Legislature(2017 - 2018)CAPITOL 106

02/22/2018 03:00 PM HEALTH & SOCIAL SERVICES

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Audio Topic
03:15:35 PM Start
03:15:56 PM HB268
03:58:16 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+= HB 268 OPIOID PRESCRIPTION INFORMATION TELECONFERENCED
Heard & Held
-- Public Testimony --
+ Bills Previously Heard/Scheduled 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