SB0133: ANALYSIS AS ENACTED (Date Completed: 12-20-23)

RATIONALE

According to testimony before the Senate Committee on Health Policy, opioid-related overdose deaths in the United States hit a record during the COVID-19 pandemic, increasing by 109% between 2019 and 2021. Testimony also indicates that transparent discussion of the circumstances surrounding an opioid-related death offer medical examiners a stronger understanding of what happened and what potential solutions could be. Reportedly, each review of an individual's death from opioid overdose requires significant work from county and State employees because statute does not standardize the death review process. Specifically, a large amount of work is put into each death review to anonymize the death. The ability to establish an overdose fatality review team will improve the death review process by standardizing a method for medical examiners and policymakers to reach solutions surrounding opioid deaths.

CONTENT

The bill enacts the "Overdose Fatality Review Act" to do the following:

-- Allow a county or multiple counties to establish an overdose fatality review team and prescribe its membership.

-- Identify and prescribe the individuals that may be invited to participate in an individual overdose review or community overdose review.

-- Prescribe the duties and responsibilities of an overdose fatality review team, including identifying potential causes and incidence of drug overdose fatalities and proposing potential changes to law, policy, or funding for prevention.

-- Require an overdose fatality review team to submit an annual report to the public, the local health department of the participating county, and the Department of Health and Human Services (DHHS).

-- Prescribe certain confidentiality requirements for members of an overdose fatality review team.

-- Require the DHHS to submit to the Governor and the Legislature an annual report

that aggregates the information provided by overdose fatality review teams in their annual reports.

The bill will take effect on February 13, 2024.

Definitions

"Community overdose review" means performing a series of individual overdose reviews to identify systematic barriers to innovative overdose prevention and intervention strategies for that community.

"County health officer" means a local health officer as that term is defined in Section 1105 of the Public Health Code: the individual in charge of a local health department or his or her authorized representative.

"Data sharing agreement" means an agreement that identifies the data that are shared and how the data are used.

"Drug" means that term as defined in Section 7105 of the Public Health Code: a substance recognized as a drug in the official United States pharmacopoeia, official homeopathic pharmacopoeia of the US, or official national formulary, or any supplement to any of them; a substance intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease in human beings or animals; a substance other than food intended to affect the structure or any function of the body of human beings or animals; or, a substance intended for use as a component of any article specified in this subsection. The term does not include a device or its components, parts, or accessories.

"Drug overdose" means that term as defined in Section 7403 of the Code: a condition including extreme physical illness, decreased level of consciousness, respiratory depression, coma, mania, or death, that is the result of consumption or use of a controlled substance or a controlled substance analogue or a substance with which the controlled substance or controlled substance analogue is combined, or that a layperson would reasonably believe to be a drug overdose that requires medical assistance.

"Hospital" means that term as defined in Section 20106 of the Code: a facility offering inpatient, overnight care, and services for observation, diagnosis, and active treatment of an individual with a medical, surgical, obstetric, chronic, or rehabilitative condition requiring the daily direction or supervision of a physician. The term does not include a mental health hospital licensed or operated by the DHHS or a hospital operated by the Department of Corrections and would include a hospital licensed under the Mental Health Code.

"Identifying information" means any representation of information that permits the identity of an individual to whom the information applies to be reasonably inferred by either direct or indirect means.

"Individual overdose review" means the case review of an individual who has died as the result of a drug overdose, including a review of both of the following:

-- Consideration of the individual's points of contact, if any, with health care systems, social services, educational institutions, child and family services, the criminal justice system, including law enforcement, and any other system.

-- Identification of the specific factors and social determinants of health that put the

individual at risk of a drug overdose.

"Mental health provider" means any of the following individuals:

-- A psychologist.

-- A licensed professional counselor.

-- A marriage and family therapist.

-- A licensed bachelor's social worker.

-- A licensed master's social worker.

"Multidisciplinary team" means a group of professionals from a variety of fields of study or sectors who work together toward a shared purpose.

"Participating county" means a county that, by itself or with one or more other counties, establishes an overdose fatality review team.

"Recovery coach" means a professional who provides assistance to support long-term recovery from a substance use disorder.

"Substance use disorder" means a pattern of using alcohol or other drugs that leads to clinical or functional impairment.

"Substance use disorder treatment provider" means an individual or entity that is licensed in the State to treat an individual with substance use disorder using medications that are approved by the US Food and Drug Administration to treat substance use disorder.

Overdose Fatality Review Team

The bill allows a county to establish an overdose fatality review team. Two or more counties may establish a single overdose fatality review team for those counties.

Any of the following individuals may be a member of an overdose fatality review team:

-- The following officials of the participating county: a) the county health officer, b) the prosecuting attorney, or the attorney's designee, c) the director of the community mental health agency, or the director's designee, or d) the county medical examiner, or the medical examiner's designee.

-- A law enforcement officer of the Department of State Police, the participating county, or a municipality within the participating county.

-- A representative of a jail or detention center in the participating county.

-- A health care provider who specializes in the prevention, diagnosis, and treatment of substance use disorders.

-- A mental health provider who specializes in the treatment of substance use disorders.

-- A substance use disorder treatment provider.

-- A representative of an emergency medical services provider in the participating county.

-- A representative from the Department of Corrections who has experience with parole, probation, or community corrections.

-- An epidemiologist from a local health department or an organization in the participating County.

-- A child protective services caseworker.

-- A representative from the DHHS who is involved with issues regarding adult protective services.

-- A representative of a hospital with a service area within the participating county.

-- Any other individual whose membership is necessary for the overdose fatality review team to complete duties required under the bill.

At the first meeting of an overdose fatality review team, it must elect a member as a chairperson and elect other officers that it considers necessary or appropriate.

The chairperson must do all the following for the overdose fatality review team:

-- Solicit and recruit additional individuals listed below to participate in individual overdose reviews and community overdose reviews.

-- Call the meetings and implement the protocols and procedures.

-- Oversee that confidentiality forms are signed as needed.

-- Request and collect the information needed to conduct individual overdose reviews and community overdose reviews.

-- If a vacancy occurs, appoint an individual from the same or equivalent position or discipline.

-- Make written requests for information that are necessary to carry out the duties of the overdose fatality review team.

Any of the following individuals may be invited to participate in an individual overdose review or community overdose review:

-- A prepaid inpatient health plan chief executive officer or the officer's designee, or the prepaid inpatient health plan substance use disorder director.

-- A superintendent of a school in the participating county, or his or her designee.

-- A representative of a hospital in the participating county.

-- A health care provider who specializes in emergency medicine.

-- A health care provider who specializes in pain management.

-- A pharmacist who has expertise in addressing prescription drug misuse and diversion.

-- A representative from a poison control center.

-- A mental health provider.

-- A prescription drug monitoring program administrator.

-- A representative from a harm reduction provider.

-- A recovery coach, peer support worker, or other representative of the recovery community.

-- A representative from a drug court in the participating county.

-- A substance use disorder prevention specialist or representative.

-- The director of the DHHS office in the participating county, or his or her designee.

-- Any other individual necessary to complete the duties of the overdose fatality review team.

Responsibilities

The bill requires an overdose fatality review team to do all the following:

-- Promote cooperation and coordination among agencies involved in the investigation of drug overdose fatalities.

-- Identify potential causes and incidence of drug overdose fatalities in the participating county.

-- Recommend and plan for changes within the agencies represented on the overdose fatality review team to prevent drug overdose fatalities.

-- Propose potential changes to law, policy, funding, or practices to prevent drug overdoses.

-- Recommend prevention and intervention strategies, focusing on evidence-based strategies and promising practices, to improve the coordination of services and investigations among agencies represented by members of the overdose fatality review team to reduce drug overdose fatalities.

Also, an overdose fatality review team must establish and implement, in consultation with the DHHS, protocols and procedures to do all the following:

-- Recruit individuals to participate in individual overdose reviews and community overdose reviews.

-- Plan and facilitate meetings.

-- Collect, analyze, interpret, and maintain data on drug overdose fatalities in the participating county.

-- Build a recommendation plan.

Meetings of an overdose fatality review team could be conducted remotely through a secure platform.

An overdose fatality review team must submit an annual report to the public, the local health department of the participating county, and the DHHS that contained all the following information:

-- The total number of drug overdose fatalities that occurred within the participating county.

-- The number of individual overdose reviews conducted by the overdose fatality review team.

-- Any recommendations.

The report could not contain identifying information.

Confidentiality

Under the bill, except as otherwise expressly prohibited by Federal or State law, overdose fatality review team members and individuals invited to participate in an individual overdose review or community overdose review may discuss confidential matters and share confidential information, as outlined in data sharing agreements, during an overdose fatality review team meeting. The bill does not authorize the disclosure of confidential information described above outside of the meeting.

If an individual has not signed a confidentiality form, he or she will not be able to participate in or observe an overdose fatality review team meeting, individual overdose review, or community overdose review. A confidentiality form must summarize the purpose and goal of the meeting or review, the requirements for maintaining the confidentiality of any information disclosed during the meeting, and any consequences for the failure to maintain confidentiality.

Except as otherwise expressly prohibited by Federal or State law, on written request of the chairperson, a health care provider, substance use disorder treatment provider, hospital, or health system must provide, within 30 business days after receiving the request, the chairperson information and relevant records regarding the physical health, mental health, or treatment for substance use disorder of an individual who is the subject of an individual overdose review of the overdose fatality review team.

Except as otherwise expressly prohibited by Federal or State law, on written request of the chairperson, a person must provide, within five business days after receiving the request, the chairperson the information and records regarding resources provided by a social services agency to a family member of the individual who is the subject of an individual overdose review and the following information or records regarding the individual who is the subject of an individual overdose review:

-- Death investigative information.

-- Medical examiner investigative information.

-- Law enforcement investigative information.

-- Emergency medical services reports.

-- Fire department records.

-- Prosecuting attorney records.

-- Parole and probation information and records.

-- Court records.

-- School records.

-- Information and records regarding resources provided by a social services agency.

A person that provides the chairperson records or information described above may charge the overdose fatality review team a fee in the same manner as a public body may charge a fee under the Freedom of Information Act (FOIA).

If a family member or friend of the individual who is the subject of an individual overdose review submits a request to submit information to an overdose fatality review team, a member of that team may contact, interview, or obtain the information about the individual from that family member or friend.

Except as otherwise provided, information obtained or created by or for an overdose fatality review team must be confidential and is not be subject to discovery, subpoena, or FOIA. Documents and records otherwise available from other sources must not be exempt from discovery, subpoena, or introduction into evidence from other sources solely because they are presented to or reviewed by an overdose fatality review team.

An overdose fatality review team must comply with Federal and State laws pertaining to confidentiality and to the disclosure of substance use disorder treatment records, including 42 USC 290dd-2 and 42 CFR part 2 (both of which generally pertain to the confidentiality of records related to substance use disorder patients).

If an overdose fatality review team member knowingly discloses confidential information in violation of the bill, a person aggrieved by that violation may bring a civil action for damages and any costs and reasonable attorney fees allowed by the court.

PREVIOUS LEGISLATION

(This section does not provide a comprehensive account of previous legislative efforts on this subject matter.)

The bill is a reintroduction of Senate Bill 1080 from the 2021-2022 Legislative Session.

BACKGROUND

Naloxone is a medicine that rapidly reverses an opioid overdose. It is considered to be an opioid antagonist, which means it attaches to opioid receptors and reverses and blocks the effects of other opioids. Naloxone can quickly restore normal breathing to an individual whose breathing has slowed or stopped because of an opioid overdose. Naloxone has no effect on an individual who does not have opioids in their system, and is not a treatment for opioid use disorder. Naloxone should be given to any person who shows signs of an overdose or when an overdose is suspected.^{^[1]}

ARGUMENTS

(Please note: The arguments contained in this analysis originate from sources outside the Senate Fiscal Agency. The Senate Fiscal Agency neither supports nor opposes legislation.)

Supporting Argument

Useful recommendations concerning the reduction of opioid fatalities have emerged from nine other states with programs like the bill's and at least two of the five counties in Michigan currently piloting overdose fatality review teams. According to testimony before the Senate Committee on Health Policy, these pilot teams recommended that policymakers focus on destigmatizing medication-assisted treatment, improving education related to the increased risk of overdose after not using for a while, and increasing naloxone accessibility (see BACKGROUND). These recommendations could decrease opioid-related fatalities in other counties across the State, and overdose fatality review teams can be used to make those determinations Legislative Analyst: Alex Krabill.

[1] National Institute on Drug Abuse, Naloxone DrugFacts, January 2022.