Amended IN Assembly August 21, 2017 CALIFORNIA LEGISLATURE 20172018 REGULAR SESSION Assembly Joint Resolution No. 19Introduced by Assembly Member ArambulaJune 05, 2017Relative to opioid awareness and dependency prevention. LEGISLATIVE COUNSEL'S DIGESTAJR 19, as amended, Arambula. Opioid awareness and dependency prevention. prevention: patient-centered postsurgical care.This measure, the California Opioid Awareness and Dependency Prevention Access to Patient-Centered Postsurgical Care Resolution, would urge public and private health care payers, state and federal regulators, agencies, and departments, the President of the United States, and the Congress of the United States to support physician and surgeon choice of treatment to prevent opioid dependency and would urge the President of the United States and the Congress of the United States to move forward with legislation to establish multimodal therapy guidelines for managing postsurgical acute pain.Digest Key Fiscal Committee: NO Bill TextWHEREAS, Opioid dependency has become a health care epidemic in California and the United States of America; and WHEREAS, The National Academy of Medicine notes an increase in pain prevalence and assumes an increase in chronic pain, due in part to the risks associated with undermanaged acute postsurgical pain that may evolve into chronic pain; andWHEREAS, Most chronic pain problems begin with an acute nociceptive pain episode. In these instances, pain is usually a symptomatic reflection of an underlying disorder or injury. Prompt, effective, and appropriate management is essential, however, when acute pain does not resolve, as it may be associated with a serious disease, condition, or injury that may evolve into chronic pain; andWHEREAS, Current pharmaceutical-based treatments for pain commonly rely on two classes of drugs: opioids and nonsteroidal anti-inflammatory drugs. Both have side effects and risk of serious complications; andWHEREAS, Opioid misuse is a national epidemic in the United States, according to the federal Centers for Disease Control and Prevention; andWHEREAS, According to the Journal of Pain & Palliative Care Pharmacotherapy, 95 percent of postsurgical patients receive an opioid, expanding the effects of opioid dependency on socioeconomic stress and the overall cost of treatment and care; and opioid; andWHEREAS, Peer-reviewed survey results in Anesthesia & Analgesia and JAMA Internal Medicine state that one in 15 surgical patients becomes a chronic opioid user after his or her procedure, and each day, 46 people in the United States die from an overdose of prescription pain killers; andWHEREAS, According to Hospital Pharmacy, with over 70 million surgical procedures performed annually in the United States, if one in 15 surgical patients becomes dependent on opioids after surgery, then approximately four million people annually will need care. Strategies for helping patients achieve pain relief and minimize use of opioids such as Vicodin, OxyContin and Percocet are needed now more than ever; andWHEREAS, In 2013, there were 230 million prescriptions for opioids, according to data from IMS Health; andWHEREAS, In March 2016, April 2017, the Annals of Surgery journal noted that after common surgical procedures, a recent study found only 28.7 percent of the pills that were prescribed were taken; 90 percent of patients had received opioid pills with a range of zero prescribed amounts up to 120 pills; and in dental procedures, 54 percent of patients had leftover pills after surgical tooth extraction extraction, and there are after such extractions an estimated 100 million unused medications as stated by the Drug and Alcohol Dependence; Dependence journal; andWHEREAS, According to a study published by the Oxford University Press in 2014, dependency on these opioid medications has risen sharply, with patients given opioids within seven days of discharge being almost 50 percent more likely to still be on them one year after surgery and opioid-related adverse drug events being the most common postdischarge complication; andWHEREAS, As acknowledged in a recent FAIR Health, Inc. white paper entitled The Impact of the Opioid Crisis on the Healthcare System, health insurers spent $446 million on opioid treatment in 2015, and health insurers have seen their payments to hospitals, laboratories, treatment centers, and other providers skyrocket 1,375 percent from 2011 to 2015 for patients diagnosed with an opioid dependence or opioid abuse disorder, and health insurers also saw treatment costs rise from $32 million to $446 million over the same period, with the average yearly cost per patient rising from $3,435 to over $19,000 to battle opioid dependence; andWHEREAS, The cost of opioid misuse and abuse has risen from $55.7 billion in 2007 to $78.5 billion in 2013 as reported by Medical Care in 2016; andWHEREAS, According to a Substance Abuse and Mental Health Services Administration survey, approximately 70 percent of people who misuse opioids report obtaining them from family, friends, or on the street, stressing the need to address unused opioids; and WHEREAS, Multimodal pain control is the use of different medications that control pain at different receptor sites in the body, beginning with local anesthetics, and this strategy reserves the use of opioid medications for breakthrough pain; andWHEREAS, The National Pain Strategy, released by the United States Department of Health and Human Services in 2016, made recommendations for improving overall pain care in the United States, including supporting the development of a system of patient-centered integrated pain management practices based on a biopsychosocial model of care that enables providers and patients to access the full spectrum of pain treatment options, such as comprehensive, multimodal pain management approaches; and WHEREAS, The Joint Commission recommends an individualized, multimodal treatment plan should be used to manage pain upon assessment, and the best approach may be to start with a nonnarcotic; andWHEREAS, The United States federal Centers for Disease Control and Prevention recommends that health care providers should only use opioids in carefully screened and monitored patients when nonopioid treatments are insufficient to manage pain; andWHEREAS, The American Society of Anesthesiologists recommends a multimodal approach to pain management, often beginning with a local anesthetic where appropriate; andWHEREAS, Patients undergoing a surgical intervention deserve to be educated that the use of opioids can lead to dependency and that all patients deserve to have open, unrestricted access to nonopioid alternative medications for their postsurgical pain; now, therefore, be itResolved by the Assembly and the Senate of the State of California, jointly, That the Legislature urges inclusion of medications like liposomals, bupivacaine, intravenous acetaminophen and other nonopioid alternatives to hospital-based pain management formularies; and be it furtherWHEREAS, The National Pain Strategy envisions an environment where payment structures would encourage comprehensive, multimodal pain management care, and WHEREAS, The National Academy of Medicine recommends that reimbursement policies be revised to foster coordinated and evidence-based pain care with optimal care of the patient as the focus; andWHEREAS, The National Pain Strategy outlined steps to reduce barriers to pain care and improve the quality of pain care by increasing patient knowledge of treatment options and risks, and helping to develop a better informed health care workforce with regard to pain management, including risks of drug dependence and addiction; now, therefore, be itRESOLVED BY THE ASSEMBLY AND THE SENATE OF THE STATE OF CALIFORNIA, JOINTLY, That the Legislature urges hospital-based pain management formularies to consider the inclusion of a range of nonopioid alternatives; and be it furtherResolved, That the Legislature urges public and private health care payers, state and federal regulators, agencies, and departments, the President of the United States, and the Congress of the United States to support physician and surgeon choice of treatment to prevent opioid dependency; and be it furtherResolved, That the Legislature urges the President of the United States and the Congress of the United States to move forward with legislation to establish multimodal therapy guidelines for managing postsurgical acute pain; and be it furtherResolved, That this measure shall be known as the California Opioid Awareness and Dependency Prevention Access to Patient-Centered Postsurgical Care Resolution; and be it furtherResolved, That the Chief Clerk of the Assembly transmit copies of this resolution to the President and Vice President of the United States, to the Speaker of the House of Representatives, to the Minority Leader of the House of Representatives, to the Majority Leader of the Senate, to the Minority Leader of the Senate, and to each Senator and Representative from California in the Congress of the United States.
Amended IN Assembly August 21, 2017 CALIFORNIA LEGISLATURE 20172018 REGULAR SESSION Assembly Joint Resolution No. 19Introduced by Assembly Member ArambulaJune 05, 2017Relative to opioid awareness and dependency prevention. LEGISLATIVE COUNSEL'S DIGESTAJR 19, as amended, Arambula. Opioid awareness and dependency prevention. prevention: patient-centered postsurgical care.This measure, the California Opioid Awareness and Dependency Prevention Access to Patient-Centered Postsurgical Care Resolution, would urge public and private health care payers, state and federal regulators, agencies, and departments, the President of the United States, and the Congress of the United States to support physician and surgeon choice of treatment to prevent opioid dependency and would urge the President of the United States and the Congress of the United States to move forward with legislation to establish multimodal therapy guidelines for managing postsurgical acute pain.Digest Key Fiscal Committee: NO
Amended IN Assembly August 21, 2017
Amended IN Assembly August 21, 2017
CALIFORNIA LEGISLATURE 20172018 REGULAR SESSION
Assembly Joint Resolution No. 19
Introduced by Assembly Member ArambulaJune 05, 2017
Introduced by Assembly Member Arambula
June 05, 2017
Relative to opioid awareness and dependency prevention.
LEGISLATIVE COUNSEL'S DIGEST
## LEGISLATIVE COUNSEL'S DIGEST
AJR 19, as amended, Arambula. Opioid awareness and dependency prevention. prevention: patient-centered postsurgical care.
This measure, the California Opioid Awareness and Dependency Prevention Access to Patient-Centered Postsurgical Care Resolution, would urge public and private health care payers, state and federal regulators, agencies, and departments, the President of the United States, and the Congress of the United States to support physician and surgeon choice of treatment to prevent opioid dependency and would urge the President of the United States and the Congress of the United States to move forward with legislation to establish multimodal therapy guidelines for managing postsurgical acute pain.
This measure, the California Opioid Awareness and Dependency Prevention Access to Patient-Centered Postsurgical Care Resolution, would urge public and private health care payers, state and federal regulators, agencies, and departments, the President of the United States, and the Congress of the United States to support physician and surgeon choice of treatment to prevent opioid dependency and would urge the President of the United States and the Congress of the United States to move forward with legislation to establish multimodal therapy guidelines for managing postsurgical acute pain.
## Digest Key
## Bill Text
WHEREAS, Opioid dependency has become a health care epidemic in California and the United States of America; and
WHEREAS, The National Academy of Medicine notes an increase in pain prevalence and assumes an increase in chronic pain, due in part to the risks associated with undermanaged acute postsurgical pain that may evolve into chronic pain; and
WHEREAS, Most chronic pain problems begin with an acute nociceptive pain episode. In these instances, pain is usually a symptomatic reflection of an underlying disorder or injury. Prompt, effective, and appropriate management is essential, however, when acute pain does not resolve, as it may be associated with a serious disease, condition, or injury that may evolve into chronic pain; and
WHEREAS, Current pharmaceutical-based treatments for pain commonly rely on two classes of drugs: opioids and nonsteroidal anti-inflammatory drugs. Both have side effects and risk of serious complications; and
WHEREAS, Opioid misuse is a national epidemic in the United States, according to the federal Centers for Disease Control and Prevention; and
WHEREAS, According to the Journal of Pain & Palliative Care Pharmacotherapy, 95 percent of postsurgical patients receive an opioid, expanding the effects of opioid dependency on socioeconomic stress and the overall cost of treatment and care; and opioid; and
WHEREAS, Peer-reviewed survey results in Anesthesia & Analgesia and JAMA Internal Medicine state that one in 15 surgical patients becomes a chronic opioid user after his or her procedure, and each day, 46 people in the United States die from an overdose of prescription pain killers; and
WHEREAS, According to Hospital Pharmacy, with over 70 million surgical procedures performed annually in the United States, if one in 15 surgical patients becomes dependent on opioids after surgery, then approximately four million people annually will need care. Strategies for helping patients achieve pain relief and minimize use of opioids such as Vicodin, OxyContin and Percocet are needed now more than ever; and
WHEREAS, In 2013, there were 230 million prescriptions for opioids, according to data from IMS Health; and
WHEREAS, In March 2016, April 2017, the Annals of Surgery journal noted that after common surgical procedures, a recent study found only 28.7 percent of the pills that were prescribed were taken; 90 percent of patients had received opioid pills with a range of zero prescribed amounts up to 120 pills; and in dental procedures, 54 percent of patients had leftover pills after surgical tooth extraction extraction, and there are after such extractions an estimated 100 million unused medications as stated by the Drug and Alcohol Dependence; Dependence journal; and
WHEREAS, According to a study published by the Oxford University Press in 2014, dependency on these opioid medications has risen sharply, with patients given opioids within seven days of discharge being almost 50 percent more likely to still be on them one year after surgery and opioid-related adverse drug events being the most common postdischarge complication; and
WHEREAS, As acknowledged in a recent FAIR Health, Inc. white paper entitled The Impact of the Opioid Crisis on the Healthcare System, health insurers spent $446 million on opioid treatment in 2015, and health insurers have seen their payments to hospitals, laboratories, treatment centers, and other providers skyrocket 1,375 percent from 2011 to 2015 for patients diagnosed with an opioid dependence or opioid abuse disorder, and health insurers also saw treatment costs rise from $32 million to $446 million over the same period, with the average yearly cost per patient rising from $3,435 to over $19,000 to battle opioid dependence; and
WHEREAS, The cost of opioid misuse and abuse has risen from $55.7 billion in 2007 to $78.5 billion in 2013 as reported by Medical Care in 2016; and
WHEREAS, According to a Substance Abuse and Mental Health Services Administration survey, approximately 70 percent of people who misuse opioids report obtaining them from family, friends, or on the street, stressing the need to address unused opioids; and
WHEREAS, Multimodal pain control is the use of different medications that control pain at different receptor sites in the body, beginning with local anesthetics, and this strategy reserves the use of opioid medications for breakthrough pain; and
WHEREAS, The National Pain Strategy, released by the United States Department of Health and Human Services in 2016, made recommendations for improving overall pain care in the United States, including supporting the development of a system of patient-centered integrated pain management practices based on a biopsychosocial model of care that enables providers and patients to access the full spectrum of pain treatment options, such as comprehensive, multimodal pain management approaches; and
WHEREAS, The Joint Commission recommends an individualized, multimodal treatment plan should be used to manage pain upon assessment, and the best approach may be to start with a nonnarcotic; and
WHEREAS, The United States federal Centers for Disease Control and Prevention recommends that health care providers should only use opioids in carefully screened and monitored patients when nonopioid treatments are insufficient to manage pain; and
WHEREAS, The American Society of Anesthesiologists recommends a multimodal approach to pain management, often beginning with a local anesthetic where appropriate; and
WHEREAS, Patients undergoing a surgical intervention deserve to be educated that the use of opioids can lead to dependency and that all patients deserve to have open, unrestricted access to nonopioid alternative medications for their postsurgical pain; now, therefore, be it
Resolved by the Assembly and the Senate of the State of California, jointly, That the Legislature urges inclusion of medications like liposomals, bupivacaine, intravenous acetaminophen and other nonopioid alternatives to hospital-based pain management formularies; and be it further
WHEREAS, The National Pain Strategy envisions an environment where payment structures would encourage comprehensive, multimodal pain management care, and
WHEREAS, The National Academy of Medicine recommends that reimbursement policies be revised to foster coordinated and evidence-based pain care with optimal care of the patient as the focus; and
WHEREAS, The National Pain Strategy outlined steps to reduce barriers to pain care and improve the quality of pain care by increasing patient knowledge of treatment options and risks, and helping to develop a better informed health care workforce with regard to pain management, including risks of drug dependence and addiction; now, therefore, be it
RESOLVED BY THE ASSEMBLY AND THE SENATE OF THE STATE OF CALIFORNIA, JOINTLY, That the Legislature urges hospital-based pain management formularies to consider the inclusion of a range of nonopioid alternatives; and be it further
Resolved, That the Legislature urges public and private health care payers, state and federal regulators, agencies, and departments, the President of the United States, and the Congress of the United States to support physician and surgeon choice of treatment to prevent opioid dependency; and be it further
Resolved, That the Legislature urges the President of the United States and the Congress of the United States to move forward with legislation to establish multimodal therapy guidelines for managing postsurgical acute pain; and be it further
Resolved, That this measure shall be known as the California Opioid Awareness and Dependency Prevention Access to Patient-Centered Postsurgical Care Resolution; and be it further
Resolved, That the Chief Clerk of the Assembly transmit copies of this resolution to the President and Vice President of the United States, to the Speaker of the House of Representatives, to the Minority Leader of the House of Representatives, to the Majority Leader of the Senate, to the Minority Leader of the Senate, and to each Senator and Representative from California in the Congress of the United States.