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AB 1748
Page 1
ASSEMBLY THIRD READING
AB 1748 (Mayes)
As Amended May 11, 2016
Majority vote
Committee
Votes
Ayes
Education
7-0
O'Donnell, Olsen, Kim,
McCarty, Santiago, Thurmond,
Weber
Judiciary
9-1
Mark Stone, Wagner, Alejo,
Chau, Chiu, Gallagher,
Cristina Garcia, Holden,
Maienschein
Appropriations
20-0
Gonzalez, Bigelow, Bloom,
Bonilla, Bonta, Calderon,
Patterson, Daly, Eggman,
Gallagher, Eduardo Garcia,
Roger Hernández, Holden,
Jones, Obernolte, Quirk,
Santiago, Wagner, Weber,
Wood
Noes
Ting
SUMMARY: Authorizes school nurses and other trained personnel to use naloxone
hydrochloride (naloxone) or another opioid antagonist to provide emergency medical aid to
persons suffering, or reasonably believed to be suffering, from an opioid overdose. Specifically,
this bill:
1) Authorizes, in the Business and Professions Code, a pharmacy to furnish naloxone or another
opioid antagonist to a school district, county office of education (COE), or charter school if
all the naloxone or another opioid antagonist is furnished exclusively for use at a school
district schoolsite, COE schoolsite, or charter school, and a physician and surgeon provides a
written order that specifies the quantity of naloxone or another opioid antagonist to be
furnished.
2) Requires records regarding the acquisition and disposition of naloxone or another opioid
antagonist furnished to be maintained by the school district, COE, or charter school for a
period of three years from the date the records were created. Requires the school district,
COE, or charter school to be responsible for monitoring the supply of naloxone or another
opioid antagonist and ensuring the destruction of expired naloxone or another opioid
antagonist.
3) Authorizes school districts, COEs and charter schools to provide emergency naloxone or
another opioid antagonist to school nurses or trained personnel for the purpose of providing
emergency medical aid to persons suffering, or reasonably believed to be suffering, from an
opioid overdose. Establishes the following definitions:
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a) "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.
b) "Opioid antagonist" means naloxone or another drug approved by the federal Food and
Drug Administration (FDA) 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.
c) "Qualified supervisor of health" may include, but is not limited to, a school nurse.
d) "Volunteer" or "trained personnel" means an employee who has volunteered 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, has been designated by a
school, and has received specified training.
4) Authorizes each public and private elementary and secondary school 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.
Prohibits a private elementary or secondary school choosing to exercise the authority
provided by this bill from receiving state funds for this purpose.
5) Authorizes each public and private elementary and secondary school 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
shall 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 shall provide the training for the
volunteers at no cost to the volunteer and during the volunteer's regular working hours.
6) Specifies that an employee who volunteers may rescind his or her offer to administer
emergency naloxone or another opioid antagonist at any time, including after receipt of
training.
7) 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 by the SPI.
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, but not limited to, the State Department of Public Health, the Emergency Medical
Services Authority, the California School Nurses Organization, the California Medical
Association, the American Academy of Pediatrics, and others.
8) Requires the training to include all of the following:
a) Techniques for recognizing symptoms of an opioid overdose;
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b) Standards and procedures for the storage, restocking, and emergency use of naloxone or
another opioid antagonist;
c) 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
pupil's parent or guardian. Specifies that the requirement for the school or charter school
administrator or other school staff member to call the emergency 911 telephone number
shall not require a pupil to be transported to an emergency room;
d) Recommendations on the necessity of instruction and certification in cardiopulmonary
resuscitation (CPR); and,
e) Written materials covering the information required in the training.
9) Requires training to be consistent with the most recent guidelines for medication
administration issued by the California Department of Education (CDE).
10) Requires a school to retain for reference the written materials developed for the training.
11) Requires the CDE to include on its Internet Web site a clearinghouse for best practices in
training nonmedical personnel to administer naloxone or another opioid antagonist to pupils.
12) 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) 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;
b) A description of the training that the volunteer will receive;
c) The right of an employee to rescind his or her offer to volunteer; and,
d) 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.
13) Requires a qualified supervisor of health at a school district, COE, or charter school electing
to utilize naloxone or another opioid antagonist for emergency aid to do the following:
a) Obtain from an authorizing physician and surgeon a prescription for each school for
naloxone or another opioid antagonist.
b) Be responsible for stocking the naloxone or another opioid antagonist and restocking it if
it is used.
14) Specifies that if a school district, COE, or charter school does not have a qualified supervisor
of health, an administrator at the school district, COE, or charter school shall carry out the
duties.
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15) Provides that a prescription may be filled by local or mail order pharmacies or naloxone or
another opioid antagonist manufacturer.
16) Specifies that 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 bill, unless the physician and surgeon's issuance of the
prescription or order constitutes gross negligence or willful or malicious conduct.
17) 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 shall be restocked as soon as reasonably
possible, but no later than two weeks after it is used. Naloxone or another opioid antagonist
shall be restocked before their expiration date.
18) Specifies that volunteers may only administer naloxone or another opioid antagonist by nasal
spray.
19) 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 under this
section will be provided defense and indemnification by the school district, COE, or charter
school for any and all civil liability, in accordance with, but not limited to, that provided in
Government Code, Division 3.6 (commencing with Section 810) of Title 1. Requires this
information to be reduced to writing, provided to the volunteer, and retained in the
volunteer's personnel file.
20) 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 shall not be subject to
professional review, be liable in a civil action, or be subject to criminal prosecution for his or
her acts or omissions in administering the naloxone or another opioid antagonist. Specifies
that the protection shall not apply in as 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 he or she is a paid public employee.
21) 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 bill,
including, but not limited to, the acceptance of naloxone or another opioid antagonist from a
manufacturer or wholesaler.
FISCAL EFFECT: According to the Assembly Appropriations Committee, General Fund (GF)
administrative costs to the CDE of approximately $60,000 in the first year of implementation to
develop minimum standards of training for the administration of an opioid antagonist and to
provide a clearinghouse for best practices in training. Ongoing costs of approximately $12,000
GF for the CDE to review and update standards as necessary.
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COMMENTS: This bill authorizes school districts, COEs and charter schools to obtain
naloxone or another opioid antagonist and allow school nurses or other trained volunteer
personnel to provide naloxone or another opioid antagonist to persons suffering, or reasonably
believed to be suffering from an opioid overdose, if a prescription is received from a physician
and surgeon. This bill requires the SPI to establish minimum standards for training, in
consultation with the State Department of Public Health, the Emergency Medical Services
Authority, the California School Nurses Organization, the California Medical Association, the
American Academy of Pediatrics, and others.
This bill is modeled after the provisions allowing school nurses or trained personnel to use
epinephrine auto-injectors to provide emergency medical aid to persons suffering, or reasonably
believed to be suffering, from an anaphylactic reaction. The major difference is that this bill
simply authorizes local educational agencies to obtain and administer opioid antagonist while
school districts, COEs and charter schools are required to stock epinephrine auto-injectors.
Opioid overdose. According to the author, "Drug overdoses are now the leading cause of injury
death in the United States (US), surpassing motor vehicle crash deaths." According to the
Centers for Disease Control and Prevention, from 2000 to 2014, nearly half a million people died
from drug overdoses; the majority of drug overdose deaths involve an opioid, including
prescription pain relievers and heroin. The most common prescription drugs involved in
overdose deaths include methadone, oxycodone (OxyContin ®) and hydrocodone (Vicodin ®).
More recently, fentanyl, a pain reliever that is 50 to 100 times more potent than morphine, has
been found in prescription painkiller Norco or what individuals thought was Norco, killing 10
people in the Sacramento area within a two week period.
Problem among youth. The 2014 National Survey on Drug Use and Health reported that 50.5%
of people who misused prescription painkillers got them from a friend or relative. The survey
also reported an estimated 0.7% of adolescents aged 12 to 17 (approximately 168,000) had a pain
reliever use disorder in 2014, while 28,000, representing 0.1% of adolescents in the same age
group, had a heroin use disorder in 2014.
Symptoms of drug overdose. The Opioid Overdose Toolkit from the Substance Abuse and
Mental Health Services Administration (SAMHSA), a division of the US Department of Health
and Human Services, states that symptoms of drug overdose may include extreme sleepiness,
slow heartbeat and/or low blood pressure, very small pupils in the eyes, fingernails or lips
turning blue/purple and breathing problems.
Naloxone hydrochloride. Naloxone is approved by the FDA as an antidote to reverse opioid
overdose. According to SAMHSA, "The safety profile of naloxone is remarkably high,
especially when used in low doses and titrated to effect. When given to individuals who are not
opioid-intoxicated or opioid-dependent, naloxone produces no clinical effects, even at high
doses. Moreover, although rapid opioid withdrawal in tolerant patients may be unpleasant, it is
not life-threatening."
Naloxone is administered by a syringe or an auto-injector into a large muscle or given under the
skin. It was recently approved by the FDA in a nasal spray form. Naloxone can reverse the
effects of an opioid overdose very quickly. As communities and states throughout the country
increased the use of naloxone, prices have increased, particularly for the nasal spray. According
to the author, the Clinton Health Matters Initiative has partnered with the manufacturer of the
nasal spray version to offer a discounted public interest price and provide two free doses to every
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high school in the United States. This bill allows a school to obtain naloxone from a pharmacy
or a manufacturer, including accepting donations from a manufacturer.
Volunteers. According to the California School Nurses Association, the ratio of school nurse to
student in 2014-15 was 1:3,048, with just a total of 2,391 nurses for 6.2 million students in the
state. Without a nurse located at each schoolsite, several recent new laws have tapped volunteers
to administer medical aid for varying conditions, including epilepsy, diabetes, and anaphylactic
reactions. The Legislature may wish to consider whether individuals with no or little medical
background should be given more and more medical-type duties.
Training. This bill requires the SPI to develop minimum standards for training volunteers, which
is provided by a school nurse or other qualified person designated by an authorizing physician
and surgeon. The training must cover techniques for recognizing symptoms of an opioid
overdose; standards and procedures for storage, restocking, and emergency use of naloxone;
emergency follow-up procedures; and the importance of instruction and certification in
cardiopulmonary resuscitation. The training shall also include written materials on the topics
covered by the training. According to the author's office, the training is intended to include
hands-on experience in administering naloxone.
Writing in support of the bill, the Drug Policy Alliance states, "Naloxone is non-narcotic, does
not produce intoxication, and has no potential for addiction or abuse… Public health experts
agree that increasing access to naloxone is a key strategy in preventing drug overdose deaths.
The American Medical Association, the White House office of National Drug Control Policy, the
US Department of Justice, and the Director of the National Institutes of Drug Abuse, among
others, have called for expanded access to naloxone."
The California Teachers Association (CTA) is opposed to this bill. According to the CTA, the
organization has a long standing policy that the health and safety of children are best met through
the services of a credentialed nurse.
Analysis Prepared by: Sophia Kwong Kim / ED. / (916) 319-2087
FN: 0003017