01/30/2018 03:00 PM House HEALTH & SOCIAL SERVICES

              HB 268-OPIOID PRESCRIPTION WARNINGS                                                                           
                                                                                                                                
3:47:40 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ announced that the  final order of business would                                                               
be SPONSOR  SUBSTITUTE FOR HOUSE  BILL NO. 268, "An  Act relating                                                               
to the  prescription of  opioids; relating  to the  Department of                                                               
Health  and   Social  Services;  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;  and  relating  to  the                                                               
practice of optometry."                                                                                                         
                                                                                                                                
3:48:32 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  LES GARA,  Alaska State  Legislature, paraphrased                                                               
from the  Sponsor Statement [Include in  members' packets], which                                                               
read:                                                                                                                           
                                                                                                                                
     House  Bill  268  seeks  to  help  address  the  opioid                                                                    
     addiction  crisis in  Alaska, by  making sure  patients                                                                    
     are  advised  of  the potential  addictive  dangers  of                                                                    
     these   prescription   drugs.  Opioid   drugs   include                                                                    
     oxycodone, hydrocodone, and  other pain reducing drugs.                                                                    
     In many cases  these drugs are needed  to address acute                                                                    
     physical pain, but the facts  show that these drugs can                                                                    
     also  have  powerful  addictive  effects.  Furthermore,                                                                    
     studies show  many heroin users started  as opioid drug                                                                    
     users.  The   relatively  low  cost  of   heroin  as  a                                                                    
     substitute  drug can  lead to  the  transition by  many                                                                    
     Americans and  Alaskans to heroin. Obviously,  this can                                                                    
     occur when  a medical  provider will no  longer provide                                                                    
     additional   prescription  medication.   A  small   but                                                                    
     troubling percentage  of people who become  addicted to                                                                    
     opioid drugs later become heroin addicts.                                                                                  
                                                                                                                                
     These  addictions  can   destroy  families,  destroy  a                                                                    
     person's  ability  to   hold  employment,  and  destroy                                                                    
     lives.  Addiction treatment  is  costly for  consumers,                                                                    
     who pay  indirect insurance costs,  as well as  for the                                                                    
     state,  which  often  covers  and  pays  for  addiction                                                                    
     treatment.  In the  worst  case,  overdose deaths  also                                                                    
     result from opioid use. According  to the Department of                                                                    
     Health and Social Services,  14,000 Americans died from                                                                    
     opioid  use in  2014 and  91 Americans  die every  day.                                                                    
     Alaska's per  capita death rate  is twice  the national                                                                    
     average.  According to  the  Department, between  2009-                                                                    
     2015, 774 Alaskans died from opioid overdose.                                                                              
                                                                                                                                
     This bill recognizes a reality.  Since 1999, the number                                                                    
     of  opioid prescriptions  has  tripled. More  Americans                                                                    
     and Alaskans  have been prescribed these  often useful,                                                                    
     but potentially dangerous drugs.                                                                                           
                                                                                                                                
     House  Bill  268  is a  patient  information  bill.  It                                                                    
     requires  prescribers to  let patients  know about  the                                                                    
     potentially  addictive qualities  of  these drugs  when                                                                    
     they  are prescribed,  and  that  they can  potentially                                                                    
     lead  to opioid  abuse  and  addiction. Providers  must                                                                    
     also  offer  information  about   opioid  use  being  a                                                                    
     potential  risk  factor  for future  heroin  addiction.                                                                    
     Patients   can  then   use  this   knowledge  to   help                                                                    
     themselves  and  their  family  members  guard  against                                                                    
     overuse and abuse when prescribed these medications.                                                                       
                                                                                                                                
     To keep the requirements flexible, and as non-                                                                             
     burdensome   as   feasible,  while   still   protecting                                                                    
     patients, medical  providers who prescribe  these drugs                                                                    
     will be  required to provide this  information to their                                                                    
     patients in their "own words".                                                                                             
                                                                                                                                
     The  bill also  requires the  Department of  Health and                                                                    
     Social Services  to prepare a  very short  handout with                                                                    
     some facts on the dangers  of opioid addiction, and the                                                                    
     potential  association  between  opioid  addiction  and                                                                    
     heroin  use.   To  increase   the  chances   that  this                                                                    
     information  will  be  presented  in  a  form  that  is                                                                    
     useful, it is  required to be concise,  and may include                                                                    
     graphics.   The  handout   is   Important  because   it                                                                    
     recognizes  that  the patient-provider  discussion  may                                                                    
     not  be  long  and  detailed, and  a  patient  may  not                                                                    
     remember what is told to  them by a medical provider in                                                                    
     this   regard.  It   also  serves   to  reinforce   the                                                                    
     information.                                                                                                               
                                                                                                                                
     This bill  does not create opportunities  for new civil                                                                    
     lawsuits   against  providers,   thus  protecting   the                                                                    
     patient-provider  relationship.   Instead  of  imposing                                                                    
     civil liability,  and raising the specter  of lawsuits,                                                                    
     the  enforcement  mechanism  in  the  bill  allows  the                                                                    
     providers' Board  to consider sanctions  for "habitual"                                                                    
     violations  of this  statute that  occur without  "good                                                                    
     cause".                                                                                                                    
                                                                                                                                
     Exceptions to the  legislation's requirements, borrowed                                                                    
     from a  similar statute  passed in New  Jersey, include                                                                    
     medical services  where opioids  may be  necessary such                                                                    
     as for opioid addiction treatment and hospice care.                                                                        
                                                                                                                                
REPRESENTATIVE GARA declared that  this was a world-wide problem,                                                               
and opined that, as heroin was  cheap, it could be substituted if                                                               
the prescription opiates were no  longer available from a doctor.                                                               
He relayed his  request that the Department of  Health and Social                                                               
Services  put a  link on  its website  for physicians  to use  to                                                               
download a concise  handout.  He offered his  own experience with                                                               
opioid prescriptions, that he had  never been told that they were                                                               
potentially  addictive  or  any   link  between  opioid  use  and                                                               
eventual heroin use.                                                                                                            
                                                                                                                                
3:54:34 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SULLIVAN-LEONARD  asked about offering  the choice                                                               
of  another  pain relieving,  non-narcotic  based  product.   She                                                               
shared  that pharmaceutical  representatives had  tried to  offer                                                               
this  to doctors,  but the  response had  been that  the patients                                                               
wanted quick relief.                                                                                                            
                                                                                                                                
REPRESENTATIVE GARA  expressed his agreement, and  he pointed out                                                               
that the proposed bill required  that a reasonable alternative to                                                               
the opioid must be mentioned to the patient.                                                                                    
                                                                                                                                
3:55:49 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE JOHNSTON asked  if the proposed bill  was just for                                                               
written prescriptions as a patient may not be able to read.                                                                     
                                                                                                                                
REPRESENTATIVE  GARA explained  that  the bill  was intended  for                                                               
written prescriptions.   He reported  that there was  some opioid                                                               
use that  was not prescription  use, and  he cited examples  of a                                                               
hospice care center  or a heroin addiction treatment  center.  He                                                               
stated that the  proposed bill did not affect these  centers.  He                                                               
explained  that  the proposed  bill  was  a requirement  for  any                                                               
prescription from an authorized provider.                                                                                       
                                                                                                                                
3:57:36 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  JOHNSTON said  that  she was  thinking of  trauma                                                               
cases in emergency rooms.                                                                                                       
                                                                                                                                
REPRESENTATIVE GARA  expressed his  agreement that it  should not                                                               
affect emergency rooms and immediate care facilities.                                                                           
                                                                                                                                
CHAIR SPOHNHOLZ pointed out that  there were times when you could                                                               
and could not give consent.                                                                                                     
                                                                                                                                
3:58:12 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TARR  directed attention to  page 11, line  6, and                                                               
suggested that the mechanism of  action with opioid use needed to                                                               
be  described  to  a  patient to  better  understand  the  health                                                               
effects, even after  the end of the prescription use.   She asked                                                               
if the  Department of Health  and Social Services  would consider                                                               
this, absent  legislation, as there  would be  immediate positive                                                               
effect.                                                                                                                         
                                                                                                                                
REPRESENTATIVE  GARA offered  his belief  that the  Department of                                                               
Health   and   Social   Services  would   not   require   medical                                                               
practitioners to  read a  statement or  provide a  handout, hence                                                               
the need  for legislation to  make this a  mandatory requirement.                                                               
He  pointed out  that should  a  warning become  too long,  there                                                               
would be  resistance from physicians.   He acknowledged  that any                                                               
appropriate  additional  information  could be  included  in  the                                                               
written handout.                                                                                                                
                                                                                                                                
4:01:18 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TARR  asked if the department  would put something                                                               
on its website more immediately.                                                                                                
                                                                                                                                
REPRESENTATIVE  GARA replied  that  it was  already  on the  DHSS                                                               
website.                                                                                                                        
                                                                                                                                
4:01:53 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ  added that  the Office  of Substance  Misuse and                                                               
Addiction  Prevention  had a  lot  of  information and  resources                                                               
available to the public and health care practitioners.                                                                          
                                                                                                                                
4:02:09 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SADDLER (alternate)  asked  about  the extent  of                                                               
impingement  on  a  professional's  judgement and  who  made  the                                                               
determination  for "without  good cause"  for failing  to provide                                                               
information.                                                                                                                    
                                                                                                                                
REPRESENTATIVE GARA  replied that the  goal of the  proposed bill                                                               
was  to be  non-burdensome on  medical practitioners  and not  to                                                               
create  a hostile  litigation  relationship  between patient  and                                                               
provider.  He  pointed out that the discipline  for providers was                                                               
very relaxed, noting that there  was no lawsuit liability created                                                               
by the  bill.   He explained that  the enforcement  mechanism was                                                               
for habitual violators of the provisions  of the bill who did not                                                               
have good cause.                                                                                                                
                                                                                                                                
REPRESENTATIVE  SADDLER asked  who  defined good  cause and  what                                                               
constituted habitual.                                                                                                           
                                                                                                                                
4:03:56 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  GARA replied  that it  was only  habitual if  the                                                               
person was not following the law on a consistent basis.                                                                         
                                                                                                                                
REPRESENTATIVE KITO asked how a  violation was determined and who                                                               
would determine these violations.                                                                                               
                                                                                                                                
REPRESENTATIVE GARA explained that  the regulatory board for each                                                               
profession  would  determine  the  violations and  the  need  for                                                               
punishment.  He  stated that the legal standard  for habitual was                                                               
determined by the dictionary definition.                                                                                        
                                                                                                                                
4:04:54 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE KITO asked  how the board members  were made aware                                                               
of the violation.                                                                                                               
                                                                                                                                
REPRESENTATIVE  GARA   replied  that  "somebody  would   have  to                                                               
complain to them" and he opined  that it would be rare as medical                                                               
practitioners would not want to violate the law.                                                                                
                                                                                                                                
4:05:37 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ said the bill would be held over.