The Florida Senate
BILL ANALYSIS AND FISCAL IMPACT STATEMENT
(This document is based on the provisions contained in the legislation as of the latest date listed below.)
Prepared By: The Professional Staff of the Committee on Fiscal Policy
BILL: CS/SB 704
INTRODUCER: Fiscal Policy Committee and Senator Boyd
SUBJECT: Substance Abuse Prevention
DATE: April 21, 2023 REVISED:
ANALYST STAFF DIRECTOR REFERENCE ACTION
1. Looke Brown HP Favorable
2. Sneed Money AHS Favorable
3. Looke Yeatman FP Fav/CS
Please see Section IX. for Additional Information:
COMMITTEE SUBSTITUTE - Substantial Changes
I. Summary:
CS/SB 704 creates the Statewide Council on Opioid Abatement (Council) within the Department
of Children and Families (DCF) for the purpose of enhancing the development and coordination
of state and local efforts to abate the opioid epidemic and to support the victims of the opioid
crisis and their families.
The bill amends two definitions in s. 381.887, F.S., to clarify that caregivers need not to have
recurring contact with persons at risk of an opioid overdose to meet the definition and to include
health care practitioners who dispense drugs in the definition of “authorized health care
practitioner.” The bill allows pharmacists to prescribe as well as dispense emergency opioid
antagonists within the constraints of that section of statute. Additionally, the bill adds emergency
opioid antagonists that are delivered through a prefilled injection device delivery system to the
types of opioid antagonists that may be prescribed, dispensed, and administered under the
section.
The bill will have an indeterminate, yet insignificant negative fiscal impact on state government.
See Section V. of this analysis.
The bill is effective upon becoming law.
BILL: CS/SB 704 Page 2
II. Present Situation:
History of the Opioid Crisis in Florida
According to the National Institute on Drug Abuse:1
 “In the late 1990s, pharmaceutical companies reassured the medical community that patients
would not become addicted to prescription opioid pain relievers, and health care providers
began to prescribe them at greater rates”; and
 “This subsequently led to widespread diversion and misuse of these medications before it
became clear that these medications could indeed be highly addictive.”
Between the early 2000s and the early 2010s, Florida was infamous as the “pill mill capital” of
the nation. At the peak of the pill mill crisis, doctors in Florida bought 89 percent of all the
oxycodone sold in the country.2
Between 2009 and 2011, the Legislature enacted a series of reforms to combat prescription drug
abuse. These reforms included strict regulation of pain management clinics; creating the
Prescription Drug Monitoring Program (PDMP); and stricter regulation on selling, distributing,
and dispensing controlled substances.3 “In 2016, the opioid prescription rate was 75 prescriptions
for every 100 persons in Florida. This rate was down from a high of 83 prescriptions for every
100 persons. ” 4
As reported at the time by the Florida Attorney General’s Opioid Working Group:
Drug overdose is now the leading cause of non-injury related deaths in the
United States. Since 2000, drug overdose death rates increased by 137
percent, including a 200 percent increase in the rate of overdose deaths
involving opioids. In 2015, over 52,000 deaths in the U.S. were attributed
to drug poisoning, and over 33,000 (63 percent) involved an opioid. In 2015,
3,535 deaths occurred in Florida where at least one drug was identified as
the cause of death. More specifically, 2,535 deaths were caused by at least
one opioid in 2015. Stated differently, seven lives per day were lost to
opioids in Florida in 2015. Overall, the state had a rate of opioid-caused
deaths of 13 per 100,000. The three counties with the highest opioid death
rate were Manatee County (37 per 100,000), Dixie County (30 per 100,000),
and Palm Beach County (22 per 100,000).5
1
Center on Positive Behavioral Interventions and Supports, Opioid Crisis and Substance Misuse, available at:
https://www.pbis.org/topics/opioid-crisis-and-substance-misuse (last visited March 17, 2023).
2
Lizette Alvarez, Florida Shutting ‘Pill Mill’ Clinics, The New York Times (Aug. 31, 2011), available at
http://www.nytimes.com/2011/09/01/us/01drugs.html (last visited March 17, 2023).
3
See Chapters 2009-198, 2010-211, and 2011-141, Laws of Fla.
4
Attorney General’s Opioid Working Group, Florida’s Opioid Epidemic: Recommendations and Best Practices, 7 (Mar. 1,
2019), available at https://myfloridalegal.com/webfiles.nsf/WF/TDGT-
B9UTV9/$file/AG+Opioid+Working+Group+Report+Final+2-28-2019.pdf (last visited March 17, 2023).
5
Id.
BILL: CS/SB 704 Page 3
Early in 2017, the federal Centers for Disease Control and Prevention (CDC) declared the opioid
crisis an epidemic.6 Shortly thereafter, on May 3, 2017, Governor Rick Scott signed Executive
Order 17-146, declaring the opioid epidemic a public health emergency in Florida.7
House Bill 21 (2018)
In 2018, the Florida Legislature passed CS/CS/HB 21 (Chapter 2018-13, Laws of Florida) to
combat the opioid crisis. CS/CS/HB 21:
 Required additional training for practitioners on the safe and effective prescribing of
controlled substances;
 Restricted the duration of prescriptions for Schedule II opioid medications to three days or up
to seven days if medically necessary;
 Reworked the PDMP statute to require that prescribing practitioners check the PDMP prior
to prescribing a controlled substance and to allow the integration of PDMP data with
electronic health records and the sharing of PDMP data between Florida and other states; and
 Provided for additional funding for treatment and other issues related to opioid abuse.
Status of the Opioid Crisis after HB 21
There is evidence that the passage of HB 21 reduced opioid use in Florida. For example, one
study that reviewed pharmacy prescriptions claims for a health plan serving more than 45,000
Floridians found that, on average, the number of enrollees per month that began opioid use
between April of 2019 and August of 2019 dropped from 5.5 per 1,000 patients to 4.6 per 1,000
patients.8
However, 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 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. 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 2020.9 From the start of 2020 through
the end of 2021, non-fatal opioid related emergency room visits and hospitalizations have
increased from 4,992 to 5,913 and 1,940 to 2,130, respectively.10 Fatal opioid related overdoses
during that time period have also trended upward with 6,089 occurring in 2020 and 6,442
occurring in 2021.11
6
See Exec. Order No. 17-146, available at https://www.flgov.com/wp-content/uploads/2017/05/17146.pdf. (last visited
March 17, 2023).
7
Id.
8
Juan M. Hincapie-Castillo, et al., Changes in Opioid Use After Florida’s Restriction Law for Acute Pain Prescriptions,
JAMA Netw Open. 2020 Feb; 3(2): e200234, available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7049083/, (last
visited March 17, 2023).
9
Project Opioid, A Pandemic Fueling an Epidemic in Florida in 2020, available at https://projectopioid.org/wp-
content/uploads/2020/12/PO-2020-Data-Study-Final_New-Section.pdf (last visited March 17, 2023).
10
Q1 of 2020 compared to Q4 of 2021, Florida Health Charts, Substance Abuse Dashboard, available at
https://www.flhealthcharts.gov/ChartsDashboards/rdPage.aspx?rdReport=SubstanceUse.Overdose, (last visited March 17,
2023)
11
Id.
BILL: CS/SB 704 Page 4
Multistate Opioid Lawsuit and Settlement
In 2018, Attorney General Pam Bondi filed suit against multiple opioid manufacturers and
distributors. The suit was later expanded to include the pharmacies CVS and Walgreens.12 The
complaint alleged that the defendants caused the opioid crisis by, among other things:
 Engaging in a campaign of misrepresentations and omissions about opioid use designed to
increase opioid prescriptions and opioid use, despite the risks.
 Funding ostensibly neutral and independent “front” organizations to publish information
touting the benefits of opioids for chronic pain while omitting the information about the risks
of opioid treatment.
 Paying ostensibly neutral medical experts called “key opinion leaders” who were really
manufacturer mouthpieces to publish articles promoting the use of opioids to treat pain while
omitting information regarding the risks.13
In 2021, McKesson, Cardinal Health, and AmerisourceBergen, the nation’s three largest
pharmaceutical distributors, as well as manufacturer Janssen Pharmaceuticals, Inc., agreed to a
national settlement in which the distributors agreed to pay $21 billion over 18 years and Janssen
agreed to pay $5 billion over nine years.14 Of the $26 billion available, approximately $22.7
billion is earmarked for use by states that participated in the lawsuit, including Florida.15 In
addition, Florida has negotiated individual settlements with multiple other companies including:
 A $65 million settlement with Endo Health Solutions;
 A $440 million settlement with CVS Pharmacy, Inc.;
 A $177,114,999 settlement with Teva Pharmaceuticals Industries, Ltd.;
 A $122 million settlement with Allergan Finance, LLC.;
 A $620 million settlement with Walgreens Boots Alliance, Inc. and Walgreens Co.; and
 A $215 million settlement with Walmart.16
These settlements will pay out over a period of time ranging from 10 years to 18 years. The
monies from the settlements in general must be used on opioid abatement, including prevention
efforts, treatment or recovery services,17 and to pay fees and costs incurred by the state, cities,
and counties. Additionally, Teva Pharmaceuticals has agreed to provide the state with $84
million worth of Naloxone Hydrochloride, which is an opioid overdose reversal medication.18
12
See Florida Sues Walgreens, CVS for Alleged Role in Opioid Crisis, (November 19, 2018) available at
https://www.npr.org/2018/11/19/669146432/florida-sues-walgreens-cvs-for-alleged-role-in-opioid-crisis (last visited on
March 17, 2023).
13
See http://myfloridalegal.com/webfiles.nsf/WF/MNOS-AYSNED/$file/Complaint+summary.pdf, (last visited on March
17, 2023).
14
Executive Summary of National Opioid Settlements, Feb. 3, 2023, available at
https://nationalopioidsettlement.com/executive-
summary/#:~:text=In%20all%2C%20the%20Distributors%20will,additional%20manufacturers%E2%80%94Allergan%20an
d%20Teva., (last visited March 17, 2023).
15
Opioid Settlements: Who’s in?, Florida DLA, available at https://myfloridalegal.com/opioidsettlement, (last visited March
17, 2023).
16
Id.
17
Id. A portion of these funds will go to the state while another portion will go directly to the cities and counties.
18
Id.
BILL: CS/SB 704 Page 5
As part of the settlement agreement, Florida agreed to establish an “Opioid Abatement Taskforce
or Council.” The agreement lays out how the Council must be structured and the tasks the
Council must perform. For a comparison of what is required of the Council in the settlement
agreement with the language from CS/SB 704, see the chart below:
Florida Opioid Allocation and CS/ SB 704 Council Provisions
Statewide Response Agreement
Create an “Opioid Abatement” Taskforce or The Statewide Council on Opioid Abatement, an advisory
Council. council as defined in s. 20.03, [F.S.,] is created within the
department for the purpose of enhancing the development
and coordination of state and local efforts to abate the opioid
epidemic and to support the victims and families of the crisis.
Council must advise the Governor, Legislature, The council shall review data from local, state, and national
DCF, and Local Governments on the priorities agencies, both on a regional and a statewide basis, to advise
that should be addressed by the expenditure of state and local governments on the status, severity, and stage
Opioid Funds. of the opioid epidemic.
The council must advise the state and local governments on
resolving or abating the opioid epidemic.
The council shall work with and provide and receive
information from the Statewide Drug Policy Advisory
Council and make sure that its recommendations and actions
are consistent with the recommendations of that council to
the extent possible.
Council must review how monies have been The council…must review how settlement monies recovered
spent and the results that have been achieved from the opioid litigation brought by state and political
with Opioid Funds. subdivisions have been spent, and the results that have been
achieved from such expenditures.
The council shall review data from local governments, other
states, and national agencies regarding how moneys are being
spent to abate the opioid epidemic, the success of such
programs, and the appropriate metrics needed to assess the
epidemic and progress in abating it.
Prior to July 1st of each year, the State and each By June 30 of each year, each county, municipality,
of the Local Governments shall provide managing entity, or state agency that receives settlement
information to the DCF about how they intend funds from an opioid settlement shall provide information to
to expend Opioid Funds in the upcoming fiscal the council related to how it intends to use settlement funds
year. and how it intends to collect data regarding its use of funds.
State and local governments shall report By August 31 of each year, each county, municipality,
expenditures to DCF no later than Aug. 31st for managing entity, or state agency that receives settlement
the previous fiscal year. funds from an opioid settlement must provide information to
the council related to its expenditure of settlement funds and
the results obtained from those expenditures.
BILL: CS/SB 704 Page 6
Florida Opioid Allocation and CS/ SB 704 Council Provisions
Statewide Response Agreement
Council will set other data sets that need to be The council shall develop and recommend metrics, measures,
reported to DCF to demonstrate the or data sets to assess the progress and success of programs
effectiveness of expenditures on Approved funded by expenditures of opioid settlement funds. The
Purposes. In setting those requirements the council must attempt to keep such metrics, measures, or data
Council shall consider the Reporting sets consistent with those used by the state with managing
Templates, Deliverables, Performance entities as well as any metrics, measures, or data sets required
Measures, and other already utilized and by the Substance Abuse and Mental Health Services
existing templates and forms required by DCF Administration of the Un