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 Health Policy
BILL: SB 1442
INTRODUCER: Senator Boyd
SUBJECT: Substance Abuse Prevention
DATE: March 16, 2021 REVISED:
ANALYST STAFF DIRECTOR REFERENCE ACTION
1. Looke Brown HP Favorable
2. AHS
3. AP
I. Summary:
SB 1442 amends and creates several sections of the Florida statutes related to substance abuse
prevention. The bill amends s. 381.887, F.S., to allow a pharmacist1 to dispense an emergency
opioid antagonist without a prescription to any person specified by the bill and to allow such
person to store, possess, and, in an emergency situation, administer the opioid antagonist. The
bill provides immunity from civil and criminal liability related to the administering of an opioid
antagonist to emergency responders, crime laboratory personnel, law enforcement personnel, and
any person dispensed an opioid antagonist pursuant to the above provision.
The bill requires the Department of Health (DOH) to develop and implement a statewide
awareness campaign to educate the public regarding the risk factors and signs and symptoms of
opioid overdoses as well as how to respond to such overdoses, including the safe storage and
administration of emergency opioid antagonists.
The bill creates s. 381.888, F.S., to require the DOH, in coordination with the Board of
Pharmacy (BOP), to establish and administer the At-home Drug Deactivation and Disposal
System Program (Program) for the purpose of identifying and distributing a suitable at-home
drug deactivation and disposal system which pharmacies must co-dispense with each opioid
prescription. The DOH, in coordination with the BOP, must develop relevant educational
materials for the program and adopt rules to implement the program. The bill amends ss. 456.44
and 465.0276, F.S., to require the concurrent prescription of the at-home deactivation and
disposal system with the prescription of an opioid drug listed as a schedule II controlled
substance.
The bill also amends s. 401.253, F.S., to require a health care facility, a basic life support service
(BLS), or an advanced life support service (ALS) to report the treatment and release or transport
1
Licensed under ch. 465, F.S.
BILL: SB 1442 Page 2
of a person in response to an emergency call for a suspected or actual overdose of a controlled
substance. Currently, reporting of such incidents is authorized, but not required, for ALS and
BLS.
The bill provides an effective date of July 1, 2021.
II. Present Situation:
History of the Opioid Crisis in Florida
According to the National Institute on Drug Abuse:2
 “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 country. At the peak of the pill mill crisis, doctors in Florida bought 89 percent of all the
oxycodone sold in the county.3
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.4 “In 2016, the opioid prescription rate was 75 per
100 persons in Florida. This rate was down from a high of 83 per 100.” 5
As reported by the Florida Attorney General’s Opioid Working Group:
Drug overdose is now the leading cause of non-injury related death 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
2
National Institute on Drug Abuse, Opioid Overdose Crisis (Rev. Jan. 2019), available at https://www.drugabuse.gov/drugs-
abuse/opioids/opioid-overdose-crisis (last visited Mar. 12, 2021).
3
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 Mar. 12, 2021).
4
See Chapters 2009-198, 2010-211, and 2011-141, Laws of Fla.
5
Attorney General’s Opioid Working Group, Florida’s Opioid Epidemic: Recommendations and Best Practices, 7 (Jan. 25,
2021), available at https://myfloridalegal.com/webfiles.nsf/WF/TDGT-
B9UTV9/$file/AG+Opioid+Working+Group+Report+Final+2-28-2019.pdf (last visited Mar. 12, 2021).
BILL: SB 1442 Page 3
opioid death rate were Manatee County (37 per 100,000), Dixie County (30 per
100,000), and Palm Beach County (22 per 100,000).6
Early in 2017, the federal Centers for Disease Control and Prevention (CDC) declared the opioid
crisis an epidemic.7 Shortly thereafter, on May 3, 2017, Governor Rick Scott signed Executive
Order 17-146 declaring the opioid epidemic a public health emergency in Florida.8
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 length 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.
Opioid Antagonists
Opioid receptor antagonists block one or more of the opioid receptors in the central or peripheral
nervous system. Opioid receptors are specific transmembrane neurotransmitter receptors that
couple G-proteins, which upon stimulation by endogenous or exogenous opioids, leading to the
intracellular process of signal transduction. The two most commonly used centrally acting opioid
receptor antagonists are naloxone and naltrexone. Naloxone comes in intravenous, intramuscular,
and intranasal formulations and is FDA-approved for the use in an opioid overdose and the
reversal of respiratory depression associated with opioid use. Naltrexone is available in both oral
and long-acting injectable formulations and is FDA-approved for the treatment of opioid and/or
alcohol maintenance treatment. The most commonly used peripheral opioid receptor antagonist
is methylnaltrexone, which is a potent competitive antagonist acting at the digestive tract and is
also FDA-approved for the treatment of opioid-induced constipation.9
Prescription Drug Disposal
Currently, the recommended method of disposing of unused prescription medications is to take
them to a drug take-back location.10 However, if there is not a drug take-back location in the area
6
Id.
7
See Exec. Order No. 17-146, available at https://www.flgov.com/wp-content/uploads/2017/05/17146.pdf. (last visited Mar.
12, 2021).
8
Id.
9
Opioid Antagonists, Theriot, Jonathan, et. al., (last updated July 27, 2020), available at
https://www.ncbi.nlm.nih.gov/books/NBK537079/#:~:text=3%5D%5B4%5D-
,The%20two%20most%20commonly%20used%20centrally%20acting%20opioid%20receptor%20antagonists,depression%2
0associated%20with%20opioid%20use. (last visited March 12, 2021).
10
See https://www.fda.gov/drugs/safe-disposal-medicines/disposal-unused-medicines-what-you-should-know (last visited
Mar. 12, 2021).
BILL: SB 1442 Page 4
or if the person cannot go to one promptly, the U.S. Food and Drug Administration (FDA)
provides two recommendations:
 That drugs on the drug flush list be disposed of immediately by being flushed down a toilet.
The FDA has identified and created a list of drugs that are either dangerous to be kept unused
for an extended period of time or are sought-after for their misuse and abuse potential. Many
of the drugs on the flush list are prescription opioids.11
 If the drug is not on the flush list, the FDA recommends that the drug be mixed with an
unappealing substance in a sealed container and thrown away in the trash.12
 In either case, the FDA also recommends that all personal information on the prescription
label be deleted before throwing away or recycling the drug container.
Drug Disposal Products
There are numerous drug disposal products available, many of which are sold directly to
consumers. A 2019 report from the San Francisco Department of the Environment examined and
compared ten of these products, eight of which are available for consumers to buy for use in the
home.13, 14 The report prefaces its findings by stating that “none of the medicine disposal
products [looked at] are approved by any federal agency; no federal agency endorses such
products, and none appear to be actively evaluating these products at this time.”15 The report
looked at each product with four questions in mind:
 Is the product safe for use?
 Are the drugs disposed of made undesirable?
 Are the drugs disposed of made non-retrievable?16
 Is the product safe for solid waste disposal?
The products used a variety of methods to dispose of drugs and make them non-retrievable,
including activated carbon, bentonite clay, mixtures of calcium hypochlorite with other
ingredients, and other proprietary methods not fully described by the products.
Activated Carbon
Four of the eight products are available for home purchase. Deterra, Drug Buster, Narc X, and
Rx Destroyer identify activated carbon as a key active ingredient.17 These products works with a
process called adsorption in which the chemicals in the drugs attach to the surface of the
11
See https://www.fda.gov/drugs/disposal-unused-medicines-what-you-should-know/drug-disposal-fdas-flush-list-certain-
medicines (last visited Mar. 12, 2021).
12
See https://www.fda.gov/drugs/disposal-unused-medicines-what-you-should-know/drug-disposal-dispose-non-flush-list-
medicine-trash (last visited Mar. 12, 2021).
13
Medicine Disposal Products: An Overview of Products and Performance Questions, Community Environmental Health
Strategies LLC, March 2019, available at
https://sfenvironment.org/sites/default/files/fliers/files/medicinedisposalproducts_march2019.pdf (last visited Mar. 15, 2021).
14
The products available for home use include Deterra, DisposeRx, Drug Buster, Element MDS, NarcX, Pill Catcher, Pill
Terminator, and Rx Destroyer.
15
Id. at p. 2.
16
The report used the U.S. Drug Enforcement Agency final rule definition of non-retrievable which is identical to the
definition in 21 C.F.R. s. 1300.05(b).
17
Id. n. 13 at p. 26.
BILL: SB 1442 Page 5
activated carbon in the disposal product.18 The process of adsorption typically takes between
eight hours and several days. However the products using this process typically recommend the
placement of the drug into the trash within two hours of placement of the drug into the carbon
solution.19 Testing of these products (reviewed but not conducted by the study) showed that the
rate and amount of adsorption of drugs placed into the products varied from product to product
and with different kinds of drugs tested.20 Additionally, it is unclear whether the adsorption
process renders the drugs non-retrievable.21
Bentonite Clay
The product Pill Catcher is the only product listed which uses a chemically altered sodium
bentonite clay. Bentonite clay interacts with chemicals through an adsorption process, similar to
that of activated carbon.22 The product manufacturer cites testing of the product for
environmental soundness but not for the non-retrievability of the drugs on which the product is
used. Other testing of similar methods of disposal show that it is unlikely that bentonite clay
treatment without other agents could achieve the DEA’s non-retrievable standard of permanent
physical or chemical alteration of a controlled substance.23
Calcium Hypochlorite
The product Pill Terminator lists calcium hypochlorite as an ingredient on its Material Safety
Data Sheet (MSDS), which also lists Fuller’s earth and a proprietary “absorbent polymer.”24
Because calcium hypochlorite is a strong oxidizing agent, the Pill Terminator product must carry
a warning label about its toxicity through skin contact, eye exposure or ingestion, and a warning
to keep away from children. If combined with other substances, calcium hypochlorite can release
chlorine gas and can also react explosively with ammonia and metals. As an oxidizing agent,
hypochlorite will react with and chemically alter some pharmaceuticals, depending on their
chemical composition. The degree of chemical degradation and resulting chemical byproducts
will depend on the pharmaceuticals being treated.25
The Pill Terminator website provides analysis by an independent test laboratory that the product
renders aspirin pills unpalatable and foul smelling. Unpublished test results from academic
researchers on treatment of morphine show release of 45 percent of the morphine by simple
water extraction after 48 hours of treatment by the Pill Terminator. The testing did not fully
characterize the chemical composition of the product-drug mixture as it would be disposed. See
the Pill Terminator’s profile in Section V of this analysis for more details.26
18
Id.
19
Supra n. 13 at p. 27.
20
Id. at p. 29.
21
Id. at p. 28.
22
Id. at p. 30.
23
Id.
24
Id.
25
Id. at p. 31.
26
Id.
BILL: SB 1442 Page 6
Unknown Mechanisms of Action
The other products available for consumer use, DisposeRX and Element MDS, use methods of
destruction that are not fully specified by the product manufacturers.
DisposeRx’s mechanism of action is described as “chemically and physically sequester(ing)
medications in a viscous gel” that becomes solid over time. The product ingredients are
described as safe and approved for use in oral medications and food.27
V23, LLC, the manufacturer of Element MDS, describes the mechanism of action on medicines
as “holds the medication in suspension and forms a solid gel making the medication
undesirable.” Descriptions on the Element MDS website do not claim that it makes drugs non-
retrievable but indicate the medicines become “undesirable.” Descriptions of the product’s
ingredients as an “organic, plant-based powder” seem out of sync with the product label’s
warnings about avoiding skin and eye contact and “Caution: harmful if swallowed.” Element
MDS recommends trash disposal of the product-drug mixture but does not provide any waste
determination data.28
III. Effect of Proposed Changes:
SB 1442 amends and creates several sections of the Florida statutes related to substance abuse
prevention.
Availability of Opioid Antagonists
The bill amends s. 381.887, F.S., to expand the section to provide for th