Existing law establishes the State Department of Public Health to implement and administer various programs relating to public health. The department administers the California Overdose Surveillance Dashboard that provides data on state- and local-level drug-related overdose outcomes for California, including, among other data, the number of deaths related to fentanyl overdoses. Existing law requires the department to update the dashboard to reflect additional information, as specified.

This bill would require the department to use best efforts to utilize all of its relevant data regarding overdoses in the state to monitor and identify current trends of fentanyl-related deaths of children 0 to 5 years of age, inclusive. The bill would require the department to develop guidance and spread awareness of the trends to protect and prevent children from fentanyl exposure. The bill would require the department, on or before January 1, 2026, to annually distribute its findings and guidance to local health departments, county boards of supervisors, and the Legislature. The bill would repeal these provisions on January 1, 2029.

Existing law establishes the State Department of Public Health to implement and administer various programs relating to public health. The department administers the California Overdose Surveillance Dashboard that provides data on state- and local-level drug-related overdose outcomes for California, including, among other data, the number of deaths related to fentanyl overdoses. Existing law requires the department to update the dashboard to reflect additional information, as specified.

This bill would require the department to use best efforts to utilize all of its relevant data regarding overdoses in the state to monitor and identify current trends of fentanyl-related deaths of children 0 to 5 years of age, inclusive. The bill would require the department to develop guidance and spread awareness of the trends to protect and prevent children from fentanyl exposure. The bill would require the department, on or before January 1, 2026, to annually distribute its findings and guidance to local health departments, county boards of supervisors, and the Legislature. The bill would repeal these provisions on January 1, 2029.

Existing law establishes the State Department of Public Health to implement and administer various programs relating to public health. The department administers the California Overdose Surveillance Dashboard that provides data on state- and local-level drug-related overdose outcomes for California, including, among other data, the number of deaths related to fentanyl overdoses. Existing law requires the department to update the dashboard to reflect additional information, as specified.

This bill would require the department to use best efforts to utilize all of its relevant data regarding overdoses in the state to monitor and identify current trends of fentanyl-related deaths of children 0 to 5 years of age, inclusive. The bill would require the department to develop guidance and spread awareness of the trends to protect and prevent children from fentanyl exposure. The bill would require the department, on or before June 1, 2025, January 1, 2026, to annually distribute its findings and guidance to local health departments, county boards of supervisors, and the Legislature. The bill would repeal these provisions on January 1, 2031. 2029.

Existing law establishes the State Department of Public Health to implement and administer various programs relating to public health. The department administers the California Overdose Surveillance Dashboard that provides data on state- and local-level drug-related overdose outcomes for California, including, among other data, the number of deaths related to fentanyl overdoses. Existing law requires the department to update the dashboard to reflect additional information, as specified.

This bill would require the department to use best efforts to utilize all of its relevant data regarding overdoses in the state to monitor and identify current trends of fentanyl-related deaths of children 0 to 5 years of age, inclusive. The bill would require the department to develop guidance and spread awareness of the trends to protect and prevent children from fentanyl exposure. The bill would require the department, on or before June 1, 2025, to annually distribute its findings and guidance to local health departments, county boards of supervisors, and the Legislature. The bill would repeal these provisions on January 1, 2031.

Existing law establishes the State Department of Public Health to implement and administer various programs relating to public health. The department administers the California Overdose Surveillance Dashboard that provides data on state- and local-level drug-related overdose outcomes for California, including, among other data, the number of deaths related to fentanyl overdoses. Existing law requires the department to update the dashboard to reflect additional information, as specified.

This bill would require the department to utilize its data use best efforts to utilize all of its relevant data regarding overdoses in the state to monitor and identify current trends of fentanyl-related deaths of children 0 to 5 years of age, inclusive. The bill would require the department to develop guidance and spread awareness of the trends to protect and prevent children from fentanyl exposure. The bill would require the department, on or before June 1, 2025, to annually distribute its findings and guidance to county public local health departments, county boards of supervisors, and the Legislature. The bill would repeal these provisions on January 1, 2031.

(1)The California Public Records Act requires a state or local agency to make public records available for public inspection, except as specified. Under existing law, a public record includes any writing containing information relating to the conduct of the publics business prepared, owned, used, or retained by a state or local agency regardless of physical form or characteristics.

This bill would prohibit an elected or appointed official or employee of a public agency from creating or sending a public record using a nonofficial electronic messaging system unless the official or employee sends a copy of the public record to an official electronic messaging system, as specified. By imposing additional duties on local agencies, the bill would create a state-mandated local program.

(2)The Legislative Open Records Act requires that legislative records be open to inspection at all times during normal business hours of the Legislature and that any person has the right to inspect any legislative record, except as specified. Existing law defines legislative records to mean any writing prepared on or after December 2, 1974, that contains information relating to the conduct of the publics business prepared, owned, used, or retained by the Legislature.

This bill would prohibit a Member of the Legislature, legislative officer, standing, joint, or select committee or subcommittee of the Senate and Assembly, or agency or employee of the Legislature from creating or sending a legislative record using a nonofficial electronic messaging system unless the Member of the Legislature, legislative officer, standing, joint, or select committee or subcommittee of the Senate and Assembly, or agency or employee of the Legislature sends a copy of the legislative record to an official electronic messaging system, as specified.

(3)The California Constitution requires local agencies, for the purpose of ensuring public access to the meetings of public bodies and the writings of public officials and agencies, to comply with a statutory enactment that amends or enacts laws relating to public records or open meetings and contains findings demonstrating that the enactment furthers the constitutional requirements relating to this purpose.

This bill would make a legislative finding to that effect.

(4)The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

 UNFINISHED BUSINESS  

Bill No: SB 908

Author: Cortese (D), et al.

Amended: 8/20/24

Vote: 21

SENATE HEALTH COMMITTEE: 11-0, 4/24/24

AYES: Roth, Nguyen, Glazer, Gonzalez, Grove, Hurtado, Limón, Menjivar, Rubio, Smallwood-Cuevas, Wiener

SENATE APPROPRIATIONS COMMITTEE: 7-0, 5/16/24

AYES: Caballero, Jones, Ashby, Becker, Bradford, Seyarto, Wahab

SENATE FLOOR: 38-0, 5/22/24

AYES: Alvarado-Gil, Ashby, Atkins, Becker, Blakespear, Bradford, Caballero, Cortese, Dahle, Dodd, Durazo, Eggman, Glazer, Gonzalez, Grove, Hurtado, Jones, Laird, Limón, McGuire, Menjivar, Min, Newman, Nguyen, Niello, Ochoa Bogh, Padilla, Portantino, Roth, Rubio, Seyarto, Skinner, Smallwood-Cuevas, Stern, Umberg, Wahab, Wiener, Wilk

NO VOTE RECORDED: Allen, Archuleta

ASSEMBLY FLOOR: 77-0, 8/26/24 - See last page for vote

SUBJECT: Fentanyl: child deaths

SOURCE: Author

DIGEST:

This bill requires the California Department of Public Health (CDPH), until January 1, 2029, to use best efforts to utilize all of its relevant data regarding current trends of fentanyl-related deaths of children up to five years of age.

Assembly Amendments

extend the date by six months by which CDPH is required to distribute its findings and guidance to local entities, and sunset the provisions in this bill two years earlier than previously proposed.

ANALYSIS:

Existing law:

1. 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]
2. Requires a county coroner to inquire into and determine the circumstances, manner, and cause of certain deaths, including all violent, sudden, or unusual deaths, and deaths due to drug addiction, among other types of deaths. [GOV §27491]
3. Permits a county Board of Supervisors to abolish the office of coroner and provide instead for the office of medical examiner, as specified, and requires the medical examiner to be a licensed physician qualified as a specialist in pathology. [GOV §24010]
4. States the intent of the Legislature that fatal drug overdose information be used for the purpose of making decisions regarding the allocation of public health and educational resources to communities adversely impacted by the use of drugs that lead to overdoses. [HSC §11758.02]
5. Requires a coroner or medical examiner who evaluates an individual who died, in the coroner or medical examiner’s expert opinion, as the result of an overdose as a contributing factor, to report the incident to the Overdose Detection Mapping Application Program (ODMAP) managed by the Washington/Baltimore High Intensity Drug Trafficking Area program. [HSC §11758.04]

This bill:

1. Requires CDPH to use best efforts to utilize all of its relevant data regarding current trends of fentanyl-related deaths of children up to five years of age.
2. Requires CDPH to develop guidance and spread awareness of the trends to protect and prevent children from fentanyl exposure.
3. Requires CDPH, on or before January 1, 2026, to distribute annually its findings and guidance to local health departments, county boards of supervisors, and the Legislature. Permits a local health departments or county board of supervisors, but is not required to, adhere to guidance distributed by CDPH related to child death data from fentanyl exposure.
4. Sunsets the provisions in this bill on January 1, 2029.

Comments

1. Author’s statement. According to the author, “In California, 25 children younger than five died between 2019 and 2022 from fentanyl poisoning. With the distressing increase in fentanyl-related fatalities among the state's youngest residents, this bill takes steps to mitigate exposure risks for infants and toddlers. Over the last two decades, more than 100 infants younger than age one have died from fentanyl poisoning. And just last year, three infants died from fentanyl poisoning in the author’s district. The author states that although the numbers aren’t as staggering as other age groups, it is a significant spike compared to years prior. The author is asking CDPH to shine a light specifically on children up to five years of age who cannot accidentally or intentionally overdose without exposure from an older person; who cannot form an addiction on their own accord; nor, who choose to consume drugs. This bill addresses the critical need for a standardized public health response to the fentanyl crisis by mandating CDPH to track and analyze trends in fentanyl poisonings of children aged zero to five, develop preventative guidelines, and annually disseminate the findings to counties, local officials, and the Legislature.”
2. Media reports on infant/child overdoses related to fentanyl. A San Jose Mercury News article published March 23, 2024, cites its previous reporting on three Bay Area infant and toddler deaths as the inspiration for this bill. In the article, the author is cited as suggesting delaying the reunification of children younger than age five with parents who have a substance use disorder (SUD). The article notes that from 1999 to 2021, just over 340 children under age five nationally were killed by fentanyl, including 105 who were younger than one year old. However, some experts noted that the state already does a decent job providing policy guidance to counties on how to handle tricky child abuse cases and that the recent deaths were due to dysfunctional county policies and practices, not faulty state guidance. Other experts were cautious about any state policy that automatically delayed the reunification of children with parents suffering from SUD. Experts also said a problem with releasing this data on child fatalities is that there are few recorded, about a dozen or fewer statewide each year, and publishing these statistics could present privacy concerns.

The Oregon Health & Science University noted in a story on its website on March 7, 2024, that its poison center managed 16 cases of illicit fentanyl exposure in children younger than six years old in 2023, an increase from just two in 2021 and none in 2020. It notes this trend is mirrored nationally when researchers examined data from all U.S. Poison Centers. Just ten cases of fentanyl exposures in children under six years old were reported to U.S. Poison Centers in 2016. By 2020, that number jumped to 120, and by 2023, there were 539 cases of illicit fentanyl exposure in children under 6 years old—a 449% increase in three years and a 5,390% increase since 2016. National data revealed that most children exposed to fentanyl experienced severe effects including losing consciousness, stopping breathing, and brain injury. Naloxone was administered to 63% of the children. Most children were two years of age or younger. The study found that 82% of pediatric unintentional exposures to illicit fentanyl occurred in the child’s home. Among Oregon children, 93% of the children were exposed in their homes, highlighting the need for education and awareness about preventing unintentional drug exposures where children live. The poison center offers important tips when it comes to fentanyl, whether prescription or illicit: lock up medication (such as using a cabinet lock or medicine lock box); carry multiple doses of naloxone; know the signs of overdose (such as pinpoint pupils, shallow breathing, and sleepiness or losing consciousness); and, call 9-1-1 right away if someone is unconscious, not breathing, or if naloxone has been given.

1. ODMAP. In 1988, Congress created the High Intensity Drug Trafficking Areas (HIDTA) program to provide assistance to federal, state, local, and tribal law enforcement agencies operating in areas determined to be critical drug-trafficking regions of the U.S. There are currently 33 HIDTAs, including four in California: Central Valley, Northern California, Los Angeles, and San Diego/Imperial Valley. In January of 2017, the Washington/Baltimore HIDTA launched ODMAP as a response to the lack of a consistent methodology to track overdoses, which limited the ability to understand and mobilize against the crisis. According to the Washington/Baltimore HIDTA, ODMAP is an overdose-mapping tool that allows first responders to log an overdose in real time into a centralized database in order to support public safety and public health efforts to mobilize an immediate response to a sudden increase, or spike, in overdose events. ODMAP is only available to government agencies serving the interest of public safety and health, and each agency wishing to use the system must sign a participation agreement designed to protect the data within the system, which currently serves more than 3,700 agencies with more than 28,000 users in all 50 states, and has logged 850,000 overdose events.

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

According to the Assembly Appropriations Committee, CDPH estimates annual staffing costs of $259,000 until January 1, 2031 to implement the provisions of this bill (General Fund).

SUPPORT: (Verified 8/26/24)

American Academy of Pediatrics, California

City of Bakersfield

Ella Baker Center for Human Rights

FIRST 5 Santa Clara County

Steinberg Institute

Todd Gloria, Mayor, City of Sand Diego

OPPOSITION: (Verified 8/26/24)

None received

ARGUMENTS IN SUPPORT: FIRST 5 Santa Clara County and other supporters state the opioid epidemic remains a public health and safety crisis in California. According to CDPH, since 2015, the potency of synthetic opioids, including fentanyl, has increased substantially resulting in an extraordinary increase of drug-related overdose deaths. With the distressing increase in fentanyl-related fatalities among the state’s youngest residents, this bill takes steps to mitigate exposure risks by codifying the analysis of data already being collected by the CDPH. This information will inform and educate elected officials, health departments, and families about a standardized public health response to ensure this trend does not continue to rise. The Steinberg Institute states that CDPH’s Substance and Addiction Prevention Branch, through initiatives such as the Overdose Prevention Initiative and the Statewide Overdose Safety Workgroup, has laid a solid foundation for tackling the complex nature of the drug overdose epidemic. This bill seeks to leverage this existing infrastructure to better analyze data trends, develop targeted guidelines, and significantly amplify awareness efforts to protect our children from the deadly reach of fentanyl. Such dissemination of knowledge as required in this bill is crucial for informing policy decisions and empowering families with the information they need to prevent these avoidable tragedies.

ASSEMBLY FLOOR: 77-0, 8/26/24

AYES: Addis, Aguiar-Curry, Alanis, Alvarez, Arambula, Bains, Bauer-Kahan, Bennett, Berman, Boerner, Bonta, Bryan, Calderon, Juan Carrillo, Wendy Carrillo, Chen, Connolly, Megan Dahle, Davies, Dixon, Essayli, Flora, Mike Fong, Friedman, Gabriel, Gallagher, Garcia, Gipson, Grayson, Haney, Hart, Holden, Hoover, Irwin, Jackson, Jones-Sawyer, Kalra, Lackey, Lee, Low, Lowenthal, Maienschein, Mathis, McCarty, McKinnor, Muratsuchi, Stephanie Nguyen, Pacheco, Papan, Jim Patterson, Joe Patterson, Pellerin, Petrie-Norris, Quirk-Silva, Ramos, Rendon, Reyes, Luz Rivas, Rodriguez, Blanca Rubio, Sanchez, Santiago, Schiavo, Soria, Ta, Ting, Valencia, Villapudua, Waldron, Wallis, Ward, Weber, Wicks, Wilson, Wood, Zbur, Robert Rivas

NO VOTE RECORDED: Cervantes, Ortega

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

8/27/24 12:08:03

**** END ****

SENATE THIRD READING

STR Bill Id:SB 908

Author:(Cortese)

As Amended Ver:August 20, 2024

Majority vote

SUMMARY

Requires the Department of Public Health (DPH) to use best efforts to utilize all of its relevant data to monitor and identify current trends of fentanyl-related deaths of children up to five years of age.

Major Provisions

COMMENTS

California is facing an overdose epidemic. According to a 2022 California Health Care Foundation report "Substance Use in California: Prevalence and Treatment," 9% of Californians have met the criteria for a substance use disorder (SUD). While the health care system is moving toward acknowledging SUDs as a chronic illness, only about 10% of people with a SUD within the last year received treatment. Overdose deaths from both opioids and psychostimulants (such as amphetamines), are soaring. This issue, compounded by the increased availability of fentanyl, has resulted in a 10-fold increase in fentanyl related deaths between 2015 and 2019.

1. Fentanyl. Fentanyl is a potent synthetic opioid drug approved by the United States Food and Drug Administration 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.
2. DPH Overdose Dashboard. As part of DPH's Opioid Prevention Initiative, DPH maintains the California Overdose Surveillance Dashboard (Dashboard). The Dashboard tracks deaths related to any opioid overdose, deaths related specifically to fentanyl, emergency department (ED) visits related to any opioid overdose, and the number of prescriptions issued for opioids in California. The data can be broken down by County, sex, age, race/ethnicity, or a specified time frame. The Dashboard reported there were 10 fentanyl-related overdose deaths and 15 fentanyl-related overdose ED visits, and 35 fentanyl-related overdose hospitalizations among children under five years of age in 2022.
3. Overdose Detection Mapping Application Program (ODMAP). In 1988, Congress created the High Intensity Drug Trafficking Areas (HIDTA) program to provide assistance to federal, state, local, and tribal law enforcement agencies operating in areas determined to be critical drug-trafficking regions of the United States. There are currently 33 HIDTAs, including four in California: Central Valley, Northern California, Los Angeles, and San Diego/Imperial Valley.

In January of 2017, the Washington/Baltimore HIDTA launched ODMAP as a response to the lack of a consistent methodology to track overdoses, which limited the ability to understand and mobilize against the crisis. ODMAP is a free, web-based tool that provides near real-time suspected overdose surveillance data across jurisdictions to support public safety and public health efforts to mobilize an immediate response to a sudden increase, or spike in overdose events. For over five years, ODMAP has been available to government agencies serving the interests of public safety and health. Each agency wishing to participate signs a data-sharing agreement that is designed to protect the data within the system. Once signed, they can begin uploading data and have access to the National Map feature which allows users to view nationwide data and built-in analytical tools. Additionally, once an agency is approved, they can set up county-level spike alerts.

Currently, there are almost 4,000 agencies in all 50 states, the District of Columbia, and Puerto Rico who are utilizing the tool. To date more than 850,000 overdose events have been entered.

According to the Author

Twenty five children younger than five died between 2019 and 2022 from fentanyl poisoning in California. The author argues that with the distressing increase in fentanyl-related fatalities among the state's youngest residents, this bill takes steps to mitigate exposure risks for infants and toddlers. The author concludes that this bill addresses the critical need for a standardized public health response to the fentanyl crisis by mandating DPH to track and analyze trends in fentanyl poisonings of children aged zero to five, develop preventative guidelines, and annually disseminate the findings to counties, local officials, and the Legislature.

Arguments in Support

First 5 Santa Clara County supports this bill, stating that over the last two decades more than 100 infants younger than age one died from fentanyl poisoning. In California alone, 25 children younger than five died between 2019 and 2022. First 5 Santa Clara County continues that with the distressing increase in fentanyl-related fatalities among the state's youngest residents, this bill takes steps to mitigate exposure risks by codifying the analysis of data already being collected by DPH. First 5 Santa Clara County argues that this information will inform and educate elected officials, health departments, and families about a standardized public health response to ensure this trend does not continue to rise.

Arguments in Opposition

None on file.

FISCAL COMMENTS

According to the Assembly Appropriations Committee, DPH estimates annual staffing costs of $259,000 until January 1, 2031 to implement the provisions of this bill (General Fund).

According to the Legislative Analyst's Office, the General Fund faces a structural deficit in the tens of billions of dollars over the next several fiscal years.

VOTES

SENATE FLOOR: 38-0-2

YES: Alvarado-Gil, Ashby, Atkins, Becker, Blakespear, Bradford, Caballero, Cortese, Dahle, Dodd, Durazo, Eggman, Glazer, Gonzalez, Grove, Hurtado, Jones, Laird, Limón, McGuire, Menjivar, Min, Newman, Nguyen, Niello, Ochoa Bogh, Padilla, Portantino, Roth, Rubio, Seyarto, Skinner, Smallwood-Cuevas, Stern, Umberg, Wahab, Wiener, Wilk

ABS, ABST OR NV: Allen, Archuleta

ASM HEALTH: 15-0-1

YES: Bonta, Aguiar-Curry, Arambula, Wendy Carrillo, Flora, Haney, Jones-Sawyer, Maienschein, McCarty, Joe Patterson, Rodriguez, Sanchez, Santiago, Schiavo, Weber

ABS, ABST OR NV: Waldron

ASM APPROPRIATIONS: 14-0-1

YES: Wicks, Sanchez, Arambula, Bryan, Calderon, Wendy Carrillo, Dixon, Mike Fong, Grayson, Haney, Hart, Pellerin, Ta, Villapudua

ABS, ABST OR NV: Jim Patterson

UPDATED

VERSION: August 20, 2024

CONSULTANT: Riana King / HEALTH / (916) 319-2097 FN: 0004207

SENATE THIRD READING

STR Bill Id:SB 908

Author:(Cortese)

As Amended Ver:May 16, 2024

Majority vote

SUMMARY

Requires the Department of Public Health (DPH) to use best efforts to utilize all of its relevant data to monitor and identify current trends of fentanyl-related deaths of children up to five years of age.

Major Provisions

COMMENTS

California is facing an overdose epidemic. According to a 2022 California Health Care Foundation report "Substance Use in California: Prevalence and Treatment," 9% of Californians have met the criteria for a substance use disorder (SUD). While the health care system is moving toward acknowledging SUDs as a chronic illness, only about 10% of people with a SUD within the last year received treatment. Overdose deaths from both opioids and psychostimulants (such as amphetamines), are soaring. This issue, compounded by the increased availability of fentanyl, has resulted in a ten-fold increase in fentanyl related deaths between 2015 and 2019.

1. Fentanyl. Fentanyl is a potent synthetic opioid drug approved by the United States Food and Drug Administration 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.
2. DPH Overdose Dashboard. As part of DPH's Opioid Prevention Initiative, DPH maintains the California Overdose Surveillance Dashboard (Dashboard). The Dashboard tracks deaths related to any opioid overdose, deaths related specifically to fentanyl, emergency department (ED) visits related to any opioid overdose, and the number of prescriptions issued for opioids in California. The data can be broken down by County, sex, age, race/ethnicity, or a specified time frame. The Dashboard reported there were 10 fentanyl-related overdose deaths and 15 fentanyl-related overdose ED visits, and 35 fentanyl-related overdose hospitalizations among children under five years of age in 2022. 
3. Overdose Detection Mapping Application Program (ODMAP). In 1988, Congress created the High Intensity Drug Trafficking Areas (HIDTA) program to provide assistance to federal, state, local, and tribal law enforcement agencies operating in areas determined to be critical drug-trafficking regions of the United States. There are currently 33 HIDTAs, including four in California: Central Valley, Northern California, Los Angeles, and San Diego/Imperial Valley.

In January of 2017, the Washington/Baltimore HIDTA launched ODMAP as a response to the lack of a consistent methodology to track overdoses, which limited the ability to understand and mobilize against the crisis. ODMAP is a free, web-based tool that provides near real-time suspected overdose surveillance data across jurisdictions to support public safety and public health efforts to mobilize an immediate response to a sudden increase, or spike in overdose events. For over five years, ODMAP has been available to government agencies serving the interests of public safety and health. Each agency wishing to participate signs a data-sharing agreement that is designed to protect the data within the system. Once signed, they can begin uploading data and have access to the National Map feature which allows users to view nationwide data and built-in analytical tools. Additionally, once an agency is approved, they can set up county-level spike alerts.

Currently, there are almost 4,000 agencies in all 50 states, the District of Columbia, and Puerto Rico who are utilizing the tool. To date more than 850,000 overdose events have been entered.

According to the Author

Twenty five children younger than five died between 2019 and 2022 from fentanyl poisoning in California. The author argues that with the distressing increase in fentanyl-related fatalities among the state's youngest residents, this bill takes steps to mitigate exposure risks for infants and toddlers. The author concludes that this bill addresses the critical need for a standardized public health response to the fentanyl crisis by mandating DPH to track and analyze trends in fentanyl poisonings of children aged zero to five, develop preventative guidelines, and annually disseminate the findings to counties, local officials, and the Legislature.

Arguments in Support

First 5 Santa Clara County supports this bill, stating that over the last two decades more than 100 infants younger than age one died from fentanyl poisoning. In California alone, 25 children younger than five died between 2019 and 2022. First 5 Santa Clara County continues that with the distressing increase in fentanyl-related fatalities among the state's youngest residents, this bill takes steps to mitigate exposure risks by codifying the analysis of data already being collected by DPH. First 5 Santa Clara County argues that this information will inform and educate elected officials, health departments, and families about a standardized public health response to ensure this trend does not continue to rise.

Arguments in Opposition

None on file.

FISCAL COMMENTS

According to the Assembly Appropriations Committee, DPH estimates annual staffing costs of $259,000 until January 1, 2031 to implement the provisions of this bill (General Fund).

According to the Legislative Analyst's Office, the General Fund faces a structural deficit in the tens of billions of dollars over the next several fiscal years.

VOTES

SENATE FLOOR: 38-0-2

YES: Alvarado-Gil, Ashby, Atkins, Becker, Blakespear, Bradford, Caballero, Cortese, Dahle, Dodd, Durazo, Eggman, Glazer, Gonzalez, Grove, Hurtado, Jones, Laird, Limón, McGuire, Menjivar, Min, Newman, Nguyen, Niello, Ochoa Bogh, Padilla, Portantino, Roth, Rubio, Seyarto, Skinner, Smallwood-Cuevas, Stern, Umberg, Wahab, Wiener, Wilk

ABS, ABST OR NV: Allen, Archuleta

ASM HEALTH: 15-0-1

YES: Bonta, Aguiar-Curry, Arambula, Wendy Carrillo, Flora, Haney, Jones-Sawyer, Maienschein, McCarty, Joe Patterson, Rodriguez, Sanchez, Santiago, Schiavo, Weber

ABS, ABST OR NV: Waldron

ASM APPROPRIATIONS: 14-0-1

YES: Wicks, Sanchez, Arambula, Bryan, Calderon, Wendy Carrillo, Dixon, Mike Fong, Grayson, Haney, Hart, Pellerin, Ta, Villapudua

ABS, ABST OR NV: Jim Patterson

UPDATED

VERSION: May 16, 2024

CONSULTANT: Riana King / HEALTH / (916) 319-2097 FN: 0004033

Date of Hearing: June 19, 2024

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Buffy Wicks, Chair

SBPCA Bill Id:SB 908

Author:(Cortese) – As Amended Ver:May 16, 2024

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

SUMMARY:

This bill requires the California Department of Public Health (CDPH) to monitor and identify trends in fentanyl-related deaths of children age five years and under and to develop guidance to raise awareness about trends in child fentanyl deaths. The bill also requires CDPH to annually disseminate its findings and guidance to local health departments, county boards of supervisors, and the Legislature.

FISCAL EFFECT:

CDPH estimates annual staffing costs of $259,000 until January 1, 2031 to implement the provisions of this bill (General Fund).

According to the Legislative Analyst’s Office, the General Fund faces a structural deficit in the tens of billions of dollars over the next several fiscal years. 

COMMENTS:

1. Purpose. According to the author:

In California, 25 children younger than five died between 2019 and 2022 from fentanyl poisoning. With the distressing increase in fentanyl-related fatalities among the state's youngest residents, SB 908 takes steps to mitigate exposure risks for infants and toddlers. This bill addresses the critical need for a standardized public health response to the fentanyl crisis by mandating the California Department of Public Health to track and analyze trends in fentanyl poisonings of children aged zero to five, develop preventative guidelines, and annually disseminate the findings to counties, local officials, and the Legislature.

1. Background.

Child Fentanyl Overdose Deaths. According to reporting by the San Jose Mercury News, from 1999 to 2021, nationally, over 340 children under age five died from fentanyl exposure, including 105 who were younger than one year old. The death of a baby named Phoenix and subsequent reporting led to calls for an overhaul of Santa Clara County’s Department of Children and Family Services and the prosecution of Phoenix’s father on felony child endangerment charges. The article quotes the author of this bill as stating the deaths of three Bay Area infants and toddlers, including Phoenix, inspired the bill.

The article also reports some experts say the state already does a decent job providing policy guidance to counties on how to handle tricky child abuse cases and that the recent deaths were due to dysfunctional county policies and practices, not faulty state guidance.

CDPH Overdose Dashboard. CDPH maintains the California Overdose Surveillance Dashboard (Dashboard), which includes data on deaths related to any opioid overdose, fentanyl, other specified drugs, including opioids, and specified combinations of drugs. The Dashboard also includes data on hospitalizations and emergency department (ED) visits related to opioid and other drug overdoses, and enables a Dashboard user to obtain county-specific reports of deaths, hospitalizations, and ED visits for fentanyl overdoses in California. The Dashboard also allows a user to view data by age group, sex, race/ethnicity, or a specified time frame. According to the Dashboard, there were 10 fentanyl-related overdose deaths and 15 fentanyl-related overdose ED visits, and 35 fentanyl-related overdose hospitalizations among children under five years of age in 2022. 

1. Related Legislation. AB 2871 (Maienschein) authorizes a county to establish an interagency overdose fatality review team to assist local agencies in identifying and reviewing overdose fatalities, facilitate communication among persons and agencies involved in overdose fatalities, and integrate local overdose prevention efforts through strategic planning, data dissemination, and community collaboration. AB 2871 is currently pending in the Senate Rules Committee.

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

Date of Hearing: June 4, 2024

ASSEMBLY COMMITTEE ON HEALTH

Mia Bonta, Chair

SBPCA Bill Id:SB 908

Author:(Cortese) – As Amended Ver:May 16, 2024

SENATE VOTE: 38-0

SUBJECT: Fentanyl: child deaths.

SUMMARY: Requires the Department of Public Health (DPH) to use best efforts to utilize all of its relevant data to monitor and identify current trends of fentanyl-related deaths of children up to five years of age. Specifically, this bill:

1. Requires DPH to use best efforts to utilize all of its relevant data to monitor and identify current trends of fentanyl-related deaths of children up to five years of age.
2. Requires DPH to develop guidance and spread awareness of the trends to protect and prevent children from fentanyl exposure.
3. Requires DPH, commencing June 1, 2025, to annually distribute findings and guidance to local health departments, county boards of supervisors, and the Legislature.
4. Permits, but does not require, a local health department or county board of supervisors to adhere to guidance distributed by DPH.
5. Repeals the provisions of this bill on January 1, 2031.

EXISTING LAW:

1. 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 disease prevention, 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.]
2. Requires a county coroner to inquire into and determine the circumstances, manner, and cause of certain deaths, including all violent, sudden, or unusual deaths, and deaths due to drug addiction, among other types of deaths. [Government Code (GOV) §27491]
3. Permits a county Board of Supervisors to abolish the office of coroner and provide instead for the office of medical examiner, as specified, and requires the medical examiner to be a licensed physician qualified as a specialist in pathology. [GOV §24010]
4. States the intent of the Legislature that fatal drug overdose information be used for the purpose of making decisions regarding the allocation of public health and educational resources to communities adversely impacted by the use of drugs that lead to overdoses. [HSC §11758.02]
5. Requires a coroner or medical examiner who evaluates an individual who died, in the coroner or medical examiner’s expert opinion, as the result of an overdose as a contributing factor, to report the incident to the Overdose Detection Mapping Application Program (ODMAP) managed by the Washington/Baltimore High Intensity Drug Trafficking Area program. [HSC §11758.04]

FISCAL EFFECT: According to the Senate Appropriations Committee, DPH estimates General Fund costs of $259,000 per year until January 1, 2031, for staffing resources.

COMMENTS:

1. PURPOSE OF THIS BILL. According to the author, 25 children younger than five died between 2019 and 2022 from fentanyl poisoning in California. The author argues that with the distressing increase in fentanyl-related fatalities among the state's youngest residents, this bill takes steps to mitigate exposure risks for infants and toddlers. The author concludes that this bill addresses the critical need for a standardized public health response to the fentanyl crisis by mandating DPH to track and analyze trends in fentanyl poisonings of children aged zero to five, develop preventative guidelines, and annually disseminate the findings to counties, local officials, and the Legislature.
2. BACKGROUND. California is facing an overdose epidemic. According to a 2022 California Health Care Foundation report “Substance Use in California: Prevalence and Treatment,” 9% of Californians have met the criteria for a substance use disorder (SUD). While the health care system is moving toward acknowledging SUDs as a chronic illness, only about 10% of people with a SUD within the last year received treatment. Overdose deaths from both opioids and psychostimulants (such as amphetamines), are soaring. This issue, compounded by the increased availability of fentanyl, has resulted in a 10-fold increase in fentanyl related deaths between 2015 and 2019.
   1. Fentanyl. Fentanyl is a potent synthetic opioid drug approved by the United States Food and Drug Administration 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.
   2. DPH Overdose Dashboard. As part of DPH’s Opioid Prevention Initiative, DPH maintains the California Overdose Surveillance Dashboard (Dashboard). The Dashboard tracks deaths related to any opioid overdose, deaths related specifically to fentanyl, emergency department (ED) visits related to any opioid overdose, and the number of prescriptions issued for opioids in California. The data can be broken down by County, sex, age, race/ethnicity, or a specified time frame. The Dashboard reported there were 10 fentanyl-related overdose deaths and 15 fentanyl-related overdose ED visits, and 35 fentanyl-related overdose hospitalizations among children under five years of age in 2022. 
   3. ODMAP. In 1988, Congress created the High Intensity Drug Trafficking Areas (HIDTA) program to provide assistance to federal, state, local, and tribal law enforcement agencies operating in areas determined to be critical drug-trafficking regions of the United States. There are currently 33 HIDTAs, including four in California: Central Valley, Northern California, Los Angeles, and San Diego/Imperial Valley.

In January of 2017, the Washington/Baltimore HIDTA launched ODMAP as a response to the lack of a consistent methodology to track overdoses, which limited the ability to understand and mobilize against the crisis. ODMAP is a free, web-based tool that provides near real-time suspected overdose surveillance data across jurisdictions to support public safety and public health efforts to mobilize an immediate response to a sudden increase, or spike in overdose events. For over five years, ODMAP has been available to government (state, local, federal, or tribal) agencies serving the interests of public safety and health. Each agency wishing to participate signs a data-sharing agreement that is designed to protect the data within the system. Once signed, they can begin uploading data and have access to the National Map feature which allows users to view nationwide data and built-in analytical tools (i.e., filters, pre-built charts, and adding additional data layers). Additionally, once an agency is approved, they can set up county-level spike alerts.

Currently, there are almost 4,000 agencies in all 50 states, the District of Columbia, and Puerto Rico who are utilizing the tool. To date more than 850,000 overdose events have been entered.

• 1. Media coverage of infant overdose deaths. Since 2020, the San Jose Mercury News has covered the fentanyl-related deaths of five children under the age of two in the Bay Area. In a subsequent story published on March 23, 2024, the author is cited as saying this bill was inspired by this ongoing reporting. The author is also cited as suggesting delaying the reunification of children younger than age five with parents who have a SUD. The article notes that from 1999 to 2021, just over 340 children under age five nationally were killed by fentanyl, including 105 who were younger than one year old. However, some experts noted in the article that the state already does a decent job providing policy guidance to counties on how to handle tricky child abuse cases and that the recent deaths were due to dysfunctional county policies and practices, not faulty state guidance. Other experts were cautious about any state policy that automatically delayed the reunification of children with parents suffering from SUD. Experts also said a problem with releasing this data on child fatalities is that there are few recorded, about a dozen or fewer statewide each year, and publishing these statistics could present privacy concerns.

1. SUPPORT. First 5 Santa Clara County supports this bill, stating that over the last two decades more than 100 infants younger than age one died from fentanyl poisoning. In California alone, 25 children younger than five died between 2019 and 2022. First 5 Santa Clara County continues that with the distressing increase in fentanyl-related fatalities among the state's youngest residents, this bill takes steps to mitigate exposure risks by codifying the analysis of data already being collected by DPH. First 5 Santa Clara County argues that this information will inform and educate elected officials, health departments, and families about a standardized public health response to ensure this trend does not continue to rise.

1. RELATED LEGISLATION.
   1. AB 1859 (Alanis) requires a coroner to test the bodily fluid of a deceased person for the presence of xylazine if the coroner reasonably suspects the person died from an accidental or intentional opioid overdose or if the person was administered an overdose intervention drug prior to death and was unresponsive to the drug. AB 1859 is currently pending in the Senate Rules Committee.
   2. AB 2871 (Maienschein) authorizes a county to establish an interagency overdose fatality review team to assist local agencies in identifying and reviewing overdose fatalities, facilitate communication among persons and agencies involved in overdose fatalities, and integrate local overdose prevention efforts through strategic planning, data dissemination, and community collaboration. AB 2871 is currently pending in the Senate Rules Committee.
2. PREVIOUS LEGISLATION. SB 67 (Seyarto), Chapter 859, Statutes of 2023, requires coroners and medical examiners to report actual or suspected overdoses to the Emergency Medical Services Agency, which is then required to submit this data to the ODMAP.

REGISTERED SUPPORT / OPPOSITION:

Support

Mayor Todd Gloria, City of San Diego

American Academy of Pediatrics, California

Ella Baker Center for Human Rights
First 5 California
First 5 Santa Clara County

Steinberg Institute

Opposition

None on file.

Analysis Prepared by: Riana King / HEALTH / (916) 319-2097

 THIRD READING  

Bill No: SB 908

Author: Cortese (D), et al.

Amended: 5/16/24

Vote: 21

SENATE HEALTH COMMITTEE: 11-0, 4/24/24

AYES: Roth, Nguyen, Glazer, Gonzalez, Grove, Hurtado, Limón, Menjivar, Rubio, Smallwood-Cuevas, Wiener

SENATE APPROPRIATIONS COMMITTEE: 7-0, 5/16/24

AYES: Caballero, Jones, Ashby, Becker, Bradford, Seyarto, Wahab

SUBJECT: Fentanyl: child deaths

SOURCE: Author

DIGEST:

Requires the California Department of Public Health to use best efforts to utilize all of its relevant data regarding current trends of fentanyl-related deaths of children up to five years of age.

ANALYSIS:

Existing law:

1. 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]
2. Requires a county coroner to inquire into and determine the circumstances, manner, and cause of certain deaths, including all violent, sudden, or unusual deaths, and deaths due to drug addiction, among other types of deaths. [GOV §27491]
3. Permits a county Board of Supervisors to abolish the office of coroner and provide instead for the office of medical examiner, as specified, and requires the medical examiner to be a licensed physician qualified as a specialist in pathology. [GOV §24010]
4. States the intent of the Legislature that fatal drug overdose information be used for the purpose of making decisions regarding the allocation of public health and educational resources to communities adversely impacted by the use of drugs that lead to overdoses. [HSC §11758.02]
5. Requires a coroner or medical examiner who evaluates an individual who died, in the coroner or medical examiner’s expert opinion, as the result of an overdose as a contributing factor, to report the incident to the Overdose Detection Mapping Application Program (ODMAP) managed by the Washington/Baltimore High Intensity Drug Trafficking Area program. [HSC §11758.04]

This bill:

1. Requires CDPH to use best efforts to utilize all of its relevant data regarding current trends of fentanyl-related deaths of children up to five years of age.
2. Requires CDPH to develop guidance and spread awareness of the trends to protect and prevent children from fentanyl exposure.
3. Requires CDPH, on or before June 1, 2025, to distribute annually its findings and guidance to local health departments, county boards of supervisors, and the Legislature. Permits a local health departments or county board of supervisors, but is not required to, adhere to guidance distributed by CDPH related to child death data from fentanyl exposure.

COMMENTS:

1. Author’s statement. According to the author:

In California, 25 children younger than five died between 2019 and 2022 from fentanyl poisoning. With the distressing increase in fentanyl-related fatalities among the state's youngest residents, this bill takes steps to mitigate exposure risks for infants and toddlers. Over the last two decades, more than 100 infants younger than age one have died from fentanyl poisoning. And just last year, three infants died from fentanyl poisoning in the author’s district. The author states that although the numbers aren’t as staggering as other age groups, it is a significant spike compared to years prior. The author is asking CDPH to shine a light specifically on children up to five years of age who cannot accidentally or intentionally overdose without exposure from an older person; who cannot form an addiction on their own accord; nor, who choose to consume drugs. This bill addresses the critical need for a standardized public health response to the fentanyl crisis by mandating CDPH to track and analyze trends in fentanyl poisonings of children aged zero to five, develop preventative guidelines, and annually disseminate the findings to counties, local officials, and the Legislature.

1. Media reports on infant/child overdoses related to fentanyl. A San Jose Mercury News article published March 23, 2024, cites its previous reporting on three Bay Area infant and toddler deaths as the inspiration for this bill. In the article, the author is cited as suggesting delaying the reunification of children younger than age five with parents who have a substance use disorder (SUD). The article notes that from 1999 to 2021, just over 340 children under age five nationally were killed by fentanyl, including 105 who were younger than one year old. However, some experts noted that the state already does a decent job providing policy guidance to counties on how to handle tricky child abuse cases and that the recent deaths were due to dysfunctional county policies and practices, not faulty state guidance. Other experts were cautious about any state policy that automatically delayed the reunification of children with parents suffering from SUD. Experts also said a problem with releasing this data on child fatalities is that there are few recorded, about a dozen or fewer statewide each year, and publishing these statistics could present privacy concerns.

The Oregon Health & Science University noted in a story on its website on March 7, 2024, that its poison center managed 16 cases of illicit fentanyl exposure in children younger than six years old in 2023, an increase from just two in 2021 and none in 2020. It notes this trend is mirrored nationally when researchers examined data from all U.S. Poison Centers. Just ten cases of fentanyl exposures in children under six years old were reported to U.S. Poison Centers in 2016. By 2020, that number jumped to 120, and by 2023, there were 539 cases of illicit fentanyl exposure in children under 6 years old—a 449% increase in three years and a 5,390% increase since 2016. National data revealed that most children exposed to fentanyl experienced severe effects including losing consciousness, stopping breathing, and brain injury. Naloxone was administered to 63% of the children. Most children were two years of age or younger. The study found that 82% of pediatric unintentional exposures to illicit fentanyl occurred in the child’s home. Among Oregon children, 93% of the children were exposed in their homes, highlighting the need for education and awareness about preventing unintentional drug exposures where children live. The poison center offers important tips when it comes to fentanyl, whether prescription or illicit: lock up medication (such as using a cabinet lock or medicine lock box); carry multiple doses of naloxone; know the signs of overdose (such as pinpoint pupils, shallow breathing, and sleepiness or losing consciousness); and, call 9-1-1 right away if someone is unconscious, not breathing, or if naloxone has been given.

1. ODMAP. In 1988, Congress created the High Intensity Drug Trafficking Areas (HIDTA) program to provide assistance to federal, state, local, and tribal law enforcement agencies operating in areas determined to be critical drug-trafficking regions of the U.S. There are currently 33 HIDTAs, including four in California: Central Valley, Northern California, Los Angeles, and San Diego/Imperial Valley. In January of 2017, the Washington/Baltimore HIDTA launched ODMAP as a response to the lack of a consistent methodology to track overdoses, which limited the ability to understand and mobilize against the crisis. According to the Washington/Baltimore HIDTA, ODMAP is an overdose-mapping tool that allows first responders to log an overdose in real time into a centralized database in order to support public safety and public health efforts to mobilize an immediate response to a sudden increase, or spike, in overdose events. ODMAP is only available to government agencies serving the interest of public safety and health, and each agency wishing to use the system must sign a participation agreement designed to protect the data within the system, which currently serves more than 3,700 agencies with more than 28,000 users in all 50 states, and has logged 850,000 overdose events.

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

According to the Senate Appropriations Committee:

CDPH estimates General Fund costs of $259,000 per year until January 1, 2031, for staffing resources.

SUPPORT: (Verified 5/14/24)

American Academy of Pediatrics, California

FIRST 5 Santa Clara County

Steinberg Institute

OPPOSITION: (Verified 5/14/24)

None received

ARGUMENTS IN SUPPORT: FIRST 5 Santa Clara County and other supporters state the opioid epidemic remains a public health and safety crisis in California. According to CDPH, since 2015, the potency of synthetic opioids, including fentanyl, has increased substantially resulting in an extraordinary increase of drug-related overdose deaths. With the distressing increase in fentanyl-related fatalities among the state’s youngest residents, this bill takes steps to mitigate exposure risks by codifying the analysis of data already being collected by the CDPH. This information will inform and educate elected officials, health departments, and families about a standardized public health response to ensure this trend does not continue to rise. The Steinberg Institute states that CDPH’s Substance and Addiction Prevention Branch, through initiatives such as the Overdose Prevention Initiative and the Statewide Overdose Safety Workgroup, has laid a solid foundation for tackling the complex nature of the drug overdose epidemic. This bill seeks to leverage this existing infrastructure to better analyze data trends, develop targeted guidelines, and significantly amplify awareness efforts to protect our children from the deadly reach of fentanyl. Such dissemination of knowledge as required in this bill is crucial for informing policy decisions and empowering families with the information they need to prevent these avoidable tragedies.

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

5/18/24 12:26:48

**** END ****

SENATE COMMITTEE ON

Senator Anna Caballero, Chair

2023 - 2024 Regular Session

SB 908 (Cortese) - Fentanyl: child deaths

Bill Summary:

SB 908 would require the California Department of Public Health (CDPH) to monitor and identify current trends of fentanyl-related deaths of children zero to five years of age, as specified.

*********** ANALYSIS ADDENDUM – SUSPENSE FILE ***********

The following information is revised to reflect amendments

adopted by the committee on May 16, 2024

Fiscal Impact:

The CDPH estimates General Fund costs of $259,000 per year until January 1, 2031, for staffing resources.

Committee Amendments:

Add a co-author.

-- END --

SENATE COMMITTEE ON APPROPRIATIONS

Senator Anna Caballero, Chair

2023 - 2024 Regular Session

SB 908 (Cortese) - Fentanyl: child deaths

Bill Summary:

SB 908 would require the California Department of Public Health (CDPH) to monitor and identify current trends of fentanyl-related deaths of children zero to five years of age, as specified.

Fiscal Impact:

The CDPH estimates General Fund costs of $259,000 per year until January 1, 2031, for staffing resources.

Background:

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

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

Proposed Law:

Specific provisions of the bill would:

• Require CDPH to use best efforts to utilize all of its relevant data regarding overdoses in the state to monitor and identify current trends of fentanyl-related deaths of children zero to five years of age, inclusive.
• Require CDPH to develop guidance and spread awareness of the trends to protect and prevent children from fentanyl exposure.
• Require CDPH to annually distribute its findings and guidance to local health departments, county boards of supervisors, and the Legislature.
• Sunset the bill’s provisions on January 1, 2031.

-- END --

SENATE COMMITTEE ON HEALTH

Senator Richard Roth, Chair

BILL NO: SB 908

SUBJECT: Fentanyl: child deaths

SUMMARY:

Requires the California Department of Public Health to utilize its data to monitor and identify current trends of fentanyl-related deaths of children up to five years of age.

Existing law:

1. 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]
2. Requires a county coroner to inquire into and determine the circumstances, manner, and cause of certain deaths, including all violent, sudden, or unusual deaths, and deaths due to drug addiction, among other types of deaths. [GOV §27491]
3. Permits a county Board of Supervisors to abolish the office of coroner and provide instead for the office of medical examiner, as specified, and requires the medical examiner to be a licensed physician qualified as a specialist in pathology. [GOV §24010]
4. States the intent of the Legislature that fatal drug overdose information be used for the purpose of making decisions regarding the allocation of public health and educational resources to communities adversely impacted by the use of drugs that lead to overdoses. [HSC §11758.02]
5. Requires a coroner or medical examiner who evaluates an individual who died, in the coroner or medical examiner’s expert opinion, as the result of an overdose as a contributing factor, to report the incident to the Overdose Detection Mapping Application Program (ODMAP) managed by the Washington/Baltimore High Intensity Drug Trafficking Area program. [HSC §11758.04]

This bill:

1. Requires CDPH to utilize its data to monitor and identify current trends of fentanyl-related deaths of children up to five years of age.
2. Requires CDPH to develop guidance and spread awareness of the trends to protect and prevent children from fentanyl exposure.
3. Requires CDPH, on or before June 1, 2025, to distribute annually its findings and guidance to county public health departments, county boards of supervisors, and the Legislature. Permits a county public health department or county board of supervisors, but is not required to, adhere to guidance distributed by CDPH related to child death data from fentanyl exposure.

FISCAL EFFECT:

This bill has not been analyzed by a fiscal committee.

COMMENTS:

1. Author’s statement. According to the author, in California, 25 children younger than five died between 2019 and 2022 from fentanyl poisoning. With the distressing increase in fentanyl-related fatalities among the state's youngest residents, this bill takes steps to mitigate exposure risks for infants and toddlers. Over the last two decades, more than 100 infants younger than age one have died from fentanyl poisoning. And just last year, three infants died from fentanyl poisoning in the author’s district. The author states that although the numbers aren’t as staggering as other age groups, it is a significant spike compared to years prior. The author is asking CDPH to shine a light specifically on children up to five years of age who cannot accidentally or intentionally overdose without exposure from an older person; who cannot form an addiction on their own accord; nor, who choose to consume drugs. This bill addresses the critical need for a standardized public health response to the fentanyl crisis by mandating CDPH to track and analyze trends in fentanyl poisonings of children aged zero to five, develop preventative guidelines, and annually disseminate the findings to counties, local officials, and the Legislature.
2. Media reports on infant/child overdoses related to fentanyl. A San Jose Mercury News article published March 23, 2024, cites its previous reporting on three Bay Area infant and toddler deaths as the inspiration for this bill. In the article, the author is cited as suggesting delaying the reunification of children younger than age five with parents who have a substance use disorder (SUD). The article notes that from 1999 to 2021, just over 340 children under age five nationally were killed by fentanyl, including 105 who were younger than one year old. However, some experts noted that the state already does a decent job providing policy guidance to counties on how to handle tricky child abuse cases and that the recent deaths were due to dysfunctional county policies and practices, not faulty state guidance. Other experts were cautious about any state policy that automatically delayed the reunification of children with parents suffering from SUD. Experts also said a problem with releasing this data on child fatalities is that there are few recorded, about a dozen or fewer statewide each year, and publishing these statistics could present privacy concerns.

The Oregon Health & Science University noted in a story on its website on March 7, 2024, that its poison center managed 16 cases of illicit fentanyl exposure in children younger than six years old in 2023, an increase from just two in 2021 and none in 2020. It notes this trend is mirrored nationally when researchers examined data from all U.S. Poison Centers. Just ten cases of fentanyl exposures in children under six years old were reported to U.S. Poison Centers in 2016. By 2020, that number jumped to 120, and by 2023, there were 539 cases of illicit fentanyl exposure in children under 6 years old—a 449% increase in three years and a 5,390% increase since 2016. National data revealed that most children exposed to fentanyl experienced severe effects including losing consciousness, stopping breathing, and brain injury. Naloxone was administered to 63% of the children. Most children were two years of age or younger. The study found that 82% of pediatric unintentional exposures to illicit fentanyl occurred in the child’s home. Among Oregon children, 93% of the children were exposed in their homes, highlighting the need for education and awareness about preventing unintentional drug exposures where children live. The poison center offers important tips when it comes to fentanyl, whether prescription or illicit: lock up medication (such as using a cabinet lock or medicine lock box); carry multiple doses of naloxone; know the signs of overdose (such as pinpoint pupils, shallow breathing, and sleepiness or losing consciousness); and, call 9-1-1 right away if someone is unconscious, not breathing, or if naloxone has been given.

1. ODMAP. In 1988, Congress created the High Intensity Drug Trafficking Areas (HIDTA) program to provide assistance to federal, state, local, and tribal law enforcement agencies operating in areas determined to be critical drug-trafficking regions of the U.S. There are currently 33 HIDTAs, including four in California: Central Valley, Northern California, Los Angeles, and San Diego/Imperial Valley. In January of 2017, the Washington/Baltimore HIDTA launched ODMAP as a response to the lack of a consistent methodology to track overdoses, which limited the ability to understand and mobilize against the crisis. According to the Washington/Baltimore HIDTA, ODMAP is an overdose-mapping tool that allows first responders to log an overdose in real time into a centralized database in order to support public safety and public health efforts to mobilize an immediate response to a sudden increase, or spike, in overdose events. ODMAP is only available to government agencies serving the interest of public safety and health, and each agency wishing to use the system must sign a participation agreement designed to protect the data within the system, which currently serves more than 3,700 agencies with more than 28,000 users in all 50 states, and has logged 850,000 overdose events.
2. Related legislation. AB 1859 (Alanis) requires a coroner to test the bodily fluid of a deceased person for the presence of xylazine if the coroner reasonably suspects the person died from an accidental or intentional opioid overdose or if the person was administered an overdose intervention drug prior to death and was unresponsive to the drug. AB 1859 is pending on the Assembly Committee on Appropriations suspense file.

AB 2871 (Maienschein) permits a county to establish an interagency overdose fatality review team to assist local agencies in identifying and reviewing overdose fatalities, facilitate communication among persons and agencies involved in overdose fatalities, and integrate local overdose prevention efforts through strategic planning, data dissemination, and community collaboration. AB 2871 pending in the Assembly Appropriations Committee.

1. Prior legislation. SB 67 (Seyarto, Chapter 859, Statutes of 2023), among other things, implemented current law requiring a coroner or medical examiner to report deaths that are a result of an overdose to ODMAP.
2. Support. FIRST 5 Santa Clara County and other supporters state the opioid epidemic remains a public health and safety crisis in California. According to CDPH, since 2015, the potency of synthetic opioids, including fentanyl, has increased substantially resulting in an extraordinary increase of drug-related overdose deaths. With the distressing increase in fentanyl-related fatalities among the state’s youngest residents, this bill takes steps to mitigate exposure risks by codifying the analysis of data already being collected by the CDPH. This information will inform and educate elected officials, health departments, and families about a standardized public health response to ensure this trend does not continue to rise. The Steinberg Institute states that CDPH’s Substance and Addiction Prevention Branch, through initiatives such as the Overdose Prevention Initiative and the Statewide Overdose Safety Workgroup, has laid a solid foundation for tackling the complex nature of the drug overdose epidemic. This bill seeks to leverage this existing infrastructure to better analyze data trends, develop targeted guidelines, and significantly amplify awareness efforts to protect our children from the deadly reach of fentanyl. Such dissemination of knowledge as required in this bill is crucial for informing policy decisions and empowering families with the information they need to prevent these avoidable tragedies.
3. Technical amendments. The author may wish to consider the following technical amendments to provide clarity to the intent of this bill:
4. Require CDPH to “use best efforts to utilize all of its relevant data regarding overdoses in the state,” rather than “utilize its data,” to monitor and identify trends in fentanyl-related deaths of children up to five years of age.
5. Replace “county public health departments” with “local health departments.”

SUPPORT AND OPPOSITION:

Support: American Academy of Pediatrics, California

FIRST 5 Santa Clara County

Steinberg Institute

Oppose: None received

-- END --