House of Representatives Staff Analysis — PCS for HB 731 Drug-related Overdose Prevention (1/18/2022)
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- 2022 3093 Professions Public Health Subcommittee Proposed Committee Bill Analyses Fn Pcs07
Summary
A House of Representatives staff analysis dated January 18, 2022 of the proposed committee substitute (PCS) for HB 731, Drug-related Overdose Prevention, prepared for the Professions & Public Health Subcommittee. It describes current Florida law on prescribing, dispensing and administering emergency opioid antagonists and on overdose reporting, and gives background data including 5,268 opioid overdose deaths reported in Florida in 2019. The analysis states that the bill amends s. 381.887, F.S. to let pharmacists order and dispense emergency opioid antagonists and to authorize law enforcement and certain other agency personnel to possess and administer them, and amends s. 395.1041, F.S. to require hospital emergency departments and urgent care centers to report certain overdoses to DOH. It reports no fiscal impact on state or local government and an effective date of July 1, 2022.
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“House of Representatives Staff Analysis — PCS for HB 731 Drug-related Overdose Prevention (1/18/2022).”
Original at www.flhouse.gov. Archived at Pandemic Darlings, https://pandemicdarlings.com/source-documents/2022-3093-professions-public-health-subcommittee-proposed-committee-bill-analyses-fn-pcs0731-pph/
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HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: PCS for HB 731 Drug-related Overdose Prevention
SPONSOR(S): Professions & Public Health Subcommittee
TIED BILLS: IDEN./SIM. BILLS:
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
Orig. Comm.: Professions & Public Health Woodruff McElroy
Subcommittee
SUMMARY ANALYSIS
An overabundance of opioids in the body can lead to a fatal overdose. Opioid antagonists are used in opioid
overdoses to counteract life-threatening depression of the central nervous system and respiratory system,
allowing an overdose victim to breathe normally.
Current law authorizes health care practitioner to prescribe and dispense an emergency opioid antagonist to a
patient or caregiver, and pharmacists may dispense an emergency opioid antagonist pursuant to a prescription
or non-patient-specific standing order. A patient or caregiver can store and possess approved emergency
opioid antagonists and, in an emergency, when a physician is not immediately available, administer the
emergency opioid antagonists to a person believed in good faith to be experiencing an opioid overdose,
regardless of whether the person has a prescription for an emergency opioid antagonist. Emergency
responders and crime laboratory personnel are authorized to possess, store, and administer emergency opioid
antagonists. Current law affords civil liability immunity to anyone who possesses, administers, prescribes,
dispenses, or stores an approved emergency opioid antagonist.
Current law allows emergency medical technicians and paramedics who provide basic and advanced life
support services to report controlled substances overdoses to the Department of Health (DOH). Hospital
emergency departments and urgent care centers that treat suspected or actual overdoses are not required to
report such information. This creates a potential gap in the data related to any person that was not transported
by a basic life support service or an advanced life support service to a hospital or urgent care center.
The Florida Public Health Institute (Institute) is a not-for-profit corporation established by s. 381.98, F.S., with
the purpose of advancing the knowledge and practice of public health, including promoting health awareness in
Florida. The law requires the Institute to, in consultation with DOH, coordinate monthly health awareness
campaigns with national, state, and local health care organizations and government entities on numerous
topics, including substance abuse.
HB 731 amends s. 381.887, F.S., to reflect that the purpose of the section is for the prescribing, ordering, and
dispensing of emergency opioid antagonists. The bill requires the Institute, in consultation with DOH, to
educate the public regarding the use of emergency opioid antagonist. Further, the bill allows pharmacist to
order and dispense an emergency opioid antagonist to a patient or caregiver.
The bill expressly authorizes personnel of a law enforcement agency or other agency, including, correctional
probation officers and child protective investigators to possess, store, and administer emergency opioid
antagonists. The bill also amends s. 395.1041, F.S., to require hospital emergency departments and urgent
care centers to report the treatment of suspected or actual overdose victims under certain circumstances.
The bill has no fiscal impact on state or local government.
The bill provides an effective date of July 1, 2022.
This docum ent does not reflect the intent or official position of the bill sponsor or House of Representatives .
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FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Opioids
Opioids are psychoactive substances derived from the opium poppy, or their synthetic analogues. 1
They are commonly used as pain relievers to treat acute and chronic pain. An individual experiences
pain because of a series of electrical and chemical exchanges among the individual’s peripheral
nerves, spinal cord, and brain.2 Opioid receptors occur naturally and are distributed widely throughout
the central nervous system and in peripheral sensory and autonomic nerves. 3 When an individual
experiences pain, the body releases hormones, such as endorphins, which bind with targeted opioid
receptors.4 This disrupts the transmission of pain signals through the central nervous system and
reduces the perception of pain.5 Opioids function in the same way by binding to specific opioid
receptors in the brain, spinal cord and gastrointestinal tract, thereby reducing the perception of pain.6
Opioids include prescription medications used to treat pain, as well as illegal drugs. Opioids include 7:
Buprenorphine (Subutex, Suboxone)
Codeine
Fentanyl (Duragesic, Fentora)
Heroin
Hydrocodone (Vicodin, Lortab, Norco)
Hydromorphone (Dilaudid, Exalgo)
Meperidine
Methadone
Morphine
Oxycodone (OxyContin, Percodan, Percocet)
Oxymorphone
Tramadol
U-47700
In 2019, an estimated 62 million people used opioids for non-medical reasons worldwide.8 Opioids are
commonly abused, with an estimated 36.3 million people worldwide suffering from drug use disorders.9
Opioids can create a euphoric feeling because they affect the regions of the brain involved with
pleasure and reward, which can lead to abuse.10 Continued use of these drugs can lead to the
development of tolerance and psychological and physical dependence. 11 This dependence is
characterized by a strong desire to take opioids, impaired control over opioid use, persistent opioid use
1 World Health Organization, Opioid Overdose, https://www.who.int/news-room/fact-sheets/detail/opioid-overdose (last visited Jan. 4,
2022).
2 Medical News Today, What is pain, and how do you treat it? (Sept. 7, 2020),
https://www.medicalnewstoday.com/articles/145750#:~:text=People%20feel%20pain%20when%20specific,immediate%20contraction%
20of%20the%20muscles (last visited Jan. 4, 2022).
3 Gjermund Henriksen, Frode Willoch, Imaging of Opioid Receptors in the Central Nervous System, Brain (2008) 131 (5): 1171-1196.
4
Id.
5 Id.
6 U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, SAMHSA Opioid
Overdose Toolkit: Facts for Community Memb ers (2018).
7 Florida Department of Law Enforcement, Drugs Identified in Deceased Persons b y Florida Medical Examiners 2019 Report, (Nov.
2020).
8 United Nations Office on Drugs and Crime, World Drug Report 2021, Glob al Overview: Drug Demand and Drug Supply (Jun. 2021),
WDR21_Booklet_2.pdf (unodc.org) (last visited Jan. 4, 2022).
9 Id.
10 National Institute on Drug Abuse, How Do Opioids Affect the Brain and Body?, (June 2020)
http://www.drugabuse.gov/publications/research-reports/prescription-drugs/opioids/how-do-opioids-affect-brain-body (last visited Jan. 4,
2022).
11 Supra note 6.
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despite harmful consequences, a higher priority given to opioid use than to other activities and
obligations, and a physical withdrawal reaction when opioids are discontinued. 12
An overabundance of opioids in the body can lead to a fatal overdose. In addition to their presence in
major pain pathways, opioid receptors are also located in the respiratory control centers of the brain. 13
Opioids disrupt the transmission of signals for respiration in the identical manner that they disrupt the
transmission of pain signals (figure 1). This leads to a reduction, and potentially cessation, of an
individual’s respiration. Oxygen starvation will eventually stop vital organs like the heart, then the brain,
and can lead to unconsciousness, coma, and possible death. 14 Within 3-5 minutes without oxygen,
brain damage starts to occur, soon followed by death. 15 However, this does not occur instantaneously
as people will commonly stop breathing slowly, minutes to hours after the drug or drugs were used. 16
An opioid overdose can be identified by a combination of three signs and symptoms referred to as the
“opioid overdose triad”:17
Pinpoint pupils.
Unconsciousness.
Respiratory depression.
Figure 1
Source: Maya Doe-Simkins, MPH, Boston Medical Center.
The rise in opioid overdose deaths can be outlined in three distinct waves:
1. The first wave began with increase prescribing of opioids in the 1990s, with overdose deaths
involving prescription opioids increasing since at least 1999.
2. The second wave began in 2010, with rapid increase in overdose deaths involving heroin.
3. The third wave began in 2013 with significant increases in overdose deaths involving synthetic
opioids, particularly those involving illicitly manufactured fentanyl. The market for illicitly
manufactured fentanyl continues to change, and it can be found in combination with heroin,
counterfeit pills, and cocaine.18
More than 70,000 Americans died from drug-involved overdose in 2019, including illicit drugs and
prescription opioids.19 Overall, drug overdose deaths increased from 2018 to 2019 with 70,630 drug
12 Supra note 1.
13 Pattinson, K.T.S., Opioids and the Control of Respiration, BJA, Vol. 100, Issue 6, Pages 747-758. https://doi.org/10.1093/bja/aen094.
14 Harm Reduction Coalition, Guide to Developing and Managing Overdose Prevention and Take -Home Naloxone Projects, (Aug. 31,
2020) http://harmreduction.org/our-work/overdose-prevention/ (last visited Jan. 4, 2022).
15 Id.
16 Id.
17 Supra note 1.
18 Centers for Disease Control and Prevention, Understanding the Epidemic, https://www.cdc.gov/drugoverdose/epidemic/index.html
(last visited Jan. 4, 2022).
19 National institute on Drug Abuse, Overdose Death Rates, https://www.drugabuse.gov/drug-topics/trends-statistics/overdose-death-
rates (last visited Jan. 4, 2022).
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overdoses reported in 2019.20 The following graph provides information on the total number of U.S.
overdose deaths involving any opioid21 from 1999 to 2019.22 Opioid-involved overdose deaths
increased from 21,088 in 2010 to 47,600 in 2017, and remained steady in 2018 with 46,802.23 This was
following by a significant increase in 2019 to 49,860 overdose deaths. 24
In 2019, Florida reported 5,268 opioid overdose deaths.25 This was an 11.9 percent increase from
2018.26 Florida also experienced 4,152 opioid and 10,464 all drug non-fatal overdoses between July
and September 2019.27
With the onset of the COVID-19 pandemic, the incidence of opioid use disorder and resulting overdose
deaths has once again risen. A report from Project Opioid details provisional data from the Florida
Department of Health (DOH) showing that deaths from drug overdoses have increased by 43 percent
between 2019 and 2020, from 56 deaths per 100,000 in 2019 to 94 deaths per 100,000 in 2020.28
Additionally, fentanyl, an extremely potent opioid drug, is the leading cause of overdose deaths in
Florida, and the incidence of fentanyl overdose deaths increased by 38 percent from 2,348 in 2019 to
3,244 in 2020.29
Opioid Antagonist
An opioid antagonist, such as Narcan or Naloxone, is a drug that blocks the effects of exogenously
administered opioids. Opioid antagonists are used in opioid overdoses to counteract life-threatening
20 Id.
21 Any opioid includes prescription opioids (natural and semi -synthetic opioids and methadone), heroin and synthetic opioids other than
methadone (primarily fentanyl).
22 Supra note 19.
23 Id.
24 Id.
25 Center for Dis ease Control and Prevention, Drug Overdose Deaths, https://www.cdc.gov/drugoverdose/data/statedeaths/drug-
overdose-death-2019.html (last visited Jan. 4, 2022).
26 Center for Disease Control and Prevention, 2018-2019 Drug Overdose Death Rate Increase,
https://www.cdc.gov/drugoverdose/data/statedeaths/drug-overdose-death-2019.html (last visited Jan. 17, 2022).
27 Florida Department of Health, Non-Fatal Opioid and All Drug Overdose Surveillance Report, Florida Q4 -2019,
http://www.floridahealth.gov/statistics-and-data/fl-dose/_documents/non-fatal-od-2019-q4.pdf
28 Project Opioid, A Pandemic Fueling an Epidemic in Florida in 2020, https://projectopioid.org/wp-content/uploads/2020/12/PO-2020-
Data-Study-Final_New-Section.pdf (last visited Jan. 4, 2022).
29 Id.
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depression of the central nervous system and respiratory system, allowing an overdose victim to
breathe normally.30 This occurs because opioid antagonists create a stronger bond with opioid
receptors than opioids. This forces the opioids from the opioid receptors and allows the trans mission of
signals for respiration to resume.31 This effect lasts only for a short period of time32 with the narcotic
effect of the opioids returning if still present in large quantities in the body. In this scenario, additional
doses of an opioid antagonist would be required and it is why it is generally recommended that anyone
who has experienced an overdose seek medical attention.
In February 2019, Florida issued a statewide Standing Order for Naloxone. The Standing Order
authorizes pharmacists to dispense certain naloxone formulations to emergency responders for
administration to persons exhibiting signs of opioid overdose. 33 Under the Standing Order, emergency
responders, including law enforcement, firefighters, paramedics, and emergency medical technicians,
can go to a pharmacy or community-based program for training on opioid antagonist administration and
receive an opioid antagonist without a patient-specific prescription. Access to naloxone is available at
most pharmacies in Florida. The following map provides information on pharmacy locations where
naloxone is available a prescription.34
30
Harm Reduction Coalition, Understanding Naloxone, (Sept. 8, 2020) http://harmreduction.org/issues/overdose-
prevention/overview/overdose-basics/understanding-naloxone/ (last visited Jan. 4, 2022).
31 Supra note 13.
32 The half-life for a common opioid antagonist in adults ranged from 30 to 81 minutes. Acute opiate withdrawal is a potential side -effect
of naloxone; however, this would be time limited to the half-life of naloxone.
33 Florida Department of Health, State of Florida, Statewide Standing Order for Naloxone (Feb. 25, 2019),
http://www.floridahealth.gov/licensing-and-regulation/ems-system/_documents/standing-order-naloxone.pdf (last visited Jan. 4, 2022).
34 New America, National Naloxone Access Map,
https://opioidepidemic.maps.arcgis.com/home/item.html?id=153b0c32fefc432eae6a0e8439b9f56b (last visited Jan. 4, 2022). The
National Naloxone Map accumulates data from many difference sources, with participation from thousands of CVS, Walmart, and
Walgreens pharmacies, along with other independent distributors. The map is meant to be a community effort, and contributing
locations is encouraged to participate, to make it the best possible representation of resources. The map is not complete, an d naloxone
prescription needs and costs vary by state, but this effort represents over 25,000 locations to obtain naloxone.
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Florida law allows an authorized health care practitioner to prescribe and dispense an emergency
opioid antagonist to a patient or caregiver, and pharmacists may dispense an emergency opioid
antagonist pursuant to a prescription or to a non-patient-specific standing order.35 Current law defines a
“caregiver” as a family member, friend, or person that has recurring contact with a person at risk of
experiencing an opioid overdose.36 Current law broadly defines a “person” to include individuals and
children.37 Therefore, an authorized health care practitioner may prescribed any person falling under
the definition an emergency opioid antagonist.
Any person prescribed an opioid antagonist, or distributed an emergency opioid antagonist pursuant to
a non-patient-specific standing order, may store and possess approved emergency opioid antagonists.
In an emergency, when a physician is not immediately available, that person may administer the
emergency opioid antagonists to an individual believed in good faith to be experiencing an opioid
overdose, regardless of whether that person has a prescription for an emergency opioid antagonist. 38
35 S. 381.887, F.S.
36 S. 381.887(1)(c), F.S.
37 S. 1.01 (3), F.S.
38 S. 381.887(3), F.S.
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Current law also allows emergency responders and crime laboratory personnel to possess, store, and
administer emergency opioid antagonists.39
A person who possesses, administers, prescribes, dispenses, or stores an approved emergency opioid
antagonist is afforded the civil liability immunity protections under s. 768.13, F.S. (Good Samaritan
Act).40
Emergency Response to Overdose
In 2017, U.S. drug overdose deaths increased 9.6% from 2016. Emergency departments treated
967,615 nonfatal drug overdoses in 2017.41 From 2016 to 2017, rates for nonfatal overdoses increased
for those involving all drugs (4.3%), all opioids (3.1%), nonheroin opioids (3.6%), heroin (3.6%), and
cocaine (32.9%).42
The following table provides information on emergency department visits related to heroin and
nonmedical use of prescription opioids by age from April 2019 to December 2020. 43 Patients aged 26 to
45 accounted for more than half (52%) of emergency department visits related to non-medical use of
prescription opioids.44
70%
63.90%
60%
51.50%
50%
40%
30.00%
30%
23.40%
20% 16.10%
12.30%
10%
2.30%
0.30%
0%
Heroin Nonmedical Use of Prescription Opioids
Under 18 18 to 25 26 to 45 Over 45
Florida Emergency Response to Overdoses Reporting Requirements
Current law allows emergency medical technicians 45 (EMT) and paramedics 46 who provide basic and
advanced life support services to report controlled substances overdoses to DOH. A report must
contain:
39 S. 381.887(4), F.S.
40 S. 381.887(5), F.S.
41 Centers for Disease Control and Prevention, Nonfatal Drug Overdoses Treated in Emergency Departments – United States, 2016-
2017, (Apr. 3, 2020), https://www.cdc.gov/mmwr/volumes/69/wr/mm6913a3.htm (last visited Jan. 10, 2022).
42 Id.
43 U.S. Department of Health, Substance Abuse and Mental Health services Administration, DAWN: Heroin and Nonmedical Use of
Prescription Opioids, https://www.samhsa.gov/data/sites/default/files/reports/rpt32814/DAWN%20Opioids%20Profile.pdf (last visited
Jan. 4, 2022).
44 Id.
45 S. 401.23(11), F.S., defines an EMT as a person who is certified by DOH to perform basic life support.
46 S. 401.23(17), F.S., defines a paramedic as a person who is certified by DOH to perform basic and advanced life support.
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The date and time of the overdose.
The address of where the patient was picked up or where the overdose took place.
Whether an emergency opioid antagonist was administered.
Whether the overdose was fatal or non-fatal.
Additionally, the report must include the approximate age and gender of the patient and the suspected
controlled substance involved in the overdose, if permitted by its reporting mechanism. Reporters must
attempt to make the report within 120 hours.
A report must be filed with DOH using the Emergency Medical Tracking and Reporting System
(EMSTARS),47 the Washington/Baltimore High Intensity Drug Tracking Overdoes Detection Mapping
Application Program,48 or other program identified by DOH in rule.
Section 395.1041(6))(b), F.S., requires hospitals with an emergency department to develop a best
practices policy to promote the prevention of unintentional drug overdoses. The policy may include, but
is not limited to:
A process to obtain a patient’s consent to notify next of kin, and each physician or health care
practitioner who prescribes a controlled substance to the patient, regarding the patient’s
overdose, the patient’s location, and the nature of the substance or controlled substance
involved in the overdose.
A process for providing the patient or the patient’s next of kin with information about licensed
substance abuse treatment services.
Guidelines for emergency department health care practitioners authorized to prescribe
controlled substances to reduce the risk of opioid use, misuse, and addiction.
The use of licensed or certified behavioral health professionals or peer specialists in the
emergency department to encourage the patient to seek substance abuse treatment.
The use of screening, brief intervention, and referral to treatment protocols in the emergency
department.
Hospital emergency departments and urgent care centers that treat suspected or actual overdoses are
not required to report such information. This creates a potential gap in the data related to any person
that was not transported by a basic life support service or an advanced life support service to a hospital
or urgent care center.
The Florida Public Health Institute, Inc.
The Florida Public Health Institute (Institute) is a not-for-profit corporation established by s. 381.98,
F.S., with the purpose of advancing the knowledge and practice of public health, including promoting
health awareness in Florida. The Institute is tasked with procuring funds to complement, supplement,
and enhance the missions of the various organizations, entities, and departments that provide public
health initiatives by serving as the lead corporation in the state for promoting public health awarenes s.
The Institute is required to enter into partnerships with providers of continuing education for health care
practitioners, including, but not limited to, hospitals and state and local medical organizations, to ensure
that practitioners are aware of the most recent and complete diagnostic and treatment tools.
Additionally, s. 381.981, F.S., requires the Institute to, in consultation with DOH, coordinate monthly
health awareness campaigns, with national, state, and local health care organizations and government
47 DOH maintains the EMSTARS to collect data and analyze the incident level data from EMS agencies for benchmarking and quality
improvement initiatives. The electronic patient care records submitted by licensed EMS agencies to EMSTARS are confidential a nd
exempt pursuant to s. 401.30(4), F.S.
48 The Washington/Baltimore High Intensity Drug Trafficking Area (HIDTA) is a federal grant program administered by the White House
Office of National Drug Control Policy which provides resources to assist federal, state, local, and tribal agencies coordina te activities
that address drug trafficking. HIDTA created an app, known as the Overdose Detection Mapping Application Program, which allow s
EMS agencies to report overdose incidents that are then transmitted in real time with electronic map showing the locatio n, date, time,
and incident type. The app does not allow EMS agencies to report on the patient’s age or gender or suspected controlled subst ance
involved in the overdose.
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entities, targeting a wide range of the public, including parents, teachers, other school employees,
students in 4th through 12th grade, colleges, universities, state agency employees, county and local
government employees, patents of county health departments, Medicaid recipients, health care
professionals and providers, and the public in general. The health awareness campaigns must include
the following diseases in at least one monthly campaign every 24 months:
Cancer, including breast, prostate, cervical, ovarian, colorectal, and skin cancer, and leukemia.
Heart Disease.
Stroke.
Lung disease, including asthma and smoking-related disease.
Neurological disorders and disease, including Alzheimer’s disease, Parkinson’s disease, and
epilepsy.
Gastrointestinal disease.
Kidney disease.
Diabetes.
Liver disease.
Autoimmune disorders.
Birth defects and prenatal care.
Obesity and malnutrition.
Sexually transmissible disease.
Hepatitis A, hepatitis B, and hepatitis C.
Arthritis.
Vaccine-preventable disease.
Infectious diseases, including HIV/AIDS.
Substance abuse.
Mental illness.
Lupus.
Osteoporosis.
Effect of Proposed Changes
HB 731 amends s. 381.887, F.S., to specify that the purpose of the section is for the prescribing,
ordering, and dispensing of emergency opioid antagonists. It requires the Institute, in consultation with
DOH, to educate the public regarding the use of emergency opioid antagonists.
The bill allows a pharmacist to order an emergency opioid antagonist with an autoinjection delivery
system or intranasal application delivery system for a patient or caregiver for use in accordance with s.
381.887, F.S. It further allows a pharmacist to dispense an emergency opioid antagonist pursuant to a
prescription by an authorized health care practitioner. Pharmacists may dispense an emergency opioid
antagonist with an autoinjection delivery system or intranasal application delivery system, which must
be appropriately labeled with instructions for use, pursuant to a pharmacist’s order or pursuant to a
non-patient standing order.
The bill expressly authorizes personnel of a law enforcement agency or other agency, including, but not
limited to, correctional probation officers and child protective investigators to possess, store, and
administer emergency opioid antagonists. Personnel of a law enforcement agency or other agency are
immune from civil liability or criminal liability as a result of administering an emergency opioid
antagonist.
Further, the bill amends s. 395.1041, F.S., to require hospital emergency departments or urgent care
centers that treat and release a person in response to a suspected or actual overdose of a controlled
substance to report such information to DOH, if that person was not transported by a basic life support
service or an advanced life support service. When making such a report, hospital emergency
departments and urgent care centers must use best efforts to make the report to DOH within 120 hours
after discovering an incident. The bill requires reports to be made using an appropriate method with
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secure access, including, but not limited to, the Washington/Baltimore High Intensity Drug Trafficking
Overdose Detection Mapping Application Program or other program identified by DOH through rule.
The bill provides an effective date of July 1, 2022.
B. SECTION DIRECTORY:
Section 1: Amending s. 381.887, F.S., relating to emergency treatment for suspected opioid overdose.
Section 2: Amending s. 381.981, F.S., relating to health awareness campaigns.
Section 3: Amending s. 395.1041, F.S., relating to access to emergency services and care.
Section 4: Providing an effective date.
II. FISCAL ANALYSIS & ECONOMIC IMPACT STATEMENT
A. FISCAL IMPACT ON STATE GOVERNMENT:
1. Revenues:
None.
2. Expenditures:
None.
B. FISCAL IMPACT ON LOCAL GOVERNMENTS:
1. Revenues:
None.
2. Expenditures:
None.
C. DIRECT ECONOMIC IMPACT ON PRIVATE SECTOR:
None.
D. FISCAL COMMENTS:
None.
III. COMMENTS
A. CONSTITUTIONAL ISSUES:
1. Applicability of Municipality/County Mandates Provision:
Not applicable. The bill does not appear to affect county or municipal governments.
2. Other:
None.
B. RULE-MAKING AUTHORITY:
DOH has sufficient rulemaking authority to implement the bill’s provisions.
C. DRAFTING ISSUES OR OTHER COMMENTS:
None.
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IV. AMENDMENTS/COMMITTEE SUBSTITUTE CHANGES
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