Legislature(2017 - 2018)CAPITOL 106
03/30/2017 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| HB164 | |
| HB100 | |
| HB186 | |
| HB159 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 100 | TELECONFERENCED | |
| += | HB 159 | TELECONFERENCED | |
| *+ | HB 164 | TELECONFERENCED | |
| *+ | HB 186 | TELECONFERENCED | |
| + | TELECONFERENCED |
HB 159-OPIOIDS;PRESCRIPTIONS;DATABASE;LICENSES
4:15:36 PM
CHAIR SPOHNHOLZ announced that the final order of business would
be HOUSE BILL NO. 159, "An Act relating to the prescription of
opioids; establishing the Voluntary Nonopioid Directive Act;
relating to the controlled substance prescription database;
relating to the practice of dentistry; relating to the practice
of medicine; relating to the practice of podiatry; relating to
the practice of osteopathy; relating to the practice of nursing;
relating to the practice of optometry; relating to the practice
of veterinary medicine; related to the duties of the Board of
Pharmacy; and providing for an effective date."
4:16:02 PM
JAY C. BUTLER, M.D., Chief Medical Officer/Director, Central
Office, Division of Public Health (DPH), Department of Health
and Social Services (DHSS), stated that HB 159 is an approach
aimed to improve the care of persons living with addiction and
to address some of the primary prevention possibilities, as
related to legal prescription of opioids in the community, by
supporting more rational pain management practices throughout
the state. He said the division would like to address concerns
expressed by various stakeholders by suggesting an amendment to
the proposed bill.
DR. BUTLER said one concern relates to a section in HB 159 that
would authorize pharmacists to partially fill prescriptions for
opioids; part of the desired amendment would align the language
more with the federal Comprehensive Addiction and Recovery Act
(CARA), by deleting language that would immediately void any
unfilled portion of the prescription, which would, as a result,
require the pharmacist to notify the prescriber. A second part
of the amendment would clarify the roles of the prescriber and
the dispenser. Regarding the prescription drug monitoring
program (PDMP), he said the intent of Senate Bill 74 last year
and the proposed HB 159 before the committee was and is that the
prescribers check the PDMP prior to issuing prescriptions for
schedule II or schedule III controlled substances, and the role
of the pharmacist is to populate the PDMP when the dispensing is
done.
DR. BUTLER said the third part of the desired amendment would
address concerns related to the daily updates of the PDMP,
recognizing that even the weekly update required under Senate
Bill 74 has not been implemented. The amendment would specify
that the implementation to daily update would not occur until
2018. He said the fourth component of the amendment would
address the waiver of liability under the opioid advance
directive. He stated, "In the bill that I presented to you a
couple of weeks ago, it specified waiving liability for not
administering an opioid when a directive was in place. This
broadens the waiver of liability to include in the instance
where perhaps ... [an] opioid is inadvertently administered to
someone, with an advance directive."
DR. BUTLER said the key points of the requested amendment were
based on feedback of a number of stakeholders, but he
specifically acknowledged the Pharmacy Association for its
helpful guidance and "a number of providers" for their input, as
well.
4:19:54 PM
CHAIR SPOHNHOLZ moved to adopt Amendment 1, [which is a typed
amendment not drafted by Legislative Legal and Research
Services, dated at top-right] "AM 3/28/2017" and read as follows
[original punctuation provided]:
Page 1, line 3, following "dentistry;":
Insert "relating to the practice of pharmacy;"
Page 2, lines 2 - 3:
Delete all material and insert:
"(b) The commissioner shall adopt regulations to
implement this chapter. The regulations under this
chapter shall"
Page 2, line 25, following "opioid":
Insert ", or for inadvertent administration of an
opioid,"
Page 15, line 14:
Delete "a"
Insert "[A]"
Delete "diagnosis"
Insert "[DIAGNOSIS]"
Page 15, line 16:
Delete "a"
Insert "[A]"
Page 15, line 17:
Delete "diagnosis"
Insert "[DIAGNOSIS]"
Page 16, following line 24:
Insert a new bill section to read:
"* Sec. 19. AS 08.68.100(a), as amended by sec. 10,
ch. 25, SLA 2016, is amended to read:
(a) The board shall
(1) adopt regulations necessary to implement this
chapter, including regulations
(A) pertaining to practice as an advanced
practice registered nurse [PRACTITIONER] and a
certified registered nurse anesthetist; regulations
for an advanced practice registered nurse who holds a
valid federal Drug Enforcement Administration
registration number must address training in pain
management and opioid use and addiction;
(B) necessary to implement AS 08.68.331 -
08.68.336 relating to certified nurse aides in order
to protect the health, safety, and welfare of clients
served by nurse aides;
(C) pertaining to retired nurse status; and
(D) establishing criteria for approval of
practical nurse education programs that are not
accredited by a national nursing accrediting body;
(2) approve curricula and adopt standards for basic
education programs that prepare persons for licensing
under AS 08.68.190;
(3) provide for surveys of the basic nursing
education programs in the state at the times it
considers necessary;
(4) approve education programs that meet the
requirements of this chapter and of the board, and
deny, revoke, or suspend approval of education
programs for failure to meet the requirements;
(5) examine, license, and renew the licenses of
qualified applicants;
(6) prescribe requirements for competence before a
former nurse may resume the practice of nursing under
this chapter;
(7) define by regulation the qualifications and
duties of the executive administrator and delegate
authority to the executive administrator that is
necessary to conduct board business;
(8) develop reasonable and uniform standards for
nursing practice;
(9) publish advisory opinions regarding whether
nursing practice procedures or policies comply with
acceptable standards of nursing practice as defined
under this chapter;
(10) require applicants under this chapter to submit
fingerprints and the fees required by the Department
of Public Safety under AS 12.62.160 for criminal
justice information and a national criminal history
record check; the department shall submit the
fingerprints and fees to the Department of Public
Safety for a report of criminal justice information
under AS 12.62 and a national criminal history record
check under AS 12.62.400;
(11) require that a licensed advanced practice
registered nurse [PRACTITIONER] who has a federal Drug
Enforcement Administration registration number
register with the controlled substance prescription
database under AS 17.30.200(o)."
Renumber the following bill sections accordingly.
Page 18, line 15:
Delete "a"
Insert "[A]"
Delete "diagnosis"
Insert "[DIAGNOSIS]"
Page 18, line 18:
Delete "a"
Insert "[A]"
Delete "diagnosis"
Insert "[DIAGNOSIS]"
Page 19, following line 15:
Insert a new bill section to read:
"* Sec. 24. AS 08.72.140 is amended to read:
Sec. 08.72.140. Qualifications for licensure. An
applicant for licensure as an optometrist
(1) shall be a graduate of a school or college of
optometry recognized by the board;
(2) may not have committed an act in any jurisdiction
that would have constituted a violation of this
chapter or regulations adopted under this chapter at
the time the act was committed;
(3) may not have been disciplined by an optometry
licensing entity in another jurisdiction and may not
be the subject of a pending disciplinary proceeding
conducted by an optometry licensing entity in another
jurisdiction; however, the board may consider the
disciplinary action and, in the board's discretion,
determine if the person is qualified for licensure;
(4) shall have successfully completed
(A) the written and practical portions of an
examination on ocular pharmacology approved by the
board that tests the licensee's or applicant's
knowledge of the characteristics, pharmacological
effects, indications, contraindications, and emergency
care associated with the prescription and use of
pharmaceutical agents;
(B) a nontopical therapeutic pharmaceutical agent
course of at least 23 hours approved by the board or
an examination approved by the board on the treatment
and management of ocular disease; and
(C) an optometry and nontopical therapeutic
pharmaceutical agent injection course of at least
seven hours approved by the board or equivalent
training acceptable to the board; and
(5) shall meet other qualifications for licensure as
established under this chapter and regulations adopted
by the board under AS 08.72.050 regulations for
qualifications for licensees who hold a valid federal
Drug Enforcement Administration number must address
training in pain management and opioid use and
addiction."
Renumber the following bill sections accordingly.
Page 23, line 9, following "prescribed.", through line
16:
Delete all material.
Page 23, line 17:
Delete "(c)"
Insert "(b)"
Page 24, lines 20 - 29:
Delete all material and insert:
"* Sec. 31. AS 17.30.200(a), as amended by sec.
21, ch. 25, SLA 2016, is amended to read:
(a) The controlled substance prescription
database is established in the Board of Pharmacy. The
purpose of the database is to contain data as
described in this section regarding every prescription
for a schedule II, III, or IV controlled substance
under federal law dispensed in the state to a person
other than those administered to a patient at a health
care facility or a correctional facility, except when
prescribing opioids to an inmate at the time of the
inmate's release."
Page 25, line 8:
Delete "daily [WEEKLY]"
Insert "weekly"
Page 25, following line 23:
Insert a new bill section to read:
"* Sec. 33. AS 17.30.200(b), as amended by sec.
32, of this Act, is amended to read:
(b) The pharmacist-in-charge of each
licensed or registered pharmacy, regarding each
schedule II, III, or IV controlled substance under
federal law dispensed by a pharmacist under the
supervision of the pharmacist-in-charge, and each
practitioner who directly dispenses a schedule II,
III, or IV controlled substance under federal law
other than those administered to a patient at a health
care facility or a correctional facility, except when
prescribing opioids to an inmate at the time of the
inmate's release, shall submit to the board, by a
procedure and in a format established by the board,
the following information for inclusion in the
database on at least a daily [WEEKLY] basis:
(1) the name of the prescribing practitioner and
the practitioner's federal Drug Enforcement
Administration registration number or other
appropriate identifier;
(2) the date of the prescription;
(3) the date the prescription was filled and the
method of payment; this paragraph does not authorize
the board to include individual credit card or other
account numbers in the database;
(4) the name, address, and date of birth of the person
for whom the prescription was written;
(5) the name and national drug code of the controlled
substance;
(6) the quantity and strength of the controlled
substance dispensed;
(7) the name of the drug outlet dispensing the
controlled substance; and
(8) the name of the pharmacist or practitioner
dispensing the controlled substance and other
appropriate identifying information."
Renumber the following bill sections accordingly.
Page 27, lines 21 - 25:
Delete all material and insert:
"(e) The failure of a pharmacist-in-charge
or a [,] pharmacist [, OR PRACTITIONER] to register or
submit information to the database as required under
this section is grounds for the board to take
disciplinary action against the license or
registration of the pharmacy or pharmacist. The
failure of a practitioner to register or review the
database as required by this section is grounds for
the practitioner's [OR FOR ANOTHER] licensing board to
take disciplinary action against the [A]
practitioner."
Page 29, line 23:
Delete all material and insert:
"* Sec. 40. Sections 22, 24, 26, 28, 30, 32, 52,
and 73, ch. 25, SLA 2016, are repealed."
Page 29, line 27:
Delete "and the Department of Commerce,
Community, and Economic Development"
Page 29, following line 30:
Insert a new subsection to read:
"(b) The Department of Commerce, Community, and
Economic Development may adopt regulations necessary
to implement the changes made by this Act. The
regulations take effect under AS 44.62 (Administrative
Procedure Act), but not before the effective date of
the relevant provision of this Act implemented by the
regulation."
Page 29, line 31:
Delete "(b)"
Insert "(c)"
Page 30, line 3:
Delete "28"
Insert "30"
Page 30, line 5:
Delete "28"
Insert "30"
Page 30, line 6:
Delete all material and insert:
"* Sec. 43. Section 28 of this Act takes effect on the
effective date of sec. 12, ch. 25, SLA 2016.
* Sec. 44. Section 31 of this Act takes effect on the
effective date of sec. 21, ch. 25, SLA 2016.
* Sec. 45. Section 32 of this Act takes effect on the
effective date of sec. 23, ch. 25, SLA 2016.
* Sec. 46. Section 34 of this Act takes effect on the
effective date of sec. 25, ch. 25, SLA 2016.
* Sec. 47. Section 35 of this Act takes effect on the
effective date of sec. 27, ch. 25, SLA 2016.
* Sec. 48. Sections 36 and 37 of this Act take effect
on the effective date of sec. 34, ch. 25, SLA 2016.
* Sec. 49. Sections 2, 3, 7 - 14, 19, 21, 24 - 26, 33,
and 38 of this Act take effect July 1, 2018.
* Sec. 50. Sections 1 and 40 of this Act take effect
July 1, 2019.
* Sec. 51. Except as provided in secs. 43 - 50 of this
Act, this Act takes effect immediately under AS
01.10.070(c)."
4:20:13 PM
REPRESENTATIVE SULLIVAN-LEONARD objected to the motion to adopt
Amendment 1, for the purpose of discussion.
4:20:31 PM
STACIE KRALY, Chief Assistant Attorney General/Statewide Section
Supervisor, Human Services Section, Civil Division (Juneau),
Department of Law, offered details related to proposed changes
to HB 159 under Amendment 1. As shown in Amendment 1, she said
the first change would be to the bill title to include "relating
to the practice of pharmacy". She explained that many of the
changes that would be made under the proposed Amendment 1 would
be technical changes to add something that was not meant to be
omitted. Ms. Kraly stated that the second change, on page 2,
lines 2-3, of HB 159, would address the advance directive
language and provide that the commissioner would adopt the
regulations. She said another change would be on page 2, line
25, and provide additional immunity for a prescriber who
inadvertently administers an opioid when a person has an advance
directive "that's been adopted by this statute." She said the
next two changes, on page 15, line 14 and [17], were recommended
by the American Cancer Association because it felt that a person
may need opioid pain management after a diagnosis, so the
language should not limit that to diagnosis.
MS. KRALY, regarding the change that would be made under
Amendment 1, on page 16, following line 24, of HB 159, explained
that two practitioners had been omitted inadvertently for
purposes of participation in the PDMP and the changes to the
continuing medical education provisions. The proposed change
would correct one of those omissions, address the inclusion of
advanced practice nurses, and make conforming edits to change
the nomenclature as was changed in legislation last year "to
make sure that we're talking about advanced practice nurses -
registered nurses." Ms. Kraly pointed to the changes on pages
18, lines 15 and 18, of HB 159, which again would delete
"diagnosis" to broaden the construct for the exceptions for
administering opioids to include, for example, post-cancer
treatment, when a diagnosis has already been addressed. She
next said that the new section proposed to be added on page 19,
following line 15, addresses one of the omissions advertently
made. The new language would include optometrists in
participation of PDMPs, as well as in the continuing medical
education (CME) requirements.
MS. KRALY said the change proposed to page 23, line 9, would
mean that a request for a prescription to be partially filled
would not void the prescription.
4:26:45 PM
DR. BUTLER added that this is the portion of the proposed
amendment about which he had previously said would align the
language with CARA.
4:26:54 PM
MS. KRALY moved on to the change that would be made on page 24,
lines 20-29. She explained that this part of Amendment 1 would
relate to when an opioid is being prescribed, so the PDMP would
apply to a prescription issued to an inmate upon release from [a
correctional facility].
4:27:58 PM
DR. BUTLER noted that this part of Amendment 1 also would update
language to specify this pertains to schedule II, III, and IV
drugs. He offered his understanding that the old language had
included federal schedule I drugs, which are illegal substances.
MS. KRALY added that the language [that would be Section 31] is
replacing Section 29.
MS. KRALY moved on to the proposed change to page 25, line 8, to
reinstate a requirement for certain information to be submitted
weekly to "the board." She said the plan is to stay with a
weekly requirement for one year, then go to daily. She said the
change proposed for language on page 25, line 23, also addresses
the change from daily to weekly. She admitted it may seem
confusing, but the reason for the repetition is for drafting and
effective date purposes.
MS. KRALY directed attention to the proposed change to page 27,
lines 21-25. She explained the change was requested on behalf
of both pharmacists and prescribers, and it would clarify that
pharmacists must register with the PDMP and submit information
on the PDMP, whereas a prescriber registers and reviews the
PDMP.
4:30:58 PM
MS. KRALY said Amendment 1 proposes technical changes on page
29, line 23, regarding a delayed effective date and the timing
of repeals. She stated that the purpose of the deletion
proposed on page 29, line 27 and the insertion proposed on page
29, following line 30 is to ensure that the Department of
Commerce, Community & Economic Development (DCCED) has
sufficient time to draft regulations that will become effective
"upon adoption of future effective dates." In other words, this
transitional language would allow DCCED to continue working on
regulations, even though certain provisions of the bill are not
effective. In response to Chair Spohnholz, she offered
clarification as to the numbering in this portion of the bill as
it would be amended by Amendment 1. She said, "When you have it
all in there, it'll make sense."
MS. KRALY next talked about the effective date sections of the
bill, Sections 43-48, all of which she said relate to conforming
edits and changes that need to be made as a result of Senate
Bill 74 "and the rolling effective dates of how the PDMP will
operate." She said it is important to coordinate the effective
dates so that "everybody's going into effect at the same time."
She said Section 49 would provide an effective date of July 1,
2018, and this would deal with the changes to the occupational
licensing boards, as to the CMEs and the obligations of the
boards to implement changes for participation in the PDMP, "so
that they all apply at the same time." Section 50 would provide
an effective date of July 1, 2019, to Sections 1 and 40 of HB
159, which deal with the opioid advance directive. Section 51
addresses everything else in the bill and gives it an immediate
effective date.
4:36:29 PM
REPRESENTATIVE EASTMAN asked about the aforementioned proposed
exemption that would result in not collecting date from a
correctional facility, except at the end of the inmate's term.
MS. KRALY explained that the purpose of having the PDMP is to
ensure that people are not "doctor shopping" or being over-
prescribed, and since a correctional facility is a confined
environment, the purpose of the PDMP is lost, because the
facility is a controlled environment. When inmates are
released, they are no longer in that controlled environment, and
when they are given a prescription, that information is in the
PDMP, so that when they visit a doctor or pick up a
prescription, the provider or pharmacist knows how recently an
opioid prescription has been given.
REPRESENTATIVE EASTMAN suggested the need to compare the
prescribing habits of a provider in a correctional facility to
that of his/her peers.
4:40:04 PM
DR. BUTLER replied, "A lot of the focus is on the outpatient
use." He said that looking back at the history of the opioid
epidemic, one of the original reviews of the risk of addiction
and substance misuse was based on an analysis of hospitalized
patients and showed that the risk of "problem use" after being
administered an opioid after hospitalization was extremely low.
Unfortunately, he said, those data were misapplied to outpatient
settings. He said he thinks it is still fair to say that the
risk is low in the setting of a patient that is
institutionalized, which is one reason why, when a patient is
being prepared for release, "if there's going to be ... a drug
taken with them when they leave the institution, as a discharge
medication, we would definitely want visibility on that."
4:41:31 PM
REPRESENTATIVE JOHNSTON referred to advance practice registered
nurses, and she said that made her think about physician
assistants. She surmised that may be part of the title with the
practice of medicine, but said she wondered how that might be
addressed.
DR. BUTLER responded that physician assistants are included and
are regulated under the [Alaska State] Medical Board. In
response to a follow-up question, he confirmed that is different
from the [Alaska Board of] Nursing.
4:42:41 PM
The committee took a brief at-ease.
4:43:29 PM
CHAIR SPOHNHOLZ asked Representative Sullivan-Leonard if she
maintained her objection to the motion to adopt Amendment 1.
4:43:38 PM
REPRESENTATIVE SULLIVAN-LEONARD removed her objection. There
being no further objection, Amendment 1 was adopted.
4:43:50 PM
CHAIR SPOHNHOLZ [opened public testimony on HB 159].
4:43:53 PM
JOSHUA STREAM, M.D., Providence Alaska Medical Center (PAMC),
stated that he is an anesthesiologist, who is fellowship trained
in acute pain management and is the chair of the Pain Management
Council at PAMC. He related that the council is an
interdisciplinary group comprising medical providers, clinical
leaders, and administrators all dedicated to improving pain
management for the benefit of PAMC's patients. He emphasized
his support of HB 159, especially its proposal of opioid
dispensing limits and provider education.
DR. STREAM said during his experience working with patients and
providers of every specialty he has seen inappropriate pain
management daily, which results in patients being hurt. He said
the mismanagement almost always involves the over prescription
of and overreliance on opioids, which is a huge patient safety
issue. He explained that beyond addiction and dependence,
opioids have many acute side effects that result in hospital
readmission, poor pain control, "and everything else that
entails." Dr. Stream said this mismanagement occurs both in
hospitals and in the community.
DR. STREAM said he has spent years committing his practice to
provider education regarding safe and effective pain management,
because "a lot of providers seem to be stuck in a different sort
of practice from decades past," which he explained was the
reason the council was created in 2015. Over the past two
years, he related, the council has spearheaded comprehensive
efforts in provider education that have had a dramatic impact on
prescribing practices. One result has been the improvement of
pain management in PAMC over the past year or so, with people
less dependent on opioids across all specialties, including
pediatrics, surgery, internal medicine, emergency medicine,
urology, obstetrics and gynecology, and orthopedics.
DR. STREAM stated that ensuring consistent and appropriate
education for providers outside PAMC has been a struggle, and HB
159 would open the door to achieving that goal. He said he
thinks it is appropriate to address the patient's perspective
with support and treatment for opioid addiction and recovery,
but he opined that would only be a Band-Aid over what he sees as
the real issue: the lack of provider education. Dr. Stream
stated, "We need to stem the tide of inappropriate opioids
flooding through our pharmacies and into the patients' bodies,
and the only way to do this is by mandating and overseeing
provider education to ensure the best, safest outcomes for all
patients in Alaska, not just those that happen to be at our
hospital." He posited that as it is medical professionals that
helped to create the current opioid crisis, it is their
responsibility to help "turn it around," and HB 159 is "a step
in the right direction."
4:46:41 PM
MICHAEL CARSON, Chair, Mat-Su Opioid Task Force, testified in
support of HB 159. He reported that 80 percent of heroin users
started with opioid use; 75 percent of those individuals got
those pills from grandparents, parents, or friends or stole
them. He suggested the state look at a program, called "Mind
Your Meds," which he said would "cut the spigot off." He
informed the committee that heroin is now being mixed with
fentanyl, the latter of which is 50-100 times more powerful than
morphine. He said the newest data, as of March 18, 2017,
published from the Medical Science Department of the University
of Arkansas, concludes that an initial 10-day prescription of
pain medication can translate to one in five patients becoming
long-term users. He said, "Dr. Martin's last statement with
that conclusion was we ... didn't really expect that." He said
addiction is powerful and deadly: 90 people die of overdoses
every day, nationally. He said consumers of medicine, as well
as all people in the medical field, need to be aware of the
addiction potential of pain medication. He related that the
Mat-Su Opioid Task Force is in full support of HB 159 and all
the amendments that have been addressed.
4:49:17 PM
REPRESENTATIVE TARR asked how there could be a partnership
between task forces such as Mr. Carson chairs and legislators.
MR. CARSON responded that the Mat-Su Opioid Task Force meets the
first Tuesday of each month, and Dr. Butler will be presenting
at the next meeting. He mentioned that his task force, along
with another, and Dr. Butler had a conversation with Governor
Bill Walker. He said the information [related to HB 159] would
be presented at the next task force meeting. He stated, "We
will do whatever it takes to get this information out and be
able to provide the information for our community." He said the
task force has identified five top priorities, and one of them
is prevention. He said the task force is hoping to get
information out to schools and to engage civic groups, in order
to have "all the stakeholders at the table to be able to find a
solution to this plague."
REPRESENTATIVE TARR said she would welcome hearing any ideas
that come out of the next task force meeting. She said the bill
focuses heavily on "the prescription side of things" and
"removing the supply," but she said she thinks groups such as
the Mat-Su Opioid Task Force are more in touch with the families
and people affected [by opioid addiction].
MR. CARSON said the task force just launched a new web site,
matsuopiatetaskforce.com, which provides a resource list of all
Southcentral Alaska providers. A future plan is to develop a
page on the web site that would list all nonclinical support.
He announced that Anchorage would have its first task force
meeting on 4/11/17. He indicated the Mat-Su Opioid Task Force
has reached out to Bristol Bay, and Copper River Valley has been
in contact with Mr. Carson's task force. He invited committee
members to reach out through the web site, including to give
feedback or ask questions.
4:53:26 PM
CHRISTINA LOVE, Community Resources Coordinator, Aiding Women in
Abuse and Rape Emergencies (AWARE Inc.), stated that she is a
person in long-term recovery from use of intravenous (IV) heroin
and other mind altering substances. She related that in her
capacity as resources coordinator, she works with women and
children that have been physically and sexually harmed; she is
the disability response team coordinator for Juneau; and she was
on the opioid task force. She stated strong agreement with the
nonopioid directive, rational pain management practices, and
continuing care education for prescribers. She said she has
been thinking of her own experience and that of the people with
whom she works, all the various prescribers in Alaska, and the
powerful idea that "right now, someone is being overprescribed -
right this very moment." She said this includes not being given
the necessary information by a prescriber.
MS. LOVE named several medical institutions in Alaska and
indicated that each has a file on her that highlights that she
is allergic to opioids and, if she were to be given them, she
would die. She clarified that she has painted a clear picture
for every doctor and nurse with whom she has come into contact
describing what her life looked like prior to coming into
recovery. She said when she was using, she could not even lift
her arms, because of the many track marks; she was on multiple
drugs; she was living on the street; her life had no meaning;
she tried to end her life several times with overdoses. She
continued as follows:
And coming into recovery, even with that picture, when
I had my daughter in 2003, I had to over and over and
over tell them that I could not have opioids. When I
sprained my ankle, they tried to give me a shot of
Dilaudid, and I had to tell them over and over and
over. When I had my wisdom teeth pulled, I had to
tell them over and over and over that "I may be in
discomfort, I may be in pain, but I will not die, you
know?" And so, they would tell me something like,
"Well, I'm going to leave it up to pharmacy for you
anyway, in case you want it." And I had to explain to
them again, "I am strong enough today to say no, but
... maybe tomorrow looks totally different," but say,
"this is a lifelong illness for me, and it does not
always mean that I will be as strong as I am today;
and if I were to relapse, that is exactly what my life
would look like."
MS. LOVE said she has seen this happen a hundred times, where
people she works with or loved ones that have had, perhaps,
three years of recovery, "went in for the same dental procedure
that I have, and they have not made it back." She emphasized
that the importance of HB 159 is one of life and death. She
described the beginning of her addiction as when she was
prescribed oxycodone following knee surgery. She said, "It lead
to a place of unspeakable horrors ..., and I never want to be
back there again." She said she wants the right to have that
information in her file so that she does not have to repeatedly
have that conversation.
MS. LOVE said there are many wonderful providers. She said she
spent the last four years of her recovery educating herself
about addiction and recovery, and she still has so much to
learn. She stated that she cannot even imagine giving a health
care provider all the information he/she would need in just two
hours. She thanked the committee for considering the issue,
giving her the opportunity to testify, and for HB 159.
4:57:26 PM
REPRESENTATIVE SULLIVAN-LEONARD remarked that after listening to
Ms. Love's testimony, it seems as if health care providers are
focused solely on opioids for pain relief. She asked Ms. Love
if she was ever offered anything else for the relief of pain
besides opioids.
MS. LOVE answered no. She said, "We had thought about making
... a safety plan." She explained that when her daughter was
born, there were many complications, and she had to have someone
come stay with her to dole out her medications as needed and
then discard the rest. Now that she has read more on the issue,
she is aware of alternative options, but she had not been aware
of them when her daughter was born, and she had been in recovery
for one year. She indicated that [the alternatives] she knows a
lot more about now would have been wonderful options then.
4:58:43 PM
KARA NELSON, Director, Haven House, testified that she is in
long-term recovery and has not taken a drink or drugs since
2011, on the day she was released from Lemon Creek Correctional
Center. She said Haven House is a faith-based, peer-led
recovery house for women coming home after incarceration. She
said she works often with Ms. Love, as well as with many other
women and men in the community. She stated that she is in full
support of HB 159, particularly the voluntary nonopioid
directive. She related having had a difficult time expressing
an opposing view to a doctor treating her daughter, who she
described as having some issues related to recovery. Ms. Nelson
talked about a woman from Haven House that had been in recovery,
went to the dentist, was prescribed opioids by her dentist, who
wanted her to have them just in case she needed them, even
though she had explained her addiction and need to not have them
prescribed. The woman ended up taking the opioids and within a
couple days was shooting heroin, but luckily came to Ms. Nelson
for help. Ms. Nelson said those just beginning recovery cannot
face making a decision [about opioid use for pain], and she said
in the woman's case, "that could have been avoided in that
moment." Ms. Nelson indicated that although her doctors know
that she is in recovery, she has been offered medication that
would not be in support of her recovery. She said she has to
repeatedly remind her doctors. She indicated that while she
supports the education piece proposed under HB 159, she thinks
two hours of training within two years of a renewal is "super
minimal" when considering [the enormity of the issue].
MS. NELSON echoed Ms. Love's remark that there are many educated
providers that have the best intention. She said the recovery
environment is changing at a rapid pace, in terms of recovery
communities, addiction, and available information. She said she
has to keep up [with the information] daily, so she cannot
imagine going to school to be a doctor, coming back years later
to get updates on best practices. Ms. Nelson concluded, "We
have 249 million prescriptions that were prescribed in 2013;
that's every single ... adult in the United States of America
with a bottle of prescribed opioids." She asserted that that
statistic is crazy, and she said HB 159 is one tool that could
"bring health and wellness to our people."
5:03:53 PM
CHAIR SPOHNHOLZ expressed appreciation to Ms. Nelson and Ms.
Love for sharing their personal experiences in recovery to shine
light on a subject that is "complicated, challenging, often
intractable for many, and yet completely preventable."
5:04:17 PM
CHAIR SPOHNHOLZ announced that public testimony would be left
open and HB 159 is held over.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB 159 Sectional Analysis ver A 3.6.17.pdf |
HHSS 3/18/2017 3:00:00 PM HHSS 3/25/2017 3:00:00 PM HHSS 3/30/2017 3:00:00 PM HHSS 4/4/2017 3:00:00 PM HHSS 4/11/2017 3:00:00 PM |
HB 159 |
| HB0159 ver A 3.6.17.pdf |
HHSS 3/18/2017 3:00:00 PM HHSS 3/25/2017 3:00:00 PM HHSS 3/30/2017 3:00:00 PM HHSS 4/4/2017 3:00:00 PM HHSS 4/11/2017 3:00:00 PM |
HB 159 |
| HB159 Fiscal Note DHSS-PHAS 3.6.17.pdf |
HHSS 3/18/2017 3:00:00 PM HHSS 3/25/2017 3:00:00 PM HHSS 3/30/2017 3:00:00 PM HHSS 4/4/2017 3:00:00 PM HHSS 4/11/2017 3:00:00 PM |
HB 159 |
| HB159 Sponsor Statement 3.6.17.pdf |
HHSS 3/18/2017 3:00:00 PM HHSS 3/25/2017 3:00:00 PM HHSS 3/30/2017 3:00:00 PM HHSS 4/4/2017 3:00:00 PM HHSS 4/11/2017 3:00:00 PM |
HB 159 |
| HB159 Supporting Document - Letter from Alaska Dental Society.pdf |
HHSS 3/25/2017 3:00:00 PM HHSS 3/30/2017 3:00:00 PM HHSS 4/4/2017 3:00:00 PM HHSS 4/11/2017 3:00:00 PM |
HB 159 |
| HB159 Supporting Document - PDMP side by side comparison 3.23.17.pdf |
HHSS 3/25/2017 3:00:00 PM HHSS 3/30/2017 3:00:00 PM HHSS 4/4/2017 3:00:00 PM HHSS 4/11/2017 3:00:00 PM |
HB 159 |
| HB159 Supporting Document - Opioid Bill FAQ 3.23.17.pdf |
HHSS 3/25/2017 3:00:00 PM HHSS 3/30/2017 3:00:00 PM HHSS 4/4/2017 3:00:00 PM HHSS 4/11/2017 3:00:00 PM |
HB 159 |
| HB 159 Governor's Amendment.pdf |
HHSS 3/30/2017 3:00:00 PM HHSS 4/4/2017 3:00:00 PM HHSS 4/11/2017 3:00:00 PM |
HB 159 |
| HB 186 Fiscal Note DEC--EH 3.24.17.pdf |
HHSS 3/30/2017 3:00:00 PM HHSS 4/4/2017 3:00:00 PM |
HB 186 |
| HB 186 Sponsor Statement 3.20.17.pdf |
HHSS 3/30/2017 3:00:00 PM HHSS 4/4/2017 3:00:00 PM |
HB 186 |
| HB 186 Support Letter - Fairbanks Community Food Bank 3.20.17.pdf |
HHSS 3/30/2017 3:00:00 PM HHSS 4/4/2017 3:00:00 PM |
HB 186 |
| HB 186 Sectional Analysis ver J 3.20.17.pdf |
HHSS 3/30/2017 3:00:00 PM HHSS 4/4/2017 3:00:00 PM |
HB 186 |
| HB 186 Supporting Documents - Feeding America Alaska Stats 3.20.17.pdf |
HHSS 3/30/2017 3:00:00 PM HHSS 4/4/2017 3:00:00 PM |
HB 186 |
| HB 186 Ver J 3.20.17.pdf |
HHSS 3/30/2017 3:00:00 PM HHSS 4/4/2017 3:00:00 PM |
HB 186 |
| HB100 Supporting Document-Support Letter Honor for All 2.6.17.pdf |
HHSS 3/30/2017 3:00:00 PM |
HB 100 |
| House Bill 100 ver A.pdf |
HHSS 3/30/2017 3:00:00 PM |
HB 100 |
| HB100 Supporting Document-PTSD Factsheet 2.23.17.pdf |
HHSS 3/30/2017 3:00:00 PM |
HB 100 |
| HB100 Fiscal Note DOA--SSA 3.24.17.pdf |
HHSS 3/30/2017 3:00:00 PM |
HB 100 |
| HB100 Sponsor Statement 2.23.17.pdf |
HHSS 3/30/2017 3:00:00 PM |
HB 100 |
| HB164 Sponsor Statement - Governor's Transmittal Letter.pdf |
HHSS 3/30/2017 3:00:00 PM HHSS 4/4/2017 3:00:00 PM |
HB 164 |
| HB164 Sectional Analysis.pdf |
HHSS 3/30/2017 3:00:00 PM HHSS 4/4/2017 3:00:00 PM |
HB 164 |
| HB164 ver A.PDF |
HHSS 3/30/2017 3:00:00 PM HHSS 4/4/2017 3:00:00 PM |
HB 164 |
| HB164 Fiscal Note-DHSS-SDSA-1-20-17.PDF |
HHSS 3/30/2017 3:00:00 PM HHSS 4/4/2017 3:00:00 PM |
HB 164 |
| HB164 Fiscal Note-DOR-OLTCO-1-20-17.PDF |
HHSS 3/30/2017 3:00:00 PM HHSS 4/4/2017 3:00:00 PM |
HB 164 |