Legislature(2017 - 2018)SENATE FINANCE 532

05/25/2017 09:00 AM FINANCE

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Audio Topic
09:02:26 AM Start
09:03:37 AM SB79
10:31:01 AM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
Heard & Held
Invited Testimony: Senator Cathy Giessel
Member, Alaska Opioid Policy Task Force
+ Bills Previously Heard/Scheduled TELECONFERENCED
SENATE BILL NO. 79                                                                                                            
     "An  Act  relating  to  the  prescription  of  opioids;                                                                    
     establishing  the  Voluntary Nonopioid  Directive  Act;                                                                    
     relating  to  the   controlled  substance  prescription                                                                    
     database;  relating  to   the  practice  of  dentistry;                                                                    
     relating to  the practice of medicine;  relating to the                                                                    
     practice  of  podiatry;  relating to  the  practice  of                                                                    
     osteopathy;  relating  to   the  practice  of  nursing;                                                                    
     relating to the practice  of optometry; relating to the                                                                    
     practice of veterinary medicine;  related to the duties                                                                    
     of  the  Board  of   Pharmacy;  and  providing  for  an                                                                    
     effective date."                                                                                                           
9:03:37 AM                                                                                                                    
SENATOR CATHY  GIESSEL, announced  that she had  listened to                                                                    
the  committee's questions  from the  previous meeting.  She                                                                    
wanted to share her thoughts based on her experience.                                                                           
9:07:08 AM                                                                                                                    
Senator  Giessel shared  a  story of  a  violent person  who                                                                    
acted in an extreme manner.                                                                                                     
9:10:39 AM                                                                                                                    
Senator Giessel  discussed the  history of  the Prescription                                                                    
Drug Monitoring Program (PDMP).                                                                                                 
9:12:17 AM                                                                                                                    
Senator Giessel  explained the history of  the Alaska Opioid                                                                    
Policy Task Force.                                                                                                              
9:13:01 AM                                                                                                                    
Senator  Giessel  referenced  a  presentation  titled,  "The                                                                    
Science of Opioid Use Disorder" (copy on file).                                                                                 
9:26:01 AM                                                                                                                    
Senator  Giessel noted  that the  bill addressed  dosage, or                                                                    
rather only addressed duration.  She shared a statement from                                                                    
the  Tennessee  Board of  Nursing.  She  announced that  the                                                                    
morphine milligram  equivalent (MME)  was used  to prescribe                                                                    
opioids. She stated  that all clinicians have  access to the                                                                    
9:35:18 AM                                                                                                                    
Co-Chair  MacKinnon remarked  that  there  was an  assertion                                                                    
from  the Board  of Pharmacy  that the  manufacturer of  the                                                                    
medication had set dosage guidelines.  She wondered how that                                                                    
dosage was determined. Senator Giessel replied that                                                                             
Co-Chair  MacKinnon remarked  that  there  was an  assertion                                                                    
that there  was a reliance  on the drug  company's suggested                                                                    
dosage.  She  remarked  that some  may  not  understand  the                                                                    
possibility  of  overprescribing.  Senator  Giessel  replied                                                                    
that there  was a  need for  continuing education  to inform                                                                    
the clinicians.                                                                                                                 
9:39:49 AM                                                                                                                    
Senator Hughes  wondered whether  the size  of a  person was                                                                    
considered  in the  dosage amount.  Senator Giessel  replied                                                                    
that size was not considered.                                                                                                   
Senator Hughes queried  the alignment with the  bill and the                                                                    
task force's  recommendations. Senator Giessel  replied that                                                                    
many  recommendations were  in the  bill, but  did not  know                                                                    
whether the recommendations were the  basis of the bill. She                                                                    
deferred to Dr. Butler.                                                                                                         
9:41:58 AM                                                                                                                    
JAY BUTLER, CHIEF MEDICAL OFFICER,  DEPARTMENT OF HEALTH AND                                                                    
SOCIAL SERVICES,  ANCHORAGE (via  teleconference), announced                                                                    
that  the   recommendations  of  the  task   force  were  an                                                                    
important informative factor in the drafting of the bill.                                                                       
Co-Chair  MacKinnon queried  the  seven-day limit  decision.                                                                    
Dr. Butler replied  that, in general, the  discussion in the                                                                    
task force  focused on  the guidelines  from the  Center for                                                                    
Disease Control (CDC).                                                                                                          
Co-Chair MacKinnon  remarked that the CDC  had a recommended                                                                    
dosage.  She  wondered  why   that  recommendation  was  not                                                                    
included in  the bill. Dr.  Butler replied that the  CDC had                                                                    
guidelines.  He did  not  want  to be  too  specific in  the                                                                    
dosage. He  stressed that the focus  was on the size  of the                                                                    
Senator  Hughes  wondered  whether   the  state  boards  had                                                                    
adopted  CDC  guidelines.  Senator Giessel  replied  in  the                                                                    
9:50:21 AM                                                                                                                    
SARA  CHAMBERS, DEPUTY  DIRECTOR, DIVISION  OF CORPORATIONS,                                                                    
BUSINESS,   AND   PROFESSIONAL  LICENSING,   DEPARTMENT   OF                                                                    
COMMERCE,  COMMUNITY  AND  ECONOMIC  DEVELOPMENT,  explained                                                                    
that   the  legislature   had   recently  requested   opioid                                                                    
guidelines  from  all  boards.   She  stated  that  the  CDC                                                                    
guidelines  had   recommended  the  state   of  Washington's                                                                    
Interagency   Guideline   on  Opioid   Prescriptions,   with                                                                    
lowering the morphine equivalent to 90.                                                                                         
Senator Hughes  wondered whether  the board were  creating a                                                                    
similar  regulation. Ms.  Chambers replied  that the  boards                                                                    
were  at different  stages  of  regulation development.  She                                                                    
stated that the bill would accommodate the flexibility.                                                                         
Co-Chair MacKinnon  queried additional comments.  Dr. Butler                                                                    
shared that one  in twenty people were still  on opioids one                                                                    
year after their first dose.                                                                                                    
10:00:10 AM                                                                                                                   
Co-Chair MacKinnon  remarked that the bill  addressed end of                                                                    
life issues  that allowed doctors  to keep patients  on long                                                                    
term opioid  prescriptions. She noted  that there  were many                                                                    
medications left after  someone that she knew  had died, and                                                                    
then taken  by law  enforcement. She wondered  whether there                                                                    
was  a way  to track  the opioids.  Dr. Butler  replied that                                                                    
leftover pills were often put  into the community. He stated                                                                    
that  there  were  not  mechanisms  for  tracking  dispensed                                                                    
opioids. He remarked  he had worked with  hospice to provide                                                                    
activated  charcoal  to  neutralize   the  opioid  safe  for                                                                    
disposal in a landfill.                                                                                                         
10:05:46 AM                                                                                                                   
Co-Chair  MacKinnon remarked  that  there were  intermittent                                                                    
drug disposal  opportunities in  her community.  She queried                                                                    
disposal recommendations, and whether  that was addressed in                                                                    
the bill.  Dr. Butler replied  that it was  not specifically                                                                    
addressed  in   the  bill.   He  supported   drug  take-back                                                                    
10:11:06 AM                                                                                                                   
Vice-Chair  Bishop  wondered  whether the  damage  could  be                                                                    
reversed. Senator Giessel replied  that Vivitrol may be able                                                                    
to reverse the effects of addiction.                                                                                            
Co-Chair   MacKinnon  wondered   whether   the  effects   of                                                                    
addiction could be reversed. Dr.  Butler replied that it was                                                                    
unknown whether the effects of addiction could be reversed.                                                                     
10:16:19 AM                                                                                                                   
Senator  Olson remarked  that many  studies  noted that  the                                                                    
receptors were scarred after drug abuse.                                                                                        
Vice-Chair  Bishop wondered  whether  was a  way  to make  a                                                                    
first  prescription  a  lower  equivalent.  Senator  Giessel                                                                    
replied  that  there  should  be  a  clarification  that  90                                                                    
milligrams  a  day  of  morphine  level  equivalent  is  the                                                                    
maximum dosage.                                                                                                                 
Co-Chair  MacKinnon recalled  that there  was a  working day                                                                    
issue, and wondered whether there  was adequate language for                                                                    
the expectation  of a possible  dispensary day  closure. Ms.                                                                    
Chambers  replied that  the Board  of Pharmacy  allowed some                                                                    
pharmacies  to opt-out,  because they  were not  engaging in                                                                    
activity that  required reporting. She stated  that the opt-                                                                    
out option would  extend to the pharmacy's day  off from the                                                                    
10:22:19 AM                                                                                                                   
Co-Chair  MacKinnon wondered  whether  the  language in  the                                                                    
bill   was  sufficient.   Ms.   Chambers   replied  in   the                                                                    
Co-Chair  MacKinnon announced  that  there was  a series  of                                                                    
questions that had been submitted to the administration.                                                                        
Senator  Olson   appreciated  the  perspective   of  Senator                                                                    
Giessel's presentation.                                                                                                         
Co-Chair  MacKinnon  wanted to  involve  the  boards in  the                                                                    
10:26:58 AM                                                                                                                   
Co-Chair Hoffman shared that the  main issue in rural Alaska                                                                    
was  mail order  drugs.  He wondered  how  other states  and                                                                    
countries  approached the  issue.  Dr.  Butler replied  that                                                                    
there should be a multifaceted approach.                                                                                        
Senator Giessel stated that the drugs were going into the                                                                       
villages through air freight, and there was a bill that                                                                         
addressed the issue currently in the legislature.                                                                               
SB 79 was HEARD and HELD in committee for further