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DPA Fact sheet NO on Prop 46.pdf

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Drug Policy Alliance | 131 10 th Street, San Francisco, CA 94103 sf@drugpolicy.org | 415.241.9800 voice | 415.241.9801 fax Drug Policy Alliance Says NO on Prop 46 October 2014 What is Prop 46? Proposition 46 (Prop 46) is the “Drug and Alcohol Testing of Doctors. Medical Negligence Lawsuits. Initiative Statute.” It is on the California ballot for the November 4, 2014 election. According to the official summary from the Attorney General it does the following:  Re
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    Drug Policy Alliance | 131 10 th  Street, San Francisco, CA 94103 sf@drugpolicy.org | 415.241.9800 voice | 415.241.9801 fax Drug Policy Alliance Says NO on Prop 46 October 2014 What is Prop 46? Proposition 46 (Prop 46) is the “Drug and Alcohol Testing of Doctors. Medical Negligence Lawsuits. Initiative Statute.” It is on the California ballot for the November 4, 2014 election. According to the official summary from the Attorney General it does the following:   Requires drug and alcohol testing of doctors and reporting of positive test results to the California Medical Board.   Requires the California Medical Board to suspend any doctor that tests positive, pending investigation of the positive test result, and to take disciplinary action if the doctor was impaired while on duty.   Requires doctors to report any other doctor suspected of alcohol or other drug impairment or medical negligence.   Requires health care practitioners to consult the state prescription drug history database before prescribing certain controlled substances.   Increases $250,000 cap on pain and suffering damages in medical negligence lawsuits to account for inflation. Drug Testing The Drug Policy Alliance opposes mandatory, suspicionless drug testing as ineffective and counter- productive.  Research has repeatedly failed to show that random, suspicionless drug testing prevents or reduces alcohol or other drug use. 1  Drug testing does not reduce the harms of drugs, but often creates incentives to use riskier substances in counterproductive ways. 2  Mandatory drug testing of students, for example, has been found not to reduce illicit drug use. 3  A recent systematic review of drug testing in the workplace found that the practice has been proven neither to decrease workplace drug use nor to reduce occupational injuries and accidents. The authors concluded, “ [T]he evidence base for the effectiveness of testing in improving workplace safety is at best tenuous. ” 4  The drug testing scheme proposed by Prop 46 is not the same as that used in aviation and transportation industries; it is not focused on impairment and doesn’t include important due process protections. Drug screens are prone to inaccurate results, especially false positives. 5  The consequences of a false positive are significant under Prop 46, as a doctor’s medical license would be suspended with a presumption of negligence until investigated further. Drug testing cannot be used to determine the extent of drug misuse, impairment, frequency or amount of use. 6  Standard tests cannot distinguish between use of prescribed opioid pain medication and illicit opioids such as heroin, 7  or between marijuana consumed over a previous weekend and that consumed before seeing a patient. 8  Drug testing is ineffective as an intervention to identify people with substance misuse disorders, 9  and punitive responses are less effective than supportive ones at encouraging people to enter treatment for such disorders. Physician health programs 10  and supportive diversion programs have very high success rates at treating doctors with impairments due to substance misuse disorders. 11   California’s diversion program for impaired physicians should be reinstated and fully funded as a needed first step before instituting random, suspicionless drug testing.    2   Drug Policy Alliance | 131 10 th  Street, San Francisco, CA 94103 sf@drugpolicy.org | 415.241.9800 voice | 415.241.9801 fax Page CURES Database and Drug Overdose Prop 46 mandates that doctors use the California prescription drug monitoring database, called the Controlled Substance Utilization Review and Evaluation System (CURES). Such databases can be a part of a comprehensive strategy to reduce prescription drug misuse and resulting harms such as accidental drug overdose, but they are not sufficient to end prescription drug misuse on their own. 12  The CURES database does not currently have the capacity to be used by all of the clinicians in California, as Prop 46 would require. The privacy protections of personal information in CURES are seen as insufficient by privacy experts. Law enforcement has access to the prescription data in CURES without a warrant. CURES is not covered by the same legal privacy protections as medical records and other health information. California has a significant drug overdose crisis: accidental drug overdose is now the leading cause of accidental death in the state. DPA has been at the forefront of passing laws to create effective interventions such as naloxone distribution in order to reduce overdose deaths in the state. CURES can be a part of a better strategy to reduce overdose deaths  –  but alone its use is unlikely to have significant results. 1   See e.g., Ken Pidd and Ann M Roche, How Effective Is Drug Testing as a Workplace Safety Strategy? A Systematic Review of the Evidence,  Accident Analysis & Prevention  71(2014): 154-65; American Academy of Pediatrics, Testing for Drugs of Abuse in Children and Adolescents:  Addendum — Testing in Schools and at Home, Pediatrics  119, no. 3 (2007). 2   See e.g.,  American Academy of Pediatrics, “Testing in Schools and at Home”;   E. E. Bonar, L. Ashrafioun, and M. A. Ilgen, Synthetic Cannabinoid Use among Patients in Residential Substance Use Disorder Treatment: Prevalence, Motives, and Correlates, Drug Alcohol Depend   143(2014); Yvonne M. Terry-McElrath, Patrick M. O'Malley, and Lloyd D. Johnston, Middle and High School Drug Testing and Student Illicit Drug Use: A National Study 1998-2011, The Journal of Adolescent Health  52, no. 6 (2013): 707-15. 3    American Academy of Pediatrics, “Testing in Schools and at Home”; S. R. Sznitman and D. Romer, Student Drug Testing and Positive School Climates: Testing the Relation between Two School Characteristics and Drug Use Behavior in a Longitudinal Study, J Stud Alcohol Drugs  75, no. 1 (2014). R. Yamaguchi, L. D. Johnston, and P. M. O'Malley, Relationship between Student Illicit Drug Use and School Drug-Testing Policies, J Sch Health  73, no. 4 (2003). 4  Pidd and Roche, How Effective Is Drug Testing as a Workplace Safety Strategy? A Systematic Review of the Evidence, 154. 5   See e.g. , Alec Saitman, Hyung-Doo Park, and Robert L Fitzgerald, False-Positive Interferences of Common Urine Drug Screen Immunoassays: A Review,  Journal of Analytical Toxicology 38, no. 7 (2014): bku075; Kristina Fiore, APA: Drug Test Results Often Flawed,  MedPage Today, May 23, 2010, http://www.medpagetoday.com/MeetingCoverage/APA/20253; and National Research Council, Strengthening Forensic Science in the United States: A Path Forward, (2009). See also, P Chen et al., The Poppy Seed Defense: A Novel Solution, Drug Testing and Analysis  6, no. 3 (2014); Opponents and Supporters  Prop 46 is opposed by a broad coalition of major organizations, including the California Medical  Association, California Society of Addiction Medicine,  American Civil Liberties Union (ACLU) of California, Planned Parenthood Affiliates of California, California Teachers Association, California State Conference of the NAACP, and California Chamber of Commerce, as well as DPA. Prop 46 is supported by consumer lawyers and was put on the ballot by Bob Pack. DPA Position The Drug Policy Alliance opposes Prop 46 because of its invasive random drug testing provisions, its ineffective and punitive approach to substance misuse, and its lack of privacy protections for personal health information. DPA is committed to reducing the harms caused by drug misuse and drug prohibition. We recommend fully funding physician-specific diversion programs to address doctors with substance use disorders, adding full privacy protections to CURES (including protection from warrantless law enforcement searches), and funding effective overdose mortality prevention initiatives in California. Michael L Smith et al., Morphine and Codeine Concentrations in Human Urine Following Controlled Poppy Seeds Administration of Known Opiate Content, Forensic Science International   241(2014). Nancy C Brahm et al., Commonly Prescribed Medications and Potential False-Positive Urine Drug Screens,  American Journal of Health-System Pharmacy   67, no. 16 (2010). 6   See e.g., Laura Radel, Kristen Joyce, and Carli Wulff, Drug Testing Welfare Recipients: Recent Proposals and Continuing Controversies, (Washington, DC: US Department of Health and Human Services, 2011); Joel B Bennett and Wayne EK Lehman, Preventing Workplace Substance  Abuse: Beyond Drug Testing to Wellness  (Washington, DC: American Psychological Association, 2003); Sharon Levy et al., Testing for Drugs of  Abuse in Children and Adolescents, Pediatrics  133, no. 6 (2014). 7  Saitman et al., False-Positive Interferences of Common Urine Drug Screen Immunoassays: A Review,”;  Brahm et al., Commonly Prescribed Medications and Potential False-Positive Urine Drug Screens. 8   Paul L. Cary, “The Marijuana Detection Window: Determining the Length of Time Cannabinoids Will Remain Detectable in Urine Following Smoking:  A Critical Review of Relevant Research and Cannabinoid Detection Guidance for Drug Courts,” Drug Court Review   5 (2005): 23, 23-24, 31; and Levy et al., Testing for Drugs of Abuse in Children and Adolescents. 9   See e.g., Radel, Joyce, and Wulff, Drug Testing Welfare Recipients ; Bennett and Lehman, Preventing Workplace Substance Abuse: Beyond Drug Testing to Wellness . 10  R. L. DuPont et al., Setting the Standard for Recovery: Physicians' Health Programs, J Subst Abuse Treat   36, no. 2 (2009). 11  M. R. Baldisseri, Impaired Healthcare Professional, Crit Care Med   35, no. 2 Suppl (2007). 12  Leonard J Paulozzi, Edwin M Kilbourne, and Hema A Desai, Prescription Drug Monitoring Programs and Death Rates from Drug Overdose, Pain Medicine  12, no. 5 (2011).
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