Legislature(2017 - 2018)CAPITOL 106
02/22/2018 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| HB268 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 268 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
HB 268-OPIOID PRESCRIPTION INFORMATION
3:15:56 PM
CHAIR SPOHNHOLZ announced that the only 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."
3:16:40 PM
REPRESENTATIVE TARR moved to adopt the proposed committee
substitute (CS) for SSHB 268, labeled 30-LS1081\R, Radford,
2/9/18, as the working draft.
3:16:54 PM
CHAIR SPOHNHOLZ objected for discussion purposes.
3:17:03 PM
REPRESENTATIVE LES GARA, Alaska State Legislature, as sponsor of
the proposed bill, paraphrased from the Explanation of Changes
[Included in members' packets], which read:
Section 3. (15) Line 5: Clarified the bill applies to
outpatient prescriptions only. Added the term
"outpatient supply" before "of an opioid to a
patient." in order to further define situations in
which a prescriber must provide patient information
about opioid medication. The term "outpatient supply"
is used in law currently.
? Concurring changes for all prescribing
professions follow in:
o Section 4 (a) Line 8
o Section 5 (15) Line 1
o Section 6 (a) Line 4
o Section 7 (13) Line 30
o Section 8 (a) Line 2
o Section 9 (12) Line 2
o Section 10 (a) Line 5
Section 4 (C)(iii). Lines 20-21: Language removed
requiring prescriber give information to a patient on
heroin addiction and the connection between opioid
prescription drug addiction and heroin use. Changed
"health danger" to "health risks". Now reads that a
prescriber must provide information on how "opioid
addiction may pose potentially life threatening health
risks".
? Concurring changes for all prescribing
professions follow in:
o Section 6, C, iii, Line 17-18
o Section 8, C, iii, Line 17-18
o Section 10, C, iii, Lines 18-19
3:19:18 PM
REPRESENTATIVE GARA presented a PowerPoint, titled "HB 268
Opioid Prescription Warnings." He directed attention to slide
1, "The Nationwide Opioid Epidemic," and reported that about
14,000 people die each year from prescription opioid misuse. He
added that, since 1999, the per capita usage of opioid
prescriptions had tripled, with as many as 1 in 4 people
receiving a long-term prescription for opioids in a primary care
setting while struggling with addiction. He moved on to slide
2, "The Alaskan Opioid Epidemic," and declared that the opioid
death rate in Alaska was, on a per capita basis, twice the
national average and that the heroin associated overdose death
rate was 50 percent higher than the national average. He
declared that opioid use and heroin use was a crisis worldwide.
3:20:48 PM
REPRESENTATIVE GARA addressed slide 3, "Extended Opioid Use
Raises Risk of Addiction," stating that the longer the use of an
opioid, the higher the chance of long term dependence, and then,
possible addiction. He shared slide 4, "Link Between Opioid
Abuse and Heroin Addiction," and relayed that 80 percent of
heroin users started out using opioid and other pain killing
prescriptions.
3:21:49 PM
REPRESENTATIVE GARA directed attention to slide 5, "HB 268," and
stated that this was a requirement of the licensee, which read
in part: "shall provide to the patient or the person authorized
to make health care decisions for the patient..." He moved on
to slide 6, "Oral Statement," and paraphrased the slide, which
read [original punctuation provided]:
An oral statement which in the licensee's or agent's
own words, includes: The licensee's reasons for
prescribing the opioid; any reasonable non-opioid
alternatives to the prescription: Information that:
the prescription could potentially lead to opioid
addiction, the danger of opioid addiction can begin to
increase if a prescription is extended over longer
periods of time, [and] opioid addiction may pose
potentially life-threatening health risks.
3:22:51 PM
REPRESENTATIVE GARA shared slide 7, "Making HB 268 Effective
Without Hurting Doctor-Patient Relationship," and stated that,
as the proposed bill did not intend to interfere with the
patient-provider relationship, there was no civil liability for
any violation of the proposed bill and that prescribers were
allowed the right to make honest mistakes if not following the
dictates of the proposed bill. He added that there was an
enforcement mechanism through the boards of each profession, if
a prescriber habitually violated the law.
REPRESENTATIVE GARA turned to slide 8, "Written Statement,"
noting that the Department of Health and Social Services would
put this on-line for the provider. He said that the department
could decide what information was necessary to provide.
3:24:47 PM
REPRESENTATIVE GARA concluded with slide 9, "CDC Checklist for
Prescribing Opioids," and explained that, although the dangers
from opioids were known, not all providers tell patients about
these dangers. He emphasized that the proposed bill was "an
information bill, this is a full disclosure bill to patients."
He shared his personal experiences with prescriptions for
opioids, stating that he had never been warned of the dangers
from opioid use. He reported on his discussions with many
people and shared that these warnings were not commonly
discussed. He added that the Centers for Disease Control and
Prevention (CDC) was aware that the warnings were not being
offered in all prescriber offices. He pointed out that the CDC
guidelines were voluntary and was even more comprehensive than
the proposed bill.
3:26:27 PM
REPRESENTATIVE JOHNSTON asked how this would be made effective.
REPRESENTATIVE GARA explained that, as the proposed bill had to
be written allowing for the board mechanisms of each profession,
each board should tell its members.
REPRESENTATIVE JOHNSTON shared an anecdote about a visit to a
clinic which had not posted the price estimates.
REPRESENTATIVE GARA said that, although he did not have a
concern, the proposed bill could be amended to ask the boards to
notify their membership.
3:28:15 PM
CHAIR SPOHNHOLZ shared that, as there were professional
organizations for each of these health care providers, the
proposed legislation would be well tracked.
3:28:46 PM
REPRESENTATIVE GARA returned attention to slide 9 and pointed
out that the mandatory requirements of the bill were lesser than
those requirements from the CDC guidelines. He pointed out that
the CDC had become involved because this was an epidemic. He
allowed that this bill would not end the opioid epidemic,
although it was necessary to have informed patients and informed
parents to watch the use of prescriptions.
3:30:00 PM
REPRESENTATIVE SULLIVAN-LEONARD asked if there was currently a
mandate to post the message for opioid use in a conspicuous
place.
REPRESENTATIVE GARA explained that he did not want to
overregulate and that a short verbal statement was the most
important as often people did not read what they were given.
3:31:10 PM
REPRESENTATIVE SULLIVAN-LEONARD asked how to follow up.
REPRESENTATIVE GARA explained that this was not mandated on
providers and there was not any liability. He offered his
belief that the provider would give a short verbal statement to
the patient.
3:32:03 PM
REPRESENTATIVE SULLIVAN-LEONARD asked if habitual offenders were
those patients who continually obtained prescriptions from a
specific medical professional.
REPRESENTATIVE GARA explained that the habitual language was
directed to each board and would be left to each board for
enforcement authority.
3:33:32 PM
CHAIR SPOHNHOLZ asked if enforcement would take place through
the boards and that, if patients make numerous complaints, the
boards would step in.
REPRESENTATIVE GARA replied "that's correct."
3:34:32 PM
REPRESENTATIVE SULLIVAN-LEONARD asked if the state medical board
was receiving a lot of complaints of physicians overprescribing
opioids.
REPRESENTATIVE GARA explained that the CDC action reflected that
this information was not always given. He questioned whether
the failure to provide this information had statistically lead
to a higher incidence of opioid addiction. He pointed out that
sharing information allowed patients to protect themselves.
3:36:01 PM
CHAIR SPOHNHOLZ removed her objection. There being no further
objection, Version R was adopted as the working draft.
3:36:19 PM
CHAIR SPOHNHOLZ opened public testimony on HB 268.
3:36:30 PM
ANNE ZINK, Alaska American College of Emergency Physicians,
paraphrased from her letter, dated February 21, 2018, [Included
in members' packets] [original punctuation provided] which read:
I appreciate your time and considering this testimony
for HB 268, Opioid Prescription Writing on behalf of
Alaska ACEP (American College of Emergency Physicians)
a local group representing more than 80% of the
emergency medicine physicians in Alaska.
3:36:48 PM
I am a full time practicing Emergency Physicians at
Mat-Su Regional Hospital in Palmer Alaska and have
spoken before on the need to better address the opioid
epidemic facing our great state.
In the Emergency Department we see both the best and
worst of opioids. When a tragic accident leaves a
patient mutilated and in agony, or an elder suffering
from the intense pain of metastatic cancer and its
resultant fractures, opioids play a critical role.
Opioids ability to provide relief from pain and
suffering remain important. We also see the
destruction that opioids wreak on patients lives, the
overdoses, and the violent threats for opioids if they
are not delivered on demand. We see a generation that
expects (and demands) a pain free life. As physicians,
we have been inappropriately incentivized to both make
our patients "satisfied" and "do everything possible
to alleviate pain". The combination of these factors,
along with aggressive marketing by the pharmaceutical
industry, have contributed to the nightmare of the
opioid epidemic we see today.
As Emergency Physicians, we recognize the critical
role that physicians and the broader medical system
play in both addressing the opioid epidemic that
exists today, as well as preventing Alaskans from
becoming embroiled in the opioid epidemic in the
future. We have worked with DHSS to create guidelines
for how opioids should be prescribed in the Emergency
Department. We are implementing IT fixes across the
state, so we can more easily identify patients at risk
for opioid addiction and overdose sooner. In
conjunction with DHSS, we are finalizing an opioid
education handout that discusses many of the aspects
of pain and opioid use and abuse called for in HB 268.
Statewide, we now have a CME requirement related to
opioids. Our state chapter of ACEP, National ACEP, and
the broader house of medicine have all recognized the
tragedy of medical opioid use and the link to opioid
addiction.
3:37:38 PM
In general, as physicians, we are concerned when
legislation inserts itself into the conversations and
relationships we have with our patients. We are
concerned by moves in other states where key issues
regarding health of patients were legislatively
prohibited from being discussed. We see the patient /
physician relationship as a special and very personal
space that we fight hard to protect.
HB 268 appears to be legislating something that we
believe physicians should be doing for their patients.
As emergency physicians we fully embrace the
importance of the risk-benefit- alternative discussion
between provider and patient any time a potentially
hazardous test or treatment is being considered. The
decision to use opioids or not certainly falls into
this category. Our hope is that with all the attention
being paid to opioids by both the house of medicine
and society in general, these conversations are
already happening.
We all play a role in creating a happy and healthy
society. We need our medical system to be better
stewards of the opioids they prescribe and administer,
we need physicians to not be graded on "ending pain",
we need better patient education about the risk and
alternatives for these medication, we need better
information systems that let providers know what
treatment a patient has received elsewhere, and we
need treatment options available for patients seeking
recovery. HB 268 may help encourage a conversation we
believe in and is in line with many other steps this
body and others have taken end this epidemic. If this
bill does pass, we would suggest the addition of a
sunset clause to ensure limited health care resources
are being devoted to the most appropriate location.
Thank you for your time and consideration and
accepting this written testimony. Please feel free to
reach out with any questions or concerns.
3:38:38 PM
REPRESENTATIVE TARR asked about the opioid prescribing
guidelines for emergency room departments.
DR. ZINK explained that the Medicaid redesign two years prior,
Senate Bill 74, included the creation of opiate guidelines for
the emergency departments. She reported that during the
numerous town hall meetings with emergency room physicians, the
CDC guidelines were reviewed for what made sense, and an opiates
guideline for the emergency departments, which followed the CDC
recommendations, was created. She stated that these guidelines
had transformed much of the conversation in the emergency
department, resulting in dramatically fewer opiates prescribed
from the emergency departments. She declared that the
guidelines were helpful and allowed for more consistent care
that did not have to involve opiates. She noted that there was
currently work on the development of a handout educating
patients about opiate and non-opiate alternatives.
3:42:05 PM
SHELIS JORGENSEN, Medical Director, Alaska Sunshine Community
Health Center, shared some background about the clinic,
reporting that the center served about 6,500 community members
for their primary medical, behavioral, and dental health care.
She reported that they had an out-patient opiate addiction
program. She explained that patients with pain issues were
screened for depression and anxiety, for alcohol or substance
use, and were required to meet with a behavioral health
provider. The clinic used a standardized opiate risk assessment
tool, did random urine drug screening, and used the Alaska
prescription drug monitoring program for every controlled
substance prescription. She shared that the clinic had written
procedures, as all the providers could dispense nasal Narcan.
She reported that the clinic counselled its patients on the
risks and benefits of any medication, especially any opiate
medications, as well as any alternative treatments and
therapies. She noted that the clinic included pain management
in its peer review process. She declared that this was not a
simple issue, as a patient in pain wanted information and a
thoughtful evaluation for the best course of treatment that
would relieve their suffering with the lowest risk. She stated
her support of the proposed bill and offered that the proposed
bill would hold providers to a minimum level of accountability
for conversations with their patients.
3:47:56 PM
REPRESENTATIVE TARR opined that the proposed bill was not
onerous, noting that her clinic was already taking advantage of
those opportunities.
MS. JORGENSEN replied that it would complement their practice
and that solid research had shown the success for conversation
and written information.
3:49:01 PM
ALISON KULAS, Executive Director, Advisory Board on Alcoholism &
Drug Abuse, Alaska Mental Health Board, Division of Behavioral
Health, Department of Health and Social Services, referenced two
letters of support [Included in members' packets] and
paraphrased from her letter dated February 7, 2018, which read
in part:
We believe opioid prescribers should talk to their
patients about the potential addictive qualities of
opioids and discuss other treatment options while
following the state prescribing guidelines. We are
aware that the Department of Health and Social
Services is developing patient information brochures
and we fully support the distribution of these
materials when prescribing opioids. Taken together,
patients will be able to make informed choices about
their healthcare.
We appreciate your hope to keep the requirements
flexible and as non-burdensome as possible. Working
with the licensing boards to offer providers training
and support on the interagency prescribing guidelines
and encouraging providers to educate their patients
will help turn the tide on opioid addiction.
3:51:56 PM
SARA CHAMBERS, Deputy Director, Juneau Office, Division of
Corporations, Business, and Professional Licensing, Department
of Commerce, Community & Economic Development, explained that
the investigative process for the licensing programs would
include an in-take process for a complaint, talk with the
provider, and review of the patient record for any notes. She
added that the board action threshold defined by the proposed
bill was that an infraction had to be habitual and without good
cause. As habitual was defined as "customary or usual," it
would require review of the records of multiple patients, who
may not be aware of this, to determine whether the "provider was
habitually and without good cause breaking the law." She added
that good cause was defined as "a legally sufficient reason," so
there would need to be a threshold. She pointed out that the
legally sufficient reason would be paired with the habituality.
She explained that "the nuts and bolts of the investigation
would be predicated on one complaint from one person."
3:55:23 PM
CHAIR SPOHNHOLZ mused that a single complaint could predicate an
investigation, but action would not necessarily be taken unless
it met the fairly high threshold for this being habitual.
MS. CHAMBERS mentioned that currently the Alaska State Medical
Board and the Alaska Board of Nursing did have requirements in
regulation which required patient education and informed
consent. She added that the Board of Dental Examiners did not
currently have these regulations while the Board of Optometry
was working on them. She noted that the division was looking at
this change of culture from the providers.
CHAIR SPOHNHOLZ clarified that optometrists have had the
authority to prescribe opiates for some time.
3:57:13 PM
CHAIR SPOHNHOLZ closed public testimony. She said that HB 268
would be held over.
| Document Name | Date/Time | Subjects |
|---|---|---|
| SSHB268 Sectional Analysis ver O 1.24.18.pdf |
HHSS 1/30/2018 3:00:00 PM HHSS 2/22/2018 3:00:00 PM HHSS 2/27/2018 3:00:00 PM HHSS 3/6/2018 3:00:00 PM |
HB 268 |
| SSHB268 Sponsor Statement 1.24.18.pdf |
HHSS 1/30/2018 3:00:00 PM HHSS 2/22/2018 3:00:00 PM HHSS 2/27/2018 3:00:00 PM HHSS 3/6/2018 3:00:00 PM |
HB 268 |
| SSHB268 Supporting Document-AK DHSS Opioid Addiction and Treatment Factsheet 1.24.18.pdf |
HHSS 1/30/2018 3:00:00 PM HHSS 2/22/2018 3:00:00 PM HHSS 2/27/2018 3:00:00 PM HHSS 3/6/2018 3:00:00 PM |
HB 268 |
| SSHB268 Supporting Document-AK DHSS Opioid Infographic 1.24.18.pdf |
HHSS 1/30/2018 3:00:00 PM HHSS 2/22/2018 3:00:00 PM HHSS 2/27/2018 3:00:00 PM HHSS 3/6/2018 3:00:00 PM |
HB 268 |
| SSHB268 Supporting Document-AK DHSS Heroin Use Infographic 1.24.18.pdf |
HHSS 1/30/2018 3:00:00 PM HHSS 2/22/2018 3:00:00 PM HHSS 2/27/2018 3:00:00 PM HHSS 3/6/2018 3:00:00 PM |
HB 268 |
| SSHB268 Supporting Document-AK DHSS Pain Treatment Handout 1.24.18.pdf |
HHSS 1/30/2018 3:00:00 PM HHSS 2/22/2018 3:00:00 PM HHSS 2/27/2018 3:00:00 PM HHSS 3/6/2018 3:00:00 PM |
HB 268 |
| SSHB268 Supporting Document-AMA Study 1.24.18.pdf |
HHSS 1/30/2018 3:00:00 PM HHSS 2/22/2018 3:00:00 PM HHSS 2/27/2018 3:00:00 PM HHSS 3/6/2018 3:00:00 PM |
HB 268 |
| SSHB268 Supporting Document-Article ADN AK Gov. Opioid Declaration 1.24.18.pdf |
HHSS 1/30/2018 3:00:00 PM HHSS 2/22/2018 3:00:00 PM HHSS 2/27/2018 3:00:00 PM HHSS 3/6/2018 3:00:00 PM |
HB 268 |
| SSHB268 Supporting Document-Article Huffington Post 1.24.18.pdf |
HHSS 1/30/2018 3:00:00 PM HHSS 2/22/2018 3:00:00 PM HHSS 2/27/2018 3:00:00 PM HHSS 3/6/2018 3:00:00 PM |
HB 268 |
| SSHB268 Supporting Document-Article New Yorker 1.24.18.pdf |
HHSS 1/30/2018 3:00:00 PM HHSS 2/22/2018 3:00:00 PM HHSS 2/27/2018 3:00:00 PM HHSS 3/6/2018 3:00:00 PM |
HB 268 |
| SSHB268 Supporting Document-Article NIDA 1.24.18.pdf |
HHSS 1/30/2018 3:00:00 PM HHSS 2/22/2018 3:00:00 PM HHSS 2/27/2018 3:00:00 PM HHSS 3/6/2018 3:00:00 PM |
HB 268 |
| SSHB268 Supporting Document-Article The Star Press Opioids and Foster Care Indiana 1.24.18.pdf |
HHSS 1/30/2018 3:00:00 PM HHSS 2/22/2018 3:00:00 PM HHSS 2/27/2018 3:00:00 PM HHSS 3/6/2018 3:00:00 PM |
HB 268 |
| SSHB268 Supporting Document-Article VOX 1.24.18.pdf |
HHSS 1/30/2018 3:00:00 PM HHSS 2/22/2018 3:00:00 PM HHSS 2/27/2018 3:00:00 PM HHSS 3/6/2018 3:00:00 PM |
HB 268 |
| SSHB268 Supporting Document-CDC Checklist for Opioid Prescribers 1.24.18.pdf |
HHSS 1/30/2018 3:00:00 PM HHSS 2/22/2018 3:00:00 PM HHSS 2/27/2018 3:00:00 PM HHSS 3/6/2018 3:00:00 PM |
HB 268 |
| SSHB268 Supporting Document-CDC Patient Opioid Fact Sheet 1.24.18.pdf |
HHSS 1/30/2018 3:00:00 PM HHSS 2/22/2018 3:00:00 PM HHSS 2/27/2018 3:00:00 PM |
HB 268 |
| SSHB268 Supporting Document-New Jersey Legislature Relevant Opioid Statutes Doc 1.24.18.pdf |
HHSS 1/30/2018 3:00:00 PM HHSS 2/22/2018 3:00:00 PM HHSS 2/27/2018 3:00:00 PM HHSS 3/6/2018 3:00:00 PM |
HB 268 |
| SSHB268 Supporting Document-NJAFP Notice RE New Jersey Opioid Law 1.24.18.pdf |
HHSS 1/30/2018 3:00:00 PM HHSS 2/22/2018 3:00:00 PM HHSS 2/27/2018 3:00:00 PM |
HB 268 |
| SSHB268 Supporting Document-STUFF Online Article on Alternative Pain Treatment in NZ 1.24.18.pdf |
HHSS 1/30/2018 3:00:00 PM HHSS 2/22/2018 3:00:00 PM HHSS 2/27/2018 3:00:00 PM HHSS 3/6/2018 3:00:00 PM |
HB 268 |
| SSHB 268 Fiscal Note DCCED-CBPL 01.29.18.pdf |
HHSS 1/30/2018 3:00:00 PM HHSS 2/22/2018 3:00:00 PM HHSS 2/27/2018 3:00:00 PM HHSS 3/6/2018 3:00:00 PM |
HB 268 |
| SSHB268 Explanation of Changes (O-R).pdf |
HHSS 2/22/2018 3:00:00 PM HHSS 2/27/2018 3:00:00 PM HHSS 3/6/2018 3:00:00 PM |
HB 268 |
| SSHB268 Supporting Document--Anne Zink Support Letter 2.21.18.pdf |
HHSS 2/22/2018 3:00:00 PM HHSS 3/6/2018 3:00:00 PM |
HB 268 |
| SSHB268 Supporting Document--Memos from Leg Legal 2.21.18.pdf |
HHSS 2/22/2018 3:00:00 PM HHSS 2/27/2018 3:00:00 PM HHSS 3/6/2018 3:00:00 PM |
HB 268 |
| SSHB268 Supporting Document--Support Letters 2.14.18.pdf |
HHSS 2/22/2018 3:00:00 PM HHSS 2/27/2018 3:00:00 PM HHSS 3/6/2018 3:00:00 PM |
HB 268 |
| SSHB268 Draft Proposed Blank CS ver R 2.14.18.pdf |
HHSS 2/22/2018 3:00:00 PM HHSS 2/27/2018 3:00:00 PM HHSS 3/6/2018 3:00:00 PM |
HB 268 |