Legislature(2017 - 2018)SENATE FINANCE 532
05/23/2017 01:30 PM Senate FINANCE
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| Audio | Topic |
|---|---|
| Start | |
| SB79 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | SB 79 | TELECONFERENCED | |
| + | TELECONFERENCED |
SENATE BILL NO. 79
"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."
1:34:46 PM
JENNIFER STUKEY, REPRESENTATIVE, BOARD OF NURSING (via
teleconference), stated that she had worked with opioid
abuse and addressed the issue of possible overprescribing
of opioids. She believed that the bill would be helpful to
combat the opioid addiction epidemic.
Senator Micciche wondered if there was an "opioid awareness
class." Ms. Stukey replied that she would like to have an
opioid awareness class. She stressed that Alaska was
different than the lower 48, so there should be a
continuing education course.
Senator Micciche assumed that creation of the class would
not be easy, but noted that there did not seem to be that
shared concern. Ms. Stukey replied that the creation of the
course would not be a difficult process.
Co-Chair MacKinnon wondered where the education should come
from at the state level. She noted that there would be a
variety of professions that would be affected by the
legislation. Ms. Stukey replied that the state should
provide that education to ensure that all professions were
in line. She stated that there was an opioid summit that
may be a good place to start the education.
Co-Chair MacKinnon wondered who should influence the state.
Ms. Stukey responded that the Board of Medicine could
influence the state.
1:40:14 PM
Co-Chair Hoffman queried the seven-day limit for
prescription opioid. Ms. Stukey replied that it was a very
good idea. She felt that there were exceptions for chronic
pain and end of life services.
Co-Chair MacKinnon wondered who would be the appropriate
party to set the standard for maximum doses. Ms. Stukey
replied that medical doctors had guidelines for
prescribing, so that decision should be left to the
physician.
Senator Micciche remarked that there were some physicians
who may be too focused on the comfort of the client, that
they may be ignoring the adverse effects of the overuse of
opioids. He noted that the Board of Medicine had expressed
concern over what the seven-day supply would provide. Ms.
Stukey replied that the education was important, and
stressed that the addition of addiction understanding would
help physicians to prescribe opioids in a better manner.
Co-Chair MacKinnon wondered whether Ms. Stukey had worked
in a hospital environment. Ms. Stukey replied in the
negative.
Co-Chair MacKinnon recalled that there was an assessment in
the hospital for a level of pain. She wondered who would
provide information about that assessment. Ms. Stukey
replied that the Board of Medicine would be the best
contact.
1:45:22 PM
DOCTOR THOMAS WELLS, PRESIDENT, BOARD OF DENTAL EXAMINERS
(via teleconference), stated that the bill was a good
start. He shared that the board had no comment on the bill.
He stated that he looked forward to regulations that would
enforce the issue.
Co-Chair MacKinnon noted the ambiguity in the bill about
education and a seven-day supply limit. She remarked that
only a doctor would have influence on a seven-day supply.
Dr. Wells replied that there were guidelines for dosages.
Co-Chair MacKinnon queried the guidelines to limit the
opioid prescriptions. Dr. Wells replied that the drug
companies provided dosage guidelines.
Co-Chair MacKinnon wondered whether the pharma // Dr. Wells
replied in the negative.
Senator Olson queried the frequency of prescribing the
amount that would cause addiction. Dr. Wells replied that
it depended on the practitioner. He asserted that there was
a population who may receive dental work in order to
receive narcotics.
1:50:28 PM
Senator Olson wondered whether there was ever a complaint
of an overprescribing licensee. Dr. Wells replied in the
negative.
Senator Olson queried the lack of requirement in the law
for the dental community. Dr. Wells replied that it was not
a burden. He stressed that many addicts used dentists to
get drugs.
Senator Olson surmised that Dr. Wells agreed with the
course. Dr. Wells agreed.
Senator Hughes wondered whether there were some dentists
who would see a benefit to the education, and curb
overprescribing. Dr. Wells replied that many dentists were
overprescribing.
Senator Hughes surmised that a dentist would typically
prescribe more than seven days' worth of opioids. Dr. Wells
replied that the issue was more about repeated
prescriptions.
Senator Micciche felt that the value of the class was
whether or not there needed to be an opioid prescription.
Co-Chair Hoffman stressed that there were some people that
have chronic pain, so they need the opioids to treat that
pain. He wondered whether a person in a rural village would
be required to travel to receive a prescription.
1:56:52 PM
DOCTOR PAUL BARNEY, CHAIR, BOARD OF OPTOMETRY (via
teleconference), stated that optometrists already had a
four-day limitation on prescription opioids. He also
supported the education element. He was in support of the
legislation.
Co-Chair MacKinnon wondered how the board established the
four-day limitation. Dr. Barney replied that the
legislative process resulted in the decision to limit to
four days.
Senator Micciche wondered whether the recent bill removed
the four-day limit. Dr. Barney replied that the bill did
remove the four-day limit. He stated that the board would
put a four-day limit in regulation.
Senator Olson remarked that bill referenced the seven-day
supply.
2:01:13 PM
DOCTOR JAMES HAGEE, CHAIRMAN, BOARD OF VETERINARY (via
teleconference), stated that the veterinary profession was
trained to deal with animals. He stated that the issue in
the veterinary profession was that drugs were prescribed
for the pets could get diverted for human use. He stressed
that most opioid use in veterinary medicine was dispensed
in house as injectables. He understood that the people
could consume the drugs that were prescribed to the
animals. He felt that the education would be very important
for veterinarians.
Senator Olson wondered queried the number of veterinarians
who had a Drug Enforcement Agency (DEA) number, and how
many prescriptions they could write. Dr. Hagee replied that
the person who held the license was responsible for the
prescription.
Senator Olson wondered whether veterinarians could
prescribe Schedule 1 or 2 drugs. Dr. Hagee replied that
veterinarians could not prescribe Schedule 1 drugs. He
stated that they could prescribe Schedule 2, 3, 4 and 5
could be prescribed. He stated that most Schedule 2 drugs
were injectables. The Schedule 3 and 4 could be dispensed.
He hoped that the veterinary community would stop
prescribing opioids.
2:07:49 PM
LEIF HOLM, CHAIRMAN, BOARD OF PHARMACY (via
teleconference), replied that the pharmacy had been
involved of the prescription drug management program (PDMP)
and its use in curbing abuse in the state. He stated that
he agreed with most of the changes in PDMP.
Vice-Chair Bishop queried the difference between a generic
and brand name drug. Mr. Holm replied that there was no
clinical difference between the drugs.
Vice-Chair Bishop queried the amount of continuing opioid
education was required by pharmacists. Mr. Holm replied
that there was no requirement.
Co-Chair MacKinnon queried the challenges that pharmacists
face moving from a monthly to daily reporting. Mr. Holm
replied that there would not be a heavy burden, except that
one must remember to do it every day.
2:14:40 PM
Senator Hughes surmised that changing from monthly to daily
reporting would not address the state opioid problem. Mr.
Holm replied that he wanted to see the effect before he
could respond to that question.
Senator Hughes wondered whether an addiction could occur in
less than seven days. Mr. Holm replied that addiction could
occur with the first dose.
Co-Chair MacKinnon remarked that there was an issue of
"doctor shopping" to receive the drug. She remarked that a
daily report would prove that an individual who was "doctor
shopping." Mr. Holm felt that the daily reporting would
only report those who were newly addicted. He felt that
month long or week-long patterns would show a seasoned
addict.
Co-Chair MacKinnon queried the practice as a business owner
for pharmacists who might identify an addict. Mr. Holm
replied that the pharmacy would contact the physician.
Co-Chair MacKinnon wondered whether the PDMP could be
accessed in the pharmacy. Mr. Holm replied in the
affirmative.
2:20:21 PM
Senator Hughes wondered whether a patient must return to a
physician for a physical prescription. She stated that
there may be an electronic prescription required. Mr. Holm
replied that all prescriptions could be electronic, but
must be approved through the DEA. He guessed that a village
may not have the electronic prescriptions, so there may be
need to provide more than the limit.
Senator Hughes wondered how many pharmacies would require
the patient to return to the physician. Mr. Holm did not
know.
Senator Hughes remarked that there may be some with chronic
pain that required opioids. She remarked that there was a
concern about those people being under scrutiny. Mr. Holm
replied that there may be a concern. He stated that he
witnessed patients with high quantities of opioid use, so
there could be a stigma with the seven-day mandate. He
remarked that there would be no use for the seven-day
mandate, if a physician was allowed to go beyond that limit
based on their professional judgment. He stressed that the
reporting in the PDMP would be more beneficial, and make
major headway in reducing the opioid epidemic.
2:27:37 PM
Senator Hughes remarked that there was a letter from the
Medical Board about whether the Pharmacy Board could limit
the prescribing of opioids. Mr. Holm replied that he was
not aware of that guideline.
Senator Hughes replied that it would be helpful to have the
State Medical Board clarify their position on the bill.
2:31:07 PM
DOCTOR JAY BUTLER, CHIEF MEDICAL OFFICER, DEPARTMENT OF
HEALTH AND SOCIAL SERVICES, introduced himself.
Vice-Chair Bishop remarked that wondered whether there was
curriculum already available, or would the education
requirements be "site specific to Alaska." Dr. Butler
replied that there were many materials that were available
for education.
Senator Hughes wondered whether Dr. Butler could speak to
the letter from the State Medical Board. Dr. Butler replied
in the affirmative. The question of the role of the
Pharmacy and Medical Boards should be deferred to the
chairs of those two boards.
Senator Hughes felt that the boards should work together.
Co-Chair MacKinnon replied that the State Medical Board
chose not to participate in the day's meeting, and
submitted a letter instead.
Dr. Butler felt that interdepartmental collaboration would
improve government efficiency.
2:35:31 PM
Senator Micciche wondered whether the state was in
"extraordinary times" as it related to drug and opioid use.
Dr. Butler replied in the affirmative.
Senator Micciche surmised that most street users began with
prescription drugs. Dr. Butler agreed.
Senator Micciche wondered whether prescription opioids
killed twice as many Alaskans as street opioids. Dr. Butler
replied that it was often use of more than one drug.
Senator Micciche stressed that there were several people
who felt the bill was inconvenient. Dr. Butler replied that
the day's meeting reflected the conversations he had with
multiple colleagues.
Senator Micciche felt that there might be a generational
difference in prescribing for pain management. The
requirements of the bill were a reminder that the
prescription could encourage addiction.
2:42:48 PM
SARA CHAMBERS, DEPUTY DIRECTOR, DIVISION OF BUSINESS AND
PROFESSIONAL LICENSING, DEPARTMENT OF COMMERCE, COMMUNITY
AND ECONOMIC DEVELOPMENT, reinforced the importance of
interdepartmental collaboration in solving the problem.
Co-Chair MacKinnon wondered whether there was merit in
state standardized curriculum and whether there was a
fiscal note that would reflect that development. Ms.
Chambers replied that she did not anticipate developing a
curriculum, but understood the benefit of an Alaska-focused
education.
Co-Chair MacKinnon wanted to know the recommendation about
how the curriculum would be delivered.
2:47:46 PM
Senator Hughes remarked that she knew of people who had
problems with opioids. She also noted that physicians were
concerns about whether the legislature would "hit the
target." She remarked that there was not current data about
overprescribing problems. She felt that the problem should
be targeting the over prescribers. She wondered whether
there was a way to stop the addicts who were "shopping."
She wondered whether the boards currently could regulate on
their own, or were in need of the statutory language. Dr.
Butler agreed that there needed to be guidelines for opioid
use.
2:53:49 PM
Ms. Chambers continued that the boards worked together to
come together on common guidelines.
Senator Hughes wondered whether the boards were already
working towards regulation, before the bill's introduction.
Ms. Chambers replied that the Medical and Nursing Boards
had overarching regulations.
Senator Hughes queried the expectation of reduction in
opioid related deaths and the opioid problem. Dr. Butler
replied that there was a hope that the bill would be a
major step in the right direction to address some of the
roots of the problem, including the volume of opioids in
the community and pain management.
3:00:12 PM
Senator Hughes stressed that she was concerned with the
issue.
Co-Chair Hoffman wondered whether the language related to
allowing a patient in a rural area to receive more than a
seven-day dose. He would consult the tribal entities to be
sure that the language was adequate.
Senator Micciche remarked that the boards would determine a
seven-day dose. He stressed the necessity of the bill.
Co-Chair MacKinnon wondered whether America had the highest
opioid usage in the world. Dr. Butler replied in the
affirmative.
3:05:30 PM
Co-Chair MacKinnon surmised that health care costs were
driven by four factors: providers, hospitals, prescription
drugs, and insurance providers. Dr. Butler felt that it was
a broad, reasonable assessment.
Co-Chair MacKinnon remarked that the state provided 60
percent of the overall health care in Alaska.
Senator Micciche wanted to compare what was passed out of
the house.
Co-Chair MacKinnon replied that the work could be done
later in the day.
Ms. Chambers stated that she had a comparison available to
the committee.
Co-Chair MacKinnon wondered whether the comparison included
the amendments. Ms. Chambers replied in the affirmative.
SB 79 was HEARD and HELD in committee for further
consideration.
| Document Name | Date/Time | Subjects |
|---|---|---|
| SB 79 Hb 159 Public Testimony Todd.pdf |
SFIN 5/23/2017 1:30:00 PM |
HB 159 SB 79 |
| SB 79 HB 159 Supporting Document - LOS from ASHNHA.pdf |
SFIN 5/23/2017 1:30:00 PM |
HB 159 SB 79 |
| SB 79 State Medical Board Position Statement.pdf |
SFIN 5/23/2017 1:30:00 PM |
SB 79 |
| SB 79 Supporting Document - LOS from Alaska Dental Society.pdf |
SFIN 5/23/2017 1:30:00 PM |
SB 79 |
| SB 79 Supporting Document - LOS from AML.pdf |
SFIN 5/23/2017 1:30:00 PM |
SB 79 |
| SB 79 Supporting Document - LOS from MSHF.pdf |
SFIN 5/23/2017 1:30:00 PM |
SB 79 |