Amendments for SB13-014

Senate Journal, February 15
After consideration on the merits, the Committee recommends that SB13-014 be amended
as follows, and as so amended, be referred to the Committee on Appropriations with
favorable recommendation.

Amend printed bill, strike everything below the enacting clause and
substitute:

"SECTION 1. Legislative declaration. (1) The general
assembly hereby finds that:
(a) Drug overdose is the leading cause of unintentional death in
Colorado, ahead of motor vehicle deaths;
(b) Opiate overdose may be reversible with the timely
administration of an opiate antagonist;
(c) Opiate antagonists have been shown to be safe and effective
at reducing overdose death; and
(d) Access to opiate antagonists is often limited unnecessarily by
laws that pre-date the overdose epidemic.
(2) Now, therefore, the general assembly hereby encourages the
administration of opiate antagonists for the purpose of saving the lives
of people who suffer opiate-related drug overdose events. A person who
administers an opiate antagonist to another person is urged to call for
emergency medical services immediately.
SECTION 2. In Colorado Revised Statutes, add 18-1-712 as
follows:
18-1-712. Immunity for a person who administers an opiate
antagonist during an opiate-related drug overdose event -
definitions. (1) Legislative declaration. THE GENERAL ASSEMBLY
HEREBY ENCOURAGES THE ADMINISTRATION OF OPIATE ANTAGONISTS FOR
THE PURPOSE OF SAVING THE LIVES OF PEOPLE WHO SUFFER
OPIATE-RELATED DRUG OVERDOSE EVENTS. A PERSON WHO ADMINISTERS
AN OPIATE ANTAGONIST TO ANOTHER PERSON IS URGED TO CALL FOR
EMERGENCY MEDICAL SERVICES IMMEDIATELY.
(2) General immunity. A PERSON OTHER THAN A HEALTH CARE
PROVIDER OR A HEALTH CARE FACILITY WHO ACTS IN GOOD FAITH TO
ADMINISTER AN OPIATE ANTAGONIST TO ANOTHER PERSON WHOM THE
PERSON BELIEVES TO BE SUFFERING AN OPIATE-RELATED DRUG OVERDOSE
EVENT SHALL BE IMMUNE FROM CRIMINAL PROSECUTION FOR SUCH ACT.
(3) (a) Licensed prescribers and dispensers. A PERSON WHO IS
PERMITTED BY LAW TO PRESCRIBE OR DISPENSE AN OPIATE ANTAGONIST
SHALL BE IMMUNE FROM CRIMINAL PROSECUTION FOR:
(I) SUCH PRESCRIBING OR DISPENSING; OR
(II) ANY OUTCOMES RESULTING FROM THE EVENTUAL
ADMINISTRATION OF THE OPIATE ANTAGONIST BY A LAYPERSON.
(b) A PRESCRIBER OR DISPENSER WHO DISPENSES AN OPIATE
ANTAGONIST IS STRONGLY ENCOURAGED TO EDUCATE PERSONS
RECEIVING THE OPIATE ANTAGONIST ON THE USE OF AN OPIATE
ANTAGONIST FOR OVERDOSE, INCLUDING BUT NOT LIMITED TO
INSTRUCTION CONCERNING RISK FACTORS FOR OVERDOSE, RECOGNITION
OF OVERDOSE, CALLING EMERGENCY MEDICAL SERVICES, RESCUE
BREATHING, AND ADMINISTRATION OF AN OPIATE ANTAGONIST.
(4) THE PROVISIONS OF THIS SECTION SHALL NOT BE INTERPRETED
TO ESTABLISH ANY DUTY OR STANDARD OF CARE IN THE PRESCRIBING,
DISPENSING, OR ADMINISTRATION OF AN OPIATE ANTAGONIST.
(5) Definitions. AS USED IN THIS SECTION, UNLESS THE CONTEXT
OTHERWISE REQUIRES:
(a) "HEALTH CARE FACILITY" MEANS A HOSPITAL, A HOSPICE
INPATIENT RESIDENCE, A NURSING FACILITY, A DIALYSIS TREATMENT
FACILITY, AN ASSISTED LIVING RESIDENCE, AN ENTITY THAT PROVIDES
HOME- AND COMMUNITY-BASED SERVICES, A HOSPICE OR HOME HEALTH
CARE AGENCY, OR ANOTHER FACILITY THAT PROVIDES OR CONTRACTS TO
PROVIDE HEALTH CARE SERVICES, WHICH FACILITY IS LICENSED,
CERTIFIED, OR OTHERWISE AUTHORIZED OR PERMITTED BY LAW TO
PROVIDE MEDICAL TREATMENT.
(b) (I) "HEALTH CARE PROVIDER" MEANS:
(A) A LICENSED OR CERTIFIED PHYSICIAN, NURSE PRACTITIONER,
PHYSICIAN ASSISTANT, OR PHARMACIST; OR
(B) A HEALTH MAINTENANCE ORGANIZATION LICENSED AND
CONDUCTING BUSINESS IN THIS STATE.
(II) "HEALTH CARE PROVIDER" DOES NOT INCLUDE A PODIATRIST,
OPTOMETRIST, DENTIST, OR VETERINARIAN.
(c) "OPIATE" HAS THE SAME MEANING AS SET FORTH IN SECTION
18-18-102 (21).
(d) "OPIATE ANTAGONIST" MEANS NALOXONE HYDROCHLORIDE
OR ANY SIMILARLY ACTING DRUG THAT IS NOT A CONTROLLED SUBSTANCE
AND THAT IS APPROVED BY THE FEDERAL FOOD AND DRUG
ADMINISTRATION FOR THE TREATMENT OF A DRUG OVERDOSE.
(e) "OPIATE-RELATED DRUG OVERDOSE EVENT" MEANS AN ACUTE
CONDITION, INCLUDING BUT NOT LIMITED TO A DECREASED LEVEL OF
CONSCIOUSNESS OR RESPIRATORY DEPRESSION RESULTING FROM THE
CONSUMPTION OR USE OF A CONTROLLED SUBSTANCE, OR ANOTHER
SUBSTANCE WITH WHICH A CONTROLLED SUBSTANCE WAS COMBINED,
AND THAT A LAYPERSON WOULD REASONABLY BELIEVE TO BE AN
OPIATE-RELATED DRUG OVERDOSE EVENT THAT REQUIRES MEDICAL
ASSISTANCE.
SECTION 3. In Colorado Revised Statutes, add 13-21-108.7 as
follows:
13-21-108.7. Persons rendering emergency assistance through
the administration of an opiate antagonist - limited immunity -
legislative declaration - definitions. (1) Legislative declaration. THE
GENERAL ASSEMBLY HEREBY ENCOURAGES THE ADMINISTRATION OF
OPIATE ANTAGONISTS FOR THE PURPOSE OF SAVING THE LIVES OF PEOPLE
WHO SUFFER OPIATE-RELATED DRUG OVERDOSE EVENTS. A PERSON WHO
ADMINISTERS AN OPIATE ANTAGONIST TO ANOTHER PERSON IS URGED TO
CALL FOR EMERGENCY MEDICAL SERVICES IMMEDIATELY.
(2) Definitions. AS USED IN THIS SECTION, UNLESS THE CONTEXT
OTHERWISE REQUIRES:
(a) "HEALTH CARE FACILITY" MEANS A HOSPITAL, A HOSPICE
INPATIENT RESIDENCE, A NURSING FACILITY, A DIALYSIS TREATMENT
FACILITY, AN ASSISTED LIVING RESIDENCE, AN ENTITY THAT PROVIDES
HOME- AND COMMUNITY-BASED SERVICES, A HOSPICE OR HOME HEALTH
CARE AGENCY, OR ANOTHER FACILITY THAT PROVIDES OR CONTRACTS TO
PROVIDE HEALTH CARE SERVICES, WHICH FACILITY IS LICENSED,
CERTIFIED, OR OTHERWISE AUTHORIZED OR PERMITTED BY LAW TO
PROVIDE MEDICAL TREATMENT.
(b) (I) "HEALTH CARE PROVIDER" MEANS:
(A) A LICENSED OR CERTIFIED PHYSICIAN, NURSE PRACTITIONER,
PHYSICIAN ASSISTANT, OR PHARMACIST; OR
(B) A HEALTH MAINTENANCE ORGANIZATION LICENSED AND
CONDUCTING BUSINESS IN THIS STATE.
(II) "HEALTH CARE PROVIDER" DOES NOT INCLUDE A PODIATRIST,
OPTOMETRIST, DENTIST, OR VETERINARIAN.
(c) "OPIATE" HAS THE SAME MEANING AS SET FORTH IN SECTION
18-18-102 (21), C.R.S.
(d) "OPIATE ANTAGONIST" MEANS NALOXONE HYDROCHLORIDE
OR ANY SIMILARLY ACTING DRUG THAT IS NOT A CONTROLLED SUBSTANCE
AND THAT IS APPROVED BY THE FEDERAL FOOD AND DRUG
ADMINISTRATION FOR THE TREATMENT OF A DRUG OVERDOSE.
(e) "OPIATE-RELATED DRUG OVERDOSE EVENT" MEANS AN ACUTE
CONDITION, INCLUDING BUT NOT LIMITED TO A DECREASED LEVEL OF
CONSCIOUSNESS OR RESPIRATORY DEPRESSION RESULTING FROM THE
CONSUMPTION OR USE OF A CONTROLLED SUBSTANCE, OR ANOTHER
SUBSTANCE WITH WHICH A CONTROLLED SUBSTANCE WAS COMBINED,
AND THAT A LAYPERSON WOULD REASONABLY BELIEVE TO BE AN
OPIATE-RELATED DRUG OVERDOSE EVENT THAT REQUIRES MEDICAL
ASSISTANCE.
(3) General immunity. A PERSON OTHER THAN A HEALTH CARE
PROVIDER OR A HEALTH CARE FACILITY WHO ACTS IN GOOD FAITH TO
ADMINISTER AN OPIATE ANTAGONIST TO ANOTHER PERSON WHOM THE
PERSON BELIEVES TO BE SUFFERING AN OPIATE-RELATED DRUG OVERDOSE
EVENT SHALL NOT BE LIABLE FOR ANY CIVIL DAMAGES FOR ACTS OR
OMISSIONS MADE AS A RESULT OF SUCH ACT.
(4) (a) Licensed prescribers and dispensers. A PERSON WHO IS
PERMITTED BY LAW TO PRESCRIBE OR DISPENSE AN OPIATE ANTAGONIST
SHALL NOT BE LIABLE FOR ANY CIVIL DAMAGES RESULTING FROM:
(I) SUCH PRESCRIBING OR DISPENSING; OR
(II) ANY OUTCOMES RESULTING FROM THE EVENTUAL
ADMINISTRATION OF THE OPIATE ANTAGONIST BY A LAYPERSON.
(b) A PRESCRIBER OR DISPENSER WHO DISPENSES AN OPIATE
ANTAGONIST IS STRONGLY ENCOURAGED TO EDUCATE PERSONS
RECEIVING THE OPIATE ANTAGONIST ON THE USE OF AN OPIATE
ANTAGONIST FOR OVERDOSE, INCLUDING BUT NOT LIMITED TO
INSTRUCTION CONCERNING RISK FACTORS FOR OVERDOSE, RECOGNITION
OF OVERDOSE, CALLING EMERGENCY MEDICAL SERVICES, RESCUE
BREATHING, AND ADMINISTRATION OF AN OPIATE ANTAGONIST.
(5) THE PROVISIONS OF THIS SECTION SHALL NOT BE INTERPRETED
TO ESTABLISH ANY DUTY OR STANDARD OF CARE IN THE PRESCRIBING,
DISPENSING, OR ADMINISTRATION OF AN OPIATE ANTAGONIST.
SECTION 4. In Colorado Revised Statutes, 12-36-117, add (1.7)
as follows:
12-36-117. Unprofessional conduct. (1.7) THE PRESCRIBING,
DISPENSING, OR DISTRIBUTION OF AN OPIATE ANTAGONIST BY A LICENSED
HEALTH CARE PRACTITIONER SHALL NOT CONSTITUTE UNPROFESSIONAL
CONDUCT IF HE OR SHE PRESCRIBED, DISPENSED, OR DISTRIBUTED THE
OPIATE ANTAGONIST IN A GOOD FAITH EFFORT TO ASSIST:
(a) A PERSON WHO IS AT INCREASED RISK OF EXPERIENCING OR
LIKELY TO EXPERIENCE AN OPIATE-RELATED DRUG OVERDOSE EVENT, AS
DEFINED IN SECTION 18-1-712 (5) (e), C.R.S.; OR
(b) A FAMILY MEMBER, FRIEND, OR OTHER PERSON WHO IS IN A
POSITION TO ASSIST A PERSON WHO IS AT INCREASED RISK OF
EXPERIENCING OR LIKELY TO EXPERIENCE AN OPIATE-RELATED DRUG
OVERDOSE EVENT, AS DEFINED IN SECTION 18-1-712 (5) (e), C.R.S.
SECTION 5. In Colorado Revised Statutes, 12-42.5-123, add (3)
as follows:
12-42.5-123. Unprofessional conduct - grounds for discipline.
(3) THE DISPENSING OR DISTRIBUTION OF AN OPIATE ANTAGONIST BY A
PHARMACIST SHALL NOT CONSTITUTE UNPROFESSIONAL CONDUCT IF HE
OR SHE DISPENSED OR DISTRIBUTED THE OPIATE ANTAGONIST IN A GOOD
FAITH EFFORT TO ASSIST:
(a) A PERSON WHO IS AT INCREASED RISK OF EXPERIENCING OR
LIKELY TO EXPERIENCE AN OPIATE-RELATED DRUG OVERDOSE EVENT, AS
DEFINED IN SECTION 18-1-712 (5) (e), C.R.S.; OR
(b) A FAMILY MEMBER, FRIEND, OR OTHER PERSON WHO IS IN A
POSITION TO ASSIST A PERSON WHO IS AT INCREASED RISK OF
EXPERIENCING OR LIKELY TO EXPERIENCE AN OPIATE-RELATED DRUG
OVERDOSE EVENT, AS DEFINED IN SECTION 18-1-712 (5) (e), C.R.S.
SECTION 6. In Colorado Revised Statutes, 12-38-117, add (6)
as follows:
12-38-117. Grounds for discipline. (6) THE PRESCRIBING,
DISPENSING, OR DISTRIBUTION OF AN OPIATE ANTAGONIST BY AN
ADVANCED PRACTICE NURSE SHALL NOT CONSTITUTE GROUNDS FOR
DISCIPLINE IF HE OR SHE PRESCRIBED, DISPENSED, OR DISTRIBUTED THE
OPIATE ANTAGONIST IN A GOOD FAITH EFFORT TO ASSIST:
(a) A PERSON WHO IS AT INCREASED RISK OF EXPERIENCING OR
LIKELY TO EXPERIENCE AN OPIATE-RELATED DRUG OVERDOSE EVENT, AS
DEFINED IN SECTION 18-1-712 (5) (e), C.R.S.; OR
(b) A FAMILY MEMBER, FRIEND, OR OTHER PERSON WHO IS IN A
POSITION TO ASSIST A PERSON WHO IS AT INCREASED RISK OF
EXPERIENCING OR LIKELY TO EXPERIENCE AN OPIATE-RELATED DRUG
OVERDOSE EVENT, AS DEFINED IN SECTION 18-1-712 (5) (e), C.R.S.
SECTION 7. In Colorado Revised Statutes, 12-42.5-102, add
(42) (b) (XIV) as follows:
12-42.5-102. Definitions. As used in this article, unless the
context otherwise requires or the term is otherwise defined in another
part of this article:
(42) (b) "Wholesale distribution" does not include:
(XIV) THE DISTRIBUTION OF NALOXONE.
SECTION 8. Safety clause. The general assembly hereby finds,
determines, and declares that this act is necessary for the immediate
preservation of the public peace, health, and safety.".


Health &
Human
Services


Senate Journal, March 1
After consideration on the merits, the Committee recommends that SB13-014 be amended
as follows, and as so amended, be referred to the Committee of the Whole with favorable
recommendation.

Amend the Health and Human Services Committee Report, dated
February 14, 2013, page 6, after line 4 insert:

"SECTION 8. Appropriation. (1) In addition to any other
appropriation, there is hereby appropriated, out of any moneys in the
division of professions and occupations cash fund created in section 24-
34-105 (2) (b) (I), Colorado Revised Statutes, not otherwise
appropriated, to the department of regulatory agencies, for the fiscal year
beginning July 1, 2013, the sum of $8,318, or so much thereof as may be
necessary, to be allocated for the implementation of this act as follows:
(a) $6,000 to the division of professions and occupations for
board meeting costs; and
(b) $2,318 to the executive director's office and administrative
services for the purchase of legal services.
(2) In addition to any other appropriation, there is hereby
appropriated to the department of law, for the fiscal year beginning July
1, 2013, the sum of $2,318, or so much thereof as may be necessary, for
the provision of legal services for the department of regulatory agencies
related to the implementation of this act. Said sum is from reappropriated
funds received from the department of regulatory agencies out of the
appropriation made in paragraph (b) of subsection (1) of this section.".

Renumber succeeding section accordingly.

Amend printed bill, page 1, line 102, strike "EVENTS." and substitute
"EVENTS, AND, IN CONNECTION THEREWITH, MAKING AN
APPROPRIATION.".


Appro-
priations


Senate Journal, March 5
SB13-014 by Senator(s) Aguilar; --Concerning the use of opiate antagonists to treat persons who
suffer opiate-related drug overdose events, and, in connection therewith, making an
appropriation.

Amendment No. 1, Health & Human Services Committee Amendment.
(Printed in Senate Journal, February 15, page(s) 241-244 and placed in members' bill
files.)

Amendment No. 2, Appropriations Committee Amendment.
(Printed in Senate Journal, March 1, page(s) 369-370 and placed in members' bill files.)

Amendment No. 3(L.006), by Senator Aguilar.

Amend Senate Health & Human Services Committee Report, dated
February 14, 2013, page 6, after line 4, insert:

"SECTION 8. In Colorado Revised Statutes, amend 12-42.5-105
as follows:
12-42.5-105. Rules. (1) The board shall make, adopt, amend, or
repeal rules in accordance with article 4 of title 24, C.R.S., that the board
deems necessary for the proper administration and enforcement of the
responsibilities and duties delegated to the board by this article, including
those relating to nuclear pharmacies.
(2) ON OR BEFORE JANUARY 1, 2014, THE BOARD SHALL ADOPT OR
AMEND RULES AS NECESSARY TO PERMIT THE DISPENSING OF AN OPIATE
ANTAGONIST, AS DEFINED IN SECTION 18-1-712 (5) (d), C.R.S., BY A
PHARMACIST TO A PERSON WHO IS AT INCREASED RISK OF EXPERIENCING
OR LIKELY TO EXPERIENCE AN OPIATE-RELATED DRUG OVERDOSE EVENT,
AS DEFINED IN SECTION 18-1-712 (5) (e), C.R.S., OR TO A FAMILY
MEMBER, FRIEND, OR OTHER PERSON WHO IS IN A POSITION TO ASSIST
SUCH A PERSON, SO LONG AS THE PRESCRIPTION FOR THE OPIATE
ANTAGONIST PROVIDES FOR THE DISPENSING OF THE OPIATE ANTAGONIST
TO SUCH A FAMILY MEMBER, FRIEND, OR OTHER PERSON.".

Renumber succeeding section accordingly.

As amended, ordered engrossed and placed on the calendar for third reading and final
passage.