certification training program for high school students in how to administer naloxone hydrochloride during an opioid overdose; requires the California Department of Public Health (CDPH) to develop the training and resource materials, in collaboration with specified entities; and requires schools that elect to stock naloxone hydrochloride to place it in specified locations.
Major Provisions
- Require, a local educational agency (LEA) that chooses to make naloxone hydrochloride or another opioid antagonist available on campus to ensure that it is placed in a location that is widely known and easily accessible, both during school hours and after school hours. Requires that the naloxone hydrochloride or another opioid antagonist is located, as directed by the governing body, in at least one specified location on campus.
- Establishes the Opioid Overdose Prevention Certification and Training Program and requires the CDPH to establish, by March 1, 2025, the certification training program for public high school students in grades 9 to 12 to gain skills in how to identify an overdose and respond, including by administering naloxone hydrochloride.
- Authorizes public high schools serving students in grades 9 to 12 to voluntarily determine whether or not to host the training program on their campuses.
- Requires the CDPH to collaborate with local, state, and national organizations to provide students working toward their certificate with integrated, comprehensive, accurate, and unbiased educational materials on opioid and drug overdose prevention, opioid and drug safety, and stigma reduction.
- Requires Program trainings to include instruction from appropriately trained instructors, with state-approved background checks, from local, state, and national drug and opioid use and prevention organizations, community health centers, community health experts, and nonprofits with related expertise.
- Specifies that the training on administering naloxone hydrochloride nasal spray may include informational videos, graphics, or in-person training on what to do and how to respond during a drug or opioid overdose; information on how to recognize signs of a drug or opioid overdose; and information on how to respond in an emergency involving a drug or opioid overdose.
- Requires the CDPH to collect data annually on the number of students participating in the Program to determine the efficacy of the program training resources and informational efforts, and to share this information with the Legislature, as specified.
COMMENTS
Addressing Fentanyl among California youth. According to the CDPH, fentanyl-related overdose deaths increased 625% among ages 10-19 from 2018 to 2020. In 2021, there were 224 fentanyl-related overdose deaths among teens ages 15–19 years old in California. Current law requires the SPI to establish minimum training standards for school employees who volunteer to administer naloxone or another opioid antagonist. In addition to setting minimum training standards, the CDE must maintain on its website a clearinghouse for best practices in training nonmedical personnel to administer naloxone or another opioid antagonist to pupils.
The CDE, in conjunction with the CDPH, provides LEAs with resources and information that they can provide to parents and students. The Fentanyl Awareness and Prevention toolkit page offer information about the risks of fentanyl and how to prevent teen use and overdoses. In addition to the toolkit, the CDPH's Substance and Addiction Prevention branch also provides resources for parents, guardians, caretakers, educators, schools, and youth-serving providers.
Governor's proposed budget. Currently, the Governor's budget proposes $97 million in new investments to tackle the fentanyl and opioid crisis, including $3.5 million for all middle and high school sites to maintain at least two doses of naloxone hydrochloride or another medication to reverse an opioid overdose on campus for emergency aid. The proposal also includes $79 million to the Naloxone Distribution Project, $10 million in grants for education, testing, recovery, and support services, as well as $4 million to make test strips more widely available.
According to the Author
“The fentanyl and opioid crisis is a state and nationwide public health emergency that has taken the lives of so many young people. Fentanyl prevention, education, and training on how to assist someone who is experiencing an opioid overdose is lifesaving. According to CDPH, in 2021 there were 7,175 deaths because of an opioid overdose. The state can take a leadership role to better inform people of how to treat those who undergo a potentially fatal overdose. AB 915 will establish a certification-training program for young people in grades 9-12. It will outline key methods on how to support a peer experiencing an opioid overdose, with the use of naloxone nasal sprays. Through comprehensive and evidence based certification training, students can prepare and learn ways to support their peers experiencing a drug related overdose.”
Arguments in Support
GENup states, “There is currently no type of certification training for young people in how to reverse an opioid overdose. Fentanyl, a synthetic opioid more potent than morphine, is FDA-approved to treat severe pain related to surgery or complex pain conditions. However, illicitly manufactured fentanyl and other illegally produced opioids are increasingly found in the drug supply and contribute to a dramatic rise in drug overdose deaths in the United States. In California, fentanyl has attributed to more than 80% of all drug related deaths in 2021 due to overdose among young people. Across the state, 7,000 people died from a fentanyl overdose in 2021. Data from the 2020 National Survey of Children's Health (NSCH) indicates that 282 deaths occurred among adolescent in 2019 and 546 deaths occurred in 2020 from a drug overdose. AB 915 will support the training and development among young people and their peers to learn how to respond safely to an opioid overdose crisis.”
Arguments in Opposition
None on file
FISCAL COMMENTS
According to the Assembly Appropriations Committee:
- One-time and ongoing General Fund costs of about $480,000 for the 2024-25 fiscal year and $700,000 for the 2025-26 fiscal year and thereafter to CDPH for two positions, an external contractor, and the development and promulgation of regulations to establish the criteria of the certification and approve curriculum instructors. CDPH notes General Fund costs could be less to the extent Opioid Settlements Funds are available.
The two positions at CDPH are needed to support regulations development, establish the curriculum-development contract through a request for proposals or interagency agreement, monitor the external contract, collect data, and develop the legislative report. Following the first year of regulation development, CDPH indicates it would hire a contractor with expertise in youth curriculum development, trauma-informed training, and substance misuse/substance use disorder prevention experience. The contractor would ensure that the curriculum is age-appropriate, trauma-informed, and accessible and inclusive and work with CDPH to establish evaluation metrics for the ongoing annual report. Costs for the contractor are estimated at $225,000 annually for two years and are based on recent quotes for a similar curriculum development and program at CDPH. After the initial two years, the type of contractual service will change from curriculum development to contractual support for training of trainers.
- Ongoing Proposition 98 General Fund costs to an LEA to provide the training, should an LEA opt to provide the training. Costs to conduct the training will depend on how LEAs deliver the training and how CDPH designs the training.
VOTES
ASM EDUCATION: 7-0-0
YES: Muratsuchi, Megan Dahle, Juan Carrillo, Hoover, Lee, McCarty, Quirk-Silva
ASM HEALTH: 15-0-0
YES: Wood, Waldron, Aguiar-Curry, Arambula, Boerner, Wendy Carrillo, Flora, Vince Fong, Maienschein, McCarty, Joe Patterson, Rodriguez, Santiago, Villapudua, Weber
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: April 27, 2023
CONSULTANT: Debbie Look / ED. / (916) 319-2087 FN: 0000844
Date of Hearing: May 10, 2023
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Chris Holden, Chair
ABPCA Bill Id:AB 915
Author:(Arambula) – As Amended Ver:April 27, 2023
Policy Committee: | Education | Vote: | 7 - 0 |
Health | 15 - 0 | ||
|
|
Urgency: No State Mandated Local Program: No Reimbursable: No
SUMMARY:
This bill requires the California Department of Public Health (CDPH), by March 1, 2025, to establish a certification training program for high school student in grades nine through 12 to gain skills to identify and respond to an opioid overdose. The training is to include information about how to administer naloxone hydrochloride nasal spray. The bill further authorizes local educational agencies (LEAs) serving students in grades nine through 12 to voluntarily determine whether or not to offer the training program. Lastly, the bill requires CDPH to annually collect data on the number of students participating in the program and share this information with the Legislature.
The bill also requires LEAs serving students in any grade of nine through 12 that voluntarily makes Naloxone hydrochloride or another opioid antagonist available on campus to ensure the opioid antagonist is placed in an appropriate location widely known and easily accessible, during school hours and after school hours.
FISCAL EFFECT:
- One-time and ongoing General Fund costs of about $480,000 for in the 2024-25 fiscal year and $700,000 for the 2025-26 fiscal year and thereafter to CDPH for two positions, an external contractor, and the development and promulgation of regulations to establish the criteria of the certification and approve curriculum instructors. CDPH notes General Fund costs could be less to the extent Opioid Settlements Funds are available.
The two positions at CDPH are needed to support regulations development, establish the curriculum-development contract through a request for proposals or interagency agreement, monitor the external contract, collect data, and develop the legislative report. Following the first year of regulation development, CDPH indicates it would hire a contractor with expertise in youth curriculum development, trauma-informed training, and substance misuse/substance use disorder prevention experience. The contractor would ensure that the curriculum is age-appropriate, trauma-informed, and accessible and inclusive and work with CDPH to establish evaluation metrics for the ongoing annual report. Costs for the contractor are estimated at $225,000 annually for two years and are based on recent quotes for a similar curriculum development and program at CDPH. After the initial two years, the type of contractual service will change from curriculum development to contractual support for training of trainers.
- Ongoing Proposition 98 General Fund costs to an LEA to provide the training, should an LEA opt to provide the training. Costs to conduct the training will depend on how LEAs deliver the training and how CDPH designs the training.
COMMENTS:
- Background. Naloxone hydrochloride is the generic name for an opioid antagonist that rapidly reverses an opioid overdose. Current law authorizes schools to provide emergency naloxone hydrochloride or another opioid antagonist to school nurses or trained volunteer personnel to provide emergency medical aid to a person suffering, or reasonably believed to be suffering, from an opioid overdose.
The Governor’s budget for the 2023-24 fiscal year provides $3.5 million in ongoing Proposition 98 General Fund for all middle schools and high schools to maintain at least two doses of naloxone hydrochloride or another medication to reverse an opioid overdose on campus for emergency aid.
- Related Legislation. AB 19 (Joe Patterson) of this session requires each public school to maintain at least two doses of naloxone hydrochloride or another opioid antagonist on its campus. The bill is pending on this committee’s suspense file.
Analysis Prepared by: Natasha Collins / APPR. / (916) 319-2081
Date of Hearing: April 25, 2023
ASSEMBLY COMMITTEE ON HEALTH
Jim Wood, Chair
ABPCA Bill Id:AB 915 (
Author:(Arambula) – As Amended Ver:April 18, 2023
SUBJECT: Pupil health: drug education: opioid overdose certification and training program.
SUMMARY: Requires the State Department of Public Health (DPH) to establish by March 1, 2024, a certification training program for public high school pupils in grades nine to 12, inclusive, to gain skills in how to identify and respond to an opioid overdose, including the administering of naloxone hydrochloride (NH) nasal spray. Specifically, this bill:
- Requires the DPH to establish by March 1, 2024, a certification training program for public high school pupils in grades nine to 12, inclusive, to gain skills in how to identify and respond to an opioid overdose, including the administering of NH nasal spray.
- Permits public high schools serving pupils in any of grades nine to 12, inclusive, to voluntarily determine whether or not to host the program on their campuses.
- Requires DPH, in establishing the program, to collaborate with local, state, and national organization, which may include community health centers, community health experts, and nonprofits with related expertise, to provide pupils working toward their certificate with integrated, comprehensive, accurate, and unbiased educational materials on opioid and drug overdose prevention, opioid and drug safety, and stigma reduction.
- Requires program training to include instruction from appropriately trained instructors from local, state, and national organizations, as specified with related expertise, and school staff. Requires instructors who are not employed by the school to undergo state-approved background checks.
- Specifies that the training on administering NH nasal spray may include, but not be limited to, the following:
- Informational videos, graphics, or in-person training on what to do and how to respond during a drug or opioid overdose;
- Information on how to recognize signs of a drug or opioid overdose; and,
- Information on how to respond in an emergency involving a drug or opioid overdose.
- Requires the program to provide resource materials related to drug and opioid use and prevention, appropriate for use with students of all races, genders, sexual orientations, and ethnic and cultural backgrounds, students with disabilities, and English learners.
- Requires DPH to collect data annually on the number of students participating in the program to determine the efficacy of the program training resources and informational efforts, and to share this information with the Legislature and the Senate and Assembly Budget Subcommittees on Education and Health and Human Services.
- Requires any school district, county office of education (COE), or charter school, serving students in grades nine to 12, that chooses to make NH or another opioid antagonist available on campus to ensure that it is placed in an appropriate location, as determined by the governing board or body, that is widely known and easily accessible, both during school hours and after school hours. Requires that the NH or another opioid antagonist is located in at least one of the following locations on campus:
- School nurse’s office;
- Athletic trainer’s office;
- Front office;
- Performing arts auditorium;
- Library;
- Cafeteria; and,
- Athletic gym.
- Defines “NH nasal spray” as a United States Food and Drug Administration (FDA)-approved nasal spray designed to rapidly reverse an overdose.
- Defines “Program” as the NH nasal spray certification training program established by this bill.
EXISTING LAW:
- Establishes DPH, directed by a state Public Health Officer (PHO), to be vested with all the duties, powers, purposes, functions, responsibilities, and jurisdiction as they relate to public health and licensing of health facilities, as specified. Gives the PHO, broad authority to detect, monitor, and prevent the spread of communicable disease in the state. [Health & Safety Code (HSC) § 131050 and § 120130, et seq.]
- Authorizes the DPH, in order to reduce the rate of fatal overdose from opioid drugs including heroin and prescription opioids, to award funding to local health departments, local government agencies, or on a competitive basis to community-based organizations, regional opioid prevention coalitions, or both, to support or establish programs that provide naloxone, or any other opioid antagonist that is approved by the FDA for the treatment of an opioid overdose, to first responders and to at-risk opioid users through programs that serve at-risk drug users, including, but not limited to, syringe exchange and disposal programs, homeless programs, and substance use disorder treatment providers. [HSC § 1179.80]
- Establishes within the California Health and Human Services Agency (CHHSA) a grant program to reduce fentanyl overdoses and use throughout the state by providing six one-time grants: two in northern California, two in the central valley, and two in southern California. [Welfare and Institutions Code § 3200]
- Permits a pharmacy to furnish NH or another opioid antagonist to a school district, COE, or charter school pursuant to existing law if certain requirements are met. [Business and Professions Code (BPC) § 4119.8]
- Authorizes a pharmacy, wholesaler, or manufacturer to furnish NH or other opioid antagonists to a law enforcement agency if specified conditions are met. [BPC § 4119.9]
- Classifies controlled substances under the California Uniform Controlled Substances Act, into five schedules and places the greatest restrictions and penalties on the use of those substances placed in Schedule I. Classifies the drug fentanyl in Schedule II. [HSC § 11054-11058]
- Authorizes school districts, COEs, and charter schools to provide emergency NH or another opioid antagonist to school nurses or trained volunteer personnel for the purpose of providing emergency medical aid to persons suffering, or reasonably believed to be suffering, from an opioid overdose. (Education Code (EC) § 49414.3 et seq.)
- Authorizes public and private elementary and secondary schools to voluntarily determine whether or not to make emergency NH or another opioid antagonist and trained personnel available at its school. Requires a school to evaluate the emergency medical response time to the school and determine whether initiating emergency medical services is an acceptable alternative to NH or another opioid antagonist and trained personnel. [EC § 49414.3 (c)]
- Requires the Superintendent of Public Instruction (SPI) to establish minimum standards of training for the administration of NH or another opioid antagonist and to review the minimum standards of training every five years, or sooner, as deemed necessary. Requires the SPI to consult with organizations and providers with expertise in administering NH or another opioid antagonist and administering medication in a school environment, including, the California Society of Addiction Medicine, the Emergency Medical Services Authority, the California School Nurses Organization, the California Medical Association, and the American Academy of Pediatrics. [EC § 49414.3(e)]
FISCAL EFFECT: Unknown. This bill has not yet been analyzed by a fiscal committee.
COMMENTS:
- PURPOSE OF THIS BILL. According to the author, the fentanyl and opioid crisis is a state and nationwide public health emergency that has taken the lives of so many young people. Fentanyl prevention, education, and training on how to assist someone who is experiencing an opioid overdose is lifesaving. According to DPH, in 2021 there were 7,175 deaths because of an opioid overdose. The state can take a leadership role to better inform people on how to treat those who undergo a potentially fatal overdose. This bill will establish a certification-training program for young people in grades nine to 12. It will outline key methods on how to support a peer experiencing an opioid overdose, with the use of NH Nasal Sprays. The author concludes that through comprehensive and evidence based certification training, students can prepare and learn ways to support their peers experiencing a drug related overdose.
- BACKGROUND.
- Fentanyl. Fentanyl is a potent synthetic opioid drug approved by the FDA for use as an analgesic and anesthetic. It is approximately 50 times stronger than heroin and 100 times stronger than morphine. First developed in 1959, it was introduced in the 1960’s as an intravenous anesthetic. Fentanyl is legally manufactured and distributed in the US; however, there are two types of fentanyl: pharmaceutical fentanyl and illicitly manufactured fentanyl. Both are considered synthetic opioids. Pharmaceutical fentanyl is prescribed by doctors to treat severe pain, especially after surgery and for advanced-stage cancer. Most recently, cases of fentanyl-related overdoses are linked to illicitly manufactured fentanyl that is distributed through illegal drug markets for its heroin-like effect. It is often added to other drugs because of its extreme potency, which makes drugs cheaper, more powerful, more addictive, and more dangerous.
According to the DPH, fentanyl-related overdose deaths increased 625% among ages 10-19 from 2018 to 2020. In 2021, there were 224 fentanyl-related overdose deaths among teens ages 15–19 years old in California.
The California Department of Education (CDE), in conjunction with DPH, provides local educational agencies (LEAs) with resources and information that they can provide to parents and students. The Fentanyl Awareness and Prevention toolkit page offer information about the risks of fentanyl and how to prevent teen use and overdoses. In addition to the toolkit, DPH’s Substance and Addiction Prevention branch also provides resources for parents, guardians, caretakers, educators, schools, and youth-serving providers. - Reversing opioid overdoses. NH is the generic name for an opioid antagonist that rapidly reverses an opioid overdose. It attaches to opioid receptors and reverses and blocks the effects of other opioids. NH can quickly restore normal breathing to a person if their breathing has slowed or stopped because of an opioid overdose. NH comes in two FDA-approved forms: injectable and prepackaged nasal spray.
Narcan nasal spray was first approved by the FDA in 2015 as a prescription drug. According to the FDA, in accordance with a process to change the status of a drug from prescription to nonprescription, the manufacturer provided data demonstrating that the drug is safe and effective for use as directed in its proposed labeling. The manufacturer also showed that consumers can understand how to use the drug safely and effectively without the supervision of a healthcare professional. The application to approve Narcan nasal spray for over-the-counter (OTC) use was granted priority review status and was the subject of an advisory committee meeting in February 2023, where committee members voted unanimously to recommend it be approved for marketing without a prescription.
- Fentanyl. Fentanyl is a potent synthetic opioid drug approved by the FDA for use as an analgesic and anesthetic. It is approximately 50 times stronger than heroin and 100 times stronger than morphine. First developed in 1959, it was introduced in the 1960’s as an intravenous anesthetic. Fentanyl is legally manufactured and distributed in the US; however, there are two types of fentanyl: pharmaceutical fentanyl and illicitly manufactured fentanyl. Both are considered synthetic opioids. Pharmaceutical fentanyl is prescribed by doctors to treat severe pain, especially after surgery and for advanced-stage cancer. Most recently, cases of fentanyl-related overdoses are linked to illicitly manufactured fentanyl that is distributed through illegal drug markets for its heroin-like effect. It is often added to other drugs because of its extreme potency, which makes drugs cheaper, more powerful, more addictive, and more dangerous.
On March 29, 2023 the FDA approved Narcan, for OTC, nonprescription use. This is the first NH product approved for use without a prescription. This approval will allow the medication to be sold directly to consumers in drug stores, grocery stores, as well as online. According to an FDA Commissioner, “The approval of OTC NH nasal spray will help improve access to NH, increase the number of locations where it’s available and help reduce opioid overdose deaths throughout the country. We encourage the manufacturer to make accessibility to the product a priority by making it available as soon as possible and at an affordable price.” It is not yet known when Narcan will become available OTC or what the pricing of the product will be.
- DPH statewide standing order for NH. NH can help reduce opioid overdose deaths in California, but many organizations find it difficult to obtain the required standing order to obtain NH from health care providers. According to DPH, of the 7,175 opioid-related overdose deaths in 2021, 83% or 5,961 were related to fentanyl. The number of deaths each year involving fentanyl increased dramatically between 2012 and 2021. During this time period fentanyl related overdose deaths increased by more than 7,250% from 82 to 5,961 in 2021. DPH issued the standing order, in 2017, to address this need and support equitable NH access. The standing order:
- Allows community organizations and other entities in California that are not currently working with a physician, to distribute NH to a person at risk of an opioid-related overdose or to a family member, friend, or other person in a position to assist; and,
- Allows for the administration of NH by a family member, friend, or other person to a person experiencing or reasonably suspected of experiencing an opioid overdose.
- DPH statewide standing order for NH. NH can help reduce opioid overdose deaths in California, but many organizations find it difficult to obtain the required standing order to obtain NH from health care providers. According to DPH, of the 7,175 opioid-related overdose deaths in 2021, 83% or 5,961 were related to fentanyl. The number of deaths each year involving fentanyl increased dramatically between 2012 and 2021. During this time period fentanyl related overdose deaths increased by more than 7,250% from 82 to 5,961 in 2021. DPH issued the standing order, in 2017, to address this need and support equitable NH access. The standing order:
Among the organizations and entities that can distribute NH under the order are colleges and universities. An individual at risk of experiencing an overdose or someone who can assist an individual at risk is allowed to do so. Under the statewide standing order, staff of community organizations and other entities distributing NH must be trained. They are also required to provide training to individuals who receive NH from them. Colleges and other organizations may apply to use the statewide standing order if they meet certain conditions.
A separate distribution program administered through the Department of Health Care Services (DHCS), the Naloxone Distribution Program (NDP) allows various entities, including schools, universities and colleges, to apply for and obtain NH at no cost to the institution. As of March 6, 2023, the NDP has approved more than 7,200 applications for NH (16% of which are from schools and universities), distributed more than 2.1 million kits of NH and reversed more than 137 thousand opioid overdoses. DHCS reports that less than one percent of the overdose reversals reported in the NDP occurred in schools and universities.
- NH Availability in California school districts. The Los Angeles Unified School District, the state’s largest school district, announced plans to stock NH at over 1,400 elementary, middle, and high schools in response to numerous incidents of students experiencing overdoses, including at least one death in 2022. San Diego Unified School District, the state’s second-largest school system, stocks NH at schools with students in sixth grade or higher. Since 2020, Elk Grove Unified School District, a large district in Northern California, has provided NH to school security officers and their supervisors. In Los Angeles County, the Palos Verdes Peninsula Unified School District trained all the district’s registered nurses on how to administer NH and made it available to them at that district’s high schools.
- SUPPORT. The Fresno State University, College of Health and Human Services (Fresno State), sponsor of this bill states the fentanyl crisis among California youth is an urgent public health emergency. There is currently no type of certification training for young people in how to reverse an opioid overdose. Illicitly manufactured fentanyl and other illegally produced opioids are increasingly found in the drug supply and contribute to a dramatic rise in drug overdose deaths in the United States. Fresno States goes on to state that in California, fentanyl is attributed to more than 80% of all drug related deaths in 2021 due to overdose among young people. Across the state, 7,000 people died from a fentanyl overdose in 2021. Data from the 2020 National Survey of Children’s Health (NSCH) indicates that 282 deaths occurred among adolescent in 2019 and 546 deaths occurred in 2020 from a drug overdose. In concluding, Fresno State states that this bill will support the training and development among young people and their peers to learn how to respond safely to an opioid overdose crisis.
- RELATED LEGISLATION.
- AB 19 (Joe Patterson) requires public schools to maintain at least two doses of NH or opioid antagonist to provide emergency medical aid to a person suffering from an opioid overdose. AB 19 is pending in the Assembly Committee on Appropriations.
- AB 33 (Bains) establishes the Fentanyl Addiction and Overdose Prevention Task Force to undertake specified duties relating to fentanyl abuse. AB 33 is pending in the Assembly Committee on Public Safety.
- AB 889 (Joe Patterson) requires a school district, COE, and charter school to annually inform parents or guardians of the dangers associated with using synthetic drugs at the beginning of the first semester or quarter of the regular school term, and to post this information on their websites. AB 889 is pending in the Assembly Committee on Appropriations.
- AB 1058 (Jim Patterson) increases penalties for possession for the purposes of sale and for transportation and sale of a controlled substance if the controlled substance involved was more than 28.35 grams of fentanyl, more than 28.35 grams of an analog of fentanyl, a substance containing more than 28.35 grams of fentanyl, or a substance containing more than 28.35 grams of an analog of fentanyl. AB 1058 is pending in the Assembly Committee on Public Safety.
- AB 1233 (Waldron) requires DHCS to conduct outreach to each of the tribal governments in California for the purpose of advising them of the availability of NH or another opioid antagonist through DHCS’ NDP. AB 1233 is pending in the Assembly Committee on Appropriations.
- SB 10 (Cortese) requires LEAs and COEs to include strategies for the prevention and treatment of an opioid overdose in their school safety plans, and require the CDE to develop training materials on the use of emergency opioid antagonists for school personnel, and safety materials for parents, guardians, and pupils in conjunction with the CHHSA. SB 10 is pending in the Senate Committee on Appropriations.
- SB 234 (Portantino) requires schools serving students in kindergarten to 12th grade, institutions of higher education, stadiums, concert venues, and amusement parks, at all times, to maintain unexpired doses of NH or other opioid antagonist on its premise, ensure that at least two employees are aware of the location of the NH or other opioid antagonist, and expand community colleges ability to administer NH. SB 234 is pending in the Senate Committee on Appropriations.
- SB 472 (Hurtado) requires each campus of a public school operated by an LEA, COE, or charter school to maintain at least two doses on its campus, and distribute, NH or another opioid antagonist pursuant to the standing order for NH and requires LEAs, COEs, and charter schools to report to the DHCS for failure to distribute NH. AB 472 is pending in the Senate Committee on Appropriations.
- PREVIOUS LEGISLATION.
- AB 1748 (Mayes), Chapter 557, Statutes of 2016, authorizes school nurses and other trained personnel to use NH or another opioid antagonist to provide emergency medical aid to persons suffering, or reasonably believed to be suffering, from an opioid overdose.
- AB 635 (Ammiano), Chapter 707, Statutes of 2013, revised certain provisions from a pilot program authorizing prescription of opioid antagonists for treatment of drug overdose and limiting civil and criminal liability, expanded these provisions statewide, and removed the 2016 sunset date for the pilot program. Permits a licensed health care provider who is authorized by law to prescribe an opioid antagonist, if acting with reasonable care, to prescribe and subsequently dispense or distribute an opioid antagonist to a person at risk of an opioid-related overdose or a family member, friend, or other person in a position to assist the person at risk, and limited the professional and civil liability of licensed health care providers and persons who possess or distribute opioid antagonists.
- SB 1438 (Pavley), Chapter 491, Statutes of 2014, required the development of training and other standards for the administration of NH by emergency medical technicians and other pre-hospital emergency care personnel.
- DOUBLE REFERRAL. This bill is double referred, it passed the Assembly Committee on Education with a 7-0 vote on April 12, 2023.
- POLICY COMMENTS. It is unclear what the rationale is for creating a formalized “certification” program versus providing a regular training program that schools may choose to make available to students. Additionally, it is unclear whether the creation of a “certification” program means that only certified students would be able/allowed to access and administer NH on school property? Additionally, with the creation of a formalized program, should those students have immunity from liability in the event they administer NH? As this bill moves forward, the author may wish to clarify the rationale for a formalized certification program and to address the liability issue.
- COMMITTEE AMENDMENTS. The certification and training program established under this bill is defined as the “Naloxone Hydrochloride Nasal Spray Certification Training Program.” The training on how to administer the nasal spray is merely one component of the certification training program, and as such, the Committee may wish to amend the bill to change the name of the entire certification program to the Opioid Overdose Prevention Certification and Training Program.
REGISTERED SUPPORT / OPPOSITION:
Support
Fresno State College of Health & Human Services (sponsor)
Genup (Generation Up)
Zachary Horton Foundation
Opposition
None on file.
Analysis Prepared by: Judith Babcock / HEALTH / (916) 319-2097
Date of Hearing: April 12, 2023
ASSEMBLY COMMITTEE ON EDUCATION
Al Muratsuchi, Chair
ABPCA Bill Id:AB 915 (
Author:Arambula) – As Amended Ver:April 3, 2023
[Note: This bill is double referred to the Assembly Health Committee and will be heard by that Committee as it relates to issues under its jurisdiction.]
SUBJECT: Pupil health: drug education: opioid overdose certification and training program
SUMMARY: Establishes a voluntary certification training program for high school students in how to administer naloxone hydrochloride during an opioid overdose; requires the California Department of Public Health (CDPH) to develop the training and resource materials in collaboration with specified entities; and requires schools that elect to stock naloxone hydrochloride to place it in specified locations. Specifically, this bill:
- Establishes the Naloxone Hydrochloride Nasal Spray Certification Training Program (Program) and requires the CDPH to establish, by March 1, 2025, a certification training program for public high school students in grades 9 to 12 to gain skills in how to identify an overdose and respond, including by administering naloxone hydrochloride nasal spray.
- Authorizes public high schools serving students in grades 9 to 12 to voluntarily determine whether or not to host the Program on their campuses.
- Requires the CDPH to collaborate with local, state, and national organizations, including community health centers, community health experts, and nonprofits with related expertise, to provide students working toward their certificate with integrated, comprehensive, accurate, and unbiased educational materials on opioid and drug overdose prevention, opioid and drug safety, and stigma reduction.
- Requires Program trainings to include instruction from appropriately trained instructors, with state-approved background checks, from local, state, and national community health centers, community health experts, and nonprofits with related expertise.
- Specifies that the training on administering naloxone hydrochloride nasal spray may include the following:
- Informational videos, graphics, or in-person training on what to do and how to respond during a drug or opioid overdose;
- Information on how to recognize signs of a drug or opioid overdose; and
- Information on how to respond in an emergency involving a drug or opioid overdose.
- Requires the Program to provide resource materials related to drug and opioid use and prevention, appropriate for use with students of all races, genders, sexual orientations, and ethnic and cultural backgrounds, students with disabilities, and English learners.
- Requires the CDPH to collect data annually on the number of students participating in the Program to determine the efficacy of the program training resources and informational efforts, and to share this information with the Legislature, as specified.
- Requires any school district, county office of education (COE), or charter school, serving students in grades 9 to 12, that chooses to make naloxone hydrochloride or another opioid antagonist available on campus to ensure that it is placed in an appropriate location, as determined by the governing board or body, that is widely known and easily accessible, both during school hours and after school hours. Requires that the naloxone hydrochloride or another opioid antagonist is located in at least one of the following locations on campus:
- School nurse’s office;
- Athletic trainer’s office;
- Front office;
- Performing arts auditorium;
- Library;
- Cafeteria; and
- Athletic gym.
- Defines “naloxone hydrochloride nasal spray” as an FDA-approved nasal spray designed to rapidly reverse an overdose.
- Defines “Program” as the naloxone hydrochloride nasal spray certification training program established by this section.
EXISTING LAW:
- Authorizes school districts, COEs, and charter schools to provide emergency naloxone or another opioid antagonist to school nurses or trained volunteer personnel for the purpose of providing emergency medical aid to persons suffering, or reasonably believed to be suffering, from an opioid overdose. (Education Code (EC) 49414.3)
- Authorizes public and private elementary and secondary schools to voluntarily determine whether or not to make emergency naloxone or another opioid antagonist and trained personnel available at its school. Requires a school to evaluate the emergency medical response time to the school and determine whether initiating emergency medical services is an acceptable alternative to naloxone or another opioid antagonist and trained personnel.
- Authorizes public and private elementary and secondary schools to designate one or more volunteers to receive initial and annual refresher training regarding the storage and emergency use of naloxone or another opioid antagonist from the school nurse or other qualified person designated by an authorizing physician and surgeon. Specifies that a benefit must not be granted to or withheld from any individual based on his or her offer to volunteer and prohibits retaliation against any individual for rescinding his or her offer to volunteer, including after receiving training. Specifies that a school district, COE, or charter school choosing to exercise the authority provided by this bill must provide the training for the volunteers at no cost to the volunteer and during the volunteer's regular working hours.
- Requires the Superintendent of Public Instruction (SPI) to establish minimum standards of training for the administration of naloxone or another opioid antagonist and to review the minimum standards of training every five years, or sooner as deemed necessary. Requires the SPI to consult with organizations and providers with expertise in administering naloxone or another opioid antagonist and administering medication in a school environment, including, the California Society of Addiction Medicine, the Emergency Medical Services Authority, the California School Nurses Organization, the California Medical Association, the American Academy of Pediatrics.
- Requires the training to include all of the following:
- Techniques for recognizing symptoms of an opioid overdose;
- Standards and procedures for the storage, restocking, and emergency use of naloxone or another opioid antagonist;
- Basic emergency follow-up procedures, including, but not limited to, a requirement for the school or charter school administrator, or if the administrator is not available, another school staff member to call the emergency 911 telephone number and to contact the student’s parent or guardian;
- Recommendations on the necessity of instruction and certification in cardiopulmonary resuscitation (CPR); and
- Written materials covering the information required in the training.
- Requires training to be consistent with the most recent guidelines for medication administration issued by the California Department of Education (CDE).
- Requires the CDE to include on its website a clearinghouse for best practices in training nonmedical personnel to administer naloxone or another opioid antagonist to pupils.
- Requires any school district, COE, or charter school electing to utilize naloxone or another opioid antagonist for emergency aid to distribute a notice at least once per school year to all staff containing the following information:
- A description of the volunteer request stating that the request is for volunteers to be trained to administer naloxone or another opioid antagonist to a person if the person is suffering, or reasonably believed to be suffering, from an opioid overdose;
- A description of the training that the volunteer will receive;
- The right of an employee to rescind his or her offer to volunteer; and,
- A statement that no benefit will be granted to or withheld from any individual based on his or her offer to volunteer and that there will be no retaliation against any individual for rescinding his or her offer to volunteer, including after receiving training.
- Requires a qualified supervisor of health, or administrator, at a school district, COE, or charter school electing to utilize naloxone or another opioid antagonist for emergency aid to do the following:
- Obtain from an authorizing physician and surgeon a prescription for each school for naloxone or another opioid antagonist; and
- Stock the naloxone or another opioid antagonist and restocking it if it is used.
- Specifies that a school nurse or, if the school does not have a school nurse or the school nurse is not onsite or available, a volunteer may administer naloxone or another opioid antagonist to a person exhibiting potentially life-threatening symptoms of an opioid overdose at school or a school activity when a physician is not immediately available. Provides that if the naloxone or another opioid antagonist is used it must be restocked as soon as reasonably possible, but no later than two weeks after it is used. Naloxone or another opioid antagonist must be restocked before their expiration date.
- Specifies that volunteers may administer naloxone or another opioid antagonist only by nasal spray or by auto-injector, in the authorized form the volunteer is most comfortable with.
- Requires that a school district, COE, or charter school electing to utilize naloxone or another opioid antagonist for emergency aid to ensure that each employee who volunteers under this section be provided defense and indemnification by the school district, COE, or charter school for any and all civil liability. Requires this information to be reduced to writing, provided to the volunteer, and retained in the volunteer's personnel file.
- Specifies that a person trained to provide naloxone or another opioid antagonist who administers naloxone or another opioid antagonist, in good faith and not for compensation, to a person who appears to be experiencing an opioid overdose not be subject to professional review, be liable in a civil action, or be subject to criminal prosecution for their acts or omissions in administering the naloxone or another opioid antagonist. Specifies that the protection does not apply in a case of gross negligence or willful and wanton misconduct of the person who renders emergency care treatment by the use of naloxone or another opioid antagonist. Specifies that any public employee who volunteers to administer naloxone or another opioid antagonist is not providing emergency medical care "for compensation" notwithstanding the fact that they are a paid public employee.
- Authorizes a state agency, the CDE, or a public school, to accept gifts, grants, and donations from any source for the support of the public school carrying out the provisions of this section, including, the acceptance of naloxone or another opioid antagonist from a manufacturer or wholesaler. (EC 49414.3)
FISCAL EFFECT: Unknown
COMMENTS:
Need for the bill. According to the author, “The fentanyl and opioid crisis is a state and nationwide public health emergency that has taken the lives of so many young people. Fentanyl prevention, education, and training on how to assist someone who is experiencing an opioid overdose is lifesaving. According to CDPH, in 2021 there were 7,175 deaths because of an opioid overdose. The state can take a leadership role to better inform people of how to treat those who undergo a potentially fatal overdose. AB 915 will establish a certification-training program for young people in grades 9-12. It will outline key methods on how to support a peer experiencing an opioid overdose, with the use of naloxone nasal sprays. Through comprehensive and evidence based certification training, students can prepare and learn ways to support their peers experiencing a drug related overdose.”
Dangers associated with Fentanyl. Fentanyl is a potent synthetic opioid drug approved by the Food and Drug Administration (FDA) for use as an analgesic and anesthetic. It is approximately 50 times stronger than heroin and 100 times stronger than morphine. First developed in 1959, it was introduced in the 1960’s as an intravenous anesthetic. Fentanyl is legally manufactured and distributed in the United States; however, there are two types of fentanyl: pharmaceutical fentanyl and illicitly manufactured fentanyl. Both are considered synthetic opioids. Pharmaceutical fentanyl is prescribed by doctors to treat severe pain, especially after surgery and for advanced-stage cancer. Most recently, cases of fentanyl-related overdoses are linked to illicitly manufactured fentanyl that is distributed through illegal drug markets for its heroin-like effect. It is often added to other drugs because of its extreme potency, which makes drugs cheaper, more powerful, more addictive, and more dangerous.
Addressing Fentanyl among California youth. According to the CDPH, fentanyl-related overdose deaths increased 625% among ages 10-19 from 2018 to 2020. In 2021, there were 224 fentanyl-related overdose deaths among teens ages 15–19 years old in California. Current law requires the SPI to establish minimum training standards for school employees who volunteer to administer naloxone or another opioid antagonist. In addition to setting minimum training standards, the CDE must maintain on its website a clearinghouse for best practices in training nonmedical personnel to administer naloxone or another opioid antagonist to pupils.
The CDE, in conjunction with the CDPH, provides LEAs with resources and information that they can provide to parents and students. The Fentanyl Awareness and Prevention toolkit page offer information about the risks of fentanyl and how to prevent teen use and overdoses. In addition to the toolkit, the CDPH’s Substance and Addiction Prevention branch also provides resources for parents, guardians, caretakers, educators, schools, and youth-serving providers.
Reversing opioid overdoses. Naloxone is the generic name for an opioid antagonist that rapidly reverses an opioid overdose. It attaches to opioid receptors and reverses and blocks the effects of other opioids. Naloxone can quickly restore normal breathing to a person if their breathing has slowed or stopped because of an opioid overdose. Naloxone comes in two FDA-approved forms: injectable and prepackaged nasal spray.
On March 29, 2023 the FDA approved Narcan, a naloxone hydrochloride nasal spray for over-the-counter (OTC), nonprescription use. This is the first naloxone product approved for use without a prescription. This will allow this medication to be sold directly to consumers in drug stores, grocery stores, as well as online. According to an FDA Commissioner, “Today’s approval of OTC naloxone nasal spray will help improve access to naloxone, increase the number of locations where it’s available and help reduce opioid overdose deaths throughout the country. We encourage the manufacturer to make accessibility to the product a priority by making it available as soon as possible and at an affordable price.”
Narcan nasal spray was first approved by the FDA in 2015 as a prescription drug. According to the FDA, in accordance with a process to change the status of a drug from prescription to nonprescription, the manufacturer provided data demonstrating that the drug is safe and effective for use as directed in its proposed labeling. The manufacturer also showed that consumers can understand how to use the drug safely and effectively without the supervision of a healthcare professional. The application to approve Narcan nasal spray for OTC use was granted priority review status and was the subject of an advisory committee meeting in February 2023, where committee members voted unanimously to recommend it be approved for marketing without a prescription.
CDPH statewide standing order for Naloxone. Naloxone can help reduce opioid overdose deaths in California, but many organizations find it difficult to obtain the required standing order to obtain naloxone from health care providers. According to CDPH, of the 6,843 opioid-related overdose deaths in 2021, 5,722 were related to fentanyl. CDPH issued the standing order, in 2017, to address this need and support equitable naloxone access. The standing order:
- Allows community organizations and other entities in California that are not currently working with a physician, to distribute naloxone to a person at risk of an opioid-related overdose or to a family member, friend, or other person in a position to assist.
- Allows for the administration of naloxone by a family member, friend, or other person to a person experiencing or reasonably suspected of experiencing an opioid overdose.
Among the organizations and entities that can distribute naloxone under the order are colleges and universities. An individual at risk of experiencing an overdose or someone who can assist an individual at risk is allowed to do so. Under the statewide standing order, staff of community organizations and other entities distributing naloxone must be trained. They are also required to provide training to individuals who receive naloxone from them. Colleges and other organizations may apply to use the statewide standing order if they meet certain conditions.
A separate distribution program administered through the Department of Health Care Services (DHCS) allows schools, universities and colleges to apply for and obtain naloxone at no cost to the institution. According to the CDPH website, since October 2018, their Naloxone Distribution Project (NDP) has distributed over 1 million units of naloxone, and recorded over 57,000 overdose reversals.
Governor’s proposed budget. Currently, the Governor’s budget proposes $97 million in new investments to tackle the fentanyl and opioid crisis, including $3.5 million for all middle and high school sites to maintain at least two doses of naloxone hydrochloride or another medication to reverse an opioid overdose on campus for emergency aid. The proposal also includes $79 million to the Naloxone Distribution Project, $10 million in grants for education, testing, recovery, and support services, as well as $4 million to make test strips more widely available.
California’s opioid settlements. According to the DHCS, on July 21, 2021, a $26 billion offer to settle was made by opioid manufacturer Janssen Pharmaceuticals (parent company of Johnson & Johnson) and the “big three" distributors, McKesson, AmerisourceBergen, and Cardinal Health to resolve their liabilities in over 3,000 opioid crisis-related lawsuits nationwide. It's estimated that California will receive approximately $2.05 billion from the Janssen and Distributors Settlement Agreements over the next 18 years. The majority of this money will be provided to local agencies to be used for opioid abatement activities. California has joined additional lawsuits against manufacturers, distributors, and other entities responsible for aiding the opioid epidemic and anticipates receiving funds from future opioid judgment and settlement agreements.
Some California school districts have opted to make Naloxone available. The Los Angeles Unified School District, the state’s largest school district, announced plans to stock naloxone at over 1,400 elementary, middle, and high schools in response to numerous incidents of students experiencing overdoses, including at least one death in 2022. San Diego Unified School District, the state’s second-largest school system, stocks naloxone at schools with students in sixth grade or higher. Since 2020, Elk Grove Unified School District, a large district in Northern California, has provided naloxone to school security officers and their supervisors. In Los Angeles County, the Palos Verdes Peninsula Unified School District trained all the district’s registered nurses on how to administer naloxone and made it available to them at that district’s high schools.
Is it appropriate to have young people trained to administer naloxone? There is no precedent in state law to allow students to administer medication. This proposal to allow students to administer naloxone hydrochloride would represent a significant departure from current practice.
The CDPH website includes an 11-minute training video to equip public health agencies, community organizations, friends, family members and others with the knowledge and skills needed to prevent opioid-related deaths by using naloxone, a drug that can reverse an overdose. It includes a six point checklist on how to recognize when a person is overdosing and demonstrates how to dispense naloxone and provide post-overdose care.
According to the National Association of School Nurses, the use of naloxone as an opioid overdose reversal agent by laypeople and first responders has doubled from 2017-2018 and has proven to be an effective strategy in preventing overdose opioid deaths. Since 2017, every state and the District of Columbia have laws that provide protection from criminal liability for naloxone administration by laypersons or first responders.
In considering a similar bill proposing a naloxone student training program in New Jersey, supporters argue that the education would be no different than training in CPR or other first aid measures. Proponents claim it will equip students with the tools and skills they need to help save lives. They further point out that a school nurse cannot be everywhere at once. Since overdose response must be quick to save the life in danger, it is important for others to be able to administer the naloxone.
Recommended Committee Amendments. Staff recommend that the bill be amended as follows:
- Include school staff in the list of those authorized to provide the training.
- Require the CDPH to provide the annual data collected to the Education fiscal and policy committees of the Legislature.
- Other technical and clarifying changes.
Related legislation. AB 19 (Joe Patterson) of the 2023-24 Session would require public schools to maintain at least two doses of naloxone hydrochloride or opioid antagonist to provide emergency medical aid to a person suffering from an opioid overdose.
AB 889 (Joe Patterson) of the 2023-24 Session would require a school district, COE, and charter school to annually inform parents or guardians of the dangers associated with using synthetic drugs at the beginning of the first semester or quarter of the regular school term, and to post this information on their websites.
SB 10 (Cortese) of the 2023-24 Session would require LEAs and COEs to include strategies for the prevention and treatment of an opioid overdose in their school safety plans, and require the CDE to develop training materials on the use of emergency opioid antagonists for school personnel, and safety materials for parents, guardians, and pupils in conjunction with the California Health and Human Services Agency (CalHHS).
SB 234 (Portantino) of the 2023-24 Session would require schools serving students in kindergarten to 12th grade, institutions of higher education, stadiums, concert venues, and amusement parks, at all times, to maintain unexpired doses of naloxone hydrochloride or any other opioid antagonist on its premise, ensure that at least two employees are aware of the location of the naloxone hydrochloride or other opioid antagonist, and expand community colleges ability to administer naloxone.
SB 472 (Hurtado) of the 2023-24 Session would require each campus of a public school operated by an LEA, COE, or charter school to maintain at least two doses on its campus, and distribute, naloxone hydrochloride or another opioid antagonist pursuant to the standing order for naloxone and requires LEAs, COEs, and charter schools to report to the DHCS for failure to distribute naloxone.
AB 33 (Bains) of the 2023-24 Session would establish the Fentanyl Addiction and Overdose Prevention Task Force to undertake specified duties relating to fentanyl abuse.
AB 1058 (Jim Patterson) of the 2023-24 Session would increase penalties for possession for the purposes of sale and for transportation and sale of a controlled substance if the controlled substance involved was more than 28.35 grams of fentanyl, more than 28.35 grams of an analog of fentanyl, a substance containing more than 28.35 grams of fentanyl, or a substance containing more than 28.35 grams of an analog of fentanyl.
AB 1748 (Mayes) Chapter 557, Statutes of 2016, authorizes school nurses and other trained personnel to use naloxone hydrochloride or another opioid antagonist to provide emergency medical aid to persons suffering, or reasonably believed to be suffering, from an opioid overdose.
AB 635 (Ammiano), Chapter 707, Statutes of 2013, revised certain provisions from a pilot program authorizing prescription of opioid antagonists for treatment of drug overdose and limiting civil and criminal liability, expanded these provisions statewide, and removed the 2016 sunset date for the pilot program. This bill permitted a licensed health care provider who is authorized by law to prescribe an opioid antagonist, if acting with reasonable care, to prescribe and subsequently dispense or distribute an opioid antagonist to a person at risk of an opioid-related overdose or a family member, friend, or other person in a position to assist the person at risk, and limited the professional and civil liability of licensed health care providers and persons who possess or distribute opioid antagonists.
SB 1438 (Pavley), Chapter 491, Statutes of 2014, required the development of training and other standards for the administration of naloxone by emergency medical technicians and other pre-hospital emergency care personnel.
REGISTERED SUPPORT / OPPOSITION:
Support
None on file
Opposition
None on file
Analysis Prepared by: Debbie Look / ED. / (916) 319-2087
Discussed in Hearing
1MIN
Senate Standing Committee on Appropriations
6MIN
Senate Standing Committee on Education
1MIN
Assembly Floor
11MIN
Assembly Standing Committee on Education
Bill Co-Author(s):
