GOOD MORNING EVERYONE THANK YOU
VERY MUCH FOR JOINING US HERE.
WITH RESPECT TO OUR SIMPLY
BUSINESS AND PROFESSIONS
COMMITTEE. OUR PERMISSION OR
HEARING A WHICH IS THE TITLE
CURES TO POINT OH. THE ON
ADVANCING TECHNOLOGY TO COMBAT
THE OAK YOU A CRISIS AND FOR
THOSE OF YOU WHO ARE NOT
FAMILIAR WITH THE TERMINOLOGY OF
CURIOUSITY REFERS TO THE
CONTROLLED SUBSTANCE UTILIZATION
REVIEW AND. EVALUATION SYSTEM.
OF THIS ALSO IS BEING TELEVISED
AND SO FOR THOSE OF YOU WHO ARE
WATCHING THANK YOU VERY MUCH FOR
JOINING US.
.
WE HAVE ALL HEARD ABOUT THE LOOK
YOU EIGHT EPIDEMIC AND THE
DEVASTATION ACROSS OF THE
COUNTRYWITH RESPECT TO. VARIOUS
LIVES IN CALIFORNIA IT MOST
CERTAINLY IS NO EXCEPTION NEARLY
TWO THOUSAND CALIFORNIANS.
A LOST THEIR LIVES TO A FEW
WEIGHTS IN A SINGLE YEAR AND
THAT WAS BACK IN TWO THOUSAND
AND SIXTEEN AND JUST WANT TO
MAKE A RECOGNITION OF THAT
NUMBERTWO THOUSAND CALIFORNIANS.
OUT WHO INDICATE THAT NOW WHEN
THEY GO TO SEE IT A DOCTOR
HEALTHCARE PROFESSIONAL THAT
THEY WOULD BE CURED OF SUCH
ELEMENTS WHEN IN FACT THEY
BECOME.
ADDICTED TO SUCH MEDICATIONS
AND THEN ULTIMATELY PASS AWAY.
ALSO TODAY WE'LL LEARN MORE
ABOUT THE CRISIS AND HOW MIGHT
BE ABLE TO STOP IT. ALLEN JOINED
BY NUMBER OF COLLEAGUES WHO WILL
BE JOINING US THROUGHOUT OF THIS
MORNING SO I THINK YOU FOR THAT
ACKNOWLEDGMENT.
WILL CEMENT TO MAKE IT KNOWN
THAT SEVERAL YEARS AGO THESE
THIS DATABASE WAS CONSIDERED A
FAILED TO STATE I T. PROJECT.
AND SO TODAY HOPEFULLY WE'LL
LEARN ABOUT THE UPGRADED SYSTEM
AND ITS SUCCESSES
FINALLY WE'LL HEAR FROM ACTUAL
HEALTH CARE PROFESSIONALS WHO
GIVE US.
OF THE REAL WORLD EXPERIENCES.
AS WELL AS EXPERTS ON
ALTERNATIVE NON OPIOID PAIN
MANAGEMENT OPTIONS.
ALSO WITH THAT IF YOU'LL. ALLOW
ME TO INTRODUCE OUR FIRST PANEL.
WHICH WOULD INCLUDE TWO HEALTH
EXPERTS TO PROVIDE AN OVERVIEW A
REVIEW OF THE.
OKAY WAIT CRISIS THE FIRST
PERSON AS DOCTOR KAREN SMITH
DIRECTOR OF THE CALIFORNIA
DEPARTMENT OF PUBLIC HEALTH.
AND STATE PUBLIC HEALTH OFFICER
AND THE SECOND INDIVIDUAL IS DR
KELLY PFEIFFER DID A DIRECTOR AT
THE CALIFORNIA HEALTHCARE
FOUNDATION.
AND THANK YOU VERY MUCH FOR
JOINING US AND PLEASE WHENEVER
YOU'RE READY.
GOOD MORNING THANK YOU VERY MUCH
GOOD MORNING CHAIR MEMBERS I'M
DOCTOR KAREN SMITH THE STATE
PUBLIC HEALTH OFFICER IN THE
DIRECTOR THE CALIFORNIA
DEPARTMENT OF PUBLIC HEALTH.
THANK YOU FOR THE OPPORTUNITY TO
SPEAK WITH YOU TODAY.
WITH NEARLY TWO THOUSAND OPIOID
OVERDOSE DEATHS PER YEAR SEVENTY
PERCENT OF WHICH ARE DUE TO
PRESCRIPTION OPIOIDS. AND
ANOTHER APPROXIMATELY EIGHT
THOUSAND HOSPITAL EMERGENCY
DEPARTMENT ADMISSIONS.
AND NEARLY TWENTY FOUR MILLION
PRESCRIPTIONS WRITTEN CALIFORNIA
CONTINUES TO FACE A SERIOUS
PUBLIC HEALTH CRISIS.
EVEN THOUGH OUR OVERALL RATES OF
OPIOID DUSTIN OVERDOSES ARE
LOWER THAN THE NATIONAL AVERAGE
THE HEALTH AND ECONOMIC BURDEN
IS SUBSTANTIAL.
BECAUSE OF THE ABSOLUTE
MAGNITUDE OF THE PROBLEM OWN
MIND CALIFORNIA'S FORTY MILLION
PEOPLE.
THERE IS ALSO WIDE VARIATION
GEOGRAPHICALLY FROM TO AND FROM
COUNTY TO COUNTY WITH SOME
COUNTIES OVERDOSE RATES HIGHER
THAN THE NATIONAL AVERAGE. AND
SOME COUNTIES ARE ARE HAVE DEATH
RATES AS HIGH AS THOSE IN THE
HEART OF THE HARDEST HIT STATES
IN THE COUNTRY.
THE STATE OF CALIFORNIA IS
APPROACHING THIS THROUGH
LEVERAGING A MULTI SECTOR
STRATEGIC COLLABORATION AT BOTH
THE STATE AND LOCAL LEVELS. TO
BUILD A COMPREHENSIVE APPROACH
TO ADDRESS THIS EPIDEMIC.
THAT APPROACH INCLUDES
COORDINATION OF EFFORTS THROUGH
THE STATE WIDE MULTI AGENCY
WORKING GROUP.
CHANGES IN POLICIES OF PUBLIC
PAYER HEALTHCARE SYSTEMS NEW
LEGISLATION MANDATING THE USE A
PRESCRIPTION DRUG MONITORING
PROGRAM. AND CREATING A ONE TIME
THE LOCKS AND DISTRIBUTION
PROJECT.
ALSO CHANGES IT TO REGULATIONS
TO INCREASE ACCESS TO NALOXONE
THROUGH PHARMACIES.
PHYSICIAN AND PHARMACIST
EDUCATION DEVELOPMENT OF PUBLIC
AWARENESS AND EDUCATION
CAMPAIGNS FOR YOUTH AND HIGH
BURDEN COUNTIES. AND SUPPORTING
TWENTY FIVE LOCAL SAFETY OPIOID
SAFETY COALITIONS.
THE FOUNDATION OF OUR
SUSTAINABLE APPROACH IS A COMMON
AGENDA SHARED MEASURES OF
PROGRESS AND ALIGNED ACTIVITIES
TOWARD COMMON SET OF GOALS THIS
IS CLASSIC A COLLECTIVE IMPACT
APPROACH.
WE HAVE SEVEN BROAD STRATEGIES
THAT WE ARE PURSUING
SIMULTANEOUSLY. CREATING A
COLLABORATIVE STATEWIDE OPIOID
SAFETY WORK GROUP PROMOTING SAFE
PRESCRIBING PRACTICES AND
POLICIES.
BUILDING COMMUNITY CAPACITY TO
RESPOND ON A LOCAL LEVEL.
PROMOTING EXPANSION OF MEDICALLY
ASSISTED TREATMENT.
SUPPORTING NALOXONE AVAILABILITY
DISTRIBUTION AND USE CONDUCTING
PUBLIC EDUCATION CAMPAIGNS TO
INCREASE CONSUMER AND PATIENT
AWARENESS. AND TRANSLATING DATA
INTO ACTIONABLE INFORMATION.
PROMOTING SAFE PRESCRIBING
PRACTICES.
WE ARE WORKING WITH HEALTH
PLANS AND PAYERS TO STOP
UNNECESSARY STARTS OF OPIOID
PRESCRIPTIONS.
BY THROUGH POLICIES THAT PROMOTE
ALTERNATIVES TO OPIOIDS
WE'RE HELPING PHYSICIANS AND
OTHER CLINICIANS MANAGE ACUTE
AND CHRONIC PAIN MORE
CAUTIOUSLY.
STARTING WITH LOWER DOSES AND
NO OPIOID AND BENZODIAZEPINE
COMBINATIONS WHICH OR
PARTICULARLY DANGEROUS.
AND REDUCING THE LEVEL OF
OPIATES THAT ARE PROVIDED WHITE
TAPE HELPING TO RUN THEM HAVE
RESOURCES TO TAPER OFF PATIENTS
WHO ARE ON HIGH AND INTERSTICES.
MORE MEDICATION ASSISTED
TREATMENT SERVICES ARE NEEDED
ESPECIALLY IN THE RURAL AREAS OF
CALIFORNIA AND WE NEED TO
PROMOTE ALL FORMS OF MEDICALLY
ASSISTED TREATMENT.
TOM BETTER EVIDENCE BASED IN
MULTIPLE SIGHTINGS AND FOR
MULTIPLE POPULATIONS INTEGRATING
BEHAVIORAL HEALTH INTO PRIMARY
CARE. ADDRESSING THE IT THE
ISSUE IN PRISONS AND JAILS.
ADDRESSING PREGNANT WOMEN AND
OTHER VULNERABLE POPULATIONS IN
PARTICULAR.
THE DEPARTMENT HEALTH CARE
SERVICES SUBSTANCE USE DISORDER
COMPLIANCE DIVISION. HAS
RECEIVED TO YEARS OF FEDERAL
FUNDING TO INCREASE MEDICALLY
ASSISTED THERE IN CALIFORNIA
EFFORTS THAT WILL NEED NEED TO
BE SUSTAINED OVER TIME.
THROUGH THESE COORDINATE EFFORTS
WE ARE MAKING PROGRESS.
PRESCRIPTION OPIOID RELATED
OVERDOSE DEATHS PEAKED IN TWO
THOUSAND NINE AND WE'VE SEEN A
FIFTEEN PERCENT DECREASE BY
TWENTY SIXTEEN. PRICE SEVENTEEN
DAVIS CURRENTLY BEING ANALYZED.
HOWEVER AT THE SAME TIME THAT
WE'RE BENDING THE CURVE FOR
HEROIN RELATED OVERDOSES AT
OVERSEE OVERDOSE DEATHS
INCREASED BY FIFTY SEVEN
PERCENT.
FROM TWENTY TWELVE TO TWENTY
SIXTEEN AND HEROIN RELATED
EMERGENCY DEPARTMENT VISITS
INCREASED A HUNDRE AND FORTY
PERCENT.
FROM TWENTY TEN TO TWENTY
FIFTEEN.
FEDERAL DASAM ALSO BEGUN TO
DRAMATICALLY INCREASE THE LAST
TWO YEARS.
THIS IS A VERY DYNAMIC EPIDEMIC
EVEN AS WE ARE BEGINNING TO BEND
THE CURVE AND MAKE PROGRESS
AGAINST PRESCRIPTION OPIOIDS.
USING THIS MULTI SECTOR APPROACH
THE EPIDEMIC IS TRANSITIONING
TOWARD MORE ILLICIT DRUG USE
INCLUDING HEROIN AND THE MOST
DANGEROUS FENTANYL.
ULTIMATELY THIS EPIDEMIC
REQUIRES PREVENTION STRATEGIES
UPSTREAM OF CLINICIAN
PRESCRIBERS AND PATIENTS
INCLUDING EXPANDING HEALTH PAYER
AND PROVIDER REGULATORY AND
POLICY OPTIONS WHICH READILY
MORE READILY AND. BROADLY
INFLUENCE PRESCRIBING BEHAVIOR
AND STOP NEW ADDICTIVE STARTS
WHILE ALSO WORKING WITH
COMMUNITIES TO DEVELOP LOCAL
APPROACHES TAILORED TO THEIR
COMMUNITIES.
UP TO DECREASE AND TO YOU CHRIS
THE STIGMA OF ADDICTION.
IF MEDICALLY ASSISTED THERAPY IS
AVAILABLE BUT THERE'S STILL HIGH
STIGMA TO BEING ADDICTED THAN
PEOPLE ARE NOT GOING TO BE
WILLING TO TAKE ADVANTAGE OF
THOSE RESOURCES WE NEED TO DO
BOTH OF THESE.
THE DEPARTMENT OF JUSTICE AND
SPECIFICALLY THE CONTROLLED
SUBSTANCE UTILIZATION REVIEW AND
EVALUATION SYSTEM LAST TIME I'M
GOING TO SAY THAT OUT LOUD.
CURES.
PROGRAM STAFF WERE FOUNDING
MEMBERS OF OUR STATEWIDE HOPE
YOU AID SAFETY WORK GROUP AND
HAVE BEEN STRONG PARTNERS ON
BOTH THE EXECUTIVE COMMITTEE AND
THERE AND ON SEVERAL OF THE WORK
GROUPS TASK FORCES. INCIDENT
TALK THIS IS AND.
REALLY I THINK ONE OF THE MOST
IMPORTANT THINGS ABOUT THE WAY
THAT WE'RE APPROACHING THIS
EPIDEMIC IS THE DEGREE TO WHICH
AGENCIES ACROSS THE THE
ADMINISTRATION ARE WORKING
TOGETHER AND WORKING WITH LOCAL
HEALTH JURISDICTIONS.
IT'S REALLY UNPRECEDENTED IN MY
EXPERIENCE AND GOVERNMENTAL
PUBLIC HEALTH AND IT SHOWING
RESULTS.
I WANTED TO SPEAK SPECIFICALLY
ABOUT THE DEPARTMENT OF JUSTICE
BECAUSE WE ARE TALKING ABOUT THE
CURE SYSTEM AND ITS VITAL
IMPORTANCE.
TO DOJ PROVIDED DATA EARLY ON TO
CD PH TO HELP DEFINE THE NATURE
IN THE SCOPE OF THE PROBLEM AS
WE BEGAN OUR WORK.
SEPIA XIN DOJ ALSO WORKED
JOINTLY ON SUCCESSFUL GRANT
APPLICATIONS BOTH FROM THE
BUREAU OF JUSTICE ASSISTANCE AND
THE CENTERS FOR DISEASE CONTROL.
DOJ'S PROVIDED SECURITY ACCESS
TO CURES TWO POINT OH DATA FOR
TRACKING REGISTRATION AND USAGE
OF DISPENSING RECORDS AND THEY
HAVE DISSEMINATED THAT DATA TO
LOCAL HEALTH DEPARTMENTS AND
OPIATE SAFETY COALITIONS ACROSS
THE STATE. THEY CONTRIBUTE DATA
TO OUR.
CALIFORNIA OPIOID SURVEILLANCE
STASH BOARD WHICH I'LL MENTION
OF MORE IN A MINUTE.
TOGETHER CDP AGE DOJ AND THE
UNIVERSITY OF CALIFORNIA DAVIS
MEDICAL CENTER OF CO AUTHORED A
P. A PAPER ON CALIFORNIA
PHYSICIAN PHARMACISTS ATTITUDES
AND KNOWLEDGE OF CURES TO PLANO.
WHICH IS BEEN ACCEPTED FOR
PUBLICATION BY THE AMERICAN
JOURNAL OF PREVENTIVE MEDICINE.
DOJ'S BEEN INSTRUMENTAL IN
PROMOTING SAFE PRESCRIBING
GUIDELINES BOTH THOSE WRITTEN BY
THE CALIFORNIA MEDICAL BOARD.
AND THE CDC AS WELL AS POSTING
ARE LETTER TO THE DOOR SEEPAGE
STRUCTURES LETTER TO PRESCRIBERS
INFORMING THEM OF THE RESOURCES
THAT ARE AVAILABLE THAT TO THEM
TO HELP MANAGE THEIR. PATIENTS
WITH OPIATE ADDICTION.
DOJ'S POLICY INITIATIVES ARE
ALIGNED ENTIRELY WITH CD PEACHES
SAFE PRESCRIBING APPROACH TO
ADDRESSING THE EPIDEMIC.
AND CITY PIGEON DOJ HAVE MADE
DRAPERIES INTUITIONS AT NUMEROUS
OPIATE CONFERENCES AND SUMMITS
HELD DURING THE LAST TWO PLUS
YEARS. TO EDUCATE AND ADDRESS IF
YOU WOULD ISSUES.
DOJ CONTINUES TO PROVIDE
TECHNICAL ASSISTANCE FOR THE
CURES TO PLANO DATA ISSUES AND
PARTICIPATES ON THE WORK FORCES
DATA TASK FORCE.
AS WE TRY TO REALLY BE SURE WE
BRING ALL THE RELEVANT DATA
SOURCES TOGETHER.
CITY PAHS PRESCRIPTION DRUG
OVERDOSE PREVENTION INITIATIVE
WHICH IS FUNDED BY THE CDC IS
PLANNING TO PROVIDE FUNDS TO
ASSIST IN IMPLEMENTING DOJ'S
CURES TO POINT NO INTER
OPERABILITY PROJECTS WHICH WILL
INTEGRATE CURES INTO ELECTRONIC
HEALTH RECORDS. AND SYSTEMS AS
AUTHORIZED BY AB FORTY.
ONE OF MOST IMPORTANT PILLARS TO
OUR STATE WIDE COLLECTIVE ACTION
IS A CONCERTED EFFORT TO
TRANSLATE DATA INTO ACTIONABLE
INFORMATION.
THE DOJ CURE SYSTEM IS AT THE
HEART OF THIS OFFER.
CURES MAKES BOTH CONTROLLED DRUG
PRESCRIBING AND DISPENSING DATA
AVAILABLE.
BOTH TO NOT JUST TO REGULATORY
LAW ENFORCEMENT WHICH IS
CRITICAL FORCES.
.
DECREASING DIVERSION AND MISUSE
BUT ALSO TO CLINICIANS WHO THEY
CAN MAKE MAKE BETTER CLINICAL
DECISION MAKING.
PICTURES THERE'S ALSO USED BY
THE PUBLIC HEALTH COMMUNITY AND
OTHER STAKEHOLDERS BOTH AT THE
STATE AND AT THE LOCAL LEVEL TO
INFORM THEIR.
THEIR ACTIVITIES RELATED TO
COMBATING THE OPIOID EPIDEMIC
AND TO MONITOR OUR PROGRESS.
YOUR STATE IS A MAJOR SOURCE OF
DATA FOR THE CALIFORNIA OPIOID
OVER DORSET VALENCE DASHBOARD
NATIONALLY RECOGNIZED PUBLICLY
ACCESSIBLE ONLINE DASHBOARD.
DEVELOPED AND CURATED BY CDP AGE
WOULD HAVE PROVIDED YOU WITH
JUST USER SCREENSHOTS FOR WHAT
IS A VERY STATIC SCREENSHOTS OF
A VERY INTERACTIVE.
DATA SYSTEM THAT ALLOWS YOU TO
DRILL DOWN TO A VERY LOW LEVELS
OF.
GRANULARITY ON DATA IN LOCAL
COMMUNITIES.
THE DASHBOARD PROVIDES ENHANCED
DATA VISUALIZATION AND
INTEGRATION OF STATEWIDE AND
GEOGRAPHICALLY SPECIFIC. OPIOID
INVOLVED OVERDOSES DEATHS AND
PRESCRIPTION DATA.
THE DASHBOARD PROVIDES TIMELY
AND ACTIONABLE DATA FOR USE BY
STATE POLICYMAKERS LOCAL OPIOID
SAFETY COALITIONS THE MEDIA.
OTHER STAKEHOLDERS IN THE
COMMUNITY AND THE PUBLIC.
CITY PH STAFF PROVIDES TECHNICAL
ASSISTANCE TO LOCAL
JURISDICTIONS IN COALITIONS ON
HOW TO USE THE DASHBOARD AND ITS
DATA AND WE'VE ACTUALLY PROVIDED
TECHNICAL ASSISTANCE TO MULTIPLE
STATES ON HOW TO BUILD OR
IMPROVE THEIR OWN DASHBOARDS.
SO IN SUMMARY THE CURE SYSTEM
PROVIDES VITAL DATA THAT HELPS
LAW ENFORCEMENT DECREASED ABOUT
DRUG DIVERSION IMPROVES CLINICAL
DECISION MAKING AND INCREASES
REFERRALS TO INDUCTION THERAPY.
AND PROVIDES DATA THAT THE
PUBLIC HEALTH COMMUNITY AND OUR
PARTNERS IS TRANSLATING INTO
ACTIONS THAT ARE ACTUALLY HAVING
A POSITIVE IMPACT IN DECREASING
OPIOID RELATED OVERDOSES AND
DEATHS IN CALIFORNIA.
THANK YOU VERY MUCH FOR THE
OPPORTUNITY.
IT ANSWERING QUESTIONS.
YEAH.
WOULD YOU LIKE TO PAUSE FOR
QUESTIONS NOW. SHAKEN PROCEED
THE PLEASE JUST GO AHEAD AND.
PRISON THAT THEN I'M SURE MANY
OF MY COLLEAGUES WOULD HAVE
ADDITION.
BUT THANK YOU TO US I REMEMBER
THE FOR THE INVITATION IT'S AN
HONOR TO BE HERE MY NAME IS
KELLY PAY FOR MY FAMILY DOCTOR
NAY WERE THE CALIFORNIA
HEALTHCARE FOUNDATION AND. I'M
HOPING TO BUILD ON DOCTORS
MISREPRESENTATION TO PROVIDE AN
OVERVIEW OF THE EPIDEMIC IN
CALIFORNIA.
AND I'VE ALWAYS FOUND THE STAT
NEWS. ARTICLE VERY COMPELLING
BECAUSE YOU CAN SEE THE FACES OF
THE EPIDEMIC AND WHEN YOU LOOK
AT THESE FACES IS JUST STRIKING
HOW YOUNG THEY ARE BECAUSE
ALTHOUGH ALCOHOL AND TOBACCO
KILL FAR MORE PEOPLE.
THEY'RE UNLIKELY TO KILL YOU IN
YOUR SLEEP TONIGHT AND THAT'S
ONE OF THE TRAGEDIES OF THE
OPIATE EPIDEMIC IS KILLS PEOPLE
YOUNG IT KILLS PEOPLE SUDDENLY.
AND A FAMILY DOCTOR AND I WAS
TRAINED IN THE AREA. WHERE WE
THOUGHT WE ARE HELPING PEOPLE BY
GIVING OPIOIDS TO? CONDITIONS WE
NEVER GIVE UP UNITS AT DOSES
THAT WERE PREVIOUSLY SEEN ONLY
IN HOSPICE AND LIKE MANY OF MY
COLLEAGUES I GOT A WAKE UP CALL.
WHEN I GOT A CALL FROM A CORNER
OF A YOUNG WOMAN WHO DIED OF MY
PILSENER HAND AGAIN THINKING
THAT I WAS BEING HELPFUL ONLY
ENDING IN HARM.
SO WHEN WE LOOK AT HOW
CALIFORNIA IS DOING COMPARED TO
THE REST OF THE U. S. IT CAN BE
EASY TO BE FALSELY REASSURING
BECAUSE THE REST OF THE U. S.
THERE.
WITH.
OVERDOSE RATE IS TWICE ALMOST
TWICE OURS AND WHEN WE LOOK AT
THE RATE OF INCREASE LAST YEAR
THEY THE U. S. INCREASED BY
TWENTY ONE PERCENT WERE ARE.
OVERDOSE RATES HAVE BEEN FAIRLY
STABLE AND I DO THINK IT'S A
CREDIT TO DOCTOR SMITH ON THE
WORK THAT WE'VE BEEN DOING
STATEWIDE OVER THE LAST FEW
YEARS. TO INCREASE ACCESS TO
TREATMENT AND CHANGE PRESCRIBING
HOWEVER IT'S.
IT'S SOME REALLY IMPORTANT NOT
TO JUST FOCUS ON THE CLIFORNIA
AVERAGE BECAUSE HALF OF
CALIFORNIANS LIVE SOUTH OF THE
BURBANK AIRPORT AND SO THE.
AVERAGE CALIFORNIAN IS REALLY
STORY OF SOUTHERN CALIFORNIA.
WHERE THE NUMBERS ARE MUCH
HIGHER THAT THE RATES ARE LOWER
SYSTEM POINT TO LOOK AT THE
VARIATION IN CALIFORNIA AND
THESE? GRAPHS COME FROM THE DASH
FOR THE DOCTOR SMITH REFERENCE
WHERE WE CAN SEE PARTS OF OUR
STATE OURS HARD HIT IS KENTUCKY
IN OTHER AREAS. OF THE COUNTRY
THAT YOU SEE IN THE NEWS ALL THE
TIME.
AND IT'S IMPORTANT UNDERSTAND
THE COMPLEXITY OF HOW WE GOT
INTO THIS PREDICAMENT BECAUSE
THERE'S GONNA BE NO YOU KNOW APT
TO SOLVE THE OPIATE EPIDEMIC WAS
THIS COMPLEX TO GET HERE IS
COMPLEX TO GET OUT OF HERE OUT
OF IT. CLEARLY OPIOID
PRESCRIBING DROVE A BIG PIECE OF
IT BECAUSE THE MORE WE DOCTORS
PRESCRIBE THE HIGHER THE DEATH
RATE.
BUT AS A AS DR SMITH SAID MORE
AND MORE OF THIS IS BECOMING AN
ILLICIT DRUG PROBLEM THAT LAW
ENFORCEMENT CAN'T POSSIBLY KEEP
UP WITH. BECAUSE YOU CAN GET FAT
NOW IN A PILL PRESS ONLINE FOR
TWO THOUSAND DOLLARS AND PUSH
OUT COUNTERFEIT PILLS AND SEND
YOUR CHECK THAT ONE DOWN TEN
MORE POP ABSOLUTE VERY CLEAR
THAT IF WE'RE GONNA STOP THIS
EPIDEMIC. WE HAVE TO MAKE
TREATMENT EASIER TO GET THAN
HEROIN AND THAT NO.
AND WHEN YOU LOOK AT THIS MAP
FROM A COUPLE YEARS AGO THE RED
AREAS ARE PLACES WITH NO OPI
TREATMENT PROGRAMS. AND IF YOU
REMEMBER THE OTHER MAPS THAT
THOSE OF THE SAME AREAS WITH THE
HIGH DEATH RATES AND SO THIS IS.
WHAT WORKED SYSTEMATICALLY
TACKLING IN CALIFORNIA TO FILL
THOSE RED AREAS OF OUR STATE
WITH TREATMENT ACCESS?
AND IT'S ALSO WORTH MENTIONING
THAT THIS IS.
WITH CALLED AN EPIDEMIC OF
DESPAIR BECAUSE THERE'S MANY
SOCIAL AND COMMUNITY FACTOR
DRIVING PEOPLE THE OPIATE
ADDICTION IF YOU HAVE IT READ
DREAMLAND THAT'S A FASCINATING.
STORY OF AND UNDERSTANDING HOW
THIS ALL CAME TOGETHER IN SOME
OF THE.
LOTS OF THE SOCIAL SAFETY NET
AND SOCIAL NETWORKS THAT HAVE
HAVE CREATED SOME OF THE
PROBLEMS IN RURAL PARTS OF OUR
STATE.
SO AS DR SMITH MENTIONED THERE
THERE'S EVIDENCE TO SUPPORT FOUR
MAJOR PARTS TO COMBAT THE OPIATE
EPIDEMIC AND WE'RE WORKING ON
ALL FOUR ACROSS CALIFORNIA.
LIFTER PREVENT A NEW GENERATION
OF PEOPLE FROM BECOMING
DEPENDENT.
CORD ADDICTED TO THOSE DRUGS AS
WORKAROUND PREVENTION WE HAVE
JUST MORE SAFELY MANAGE CHRONIC
PAIN WE'RE CERTAINLY SEEING A
BACKLASH WHERE PEOPLE THAT WE
DOCTORS HAVE MADE DEPENDED ON
THESE OPIOIDS.
SUDDENLY LOSE ACT ACCESS BECAUSE
DOCTORS SAY CAN'T DO IT ANYMORE
NOT TO PRESCRIBE OPIOIDS AT ALL
AND THAT'S.
CREATES A DANGER BOTH FOR THE
PEOPLE WHO ARE DEPENDENT ON
OPIOIDS AND ALSO FOR PEOPLE ON
PALETTE OF CARE HOSPICE WHO NEED
ACCESS.
SO WE HAVE TO FOCUS ON THOSE WHO
ARE HIGHEST RISK AND HELP THEM
GET TO SEE PRODUCES AND NOT LACK
ACCESS FOR ALL.
WE HAVE TO TREAT MEDIC.
ADDICTION EFFECTIVELY AND IT'S
QUITE CLEAR THAT IN OPIOIDS. ON
OPIATE ADDICTION MEDICATIONS AND
BEHAVIORAL HEALTH IS CRITICAL
BECAUSE WITHOUT MEDICATIONS THE
OVERDOSE RATE DOUBLED OR EVEN
TRIPLED.
AND FINALLY WE HAVE TO STOP OVER
DOES DOES UNTIL WE CAN DEAL WITH
THE SUPPLY PROBLEM IN THE DEMAND
PROBLEM THROUGH IT TREATMENT WE
HAVE TO MAKE SURE USING HARM
REDUCTION. LIKE NALOXONE AGAIN
DOCTOR SMITH MENTIONED IS IN THE
OVERDOSE ANTIDOTES TO HELP SAVE
LIVES AND PEOPLE ACCIDENTALLY
OVERDOSED.
SO JUST A QUICK SNAPSHOT ON HOW
WE'RE DOING IN EACH OF THOSE
FRONTS WHEN YOU LOOK AT OUR
PREVENTION EFFORTS ARE TOTAL NET
AMOUNT OF OPIATES WE PRESCRIBE
HAS BEEN DROPPING OVER THE LAST
FEW YEARS. ARE HIGH DOSE
PRESCRIPTIONS MEANING PEOPLE WHO
ARE TAKING THE EQUIVALENT OF
TWENTY NOR CAL A DAY.
WHICH CAN BE A TEENY LITTLE
PILL AND I THINK ONE OF THINGS
THAT PEOPLE. DON'T UNDERSTAND IS
AN TINY OXYCONTIN TABLET EIGHTY
MILLIGRAMS A TO SMALLER THAN IT
THEN AND BABY ASPIRIN. IS THE
EQUIVALENT OF TWENTY FOUR NERVE
CHO AND AGAIN THAT'S WHY.
NGUYEN THEN AMOUNT OF
PRESCRIBING HAS BEEN SO HIGH
BECAUSE A SMALL PILLS JUST THAT
POTENT. BUT AGAIN WE'RE DOING
BETTER WITH THE NUMBER OF PEOPLE
ON HIGH DOSE DROPPING.
I TREAT EM ALTHOUGH
BUPRENORPHINE OR SUBOXONE YOU'VE
HEARD IS A IS A VERY COMMON
TREATMENT FOR OPIATE ADDICTION
IT'S OUT THE ONLY TREATMENT BUT
IT'S THE ONE THAT WE CAN TRACK
IN CARRIERS IN THE DATABASE AND
WE USE IT AS A MARKER FOR HOW
WE'RE DOING WITH ADDICTION
TREATMENT. ACCESS AND WE'RE
GETTING BETTER AS WELL BUT AGAIN
THIS IS WE CAN'T REST BECAUSE
OUR OVERDOSE DEATHS HAVE NOT
DROPPED.
THAT KNOWN HEROINES GOING UP IN
SOME VERY FEARFUL OF WHAT WE'RE
GONNA SEE NEXT YEAR.
UNLESS WE REALLY.
DO BETTER WITH TREATMENT.
SO JUST A QUICK WORD ABOUT
TREATMENT BECAUSE IT'S IT'S VERY
DIFFICULT I THINK IF YOU'RE NOT
MEDICINE UNDERSTAND WHY ON EARTH
WOULD YOU REPLACE A DRUG WITH A
DRUG AND IT'S IMPORTANT
UNDERSTAND WHAT HAPPENS TO THE
BRAIN WITH LONG TERM OPIOID
ADDICTION. THE PART OF MY BRAIN.
CALL THE DOPAMINE ACCESS THAT
REGULATES.
HOW WE CONNECT WITH OTHERS HOW
WE DO THINGS THAT ARE DIFFICULT?
HOW WE ORGANIZE OURSELVES THAT
GETS BROKEN AND OPIATE ADDICTION
AND THE EXPERIENCE OF BEING AN
ADDICT IS DATED DAY CHAOS AND
SURVIVAL OF?
DOING EVERYTHING YOU CAN NOT TO
FEEL LIKE YOU'RE GONNA DIE WHICH
IS WHAT DOPES THAT MEANS IF YOU
FEEL LIKE YOU'RE GONNA DIE
EVERYTHING. HURTS YOU CAN'T
FOCUS AND BUT WHEN YOU GET ON A
LOT OF THESE MEDICATIONS WHICH
STABILIZE BRAIN CHEMISTRY. THAT
ALLOWS PEOPLE TO THINK PLAN BOND
WITH OTHERS AND PARTICIPATE
RECOVERY. IT'S ALSO IMPORTANT TO
KNOW THAT THEIR THREE
MEDICATIONS THAT ARE APPROVED
FOR OPIOID ADDICTION BUT THEY'RE
VERY DIFFERENT.
NASDAQ DISMISSIVELY CAN'T A ONE
SIZE FITS. ALL APPROACH BECAUSE
WE KNOW THE METHADONE DEEPEN OUR
FEET HAVE BOTH PROVEN TO DROP
DEATH RATES IN HALF WERE BY EVEN
TWO THIRDS.
NOW TRACKS OWN WORKS WONDERFULLY
I USE OFTEN HECKLED HIM THE
TRIAL AND IN SUB POPULATIONS
LIKE PEOPLE WITH LICENSES LIKE
HEALTHCARE PROVIDERS AND PILOTS
AND DOCTORS.
BUT THEY IT'S VERY DIFFICULT TO
GET ON AND ON THE FOURTH OF
PEOPLE DROP OFF BEFORE THEY CAN
EVEN GET ON IN THE TO TWELVE
MONTHS SUCCESS RATE IS QUITE
LOW.
SO EVEN OF THIS BEEN A LOT OF
PRESS ABOUT BEING THE SAME AS A
BOXER AND FOR THREE MONTHS IT'S
TRUE SHORT TERM. BUT WE DON'T
KNOW A LOT OF TENNIS AGAIN OUR
GOAL IS GOING TO GET ALL FORMS
OF TREATMENT AVAILABLE TO ALL
PEOPLE IN ALL SETTINGS. IT
INCLUDING IN JAILS.
SO WE HAVE SEVERAL CAMPAIGNS
THAT DOCTOR SMITH REFERRED TO
AND I'M JUST GOING TO BRIEFLY
HIGHLIGHT EACH ONE.
AND ONE OF THE AND THEY'RE ALL.
REPORTING TO THE WE'RE PROVE ALL
AIMING TO STAY IN ALIGNMENT TO
LEAVE THIS WHO WOULD FOR TYLER
CARRIES TO PLANO SMARTCAMP
CALIFORNIA.
THE CALIFORNIA OPIATES SAFETY
NETWORK AND THAT WHAT HEALTH
CARE SERVICES IS DOING WITH
ADDICTION AND I'M WITH LIMITED
TIME I'M JUST GOING TO BRIEFLY
TOUCH AND EACH. WITH KIDS TO
PLANO AS A DOCTOR I CAN NOW LOOK
UP INSTEAD OF. THE WAY IT WAS A
FEW YEARS AGO WHERE I GET
CONFUSING REPORTS I GET KICKED
OUT A LOT I CAN GET A PASSWORD
IS VERY DIFFICULT TO USE. THIS
IS PHENOMENAL BECAUSE I CAN GO
IN AND I CAN SEE ALERTS FOR WHO
OF MY PATIENTS AT HIGHEST RISK
OF DEATH AND THAT'S A GAME
CHANGER IS NATIONALLY
RECOGNIZED.
BUT IT'S NOT THAT HELPFUL UNLESS
IT'S INTEROPERABLE WITH MY
RECORDS BECAUSE I'M SEEING
PATIENTS EVERY FIFTEEN MINUTES.
I CAN'T STOP LOG OUT LOG ON TO
SOMETHING ELSE AND CHECK
SOMETHING EXPECT THAT TO BE DONE
CONSISTENTLY SO.
BUILDING INTO THE WORK FLOWS
SOMETHING DOJ'S REALLY WORKING
HARD ON OUT IT'S GOING TO BE
CRITICAL OF TWO. MORE ADOPTION
OF THE OF CARE IS BY CLINICIANS.
ITS MARKET CALIFORNIA'S VERY
EXCITING BECAUSE IT'S THE FIRST
TIME THE BIG PUBLIC PURCHASERS
IN CALIFORNIA WHICH IS.
CALPERS COVERED CALIFORNIA MEDI
CAL HAVE ALL DONE TOGETHER AND
SING AND SAID WE ARE GOING TO
COORDINATE AND WORK TOGETHER TO
DROP OVERDOSED ASSN ADDITION TO
DROP UNNECESSARY SEE SECTIONS
AND BETTER. CARE OF LOW BACK
PAIN AND SO THEY'RE WORKING WITH
HEALTH PLANS AND PROVIDERS AND
CONSUMERS AGAIN TRYING TO LINE
ALL OUR EFFORTS BECAUSE HEALTH
PLANS ARE POWERFUL ALLY AGAINST
THE A BICU EIGHT.
CRISIS BECAUSE I'M DOING THE
RIGHT THING ABOUT SAFER
PRESCRIBING AND MAKING SURE
ADDICTION TREATMENT IS EASY
ACCESS. IS CRITICAL BECAUSE AS
YOU PROBABLY HAD MANY PEOPLE ARE
READY TO QUIT BUT THEN HAVE
INSURANCE CHALLENGES GETTING THE
TREATMENT THEY NEED.
THE CALIFORNIA UP ITS EIGHTEEN
NETWORK IS THAT IS ALL OF THE
LOCAL COALITIONS BATHTUB BOUND
TOGETHER IN ONE NETWORK AND ALL
OF THOSE BLUE COUNTIES. HAVE A
LOCALLY LED COALITION OFTEN LED
BY PUBLIC HEALTH DEPARTMENT OR
MEDICAL SOCIETY THAT GETS
ALL THE STAKEHOLDERS TOGETHER
LAW ENFORCEMENT PHARMACIES
HOSPITALS ADDICTION TREATMENT.
THEY LOOK AT THE LOCAL DATA SAY
WE'VE GOT A PROBLEM IN OUR
COMMUNITY AND WORK TOGETHER TO
SOLVE IT AND SO IT'S VERY
EXCITING FOR THAT WE'VE OF.
IN JUST EIGHTEEN MONTHS SINCE
THE CALIFORNIA HEALTHCARE
FOUNDATION STARTED THIS PROJECT
WE'RE SEEING MOST OF CALIFORNIA
PARTICIPATING AND THE PUBLIC
HEALTH INSTITUTE IS PUT IS
PUTTING FORTY VISTA VOLUNTEERS
IN ALL OF THESE COMMUNITIES TO
HELP. FIGHT THE EPIDEMIC SO WAS
THAT A GOOD WORKFORCE IT'S QUITE
EXCITING.
AND FINALLY AS YOU PROBABLY KNOW
THERE'S TWO MAJOR EFFORTS THAT
THE HEALTH SERVICES DEPARTMENT
IS LEADING TO MAKE SURE THAT MAP
CHANGES IN THAT EVERYBODY CAN
ACCESS TREATMENT IN THEIR
NEIGHBORHOOD WITHOUT TRAVEL. ON
THE LEFT IS THE DRUG MEDI CAL
SYSTEM WHERE ALL OF THOSE ORANGE
COUNTY'S HAVE PLANS TO CREATE
ADDICTION TREATMENT ACCESS FOR
ALL ADDICTIONS NOT JUST FOR
OPIOIDS. AND ON THE RIGHT IS A
REAL.
TRANSFORMATION OF HOW WE THINK
ABOUT METHADONE CLINICS IN THE
PAST METHADONE CLINICS WHERE IN
GHETTOS AND THEY WERE SEGREGATED
AND THEY NEVER WOULD TALK TO ME
A PRIMARY CARE DOCTOR. AND WE'RE
TRYING TO CHANGE IT INTO A
PRIMARY CARE SPECIALTY
RELATIONSHIP WHERE FIVE A.
COMPLEX HEART FAILURE PATIENTS
THEY GO TO SPECIALIST WHEN THAT
PERSON STABLE THEY COME BACK TO
ME. AND THAT'S WERE TRYING TO DO
IN METHADONE CLINICS ARE NOW
SEEN AS SPECIALIST IN THERE
WORKING WITH PRIMARY CARE
DOCTORS. SO THAT WE CAN HAVE A
SYSTEM OF OF STE OF MILDER
ADDICTION TREATED IN PRIMARY
CARE MORE SEVERE ADDICTION
TREATED AND AND TREATMENT
PROGRAMS.
AND SO SOMETIMES WHEN I GET
DISCOURAGED I THINK OF THE LAST
MAJOR HEALTH CRISIS WE HAD AND
WHEN YOU LOOK AT THAT DEATH RATE
ON THE LEFT AND WAS CLIMBING AND
CLIMBING IT FELT HOPELESS. BUT
WE DROPPED THE DEATH RATE FOR
HIV AND WE DID IT IN A VERY
SIMILAR WAY TO WHAT WE NEED TO
DO NOW WHICH IS WE MADE.
I'M IT IMPOSSIBLE AS A PERSON'S
HIV AIDS TO TO NOT GET ACCESS TO
TREATMENT ADVOCATES AND
GOVERNMENT AND AND NON PROFITS
CAME TOGETHER TO STRIP AWAY ANY
BARRIERS FOR FROM PEOPLE FROM
GETTING AIDS TREATMENT THEY NEED
WHICH IS THE. EFFORT WE NEED TO.
DO HERE BECAUSE STILL THOSE MANY
REGULATORY INSURANCE IMPRACTICAL
BARRIERS FOR PEOPLE GETTING
ADDICTION TREATMENT AND WE WON'T
DROPPED US INTO WE DO THAT AS
WELL AS REDUCING THE STATEMENTS
OF PEOPLE ARE WILLING TO COME
FORTH. FOR TREATMENT SPEND
EQUIVALENT OF WHAT OF MEMBER
RYAN WHITE AND MAGIC JOHNSON
MADE HIV FEEL MORE PERSONAL AND
WHERE THEY WERE TRYING TO DO THE
SAME THING WITH ADDICTION.
AND IT'S BEEN DONE BUT IT'S NOT
BEEN DONE IN THIS COUNTRY WHILE
OUR COUNTRY DEATH RATES RISE.
FRANCE WAS ABLE TO DROP THEIR
DESPERATE EIGHTY PERCENT IN JUST
A FEW YEARS. BY MAKING
BUPRENORPHINE TEXAS A BOX ON
WIDELY AVAILABLE HEALTH
INSURANCE PLANS WERE REQUIRED TO
PAY DOCTORS MORE TO TREAT
ADDICTION. THERE WAS NO SUCH
THING AS NEEDING WAIVERS ARE
GETTING DE A VISITING YOUR
PRACTICE IT WAS MADE LIKE ANY
OTHER MEDICATION VERY SIMPLE.
BUT WHAT HAPPENED AND THEY ARE
THERE WAS A BIG WORRY WHAT
HAPPENS WITH DIVERSION IS AND
FELT THE STREETS BUT TURNS OUT
WHEN YOU MAKE ADDICTION
TREATMENT REALLY EASY TO ACCESS.
PEOPLE DON'T NEED TO BUY
ADDICTION TREATMENT ON THE
STREETS AND AMOUNT OF SUBOXONE
DIVERSION WAS VERY VERY SMALL IN
THE FRANCE EXPERIENCE.
IN ANY CASE SAM A AGAIN IT WAS
AN HONOR TO PRESENT IN A.
THAT'S NOT GONNA BE HAPPY TO
TAKE QUESTIONS.
THANK YOU VERY MUCH DOCTOR
PFEIFFER AND I JUST WANT TO MAKE
IN BED NOTES THAT OF. THIS ISSUE
TRANSCENDS PARTISANSHIP AND IN
FACT A NUMBER OF COLLEAGUES ON
BOTH SIDES OF THE AISLES HAVE
COME HERE TODAY BECAUSE OF THEIR
GREAT INTEREST IN THIS EFFORT
AND IN FACT THERE ARE
APPROXIMATELY OVER TEN BILLS. OF
THAT WE'VE SEEN THAT HAVE BEEN
INTRODUCED WITH RESPECT AS YOU
ARE READY SO I VERY MUCH
APPRECIATE YOUR OPPOSING YOUR
EXPERTISE ON THIS. ALSO FIRST
VICE VIA A QUESTION BY A SOMEONE
EGGMAN.
THANK YOU VERY MUCH AND I THINK
YOU FOR YOUR PRESENTATION.
THE A BILL AYE IN SOME OF MY
COLLEAGUES APPEAR DID LAST YEAR
WAS TOO WELL AUTHORIZED A.
IF INJECTION SITES
FOR INTERVENES DRUG USE ARE IN
THAT BECAUSE IT AS AS YOU
CLEARLY HAVE POINTED OUT
ADDICTION IS A CONTINUUM AND IT
STARTS ON OFFENSE AND. THAT
DIFFEREN POINTS THE CONTINUUM
THERE NEEDS TO BE DIFFERENT.
MODALITIES OFFERED AND OR AS
AND AS WE CONTINUE TO TO FOCUS
ON HARM REDUCTION IN PREVENTING
OVERDOSES.
SO WE CAN GET ALL THE WAY
THROUGH WHERE WE'RE STILL IN
MOTION ON THAT BILL BUT I THINK
I'VE BROUGH THIS MORNING SAN
FRANCISCO IS GOING TO GO AHEAD
AND START ONE.
AND THE WAY WE HAVE A
CONCEPTUALIZES I WOULD GO TO
PUBLIC HEALTH IT WOULD BE
THAT A COMMUNITY COLLABORATION
AND THE SITES WHERE IT WOULD BE
HOW WOULD BE MOST SAFE AND AS
YOU POINTED OUT. THAT WOULD ONLY
BE SET IN A IN THE AREA WHERE
PEOPLE ARE ALREADY USING
PUBLICLY UP ON THE STREETS AND
OVERDOSING AND I'M JUST
WONDERING WHO ARE YOUR THOUGHTS
ABOUT. THE SYSTEMS LIKE THIS AND
WE KNOW IT'S WORKED AND OTHER
PLACES IN THE WORLD AND YOUR
THOUGHTS ABOUT IT HERE.
WHO OF?
SURE I AM I AM I CAN'T COME IN
ENACTED LEGISLATION BUT I CAN
SAY THAT IF I'M HARM REDUCTION
IS THE WAY WE THINK ABOUT ANY
CRIED DISEASE IF I HAVE A
DIABETIC AND THEN THEY BINGE ON
KRISPY KREME'S I TREAT THEM IN
THE YEAR I DON'T JUDGE THEM. I
ACCEPT THAT SEVENTY PERCENT OF
DIABETICS ARE CONTROLLED AND THE
OTHERS STRUGGLE AND I'M I THINK
WE NEED TO ADAPT THAT SAME
METHOD FOR ADDICTION REALIZING
THERE'S A CONTINUUM OF
BEHAVIORS.
THERE'S PERFECTION WHICH VERY
FEW PEOPLE ACHIEVE AND THERE'S
TOTAL ALL OUT ADDICTIVE
BEHAVIORS OF IN THE MIDDLE IS
WHERE. HARM REDUCTION LIKE SAFE
INJECTION SITES AND NEEDLE
EXCHANGES AND A LOT SOME LIVE IT
BASICALLY IS LET'S KEEP PEOPLE
ALIVE UNTIL THEY'RE READY FOR
RECOVERY. BECAUSE NOT EVERYBODY
WAS READY FOR RECOVERY RIGHT
AWAY AND THAT EVERYBODY'S
PERFECT WHEN THEY ENTER
RECOVERY.
SO I WOULD JUST ADD THAT HARM
REDUCTION STRATEGIES LIKE NEEDLE
EXCHANGE LIKE SAFE INJECTION
SITES HAVE ADDED BENEFITS AS
WELL IN THAT THEY PROVIDE AN
OPPORTUNITY TO CONNECT
INDIVIDUALS WHO ARE USING. WITH
OTHER SERVICES TO EDUCATE THEM
IN A FRIENDLIER ENVIRONMENT THAN
MANY OTHER ENVIRONMENTS THAT
THEY COME INTO BUT ALSO
PROVIDING CLEAN.
SYRINGES AT HAVE AND WELL
PROVIDING CLEAN SYRINGES HELPS
US REDUCE RATES OF TRANSMISSION
OF HIV AND OTHER BLOOD BORNE
DISEASES LIKE HEPATITIS C. WHICH
IS EPIDEMIC THROUGHOUT.
ON THE UNITED STATES INCLUDING
CALIFORNIA I'M AND THEN FINALLY
THE READY PROVISION OF NALOXONE
IN AN INDIVIDUAL SITE AND CAN
POTENTIALLY CONCEIVE OF FOLKS
FROM AND RECOGNIZED FENTON ALL.
INJECTIONS AND SAVE LIVES ON THE
SPOT. IN THROUGH NEEDLE
EXCHANGES NALOXONE IS WE'RE
PRETTY THAT'S ACTUALLY ONE OF
THE MAJOR VENUES THAT WE'RE
USING TO GET NALOXONE OUT TO THE
USER COMMUNITY AS WELL.
THANK YOU SO SO YOU MEAN THAT
WHEN WHEN SOMEONE WOULD CALL
WHEN WHEN THEY WOULD START THAT
THAT CARRYING SUPPORT OF NON
JUDGMENTAL RELATIONSHIP THEY MAY
ALSO THEN LOOK AT ISSUES AROUND
HOUSING AROUND TREATING AN
ABSCESS AROUND DOMESTIC VIOLENCE
AROUND HUMAN TRAFFICKING. OTHER
ISSUES THAT MAY IMPACT THEIR
LIFE BECAUSE OF THIS YEAR
DEBATE.
AND ADDICTION THEY COULD ALSO
THEM BECOME A BEGIN GETTING
TREATMENT FOR THOSE KINDS OF
THINGS TO. THAT STANDARD
PRACTICE IN IN SYRINGE EXCHANGE
PROGRAMS RIGHT THERE AND IF THEY
BECOME ALMOST A COMMUNITY HOW
BUT IN THE POSITIVE SENSE AS
OPPOSED TO KIND OF THE THE
VISION THAT THE GENERAL PUBLIC
HOUSES.
I THINK YOU VERY MUCH FOR FOR
YOUR EDUCATION FOR MYSELF AND
ALL MY COLLEAGUES.
AS WE CONTINUE TO MOVE THE BOOK
BILL FORWARD.
IT'S ALSO QUITE ILLUSTRATIVE.
TO SEE THEIR PRESENTATION KEY
ELEMENTS WITH RESPECT POTENTIAL
PIECE OF LEGISLATION THAT WE'VE
ALSO SEEN TOO SO THERE ARE SOME
SIMILARITIES MOST CERTAINLY.
ASSEMBLY MEMBER GIPSON.
THANK YOU VERY MUCH WAS CHAIRMAN
THANK YOU VERY MUCH FOR YOUR
PRESENTATION IT WAS QUITE
ENLIGHTENING CAN TALK ABOUT THE
RACIAL DISPARITIES THAT EXIST
AND. POINTING THOSE RACIAL
DISPARITIES OUT AND ALSO YOU
MADE MENTION OF THE FRANCE
FRANCE SEEMS LIKE THEY'RE
GETTING A RIDE WHAT ARE WE DOING
GETTING A RAW.
SO I AM THIS IS ONE OF THE GREAT
ADVANTAGES THAT THE PUBLIC
HEALTH DEPARTMENT HAS A
DASHBOARD BECAUSE THIS IS BEEN
DESCRIBED AS A WHITE EPIDEMIC IN
OTHER PARTS OF THE COUNTRY AND.
THE WAY I'M ALL OF US HAVE BEEN
WORKING ON IS THIS IS THAT EVEN
THOUGH THAT'S THE WAY IT'S BEEN
PORTRAYED IN THAT CERTAINLY.
HIDES THE FACT THAT THERE'S BEEN
HUGE INEQUITIES.
FOR OTHER RACIAL GROUPS IN THE
PAST WE'VE BEEN MAINLY FOCUSING
ON LAW ENFORCEMENT
CRIMINALIZATION AND NOW THIS
WHITE AT EPIDEMIC IT SEEMS MORE
FOCUSED ON TREATMENT BUT. OUR
POINT OF VIEW IS THAT IS THAT AS
THE MONEY AND THE ATTENTION IS
COMING AND LET USE THAT
OPPORTUNITY TO CHANGE THE
STANDARDS OF CARE FOR PEOPLE. OF
ALL RACES AND ETHNICITIES AT ALL
TYPES OF ADDICTION.
GETTING BACK TO THE DASHBOARD
IF YOU LOOK IN SAN FRANCISCO
THERE'S THREE TIMES THE DEATH
RATES.
FOR AFRICAN AMERICANS AND THERE
ARE FOR WEIGHTS FROM OPIOID
OVERDOSE SO WE IN OUR URBAN
AREAS IS NOT A WHITE EPIDEMIC
AND SO IT'S A REALLY IMPORTANT
AS WE BUILD THESE NEW.
STRUCTURES OF ADDICTION
TREATMENT THAT WE ARE ABLE TO DO
IT AND CULTURALLY COMPETENT WAYS
THAT REACH OUT TO ALL
COMMUNITIES.
BUT I WOULD I JUST SECOND THAT
PARTICULAR THE ISSUE OF LOOKING
AT THE LOCAL COMMUNITY BECAUSE
THIS EPIDEMIC AND AND IN TRUTH
ALL DRUG USE IS VERY DIFFERENT
FROM PLACE TO PLACE.
THE OTHER THING THAT'S THE
REASON THAT WERE FOCUSING ON
STRATEGIES THAT ADDRESS THE
OPIOID EPIDEMIC BUT ALSO GENERIC
STRATEGIES THE DECK ADDRESS ALL
ADDICTION IS THAT. WE CONTINUE
TO SEE INCREASES IT FOR EXAMPLE
IN METHADONE AND I'M SORRY
METHAMPHETAMINE OVERDOSES. ARE
GOING UP AND THAT'S TRUE IN MANY
OF THE SAME PARTS OF THE STATE
OF THE CALIFORNIA THAT.
OPIATES ARE THE APPROACHES
AROUND SAFE PRESCRIBING AT ITS
CENTER THAT OBVIOUSLY ISN'T
RELEVANT TO THAT PARTICULAR
DRUG.
OR EVEN TO SOMETHING LIKE
ALCOHOLISM WHICH BY THE WAY IS
STILL THE SINGLE LARGEST DRUG OF
ABUSE IN THE UNITED STATES AND
IN CALIFORNIA. SO WE'RE TRYING
TO MAKE ONCE WE MAY WE IF WE CAN
NORMALIZE ADDICTION AS A DISEASE
AND THE PROVISION OF ADDICTION
TREATMENT AS SOMETHING OF COURSE
YOU WOULD DO. THAT I THINK WE
HAVE THE OPPORTUNITY TO BENEFIT
OUR SOCIETY AND A LOT OF
DIFFERENT AREAS.
MAYBE I MISSED SOMETHING SO ARE
DID YOU SAY THAT AFRICAN
AMERICANS.
HAS TO RECEIVE IS THREE TIMES
HIGHER. IN SAN FRANCISCO THAN
ANY OTHER ETHNICITY AND NATIVE
AMERICANS HAVE THE HIGHEST DEATH
RATE ACROSS THE STATE. YEAH SO
WHERE THAT WHERE THE RESOURCES
GOING IN THOSE THOSE COMMUNITIES
THE TARGET THAT PARTICULAR
ETHNICITY.
THAT'S ACTUALLY ONE OF THE
REASONS WE ARE WORKING SO
ACTIVELY IN AND HELP EIGHT
CATHERINE HEALTHCARE FOUNDATION
BEGAN THE FUNDING OF OF OPI
COALITIONS LOCAL COALITIONS AND
WE'RE CONTINUING THAT BECAUSE
THOSE COMMUNITIES. KNOW HOW TO
TARGET THOSE WE ARE NOT MAKING
DECISIONS AT THE STATE LEVEL
ABOUT EXACTLY WHERE PARTICULAR
RESOURCES SHOULD BE PLACED.
WE'RE DOING THAT IN
COLLABORATION WITH THE PEOPLE
WHO KNOW THOSE COMMUNITIES ONE
OF THE MOST IMPORTANT THINGS
ABOUT THE STAFF BOARD IS THAT
DATA IS AVAILABLE TO THE LOCAL
COMMUNITY SUIT ACTUALLY.
IRRESPECTIVE OF WHO COMES TO THE
TABLE WHAT WHAT PRECONCEIVED
NOTIONS ABOUT WHO THIS EPIDEMIC
IS AFFECTING. WE HAVE CONCRETE
GRANULAR DATA ABOUT THEIR
COMMUNITY TO HELP INFORM.
EXACTLY DOT ISSUE WHERE
RESOURCES GOING WHAT SPECIFIC
RESOURCES ARE NEEDED WHAT ARE
THE UNDERLYING SOCIAL ISSUES
THAT ALSO NEED TO BE A DROUGHT.
OKAY.
THREE MUCH
A SUMMER GALLAGHER.
THANK YOU MISTER CHAIRMAN AND.
YEAH THANK YOU FOR INVITING ME
TO BE PART OF THE COMMITTEE THIS
MORNING VERY IMPORTANT.
I ISSUE.
IN MY DISTRICT BUT THROUGHOUT
THE STATE AND I THINK WE SAW LOW
THE NUMBERS THERE.
ONE THING I WANTED TO FOCUS IN
ON I THINK A.
MY COLLEAGUE.
AND SO MEMBER GIPSON BROUGHT UP
THERE THE RACIAL. DISPARITIES
ANOTHER ISSUE I THINK IS
GEOGRAPHY AND.
THIS IS REALLY IMPACTING THE
RURAL PARTS OF THE STATE A VERY
SIGNIFICANT WAY I THINK IF YOU
LOOK AT THOSE.
YOUR YOUR.
OPIATE OF THE DASHBOARD AND IT
SHOWS YOU KNOW A LOT OF THESE
RURAL COUNTIES ARE VERY HEAVILY.
IMPACT IN TERMS OF.
OVERDOSES PER PER CAPITA.
HOSPITALIZATIONS PER CAPITA.
AND.
AND SO.
THAT'S ONE THING I THINK WE
HAVE TO REALLY FOCUS IN ON IS
WELL AND I THINK YOU MENTIONED
ONE OF THE THINGS YOU MENTIONED
WAS.
A LACK OF SAFETY NET THE. BUT
THE OTHER ISSUE HERE IS WE'VE.
YOU THAT'S THAT I CAN TELL YOU
ABOUT THESE AREAS IS THE.
DIMINISHING TIMBER MINING.
.
INDUSTRIES THAT HAVE BEEN IMPACT
MANUFACTURING HAS AS THAT HAS
GONE AWAY. AND YOU HAVE
GENERATIONS OF PEOPLE
UNEMPLOYED.
AND TURNING TO DRUGS AND ALCOHOL
EARNED THAT HAS BEEN YOU KNOW WE
SAW THE METHAMPHETAMINE WE SAW
THAT NOW AND NOW WITH THE OP A
CRISIS.
AND THAT'S ANOTHER FACTOR YOU
KNOW SO.
BUT AND IN GETTING THAT THE YOU
KNOW.
.
AND THE RURAL PARTS OF THE STATE
I THINK ANOTHER THING YOU SHOWED
HERE IS THAT THERE ARE A LOT OF
LOCAL.
COALITIONS THERE'S RESOURCES
BUT.
IF YOU LOOK AT IT WHERE THOSE
ARE AT IT'S ALMOST THE INVERSE
OF WHERE SOME OF THE PROBLEMS
ARE YOU'RE STILL SEEING A LOT OF
AREAS THAT AREN'T COVERED.
HOW COME YOUYOU KNOW HOW CAN WE
BETTER GET THAT GETTING SOME OF
THESE RESOURCES OUT TO SOME OF
THE REALLY HOT SPOTS WHICH TEND
TO BE IN A RURAL PARTS?
OF THE STATE.
NAM.
IS THAT SOMETHING YOU'RE
THINKING ABOUT AND WHAT KIND OF
EFFORTS HERE. BEING DONE THAT IS
YEAH IT'S VERY MUCH THINGS THAT
WERE THAT WERE ARMED THAT THE
COALITIONS THAT THE DEPARTMENT
IS FUNDING ARE ACTUALLY VERY
EXPLICITLY THOSE IN THESE RURAL
AREAS SO THAT WE DON'T RUN THE
RISK OF A COALITION NOT HAVING A
FUNDING TO CONTINUE. WE ALSO
HAVE SOME STRATEGIES THAT ARE
VERY SPECIFIC TO THOSE RURAL
AREAS FOR EXAMPLE ONE OF THE
EDUCATION CAMPAIGNS THAT WE'RE
CREATING WERE ACTUALLY WORKING
WITH LOCAL JURISDICTIONS IN THE
RURAL AREAS SO THAT THAT
CAMPAIGN IS VERY TARGETED TO WHO
IS AT HIGHEST RISK THERE AS
OPPOSED OTHER PARTS. OF THE
STATE.
AND FINALLY WE ALSO ARE USING.
AS STRATEGY CALLED ACADEMIC
DETAILING WHICH IS M. IF YOU'VE
EVER BEEN SITTING IN YOUR
DOCTOR'S OFFICE IN THE WAITING
ROOM AND SOMEBODY INCREDIBLY
WELL DRESSED STROLLS THROUGH AND
GOES IMMEDIATELY TO THE BACK FOR
A FEW YOU KNOW. AN HOUR TO THIS
OUR DRIVE REPRESENTATIVES COMING
IN TO TALK TO THEIR DOCTORS
ABOUT THEIR LATEST DRUG THAT'S
RELEASED IN PROVIDING THEM LOTS
OF EDUCATION ON WHAT IT'S GOOD
FOR HOW TO USE IT IT CETERA.
THAT'S CALLED ACADEMIC DETAILING
WE'RE DOING THE SAME THING USING
SOME OF INDIVIDUALS FROM THOSE
COMMUNITIES TO DO ACADEMIC
DETAILING ABOUT SAFE PRESCRIBING
ON OPIOIDS ABOUT WHO'S AT RISK
OF OPIATE. OVERDOSE AND REALLY
ONE ON ONE WITH THE CLINICIANS
FIRST TARGETING THOSE THAT ARE
HIGHEST PRESCRIBERS USING CURES
TO IDENTIFY THOSE INDIVIDUALS
BUT THEN MOVING OUT TO ALL THE
CLINICIANS.
THAT'S ON THE ON THE LEGAL
PRESCRIPTION SIDE OF THE HOUSE
THERE'S ALSO THE DIVERSION SIDE.
COALITIONS HAVE ENGAGED LAW
ENFORCEMENT AND VERY
AGGRESSIVELY IN THESE AREAS TO
TRY TO.
.
SHIFT THE THE FOCUS UP AWAY FROM
CRIMINALIZATION OBVIOUSLY WITH
THE EXCEPTION OF THOSE HEARD ARE
DEALING DRUGS AND MORE TO.
OTHER METHODS OF DECREASING
DIVERSION ON THERE ARE SOME
VERY.
INTERESTING TECHNIQUES THAT HAVE
BEEN USED TO HELP IDENTIFY DOT
DOCTORS TO HELP THEM REALIZE THE
CONSEQUENCES OF A POOR
PRESCRIBING.
THE WAY DOCTOR FIFER FOUND OUT
ABOUT HER AND PATIENT WAS FROM A
LETTER FROM THROUGH A CORNER
INTO SOME OF THE SAME
JURISDICTIONS. ARE TAKING THAT
KIND OF APPROACH.
FOCUSING ON THE DOCTORS.
AND SO THEN THE OTHER THING
THAT IS THIS IS WHAT WE THIS IS
THE GREAT HOPE I THINK OF THIS
HUB AND SPOKE MODEL AT THAT
DEPARTMENT HEALTHCARE SERVICES
IS PUTTING IN PLACE FOR
MEDICALLY ASSISTED TREATMENT.
YOU DON'T HAVE TO BUILD A CENTER
OF EXCELLENCE FOR ADDICTION
THERAPY IN EVERY SINGLE SMALL
COMMUNITY WHAT YOU CAN DO IS
PROVIDE TRAINING ON THAT WELL
ACTUALLY MOONLIGHT YOU TALK
ABOUT THE HAVE THE ABOUT THAT
METHOD BECAUSE YOU'RE MORE OF
THE CLINICIAN THAT.
SO YOU CAN SEE BY THESE MAPS AT
THE RURAL AREAS WERE
PARTICULARLY FOCUSED.
ON THE HUB AT THE HUB AND SPOKE
PROGRAM WHICH IS EIGHTY NINE
MILLION DOLLARS OF FEDERAL
FUNDING COMING AND TIPPED TO
INCREASE ACCESS SPECIFICALLY FOR
OPIOID ADDICTION. IS LARGELY
BEING TARGET IN THE RURAL AREAS
THAT ARE THE HARDEST HIT AND
THERE'S A SPECIAL PART OF THAT
IS ALSO FOCUSED ON THE NATIVE
AMERICAN POPULATION. AND AGAIN
THE AT THE IDEAS AS A PRIMARY
CARE DOC AND NEVER WAS TRAINED
IN ADDICTION IT'S VERY
INTIMIDATING TO THINK ABOUT.
STARTING THIS WHOLE NEW PRACTICE
WITH SOMETHING I DON'T
UNDERSTAND ESPECIALLY WITH IT
THE A LOT OF TAX FEEL WHAT
THERE'S A LOT OF STIGMA WHAT IF
THOSE PEOPLE SHOW UP IN MY
WAITING ROOM IN MY OTHER
PATIENTS DON'T LIKE IT OR. OR.
IT HELPS TO HAVE SENT A COACH
OR MENTOR IN THAT THE WAY I
STARTED BACK IN THE EARLY TWO
THOUSANDS WAS. FINDING A FRIEND
WHO'D DONE IT AND HAVE AND
TALKING THROUGH MY FIRST FEW
CASES AND AGAIN WE WERE FINDING
IT MORE PRIMARY CARE PROVIDERS.
NURSE PRACTITIONERS AND
PHYSICIAN ASSISTANTS AND DOCTORS
ARE WILLING TO STEP UP TO TREAT
ADDICTION. IF THEY'RE NOT ALONE
IF THEY'RE ABLE TO REACH OUT TO
A SPECIALIST TO GET HELP THROUGH
THOSE FIRST FEW CASES.
MOST OF US FIND THAT AFTER THE
FIRST THREE WE SAY THIS WASN'T A
BIG DEAL I DON'T KNOW WHY I WAS
SO WORRIED IT'S IS A GREAT ANTI
BURNOUT METHOD BECAUSE YOU SEE
PEOPLE GO FROM CHAOS. TO
RECOVERY IT IS INCREDIBLY
REWARDING AS A DOCTOR WHEN MOST
OF OUR PATIENTS WITH CHRONIC
DISEASES JUST GET WORSE OVER
TIME. SO AGAIN THE IDEA IS THAT.
THESE UMPTEEN PREVIOUSLY CALLED
METHADONE CLINICS WILL BECOME
THE DEBT THOSE RESOURCES AND
HELP RURAL AREAS WITHOUT.
SPECIALIST TREATMENT PROGRAMS
BUILD THE CONFIDENCE OF THOSE
LOCAL CLINICIANS TO BE ABLE TO
TREAT ADDICTION AND CAN CREATE
THIS NETWORK OF OF MUTUAL
SUPPORT.
I THINK ONE CHALLENGE ALSO FOR.
RURAL AREAS AS WITH EVERY EVERY
OTHER ASPECT OF HEALTH CARE AND
THE LACK OF ACCESS TO IT IN THE
RURAL AREAS.
IT'S VERY IMPORTANT TO HAVE
ALTERNATIVES TO OPIOID SO AND
THOSE THINGS ARE. THINGS EVEN
IN.
MORE POPULOUS AREAS CAN BE
DIFFICULT TO COME BY THINGS LIKE
PHYSICAL THERAPY.
THINGS LIKE.
ACUPUNCTURE ETCETERA TO
INCREASINGLY HEALTH PLANS ARE
RECOGNIZING THAT THEY NEED TO
COVER THESE SERVICES
PARTICULARLY THOSE THAT HAVE A
GOOD EVIDENCE BASED BUT GETTING%
ACCESS TO THAT IN THE RURAL
AREAS IS REALLY CHALLENGING.
EVEN MORE THEN.
PRIMARY CARE THING
SO THAT'S ABOUT REMAIN SOMETHING
THAT WE NEED TO WORK HARD ON.
NO THANK YOU FOR THAT I MEAN
THERE WAS A LOT A LOT THERE.
I'D I THINK THERE ARE SOME GOOD
THINGS IN PLACE THAT ARE TRYING
TO ADDRESS THIS BUT I WOULD.
HAVE MY COLLEAGUES JUST LOOK AT
THAT MAP.
AND YOU KNOW THERE'S A LOT OF
GRAY AREA THERE AND THOSE GRAY
AREAS.
OUR RURAL PARTS OF THE STATE.
AND SO WE HAVE A LOT OF WORK TO
DO ITS IT'S YOU KNOW THE EVEN
THOUGH THERE ARE THINGS IN PLACE
IN NOT SAYING THERE'S NOT HAVE
BEEN SPOKE ALL THOSE.
AND AND IT'S GONNA TAKE
RESOURCES TO DO IT AND.
THOSE WHO'VE BEEN RESPONSIBLE.
FOR HELPING TO CREATE THIS
EPIDEMIC NEED TO BE.
PARTNERS IN IN HELPING US TO
PULL THE RESOURCES TO GET THERE.
THANK YOU VERY MUCH A SEMI DEL.
I THINK YOU FIRST ALONE I THINK
THAT THE CHAIR THE COMMITTEE
FOR.
.
HAVING AND WELCOME YOU HERE THIS
AYE I REPRESENT.
THE NORTHEASTERN PART OF THE
STATE AND ACTUALLY LASSEN
COUNTIES WHERE I LIVE IN A AND
I'M LOOKING AT THIS HAND OUT
THAT WE HAVE UP HERE.
AND IT'S MY WHOLE COUNTIES
COMPLETELY RED. AND SO.
IT'S FORTY FIVE HUNDRED SQUARE
MILES JUST LASSEN COUNTY WHERE I
RESIDED FOR MY WHOLE LIFE.
MY COUSIN IS A DOCTOR.
WHO'S BEEN THERE FOR THIRTY
YEARS OF GENERAL PRACTITIONER.
WHO WORKS A ROTATION IN AN
EMERGENCY ROOM?
IS THE ONLY HOSPITAL FOR A
HUNDRED MILES.
THAT HAS A FULL TIME EMERGENCY
ROOM AND SO. I SPENT A LOT OF
TIME WITH HIM.
A TALKING ABOUT HEALTHCARE
ISSUES IN RULE CALIFORNIA AS WE
HAVE WE HAVE THE EIGHTY RURAL
HEALTH CLINIC IN. MY COMMUNITY
WHERE HE WORKS DURING THE DAY
AND DOES THE ARE IN THE EVENINGS
AND AND ROTATE SO WE HAVE. A
VERY A.
BUT IT'S VERY HARD FOR US TO GET
DOC'S EVEN LIVE IN OUR AREAS
NUMBER ONE SO WE HAVE A ROTATION
PEOPLE COME IN AND ACTUALLY WORK
OUR EMERGENCY ROOMS. AND THEN GO
BACK TO THEIR COMMUNITIES.
SO.
I WANTED IT'S I HAVE SOME
THINGS I WANT TO SHARE WITH YOU
AND THEN I'M AND HOUSE QUESTION
AT THE END SO NUMBER ONE WE AT
THIS I ASK HIM. THE FOLKS THAT
COME THROUGH THE EMERGENCY ROOM
WHO ARE SO WE CALM WE WE DID A
BILL LAST THING WAS LAST YEAR.
THAT SENATOR LARA CARED A BILL
ON.
OR NOT TRYING TO IDENTIFY A CURE
IT CURES DATABASE PAISLEY TRYING
TO FIGURE OUT WAYS TO IDENTIFY.
AND AND TRACK.
BUT THE POINT IS IS THAT A THIRD
OF THE FOLKS THAT COME THROUGH
THE MERGER ZERO. NO THEY SWAP
THEM NOW SO THEY CAN FIND OUT
WHAT OTHER IPS LOTTIE'S FOLKS
RUN OTHER DRUGS IN AND. TRY NOT
TO. KEEP THEM FROM ODEON
BASICALLY BUT A THIRD OF THE
FOLKS THAT COME THROUGH HABIT
NOT THEIR PRESCRIPTION IN THEIR
SYSTEM.
SO THEY'RE GETTING THAT AND
THEY'RE TAKING IT OUT AND IT'S A
BUSINESS MACY'S A BUSINESS MODEL
SO USE NOT TO CELLS NUMBER ONE.
NUMBER TWO THIS DISCOVERY MIGHT
BE IF I WAS.
I KEEP GREW UP DURING THE
EIGHTIES WHEN WE WHEN COCAINE
WAS LIKE THE THE. RICH PERSON'S
DRUG AND THEN YOU RECALL CRACK
CAME OUT AND THAT WAS A LOWER
LEVEL TO WHAT WE HAVE NOW IS AB
OPIOID WHICH IS A WHICH IS
BASICALLY A RICH PERSON'S.
CHOICE AND THEN WILL NOT GETS
CUT OFF THEY GO TO THE CHEAP
VERSION WHICH IS NOW ON.
HEROIN.
AND THAT'S WHERE WE SEE A LOT OF
OUR OVERDOSES SO.
.
I MEAN ASK WHAT WHAT IT WILL IT
IN INDIVIDUAL AREAS WHERE WE
HAVE VERY FEW LITTLE SERVICES
AND MANY MANY MILES TO TRAVEL TO
GET TO THOSE SERVICES IN MANY
CASES.
WHAT WOULD YOU SAY IS A GREAT
WOULD BE THE NUMBER ONE THING
THAT YOU THINK WOULD BE
EDUCATION WISE BECAUSE AT THE
END OF THE DAY WE BASS THAT
EDUCATE THESE FOLKS ON? WHICH
SOME OF THEM THEY WANTED HER
SURGERY. GOT ADDICTED AFTER WORK
AFTER THEIR. SURGERY AND THEN
THERE'D THERE'D CUT OFF AND THEN
THEY'RE GOING TO A CHEAPER
VERSION OF SOMETHING TO MANAGE
THEIR ADDICTION. A AND OVER AND
OVER DISTANCES ARE ONE THING
THAT WE COULD FOCUS ON IN THOSE.
ROLE AREAS OR.
MAYBE TO THAT WE THINK WOULD BE.
HELPFUL IN GETTING STARTED ON
THE EDUCATION PROCESS.
SO.
.
WHEN THE TARGET IS THE GENERAL
PUBLIC AND IN PARTICULAR THE THE
USERS.
IT IN GENERAL AND PUBLIC HEALTH
THE BEST APPROACH TO THAT IS TO
FIND TRUSTED SPOKESPEOPLE SO WHO
IS IT THAT THOSE FOLKS REALLY
LOOK TO FOR GOOD INFORMATION.
BECAUSE FOR EACH.
PLACE IT'S A LITTLE BIT
DIFFERENT AND FOR EACH
POPULATION IT'S A LITTLE BIT
DIFFERENT AND THEN PROVIDING
THOSE PEOPLE REALLY GOOD
INFORMATION THAT THEY CAN THEN
PASS ON IS ONE OF THE THINGS
THAT WE.
WE DO WITH OUR SYRINGE EXCHANGE
PROGRAMS THAT WE.
PROVIDE RESOURCES FOR IS TO
MAKE SURE THAT THE PEOPLE IN
THOSE PROGRAMS AND REALLY
UNDERSTAND THE WHOLE ISSUE OF
OPIATES THE TRANSITION FROM
OPIATES TO HEROIN ET CETERA. SO
THAT THEY CAN TALK AS PEERS.
AND AS TRUSTED.
PURVEYORS INFORMATION TO THE
POPULATIONS AND SO THAT THAT'S
ONE OF THE REASONS WHY SO MUCH
OF OUR EFFORT AND RESOURCES ARE
GOING TO SUPPORTING THESE LOCAL
OPIOID.
COALITIONS BECAUSE THEY'RE THE
FOLKS WHO LIVE IN THESE
COMMUNITIES SERVE THESE
COMMUNITIES AND HOPEFULLY CAN
HELP IDENTIFY WHO ARE THE PEOPLE
WHO ARE GOING TO BE ABLE TO GIVE
THOSE MESSAGES IN A WAY THAT
THEY CAN BE HEARD AND
UNDERSTOOD.
AND HONESTLY YOU JUST HAVE TO DO
IT AGAIN AND AGAIN AND AGAIN AND
COMBINE IT WITH ACCESS TO
TREATMENTS. THAT ARE AVAILABLE
WHEN THOSE PEOPLE ARE READY.
AB BECAUSE THAT IS A HUGE PART
OF WHAT PREDICT SUCCESS IN
RECOVERY.
SO FOLLOW UP TO THAT AM.
I WAS RAISED WITH OF A FATHER
WHO WAS AN ALCOHOLIC IN BACK
WHEN THERE WAS NO TREATMENT
CENTERS AVAILABLE.
AND YOU WE DIDN'T DEAL FIRST
IDENTIFY THERE'S A PROBLEM YET
TO THE THAT THE DEBT THAT PERSON
WHO'S ADDICTED JUSTICE HAVE A
PROBLEMWHICH WAS NOT POPULAR
BACK INTO BETTY FORD ACTUALLY
CAME OUT AND SAID HEY ALCOHOL
AND. ISM IS IS A DISEASE.
AND SO SAME THING IN THIS IN
THIS WORLD WHERE IS THIRTY YEARS
FORWARD FOR THIRTY FIVE YEARS
FORWARD NOW AND WORK TO WITH
OPIOIDS AND WE HAVE TO IDENTIFY
HEY WE HAVE A PROBLEM AND YOU
CAN GET ADDICTED AND THAT NAY
AND YOU WE CAN START TREATING SO
I. THINK THAT'S KIND OF WHERE
WE'RE AT NOW.
AND I'M HOPEFUL THAT THAT FOLKS
WILL FIRST REALIZE THAT YOU KNOW
THIS IS NOT SOMETHING THAT SNUCK
UP ON THEM IN ADDICTION IS REAL
AND IT NEEDS TO BE DEALT WITH
AND WE NEED TO BE ABLE TO.
COMMUNICATE THAT TO THEM AND
HAVE A PLACE FOR THEM TO GO.
WHERE THERE'S A TREATMENT
CENTER?
AND IF I COULD BUILD ANNA AND
OTHER SMIS COMMENTS IN THE RURAL
AREAS WE'RE TRYING TO DO IS IS
EVERY PLACE A PERSONAL ADDICTION
CAN TOUCH WE WANNA MAKE SURE
ADDICTION TREATMENTS THERE SO
WE'VE GOT PROJECTS TO GET.
SUBOXONE IN THE EMERGENCY ROOM
BECAUSE IF YOU GET YOUR DOSE IN
THE EMERGENCY ROOM YOU'RE TWICE
AS LIKELY TO STAY IN TREATMENT
SUBOXONE IN THE HOSPITAL SO IF
YOU GET SAID HARD INFECTION FROM
YOUR AB USE WHILE YOU'RE IN THE
HOSPITAL YOU CAN GET YOUR
ADDICTION TREATMENT. FORGETTING.
TREATMENT ON YOUR PHONE SO THEY
IS TELEHEALTH IS A GREAT
SOLUTIONS OF THE YOU CAN TAP
CHAIR PROVIDER AND GET
COUNSELLING ON THE PHONE.
AND ULTIMATELY OTHER STATES I'M
HAVE REALLY INVESTED IN THIS
IDEA APPEAR PROVIDERS SEE SHOW
UP AT THE ER WITH AN OVERDOSE
SOMEONE WHO'S WALKED IN THOSE
SHOES. MEET YOU AND WORKS WITH
YOU FOR THIRTY DAYS AND THAT'S
I'M BEEN WIDESPREAD IN RHODE
ISLAND IN NEW JERSEY IN WOULD
BE.
IS SOMETHING WORTH EXPLORING IT.
SO I THINK WE HAVE AN
OPPORTUNITY THIS IN PARTICULAR
THIS NETWORK OF LOCAL COALITIONS
A COVER SO MUCH OF THE STATE
UNFORTUNATELY NOT ALL OF THE
STATE AND WE ARE WORKING ON
THAT.
.
TO THEIR IT WE'RE SORT OF TRYING
TO GATHER AND KIND OF A TOOL KIT
OF A VARIETY OF THESE KINDS OF
THERE'S THE WHOLE HEALTH CARE
AND. INTERVENTIONS RICHER VERY
SPECIFIC SET OF INTERVENTIONS
BUT THEN THERE MANY OTHER
APPROACHES TO.
THE THE SOCIAL ASPECTS IN THE
EDUCATIONAL ASPECT BOTH OF THE
USERS AND THE COMMUNITIES AND
MAKE SURE THAT THE SCHOOL LOCAL
COALITIONS HAVE ACCESS TO SORT
OF AN ENTIRE TOOL KIT OF. OF
THINGS THAT MAY OR MAY NOT WORK
FOR THEM DEPENDING ON WHO'S
INVOLVED AND WHAT RESOURCES THEY
HAVE. I'M AND ALSO GATHERING
INFORMATION ON WHAT'S WORKING
AND WHAT'S WORKING WHERE BECAUSE
THERE ISN'T A HUGE AYE EVIDENCE
BASED FOR SOME OF THESE.
KINDS OF INTERVENTIONS AND YET
THEY CAN BE INCREDIBLY SIX.
THANK YOU VERY MUCH US SOMEONE
WHAT WALDRON.
THANK YOU MISTER CHAIR.
.
LOTS OF GREAT INFORMATION.
THERE'S JUST SO MUCH MORE THAT
YOU COULD ALMOST EVERY HEARING
JUST SAW THEM KNOW WHAT WE'RE
TALKING ABOUT.
.
I WAS ALSO THINKING ABOUT THE
AIDS HIV YOU KNOW HISTORY THERE
WHEN YOU WERE SPEAKING BECAUSE
WITH A THAT UP ON THE WALL OF
THE RYAN WHITE LEGISLATION THAT
CAME OUT ON. THE EFFORTS OF
THERE'S STILL A STIGMA EVEN WITH
TREATMENT OF HIV IN PRIMARY CARE
OFFICES.
TO COUNSEL ON THINGS LIKE PREP
AND PAP AND.
YOU KNOW MORE NEEDS TO BE DONE
THERE AND TRAINING AND.
.
GOING BACK TO PHYSICIANS. ARE
CURRENTLY WHO ARE OF PRACTICING.
AND I COULD SEE THE SAME THING
WITH THE OPIOID ISSUE.
YOU KNOW WOULD IT TAKE.
I EFFORTS TO HAVE THE MEDICAL
BOARD GO BACK AND LOOK AT THE
RESIDENCY PROGRAMS AND
INCREASING. YOU KNOW
CERTIFICATIONS FOR SOME BOX ON
WHICH IS.
ONE OF THE THINGS THAT COULD
REALLY HELP RURAL AREAS
ESPECIALLY.
SO I BELIEVE YOU'RE GOING TO BE
HEARING FROM THE MEDICAL BOARD
SOON ABOUT WHAT WHAT THEY'RE
THEY'VE BEEN.
THEY ALSO ALONG WITH FARMS
SUPPORT OUR FOUNDING MEMBERS OF
OUR OPIATE WORKGROUP AND HAVE
BEEN ACTIVELY. THE MEDICAL BOARD
OF CALIFORNIA PUT OUT THEIR
GUIDELINES WELL BEFORE THE CDC
EVER PUT OUT THERE'S A CUT
THEY'VE REALLY BEEN AT THE FRONT
EDGE ON THIS SO.
NOW THAT'S GOTTEN ON THE.
.
YOU ALSO TALKED ABOUT THE
TARGETED EDUCATION CAMPAIGN AS
WELL AS THE HUB AND SPOKE.
WHERE TO THE PHARMACISTS
FIT INTO THAT ARE THEY PART OF
THAT AND?
YES ARE YOU ALSO BE HEARING FOR
THE BOARD PHARMACY ANOTHER
FOUNDING MEMBER HERBERT GROUP.
SOME OF THE POLICY CHANGES THAT.
WENT INTO EFFECT BECAUSE OF THE
WORKING OF THE BOARD OF PHARMACY
HAVE REALLY DRAMATICALLY.
INCREASED ACCESS TO FOR EXAMPLE
THE LOCKS AND.
WITHOUT A PRESCRIPTION AND AND
AGAIN I'M GOING TO DEFER TO THEM
TO TO ANSWER THOSE QUESTIONS FOR
YOU.
PALM AND JUST LAST REALLY
BRIEFLY ARM ONE OF THE THINGS
I'VE BEEN WORKING ON IS TRYING
TO INCREASE.
PRESCRIBER REIMBURSEMENT FOR.
PHYSICIANS WHO BECOME CERTIFIED.
ARE TO TREAT WITH SUBOXONE.
AND THE.
BECAUSE OF THAT AND THE WAY IT
OPERATES HAVING MOTIVATED.
.
MOST PATIENTS WHO REALLY WANT TO
GET OFF THE DRUGS AND HAVE USING
TELEHEALTH AND ABILITIES TO.
HARM HAVE A PRESCRIPTION CAN
REALLY HELP PEOPLE IN RURAL
AREAS.
.
AND I KNOW YOU MENTIONED THAT
AND I THINK THAT'S IMPORTANT
BCAUSE WE HAVE. ACCORDING THE
THE DATA AYE OF LESS THAN TWO
PERCENT OF CALIFORNIA MEDICAL
PROVIDERS A CERTIFIED.
TO PRESCRIBE SO BOX ON WHICH
I THINK IS YOU KNOW.
AND BIG OPTION A BIG OPPORTUNITY
FOR US.
ONE OTHER THING CHF WILL BE
SHARING IN THE NEXT COUPLE WEEKS
IS SNAPSHOTS BY COUNTY WHERE WE
ESTIMATE THE PREVALENCE OF
OPIOID USE DISORDER AND I
COUNTY.
THE CURRENT NUMBER OF EVEN OUR
FAME PRESCRIBERS AND METHADONE
SLOTS AND THEN WHAT IT WILL TAKE
TO MEET THE TREATMENT GAP AND SO
I'M HOPING THAT WILL BE USEFUL
WHEN YOU LOOK AT YOUR OWN.
COUNTIES TO FIGURE OUT I'M
EXACTLY HOW MUCH TREATMENT DO
YOU NEED TO BUILD BECAUSE IT'S
ONE OF THE QUESTIONS THAT'S BEEN
ASKED.
THANK YOU.
ASSEMBLY WOMAN OR RENT.
THANK YOU OF YOU KNOWS GREAT TO
SEE I MEAN.
VERY HEARTENING TO SEE THAT
CHART OF HOW MANY LESS
PRESCRIPTIONS ARE BEING WRITTEN
AND OBVIOUSLY.
CURIOUS HAS HELPED OUT A LOT IN
EDUCATION.
OF OF PHYSICIANS HAS HAS HELPED
THAT.
SO I WAS WONDERING THAT THE
NUMBER OF OVERDOSES IS NOT.
DECREASING.
IT BUT IS THE NUMBER OF ARE THE
NUMBER OF ILLEGAL DRUG OVERDOSES
INCREASING FASTER THAN THE
NUMBER OF.
LEGAL PRESCRIPTION SERVES THE
I'M SORRY I DON'T HAVE THE MOST
RECENT DATA THOUGH IN THE NUMBER
OF OVERDOSES IS IN FACTUALLY IN
FACT IT'S IT'S DECREASING
ALTHOUGH THE DECREASE IS NOT YET
STOOD TO
LIKELY SIGNIFICANT THAT'S WHY
YOU'RE SEEING IT I'M FLAT ON THE
GROUND SO IT IS SO. IT IS
DECREASING.
THERE PER BE NUMBER OF.
OVERDOSES ASSOCIATED WITH
HEROIN AND AND FENTON ALL ARE
INCREASING
THEY'RE STILL. UM'S
STILL SEVENTY PERCENT OF THE
OVERDOSES INDESIT WE SEE ARE
RELATED TO PRESCRIPTION OPIOID
SO IT'S IMPORTANT THAT IS STILL
THOUGH THE PREPONDERANCE OF OF
THE PROBLEM RIGHT NOW. BUT WE DO
EXPECT THAT PROPORTION TO SHIFT
AS WE.
IN GAY IT AS WE ARE MORE AND
MORE SUCCESSFUL WITH THE
PRESCRIBING COMMUNITY AND
LIMITING.
ACTUAL PRESCRIPTIONS A NEW
ADDICTIONS THAT ALSO LIMITS THE
DRUG AVAILABILITY FOR DIVERSION
AND SO THAT WE HOPE THAT THAT
WILL DECREASE THE OVERALL AMOUNT
OF OF.
OPIATES CIRCULATING IN A
COMMUNITY BUT WHAT WE'VE SEEN ON
THE EAST COAST IN PARTICULAR IS
THAT.
HEROIN COMES UP REALLY QUICKLY
AND THAT'S
THAT'S WHY WE NEED THAT
PARTNERSHIP WITH LAW ENFORCEMENT
AS WELL AND BECAUSE THE
INTERVENTIONS IN THAT WORLD AS
FAR AS THAT. THE USER IS
CONCERNED THE INTERVENTIONS ARE
VERY SIMILAR IF NOT THE SAME
BUT.
IN TERMS OF DECREASING THE
AMOUNT OF THAT THOSE DRUGS THAT
ARE AVAILABLE TO VERY DIFFERENT
WORLD.
RIGHT BUT IF AND IF YOU LOOK AT
THAT CHART NO IT HAS BEEN VERY
SIGNIFICANT IN THE LAST FIVE
YEARS YEAH SO I WOULD I WOULD
THINK THAT WE WOULD ALL BE
PREDICTING A HUGE SPIKE IN AND
HEROIN.
YEAH AND SO IT SEEMS THAT THIS
IS REALLY THE TIME TO THAT TO
HAVE. A BIG FOCUS ON THESE
ALTERNATIVE.
STRATEGIES ABSOLUTELY BECAUSE
YOU COULD GET A HOPEFULLY WE'RE
GOING TO DO IS HAVE A CHART LIKE
THE FRANCE CHART. IF YOU ARE
ABLE TO OFFER OF AND YOU KNOW AS
SOON AS THEY'RE OFF THE
PRESCRIPTION DRUGS.
THE THE SUBOXONE OR THAT.
METHADONE THAT'S EXACTLY WHAT
WE'RE HOPING FOR GOING TO
ABSOLUTE WE WE WANT TO AVOID THE
CHALLENGES THAT WERE SEEN.
ELSEWHERE IN THE UNITED STATES
WHEN THEY DIDN'T RECOGNIZE THAT
THIS WAS SHIFTING WE'VE KNOWN
THAT FROM THE BEGINNING THAT
THAT WAS A RISK AND THAT'S WHY
WE'RE HAVE THIS MULTI SECTOR
COLLABORATIVE TO TRY TO. PUT ALL
THOSE THINGS AND PLAY.
YEAH I JUST SPOKE WITH THE
MEDICAID DIRECTOR OF WEST
VIRGINIA WITH THE HIGHEST DEATH
RATE IN THE COUNTRY AND THEY'RE
DOING AN ALL OUT LAW ENFORCEMENT
APPROACH TO THE EPIDEMIC IN
THEIR.
IN THEIR DEATH RATE CONTINUES
TO RISE IN THE WHAT'S HAPPENING
IS THAT THAT LAW ENFORCEMENT
HATES A BOX UNDER THE SEAT SOLD
ON THE STREET AND WHAT THEY
DON'T UNDERSTAND IS IT SOLD ON
THE STREET BECAUSE YOU CAN'T GET
IT. LEGAL IS VERY DIFFICULT TO
GET TREATMENT AND THERE'S IS
INVERSE RELATIONSHIP AS THE MORE
YOU MAKE IT EASIER TO GET
TREATMENT THE LESS YOU NEED
ADVICE ABOUT SOME ON THE STREET.
BUT IT'S A REAL CULTURE SHIFT IN
LAW ENFORCEMENT TO EMBRACE
TREATMENT AND AND I JUST WANNA
RECOGNIZE THAT THAT'S DIFFICULT
AND AND.
AYE AYES YEAH THEY DON'T SEEM
TO LIKE THIS METHADONE EITHER
BUT THEY'RE VERY EXCITED ABOUT
THESE TRIALS WITH ON THIS
PATROL.
THAT THERE AND VENTURA COUNTY
THEY'RE RUNNING A TRIAL RIGHT
NOW YEAH I THINK THERE'S A ROLE
FOR FOR ALL OF. THE TYPES OF OF
ATTRITION AND PART OF THAT WE DO
THINGS WE HAVE SEEN IN THE IN
THE LOCAL COALITIONS.
I WAS AT THE LOCAL LEVEL BEFORE
I CAME HERE AND WE HAD A
COALITION IN AND.
NAPA WHERE I WORKED AND. I'M IT
WASN'T VERY LONG AFTER ENGAGING
LAW ENFORCEMENT THAT THEY
ACTUALLY BEGAN TO UNDERSTAND THE
DYNAMICS IN THAT STAND THE WHOLE
PROBLEM
MINISTRY FOR ALL OF US IF WE
STAY IN OUR SILO AND THAT'S. ONE
OF THE REASONS I I'M I'M PRETTY
OPTIMISTIC ABOUT OUTCOMES AND IN
LAW ENFORCEMENT IS A IS A
PARTNER IN EVERY SINGLE ONE OF
THESE LOCAL COALITION.
AND IF I COULD DO ONE MORE STORY
WE WENT TO GO VISIT REIKERS
ISLAND IN RHODE ISLAND BECAUSE
THEY OFFER METHADONE PEOPLE
OFTEN END OF A TRIAL IN THE
JAILS. AND PRISONS THERE AND THE
MAIN REASON THEY DID THAT IS
THEY FOUND A QUARTER OF THE
PEOPLE WHO DIED IN RHODE ISLAND
FROM OVERDOSE DEATHS. WERE
WITHIN THIRTY DAYS OF RELEASE
FROM JAIL AND THE REASON IS YOU
GO TO JAIL YOU GET DE TAXED YOU
LOSE YOUR TOLERANCE YOU. GET
RELEASED FROM JAIL.
AND IF YOU GO BACK TO YOUR
DREAD THEM OUT THEY USED
TOLERATE IS NOW ENOUGH TO KILL
YOU SO THERE'S A. REAL NATIONAL
EFFORT TO GET ALL THREE
MEDICATIONS INTO JAIL AND PRISON
RE ENTRY TO PREVENT THOSE THOSE
DEATHS.
THE YOU MUCH WE HAVE A DOCTOR
RAMBLER SOME BLOOM AND THEN
ASSEMBLY MEMBER GIPSON.
THANK YOU.
COME I WANTED TO FOCUS MY
COMMENTS OF A COULD DOCTOR
PFEIFFER ON THE INTER
OPERABILITY THAT YOU SPOKE OF
WITH CURES AND QUIRK FLOW.
HAVING WORKED WITH CURES ONE
POINT NOW I KNOW THERE WERE
QUITE SOME GROWING PAINS.
AND WANTED TO SEE WHAT
OPPORTUNITIES THERE WERE.
REGARDING HIT BY AND EVERYTHING
ELSE THAT WE HAVE TO WORK
THROUGH ABOUT FIGURING OUT HOW
ALERTS COULD HELP US TO TRIGGER.
OR IF WE COULD GET YOU THE GAME
INFORMATION JUST LIKE WE DO
VITAL SIGNS I THINK IT'S AS
IMPORTANT FOR US AS PRESCRIBERS.
TO KNOW WHAT OUR PATIENTS ARE ON
AND WOULD LIKE TO HEAR CREATIVE
SOLUTIONS THAT YOU MAY SUGGEST
TO HELP WITH WORK.
WELL I WANT TO THANK YOU ALL FOR
PASSING AB FORTY BECAUSE IT USED
TO BE IMPOSSIBLE TO HAVE THIS
CONVERSATION AND NOW THE
DEPARTMENT OF JUSTICE IS
ACTIVELY WORKING TO. REACH OUT
TO ELECTRONIC HEALTH RECORD
VENDORS AND SEE WHAT IT WOULD
TAKE TO MAKE THOSE CONNECTIONS
SO NOW INSTEAD OF A POLICY
PROBLEM IT'S A. IT'S A TECHNICAL
AND RESOURCE PROBLEM JUST MAKING
SURE THAT THEY'VE GOT THE
RESOURCES THEY NEED TO DO THE
WORK TO MAKE THESE CONNECTIONS
BECAUSE.
IT'S IT'S THERE'S NO QUESTION
IT WILL IMPROVE CARE AND AND YOU
DON'T NEED TO MANDATE
PRESCRIBERS TO CHECK IT IF IT'S
FLOWS AND IT'S RIGHT THERE. IN
YOUR FACE AND SO AGAIN I THINK
THAT.
I KNOW THEY'RE ACTIVELY WORKING
ON IT AND WE'VE BEEN TRYING TO
HELP IN ANY WAY WE CAN.
YOU HAD ALSO MENTIONED THE PURE
PROVIDERS AND THAT WAS A NEW
TOPIC FOR ME CAN YOU EXTRAPOLATE
A LITTLE BIT.
WELL IT'S IT'S VERY DIFFICULT
FOR SOMEONE IN THE THROES OF
ADDICTION TO LISTEN TO WHITE
MIDDLE AGED WOMAN TELL THEM.
THEY CAN FEEL BETTER IT'S VERY
IT'S A DIFFERENT EXPLAINS OF
SOMEONE'S WALK THAT TALK TO SAY
I'VE BEEN IN YOUR SHOES MY LIFE
WAS CHAOS AND NOW EMPLOYED I'VE
GOT MY FAMILY THAT YOU CAN DO
THIS TOO AND SO.
RHODE ISLAND FOR EXAMPLE HAD A
STATEWIDE CAMPAIGN WHERE THEY
MADE SURE EVERY SINGLE EMERGENCY
ROOM.
WAS ABLE TO GIVE SUBOXONE IN THE
EMERGENCY ROOM SO YOU TAKE
SOMEONE YOU KNOW THEY JUST
OVERDOSE THEY'D GET MARK AND
THEY'RE IN THE WORST WITHDRAW
THEIR LIFE. AND WE GET MAD AT
THEM WHEN THEY RUN OUT THE DOOR
TO GET A FIX BECAUSE THEY FEEL
LIKE THEY'RE GONNA DIE IF THEY
GETS A BOX ON THEIR BRAIN STABLE
AND THEN. APPEAR PROVIDERS ON
CALL IN THEY'VE CREATED A
NETWORK OF THESE PEER PROVIDERS
WHO HAD SOME EDUCATION SO THAT
THEY'RE NOT.
AGAINST MEDICATIONS BECAUSE OF
COURSE IF YOU'VE IF YOU'VE
BECOME CLEAN AND SOBER WITHOUT
MEDICATIONS AND THEN YOU CAN BE
VERY JUDGMENTAL OF THOSE WHO
NEED MEDICATIONS. AND SO THEY
DIDN'T EDUCATIONAL CAMPAIGNS OF
THE NEW THE DATA THEY KNEW THAT
YOU'RE TWICE AS LIKELY TO DIE
WITH OPIATE ADDICTION IF YOU
DON'T HAVE MEDICATIONS AND
BEHAVIORAL HEALTH. AND SO THEY
CREATED THIS THIRTY DAY
INTERVENTION WHERE THE PEER
PROVIDERS WILL BE CHECKING IN
WITH AND THE NEXT DAY BY PHONE
THE NEXT DAYS HAVE YOU GOTTEN
DEDUCTION TRIMMING AND WHAT'S
GOING ON RIGHT AND. AND AGAIN
THE MORE THAT SOMEONE LIKE YOU
HELP SHOOTS THEM OR YOU'RE GOING
TO RESPOND TO IT.
FINALLY.
IN YOUR COMMENTS HE SAID THAT
SUBOXONE THAT CAN BE TRACKED BY
CURES.
THE FLIP OF THAT WOULD INFER
THAT OTHER MEDICAL ASSISTANT
TREATMENTS ARE NOT.
TRACKED BY CURIOUS CAN YOU
EXPLAIN WHY THAT IS.
SO S. DATABASE
AND NOW TRACK SOUNDS NOT A
CONTROLLED SUBSTANCE AND SCARES
DATABASE ONLY TRACKS CONTROLLED
SUBSTANCES SO. WE DO THINK IT'S
USEFUL IF IF WERE IF THE
MESSAGES ALL THREE DRUGS SHOULD
BE AVAILABLE IN ALL SETTINGS AND
IF WE SEE PEOPLE OFTEN GO UP. WE
CAN INFER THAT IT'S GOING UP IN
OTHER WAYS WE HAVE TO USE OTHER
DATA SOURCES TO UNDERSTAND.
WHO'S GETTING METHADONE ENOUGH
TRUCKS ON.
THANK YOU.
ASSEMBLY MEMBER BLOOM.
THANK YOU MISTER CHAIR.
AND THANK YOU FOR THE
ELIMINATING PRESENTATION.
.
AND I KNOW WE HAVE A BUNCH OF
OTHER PRESENTATIONS ON WHICH I
KEEP TO SUCK ON MY QUESTION TO A
MINIMUM AND AND THAT IS.
DO YOU HAVE DATA ERRORS ARE DATA
AVAILABLE ON THE.
OVERLAP BETWEEN HOMELESSNESS
AND THE.
OPIOID OVERDOSE.
WE DO NOT HAVE A CLEAR.
SOURCE OF DATA FOR THAT WE.
OUR DON'T WE HAVEN'T ACTUALLY
TRIED TO.
ASSESSED THAT SPECIFICALLY IT
WOULD REQUIRE DATA SOURCES THAT
ARE AT THE LOCAL LEVEL.
IN COMBINATION WITH THE
RESOURCES AT TE STATE LEVEL AND
IT'S NOT SOMETHING WE'VE WE'VE
ATTEMPTED AT THIS POINT ALTHOUGH
I BOTH YOU KNOW ANECDOTALLY IT'S
OBVIOUSLY A HUGE OVERLAP FOR FOR
THE CHRONIC.
THE CHRONICALLY ADDICTED FOLKS.
ALRIGHT THANK YOU.
SOME AMERICAN. THANK YOU VERY
MUCH MISTER CHAIRMAN I'M GOING%
TO QUIT BECAUSE I KNOW WE HAVE
OTHER PRESENTERS.
I'M I'M INTERESTED IN THE AGE
GROUP THAT YOU HAVE FOUND HAS
BEEN THE MOST AT RISK IN TERMS
OF THIS EPIDEMIC THAT'S ONE
QUESTION. AND THEN TO.
I CAN CERTAINLY APPRECIATE MY
DOCTOR.
DOCTOR RAMBLE AND OTHERS IN
THIS FIELD WHO ARE EXPERTS CAN
WE JUST STOP.
PRESCRIBING. THIS
DRUG.
WHAT'S YOUR REACTION IS OR
SOMETHING ELSE IS THERE
SOMETHING ELSE OUT THERE.
THAT WILL HAVE THE.
LEASE KIND OF AFFECT.
ON PEOPLE WITH THEY'LL CONTINUE
TO FEED THIS ADDICTION.
SO MANY DO THE LAST ONE FIRST IN
TWO THOUSAND FIFTEEN ENOUGH
OPIOIDS ARE PRESCRIBED IN
CALIFORNIA FOR EVERY MAN WOMAN
AND CHILD TO MEDICATE THEMSELVES
AROUND THE CLOCK FOR A MONTH. SO
AND THE PROBLEM IS THAT WE'VE
ALREADY GOT A GENERATION OF
PEOPLE WHO ARE DEPENDENT ON
THESE MEDICATIONS AND THEIR
BRAIN HAS BEEN SOMETIMES
PERMANENTLY ALTERED BY
DEPENDENCE ON THIS MEDICATION SO
FLEET WHAT WE FOUND IN INDIANA
AND OTHER STATES AS YOU.
SUDDENLY STOP PRESCRIBING THE
DRUG YOU HAVE THE SAY EVEN IF
YOU CAN TAKE IT FOR PAIN NOT
BECAUSE YOU'RE ADDICTED YOUR
TAKE IT LIKE A DOCTOR PRESCRIBED
YOU GET THE SAME LEVEL OF.
WITHDRAWAL AND CRAVING AND
TECHNICALLY DOPE SICKNESS WHERE
YOU FEEL LIKE YOU'RE GONNA DIE.
YOU IN ORDER TO SURVIVE HE
TURNED TO STREET DRUGS THE
TYPICAL PASSES HE START BUYING
OXYCODONE THERE AND THEN YOU
CAN'T AFFORD IT ANYMORE AND
HEROINES CHEAPER AND SO
INDIANA'S ARE REALLY BIG SPIKE
IN HIV. BECAUSE OF MIDDLE CLASS.
PEOPLE WHO WERE PROCLAIM
PATIENTS WHO GOT CUT OFF
SUDDENLY SO. I THINK IT'S VERY
IMPORTANT TO STOP PRESCRIBING
THE DRUG EXCESSIVELY TO STOP
PRESCRIBING AT HIGH DOSES TO
STAB PRESCRIBING. FOR LONG
DURATIONS.
AND THAT TAKES A REAL CULTURE
CHANGE FOR THE SAME TIME WE WANT
TO MAKE SURE IT'S AVAILABLE FOR
TRAUMA AND CANCER AND END OF
LIFE CARE. AND WE WANNA MAKE
SURE PEOPLE WHO ARE DEPENDENT ON
HIGH DOSES ARE SLOWLY TAPERED TO
A SAFER LOWER DOSES WITHOUT
BEING CUT OFF BECAUSE THAT WILL
ONLY INCREASE THE DEATH RATE.
.
I'D SAY THE FIRST QUESTION WAS
ALL AGES WHAT WE'RE SEEING IS
THAT IT THE.
IT'S A MUCH YOUNGER PROFILE
THAN ALCOHOL AND TOBACCO.
THESE YOUNG PEOPLE ARE DYING IN
THE FIRST COUPLE YEARS OF THEIR
DICTION SO WE'RE SEEING A LOT OF
DUST IN THEIR TWENTIES AND WE'RE
ALSO SEEING.
EARLY MIDDLE AGE BECAUSE THOSE
ARE THE FOLKS WHO.
HAVE CHRONIC PAIN A LOT OF THEM
ARE WORKING CLASS DID MANUAL
LABOR THAT SPINE INJURIES WENT
TO THE DOCTOR. DIET PILLS AND
THEN GOT DEPEND ON BECAME
DEPENDENT ON THOSE PILLS SO I AM
THAT'S WHY WE'VE ULTIMATELY.
SHIFTED THE LIFE EXPECTANCY IN
THE U. S. BECAUSE THESE THESE
FOLKS ARE DYING AT YOUNGER AGES.
THANK YOU BUT THE DETAILS ARE IN
THE DASHBOARD AND IT'S REALLY
FUN TO PLAY AN ENCOURAGE YOU TO
GO IN AND LOOK BY AGING REGION
THAT CAUSES A LOT OF
INFORMATION.
THANK YOU.
THIRTY FIVE AND DOCTOR SMITH
THANK YOU VERY MUCH FOR THAT
THIS TIME THAT HE'S BEEN FESTIVE
TODAY.
THANK YOU WELL NOW I TRANSITION
INTO OUR SECOND PANEL IN WHICH
WE HAVE OF FOR REPRESENTATIVES.
MISS TINA FOR ALL IS WHO WORKS
FOR THE DEPARTMENT OF JUSTICE
TECHNOLOGY DIVISION WHICH
MAINTAINS THE CURES PROGRAM.
ALSO MISTER BRIAN CLIFFORD WHO
REPRESENTS THE DEPARTMENT A
CONSUMER AFFAIRS. WHICH OVERSEES
THE VARIOUS PORTS THAT FUN AND
UTILIZED SECURES.
MISS VIRGINIA HEROLD THESE THE
EXECUTIVE OFFICER FOR THE BOARD
OF PHARMACY WHICH REGULATES
PHARMACISTS TO SUBMIT DATA INTO
CHEERS.
AND FINALLY MISS KIMBERLY KURT
MEYER THE EXECUTIVE DIRECTOR OF
THE CALIFORNIA MEDICAL BOARD
WHICH ALSO REGULATES DOCTORS
WHO.
OVERSEE AND.
USED CURES.
SO WITH THAT.
.
PLEASE WERE WHENEVER YOU'RE
READY WHOEVER'S LIKE OF
.
THIS HOW WOULD YOU CARE TO TO BE
IT OR DO YOU. HAVE ANYONE IN
PARTICULAR MISSED MISS ROBBINS.
OKAY GREAT THANK YOU.
GOOD MORNING. UP GERMAN LOW IN
THE THING WITH MEMBERS OF THE
ASSEMBLY COMMITTEE UNDER THE
THING PROFESSIONS.
THE ATTORNEY GENERAL'S OFFICE
THANKS YOU FOR THE OPPORTUNITY
TO PROVIDE TO PROVIDE AN
OVERVIEW OF CALIFORNIA'S
PRESCRIPTION DRUG MONITORING
PROGRAM OR PNP. CULTURE IF.
MY NAME IS JENNIFER ALISON I AM
THE MANAGER OF THE CURE'S
PROGRAM.
AND WITH ME OF MY COLLEAGUE
SPECIAL ASSISTANT TO THE
ATTORNEY GENERAL MELANIE. BONTA
THREE NEAR.
CURIOUS NOW FOR CONTROLLED
SUBSTANCE UTILIZATION REVIEW AND
EVALUATION SYSTEM. I'M OBLIGATED
TO SAY THAT EVERY TIME I FOR
THAN TWENTY YEARS.
CREATED IN NINETEEN THIRTY NINE
CALIFORNIA'S PMP OF THE OLDEST
IN THE COUNTRY. ORIGINALLY THE
TRIPLICATE PRESCRIPTION PROGRAM
OR TPP.
ONLY FILL TWO DISPENSATIONS
REPORTED TO DOJ AND MADE
AVAILABLE TO LAW ENFORCEMENT
SURFACED IN INVESTIGATIONS OF
CRIMINAL DRUG DIVERSION AND
FRIED.
IN TWO THOUSAND FIVE CURES
REPLACE THE TPP AND BECAME
PERMANENT.
DURING THE TWO THOUSAND ELEVEN
STATE BUDGET CRISIS DOJ'S BUREAU
OF NARCOTIC ENFORCEMENT WHICH
MAINTAIN THE CURE'S PROGRAM.
DISSOLVED AND ACUTE PROGRAM WITH
LEFT COMPLETELY DEFUNDED.
EVENTUALLY IN TWENTY THIRTEEN
THE STATE BUDGET ACT ALLOCATED
FUNDS SPECIFICALLY FOR THE NEW
CARE SYSTEM BUILT PROJECT.
ALSO IN TWENTY THIRTEEN SENATE
BILL EIGHT ON NINE ESTABLISH THE
REQUIREMENT FOR PRESCRIBER THAN
DISPENSERS TO REGISTER FOR
CURIOUS BY TWENTY SIXTEEN.
THE BILL ALSO CREATED AN ONGOING
FUNDING MECHANISM TO SUPPORT THE
OPERATION AND MAINTENANCE OF THE
CARE SYSTEM.
THROUGH THE COLLECTION OF A
FIXED DOLLAR ANNUAL FEE
PROFESSED HIGH LIFE AND SEE THAT
THE TIME OF LICENSE RENEWAL.
THE PROCEEDS ARE DEPOSITED INTO
THE CURE FUND. FOR THE
DEPARTMENT CAN THOROUGHFARES TO
REIMBURSE DOJ FOR MAINTAINING
THE CURRENT DATABASE.
TO THIS END DEAR JANE DE CA HAVE
A FORMALIZED WORKING
PARTNERSHIP.
THE DOJ IN DC MEET REGULARLY TO
DISCUSS CURIOUS TO POINT NO
UPDATES AND CURES TO POINT A
CHANGE CONTROL BOARD MATTER TH.
AND TWENTY SIXTEEN IS WHEN THE
CURIOUS TO POINT OF SYSTEM WENT
LIVE.
SO WHAT INFORMATION IS CONTAINED
IN CURIOUS.
PHARMACY THE DISPENSERS ARE
REQUIRED TO REPORT THEIR
DISPENSATIONS OF SCHEDULE TWO TO
FOUR PRESCRIPTIONS TO DOJ AT
LEAST WEEKLY.
SINCE THE PHARMACY AND DISPENSER
CREATE AN OWNS A PRESCRIPTION
RECORD THE CURE SYSTEM THEREFORE
REFLECTS THAT INFORMATION
EXACTLY AT THAT HAVE REPORTED TO
DOJ.
ONE OF THE BENEFITS FOR
PROVIDERS CHECKING CURIOUS THAT
THEY CAN. GET A COMPREHENSIVE
VIEW OF THAT THEIR PATIENT'S
PRESCRIPTION HISTORY.
INCLUDING THOSE PRESCRIPTIONS
THAT TOOK PLACE OUTSIDE OF THE
PROVIDER OF NETWORK OR
HEALTHCARE SYSTEM.
TO GIVE ME AN IDEA OF HOW MANY
PRESCRIPTIONS ARE DISPENSED IN
CALIFORNIA. GROUP RECEIVES ABOUT
A MILLION PRESCRIPTION RECORDS
EACH WEEK.
THOUGH THE AUTHOR WRITES ACCESS
CURES INCLUDE PRESCRIBERS DEFEND
THIRDS LAW ENFORCEMENT OFFICIALS
REGULATORY. BOARD OFFICIALS AS
WELL.
DATA CAN ALSO BE MADE AVAILABLE
FOR STATISTICAL ANALYSIS
EDUCATION AND RESEARCH.
THIS GRAPH REPRESENTS CURED
REGISTRATION AND APPROVAL RATE.
THE RED VERTICAL LINE
REPRESENTING CURE SOPRANO WENT
LIVE IN TWENTY SIXTEEN. AND THE
BLACK VERTICAL LINE REPRESENTS
WHEN THE MANDATORY REGISTRATION
DEADLINE WAS AND IN JULY TWENTY
SIXTEEN.
PROGRAMMER DISPENSARY JUST
RATIONS REPRESENTED BY THE
ORANGE AND YELLOW LINES ON THIS
CHART SHOW A GRADUAL INCREASE IN
REGISTRATION FIFTH ENACTMENT OF
SENATE BILL EIGHT OR NINE.
WHEN TH CURIOUS TO POINT NO
LAUNCHED IN TWENTY SIXTEEN OF
THE FULLY AUTOMATED REGISTRATION
PROCESS.
DID THE HEAVY LIFTING IN GETTING
THE MAJORITY PRESCRIBER THAN
DISPENSERS REGISTERED BY THE
DEADLINE.
IN TWENTY ELEVEN THE NUMBER
PRESCRIBE WITH REGISTERED WITH
ABOUT FIFTY FIVE HUNDRED AND BY
TWENTY SEVENTEEN THERE WERE OVER
A HUNDRED AND TWENTY EIGHT
THOUSAND PRESCRIBERS REGISTERED
IN HERE IF.
FOR DISPENSER THAN TWENTY ELEVEN
THERE ARE JUST UNDER THOUSAND
DISPENSERS REGISTERED AND BY
TWENTY SEVENTEEN THERE OVER
FORTY THOUSAND DISPENSERS
REGISTERED.
THE BLUE AND GREEN LINE AT THE
BOTTOM REPRESENTS LONG FOURTH
MINUTE AND REGULATORY BOARD
REGISTRATIONS.
THE FIVE OF THE BOTTOM RATHER
DIFFICULT THE MAINLY BECAUSE LAW
ENFORCEMENT AND REGULATORY BOARD
REGISTRATIONS ARE LOW IN
COMPARISON TO THE PRESCRIBER
THEN THE FENCERS.
IN TWENTY ELEVEN THERE WERE
ABUT THREE HUNDRED FIFTY LAW
ENFORCEMENT OFFICIALS REGISTERED
AND BY TWENTY SEVENTEEN THERE
ARE FOURTEEN HUNDRED.
FOR REGULATORY OFFICIALS IN
TWENTY ELEVEN THERE WERE THERE
WERE ROUGHLY TEN AND BY TWENTY
FIFTEEN THERE WERE NINETY.
THIS GRAPH REPRESENTS CURED
UTILIZATION LEVELS.
DURING TWENTY ELEVEN THE NUMBER
OF PATIENT ACTIVITY REPORTS THAT
WERE GENERATED BY PRESCRIBERS
WITH THAT ABOUT FIFTEEN AND
FORTY FIVE THOUSAND. MY TWENTY
SEVENTEEN PRESCRIBERS GENERATED
OVER FOUR MILLION PATIENT
ACTIVITY REPORTS ARE PART IN
THAT YEAR.
IN TWENTY ELEVEN THE NUMBER OF
PARS GENERATED BY DISPENSERS
WITH ABOUT A HUNDRED AND FIFTY
ONE THOUSAND. AND BY TWENTY
SEVENTEEN DISPENSERS GENERATED
ABOUT FIVE POINT EIGHT MILLION
PARTISAN THAT YEAR.
RELATIVE TO PRESCRIBER THAN
DEFEND THROUGH IF LAW
ENFORCEMENT AND REGULATORY BOARD
USAGE IS LOW MAINLY BECAUSE OF
THE DIFFERENCE IN THE NUMBER OF
REGISTRANTS.
BUT TO PROVIDE YOU WITH THE
THOUGHT OF HOW MANY PATIENT
ACTIVITY REPORTS WERE CREATED.
IN TWENTY ELEVEN THE NUMBER PART
BY LAW ENFORCEMENT THERE WERE
ABOUT TEN THOUSAND CREATED.
AND BY TWENTY SEVENTEEN THERE
ARE TWO THOUSAND.
FOR REGULATORY BUT OFFICIALS IN
TWENTY ELEVEN THE CREATED ABOUT
EIGHT HUNDRED PARTS IN MY TWENTY
SEVENTEEN.
OVER SIX THOUSAND PARTH.
ONE FOURTH MINUTE REGULATORY
BOARD USERS ARE AUTHORIZED TO
ACCESS NOT ONLY PART OF BUT THE
CAN OBTAIN PRESCRIBER AND.
PRESCRIPTION REPORTS.
THERE ARE SOME NOTABLE
DIFFERENCES BETWEEN THE
CAPABILITIES OF CARE OF ONE
POINT NOW ENSURES TO PLANO.
YOU'RE GOING POINT WITHOUT
DEADLINE FOR FLEXIBILITY AND
SCALABILITY.
GIVEN PLANO ALSO LACKED ANALYTIC
AND COULD NOT SUPPORT ACADEMIC
RESEARCH OR PUBLIC HEALTH SECTOR
DATING YOUTH.
YOUR TWO POINT ADDRESSES THESE
INADEQUACIES BY PROVIDING AN
IMPROVED USER INTERFACE ROBUST
PERFORMANCE.
ANALYTICS AND INNOVATIVE PMP
INFORMATIONAL FEATURES.
ONE OF THE NEW FEATURES OF CURES
TO POINT OUR THE A FULLY
AUTOMATED REGISTRATION PROCESS
FOR CALIFORNIA LICENSE
PRESCRIBER THAN DEFENSE EARTH.
SINCE GOING LIVE WITH CURIOUS TO
POINT OUT OVER A HUNDRED
THOUSAND YOU CURIOUS USERS HAVE
BEEN APPROVED FOR ACCESS.
ANOTHER KEY STOOD ON A FEATURE.
PROVIDES PRESCRIBER THE DEFENSE
THROUGH THE ABILITY TO DESIGNATE
OTHER TH OR OR DELEGATES TO
INITIATE PATIENT INCREASE ON
THEIR BEHALF.
SINCE MAKING THIS DELEGATE
FEATURE AVAILABLE OVER THIRTY
FIVE THOUSAND DELEGATE INITIATED
PARTS OF BEEN CREATED.
YOUR SUPPORT ALSO LOVE
PRESCRIBERS TO NOTATE THEIR
PATIENTS WITH WHOM THEY HAVE A
TREATMENT EXCLUSIVITY COMPACT.
PATIENTS WITH COMPACT ARE
TYPICALLY BEING TREATED FOR
CHRONIC PAIN. WHEN PRESCRIBING
ZEOLITE THIS FEATURE FILTERS
USERS CAN VIEW OF A COMPACT OF
THIS FOR THE PATIENT.
WHICH MAY THINK WE'LL TO THOSE
PROVIDERS THAT ADDITIONAL
PRESCRIBING TO THESE PATIENTS
CAN BE POTENTIALLY
COUNTERPRODUCTIVE TO THEIR
EXISTING TREATMENT.
PRESCRIBER THE DISPENSER CAN
ALSO SECURELY FUND MESSAGES
CONCERNING MUTUAL PATIENTS.
MESSAGES DO NOT GET BENT OUT TO
PERSONAL EMAIL ACCOUNTS RATHER
THESE MESSAGES ARE SENT WITHIN
THE CURIOUS TO POINT NO
ENVIRONMENT.
A CURATIVE* ENVIRONMENT. SO
SO THE OTHER HAVE TO LOG INTO
THE CURE THE COUNT IN ORDER TO
VIEW AND VENDOR THESE MESSAGES.
WE THINK YOU'RE IS TO POINT OUT
PATIENT SAFETY ALERT FOR
DELIVERY TO PRESCRIBERS DAILY.
THESE ALERTS ARE INFORMATIONAL
AND CAN ASSIST THE PRESCRIBER IN
ABSOLUTE APTLY DETERMINING
PATIENT TREATMENT.
AND THE OTHER A FIVE PATIENT
SAFETY ALERT THAT WE HAVE
AVAILABLE FOR PRESCRIBERS.
NEW ALERTS ARE GENERATED DAILY
AND PREVENTED TO PRESCRIBERS
WITH THEM THE CURES TO PLANO
ACCOUNTS DASHBOARD.
WHEN CHALLENGE OF PRESCRIPTION
DATA IS THAT THE INFORMATION
EXCLUDES UNIQUE POSITIVE
IDENTIFIERS.
THE PATIENT EVER AND FROM.
GIVE ME THE PATIENT LEVEL
INFORMATION CURED RECEIVE.
THE LIMITED TO THE PATIENT NAME
DATE OF BIRTH GENDER AND
ADDRESS.
FREQUENTLY INFORMATION FOR A
SINGLE PERSON MAY DIFFER ACROSS
OR MULTIPLE PRESCRIPTIONS
BECAUSE THE VARIATIONS IN THEIR
NAME OR NAME SPELLING OR THE
PERSON LOOK AT MULTIPLE
ADDRESSES. OR BECAUSE THE SIMPLE
TYPE OF BY THE REPORTING
PHARMACY.
IN ORDER FOR CURIOUS TO PRODUCE
PATIENT SAFETY ALERTS THE
ANALYTICS ENGINE DE DUPLICATE
THE DATA WHICH WILL MATCH
RECORDS CONSIDERING VARIATIONS
ON PATIENT LEVEL INFORMATION.
FOR EXAMPLE.
JOHN SMITH BELLAGIO H. AND.
COULD BE CONSIDERED THE FAME
PERSON AT THE JOHN SMITH BILL J.
O. N..
THIS PROCESS OF LINKING ALL OF
THE RIGHT JOHN SMITH VARIATIONS
TOGETHER IF CALLED
DEDUPLICATION.
OR PATIENT ENTITY REVOLUTION.
THE CURIOUS DE DUPLICATION
PROCESS CONSIDER THE VARIATIONS
IN DIFFERENT COMBINATIONS OF
NAME DATE OF BIRTH STREET
ADDRESS FITTING IN THAT CODE.
CURATOR STEVE APPROXIMATELY
HUNDRED SIXTY FIVE THOUSAND YOU
PRESCRIPTION RECORD EACH DAY. SO
ALL OF THESE NEW PATIENT
PRESCRIPTION RECORDS WILL BE DE
DUPLICATED OR INVOLVED EVERY
NIGHT AGAINST THE ALREADY THE
STING DATING CURES.
PRIOR TO FURTHER SYSTEM ANALYTIC
PROPHECIES THAT LEAD TO THE
ALERTS CREATION.
ONCE THE NIGHTLY DE DUPLICATION
PROCESS IS COMPLETE CALCULATIONS
AGAINST THE REVOLVED PERSONS
CURRENT PRESCRIPTION DATA IF
CALCULATED AND WENT APPLICABLES.
THE PATIENT SAFETY ALERT IS
DELIVERED TO THAT PERSON'S
CURRENT PRESCRIBERS.
THE SYSTEM GENERATES
APPROXIMATELY TURN A FIFTY
THOUSAND YOU PATIENT ALERTS EACH
DAY.
DE DUPLICATION OF ALSO PERFORMED
DURING THE PRODUCTION OF DE
IDENTIFIED DATA SETS THAT ARE
AVAILABLE TO COUNTY PUBLIC
HEALTH OFFICES AND RESEARCHERS.
ON A QUARTERLY AND ANNUAL BASIS
CURES TO PLANO CAN NOW
SYSTEMATICALLY PRODUCE.
WHEN STATEWIDE AND FIFTY EIGHT
COUNTY SPECIFIC DE IDENTIFIED
DATA SETS.
THE COUNTY PUBLIC HEALTH OFFICES
THAT HAVE RECEIVED IF DATA STATE
PICURIS HAS HELPED WITH.
INCREASING PROVIDER COMMUNITY
AWARENESS OF THE LOCAL OPIOID
ISSUES.
HELP TARGET PREVENTION AND
EDUCATIONAL EFFORTS TO CHANGE
PRESCRIBING BEHAVIOR AND THEN
MEASURE OF SUCCESS OF SUCH
INITIATIVES.
AND HELP INFLUENCE PRESCRIBING
GUIDELINES AND DRIVE LOCAL
HEALTH POLICY.
DOJ ALSO CONTRIBUTES CURIOUS DE
IDENTIFIED DATA TO THE
CALIFORNIA DEPARTMENT OF HEALTH.
WELL BEARD OVERDOSE SURVEILLANCE
DASHBOARD.
DE IDENTIFIED DATA HAVE ALSO
PROVIDED TO FEDERALLY SPONSORED.
PRESCRIPTION BEHAVIOR
SURVEILLANCE SYSTEM OR PDFS
PROJECT.
WHICH IS CONDUCTED AT BRANDEIS
UNIVERSITY.
THE GOAL OF PBS AT THIS TO
CREATE AN EARLY WARNING
SURVEILLANCE EVALUATION TOOL
BASED ON DE IDENTIFIED
LONGITUDINAL DATA FROM ST PETE
IMPIOUS.
LIST TO LIVE INTENDED TO MEASURE
TRENTON CONTROL SORT OF
PRESCRIBING A DEFENSE THING AS
OLIVE INDICATOR THE MEDICAL USE
IMPOSSIBLE NON MEDICAL
PRESCRIPTION DRUG ABUSE AND
DIVERSION. CALIFORNIA'S ONE OF
ELEVEN STATES THAT CONTRIBUTE DE
IDENTIFIED PMP DATA TO THIS
PROJECT.
WITH SPECIFIED EXCEPTIONS SENATE
BILL FORTY TWO REQUIRED
PRESCRIBER CSUS CONSULT HERE OF
PRIOR TO PRESCRIBING A SCHEDULE
TWO TO FOUR CONTROLLED
SUBSTANCE.
AND AT LEAST ONCE EVERY FOUR
MONTHS OF THE CONTROLLED
SUBSTANCE CONTINUES TO BE PART
OF THE PATIENT'S TREATMENT.
THIS MANDATORY CURIOUS CHECK
WILL BECOME EFFECTIVE SIX MONTH
AFTER DOJ CERTIFY SYSTEM PROGRAM
RIGHT ENOUGH.
OTHER JANUARY TWENTY EIGHTEEN
THE CURE PROGRAM COMPLETED
HIRING RESOURCES THAT WILL BE
DEDICATED TO THIS EFFORT.
AND THE CURE APPLICATION TEAM IS
CURRENTLY CONDUCTING SYSTEM IN
THE TESTING AND ONCE IT IS
COMPLETE THE TO. THE DEPARTMENT
WILL CERTIFY THE SYSTEM.
A SIMILAR BEEF ASSEMBLY BILL
FORTY REQUIRED DJ TO MAKE YOUR
DATA AVAILABLE TO OPERATE THE
THIRDS VIA INTEGRATION WITH
HEALTH INFORMATION TECHNOLOGY
SYSTEMS BY OCTOBER ONE TWENTY
EIGHTEEN.
ONCE IMPLEMENTED CURE THE FIFTH
ABILITY WILL BE GREAT WILL
GREATLY IMPROVE.
ACCESS TO THE HEALTHCARE
COMMUNITY.
DOJ THEM EARLY STAGE OF THE
DEVELOPING THE TECHNICAL AND
ADMINISTRATIVE ASPECT OF AB
FORTY.
AND PLANS TO.
MOVE FORWARD WITH TIME
COLLECTING INFORMATION AND I'M
DEVELOPING THE SOLUTION BY
OCTOBER ONE.
THIS CONCLUDES.
ARE CURIOUS PROGRAM OVERVIEW
ONCE AGAIN THANK YOU FOR THIS
OPPORTUNITY TO PREVENT
INFORMATION ON THE CURE IS TO
POINT OUT SYSTEM.
YOU VERY MUCH.
WELCOME.
GOOD MORNING CHAIR LOAN ASSEMBLY
MEMBERS MY NAME IS BRIAN
CLIFFORD AND I AM THE SENIOR
PLANNING IMPLEMENTATION MANAGER
AT THE DEPARTMENT CONSUMER
AFFAIRS.
IN MY ROLE AS SERVE AS A CENTRAL
POINT OF CONTACT AT DCA FOR OUR
BOARDS IN THE DEPARTMENT OF
JUSTICE REGARDING HERE'S.
I'VE BEEN ASKED TO SPEAK TODAY
ABOUT THE ROLE DE CA IN OUR
RELATIONSHIP.
WITH THE BOARDS AND DOJ. IN IN
IMPLEMENTING CURES TO DATA.
BRIEFLY FOR BACKGROUND ON DCA
THERE ARE THIRTY EIGHT BOARDS
AND BUREAUS UNDER THE DEPARTMENT
BUT ONLY TEN BOARDS LICENSE AND
REGULATE THOSE INDIVIDUALS. THAT
MAY PRESCRIBE DISPENSE
CONTROLLED SUBSTANCES.
DC AS ROLE IN REGARDS SECURES IS
THREEFOLD.
FIRST WE SUPPORT DOJ AND A
TECHNICAL CAPACITY TO CONFIRM
THAT ACCESS SHOULD BE GRANTED TO
A LICENSED PRACTITIONER.
AUTHORIZED PRESCRIBER DISPENSE
CONTROLLED SUBSTANCES.
WE DO THIS THROUGH DAILY AND
MONTHLY DATA EXCHANGES WITH DOJ
TO VALIDATE APPLICANT
INFORMATION AND CONFIRM THAT AN
INDIVIDUAL REQUESTING ACCESS HAS
AN ACTIVE LICENSE.
WE ALSO SYSTEM TROUBLESHOOTING
PROBLEMS SUCH AS LOGGING ISSUES
AND MANY REPORTS BROUGHT FORWARD
BY OUR USERS AT THE BOARDS.
SECOND DCA ADMINISTERS SECURES
FUND AND PAYS REIMBURSEMENTS TO
DOJ FOR THE CURE SYSTEM.
LICENSEES THAT CAN PRESCRIBE
DISPENSE CONTROLLED SUBSTANCES
ARE REQUIRED TO PAY AN ANNUAL
FEE OF SIX DOLLARS AT THE TIME
OF THEIR LICENSE RENEWAL. AND
THAT MONEY IS DEPOSITED INTO
DC'S CURES FUND.
DOJ THEN PROVIDES INVOICES TO
DCA DETAILING WHAT COSTS SHOULD
BE REIMBURSED BY THE CURES FUND.
INCLUDING PERSONNEL AND ONGOING
SYSTEM MAINTENANCE COSTS.
FINALL IN ADDITION TO BOARD
STAFF USERS THERE IS ALSO STAFF
AT DC WHO DO YOU LAST YEAR'S.
THESE INDIVIDUALS ARE
INVESTIGATORS IN THE
DEPARTMENT'S DIVISION OF THE
VESTED NATION AND RANCHERS
REPORTS IN THE COURSE OF
INVESTIGATING COMPLAINTS THAT
HAVE BEEN REFERRED BY OUR PORTS.
CASES INVOLVING DRUG VERSION ARE
GIVEN HIGH PRIORITY BY THE
DIVISION. UNDER ITS CONSUMER
PROTECTION ENFORCEMENT
INITIATIVE GUIDELINES.
WELL DOJ CONTROLS AND OPERATES
CURES.
DC EIGHT ITS BOARDS ARE ABLE TO
PROVIDE INPUT INTO DECISION
MAKINGTHROUGH THE CURES CHANGE
CONTROL BOARD. THE CHANGE
CONTROL BORDER CCB IS A GROUP OF
SIX INDIVIDUALS COMPRISED OF DOJ
DE CA. AND BOARD EXECUTIVE
OFFICERS IN ITS QUARTERLY TO
REVIEW STEERING ITEMS SUCH AS
STAFFING EXPENDITURES.
CHANGE REQUESTING USER DATA.
THE TYPES OF USER DATA CURRENTLY
REVIEWED INCLUDES THE NUMBER OF
REGISTRANTS THE NUMBER OR THE
NUMBER OF REPORTS RUN.
AND THE NUMBER OF TIMES A SYSTEM
WAS ACCESS.
FOLLOWING THE LAUNCH APPEARS TO
OUT OF THIS GROUP WAS AGREED TO
BY ALL AGENCIES INVOLVED WHO THE
INTERAGENCY AGREEMENT BETWEEN
THE CIA AND DOJ. REGARDING THE
ONGOING MAINTENANCE AND
OPERATION OF CURES.
STAFF FROM DCA DOJ IN THE BOARDS
ALSO MEET MONTHLY TO DISCUSS
TECHNICAL ISSUES SUCH AS USER
QUESTIONS REPORT CHANGES AND
OPPORTUNITIES FOR TRAINING.
THESE MEETINGS PROVIDE VALUABLE
AVENUES OF COMMUNICATION FOR DE
CA TO ELEVATE ISSUES AND WORK
WITH DOJ TO EVALUATE OPTIONS FOR
RESOLUTION.
DC ALSO FACILITATES REGULAR
MEETINGS WITH ITS EXECUTIVE
OFFICERS INVOLVED WITH CURES. TO
SHARE INFORMATION AND RECEIVE
FEEDBACK ON THE USE OF THE
SYSTEMS AND THE ISSUES THEY ARE
FACING.
AND TWENTY SEVENTEEN D. C. BEGAN
HOSTING THE USER GROUP TO HELP
BRING TOGETHER PRIMARY STAFF
USERS AT THE BOARDS.
DISCUSS REPORTS AND
FUNCTIONALITY AVAILABLE IN THE
SYSTEM AS WELL AS TRAINING
NEEDS.
DOJ HAS PARTICIPATED IN THESE
MEETINGS AND ASSIST IN PROVIDING
TRAININGS AND WALKTHROUGHS OF
THE SYSTEM.
THROUGH THESE EFFORTS DCA SEEKS
TO DO WHATEVER I CAN TO SUPPORT
THE BOARDS AND ASSIST IN
ADDRESSING THE ISSUES THEY MAY
HAVE AS QUICKLY AS POSSIBLE AND
PROTECTING CALIFORNIA CONSUMERS.
THANK YOU FOR THE OPPORTUNITY TO
SPEAK TO YOU TODAY AND I'D BE
HAPPY TO ANSWER QUESTIONS IN MY
HOUSE.
TO BE MUCH.
GOOD MORNING.
ASSEMBLY BUSINESS AND
PROFESSIONS COMMITTEE MY NAME'S
VIRGINIA HEROLD ON THE EXECUTIVE
OFFICER THE BORDER PROMISE.
PHARMACY IS GROUND ZERO AND ALL
OF THIS MASS AND WE'VE BEEN
INVOLVED WITH OPIOID ABUSE AND
SPECIFICALLY WITH CHARIS FOR
YEARS.
WE WE AND THE DEPARTMENT OF
JUSTICE HAVE A LONG HISTORY IN
THIS AREA GOING BACK BEFORE
THESE PEOPLE WHERE THERE ARE.
CONSIDERABLY OLDER UNTIL I'D
BEEN AROUND FOR EVER.
AS YOU CAN TELL.
AND I CAN'T TAKE A PAPER CLIP
OFF MY PACKET. I'M I'M GOING TO
TALK BRIEFLY.
ABOUT WHAT WE'VE BEEN DOING
WITH RESPECT HERE'S HOW
INVALUABLE IT IS TO THE PRACTICE
OF PHARMACY AND HOW WE REQUIRE
PHARMACISTS TO REALLY RELY ON
THE INFORMATION IN CARES TO MAKE
JUDGMENTS WHEN THEY HAVE A
PATIENT IN FRONT OF THEM.
ESPECIALLY PATIENT THEY'RE NOT
FAMILIAR WITH. BEFORE I GET
STARTED HOWEVER I NEED TO.
.
STATE THAT THE BOARD MANDATE
THIS CONSUMER PROTECTION AND
SPECIFICALLY PROTECTION OF
PUBLIC AND. WE START ALL
PRESENTATIONS WITH THAT
PARTICULAR AFFIRMATION OF WHY
WE'RE HERE.
I'M JUST REAL QUICKLY THE BOARD
LICENSES A HUNDRED AND FORTY
THOUSAND DIFFERENT LICENSEES IN
DIFFERENT PROGRAMS AND WE
LICENSE INDIVIDUALS WITH LICENSE
FIRMS. AND WE LICENSE THE
PRODUCT ITSELF
SO WE PRETTY MUCH HAVE A FULLY
INTEGRATED SHOP. ON WE GO INSIDE
AND OUTSIDE CALIFORNIA WITH
RESPECT TO OUR ON INSPECTIONS
BECAUSE OF THE NATURE OF SOME OF
THE ON PUBLIC PROTECTION ISSUES
INVOLVED.
SO WE HAVE FORTY FIVE THOUSAND
PHARMACISTS ABOUT SEVEN THOUSAND
PHARMACIES IN CALIFORNIA SIXTY
SIX HUNDRED OF THEM ARE
COMMUNITY PHARMACIES WHICH
LOOKED COMMUNITY. PHARMACY ON
THE CORNER THAT YOU THINK ABOUT
WE ALSO REGULATE WHOLESALERS
WHICH WE'RE NOT TALKING ABOUT
TODAY BUT IT IS THE WHOLESALERS
THAT SHIP THE DRUGS FROM THE
MANUFACTURE.
TWO THE PHARMACIES AND THEY ARE
ALSO PART OF THIS MESS WITH US.
.
DOCTOR STEPHEN HENRY IS IN THE
AUDIENCE AND IN TWO THOUSAND
SEVENTEEN HE CONDUCTED A SURVEY
OF PHARMACISTS AND CONCLUSIONS
FOR THEIR OPINIONS ON CURIOUS.
AND SO I'M GONNA RUN RUN THROUGH
A SERIES OF FINDINGS FROM THAT
IT'S JUST GOING TO BE REAL FAST.
AND IF YOU'VE HAD ENOUGH
SOMEBODY JUST TELL ME TO STOP
BUT I'M NOT I PROMISE THERE
AREN'T THAT MANY OF THEM BUT
THEY'RE VERY IMPORTANT.
OKAY SO THE SURVEY.
WAS COMPLETED HOME ABOUT A YEAR
AGO COMPLETED THE RESULTS IN
SEPTEMBER THEY WERE DOING IT
ABOUT A YEAR AGO.
I THINK IT'S IMPORTANT TO NOTE
THAT TWENTY THREE PERCENT OF
THOSE REGISTERED IN ON CURES.
AND ARE PROVIDING INFORMATION
INTO THE CARE SYSTEM OUR
PHARMACISTS BUT YET.
SIXTY PERCENT OF THE REPORTS
PULLED OUT OF CURES ARE BEING
PULLED BY PHARMACISTS.
SO WE HAVE MADE AT LEAST A
PIVOTAL IN A VERY IMPORTANT STEP
IN CONVINCING OUR LICENSEES TO
RELY ON THE SYSTEM. AS A
DECISION MAKING STEP IN
PROVIDING CARE TO THEIR
PATIENTS.
.
COP PHARMACISTS GENERALLY HAVE
EXPRESSED CONCERN ABOUT
PRESCRIPTION DRUG ABUSE AND
MAKES BEST EXPRESSED JUST
GREATER SENSE OF PROFESSIONAL
OBLIGATION TO USE CURES AND
THAT'S BORNE OUT IN THE DATA I
JUST PROVIDED WITH YOU.
PHARMACIST LISTED INFORMATION
FROM TEARS AS THE MOST COMMON
REASONS FOR CHANGES IN THEIR
DISPENSING PATTERNS.
SO AGAIN AND THE SHORT FEW YEARS
THAT PHARMACIES HAVE REALLY BEEN
ACCESSING CURES WE'VE SEEN I'M I
DEMONSTRATED DIFFERENCE THERE.
NEARLY ALL PHARMACISTS REPORTED
THEY'D HEARD OF CURES WHICH IS
GOOD SO THERE'S ANY THERE'S.
IDENTIFICATION
BESIDES THAT THEY ALL HAVE TO BE
REGISTERED IF THEY HAVE AN
ACTIVE LICENSE EVEN IF THEY'RE
OUTSIDE CALIFORNIA THE REQUIRED.
REGISTERED.
AMONG RESPONDENTS WHO WERE
REQUIRED TO REGISTER PICTURES
NINETY SIX PERCENT OF THE
PHARMACIST REPORTED THEY WERE
REGISTERED ARE IN THE PROCESS OF
REGISTERING FOR CHARIS. KEEP IN
MIND THIS SURVEY WENT BACK TO
NOVEMBER OF TWO THOUSANDS.
SEVENTEEN WHICH WAS
SIX MONTHS RIGHT AFTER THAT DROP
DEAD DEADLINE.
SO.
THEY SHOULD HAVE ALL BEEN THERE
SO. PERHAPS WE HAVE MORE
EDUCATION.
WHEN ASKED WHETHER THEY FELT
THEY NEEDED ADDITIONAL TRAINING
EDUCAR IN EDUCATION ABOUT CURES
FORTY PERCENT OF THE RISK
PHARMACIST RESPONDED
AFFIRMATIVELY.
SO THEY'RE NOT USING IT FOR MORE
THAN JUST CLEAN A SINGLE PATIENT
REPORT ONE AT A TIME SOMETIMES.
AND I THINK THE SUBSCRIBER
ALERTS AND SOME OF THE
NOTIFICATIONS ARE INTEGRAL PARTS
OF THE NEW SYSTEM THAT WE HAVE
NOT HELPED OUR PROFESSION.
ON ACCESSING UP AND SO WITH THAT
WE'LL BE WORKING WITH THE
DEPARTMENT OF JUSTICE TO HELP
IMPROVE THAT.
A SENSE FINANCIAL MAJORITY OF
PHYSICIANS AND PHARMACISTS AND
PHARMACIST HAD THIS AT NINETY
ONE PERCENT AGREED THAT THEIR
COLLEAGUES SHOULD BE USING CARES
BEFORE THEY DISPENSE.
SO MAYBETHEY DON'T DO IT
THEMSELVES BUT THEY THINK
THEY'RE COLLEAGUES SHOULD BE
DOING THAT.
AND THEN THIRTY NINE PERCENT A
PHARMACIST SUPPORTED MANDATORY
CURES FOR THEIR COLLEAGUES.
SO THE END RESULT IN THERE SOME
ADDITIONAL ONES BUT IN THE
INTEREST OF TIME TO GET THE
OTHER PANELISTS OPPORTUNITY TO
SPEAK. THE SURVEY RESULTS
SUGGEST THAT ACCESS TO CURES HAS
A MAJOR IMPACT ON PHARMACISTS
DISPENSING. PRACTICES THAT
INCREASE PROFESSIONAL AWARENESS
OF RISK AND BENEFITS PLAYS A
MAJOR ROLE IN DECREASED
PRESCRIBING AND DISPENSING FOR
BOTH PHYSICIANS AND PHARMACISTS
AND FINALLY THE SURVEY RESULTS
INDICATE THE PHARMACIST. HAVE
PRETTY NEAR COME PERFECT
COMPLIANCE WITH MANDATORY CURES
REGISTRATION.
SO. I AM NOW GOING TO GO BACK TO
A COUPLE OF OTHER THINGS WE'VE
BEEN DOING.
I WANT TO TALK ABOUT THE VALUE
OF CURES FIRST
YOU HEARD ON THIS FOR ALICE
SPEAK ABOUT SIX.
PRESCRIBERS.
SIX PHARMACIES IN SIX MONTHS.
LET'S LET ME TALK ABOUT. SOME OF
THE STARK HORROR STORIES THAT
WE'VE GOT.
IN A FOUR YEAR PERIOD THAT
PERIOD WE HAVE ONE PATIENT IN
THIS IS FROM THE BOREDOM
DESICCATION. WE FOUND FOR
DIFFERENT PATIENTS WITH
OBSCENELY HIGH DRUG USAGE.
THIS IS WHAT A DOCTOR SHOPPER
LOOKS LIKE
IN A FOUR YEAR PERIOD PERIOD A
PATIENT OBTAIN SIX HUNDRED AND
THIRTY SIX PRESCRIPTIONS FOR
VARIOUS CONTROLLED SUBSTANCES
THERE WERE OVER TWENTY FIVE
DIFFERENT CONTROLLED SUBSTANCES
THAT WERE PRESCRIBED.
THE PATIENT SAW HUNDRED AND
SIXTEEN POSITIONS OVER THAT FOUR
YEAR PERIOD INCLUDING DENNIS
POSITION ASSISTANCE AND FARM AND
POSITIONS.
THE PATIENT SOFT FIFTY EIGHT
PRESCRIBERS AND OBTAINED ONLY A
SINGLE PRINT PRESCRIPTION FROM
FIFTY EIGHT SO THAT TURNS OUT
EXACTLY HALF OF THOSE HUNDRED
AND SIXTEEN ONLY WROTE ONE
PRESCRIPTION. FOR THIS PATIENT
THE PATIENT MAY HAVE NOT GOTTEN
EVERYTHING THAT SHE WANTED IN
THIS PARTICULAR CASE AND THEN
WENT ON TO PLAYING THE OTHER
ONCE.
THE PATIENTS YOU SEVENTY SIX
PHARMACIES TO BUILD THE
PRESCRIPTIONS WHICH HAS A LOT OF
WORK.
AND SEVENTEEN PHARMACIES FILLED
MORE THAN ON FIFTEEN
PRESCRIPTIONS OF THIS PATIENTS
OVER THE FOUR YEARS. FIFTEEN
PHARMACIES BILL BETWEEN FIVE AND
TEN WHICH WITH MODERATE USE AND
FORTY FOUR PERCENT FEWER KILLED
BICU FOUR OR FEWER.
KEEP IN MIND WE'RE TALKING NOW
SIX HUNDRED THIRTY SIX
PRESCRIPTIONS TWENTY FIVE
CONTROLLED. SUBSTANCES A HUNDRED
AND SIXTEEN PRESCRIBERS.
AND DURING THAT PERIOD THE
PHARMACIES ACCORDING TO CURES
DISPENSED FORTY FOUR THOUSAND
FOUR HUNDRED TWENTY THREE DOSES.
OF THOSE THE WERE ALMOST TWELVE
THOUSAND HYDROCODONE DOSES.
THERE WERE SIXTY FIVE HUNDRED
MORPHINE SULFATE DOSES.
SIXTY FIVE HUNDRED
HYDROMORPHONE.
DOSES THREE THOUSAND OXYCODONE
DOSES TWENTY SIX HUNDRED
ALPRAZOLAM. AND FOURTEEN HUNDRED
SOMA.
THAT'S ONLY FIFTY PERCENT WHAT I
JUST READ OFF OF THE FORTY FOUR
THOUSAND THE STREET VALUE OF
THOSE DRUGS ALONE OF THE OF THE
ONES I JUST LISTED WAIT HUNDRED
AND FIFTY THOUSAND DOLLARS.
SO YOU CAN SEE THAT YOU CAN MAKE
QUITE A BIT OF MONEY IN A VERY
NARROW TIMEFRAME.
ONE OF THE THINGS THAT WE ARE
VERY.
THERE IS ONE OTHER ARM START
THERE IS ONE OTHER ONE LET ME
SEE IF I CAN JUST REMEMBER THE
NUMBERS OFF THE TOP MY HAD. THIS
WAS ONE PATIENT THAT WENT TO ARM
ONE POSITION BUT WHAT TO TWENTY
EIGHT DIFFERENT PHARMACIES OVER
A ONE YEAR PERIOD.
DURING NOT TWENTY DURING THOSE
VISITS THERE WERE THIRTY
THOUSAND OXYCODONE DISPENSED TO
THAT PATIENT.
THOSE WERE NOT SELF USE THAT WAS
STRUCK CELLS.
SO CURIOUS IF PHARMACISTS WOULD
GET IN THE HABIT OF LOOKING AT
THEM.
THEY CAN IDENTIFY WHAT'S GOING
ON S. COULD THE PRESCRIBERS AT
THE TIME THE PRESCRIBING WHICH
IS PART OF WHAT THE ROLE THAT
WERE ALL UP HERE.
AND THIS.
IT'S IMPORTANT THAT WE
UNDERSTAND IT.
THE BOARD IS SPENDING A LOT OF
TIME DOING SOME PROACTIVE THINGS
WITH THE PROFESSION. ON WE ARE
THE ORIGIN OF SEVERAL
MODIFICATIONS PROPOSED FOR CURES
WHICH MINIATURE LOW IS THE
AUTHOR OF THE. THANK YOU VERY
MUCH.
WE LOOK FORWARD TO WORKING WITH
YOU ON THAT.
WE CONDUCT PERIODICALLY ABOUT
EVERY TWO TO THREE MONTHS C. E.
SEMINARS WHERE THE BOARD OF
PHARMACY LITERALLY TALKS TO OUR.
LICENSEES THEY GIVE SOME SIX
HOURS OF SLEEP ANY PRETENDING
SIX HOUR SESSIONS WHERE WE TALK
ABOUT PRESCRIPTION DRUGS OF
ABUSE BECAUSE SOMETIMES
PHARMACISTS DON'T KNOW THAT
THOSE DRUGS THAT ARE BACK ON
THEIR SHELVES. HAVE SUCH HIGH
STREET VALUE AND IN THAT ALL
JUST GIVE THE OLD STORY ABOUT
PROMETHAZINE WITH CODEINE. COST
THE PHARMACY APPROXIMATELY
TWELVE DOLLARS TO PURCHASE A
PLATE OF IT. ON THE STREET THAT
DRUG IS WORTH TWELVE HUNDRED
DOLLARS THERE'S A HUGE SPREAD
AND THAT THE ROBBERIES YOU'RE
SEEN IN SACRAMENTO IF YOU'RE
WATCHING TV. BUT THEY'RE JUMPING
COUNTERS.
PRINCIPAL TARGET OF THOSE
JUMPING THE COUNTERS IS PRO MET
WITH CODY WHICH IS CURRENTLY
SCHEDULED PIPE DRUG.
AND NOT REPORTED IN. INTEGERS.
ON.
WE ARE. ALSO.
ARE TALKING ABOUT THE USE OF
CURES AND WE PROMOTE IT. WE HAVE
THE D. E. YEAR D. E. ACRE MEN
AND THEY TALK ABOUT HOW TO
SURVIVE THE D. E. A. INSPECTION
BECAUSE THE D. E. A. DOES GO IN
AND INSPECT AS DOES THE BOARD OF
PHARMACY. WE HAVE OUR OWN BOTTOM
PHARMACISTS THAT OUR
INVESTIGATORS AND WE HAVE FIFTY
OF THEM.
SO WE ARE BUSY WITH THOSE FIFTY
ONE THIRD OF THEM TARGET
SPECIFICALLY PRESCRIPTION DRUG
ABUSE AND FRAUD.
DRUG DIVERSION FROM PHARMACIES
AND WHOLESALERS.
WE ARE IN THE PROCESS OF.
.
TALKING ABOUT CORRESPONDING
RESPONSIBILITY AND IN THE
INTEREST OF TIME I DON'T WANT TO
GO ON ABOUT THAT BECAUSE IT'S A
DIFFERENT SUBJECT TO A DEGREE.
BUT BASICALLY CORRESPONDING
RESPONSIBILITY IS A LOT BUT THE
FEDERAL AND STATE LEVEL WERE A
PHARMACIST HAS THE OBLIGATION
PROFESSIONAL ON RESPONSIBILITY.
AND LEGAL REQUIREMENT TO ASSURE
THAT WHEN HE OR SHE IS FILLING A
PRESCRIPTION THAT THE
PRESCRIPTION IS RIGHT FOR THAT
PATIENT. AND EVEN IF THE
PRESCRIBER IDENTIFIES THAT YES I
WROTE THE PRESCRIPTION WE EXPECT
THE PHARMACIST TO SAY NO IF IT'S
IN HIS OR HER PROFESSIONAL
JUDGMENT THAT PATIENT SHOULDN'T
HAVE. AND THERE'S A SERIES OF
RED FLAGS THAT DID NOTE WHEN.
PERHAPS YOU SHOULD NOT BE
DISPENSED IN A DRUG TO APPEASE.
.
WE ARE WORKING WITH PHARMACIES
ON MEDICATION RECONCILIATION AND
COUNTING THEIR SCHEDULE TWO
DRUGS BECAUSE PHARMACIES ARE A
MAJOR SOURCE OF LEACHING OUT
INTO THE STREET. EMPLOYEES AND
PHARMACIES ARE THOSE THAT HAVE
ACCESS THE DRUGS ARE SO VALUABLE
THEY CORRUPT AND THEY END UP
COMING OUT OF THE PHARMACIES AND
SO WE ARE NOW AT THE STAGE WHERE
STARTING APRIL ONE. AND IT'S NOT
A JOKE WE ARE REQUIRING
PHARMACIES
ACCOUNT SCHEDULE TWO DRUGS IN
THEIR POSSESSION. EVERY NINETY
DAYS
AND THEY HAVE TO RECONCILE WHAT
THEY PURCHASE WITH WHAT THEY
DISPENSED TO FIND OUT IF THERE
WERE LOSSES OR OVER JUST IN
WHICH CASE THEY'RE REQUIRED TO
EXPLAIN.
SO. ON. THAT PRETTY MUCH
CONCLUDES THE BULK OF WHAT I
HAVE TO DO IT TODAY AND WHAT I'D
LIKE TO SAY. ON WE ARE VERY
INTERESTED IN WORKING WITH
MEMBERS IN TRYING TO HELP
PROVIDE A SAFER ENVIRONMENT FOR
PATIENTS WE ARE IN THE MIDDLE OF
A MASS AND WE HAVE A LOT OF WORK
TO DO TO GET OUT.
THE. CHAIRMAN NO AND I MEMBERS
THANK YOU SO MUCH FOR HAVING ME
HERE TODAY ANIMUS KIMBERLY KIRK
MAYER AND I'M THE EXECUTIVE
DIRECTOR OF THE MEDICAL BOARD OF
CALIFORNIA.
THE MEDICAL BOARD HAS BEEN PART
OF THE PROCESS TO IT ESTABLISH
CARES TO POINT KNOW WITH THE
DEPARTMENT OF CONSUMER AFFAIRS
IN THE BOARD OF PHARMACY.
I ACTUALLY SAT ON THE CHANGE
CONTROL BOARD ASKED US MISS
HAROLD NEXT TO ME. AND BE
ACTUALLY WE'VE BEEN VERY
INVOLVED FROM THE BEGINNING IN
ESTABLISHING THE REQUIREMENTS
FOR THE SYSTEM AND THEN ALSO
ATTENDING MEETINGS TO FIND OUT
ABOUT IT STATUS. I'M CALM
COMPLETION AND THEN ONGOING
IMPROVEMENTS BECAUSE WE BELIEVE
THAT'S VERY IMPORTANT IN THE
PROCESS OF THE SYSTEM.
WITH THE DEPARTMENT THE BOARD OF
PHARMACY WE ALSO ATTEND MONTHLY
MEETINGS STATUS MEETINGS AND
QUARTERLY CHANGE CONTROL BOARD
MEETINGS.
AS ISSUES ARISE THE DEPARTMENT
OF JUSTICE HAS BEEN A TENTATIVE
TO OUR CONCERNS AND HAS MADE
CHANGES BASED UPON BOARD STAFF'S
REQUEST.
IN ADDITION DOJ STAFF HAS
PROVIDED TRAINING TO ASSIST WITH
THE NEW SYSTEM.
THE BOARD IS VERY PLEASED WITH
THE NEW CARES TO POINT OUT
SYSTEM AS NOT ONLY DOES IT
PROVIDE MORE EFFICIENT AND
TIMELY ACCESS BUT IT ALSO
PROVIDES MORE INFORMATION TO THE
BOARD. FOR EXAMPLE WERE GETTING
PRESCRIPTION NUMBERS REFILLS
IMPARTIAL REFILLS INFORMATION
AND THE ADDRESS OF THE RECORD
OF.
DRESS OF RECORD OF THE PHARMACY
AND THEN ALSO PAYMENT METHODS
AND THE ABILITY NOW TO CUSTOMIZE
REPORTS.
THE MEDICAL BOARD CANNOT
UNDERSCORE THE IMPORTANCE OF
CARE SYSTEM AND IT'S AN
INVESTIGATIVE PROCESS AND ITS
MISSION OF CONSUMER PROTECTION.
SPECIFICALLY AS IT RELATES TO
THE CURRENT OPIOID EPIDEMIC.
HOWEVER BEFORE AGAIN TO BEGIN
TALKING ABOUT HOW WE ACTUALLY
USED THE CARE SYSTEM AND THE
IMPORTANT IMPROVEMENTS FROM KIDS
TO PLAY NOW. I WOULD LIKE TO BE
CLEAR THAT THE CARES IS JUST A
TOOL USE IN THE INVESTIGATION
PROCESS.
THE BOARD COULD NEVER TAKE
ACTION AGAINST THE POSITION JUST
BASED UPON THE CARES REPORT.
MANY MORE PROCEDURES ACTUALLY
HAVE TO BE COMPLETED SO THE
BOARD MUST VALIDATE THE
INFORMATION AND CARES AND MORE
IMPORTANTLY WE MUST ATTAIN A
PATIENT'S MEDICAL RECORDS.
IN ADDITION IN THESE TYPES OF
CASES THE BOARD MUST HAVE A
MEDICAL EXPERTS SAY THAT THERE
WAS A DEPARTURE FROM THE
STANDARD OF CARE. IN THE
TREATMENT PROVIDED TO THE
PATIENT BY THE PHYSICIAN.
BUT AGAIN THE USEFULNESS OF
CURES IN THIS PROCESS AGAIN
CANNOT BE UNDERSCORED. ABOUT
THIRTY PERCENT OF THE
INVESTIGATIONS THAT ARE GOING ON
AT THE HEALTH QUALITY
INVESTIGATION UNIT ARE RELATED
TO INAPPROPRIATE UNDER OVER
PRESCRIBING OF CONTROLLED
SUBSTANCES BY A PHYSICIAN.
THE BOARD USES THE CARE SYSTEM
IN ORDER TO MEET ITS MISSION OF
CONSUMER PROTECTION AND TO TAKE
ACTION AGAINST THE POSITIONS WHO
ARE A DANGER TO THE PUBLIC.
WITHOUT KID HERE'S THE BOARD
WOULD NOT BE ABLE TO MEET THIS
MISSION AND WOULD NOT BE ABLE TO
STOP INAPPROPRIATE AND OVER
PRESCRIBING INTO VERSION OF
CONTROLLED SUBSTANCES.
THE BOARD USES CARES IN ITS
ROLE.
BASICALLY IN ITS ENFORCEMENT
PROGRAM IF THE BOARD RECEIVES A
COMPLAINT REGARDING ANY
PRESCRIBING ISSUES RELATED TO
CONTROLLED SUBSTANCES IT IS ABLE
TO NOT ONLY OBTAIN FROM A CURES
RECORD OF THE PRESCRIPTIONS FOR
THE PATIENT INVOLVED IN THE
COMPLAINT. BUT ALSO FOR THE
PHYSICIAN LISTED AS THE
PRESCRIBER.
THIS IS USUALLY THE FIRST STEP
IN THE INITIAL REVIEW OF THESE
TYPES OF COMPLAINTS.
THE BOARD WILL RUN A PATIENT
PROFILE REPORT AND A PRESCRIBER
HISTORY REPORT TO OBTAIN THE
PRESCRIPTION INFORMATION.
DEPENDING UPON THE COMPLAIN THE
CURES REPORT MAY NEED TO BE
EVALUATED BY A MEDICAL EXPERT.
IN THE SAME SPECIALITY ASK THE
POSITION TO IDENTIFY THE
PATIENTS NEED TO BE REVIEWED TO
DETERMINE IF THE PHYSICIAN IS
INAPPROPRIATELY PRESCRIBING. IN
ADDITION THAT EXPERT COME LOOK
AT THE COMBINATION OF DRUGS USE
AS WELL AS ANY OTHER RED FLAGS
THAT SUGGEST THE POSITION MAY BE
A DANGER TO THE PUBLIC.
AND ITS ALSO VERY IMPORTANT A
POINT OUT THAT WHEN WE GET TO
THAT POINT WE ACTUALLY THERE'S
ONLY THREE WAYS IN CALIFORNIA
THAT WE CAN OBTAIN THOSE
PATIENTS MEDICAL RECORDS.
SO THE FIRST WAY IS THAT WE
ACTUALLY HAVE TO OBTAIN A SIGNED
PATIENT AUTHORIZATION TO GET
THOSE MEDICAL RECORDS
OR IF THE PATIENT IS DECEASED WE
HAVE TO ATTEMPT TO GET
AUTHORIZATION FROM THE PATIENT'S
BENEFICIARY OR PERSON. PERSONAL
REPRESENTATIVE.
OBVIOUSLY AS YOU CAN IMAGINE A
LOT OF THESE OVER PRESCRIBING
CASES THE BOARD CANNOT GET THE
AUTHORIZATION FROM THE PATIENT.
SO THEREFORE THE BOARD MUST GO
TO ITS SECOND OPTION AND MUST BE
ABLE TO OBTAIN AT A SUBPOENA FOR
THIS MATTER BUT WE DO HAVE TO
HAVE A PATIENTS NAMES AND THE
ONLY WAY WE CAN OBTAIN THAT IS
THROUGH THE CARE SYSTEM.
AND THEN IN ADDITION WE ALSO
HAVE TO HAVE GOOD CAUSE TO
SUBSTANTIATE THAT SUBPOENA.
I'M IF THE MATTER WAS ACTUALLY A
CRIMINAL MATTER THIS IS THE
THIRD WAY WE WOULD ACTUALLY THEN
BE ABLE TO OBTAIN A SEARCH
WARRANT BUT AGAIN WE HAVE TO
HAVE THAT INFORMATION TO SUPPORT
THAT. TO GO TO THE COURTS
SO AS YOU CAN SEE IN OUR PROCESS
OF TAKING ACTION AGAINST A
POSITION AT THAT THE IMPORTANCE
OF CURES IS WHAT HELPS US TO DO
OUR ROLE. IN MEETING THE MANDATE
OF CONSUMER PROTECTION AND THEN
ALSO BEING ABLE TO DISCIPLINE
PHYSICIANS WHO ARE IN DANGER I'M
FOR THE PUBLIC AND SO WITH THAT
I'LL CLOSE AND.
THAT ANSWER ANY QUESTIONS YOU
MAY HAVE AND AGAIN THANK YOU FOR
HAVING ME HERE.
CRITIC YOU VERY MUCH INDEED GOOD
QUESTIONS ON DR GRANT.
SO FIRST I JUST WANT TO AGAIN
SAY THANK YOU FOR THE UPDATE
FROM ONE POINT OUT TO TO POINT
OUT THE.
TRANSITIONS THE AUTOMATED
AUTHORITY THE COMPACTS ARE TRULY
TRANSFORMATIVE TO THE PROGRAM
AND REALLY HAVE MADE SIGNIFICANT
IMPROVEMENTS AND. WE NEED TO BE
CELEBRATING WHEN YOU'VE BEEN
RESPONSIVE AND REALLY LISTENING
TO PROVIDERS WANTING TO HELP.
SO I WANTED TO ACTUALLY TURN IF
I COULD ASK THE PHARMACIST I
KNOW THAT WE HAD.
ATTEMPTED TO.
.
ALLOW PHARMACISTS TO BE ABLE TO
PRESCRIBE NOR CAN TO PATIENTS IN
THOSE SITUATIONS THAT YOU WERE
DESCRIBING EARLIER OF OF THE OUT
LIARS.
DO WE HAVE ANY DATA TO FOLLOW UP
AND FIGURE OUT IF WE'VE BEEN
PRESCRIBING NOR CAN.
WHAT ARE THE RATES THAT
PHARMACISTS ARE USING?
TO HAVE THAT LIFESAVING
MEDICATION OUT AND IS THERE
OPPORTUNITIES WITHIN THAT FOR.
WELL.
YES AND NO WE ARE IN THE PROCESS
OUR C. E. SEMINARS IF THEY STAY
AN EXTRA HOUR WE ARE EDUCATING
PHARMACISTS THAT STAYED THE
EXTRA HOUR TO EARN THAT OUR THAT
THEY NEED IN ORDER TO PROVIDE
THAT UNDER THEIR OWN AUTHORITY.
WHAT THIS IS IT'S A DRUG THAT
BLOCKS OVERDOSE AND ALTHOUGH
IT'S A PRESCRIPTION ITEM THAT
ALLOWS A PHARMACIST TO PROVIDE
HAND? SO AT THE TIME FOR EXAMPLE
WE SEE A USE AT THE TIME YOU GET
AND.
OPIOID FROM THE PHARMACY THEY
SHOULD BE ENCOURAGING THE
CONSULTING SPECIFICALLY IN THE
AREA. THERE IS A STRUGGLE AT IN
THE EVENT YOU HAVE AN ACCIDENTAL
OVERDOSE THIS IS WHAT YOU TAKE
WE'RE NOT THERE YET BOMB I THINK
THAT THERE'S GOING BE BUILT MORE
LESS TO THAT EFFECT INTRODUCED
THIS YEAR. WE HAVE TRAINED
OURSELVES ABOUT SEVEN HUNDRED
PHARMACISTS SPECIFICALLY TO
PROVIDE NALOXONE BECAUSE WE
STRONGLY BELIEVE IT'S AN
IMPORTANT SAFEGUARD. WE ARE
ABOUT TODAY WE HAVE A BOARD
MEETING WHERE ONE OF THE
OUTCOMES IS GOING TO BE PUT ON A
WHEN OUR C. E. PROGRAM. ONLINE
THAT THEY'LL BE ABLE TO TAKE GO
ONLINE AND CERTIFY AND DO IT
THAT WAY.
BUT PART OF THE PROBLEM AS WITH
ANY DRUG AND EVEN THE ABUSE ONCE
BUT IT'S THE REIMBURSEMENT PEACE
AND SO THE PHARMACY WOULD HAVE
TO ASK THE PATIENT EITHER
SOMETIMES INSURANCE WILL COVER
IT. SOMETIMES IT WON'T.
AND IF IT DOESN'T THEN THEY'LL
HAVE TO CHARGE THE PATIENT FOR
THE DRUG AND THAT BECOMES A
DETERRENT AND UNFORTUNATELY LIKE
MANY THINGS SOME OF THE DRUGS
HAVE GOTTEN VERY EXPENSIVE. THE
MOST WONDERFUL DEVICE OUT THERE
IS THE FORTY FIVE HUNDRED DOLLAR
FOR TWO ADMINISTRATIONS.
SELF ADMINISTRATOR EIGHT
ADMINISTERING UNIT THAT WALKS
YOU THROUGH STICKING YOURSELF
WITH THE PRODUCTS THOUGH THAT
IN.
IF SOMEONE'S OVERDOSING AT LEAST
PEOPLE LIKE ME ARE GOING TO BE
VERY INTIMIDATED VERY FRIGHTENED
THIS LITERALLY WALKS YOU THROUGH
VERY CALMLY WE THREE COULD DO.
BUT FORTY FIVE HUNDRED DOLLARS
FOR TWO DOSES THAT IS ALL AROUND
FOR MANY AND I BELIEVE THAT IS
ACTUALLY THE WHOLESALE PRICE.
SO TO ANSWER YOU WE'VE GOT A
LONG WAY TO GO IN THIS BUT WE
SEE REAL PROMISE SOME REAL
POTENTIAL AND IT IS IN FACT A
BOARD PRIORITY. TO REALLY HELP
PHARMACIST BECOME FOR.
THE POSITION AND TO PROVIDE NO
WATSON BECAUSE THEY'RE IN THE
RIGHT PLACE TO DO IT.
I AM I WAS INTERESTED IN YOUR
COMMENT THAT PHARMACIES ARE
GOING TO BE TRACKING THE
MEDICATIONS THAT YOU HAVE ON A
NINETY DAY.
CYCLE. PARTICULARLY BECAUSE THE
LEGISLATURE PASSED PARTIAL FILL
PRESCRIPTIONS LAST YEAR AND
WE'RE GOING TO NEED TO ENSURE
THAT WE'RE HAVING THE SAFEGUARDS
IN PLACE THAT PHARMACIES ARE.
TRACKING A FOLLOWING WHERE THOSE
MEDICATIONS ARE SO I JUST WOULD
LIKE TO REACH OUT TO YOU AND.
YOUR TEAM TO MAKE SURE THAT THE
IMPLEMENTATION OF THAT LOSS
DOWN.
BEING PUT TO THE BEST USE.
WE WILL IT WILL WORK WITH YOUR
OFFICE IF YOU'D LIKE SIR IT'S
VERY IMPORTANT TO US THAT WE
STOP THIS FLOW OUT OF PHARMACIES
THEY HAVE TO REPORT TO S..
WITHIN EITHER FOURTEEN OR THIRTY
DAYS WHEN THERE'S A CONTROLLED
SUBSTANCES DRUG LOST. SOMETIMES
THEY DON'T DO IT SOMETIMES WHEN
THEY DO IT'S ALARMING WHAT THEY
REPORT.
AND IT ISN'T TYPICALLY A THIRTY
DAY LOS IT'S JUST THE NOTICE
REQUIRES YOU COUNT WHAT'S
IMPORTANT.
SO THAT'S WHAT WE'RE HELPING
THEM DO.
THANK YOU VERY MUCH AMASS A
QUESTION FOR THE ATTORNEY
GENERAL'S OFFICE WITH RESPECT TO
THE.
LEGISLATURE'S MANDATE OF FOR
DOCTORS TO AND CHECK IN WITH
TEARS UP AND IS THAT GOING TO BE
A CERTIFIED IS THERE ANY.
UPDATE WITH RESPECT AS.
THAT ISSUE.
AND YES THEM WE YOU KNOW WE JUST
COMPLETED HIRING THE RESOURCES
THAT WOULD BE DEDICATED TO THAT
EFFORT AND WHERE YOU KNOW
CURRENTLY CONDUCTING SYSTEM AND
LOW TESTING.
BUT SWEET WE DO PLAN TO NO
LATER THAN JULY CERTIFIED.
WONDERFUL.
GREAT THANK YOU VERY MUCH ANY
ADDITIONAL QUESTIONS FROM ANY
OTHER MEMBERS.
WONDERFUL THANK YOU VERY MUCH
FOR.
PARTICIPATION HERE TODAY.
THEN FOR US AUTHOR PANEL OF.
OF WE WILL.
.
CONTINUOUS HAVE.
.
SCRIPT MIRED THANK YOU VERY MUCH
FOR REMAINING FOR THE
CALIFORNIA.
WITH A MEDICAL BOARDS
AND ALSO.
STIR EDWARD KIM WHO RIPS AND THE
ATTORNEY GENERAL'S OFFICE MISTER
JOHN LEVEL REPRESENTS THE
CALIFORNIA NARCOTICS OFFICERS.
AND MISTER PETER YOU BRING WITH
THE.
DIRECTOR OF POLICE PRACTICES FOR
THE ACLU
.
MR CAN WOULD YOU CARE TO GET.
THANK YOU VERY MUCH.
CARILLO AND DISTINGUISHED
MEMBERS OF THE BUSINESS AND
PROFESSIONS COMMITTEE.
I AM DEPUTY ATTORNEY GENERAL
EDWARD CAM.
THE CALIFORNIA DEPARTMENT OF
JUSTICE APPRECIATES THIS
OPPORTUNITY TO PROVIDE AN
OVERVIEW OF THE RECENT DECISION
BY THE CALIFORNIA SUPREME COURT.
LUIS VERSUS SUPERIOR COURT.
AS ONE OF TWELVE LEAD
PROSECUTORS IN THE DEPARTMENT OF
JUSTICE'S HEALTH QUALITY
ENFORCEMENT SECTIONS
JOINT DEPARTMENT.
OF JUSTICE IS HELP QUALITY
ENFORCEMENT SECTIONS JOINT
BROOKLYN FOR SPENT MODEL WITH
THE MEDICAL BOARD OF CALIFORNIA
I'VE SEEN THE DANGERS PRESENTED
BY NEGLIGENT AND INCOMPETENT
PRESCRIBERS.
AND THE THREAT OF OVER
PRESCRIBING OPIOIDS TO PATIENTS.
AS WELL AS THE CONSEQUENCES OF
ABUSE AND DIVERSION OF
CONTROLLED SUBSTANCES.
OUR OFFICE WORKS REGULARLY WITH
SEVERAL HEALTH CARE OVERSIGHT
AGENCIES THROUGHOUT THE STATE.
TO INVESTIGATE AND PROSECUTE
UNLAWFUL PRESCRIBING PRACTICES
BY LICENSEES.
THE RISING DEATH RATE FROM
PRESCRIPTION DRUG OVERDOSE IS A
NATIONAL PROBLEM.
THE CENTER FOR DISEASE CONTROL
AND PREVENTION RECENTLY REPORTED
THAT AND TWENTY SIXTEEN.
THERE WERE SIXTY FOUR THOUSAND
DRUG OVERDOSE DEATHS IN THE
UNITED STATES AN ALARMING TWENTY
ONE PERCENT INCREASE FROM THE
PRIOR YEAR.
TO PUT THIS NUMBER INTO
PERSPECTIVE THAT EXCEEDS THE
NUMBER OF FATALITIES FROM MOTOR
VEHICLE ACCIDENTS IN TWENTY
FIFTEEN.
AND P. COMMERCE SITES IN
NINETEEN NINETY ONE.
THE CONTROLLED SUBSTANCES.
YOU BILL UTILIZATION REVIEW AND
EVALUATION SYSTEM BETTER KNOWN
AS CHEERS IS CALIFORNIA'S
PRESCRIPTION DRUG MONITORING
PROGRAM.
CURIOUS IS A CRITICAL TOOL
HEAVILY RELIED ON BY THE
DEPARTMENT OF JUSTICE AND OTHER
STATE AGENCIES.
FOR EXAMPLE THE MEDICAL BOARD OF
CALIFORNIA UTILIZES CURES TO
MONITOR INVESTIGATE AND OVERSEE
TO PRESCRIBING PRACTICES BY ITS
LICENSEES.
EFFECTIVE USE OF PRESCRIPTION
DRUG MONITORING PROGRAM SUCH AS
CURES CAN REVEAL WHEN PATIENTS
AMONG OTHER THINGS ARE DOCTOR
SHOPPING.
INFORMATION THAT DOCTORS NEED TO
DETECT AND PREVENT ABUSE AND
DIVERSION.
CALIFORNIA DEPARTMENT OF JUSTICE
HAS BEEN AT THE FOREFRONT OF
ADDRESSING THE EFFECTS OF
NEGLIGENT OR INCOMPETENT
PRESCRIBING AND DISPENSING.
WE UNDERSTAND ALL TOO WELL THAT
TIME LOST IN AN INVESTIGATION
CAN MEAN LIVES LOST.
AND DEVASTATED FAMILIES.
THE LUIS DECISION IS CRITICAL
FOR PUBLIC SAFETY BECAUSE IT
AFFIRMS THE ABILITY OF
CALIFORNIA'S HEALTH CARE
REGULATORY AGENCIES.
TO REVIEW INFORMATION FROM THE
CURIOUS DATABASE WITHOUT A
WARRANT OR SUBPOENA.
ANY DELAY IN ACCESS TO CURES
CRITICALLY AFFECTS PINE LINES IN
INVESTIGATIONS.
REGULATORS USE CURES TO WAY
PHYSICIANS USE YOUR STETHOSCOPES
TO EVALUATE THEIR PATIENTS.
JURORS ALLOWS FOCUSED INCREASE
INTO THE STANDARD OF CARE
APPLICABLES TO PROVIDERS IS
PRESCRIBING AND THE
CORRESPONDING RESPONSIBILITY A
PHARMACIST.
TEARS ALLOWS REGULATORS TO SPOT
CHECK
ESCRIBIR FOR COMPLIANCE IN ORDER
TO DETECT AND ADDRESS PROBLEMS
BEFORE PATIENTS ARE THREATENED.
THIS CRITICAL TOOL WAS
RECOGNIZING LUIS CASE.
AND LUIS THE CENTRAL LEGAL
QUESTION WAS DID THE MEDICAL
BOARD VIOLATE PATIENTS' RIGHT TO
PRIVACY UNDER THE CALIFORNIA
CONSTITUTION WHEN IT OBTAINED
CURES DATA WITHOUT A WARRANT
WERE SUBPOENA.
DURING THE COURSE OF
INVESTIGATION OF THE PATIENT'S
PHYSICIAN DR LUIS.
THE CALIFORNIA SUPREME COURT
HELD THAT IT DID NOT.
DO LUIS CASE BEGAN IN TWO
THOUSAND AND EIGHT. WITH A
PATIENT COMPLAINT TO THE MEDICAL
BOARD THAT DID NOT INVOLVE
DOCTOR LEWIS IS PRESCRIBING OF
CONTROLLED SUBSTANCES.
ACCESS TO CURIOUS DID NOT
REQUIRE A PATIENT RELEASE OR
SUBPOENA.
EARLY IN THE INVESTIGATION A
SWORN BORN AND EXPLORING BOARD
INVESTIGATOR OBTAINED IT CURES
PRESCRIBER ACTIVITY REPORT ON DR
LUIS.
AFTER REVIEW BY MEDICAL
CONSULTANT THE INVESTIGATOR
SOUGHT AND OBTAINED RELEVANT
MEDICAL RECORDS.
ULTIMATELY THE BOARD FILE CHILD
CHARGES BASED UPON THE ORIGINAL
COMPLAINT AND FIVE ADDITIONAL
PATIENTS AFTER REVIEW OF THE
CURE'S DATA.
A HEARING WAS HELD.
BEFORE ADMINISTRATIVE JUDGE AND
THE BOARD ISSUED ITS DECISION
PLACING DOCTOR LOUIS ON THREE
YEARS PROBATION.
LUIS APPEALED INDICATES
ULTIMATELY MADE ITS WAY TO THE
CALIFORNIA SUPREME COURT WHICH
GRANTED REVIEW.
THE CALIFORNIA SUPREME COURT
HELD THAT ANY INTRUSION INTO
LEGALLY PROTECTED. PRIVACY
INTERESTS HERE WAS JUSTIFIED BY
THE STATE'S DUAL INTEREST IN
NUMBER ONE. PROTECTING THE
PUBLIC FROM THE UNLAWFUL USE AND
DIVERSION OF PARTICULARLY
DANGEROUS DRUGS
NAMELY CONTROLLED SUBSTANCES.
AND NUMBER TWO PROTECTING
PATIENTS.
FROM NEGLIGENT AND INCOMPETENT
DOCTORS.
THREE SALIENT FILINGS ONSITE
THREE SALIENT FINDINGS MADE BY
THE SUPREME COURT AND LUIS ARE
FIRST. PATIENTS KNOW THAT THE
GOVERNMENT MONITORS CONTROLLED
DRUGS.
SECOND DELAYS PLACE THE PUBLIC
AT RISK.
AND THIRD PRIVACY PROTECTIONS
EXIST FOR THE INFORMATION AND
CURES.
REGARDING THE STATE'S MONITORING
OF CONTROLLED SUBSTANCE
PRESCRIBING.
SUPREME COURT FOUND THAT
ALTHOUGH PATIENTS HAVE SOME
REASONABLE EXPECTATION OF
PRIVACY IN THEIR PRESCRIPTION
RECORDS. THAT PRIVACY INTERESTS
WAS LESS ROBUST THAN THE PRIVACY
INTERESTS ASSOCIATED WITH FULL
MEDICAL RECORDS.
UNLIKE A PATIENTS COMPREHENSIVE
MEDICAL RECORD MAINTAINING A
DOCTOR'S OFFICE.
IT RESEMBLED AND PATIENT WOULD
KNOW OR SHOULD KNOW THAT THE
GOVERNMENT MONITORS TO SAILING
DISTRIBUTION OF CONTROLLED
SUBSTANCES.
AND THAT PRESCRIPTION RECORDS
ARE ROUTINELY REVIEWED BY
PHARMACISTS AND INSURANCE
COMPANIES.
AS TO THE NEED FOR AN EXPEDITION
EXPEDITIOUS ACCESS TO CURES.
THE SUPREME COURT FOUND THAT
REQUIRED THE BOARD FIRST
OBTAINED COURT PERMISSION TO
ACCESS CURES DATA WOULD ENTAIL.
PRESENTING EVIDENCE JUDICIAL
OFFICER ESTABLISHING GOOD
BECAUSE AS PART OF ITS
PRELIMINARY INVESTIGATION.
IT COULD RESULT IN PROTRACTED
LEGAL BATTLES THAT EFFECTIVELY
DERAIL THOSE INVESTIGATIONS.
SUCH A DELAY WHICH IN RECENT
APPELLATE LITIGATION BY OUR
OFFICE HAS TAKEN YEARS.
IS TOLERATED IN CONNECTION WITH
FULL MEDICAL RECORDS BECAUSE OF
THE HEIGHTENED PRIVACY INTERESTS
IMPLICATED.
BY GOVERNMENT SEARCHES OF
MEDICAL RECORDS.
FOR PRESCRIPTION RECORDS HOWEVER
DELAYS OF THAT MAGNITUDE WOULD
IMPEDE THE BOARD'S ABILITY TO
SWIFTLY IDENTIFY. AND STOP
DANGEROUS PRESCRIBING PRACTICES.
THE US TIMELY ACCESS TO
PRESCRIPTION DISPENSING DATA IS
CRITICAL TO ENSURING THE QUALITY
OF MEDICAL CARE IN CALIFORNIA.
TO SAVING LIVES.
FINALLY REGARDING PROTECTIONS
THE SUPREME COURT RECOGNIZED AT
THE LAW CONTAINS A NUMBER OF
PROVISIONS DESIGNED TO SAFEGUARD
PATIENT PRIVACY AND
CONFIDENTIALITY. WHICH LIMIT THE
DEGREE TO WHICH PATIENT PRIVACY
IS INVADED WHEN THE BOARD
EXAMINES PRESCRIPTION RECORDS.
FAILURE TO ABIDE BY THOSE
LIMITATIONS
CAN RESULT IN SERIOUS
CONSEQUENCES.
IN CONCLUSION HERE SOME
TAKEAWAYS FROM THE LUIS
DECISION.
FIRST THE IMPACT OF THE LEWIS
DECISION ON FUTURE ENFORCEMENT
ACTIVITIES IS PROFOUND.
A DIFFERENT RESULT COULD HAVE
STYMIED THE PURPOSE OF CURES AND
POTENTIALLY PLACED AT RISK THE
EFFICACY AND VIABILITY OF
PRESCRIPTION DRUG MONITORING
PROGRAMS PROTECTING PATIENTS AND
OTHERS THROUGHOUT THE NATION.
SECOND.
THE SUPREME COURT ACKNOWLEDGED
THAT THE BOARD CAN INVESTIGATE
DOCTORS BASED ON ITS OWN
INITIATIVE.
THIS ACKNOWLEDGEMENT IN
CONJUNCTION WITH THE ANALYTICAL
FEATURES OF CURES CAN LEAD TO
DIRECTED PROACTIVE INVESTIGATIVE
EFFORTS TO AVOID PUBLIC HARM.
THE US SUPREME COURT FOUND THAT.
THE BOARD'S COUNTERVAILING
INTEREST IN PROTECTING THE
PUBLIC FROM NEGLIGENT AND
INCOMPETENT DOCTORS.
AND.
TO PREVENT AGAINST ABUSE AND
DIVERSION OF SCHEDULE TWO TOOK
SCHEDULE FOUR CONTROLLED
SUBSTANCES OUT WEIGH ANY
POTENTIAL INVASION OF PRIVACY.
CAUSED BY THE BOARD'S ACTIONS.
AND IT REJECTED AN
INDIVIDUALIZED COULD CAUSE
REQUIREMENT HERE SINCE TO BOARD
TO USE AIDED ITS EFFORTS TO
CONTROL THE DIVERSION AND RESULT
IN ABUSE OF CONTROLLED
SUBSTANCES.
THE ATTORNEY GENERAL RECOGNIZES
THE HARD WORK OF ALL THOSE AT
THE DEPARTMENT CONSUMER AFFAIRS
AND
DEPARTMENT JUSTICE IN THIS CASE.
IT WAS TRULY A TEAM EFFORT.
THROUGH THESE EFFORTS TO SUPREME
COURT DECISION IN LUIS AFFIRMS
CRUISES CRITICAL FUNCTION AS A
TOOL IN ADMINISTRATIVE
INVESTIGATIONS TO ANALYZE
PRESCRIBING PRACTICES. AND
DISPENSING HISTORY THAT CAN LEAD
TOWARDS BETTER PUBLIC
PROTECTION.
THANK YOU FOR THIS OPPORTUNITY
TO PRESENT.
BIGGEST CAN.
AS STATED BY MR CAM OF THE LUIS
DECISION DOES NOT CHANGE THE WAY
THE BOARD USES CARES.
THE BOARDS USE OF CARES PROVIDES
PRESCRIPTION DATA TO THE BOARD
AND PROVIDES INVESTIGATOR A
ROADMAP
IN DETERMINING IF A POSITION AS
A DANGER TO THE PUBLIC.
AS PREVIOUSLY STATED THE PORT
COULD NOT OBTAIN A PATIENT'S
MEDICAL RECORDS WITHOUT
AUTHORIZATION OR GOOD CAUSE FOR
A SUBPOENA OR A SEARCH WARRANT.
IN ADDITION ONCE A PATIENT'S
MEDICAL RECORDS ARE OBTAINED THE
MEDICAL BOARD DOES NOT RELEASE
THOSE RECORDS EXCEPT UNDER
DISCOVERY OR DURING AN
EVIDENTIARY HEARING BEFORE AN
ADMINISTRATIVE LAW JUDGE. OR
BEFORE A JUDGE IN A CRIMINAL
COURT OR NGUYEN REQUIRED BY LAW
SUCH AS WHEN REQUIRED BY A COURT
ORDER.
IN ADMINISTRATIVE CASES THE
DEPUTY ATTORNEY GENERAL HANDLING
THE CASE
WILL REQUEST THE RECORDS TO BE
SEALED UNDER THE EXHIBITS.
THE BOARD TAKES PRIVACY
SERIOUSLY AND WILL CONTINUE TO
DO SO WHILE MEETING ITS MISSION
OF CONSUMER PROTECT.
THANK YOU.
THANK YOU CHAIRMAN LOW AND.
HONORABLE COMMITTEE MEMBERS MY
NAME IS PETER BE BRING I AM
DIRECTOR OF POLICE PRACTICES
FORTY.
ACLU OF CALIFORNIA.
WE FILED AN AMICUS BRIEF AND.
THE LUIS CASE.
OUTLINING PRIVACY CONCERNS IT'S
I'D LIKE TO DISCUSS A LITTLE BIT
HERE.
OF COURSE THIS COMMITTEE HAS
HEARD HEALTH AND.
OPIOID EPIDEMIC.
AND.
.
I WOULD LIKE TO TODAY JUST
SKETCHES.
THE THE PRIVACY INTERESTS AT
STAKE WITH.
CURES AND IN DOING THAT I I
WANT TO.
.
DRAW A COUPLE OF DISTINCTIONS
THAT ARE GONNA RUN THROUGHOUT.
MY TESTIMONY HERE FIRST.
.
I'M TALKING HERE ABOUT
IDENTIFYING PATIENT INFORMATION
SO.
.
Q. IS COULD OPERATE.
UNDER REGIME WHERE INFORMATION
ABOUT PRESCRIPTIONS THAT
DOCTORS.
THE PHARMACIES ALL ACCESSIBLE
TO LAW ENFORCEMENT.
WHILE.
INFORMATION ABOUT THE
INDIVIDUAL PATIENTS IDENTIFYING
INFORMATION AND THEIR MEDICAL
INFORMATION IS
PRIVATE. SO I WANT.
BE CLEAR ABOUT THAT.
.
BALANCING THE PUBLIC HEALTH
INTERESTS IN A DEBT IN
ADDRESSING YOUR GOOD CRISIS WITH
STRONG PRIVACY INTERESTS AND
PRESCRIPTION. INFORMATION.
IS POSSIBLE IT CAN BE DONE OTHER
STATES DO IT.
BUT CALIFORNIA.
I WOULD RESPECTFULLY SUBMIT IS
NOT SETTING THAT BALANCE.
CORRECTLY THIS TIME ADEQUATELY
PROTECTING PRIVACY.
SO IS THIS COMMITTEE HAS ALREADY
HEARD THIS MORNING.
THE BASIC DATABASE CONTENT FOR.
CURES INCLUDES.
THE FULL NAME ADDRESS AND
TELEPHONE NUMBER OF THE PATIENT
THEIR GENDER. AND DATE OF BIRTH
THAT IS WHAT I WOULD. CLASSIFY
AS THE PATIENT IDENTIFYING
INFORMATION
IT ALSO OF COURSE CONTAINS
INFORMATION ABOUT THE
PRESCRIPTION.
THE. NATIONAL DRUG CODE NUMBER
OF THE MEDICATION DISPENSED DRUG
QUANTITY ARMS NUMBER OF REFILLS
ORDERED WHETHER IT IS THE FIRST
TIME REQUEST.
OR REFILL. THE ORIGIN OF THE
PRESCRIPTION AND THE DATE OF
THIS
I THINK.
.
AND.
THE KEY THE KEY TO THE PRIVACY
CONCERN HERE.
IS THAT ALTHOUGH.
.
SOME OF THE TESTIMONY HERE TODAY
AND THE STATE IN THE LUIS CASE
DRAWS A.
TRY TO DRAW A STRONG DISTINCTION
BETWEEN THE PRIVACY INTERESTS
AND FULL MEDICAL RECORDS WHICH.
EXHIBITS CHRYSLER HAS INDICATED
THEY REQUIRE A CITY.
.
HE'S A SUBPOENA FOR AND
PRESCRIPTION INFORMATION
THE FACT IS THAT PRESCRIPTION
INFORMATION SENSITIVE MEDICAL
INFORMATION.
.
THAT IN MANY CASES.
BECAUSE DRUGS ARE APPROVED ONLY
TO TREAT A NARROW RANGE OF.
SPECIFIC MEDICAL CONDITIONS
DESCRIPTION INFORMATION CAN
REVEAL HIGHLY SENSITIVE
UNDERLYING HEALTH INFORMATION
FOR EXAMPLE.
HORMONE REPLACEMENT THERAPY FOR
TREATMENT OF GENDER IDENTITY
DISORDER OR SEXUAL DYSPHORIA.
.
HE'S LIKELY TO BE REVEALED
SIMPLY BY THE PRESCRIPTION.
SIMILARLY.
.
CONDITIONS INCLUDING WEIGHT LOSS
ASSOCIATED WITH.
AIDS.
MENTAL HEALTH CONDITIONS
INCLUDING TRAUMA AND STRESS
RELATED DISORDERS OR ANXIETY
DISORDERS ALCOHOL ADDICTION
OPIOID ADDICTION.
.
EIGHTY HD EPILEPSY A VARIETY OF
HEALTH CONDITIONS ARE LIKELY TO
BE REVEALED OR AT LEAST WRONGLY
INDICATED.
SIMPLY BY THE.
NATURE OF THE PRESCRIPTION.
A SECOND POINT UNDER THE CURIOUS
SYSTEM.
LAW ENFORCEMENT CURRENTLY HAS
ESSENTIALLY OPEN ACCESS.
.
HEALTH AND SAFETY CODE.
ONE ONE ONE SIX FIVE C. TO
CONTEMPLATE GIVING CURIOUS DATA
BROADLY TO APPROPRIATE STATE
LOCAL AND FEDERAL PUBLIC
AGENCIES FOR DISPLAYING CIVIL OR
CRIMINAL PURPOSES AND OTHER
AGENCIES AND ENTITIES IS TO.
DETERMINED BY THE DEPARTMENT OF
JUSTICE FOR THE PURPOSE OF
EDUCATING PRACTITIONERS AND
OTHERS.
IN LIEU OF DISCIPLINARY CIVIL
OR CRIMINAL ACTIONS IS AN
INCREDIBLY BROAD MANDATE FOR
ACCESS. AND ALTHOUGH THERE ARE.
.
PROVISIONS IN THE LAW THAT THAT.
CALL FOR COMPLIANCE WITH ALL
APPLICABLE FEDERAL AND STATE
PRIVACY LAWS AND REGULATION IS
NO ENFORCEMENT MECHANISM.
AND NO PENALTIES FOR VIOLATION
OF A.
PATIENT PRIVACY IN FACT IN IN
THE LUIS CASE THE TESTIMONY.
OF ONE OF THE MEDICAL BOARD
EXAMINERS.
WAS THAT. THE BOARD ROUTINELY
RUN SECURE SUPPORT ON PHYSICIANS
UNDER INVESTIGATION IN FACT THE
FACTS OF LUIS SHOW THAT.
THAT WAS A CASE WHERE DOCTOR
LEWIS WAS UNDER INVESTIGATION
BECAUSE HE RECOMMENDED.
WHAT A PATIENT BELIEVE WAS AN
UNHEALTHY DIET HE SUGGESTED THAT
THAT?
SHE SHOULD TRY LOSING WEIGHT BY
EATING.
BY A FIVE BY DIET FIVE BITES OF
FOOD AT LUNCH AND FIVE BITES OF
FOOD AT DINNER.
IN THE COURSE OF INVESTIGATING.
THAT COMPLAINT.
THE MEDICAL BOARD PULL THREE
YEARS OF PRESCRIPTION DATA.
CLEARLY UNRELATED TO THE NATURE
OF THE COMPLAINT.
.
AND WE SEEN THAT IN IN OTHER
CASES ACTUALLY OUTSIDE OF
CALIFORNIA ONE OF THE OTHER.
MAJOR PIECES OF LITIGATION
INVOLVES A.
PATIENT.
.
A PARAMEDIC.
RYAN PILE IN UTAH. WHO?
WHOSE FIRE STATIONS WERE.
BEING INVESTIGATED FOR.
MORPHINE THEFT WAS MORPHINE AT
THE FIRE STATION THAT WAS BEING.
TAMPERED WITH AND POTENTIALLY
STOLEN.
IN THE COURSE OF THAT
INVESTIGATION YOU TO AUTHORITIES
PULLED THE PRESCRIPTION DRUG.
RECORDS OF EVERY ALL OF THE
FOUR HUNDRED EIGHTY EMPLOYEES
OF THE FIRE STATIONS AND JUST
LOOK AT THEM.
MISTER PYLE WAS NOT CHARGED OR
INVESTIGATED IN CONNECTION WITH
THE THEFT OF THE MORPHINE. BUT
THEY THE AUTHORITIES FOUND WHAT
THEY BELIEVED WAS.
EVIDENCE OF PRESCRIPTION DRUG
FRAUD TRYING TO ON GET
PRESCRIPTIONS FROM MULTIPLE
DOCTORS.
AND AFTER US THIS WAS UNCOVERED
IN THE COURSE OF A UNRELATED
INVESTIGATION BECAUSE OF FREE
ACCESS.
OVER THE COURSE OF SEVERAL
YEARS. AND INVESTIGATION THAT
CAUSED.
MISTER PYLE DEPRESSION NEARLY
COST HIM THE ADOPTION OF HIS TWO
SONS.
CHARGES WERE ULTIMATELY
DISMISSED AS WITHOUT EVIDENCE
AND THAT IS THE POTENTIAL COST
TO PRIVACY FROM ALLOWING FREE
AND UNFETTERED ACCESS TO TO
SENSITIVE.
MEDICAL.
INFORMATION.
THIS KIND OF OPEN ACCESS IS NOT.
REQUIRED FOR JURIST OPERATE AND
THEIR.
CIVIL THINGS CAN BE DONE IN
FIRST OF ALL.
PHYSICIAN AND PHARMACY
INFORMATION CAN BE MADE VISIBLE
WHILE PATIENT INFORMATION IS
ANONYMIZED PATIENTS PROVIDED.
UNIQUE IDENTIFYING INFORMATION
WE HEARD EARLIER.
ABOUT THE PROCESS OF DE
DUPLICATION ON USING.
AN ANALYTICS ENGINE TO STUDIES.
VARIATIONS IN SPELLINGS OF
NAMES ARE ST DRESSES. THAT CAN
BE DONE INDEPENDENTLY OF THE
PRESCRIPTION INFORMATION.
BEFORE ANONYMOUS ASIAN OCCURS.
.
SECOND THE BOARD CAN STILL USE
INFORMATION ABOUT PATIENT
ACTIVITY TO GET ON A WARRANT OR
SOME OR SUBPOENA. FOR THE
PATIENTS IDENTIFYING
INFORMATION%
IF AN ANALYSIS IF THE BOARD'S
ANALYSIS.
OF A PARTICULAR PATIENT SHOWS A
PATTERN BY. THEIR.
UNIQUE PATIENT.
IDENTIFIER THAT SUGGESTS.
.
PATTERN OF PRESCRIPTION FRAUD.
THEY CAN EASILY PRIVATE.
OBTAIN A SIX A SUBPOENA OR
WARRANT FOR.
THAT PATIENT.
.
AND CERTAINLY IF IF PATIENT
ASSISTANCE IS NEEDED IN THE
INVESTIGATION OF A DOCTOR.
.
THAT THE BOARD CAN PROCEED
EITHER WITH ITS APPEAL WITH THE
REQUEST FOR CONSENT.
.
AND IT'S IMPORTANT TO NOTE THAT.
OPEN ACCESS TO THIS.
INFORMATION IS NOT A UNIVERSAL
RULE ALTHOUGH A FORTY NINE
JURISDICTIONS
IN THIS COUNTRY OPERATE SOME
KIND OF.
PRESCRIPTION DRUG DATABASE.
TEN STATES REQUIRE A WARRANT OR
DEMONSTRATION OF PROBABLE CAUSE.
BY STATUTE ANOTHER REQUIRES ONE
BY A JUDICIAL OPINION.
.
STE NINE OTHERS REQUIRE
REASONABLE SUSPICION. OR A
SUBPOENA COURT ORDER OTHER THAN
A WARRANT OR MAKE NO.
EXPLICIT PROVISION FOR LAW
ENFORCEMENT ACCESS AND ONE STATE
OF VERMONT ACTUALLY PROHIBITS
LAW ENFORCEMENT ACCESS.
AND THESE WARRANT REQUIREMENTS
THESE.
THAT OR SUBPOENA REQUIREMENTS.
THERE IN PLACE IN OTHER STATES
SHOW THAT THE. THE CONCERN THAT
DOING SO IN CALIFORNIA WOULD
COMPLETELY UNDERMINE THE SYSTEM
ARE.
OVERBLOWN AND AND I THINK IT'S
WORTH IT A GUT CHECK WARRANTS
DON'T TAKE YEARS WANTS TAKE.
A DAY SOMETIMES HOURS SOMETIMES
EVEN EVEN LESS TIME.
LAW ENFORCEMENT OBTAINS ONCE
A TEAM ONLY USES SUBPOENAS
ROUTINELY. THAT LEVEL OF.
.
OF INDIVIDUALIZED SUSPICION ON A
PROCEDURAL PROTECTION. ON CAN
PROVIDE A GREAT DEAL OF.
.
PROTECTION FOR FOR PRIVATE
MEDICAL RECORDS.
AND IN FACT.
CONCERNS ABOUT LAW ENFORCEMENT
ACCESS IN UTAH WHICH.
THE STATE WHERE THE.
THE PARAMEDIC I DISCUSSED
EARLIER.
HAD.
.
HIS ORDEAL.
LED THE UTAH LEGISLATURE TO IN
FACT INSTALL A STATUTORY WARRANT
REQUIREMENT.
EFFECTIVE IN MAY TWO THOUSAND
FIFTEEN FOR THE ACCESS TO THEIR
PRESCRIPTION DRUG DATABASE.
AN AUDIT OF THE LAW ENFORCEMENT
ACCESS SHOW THAT PRIOR TO THE.
.
ESTABLISHMENT OF THAT
REQUIREMENT MORE THAN SIXTY
PERCENT OF LAW ENFORCEMENT CASES
OF LAW ENFORCEMENT.
INCREASES THE DATABASE WERE
QUESTIONABLE. WHEN THE WILL
WARRANT REQUIREMENT WAS PUT IN
PLACE.
LAW ENFORCEMENT ACCESS DROPPED
BY NINETY FIVE PERCENT STRONGLY
SUGGESTING.
THAT LAUNCH WAS WAS JUST
TROLLING THE DATABASE.
.
AND FINALLY I'D I WANT TO
ADDRESS.
THAT LEGAL FRAMEWORK FOR THIS I
IT IS CERTAINLY THE CASE THAT
THE SO CALIFORNIA SUPREME COURT
IN LUIS HAS HELD.
DEFINITIVELY THAT.
THE CALIFORNIA CONSTITUTIONAL
RIGHT OF PRIVACY DOES NOT
REQUIRE A WARRANT OR INDIVIDUAL
A SUSPICION FOR LAW ENFORCEMENT.
TO ACCESS THE CURE'S DATABASE
BUT THAT IS NOT THE END OF THE
LEGAL QUESTIONS.
.
SURROUNDING A LAW ENFORCEMENT
ACCESS FIRST ALL THE COURT
EXPLICITLY RESERVE THE QUESTION
OF ANONYMOUS ASIAN AND DID NOT
ADDRESS IT IN THAT CASE BECAUSE
IT HAD NOT BEEN BRIEFED AND
ALSO.
EXPLICITLY RESERVED.
.
ANY OPINION ON WHETHER ACT LAW
ENFORCEMENT ACCESS.
WARRANTLESS SUSPICION WAS
ACCESS WAS ALLOWED UNDER THE FOR
FOURTH AMENDMENT TO THE U. S.
CONSTITUTION.
THERE IS STRONG REASON TO THINK
THAT.
LAW ENFORCEMENT ACCESS.
WITHOUT SUSPICION WITHOUT A
WARRANT VIOLATES
THE FOURTH AMENDMENT.
THAT HAS BEEN LITIGATED IN A
NUMBER OF OTHER CASES THROUGHOUT
THE.
COUNTRY WITH DIFFERING RESULTS
TO DISTRICT COURTS THAT
SOMETHING THAT'S PERCOLATING UP
THROUGH THE COURTS.
AND AND THAT IS.
A SIMPLE MATTER OF. THE FACT
THAT PATIENTS DO REASONABLY
EXPECT THAT THE RECORDS OF THEIR
PRESCRIPTION DRUG INFORMATION
WILL REMAIN PRIVATE BETWEEN
THEM.
AND THEIR DOCTOR THEY EXPECTED
NOT TO BESHARED WITH NON
MEDICAL PERSONNEL WITHOUT
CONSENT COURTS HAVE REPEATEDLY
FOUND NOT JUST FULL MEDICAL
RECORDS.
TO BE PROTECTED BY A REASONABLE
EXPECTATION OF PRIVACY BUT. BUT.
PIECES OF MEDICAL RECORDS
INCLUDING PRESCRIPTION.
DRUG INFORMATION CERTAINLY A
MAJORITY OF FEDERAL APPELLATE
COURTS HAVE RECOGNIZED THAT. ON.
IN STUDIES A PATIENT OPINION.
.
NINETY THREE ZOGBY POLLS HAVE
SHOWN THAT NINETY THREE PERCENT
OF PATIENTS WANT.
TO DECIDE WHICH GOVERNMENT
ENTITIES CAN ACCESS THEIR
RECORDS AND EIGHTY EIGHT PERCENT
OPPOSE LEADING POLICE ACCESS
WITHOUT PERMISSION.
.
AND.
ALTHOUGH THERE THERE ARE A
NUMBER OF ARGUMENTS THAT ARE
PERCOLATING THROUGH THE COURTS I
THINK THIS THIS QUESTION IS
UNRESOLVED. ON AND THERE IS A
STRONG ARGUMENT THAT.
THE FOURTH AMENDMENT BARS THE
KIND OF ACCESS THAT.
CALIFORNIA CURRENTLY ALLOWS.
PREFIGURING MUCH MISTER LITTLE.
THANK YOU OF MY NAME IS JOHN
LEVEL AND I REPRESENT THE THE
CALIFORNIA NARCOTICS OFFICERS
ASSOCIATION.
FOR THOSE OF YOU WHO DON'T KNOW
MUCH ABOUT SEE IN A WAY WE HAVE
ABOUT.
EIGHT THOUSAND MEMBERS.
OUR MEMBERS ARE CHARGED WITH
THE ENFORCEMENT OF STATE AND
FEDERAL CONTROLLED SUBSTANCE
LAWS.
PARENTHETICALLY I'D NOTE THAT
IT'S VERY DANGEROUS WORK EIGHTY
OF OUR MEMBERS NAMES ARE ON THE
PEACE OFFICER MEMORIAL WALL. AND
AND HERE'S WHAT'S REALLY UNUSUAL
BECAUSE YOU'VE DEALT WITH A
NUMBER OF LAW ENFORCEMENT GROUPS
THAT COME HERE AND TESTIFY.
THREE OF OUR FORMER PRESIDENTS
WERE KILLED IN THE LINE OF DUTY
THEIR WORKS IT'S HIGHLY
DANGEROUS.
FIRST OF ALL I WANT TO COMMAND
THE CHAIR FOR CALLING THIS
HEARING IT'S TERRIBLY IMPORTANT
ISSUE.
WE HAVE.
YESTERDAY OUR LEGISLATIVE
COMMITTEE MET.
AND WE'VE EXAMINED YOUR THREE
BILLS WHICH WE WILL STRONGLY
SUPPORT WE BELIEVE THEY ARE AN
IMPORTANT.
STEP IN THE RIGHT DIRECTION THE
INTERSTATE STRATEGY IS AN
EXCELLENT ONE.
INCLUDING SCHEDULE FIVE IS
IMPORTANT.
NOT JUST FOR THE STAND THE LINE
STANDALONE LOOK AT SCHEDULE FIVE
BUT. PART OF THIS TRAGEDY.
WITH OUR MANY OVERDOSES IS THERE
TRULY ACCIDENTAL.
PATIENTS AND PHYSICIANS IF THEY
DON'T LOOK.
DON'T REALIZE THAT THE
INTERACTION.
BETWEEN SOME OF THOSE DRUGS AND.
SOME OF THE OPIOIDS CAN BE
FATAL.
OF SO THAT THAT'S AN IMPORTANT
ADDITION AND.
TIGHTENING UP THE SECURE
PRINTING SYSTEM FOR ALL
SCHEDULED DRUGS IS ALSO VALUABLE
SO SEE AN AWAY WILL BE. WILL BE
SUPPORTING THEM.
.
WE WERE PLEASED TO CO SPONSOR
SENATE BILL FOUR EIGHTY TWO.
ALONG WITH THE CONSUMER
ATTORNEYS AND A NUMBER OF.
PATIENT ADVOCATE DUB PATIENT
SAFETY ADVOCATE GROUPS.
WHAT? THAT BILL.
REQUIRES THAT PRACTITIONERS
EXAMINED EITHER THEMSELVES OR
THROUGH SOME ON THE DELEGATE.
EXAMINED THE CURIOUS DATABASE
CRIER TO.
WRITING A PRESCRIPTION FOR A
PARTICULAR PATIENT.
NOW WHAT WHAT IS OF CONCERN TO
US.
IS THAT.
THAT LAW WAS SIGNED BY THE
GOVERNOR.
IN SEPTEMBER OF TWENTY SIXTEEN.
WE ARE NOW AND FEBRUARY OF
TWENTY EIGHTEEN.
AND THE DEPARTMENT OF JUSTICE
HAS NOT YET CERTIFIED.
CURES TWO POINT ZERO.
TO US.
AND WE'RE NOT PROFESSIONALS IN
THAT ORGANIZATION BUT FOR US
THAT.
GIVEN THE CRISIS THAT WE'RE
FACING. THAT DELAYS IN
EXPLICITLY INEXPLICABLE
AND.
WE WOULD HOPE AND HEARING TODAY
THAT MAYBE WE WOULD GET SOME
CERTIFICATION IN JULY.
AGAIN WE WOULD HOPE THAT THAT
PROCESS WOULD BE ACCELERATED.
SO THAT WE CAN IMPLEMENT FOR
EIGHTY TWO TO ITS FULLEST.
IN A MORE TIMELY FASHION THEM
WE'VE EXPERIENCED.
SO FAR.
I'M NOT GOING TO RELITIGATE THE
LUIS CASE WE THINK IT'S GOOD LAW
WE THINK THAT THE BALANCE STRUCK
IAN.
LOUIS.
REALLY REFLECTS.
.
THE STATE OF AFFAIRS THAT WE'RE
WE'RE GOING THROUGH THE THE
LEWIS CASE DID TALK ABOUT.
THEORETICAL PRIVACY RIGHTS THAT
THAT MIGHT BE. INTRUDED UPON.
BUT IT MADE KNOWN THE IT MADE
SPECIFIC NOTE OF THE STATE'S
DUAL INTEREST.
IN PROTECTING THE PUBLIC FROM
THE UNLAWFUL USE AND DIVERSION.
A PARTICULARLY DANGEROUS CLASS
OF PRESCRIPTION DRUGS AND
PROTECTING PATIENTS FROM
NEGLIGENT OR INCOMPETENT
PHYSICIANS THAT'S A VERY
IMPORTANT BALANCING TEST.
THE CITATION OF THE UTAH.
SITUATION IS TOTALLY IRRELEVANT
TO THIS DISCUSSION FIRST OF ALL
CALIFORNIA CONTRARY TO WHAT YOU
AGES TOLD. THE ATTORNEY
GENERAL'S OFFICE
DOES NOT PERMIT UNFETTERED
ACCESS
A PATIENT RECORDS IN FACT.
ATTORNEY GENERAL HARRIS.
.
AS PART OF THE GUIDELINES THAT
SHE PROMULGATED.
A LAW ENFORCEMENT CAN ONLY GET
ACCESS TO PATIENT RECORDS IN A
CRIMINAL INVESTIGATION.
OF THE PATIENT WHERE THEY HAVE A
WARRANT.
SO.
AYE AYE I WOULD CAUTION YOU
AGAINST.
LOOKING AT IRRELEVANT EXAMPLES
FROM OTHER STATES I MEAN THE
PRIVACY ISSUE SERIOUS BUT IT
NEEDS TO BE LOOKED AT SERIOUSLY
AND SOBERLY.
.
FINALLY JUST A COUPLE OF NOTES
TO CALL TO YOUR ATTENTION.
.
THERE BEEN SOME UNINTENDED
CONSEQUENCE
OF PROPOSITION FORTY SEVEN.
WHICH AS YOU KNOW OF REDUCES THE
PENALTY FOR CERTAIN RETAIL THEFT
SO LONG AS YOU STEAL LESS THAN
NINE HUNDRED AND FIFTY DOLLARS
MAKES IT A FELONY I MAKES A
MISDEMEANOR.
WHAT ONE OF THE SIDE EFFECTS OF
THAT THAT HAS
NOT BEEN DISCUSSED IS THERE'S A
NICHE OF THAT CRIMINAL ACTIVITY?
WHERE PERSONS ARE STEALING
PRESCRIPTION DRUGS?
THAT HAVE A RETAIL VALUE.
CONTROLLED SUBSTANCES
YOU HAVE A RETAIL VALUE UNDER
NINE HUNDRED AND FIFTY DOLLARS
BUT IS ONE OF THE WITNESSES ON A
PREVIOUS PANEL. INDICATED HAVE A
STREET VALUE IN THE HUNDREDS OF
THOUSANDS OF DOLLARS.
AND THERE'S BEEN A LOT OF DEBATE
ABOUT.
THE PROP FORTY SEVEN RETAIL
THEFT
GAP THE UNINTENDED CONSEQUENCES.
BUT MISSING FROM THAT DISCUSSION
THUS FAR BY THIS LEGISLATURE.
HAS BEEN FOCUSING ON THIS MORE
NARROW NICHE
WHERE PEOPLE CAN STEAL OPIOIDS.
AS LONG AS THEY'RE UNDER NINE
HUNDRED AND FIFTY BUCKS HEY
IT'S.
IT'S A MISDEMEANOR.
IN THEN THAT'S OUT IN THE
STREETS SO I THINK THAT'S A
PIECE THAT WE NEED TO LOOK AT.
.
DESPITE.
ARE VERY HIGH RESPECT FOR DR
EGGMAN.
WE RESPECTFULLY OPPOSE AB ONE AB
SIX
FOR SEVERAL REASONS
FIRST OF ALL AB ONE EIGHTY SIX
HAS NO PATH TO TREATMENT.
IT AND IT'S IMPORTANT WHEN
WE'RE LOOKING AT ADDICTIVE
BEHAVIOR AND TREATMENT.
DO YOU HAVE A PATH TO TREATMENT
AND NOT TO ENABLE CONTINUED
ADDICTIVE BEHAVIOR.
SECONDLY AB ONE EIGHTY SIX HAS.
NO REAL STRATEGIC USE OF
METHADONE THERAPIES WHICH ARE
IMPORTANT.
SUBSTITUTE FOR OPIOIDS.
THIRDLY.
AND VERY DISTURBING IS THERE'S
NO STRATEGY IN AB ONE AB SIX TO
DEAL WITH IMPAIR DRIVING. NOT
EVERYONE WHO GOES TO SAFE
INJECTION SITE.
IS WALKING.
YOU KNOW IN FACT A LARGE
PERCENTAGE OF PEOPLE WHO ARE
OPIOID ADDICTED AB JOBS.
IF CARS THERE'S NO.
THERE'S NO STRATEGY FOR MAKING
SURE WHAT'S THE PERSON IN
JACK'S.
THAT THERE.
NOT SO IMPAIRED
THAT THEY WOULD BE A DANGER TO
THEMSELVES OR OTHERS WHEN THEY
DROVE AWAY IN THEIR VEHICLE.
FINALLY THERE HAVE BEEN SERIOUS
ISSUES RAISED.
ABOUT. WHAT?
PEOPLE SEE AS.
WHERE THE CITING OF?
OF THESE. SITES WILL BE IN FACT.
I WAS IN A MEETING THE OTHER DAY
OF THE CONGRESS OF RACIAL
EQUALITY. AND THEY FOCUSED ON
THAT THE CITING ISSUES OF THIS
BILL AND.
THE PRESIDENT REFERRED TO WHAT
HE SAW US THE POTENTIAL OF THIS
IS THE.
THE SOFT BIGOTRY OF REMOTE
INSTITUTIONS SO THERE ARE THOSE
CONCERNS.
FINALLY THERE'S ONE OTHER POINT
I WANT TO LEAVE YOU WITH.
.
IS LOOKING AT.
THE ISSUE OF MANUFACTURE
DISTRIBUTION.
NOW I DON'T HAVE ANY EVIDENCE
THAT THAT'S A PROBLEM HERE BUT I
WILL TELL YOU WHEN I WAS A
PROSECUTOR IN THE LA CITY
ATTORNEY'S OFFICE YEARS AGO.
ONE PHARMACEUTICAL COMPANY.
SOLD.
FORTY FIVE PERCENT OF THEIR
WESTERN STATES INVENTORY OF APC
CODY NUMBER FOUR WHICH HIGH
GRADE PAIN KILLER.
TO SEVEN STOREFRONT PHARMACIES
IN SOUTH CENTRAL LOS ANGELES.
AND IS A DIRECT RESULT OF THAT
BEHAVIOR THOSE A STREET DRUGS.
A. B. C. CODED NUMBER FOUR DOOR
IT WAS CALLED DOORS AND FORCE
INDUSTRY. WAS KILLING ABOUT
FORTY PEOPLE A MONTH IN LA
COUNTY.
WE WENT AND PROSECUTED
THE PHARMACY WE TURNED OVER THE
NAMES OF THE DOCTORS
TO.
THE MEDICAL BOARD.
BUT TO OUR HORROR.
THE TIME THERE WAS NO LAW
ADDRESSING. MANUFACTURE PER.
PRACTICES LIKE THAT.
THE FOLLOWING YEAR WHEN MY BOSS
WAS ELECTED L. A. B. A I WAS HIS
LOBBYIST UP HERE.
WE SPONSORED LEGISLATION WHICH
IS NOW LAW. THAT MAKES IT A
CRIME
FOR A MANUFACTURER TO WITH
KNOWLEDGE OR CONSCIOUS
DISREGARD.
SELL THEIR PRODUCT.
THAT IT.
WHERE IT CAN BE DIVERTED INTO
THE STREETS
SO THAT'S ALREADY CURRENT LINE
IF THAT IS A PROBLEM HERE AND
I'M NOT SAYING THAT IT IS? NO
THAT YOU HAVE A TOOL.
THAT THAT CAN BE USED IN AGAIN I
WANNA.
THANK YOU FOR.
THIS HEARING AND AND I WOULD BE
REMISS IF I DIDN'T SINGLE OUT
YOUR STAFF FOR AN EXCELLENT.
BACKGROUND DATA SHEET HOW THEY
TOOK.
THIS WHOLE WATERFRONT AND
CONCISELY.
PUT IT TOGETHER WAS IT. TRUE
TRIBUTE TO FIND MORE. THANK YOU
SO MUCH GREAT THANK YOU VERY
MUCH AND WITH THAT MR LEVEL THAT
WILL CA CONCLUDE OUR OUR. OF
THIS PANEL DISCUSSION SO THEY
GIVE VERY MUCH FOR FOR THIS AND
WE'LL HEAD INTO OUR FOURTH OF
PANEL.
AND AGAIN FOR MEMBERS OF THE
PUBLIC THERE IS OPPORTUNITY FOR
PUBLIC COMMENT AFTER CONCLUDING
OUR FOURTH AND FINAL PANEL. IN
THIS FOURTH AND FINAL PANEL WILL
DISCUSS A RANGE FROM LICENSE
HEALTH PROFESSIONALS CAN SPEAK
ON HOW TO ENGAGE WITH THE OPIOID
CRISIS IN THEIR DAILY PRACTICE.
WE HAVE MISS VERONICA BANDY WHO
IS A LICENSED PHARMACIST AND
PROFESSOR VECTOR LEASE KNOW
BECAUSE A PHYSICIAN WHO
SPECIALIZES IN. PAIN MEDICINE.
DOCTOR DAVE READ MINUTE TOM
INTERESTS BASED IN SANTA CLARA
COUNTY. DR BILL UPDIKE WHO IS A
LICENSED CHIROPRACTOR IN ANY OF
THE TECHIE. BOTH OF POSITION AND
OF LICENSES ACUPUNCTURIST SO
THANK YOU VERY MUCH FOR JOINING
US HERE AND I KNOW THAT I'VE
SEEN MANY OF YOU.
WHO WERE ALSO IN THE AUDIENCE
AND ALSO OBSERVE THE ROBUST
CONVERSATION SO IF YOU ALSO WISH
TO ADDRESS ANY THESE OTHER
ISSUES THAT WERE PREVIOUSLY
DISCUSSED THOSE PLEASE FEEL FREE
TO DO SO? SOFA SORT OFF OF WITH
MISPRINT MISS BETTY SKEWED.
MANY. AND DOCTOR BROADBAND THE
PRESIDENT ELECT OF THE
CALIFORNIA PHARMACISTS
ASSOCIATION AND THE PHARMACIST.
ON BEHALF OF CPJ LIKE TO THANK.
THE MEMBERS OF THIS COMMITTEE
FOR THE OPPORTUNITY TO SPEAK ON
THIS VERY IMPORTANT ISSUE.
PHARMACIST TAKEN NOTE TO DEVOTE
OURSELVES TO THE LIFETIME OF
SERVICE TO OTHERS TO THE
PROFESSION OF PHARMACY. AND IN
DOING SO PROMISED TO CONSIDER
THE WELFARE OF HUMANITY. AND THE
RELIEF OF SUFFERING AS OUR
PRIMARY CONCERN.
AS WITH THIS IN MIND THAT THE
CALIFORNIA FARM ASSOCIATION HAVE
ALWAYS SUPPORTED A WORKABLE.
SUSTAINABLE PRESCRIPTION DRUG
MONITORING PROGRAM FOR
CONTROLLED SUBSTANCES. WITH
GIVES HEALTHCARE PROVIDERS A
MEANINGFUL WAY TO ENSURE THE
CONTROLLED SUBSTANCES ARE
PRESCRIBE AND DISPENSE SAFELY
AND APPROPRIATELY.
CPJ HAS SUPPORTED THE
LEGISLATION WHICH ESTABLISHED
HERE'S TWO POINT NOW. WELL WE
ACKNOWLEDGE IT IS A BETTER
SYSTEM ITS PREDECESSOR IT IS
LACKING THE ABILITY TO PROVIDE
PHARMACISTS WITH THE BENEFIT OF
THE INTEGRATED WORK FLOW SYSTEM.
THE RECENT PASSAGE OF AB FORTY
COMMITTEE INTERFACING WITH
SOFTWARE PROVIDES ABILITY FOR
MEMBERS ON BEHALF OF THE
HEALTHCARE TEAM TO HAVE ACCESS
TO THE HEALTHCARE RECORD OF A
PATIENT.
INCLUDING THE INFORMATION CURES
THIS IS SIGNIFICANT IMPROVEMENT
WHICH RESULT IN BETTER AND VERY
TIMELY CARE FOR PATIENTS.
ALONG WITH OUR COLLEAGUES IN
MEDICINE WE SEE FIRSTHAND THE
DEVASTATING IMPACT OF
PRESCRIPTION DRUG ABUSE IT IS
TRULY A PUBLIC HEALTH CRISIS
WHICH IS PLAYING EVERY COMMUNITY
IN OUR STATE.
THE DELIVERY OF HEALTHCARE HAS
CHANGED SIGNIFICANTLY OVER THE
YEARS IT IS NO LONGER PROVIDED
BY AN INDIVIDUAL BUT BY AN INTER
DISCIPLINARY HEALTH CARE TEAM
WHICH INCLUDES PARTS.
THIS MODEL PROVIDES US THE
OPPORTUNITY TO TREAT THE WHOLE
PATIENT.
COLLABORATE ON THEIR HEALTHCARE
NEEDS.
TOO OFTEN THAT TREATMENT NOW
INCLUDE SUBSTANCE ABUSE
CURES PROVIDES MEMBERS OF THIS
TEAM A TOOL TO TRACK THE
MEDICATION USE OF OUR PATIENTS.
WELL USEFUL IS STILL LACKING A
FEW KEY PIECES OF INFORMATION.
IN ORDER FOR ALL MEMBERS OF THE
HEALTHCARE TEAM TO SHARING CASE
MANAGEMENT THE PATIENT THE
MEDICAL HISTORY INCLUDING
BEHAVIOR PRIOR SUBSTANCE ABUSE
OVERDOSE HISTORY. WOULD BE
EXTREMELY IMPORTANT PERMISSION
TO HAVE ACCESS IN ORDER TO
EVALUATE THE RISK OF ABUSE.
ADDITIONALLY UNDER OUR CURRENT
SYSTEM HEALTHCARE PROVIDERS ARE
LIMITED TO THE INFORMATION
WITHIN THE CALIFORNIA TOO.
CURIOUS TO POINT OUT SYSTEM.
WE DO NOT HAVE THE ABILITY TO
TRACK THE PROCESS PATIENTS
PRESCRIPTION USES ACROSS OUR
BORDERS.
INTERSTATE IMMIGRATION IS KEY TO
ADDRESSING THAT PRESCRIPTION
DRUG ABUSE CRIME.
IN ADDITION TO THIRTY NINE
STATES OUR NEIGHBORING STATES
UTILIZE A SYSTEM WHICH RIGHTS
HEALTHCARE TEAM ACCESSIBILITY TO
ACCESS TO HEALTH RECORDS OF
PATIENTS FROM STATES. WHICH USE
AN INTEGRATED INTERSTATE SYSTEM.
CALIFORNIA HAS BEEN A LEADER IN
MANY SIGNIFICANT HEALTH POLICIES
ABORTING THIS IS NOT THE CASE
FOR TRACKING THE MEDICATION
REALIZATION THE MEDICATION
RECORDS COURSE THIS LOOKS.
THERE ARE DO YOU AND OUR
EXISTING MODELS THAT WORK
CALIFORNIA PHARMACISTS
ASSOCIATION URGES THIS BODY TO
STUDY THOSE MODELS.
AND IMPLEMENT THEM IN
CALIFORNIA.
CBJ LOOKS FOR TO WORKING WITH
THE MEMBERS OF THIS COMMITTEE
AND OUR COLLEAGUES IN HEALTH
CARE TO DEVELOP A WELL THOUGHT
OUT PLAN WHICH MEANS OUR
COLLECTIVE GOAL OF PROVIDING
CARE TO CALL CAL.
JUST A.
MY NAME IS LEE SNARK I AM A.
CHRONIC PAIN SPECIALIST IN
SACRAMENTO BEEN WORKING FOR OVER
THIRTY YEARS AND ESPECIALLY PAIN
MEDICINE. AND REPRESENTING THE
CALIFORNIA MEDICAL ASSOCIATION.
I'M BOARD CERTIFIED IN
ANESTHESIOLOGY INTERNAL MEDICINE
ADDICTION MEDICINE PAIN MEDICINE
AND I'M A MEDICAL REVIEW
OFFICER.
CHAU I HAVE BEEN INVOLVED.
FOR MANY YEARS IN PRESCRIBING
CONTROLLED SUBSTANCES.
THE CALIFORNIA MEDICAL
ASSOCIATION RECOGNIZE THE
IMPORTANCE OF OUR ABILITY TO
MANAGE PATIENTS WITH CHRONIC
PAIN. THE OLD RECALL THE
INTRACTABLE PAIN ACT AND SOME OF
THE THINGS WHO WENT INTO.
HELPING US MANAGE INTRACTABLE
PAIN.
IN FACT THE LEGISLATURE PASSED
BILL NOT THAT LONG AGO THAT
MANDATED A CONTINUING MEDICAL
EDUCATION SO THAT WE COULD LEARN
HOW TO PRESCRIBE MEDICATIONS
MORE SAFELY. ASKED ESPECIALLY ON
OUR UNDERSTANDING HAS EVOLVED TO
BECOME SMARTER ABOUT THINGS.
WE HAVE.
WORKED TO REFINE OUR BILL USED
TO MANAGE PATIENTS. NOW. THERE
THERE'S BEEN A LOT OF EXPERT
TESTIMONY THIS IS A VERY VERY
COMPLEX ISSUE.
WHEN WE MET WITH THE MEDICAL
BOARD OF CALIFORNIA PART RING
WITH TERROR.
CALLINGS.
TO UPDATE THE ABOARD
RECOMMENDATIONS FOR CONTROLLED
SUBS PRESCRIBING WE RECOGNIZE
THAT ONE SIZE DOES NOT FIT ALL.
REGRADED THE GUIDELINE WITH THE
PREAMBLE OF EIGHT TO TEN PAGES
IT COVERS EVERYBODY. AND THEN
HAD SUB CATEGORIES OF OUT
PATIENT SPECIFIC POPULATIONS OF
FOR EXAMPLE PEDIATRICS ELDERLY
CARE A CANCER PAIN MANAGEMENT
ADDICTIVE DISORDERS. AND OTHERS
WERE CONSIDERED IN OUR FORWARD
THINKING AND COMPREHENSIVE
MEDICAL OR CALIFORNIA TREATMENT
GUIDELINES.
THIS IS VERY PORTENDED PROCEED
AS NOTED THE CENTERS FOR DISEASE
CONTROL CENTERS FOR DISEASE
CONTROL TREATMENT GUIDELINES.
WHICH WERE DIRECTED PRIMARILY AT
PRIMARY CARE.
THE MEDICAL BOARD CALIFORNIA
TREATMENT GUIDELINES COVER ALL
CARE ALL SPECIALTIES REPRESENTS
ALL POSITIONS PRICING IN THE
STATE.
AS AA IMPORTANT COMPONENT OF OUR
MANAGEMENT OF THESE PATIENTS AN
ELECTRONIC PRESCRIPTION
MONITORING PROGRAM HAS ALWAYS
BEEN SUPPORTED. IN FACT WE'VE
SUPPORTED THE NATIONAL.
NASCAR PROGRAM IT WAS SIGNED BY
GEORGE W. BUSH AND IS STILL BEEN
INADEQUATE FUNDED BY CONGRESS.
WE THINK IS VERY IMPORTANT IT
INTERSTATE ELECTRONIC
PRESCRIPTION MANTRA BE
AVAILABLE.
BUT WE COULD CONTROL IS WORKING
WITH OUR PARTNERS IN CALIFORNIA
TO PROTECT THE PUBLIC INTEREST
OF BEST. PATIENT CARE WE COULD
PROVIDE AND WE'VE SUPPORT IN THE
ELECTRONIC PRESCRIPTION MARK
PROGRAM KNOWN AS JURORS IN
CALIFORNIA.
NOW AS WE HAVE SUPPORTED THAT.
IN WE'RE GROWING.
BY WITH ALL OF THE THINGS THAT
HAVE BEEN TESTIFIED TO. HER TO
CONTINUES TO BE SOME PROBLEMS
ARE I DO WANNA I DO WANT TO
EMPHASIZE THAT.
THE OVERALL TENOR OF THIS OF
THE PRESENTATION THIS MORNING
NEWS IS DIRECTED AT OPIOID
MISUSE OPIATE ABUSE AND HOPE YOU
DEDUCTION.
BUT I WOULD REMIND EVERYBODY
THAT THE INCIDENCE OF ADDICTION
IS ARGUABLY SOMEWHERE AROUND
FIFTEEN PERCENT OF THE
POPULATION. THAT WOULD LEAVE
EIGHTY FIVE PERCENT OF THE
POPULATION THAT IS IS.
AT RISK FOR NOT HAVING ACCESS TO
THESE MEDICATIONS.
CURRENTLY
CURRENTLY SIMPLY PRESCRIBING AN
OPIOID.
IS STIGMATIZED
JUST AS. WELL FOR FOR
PRACTITIONERS LIKE ME IS IS
INCREASINGLY VERY DIFFICULT TO
PROVIDE COMPLEX MEDICAL.
SOLUTIONS THAT MAY INVOLVE
POLYPHARMACY OR COMBINE
MEDICATIONS
BECAUSE OF ME.
LIMITATIONS ON WHAT YOU CAN
PRESCRIBE A YOU'VE HEARD
TESTIMONY ABOUT RED FLAGS AND
DANGEROUS COMBINATIONS.
SOMETIMES COMPLEX MEDICAL
CONDITIONS REQUIRE.
COMPLEX SOLUTIONS
IT IS NOT A ONE SIZE FITS ALL
WORLD.
AND UNFORTUNATELY SOME PATIENTS
WITH CHRONIC PAIN MANY OF WHOM
I'VE HAD THE PRACTICE FOR
DECADES ARE FINDING IT
INCREASINGLY DIFFICULT TO OBTAIN
MEDICATIONS. BECAUSE OF THE
CURRENT THINKING ABOUT MAXIMUM
DOSAGE LIMITATIONS AND THAT SORT
OF THING.
WHICH IN A GENERAL WAY WAS GOOD
BUT IN A SPECIFIC WAY MAY NOT BE
FOR CERTAIN PATIENT POPULATIONS.
.
SO. OUR CURRENT CONCERNS ABOUT
JURORS IS THAT.
WE'VE SEEN IMPROVED
FUNCTIONALITY OVER THE EARLIER
VERSIONS AND WE APPLAUD THAT.
WE'VE BEEN INVOLVED THE BETA
TESTING AND AND AS SUGGESTING.
SOLUTIONS TO IMPROVING. ITS.
.
A UTILITY.
A COUPLE OF THINGS OF CONCERN A
WAGON DATA REPORTING IS A
CURRENT SEVEN DAY REQUIREMENT
PERFORMANCES.
IT LEAVES A GAP IN WHICH A TRUE
DOCTOR SHOPPER COULD OBTAIN
INFILL MULTIPLE PRESCRIPTIONS
PER PER DATA WHICH OPEN AND
CURES.
DATABASE SIMILAR TO PRESCRIBE
OR THE PHARMACIST.
AND SHE MAYES ADVOCATED
CONTINUES TO SUPPORT EFFORTS TO
REDUCE THE REPORTING TIMELINE
FOR PHARMACISTS WHICH COULD MAKE
A LARGE IMPACT ON THE SYSTEM'S
USEFULNESS.
AND SADLY.
THEY'RE STILL VERY FREQUENT
PROBLEMS WITH THE SYSTEM KICKING
USERS OFF.
AS YOU'RE TRYING TO PULL PATIENT
REPORTS OR NOT I MEAN ALLOWING
THEM TO LOG IN.
NO NO I WORK WITH.
THE DOJ AND EARLY VERSIONS SAYS
DURING PORTENT CLINICAL PRACTICE
LIKE MINOR OR IN PRACTICE FOR
THAT MATTER. IF WE'RE GOING TO
FULLY IMPLEMENT CURES DATABASE
AND WE NEED TO BUILD ACCESS
THROUGHOUT THE OFFICE.
IN MY PRACTICE WE.
DO A HUNDRED PERCENT CURES.
REVIEW WE ACTUALLY.
A DOWNLOAD THE.
CURES REPORT.
AND APPENDEDTO THE OFFICE
REPORTS ON ALL MY PATIENTS
DEMOCRATIC PAIN PRACTITIONERS SO
THAT'S THAT'S AN IMPORTANT PART
OF MY MONITORING AND MANAGEMENT
PATIENTS. PATIENTS AWARE OF ALL
OF THIS STUFF AS WAS DONE
PREVIOUSLY TESTIFIED TO. OF
PATIENT AGREEMENT OR CONTROLLED
SUBSEQUENT IS ALSO COMPONENT OF
A PRACTICE.
WHERE YOU'RE PRESCRIBING
CONTROLLED SUBSTANCE?
CHAU AS PART OF THE PARTNERSHIP
OF PROVIDING SAFE.
MEDICAL PRACTICE THAT THE
PATIENTS ARE AWARE THAT THIS
DOES IS GOING ON.
.
SO WE SHOULD CONTINUE HAVE
INFORMATION.
TECHNOLOGY PROBLEMS.
.
A PERHAPS THERE COULD BE SOME
SHOPPING IMPROVEMENTS IN THE
DOJ.
.
AND OUR CONCERN ABOUT MANDATING
A SYSTEM THAT MAY NOT BE READY
FOR PRIMETIME IS THAT IT IT IT
IT UNFAIRLY IMPACTS A
PRACTITIONER.
IN AND TRYING TO PROVIDE A A
MANDATED.
DOCUMENTATION THAT WERE UNABLE
TO TO PROVIDE.
ALSO IMPORTANTLY THE CURE
SYSTEM IS DIFFERENT FROM ANY
OTHER STATES IN CRITICAL WAYS IT
IN HIS HOUSE INTO LAW
ENFORCEMENT ENTITY.
AND.
FOR THE PAINT COMMUNITY OF
MINING OF CURSE DATA AND AND.
FINDING AN ASSOCIATION BETWEEN
PRESCRIBE MEDICINES AND
PRESUMING. THAT THE.
AS IT'S BEEN DESCRIBED
INCOMPETENT DANGERS POSITIONS A
MAY NOT NECESSARILY CORRELATE.
THESE ARE NECESSARILY RED FLAGS
AND THERE'S NO IS AN IMPLICATION
THAT PHYSICIANS ARE PRODUCTION
FOR MEDICINE AND THERE MAY NOT
BE TRUE.
BUT AGAIN CURSES HIS HOUSE IN A
LAW ENFORCEMENT ENTITY.
IT DOES NOT HAVE THE REQUIRED
ADVISORY COMMITTEE THAT INCLUDES
PROVIDERS USED TO SYSTEM THAT
DEPTH ELECTION HAPPENS WHO WE
COULD PROVIDE FEEDBACK.
ABOUT THIS UNDERMINE ITS ABILITY
TO FUNCTION AT ITS HIGHEST
POTENTIAL AS A PUBLIC HEALTH
TOOL.
AND TO EFFECTIVELY MEET THE
NEEDS PROVIDERS WHICH IS COLONEL
TOO TO ENSURING THE SUCCESS OF
THE PRESCRIPTION MARKER PROGRAM.
WE CALIFORNIA MEDICAL SAY
ISSUES ASSOCIATION STRONGLY
SUPPORT ELECTRONIC PRESCRIPTION
MONITORING PROGRAM IN SUPPORT TO
CURES.
SYSTEM. WE PREFER A BEHIND US
IN A NON LAW ENFORCEMENT ENTITY.
SO THAT IS SERVICES FUNCTION FOR
PUBLIC HEALTH.
AND I THANK YOU FOR ALLOWING ME
TO PROVIDE COMMENTS LIKE VERY
MUCH CREDIT YOU VERY MUCH AND IT
LOOKS LIKE WE HAVE TO BE AT THIS
ROOM AND ABOUT TEN MINUTES OR SO
BUT. IF WE CAN COMING CATHOLIC
THIS COMES BY KNOW THAT MANY OF
YOU HAVE TRAVELED QUITE THE
DISTANCE TO BE HERE TODAY SO
THANK YOU VERY MUCH ON IT NOW GO
ON TO.
DOCTOR DAVID RENDON.
ANY.
AS WE ARE THIS MORNING THE
OPIATE EPIDEMIC IS A BIG PROBLEM
IN THEIR STE NATION AND OUR
STATE. BUT IT HASN'T BEEN A BIG
ISSUE IN MY PROFESSION OF
OPTOMETRY.
CALIFORNIA LAW ALLOWS
OPTOMETRIST TO PRESCRIBE ONLY TO
CONTROLLED SUBSTANCES.
HYDROCODONE TRAMADOL AND LIMITS
THE A PRESCRIPTION DATE TWO
THREE DAYS.
AN OPIATE PRESCRIPTION CAN BE
NEEDED BY AT TOM JUST PROPOSED
SURGICAL CONTROL PAIN AND TO
TREAT AYE INJURIES. THE MOST
OPTOMETRISTS MORE CALMLY MANAGE
THE PAIN WITH BANDAGE CONTACT
LENSES AND AL ANALGESICS LIKE
IBUPROFEN AND NAPROXEN.
OFTEN A MORE OBVIOUS IN
OPTOMETRY WHEN A PATIENT'S
CONDITION WOULD REQUIRE OPIATES
BECAUSE THE PAIN IS PHYSICALLY
NOTICEABLE. AS THE SHIP THEY
HAVE SOMETHING LIKE CORNEAL
ABRASION OR FOREIGN BODY IN
THEIR EYE.
THERE'S NOT A LOT OF THE DATA
AVAILABLE ON HOW OFTEN THAT TOM
JUST PRESCRIBE CONTROLLED
SUBSTANCES HOWEVER UNDER THE
MEDICARE SYSTEM IN TWENTY
FIFTEEN THERE WERE ABOUT FOUR
POINT THREE MILLION
PRESCRIPTIONS.
DESCRIPTIONS WRITTEN BY
OPTOMETRISTS IN U. S. AND OF
THOSE SEVEN HUNDRED THIRTY THREE
WERE FOR OPIATES.
THAT'S ZERO POINT ZERO THREE
OPIATE PRESCRIPTION RATE. AND
THIS DOESN'T INCLUDE THE NUMBER
OF YOUNGER PATIENT YOU MIGHT
HAVE WORK RELATED INJURIES THEY
CAN CAUSE PAIN BUT IT DOES
SUGGEST OVERALL WOULD
PRESCRIBING. LAPTOP PURCHASE IS
VERY LOW.
I DON'T TYPICALLY PRESCRIBED IN
IN MY PRACTICE
IN FACT IN PREPARATION FOR DID A
WE CANNOT FIND A PRACTICING UP
TOM JUST THAT HAD USED IN THE
CARE SYSTEM.
NEVERTHELESS THE AMERICAN
OPTOMETRIC ASSOCIATION HAS
DISTRIBUTED SPECIFIC GUIDELINES
TO DOCTORS OF OPTOMETRY.
REGARDING THE ROLE IN PROTECTING
THEIR PATIENTS AND FOR RISKING
AN INAPPROPRIATE USE OF OPIOIDS.
SO THANK YOU FOR LETTING ME
SHARE MY PERSPECTIVE THIS
MORNING.
THANK YOU VERY MUCH AND I'M
GOING TO A DOCTOR UPDIKE WHO
ALSO HAPPENS COINCIDENTALLY TO
THE FROM SENECA COUNTY.
GOOD MORNING.
CHAIR MEMBER COMMITTEE THANK
YOU FOR ALLOWING ME TO BE HERE.
LITTLE STRANGE HAVE A DOCTOR OF
CHIROPRACTIC YOU'RE TALKING
ABOUT OPIOIDS BOMB BUT WERE A
LITTLE BIT. ON AS OPPOSED TO ALL
THE WORK YOU'RE DOING ON DEALING
WITH THE ISSUE. WE WORK ON THE
FRONT END.
WE BELIEVE AND THAT'S A GOOD
DATA TO SUPPORT THAT IF YOU GET
THE RIGHT CONSERVATIVE CARE AT
THE FRONT END OF A PROBLEM. THAT
SOMEBODY HAS RELATED TO.
MUSCLE SKELETAL ORTHOPEDIC
PROBLEM.
YOU ACTUALLY DON'T END UP
NEEDING TO HAVE A LOT OF
MEDICATIONS.
I WORK IN A VERY INTEGRATED.
ONSITE MEDICAL CENTER AT CISCO
MANAGED BY STANFORD AND WE WE
HAVE PRETTY MUCH ALL OF THE
STANDARD PROVIDERS THEIR ON SITE
FOR THE EMPLOYEES.
OBVIOUSLY MEDICAL DOCTORS.
MULTIPLE DIFFERENT MEDICAL
SERVICES OUR PHYSICAL THERAPY
CHIROPRACTIC ACUPUNCTURE WE HAVE
MENTAL HEALTH.
COUNSELING.
HOW WILL SEVERAL PHARMACY AND
LAB WE HAVE DENTAL WE'VE
DIVISION CENTER I'M SO EVERY
IT'S A ONE STOP SHOP FOR STUFF
THAT YOU WOULD TYPICALLY WANT TO
GO TO IT AND? I'M JUST USE A
LITTLE BIT OF DATA AND TWO
THOUSAND FOURTEEN WE RAN THE
NUMBERS IN OUR PHARMACY THE
LOOKED AT.
PRESCRIBING HABITS
OF THE DOCTORS THAT WROTE
PRESCRIPTIONS TO OUR PHARMACY
FROM OUTSIDE AND FROM INSIDE.
AND.
WHILE THE DOCTORS INSIDE THE
CLINIC WROTE THIRTY SIX PERCENT
OF THAT TOTAL PRESCRIPTIONS THAT
WERE FILLED. OUT OF THIRTY ABOUT
THIRTY THOUSAND PRESCRIPTIONS.
ARE PROVIDERS ONLY WROTE SIX
PERCENT OF THE OPIOID
PRESCRIPTIONS SO YOU WOULD THINK
IF THERE WAS A. LEVEL PLAYING
FIELD THAT THEY WERE EVERYBODY
WAS PRACTICING THE SAME THEY'D
BE WRITING UP A THIRD.
OR SO OF THOSE PRESCRIPTIONS.
I'M SORRY I MISSED A.
YEAH.
ROUGHLY THAT AMOUNT.
AND BUT THE THE POINT BEING
THAT WHEN YOU HAVE ACCESS TO ALL
THE PROVIDERS THAT CAN HELP
PEOPLE IN THEIR IN PAIN ON THE
FRONT END.
WHETHER IT'S THROUGH THE
REIMBURSEMENT SYSTEM OUR A
CLINIC THAT'S AVAILABLE. AND WE
CAN HELP PEOPLE FROM NOT HAVING
TO MEET THE OPIOIDS AND END UP
IN THIS NEGATIVE SPIRAL THAT'S
CREATED THIS PROBLEM FOR
CALIFORNIA SO.
I THINK I'LL KEEP MY COMMENTS.
RIGHT THERE.
THANK YOU VERY MUCH.
TAKING.
BURNING.
THANK YOU SYMBOL AND REMEMBER
LOW.
AND THE MEMBERS FOR YOU BY ME
HERE MY NAME IS A DOCTOR IN THE
MY TECHIE. AND I'M A PRACTICING
PHYSICIAN.
YOU IN OAKLAND AND BERKELEY ON
PRACTICE.
AS INTEGRATING MEDICINE DOCTOR
WHICH IS A MEANS I DO PRESCRIBE
THE PAIN MEDICATION OPIOID
MEDICATIONS BUT ALSO I ADD
ACUPUNCTURE TO MY PRACTICE OF
FOR THE LOSS THE FIFTEEN YEARS.
DISAVOW THE NOTE I'M CURRENTLY
ON THE ACUPUNCTURE BORED AS THE
PRESIDENT BUT IT TODAY I'M HERE
NOT A REPRESENT OF THE
ACUPUNCTURE BOARD.
AND BUT I WANT TO SHARE YOU KNOW
FULL ALL THE PANELS HERE A THANK
YOU GUYS FOR BEING THE PARTNER
TOGETHER COLLABORATE TO TO TAKE
CARE OF OUR PATIENTS AS A SEWING
IMPORTANT. I SEE THE PAYING WITH
THE MY PATIENTS I REMEMBER EARLY
MISS THE GIPSON WAS A TALKING
ABOUT A COULD YOU GUYS TO STOP
PRESCRIBING. PAIN MEDICATION MA
I JUST OPENED UP I SAID IN MY
PATIENTS WOULD KILL US AND YOU
KNOW AS A PHYSICIAN YOU CAN TO
SEE OUR PATIENTS THIS OFFER. SO
THERE IS A REALLY LIMITED TO TO
USE FOR US TO YOU KNOW HELP
ABOUT PATIENTS SO HERE I WANT TO
SEE ACUPUNCTURE ACTUALLY HAS
BEEN REALLY.
INTEGRATED THE TWO OF A
HOSPITAL SYSTEM.
I GET IT NICKNAMED AS A DOCTOR
HAPPY SO IF YOU GUYS ARE
THINKING YOU WANNA YA PATIENTS
HAPPY Y. YA STAFF AND PHYSICIANS
LESS BURNED OUT AND HE'LL
NURSING STAFF. UNLESS BURNED OUT
BY THE STREAMING PATIENTS
THINKING ABOUT A CALL OF
ACUPUNCTURE TEAM. AND A WE
STARTED AT THE.
ACUPUNCTURE CHINESE MEDICINE
RESIDENCY PROGRAM A YOUNG
HIGHLAND HOSPITAL TWO YEARS AGO
HAS BEEN BECOME REALLY POPULAR
IN THE EMERGENCY ROOM.
POST OPERATION I SEE YOU ALSO
ONCOLOGY INFUSION CONDUCT.
SO I WANT TO KEEP MYSELF SHORT
IF AS AND YOU QUESTIONS I'M HERE
TO ANSWER AND THANK YOU FOR
GIVING ME THE CHANCE.
THANK YOU VERY MUCH.
ASSEMBLY IT IS
THE MOST OF.
DIFFICULT PRACTICE TO DEAL WITH
IF YOU'RE IF YOU'RE A DOCTOR AND
PAIN MANAGEMENT AND AND
CERTAINLY IN OUR AREA WE'VE HAD.
SOME OF THE PAIN MANAGEMENT
DOCTORS THAT WENT OFF IN THE.
DIRECTION OF OF LOVE OVER
PRESCRIBING OPIOIDS AND CREATING
ISSUES AND ARE. A COMMUNITY WHAT
I'M CURIOUS ABOUT IS HOW MUCH
HAVE YOU DECREASED
OPIOID.
.
I I HEAR OPIOID PRESCRIPTIONS
AND THEN YOU ALSO MENTIONED
THAT.
SOMETIMES PEOPLE WITH LONG TERM.
CARE REALLY DO OF REQUIRE
OPIOIDS AND IT SEEMS THAT THE
THE ONE I'VE BEEN READING LATELY
IS THAT THERE'S NOW NEXT.
FEELINGS ON LONG TERM.
USE OF OPIOIDS TO TREAT CHRONIC.
DISEASE SO MAYBE YOU CAN SHINE
A LIGHT ON.
OKAY THANK YOU.
.
THE.
.
RISK BENEFIT RATIO FOR OPIOIDS.
A COMPARABLE DE OTHER
MEDICATIONS WERE AVAILABLE TO US
IN THE LAST THIRTY TO FIFTY
YEARS.
ANNOUNCED ROYALS.
PREDNISONE.
.
YEAH MEMORY STABILIZE
MEDICATIONS ANTI SEIZURE
MEDICINES ANTIDEPRESSANT
MEDICATIONS THAT TYPE OF STUFF
WE WOULD USE AN INTERNAL
MEDICINE PRACTICE.
FOR.
IN IN COMBINATION.
WE WOULD USE COMMON I COME BY
MEDICATIONS FOR ANY OTHER
CHRONIC ILLNESS
HEART DISEASE LUNG DISEASE
KIDNEY DISEASE RHEUMATOLOGIST
DISEASE THOUGH IT IT IS IT'S
VERY CONSISTENT WITH AN INTERNAL
MEDICINE APPROACH TO.
A INTRACTABLE DISEASE ENTITY TO
USE COMBINE TO MEDICATIONS.
NO.
S. ESPECIALLY A PAIN MEDICINE IS
INVOLVED OVER THE YEARS.
WE'VE BEEN TRYING TO FIND WHAT'S
THE METRIC HOW DO WE MEASURE
BEAUSE IT'S EIGHT IT'S
INHERENTLY A SUBJECTIVE.
DISEASE PEOPLE WILL TELL YOU
WHAT THEY FEEL.
SO WEEK KNOWING TO RISE TO RIGHT
METRICS TO MEASURE THAT THE
IMPORTANT THING IS A IS AN
ASSESSMENT FUNCTION.
IN ACTIVITIES OF DAILY LIVING AN
ESSENTIAL.
AYE ACTIVITIES OF DAILY LIVING
TO IT MEASURE THAT.
AND WE JUST PRESCRIBE THE
AMOUNT OF MEDICATIONS THAT WE
THAT.
YEAH.
CORRELATED WITH.
THAT BENEFIT FOR THE PATIENTS
NOW AS A CONSEQUENCE OF.
MORPHINE EQUIVALENT DOSAGES AND
AN ARBITRARILY CAPS BEING PLACED
ON PRESCRIBING.
THERE'S BEEN AN OVERWHELMING OF
PRESSURE TO REDUCE THE AMOUNT
THE MEDICATION YOU'RE GIVING.
WHICH IN SOME CIRCUMSTANCES
BURGER SOME PATIENTS GET BETTER
NAY SAYS I'M GLAD I MARK THIS
MEDICATION BUT NOT EVERYBODY.
THEIR NUMBER PATIENTS DON'T DO
WELL.
AND ALSO LIKE TO EMPHASIZE THAT.
METHADONE MAINTENANCE.
WERE.
OPIATE USE DISORDER IS A HARM
REDUCTION STRATEGY.
ALSO ONE EMPHASIZING PEOPLE ARE
FINE IS AN OPIOID.
IT WAS OUR TAKING AWAY OPIOIDS
YOU ARE NOW INCOMPARABLE
DISEASES ALCOHOLISM WAS WAS.
MENTIONED ALCOHOLISM.
YOU KNOW HIS CLASSIC FORMAT IS
AN ABSENCE
PROGRAM AN ABSENCE PROGRAM ZERO
ALCOHOL THERE'S NO ALCOHOL
MAINTENANCE PROGRAM. SOME OF THE
NEWER MEDICATIONS LIKE VALTREX
THAT'S THAT'S THAT'S VERY
PROMISING NOW IN THE TREATMENT
OF SUBSTANCE USE DISORDERS IS
RELATIVELY NEW.
JERRY WE DON'T HAVE LONG TERM
DATA ON THAT.
AS A PAIN SPECIALIST USED TO
PUT OUR FEET FOR PAIN MANAGEMENT
IS VERY EFFECTIVE FOR SOME
PATIENTS BUT LIKE WITH ANY OTHER
PHARMACEUTICAL.
ONE SIZE DOES NOT FIT ALL AND
THE BEAUTY OF OUR MEDICAL BOARD
TREATMENT GUIDELINES CITY ALLOWS
FOR INDIVIDUAL VARIATION. GROUP
WITH WITH THE HEALTHCARE
PROVIDER POSITION IN MY CASE
WITH THE PATIENT TO TAILOR THE
PROGRAM.
SPECIFICALLY FOR THAT PATIENT
BASED UPON THE METRICS WE TALKED
ABOUT.
USING KNICKERS IN SOME OF THESE
OTHER STUFF IS A COMPONENT TO
THE TREATMENT PLANT TO HELP US
BE CLINICALLY MORE EFFECTIVE.
IN MY PRACTICE BECAUSE OF THE
THE POLITICS OF WHAT'S GOING ON
IT'S REALLY POLITICAL IN MANY
WAYS.
IT AS I'D EMPHASIZE YOU KNOW
WERE WERE WERE DIRECTING TOWARDS
ADDICTIVE.
THE ADDICTIVE PROBLEM THE OP
WAIT.
.
EPIDEMIC BUT KEEP IN MIND OUT OF
THE SIXTY FOUR THOUSAND PEOPLE
THAT DIED WHEN YOU PARSE THAT
DOWN.
YOU KNOW TWO THIRDS OF IT IS.
PARA ONE AND FENTANYL.
SO IN IN A IN NO WAY DO I WANNA.
TWO.
DIMINISH THE IMPORTANCE OF
THAT'S OF THAT FACTOR.
BUT WHEN YOU START DE
AGGREGATING THE DATA WE WOULDN'T
WE START LOOKING A PRESCRIPTION
USE.
DIVERSION OR ABUSE IT STARTS
COMING DOWN VERY VERY SMALL
AMOUNT OF OF THE DESKS ARE FROM
PATIENTS THAT ARE TAKING THE
MEDICATIONS AS PRESCRIBED.
AND AND THAT WAS MY MIND.
CONCERNED WHEN I TALK WITH THE
SENATE FOR DISEASE CONTROL WHEN
THEY CAME OUT THEY SAID WE'RE
NOT SPUR SPURS ARGO BICU IS AT
ALL WELL. AS AN ANESTHESIOLOGIST
IF WE DID MANAGE PER AB PAIN.
WELL PATIENTS WOULD HAVE
INCREASED INCIDENCE OF PNEUMONIA
THAT WOULDN'T HEAL AS WELL AND
ON AND ON SO EFFECTIVE ANALGESIA
WAS A CORNERSTONE OF ANESTHESIA
MANAGEMENT AND THAT'S AN ACUTE
SITUATION.
IN MY CLINICAL PRACTICE IT'S A
CHRONIC SITUATIONS IT'S A
DIFFERENT ANIMAL.
BUT.
.
WE YOU KNOW WE ANSWERED A
QUESTION YOU KNOW WE ARE
REDUCING THE MEDICATIONS AS BEST
WE CAN BUT THERE ARE SOME
THERE'S GOING.
COHORT OF PATIENTS THAT THAT'S
JUST NOT THE BEST MEDICAL
PRACTICE IN AM ALL I WANNA DO
IS.
IS BE ABLE TO PROVIDE A
REASONABLE CARE BASED UPON THE
BEST AVAILABLE EVIDENCE TO US AT
THIS TIME AND THAT SHOULD NOT BE
LIMITED TO AN ARBITRATED
ARBITRARY DOSAGE OR COMBINATION
OF MEDICATIONS.
FOR A SELECT GROUP OF PATIENTS.
AS A PAIN SPECIALIST
THAT THAT'S MY REQUEST
AND THEN AND I CAN CERTAINLY
UNDERSTAND THAT THAT'S BEING.
WE KNOW OUR READY PEOPLE HEAL
FASTER IF THEY'RE NOT IN PAIN
IT'S FOR
THE QUESTION OF.
OF HOW YOU GET THERE. WITHOUT
CREATING OTHER.
SOCIAL PROBLEMS
AND THEN JUST RIVER I BY NO
ALMOST JUST ONE REAL QUICK
QUESTION I THINK A COUPLE OF YOU
MANDATE OF MENTIONED.
THAT THERE'S NO INTERSTATE
INTEGRATION AND AND MAYBE DOCTOR
DANTE CAN I DIDN'T QUITE CATCH
YOU SAID THIRTY NINE STATES USE
SOMETHING LIKE CURIOUS BUT ARE
THERE ARE ANY OF THEM INTEGRATED
ACROSS.
BORDERS.
MAYBE I MISUNDERSTOOD.
I'M IT'S MY UNDERSTANDING THAT
THERE ARE SOME STATES THAT DO
HAVE SOME IMMIGRATION WE
CURRENTLY DO NOT SO WE WOULD
LIKE TO LOOK INTO THAT AND HAVE
OUR STATE.
BECAUSE WE ARE SO CLOSE TO OTHER
NEIGHBORING STATES AND EVEN IN
SACRAMENTO I PRACTICE AND I'M
THE RETAIL PHARMACISTS WHO
TRAVELS SO I DON'T HAVE A HOME
SITE.
I SEE PATIENTS FROM OTHER STATES
COMING INTO OUR STATE I DON'T
HAVE ACCESS TO ALL THEIR
INFORMATION.
IT WILL BE VERY HELPFUL AS A
PROVIDER TO BE ABLE TO PROVIDE
THEM WITH THE BEST POSSIBLE
CARE.
ESPECIALLY BECAUSE HOW CLOSE WE
ARE TWENTY THREE STATES TO HAVE
A SYSTEM THAT COULD AT LEAST
TALK TO THE OTHERS.
AND DO YOU KNOW IF WORK IS BEING
DONE TO AND A GREAT.
CURRENTLY I DO NOT HAVE THAT IN
FRONT OF ME BUT I CAN GET MY
STUFF TO GET BACK TO YOU.
DENVER FOR. A QUESTION FOR
DOCTOR REDMOND WITH RESPECT TO
THIS NOTION OF DOCTOR SHOPPING
DO YOU DO YOU FEEL ALSO WOULD
APPLY TO THE FIELD OF ATOMIC
TREE.
I DON'T BELIEVE SO SINCE WE'RE
LIMITED ONLY THREE DAYS
TREATMENT IT JUST DON'T SEE IT
HAPPENING.
OKAY OKAY AND THEN.
FOR PERHAPS A DR APPT I CAN A
DOCTOR PATAKI WITH RESPECT TO.
.
OPIOIDS AND THE COMPLIMENTARY
PRACTICE OF AND THAT WILL PUT
YOU PROVIDE AND IT DEEP WOULD
YOU BELIEVE THAT AND SITE DO
BELIEVE THEY ARE COMPLEMENTARY.
AT WITH RESPECT TO THAT OF THE
SERVICES THAT PROVIDE IN THAT OF
OPIOIDS OR. NOT.
WILL GENERALLY SINCE WORK WE
DON'T PROVIDE DRUGS WE DON'T DO
SURGERY MOST OUR PATIENTS AREN'T
ON OPIOIDS.
I THINK YOU PRACTICE MORE IN A
WORKERS COMPENSATION PRACTICE
THERE'D BE A MUCH HIGHER RATE OF
THAT.
BUT IN MY THIRTY YEARS OF
PRACTICING A BIT IN MANY
DIFFERENT SETTINGS AND THAT'S
REALLY THE ONLY TIME IN MY WORLD
WHERE PEOPLE ARE IN SO MUCH PAIN
THEY NEED TO BE ON OPIOIDS.
.
BUT IT SEEMS LIKE EVERYBODY ELSE
GETS ALONG PRETTY WELL WITHOUT
HAVING TO GO TO THAT.
LEVEL OR THEY CAN USE THEM FOR
A SHORT PERIOD TIME SHARE.
I JUST WANNA ADDED TO ACTUALLY
WITH THE WAY I IN THE HOSPITAL
CURRENTLY WE HAVE A INTENSIVE
CARE UNITS UP PUBLICITA
ACUPUNCTURE STUDY FEASIBILITY
STUDY FOR PAIN MANAGEMENT AT TWO
SHOWED SIGNIFICANTLY. DECREASE
THE MORPHINE USE AND A CURRENT
ILLEGAL AND THE EMERGENCY ROOM
WE I GATHER ALL THE DATA ALSO.
AND.
YOU KNOW SO OF IF I MAY I WOULD
OSCO CURRENTLY THE SHORTAGE OF
ACUPUNCTURE GO TO THE RURAL
AREA.
IS THE MANY OFTHEM BECAUSE OF
THE PAY YOU ISSUES YOU KNOW I'VE
ACUPUNCTURIST
I TO LEGAL INVESTED A HUGE
AMOUNT OF THE STUDENTS.
THE HIDE THAT AND WHEN THEY GET
OUT THERE IS UNLIMITED INSURANCE
COVERAGE YOU KNOW FOR THEM TO.
GET REALLY START EXPAND THEIR
PRACTICE INTO VARIOUS. AREA.
PRODUCERS AND FIFTEEN SECONDS IF
YOU. YEAH I JUST WANT TO ADD
THAT.
IT'S GENERALLY WELL RECOGNIZED
AND MULTI DISCIPLINARY CARE
REQUIRES ALL OF US SITTING HERE
TO WORK TOGETHER.
I'M REFERENCING A VERY SMALL
GROUP OF PATIENTS THAT HAVE NOT
RESPONDED TO THAT OR NOT RESPOND
AS WELL AS A COULD I WOULD
PREFER NOT PRESCRIBE ANYTHING IF
I COULD AVOID IT I USE
ACUPUNCTURE PACKAGE. RIGHT
TRAINED IN ACUPUNCTURE IS WELL I
JUST RAN OUT A LETTERS TO PUT ON
THE PITCH.
BUT IN A PRESCRIBED WE USE
CHIROPRACTIC ALL THE TIME.
AND IF SOMEBODY NEEDS GOOD EYE
EXAM THEY GET THAT TO.
CHAU.
VERY MUCH VERY UNFAVORABLE OF
COMPLEMENTARY TECHNIQUES TO DO
WHATEVER YOU CAN TO AVOID.
HAVING.
TO BE ON A MEDICATION THE SAME
WOULD APPLY TO DIABETES
HYPERTENSION OR ANYTHING ELSE SO
MUCH SUPPORT OF ALL THAT.
CRITICAL I KNOW THAT MANY OF YOU
HAVE TAKEN TIME OUT OF YOUR
PERSONAL PRACTICES IN YOUR DAILY
WORK ROUTINE TO BE WITH US HERE
TODAY TO SHARE SOME INSIGHTS OF
THANK YOU VERY MUCH.
WE WILL ALLOW FOR A PUBLIC
COMMENT AT THIS POINT SO WOULD
ANY MEMBER OF THE PUBLIC LIKE
TO.
I SPEAK UP TO THE MICROPHONE AND
WILL ALLOW YOU UP TO A ONE
MINUTE FOR PUBLIC COME
SO PLEASE COME TO THE MIKE.
AND NAME AFFILIATION AND PUBLIC
COMMENT PLEASE.
THANK YOU GOOD MORNING MISTER
CHAIRMAN AND MEMBERS OF THE
COMMITTEE MY NAME STERILE
KIRKLAND AND I'M A VICE
PRESIDENT WITH SEP PUBLIC
SERVICES. SAP'S ONE THE WORLD'S
LARGEST PROVIDERS OF SOFTWARE
SOLUTIONS.
TO GOVERNMENT.
ANIMA COURAGE TODAY BY THE.
LISTEN DAHLE FOUR PANELS THE
LEVEL OF.
COOPERATION BETWEEN
ORGANIZATIONS DEPARTMENTS AND
THAT AND THE COMMUNITY I THINK
THAT THE INFORMATION TECHNOLOGY.
COMMUNITY IS ALSO KEY TO THAT
PARTNERSHIP.
SO SMBS COMMITTED HELPING PUBLIC
SECTOR CUSTOMERS SAW SOME OF THE
LARGEST MOST COMPLEX CHALLENGES
THEY HAVE INCLUDING THE OPIOID
CRISIS.
AS A COMPANY WE CARE DEEPLY
ABOUT THIS CRISIS.
ON ITS IT WOULD THIS IMPACT OUR
OWN EMPLOYEES AS WELL AS THE
COMMUNITY AT LARGE.
WE HAVE CUSTOMERS AND HEALTH
CARE PUBLIC SECTOR INDUSTRIES
THAT ARE IT IS IN PARDONING TO
DEVELOP INNOVATIVE AND
COMPASSIONATE SOLUTIONS THAT
WILL REDUCE THE IMPACT OF THIS
CRISIS IS HAVING ON FAMILIES
AROUND THE WORLD. NOT JUST HERE
IN THE U. S..
S. EP IS WORKED WITH OTHER
GOVERNMENT PARTNERS IN THE U.
S..
TO DEVELOP STRATEGIES TO ADDRESS
THE OPIATE CRISIS
PACIFIC WE WE FELT THE STATE OF
INDIANA WHICH IS REFERENCED BY
DOCTOR FIGHT FOR IN THE FIRST
PANEL.
DEVELOP A DATA DRIVEN APPROACH
TO LOOK GOOD DATA ANALYSIS
AND PROGRAM MANAGEMENT
WE DID THIS BY BRINGING
SOLUTIONS THE STATE THAT ALLOWED
HIM TO GAIN INSIGHT ON THE
PROBLEM THAT THEY PREVIOUSLY DID
NOT HAVE.
NEW DOLLARS WERE ALLOCATED FOR
FIVE TREATMENT FACILITIES.
AND THOSE WERE SAUDIS WERE GONNA
BE PLACED NEAR HIGH POPULATION
AREAS.
BY LEVERAGING TECHNOLOGY INDIANA
BROUGHT TOGETHER DATA FROM
DIFFERENT AGENCIES CLEANSE THE
DATA.
RAN ANALYTICS TO DETECT PATTERNS
OF FAMILIES THAT LIVE IN THE RUN
UP FOR US BODY COULD YOU KINDLY
WRAP UP GET.
I WILL.
.
SO THEY.
WHEN THE POINT I WANT TO MAKE
THOSE A.
RAN THE ANALYTICS TO THEN
PLACED THE TREATMENT CENTERS
WHERE THE DATA TOLD THEM IF THEY
WERE MOST COMMONLY.
SO THANK YOU FOR YOUR TIME WE
APPRECIATE FURTHER CONVERSATIONS
ON HOW WE CAN PARTICIPATE. TO
HELP ADDRESS THE OPIATE CRISIS
GREAT THANK YOU VERY MUCH.
MISTER CHAIR MEMBERS TO MADDEN
REPRESENT CALIFORNIA CHAPTER OF
THE AMERICAN COLLEGE MEMBERS THE
PHYSICIAN'S WANT TO THANK YOU
FOR CALLING THIS HEARING. AND AS
YOU HEARD AYE THROUGHOUT THE DAY
PARTICULARLY FROM DOCTOR
PFEIFFER.
THE EMERGENCY DEPARTMENT IS A
PLACE WHERE WE SEE A LOT OF
FOLKS COMING IN WITH ADDICTION
ISSUES.
CAN WE HEAR FOR FOLKS ON A
REGULAR BASIS THEIR CHALLENGES
NOT ONLY WITH I'M DEALING WITH
PATIENTS ON ADDICTION. BUT THEN
GETTING THE CARE THEY NEED
BECAUSE OUR JOB IS SIMPLY TO
STABILIZE THE PATIENT AND GET
HIM TO THAT HIGHER LEVEL OF
CARE.
AT UC DAVIS THE RECENTLY
INITIATED A PILOT PROGRAM WHERE
THEY HAD A CERTIFIED SUBSTANCE
USE COUNTS WERE PLACED IN THE
MERCY DEPARTMENT ON AND A FULL
TIME BASIS AND THEIR JOB WAS
SIMPLY TO WORK WITH THESE FOLKS
COMING IN. WITH ADDICTION ISSUES
AND TRY CONNECTING TO THE
SERVICES THAT THE THAT THEY NEED
IN THE COMMUNITY. THE RESULTS
HAVE BEEN VERY GOOD AND AS A
RESULT OUR ORGANIZATION IS
LOOKING TO MAKE A BUDGET REQUEST
THIS YEAR TO TRY AND EXTEND THAT
ON A STATEWIDE BASIS SO GET A
ONE TIME FUNDING.
TO PLAY CERTIFIED SUBSTANCE USE
COUNSELORS IN EMERGENCY
DEPARTMENTS THROUGHOUT THE
STATE.
AND WE THINK THE BENEFITS
PARTICULAR FROM MEDICAL
PERSPECTIVE WILL BE VERY
IMPRESSIVE SCHOOL OF FORWARD TO
WORKING WITH YOU BOTH ON THIS AS
IT MOVES OR. THINK YOU VERY
MUCH.
GOOD MORNING MARY MCCUEN HERE ON
BEHALF OF CALIFORNIA DENTAL
ASSOCIATION REPRESENTING OVER
TWENTY SEVEN THOUSAND DENNIS
THROUGH OUT THE STATE. WE HONEST
THANK SENATOR LOW IN THE
COMMITTEE FOR TAKING THE TIME TO
JUST THIS IMPORTANT ISSUE.
CDAC IS CURIOUS AS AN IMPORTANT
TOOL FOR PROVIDERS IN ADDRESSING
THE OPIOID CRISIS AND OR NOT
REDUCING NONESSENTIAL OPIOID
USE.
DENNIS PRESCRIBE A LIMITED SOME
SET OF CIRCUMSTANCES USUALLY
RELATED TO A SURGICAL PROCEDURE
OR FOR PAIN FROM.
INFECTION OR DECAY.
CDA PRECEDES THE STATE'S EFFORTS
TO CREATE A PTM PIECE THAT IS
ACCURATE AND USER FRIENDLY AND
LOOKS FORWARD TO THE
CERTIFICATION. THAT THE SYSTEM
IS READY AND RELIABLE FOR
WIDESPREAD PRESCRIBER USE.
CDA CONTINUES TO PROMOTE THE
BEST PRACTICES IN COMPLIANCE
WITH FEDERAL AND STATE LAWS ON
OPIOID PAIN MANAGEMENT THROUGH
COMPLIANCE GUIDES WEBINARS ON
REGISTERING UTILIZING HERE'S.
AND REOCCURRING UPDATES.
AND REMINDERS ABOUT YEARS
REQUIREMENTS.
CDA IS PARTNERED WITH OUR
COLLEAGUES IN PHARMACY AMSA
PUBLISH A JOURNAL ON BEST
PRACTICES FOR ACT ACUTE PAIN
MANAGEMENT AND WE.
OFFERED CONSISTENTLY WELL
ATTENDED SEMIANNUAL COURSE ON
PRESCRIBING CONTROLLED
SUBSTANCES.
ADDITIONALLY CDA SUPPORTS AND
COMMANDS THE DONALD FOR AIDS
RECENTLY ADOPTED POLICY
STATEMENT ON OPIOID ABUSE AND
LOOKS FORWARD TO COLLABORATING
ON CONTINUING THE COLLABORATE
WITH THE DENTAL BOARD IN THE
LEGISLATURE.
AND OFFERING SUPPORT AND
EXPERTISE WHEN EVER POSSIBLE
THANK YOU.
BASED ON THE ONE STANDING
BETWEEN YOU AND AND TAKEN OFF SO
THANK YOU VERY MUCH FOR STICKING
AROUND. SO WE WOMAN EARNED A
IRWIN AND CHAIRMAN LOW.
THANK YOU VERY MUCH TO YOUR
STAFF FOR THE GREAT WORK THAT
THEY DID PUTTING THIS TOGETHER.
MY NAME IS MARK AGAIN I
REPRESENT A GROUP NAME A
SHATTERPROOF REST I'D NATIONWIDE
NONPROFIT GROUP.
COMMITTED TO HOPE YOU AID IN
PRESCRIPTION DRUG ADDICTION AYE
WE WORKED VERY HARD ON THE LARA
BILL AFEW YEARS BACK THAT TO
MAKE SURE THAT WE HAD MANDATORY
QUERY. I WAS VERY PLEASED TO
HEAR FROM THE ATTORNEY GENERAL'S
OFFICE TODAY THAT THEY
ANTICIPATE.
I THAT SYSTEM BEING CERTIFIED BY
JULY I DON'T WANT TO RECAP
ANYTHING THAT WE'VE HEARD
BECAUSE I WE'RE NEAR THE END
HERE BUT I DO WANT TO BRING UP
ONE THING THAT KIND OF STUCK IN
THE BACK OF MY MIND. WANTED
THINGS AT SHADOWPROOF IS
FOCUSING ON RIGHT NOW WAS
TREATMENT.
AND THE LACK OF TREATMENT AND
ONE OF THE THINGS THAT WE HEARD
FROM DOCTOR PFEIFFER IN THE VERY
FIRST PANEL. WAS THAT.
SHE WAS CONCERNED ABOUT
TREATMENT AND AFTER SHE HAD DONE
IT ABOUT THREE TIMES SHE FELT
VERY COMFORTABLE. BUT IN ORDER
TO.
FIND OUT WHAT TO DO SHE HAD TO
SEEK HELP FROM HER COLLEAGUES.
I THINK THAT'S A SHAME THAT.
A DOCTOR IN THE STATE OF
CALIFORNIA HAS TO SEEK
ASSISTANCE FROM A COLLEAGUE.
IN ORDER TO ADDRESS SOMETHING
LIKE OP O. AID.
ADDICTION I WE WOULD LIKE TO
SEE.
TREATMENT BE MANDATED TRAINING
THAT DOCTORS IN THIS STATE.
BE TREATED.
.
BE TAUGHT HOW TO DO TREATMENT
AND THAT THAT TREATMENT BE OUT
RESEARCH BASED ON OUTCOMES BASED
A TREATMENT.
AND WE'D LIKE TO SEE THAT
SPREAD AS WIDELY AS POSSIBLE
ORGANIZATION I HAS BEEN INVOLVED
WITH THIS FOR QUITE AWHILE WILL
CONTINUE TO BE INVOLVED IN IT WE
APPRECIATE YOUR LEADERSHIP.
IN THE PACKAGE OF BILLS THAT
YOU HAVE.
AND.
THE ATTENTION THAT THE
LEGISLATURE IS PLACING ON THIS
AND WE PLAN ON BEING INVOLVED IN
WILL MAKE OURSELVES AVAILABLE IF
YOU NEED ANY INFORMATION OR IF
YOU NEED TO SPEAK WITH ANYBODY
IN THE STATE. OR IN YOUR
DISTRICT THAT SUFFERS FROM THIS
WE HAVE BY AMBASSADORS IN NEARLY
EVERY CITY IN THE STATE.
THANK YOU VERY MUCH ANY
ADDITIONAL MEMBERS WISHING TO
SPEAK DURING PUBLIC COMMENT.
SEE NOW WHY I KNOW THAT THERE
ARE NUMBER OF US WHO ARE VERY
INTERESTED IN THIS ISSUES AS YOU
CAN SEE BY THE TIMES THAT WE HAD
EARLIER THING THROUGHOUT THE DAY
OF A MEMBERS OF BOTH SIDES OF
THE AISLE. AND WILL CONTINUE TO
ENGAGE WITH MANY OF YOU HAVE
COME OUT HERE TODAY AS WELL TO
WANT TO PUBLICLY THANK OF ROBBIE
AND DID YOU KNOW WITH OUR
COMMITTEE STAFF AND ALL THOSE
WHO HELPED MAKE TODAY POSSIBLE.
ABOUT WE WILL BE CONTINUING TO
ENGAGE IN THIS STUFF A
CONVERSATION SO THAT CONCLUDES
OUR PERMISSION HEARING THANK YOU
VERY MUCH