There is good news regarding California's continued push to reduce unnecessary psychotropic drug use and improve dementia care.  Assemblymember Aguiar-Curry has introduced AB 48, a bill to require written informed consent for psychotropic drug prescriptions in nursing homes.  A prior version of the bill, AB 1809, was vetoed by Governor Newsom in September.  Unfortunately, there had been a mix-up about some last-minute amendments that could not be fixed after the bill was sent to the governor.  However, Assemblymember Aguiar-Curry has reintroduced the bill, with suggested amendments from the California Department of Public Health, for 2023. 

AB 48 formalizes the psychotropic drug discussion between prescribers and residents and empowers residents and their decisionmakers to decline unwanted or unnecessary prescribing and administering of psychotropics.  The centerpiece of the bill is a requirement that written consent for psychotropic drugs be obtained by the prescriber before a nursing home can administer the drugs to a resident, similar to what is required in Massachusetts and Wisconsin.  The information given to the resident or decisionmaker must include “Black Box” drug warnings, if applicable, and explain whether the drug is being used off-label.  The bill instructs the Department of Public Health to create a standardized informed consent form for prescribers to use by December 31, 2024, after receiving input from interested stakeholders.

Written informed consent is needed more than ever in California.  2022 marked the ten-year anniversary of the launching of a federal campaign to reduce the inappropriate use of antipsychotic drugs.  The percentage of residents receiving an antipsychotic in California nursing homes dropped from over 25% in 2011 to 19% in 2016.  Since then, however, the rate has risen back to 23%.  Last month, the OIG reported that a whopping 80% of long-stay nursing home residents receive at least one psychotropic drug.  Clearly, the federal campaign aimed at overprescribing of psychotropic medications has lost its momentum.

Hopefully, AB 48 can be one important piece of a reinvigorated effort to reduce the inappropriate use of psychotropic medication in nursing home residents and improve dementia care.  By ensuring residents are given important information about psychotropic drugs that have been prescribed for them and a meaningful opportunity to consent or withhold consent, the bill will spur more meaningful resident engagement in treatment decisions.  The best line of defense against psychotropic drug misuse has always been the residents and their family.  AB 48 will better enable them to play this critical role. 

Note: This article represents the views of the author and does not constitute CALTCM policy.