Legislature(2017 - 2018)SENATE FINANCE 532

05/11/2017 09:00 AM FINANCE

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Heard & Held
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SENATE BILL NO. 79                                                                                                            
     "An  Act  relating  to  the  prescription  of  opioids;                                                                    
     establishing  the  Voluntary Nonopioid  Directive  Act;                                                                    
     relating  to  the   controlled  substance  prescription                                                                    
     database;  relating  to   the  practice  of  dentistry;                                                                    
     relating to  the practice of medicine;  relating to the                                                                    
     practice  of  podiatry;  relating to  the  practice  of                                                                    
     osteopathy;  relating  to   the  practice  of  nursing;                                                                    
     relating to the practice  of optometry; relating to the                                                                    
     practice of veterinary medicine;  related to the duties                                                                    
     of  the  Board  of   Pharmacy;  and  providing  for  an                                                                    
     effective date."                                                                                                           
9:14:56 AM                                                                                                                    
DOCTOR  JAY  BUTLER,  CHIEF  MEDICAL  OFFICER,  DIVISION  OF                                                                    
PUBLIC  HEALTH, DEPARTMENT  OF HEALTH  AND SOCIAL  SERVICES,                                                                    
(DHSS) explained  the reason for the  legislation. He shared                                                                    
that more  than 90 Alaskans  died of an opioid  overdose the                                                                    
year  prior,  which  was  more  than  twice  the  number  of                                                                    
Alaskans who died  of AIDS at the peak of  the HIV epidemic.                                                                    
He stated that an opioid  overdose represented nearly one in                                                                    
every  forty deaths  that  occurred in  the  state the  year                                                                    
prior. He shared that two-thirds  of those deaths involved a                                                                    
prescription opioid. He remarked  that the majority of those                                                                    
people who use heroin and  other illicit opioids report that                                                                    
they first  became addicted  using prescription  opioids. He                                                                    
stressed  that  often  the  opioids  were  obtained  from  a                                                                    
trusted and  well-meaning health care provider.  He stressed                                                                    
that  the  state  was  responding  to  the  opioid  epidemic                                                                    
through  community  coalitions,  citizen action,  and  state                                                                    
government. He shared that SB  91 was passed and signed into                                                                    
law in March 2017, which  authorized increased access to the                                                                    
life-saving drug Naloxone.                                                                                                      
Co-Chair    MacKinnon    acknowledged   Senator    Giessel's                                                                    
participation in the bill process.                                                                                              
9:16:59 AM                                                                                                                    
Dr. Butler  echoed stated  that there  were many  people who                                                                    
were saved by the Naloxone  kits. He remarked that the kits,                                                                    
however,  did  not address  some  of  the underlying  issues                                                                    
surrounding  the opioid  epidemic. He  stated that  the kits                                                                    
did not  support those  in recovery  who wanted  to maintain                                                                    
their  sobriety. He  remarked  that the  kits  also did  not                                                                    
address some  of the underlying  factors in the  increase of                                                                    
opioid use and addiction.                                                                                                       
9:33:19 AM                                                                                                                    
Senator  von Imhof  wondered what  happened to  the reports,                                                                    
and  what occurred  with  a pattern  and  whether there  was                                                                    
action on those  trends. Dr. Butler replied  that the intent                                                                    
of  the bill  was for  authorization for  the Department  of                                                                    
Commerce,  Community  and  Economic Development  (DCCED)  to                                                                    
issue the report card. He  stressed that there was currently                                                                    
no legal authority to issue  that report. He stated that the                                                                    
information to the provider was solely for that provider.                                                                       
Senator  von Imhof  surmised that  the bill  would create  a                                                                    
database that showed all the  prescriptive drug behavior for                                                                    
all health care  providers in the state.  Dr. Butler replied                                                                    
that there  would not be  a new database, but  enhancing the                                                                    
existing  database.  He stated  that  the  database was  for                                                                    
controlled substances only.                                                                                                     
9:36:22 AM                                                                                                                    
Senator Hughes  expressed concern about the  opioid epidemic                                                                    
in  the  state. She  wanted  to  ensure  that the  bill  was                                                                    
addressed the real problem. She  felt that there might be "a                                                                    
few bad apples" in the  state who were over-prescribing. She                                                                    
remarked that  the Division  of Public  Health did  not have                                                                    
the  authority to  forward names  to the  board, but  rather                                                                    
could only  recognize trends. She wondered  whether the data                                                                    
showed  that  most  prescribers  were  contributing  to  the                                                                    
problem,  or was  it only  a few  prescribers. She  wondered                                                                    
whether the suspicious activity  should be investigated, and                                                                    
then  forward that  information to  the appropriate  boards.                                                                    
Dr. Butler agreed  that there were remarkable  efforts and a                                                                    
robust recovery community in the  Mat-Su. He stated that the                                                                    
broader nationwide  data showed that  more than half  of the                                                                    
prescribed  opioids came  from  primary  care providers.  He                                                                    
stated that  the authority  to pursue  problematic providers                                                                    
was within the boards in DCCED.                                                                                                 
9:42:16 AM                                                                                                                    
Senator  Hughes wondered  whether the  various boards  could                                                                    
look at  the Prescription Drug Monitoring  Program (PDMP) to                                                                    
determine the  outliers. She understood that  the boards did                                                                    
not have that  authority. Dr. Butler replied  that there was                                                                    
an issue  with staffing. The  PDMP manager was  currently in                                                                    
recruitment. He stated that there  were red flagged criteria                                                                    
for behavior  related to the  number of prescribers  and the                                                                    
number of pharmacies visited over a set period of time.                                                                         
Senator Hughes felt  that there needed to  be an examination                                                                    
of  the over-prescribers  that were  shown in  the database.                                                                    
She  wondered whether  there needed  to be  a specific  name                                                                    
assigned in the database,  rather than locations and trends.                                                                    
Dr. Butler deferred to Ms. Chambers.                                                                                            
9:45:08 AM                                                                                                                    
SARA  CHAMBERS, DEPUTY  DIRECTOR,  DIVISION OF  CORPORATIONS                                                                    
BUSINESS   AND   PROFESSIONAL   LICENSING,   DEPARTMENT   OF                                                                    
COMMERCE,  COMMUNITY  AND  ECONOMIC  DEVELOPMENT,  responded                                                                    
that the  boards were  recently given  authority to  get the                                                                    
high-level trending non-specific  information, and authority                                                                    
to issue  license discipline if the  prescription drugs were                                                                    
not used  within generally safe  practices. She  agreed that                                                                    
that the  boards did not have  the ability to view  the PDMP                                                                    
and  transmit  the  information on  a  specific  prescriber,                                                                    
unless   there  was   a  subpoena.   She  stated   that  the                                                                    
legislation  expanded the  ability  to provide  information,                                                                    
through  a  subpoena,  to  a  law  enforcement  agency.  She                                                                    
stressed that the PDMP was  not currently used as a punitive                                                                    
investigative tool,  but remarked that it  could change with                                                                    
a policy change.                                                                                                                
Senator Hughes surmised that the  board could only pursue an                                                                    
individual  person after  a  filed  complaint. She  wondered                                                                    
whether  the  courts  were  ever  used  in  investigating  a                                                                    
complaint. Ms. Chambers replied in the affirmative.                                                                             
Senator Hughes  hoped that  there would be  a report  to see                                                                    
whether the  PDMP manager  could have  greater investigative                                                                    
Senator Micciche felt  that the most valuable  aspect of the                                                                    
bill  was  the daily  prescription  limit.  He queried  more                                                                    
information  about the  four-day  and  seven-day limits.  He                                                                    
remarked  that  there  was  data   showing  that  a  ten-day                                                                    
prescription  could   result  in  addiction.   Ms.  Chambers                                                                    
replied that  the Optometry Board  currently had  a four-day                                                                    
limit  in statute,  so that  board was  not included  in the                                                                    
bill. She  stated that the  seven-day limit extended  to all                                                                    
other practitioners, except for veterinarians.                                                                                  
Senator Micciche felt that the limit could be successful.                                                                       
9:52:20 AM                                                                                                                    
Vice-Chair  Bishop  wondered  whether   the  bill  would  be                                                                    
addressed in  the afternoon.  Co-Chair MacKinnon  replied in                                                                    
the negative.                                                                                                                   
Vice-Chair  Bishop queried  the background  of opioids.  Dr.                                                                    
Butler responded  that opium had  been used  medicinally for                                                                    
thousands  of years.  He remarked,  however, that  opium had                                                                    
been known  to result  in addiction and  physical dependency                                                                    
for thousands  of years. He  stated that there  was approval                                                                    
in the 1990s that were introduced.                                                                                              
Co-Chair MacKinnon discussed committee business.                                                                                
Senator Olson requested more information about the boards.                                                                      
Co-Chair MacKinnon CLOSED public testimony.                                                                                     
SB  79  was   HEARD  and  HELD  in   committee  for  further                                                                    
10:00:36 AM                                                                                                                   
2:18:10 PM                                                                                                                    

Document Name Date/Time Subjects
HB 111 Work Draft version B.pdf SFIN 5/11/2017 9:00:00 AM
HB 111
HB 111 v B Sectional Analysis.pdf SFIN 5/11/2017 9:00:00 AM
HB 111
CS SB 34 v.T Explanation.pdf SFIN 5/11/2017 9:00:00 AM
SB 34
SB 34 CS SB 34 v.T.pdf SFIN 5/11/2017 9:00:00 AM
SB 34
SB 34 Air Force Letter - Real ID.pdf SFIN 5/11/2017 9:00:00 AM
SB 34
HB 111 Public Testimony Letters 4.pdf SFIN 5/11/2017 9:00:00 AM
HB 111