Legislature(2023 - 2024)BUTROVICH 205
02/28/2023 03:30 PM Senate HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| SB53 | |
| SB51 | |
| SB59 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| += | SB 53 | TELECONFERENCED | |
| *+ | SB 51 | TELECONFERENCED | |
| *+ | SB 59 | TELECONFERENCED | |
SB 51-CONTROLLED SUB. DATA: EXEMPT VETERINARIAN
3:51:04 PM
CHAIR WILSON reconvened the meeting and announced the
consideration of SENATE BILL NO. 51 "An Act exempting
veterinarians from the requirements of the controlled substance
prescription database; and providing for an effective date."
3:51:32 PM
TREVOR BAILLY, Staff, Senator Löki Tobin, Alaska State
Legislature, Juneau, Alaska, presented the following sponsor
statement for SB 51 on behalf of the sponsor:
[Original punctuation provided.]
In 2008, in response to the nationwide opioid
epidemic, the Alaska State Legislature created the
Prescription Drug Monitoring Program (PDMP). This
program created a database of prescriptions for
controlled substances in Alaska, with the stated
intent was to place obstacles in front of individuals
seeking opioids from multiple providers. In 2016, the
Legislature expanded the program to include
veterinarians. Unfortunately, the program failed to
account for the major differences between the practice
of human medicine and veterinary medicine. SB 51
addresses this conflict by exempting veterinarians
from the Prescription Drug Monitoring Program.
Eliminating the requirement for veterinarians in
Alaska to use the PDMP does not cause deregulation.
Veterinarians will continue to be covered by federal
statutes and regulated by the Drug Enforcement Agency
(DEA) and the Alaska Board of Veterinary Examiners.
Additionally, provisions in state statute will
continue to limit the number of opioids a veterinarian
can prescribe to a seven-day prescription, with two
exceptions. Those exceptions are if the prescription
is part of long-term chronic care, or if there is
logistical or travel barrier to returning within seven
days.
Prescription drug monitoring is not unique to Alaska.
All 50 states have some variation of prescription drug
monitoring, with 34 states exempting veterinarians.
Previously, 10 of those states mandated veterinarians
be part of prescription drug monitoring efforts;
however, those states soon realized that including
veterinarians had no clear benefit. Instead, these
states found that including veterinarians in their
prescription drug monitoring programs placed
unnecessary time-consuming barriers on those who
practice veterinary medicine. In Alaska, the PDMP
fails to be effective because animal patients do not
have identifiers such as social security numbers. As a
result, veterinarians must try to get the private
health data of those who seek care for their animals
prior to treating the animal. This is both inefficient
and an invasion of privacy.
Senate Bill 51 seeks to correct an overexpansion of
the Prescription Drug Monitoring Program to ensure
continued access to veterinary care in Alaska.
3:54:13 PM
MR. BAILLY presented the following sectional analysis for SB 51:
[Original punctuation provided.]
Section 1
Deletes the requirement that the Board of Veterinary
Examiners to notify the Board of Pharmacy when a
practitioner registers with the controlled substance
prescription database.
Section 2
Creates a new subsection in the controlled substance
prescription database statutes that exempts
veterinarians from the requirements of the controlled
substance prescription database.
Section 3
Repeals the subsection that requires veterinarians
register with the controlled substance prescription
database.
Section 4
The act takes effect immediately upon passage.
MR. BAILEY commented that SB 51 is an iteration of legislation
from the 32nd legislature. Although SB 51 may look substantially
different from the previous bill, it still has the same
legislative purpose and intent. The legislative legal department
made SB 51 clear and succinct while meeting the goals of the
previous legislation.
3:55:20 PM
CHAIR WILSON announced invited testimony on SB 51.
3:55:55 PM
RACHEL BERNGARTT, DMV, JD, Chair, Board of Veterinary Examiners,
Juneau, Alaska, introduced herself as a doctor of veterinary
medicine and a lawyer.
3:56:16 PM
TRACY WARD, DVM, Past-President, Board of Veterinary Examiners,
Juneau, Alaska, stated she is a veterinarian that practices
animal rescue.
3:56:32 PM
DR. BERNGARTT turned to slides 2 - 3 and said SB 51 exempts
veterinarians from the controlled substance prescription
database requirements. The Alaska State Veterinary Medical
Association (AKVMA) and the Board of Veterinary Examines (BOVE)
support SB 51. Also, the Alaska Board of Pharmacy, which
administers the PDMP, passed a motion on February 18, 2022, that
supports the exemption of veterinarians from participation.
3:57:01 PM
DR. WARD turned to slide 4 and said the PDMP was established
with voluntary participation in 2008. In 2016, House Bill 159
was amended due to the increase in opioid use in the US. The
amendment mandated participation for all actively licensed
practitioners who held a drug enforcement agency (DEA) license
to prescribe, administer, or dispense controlled substances on
the federal II, III, or IV drug schedules. The change went into
effect in 2017. The committee that was formed to discuss the
amendment included all affected boards except AKVMA and BOVE.
3:58:24 PM
DR. WARD turned to slide 5 and spoke to the following points:
[Original punctuation provided.]
2008: Alaska's PDMP established by SB 196.
2017: In reaction to growing opioid epidemic, the PDMP
was amended by via HB 159 to include all DEA permit
holders, including veterinarians.
Neither AKVMA nor BOVE were consulted regarding this
amendment.
PDMP reporting is required for all actively licensed
practitioners who hold a Federal Drug Enforcement
Agency registration number and who prescribe,
administer, or dispense federally scheduled II IV
controlled substances in the state.
4:00:02 PM
DR. WARD moved to slides 5 - 7 and discussed why it makes sense
to exempt veterinarians from the PDMP:
[Original punctuation provided.]
The PDMP is not an effective database for
veterinarians or our patients.
• The PDMP was established for human medicine.
Querying of PDMP data for animals is not possible
with the PDMP (and reported drugs for an animal
are not visible in the PDMP database).
• A query is made on the individual(s) that bring
the animal to the veterinarian and human data is
obtained, not animal data.
• Human data obtained from the PDMP query is not
usable for the veterinarian. Veterinarians are
not trained in human medicine to understand what
the dosages mean.
Querying of human PDMP information is invasion into an
individual's medical privacy.
• Clients find it intrusive when the veterinarian
is required to query their private health data in
the PDMP
• An individual's private medication information
becomes known to the veterinarian for certain
drugs, such as narcotics, sedatives, and
stimulants.
Examples of some common medications seen include, but
are not limited to: Adderall, Ritalin, anabolic
steroids such as testosterone, postpartum depression
medications, sex hormones, Xanax, Klonopin, Valium,
Ativan, Domar, and sleep aids like Ambien and Lunesta.
Veterinarians are monitored by the Drug Enforcement
Agency and must adhere to controlled substance
regulations.
• Veterinarians who prescribe or dispense
controlled substances are licensed through the
Drug Enforcement Agency (DEA). There is already a
significant level of accountability, record
keeping, and medication storage requirements that
veterinarians must adhere to.
• Distributors of controlled substances monitor
utilization patterns of veterinarians. The
Suspicious Order Monitoring System is in place
and data is gathered by distribution companies
who are required by the DEA to monitor and report
unusual purchase patterns a veterinarian may
have. Distributors are required to flag purchases
that fall outside of norms for either previous
purchase history or the norms for practices of
similar size/type. DEA oversight is to
control/prevent diversion from licensed
professionals to drug dealers and users.
4:03:03 PM
DR. BERNGARTT moved to slide 8 and spoke about why it makes
sense from a licensing perspective to exempt veterinarians from
the PDMP:
[Original punctuation provided.]
33 other states have exempted veterinarians from
participating in the PDMP.
• 10 states formerly mandated veterinary reporting
but repealed their inclusion due to the problems
experienced, lack of identified benefits to
veterinary participation, and demonstration that
exempting veterinarians does not decrease
protection of public health and safety. These
states are Alabama, Arizona, Idaho, Illinois,
Kansas, Kentucky, Louisiana, New Mexico, West
Virginia (2021), and Wyoming.
• Missouri was the last state to implement a PDMP
in 2021 and did not require veterinarians to
participate.
4:04:23 PM
DR. BERNGARTT turned to slide 9 and said the drugs most often
implicated in overdose and death are not drugs veterinarians
prescribe. The graph depicts trends in US drug overdose deaths
from 1999 - 2021. She noted a correction to the synthetic
opioids category stating deaths have increased 97-fold,
excluding methadone overdose. Fentanyl and oxycodone are
synthetic opioids that are increasing deaths the most.
Veterinarians do not prescribe these two drugs for dispensing.
Veterinary fentanyl is administered directly to the animal at
the hospital. Oxycodone does not have veterinary usage. It is
important to remember that veterinarians do not dispense the
drugs that cause problems in the US. She said opioid medications
prescribed by veterinarians (728,223) were only 0.34 percent of
the total opioid prescriptions (214 million) dispensed by US
retail pharmacies in 2017.
4:06:11 PM
DR. BERNGARTT said the PDMP is just one tool for monitoring
veterinary drug use. There is a natural barrier that prevents
drug seekers from using veterinarians for doctor shopping.
Veterinarians require upfront payment for services. If a person
cannot pay for veterinary services, a pet will not receive the
diagnostic services necessary for a vet to consider dispensing
an opiate. Also, if a vet dispensed a drug, it may not be a
sought-after drug. Exempting veterinarians from the PDMP is not
expected to make them a source for doctor shopping.
4:08:09 PM
SENATOR KAUFMAN said one of the objections he has heard is that
the .34 percent of opioid medication prescribed by veterinarians
would increase if veterinarians were exempt. He asked if it
would be possible for a person to visit several veterinary
locations with a dog in obvious pain, pay for services, and
receive desirable opioids.
4:08:58 PM
DR. WARD said anything is possible, but it would be improbable.
Given the current veterinary shortage, the wait time to see a
vet is 3 - 14 days. A visit to the vet for an animal in pain
costs approximately $500 - 800. Rarely are opioids a vet's first
choice for an animal in pain. A vet usually admits an animal if
it is in enough pain to receive an opioid. The medication is
dispensed to the animal by the vet. She estimated that animal
owners had gone home with something other than a non-steroidal
anti-inflammatory less than five times since beginning her
practice. She stated that it is virtually impossible to visit
several vets in a short amount of time to receive opioids.
4:10:44 PM
SENATOR KAUFMAN asked whether veterinarians typically act as the
dispensary for the medications they prescribe and, if so, would
the passage of SB 51 create any tracking issues.
4:11:12 PM
DR. BERNGARTT said approximately 60 veterinarians directly
dispense prescription-controlled substances from their clinics.
The clinics may use the substances in their practice but also
directly dispense them.
4:12:04 PM
SENATOR KAUFMAN asked if veterinarians dispense a controlled
substance in a potency of interest to someone. He also asked if
there would be a control mechanism to track dispersion if
veterinarians were not in the PDMP.
4:12:27 PM
DR. WARD said 60 veterinarians in Alaska dispense drugs. The
other 350 licensed veterinarians in Alaska send written
prescriptions to pharmacies. Record keeping takes place at the
pharmacy.
SENATOR KAUFMAN asked whether SB 51 would create a tracking gap
if veterinarians who dispense controlled substances did not have
to report using the PDMP.
4:13:35 PM
DR. WARD replied that there is a small potential gap. Most of
the 60 Alaskan clinics dispense schedule IV drugs, such as
phenobarbital, for seizure control. Only a handful of clinics
dispense opioid class schedule II drugs.
4:14:20 PM
SENATOR DUNBAR asked how a vet would be caught if one of the 60
that distribute controlled substances did so illegally.
4:14:55 PM
CHAIR WILSON interjected that it might be helpful if Ms. Robb
discussed the utilization of the PDMP because the Drug
Enforcement Agency does not review the PDMP for bad actors.
4:15:28 PM
DR. BERNGARTT said a vet who engages in nefarious behavior with
illicit drug consumption or distribution would not be captured
by the PDMP because a vet who diverts drugs would not be
entering those controlled substances into the data base. She
said she is aware that the DEA caught one vet in eight years,
and it was through drug log requirements.
4:16:56 PM
DR. BERNGARTT moved to slides 10 - 11 and spoke about the
following points:
[Original punctuation provided.]
The unwieldy PDMP leads to costly and burdensome
investigations of veterinarians by the Alaska Board of
Veterinary Examiners.
Costly and onerous requirements for monitoring
veterinarians have been placed on the board of
veterinary examiners (BOVE).
Licensing fees for veterinarians will likely increase
as a result of the cost to conduct needless
investigations of veterinarians with DEA licenses. The
cost of doing business will be passed on to consumers.
Alaska has the highest licensing fees for
veterinarians in the country.
Licensing fees are expected to increase in the State
of Alaska as a result of the cost of PDMP
investigations.
Charging veterinarians for the cost of enforcement of
an unusable PDMP system, and regulations with which
they are unable to comply, is not responsible
stewardship of resources.
4:19:34 PM
DR. BERNGARTT moved to slide 12, AKVMA and BOVE Ask For Support
of SB 51, and read the following:
[Original punctuation provided.]
An Exemption of Veterinarians from participating in
the PDMP:
Will allow veterinarians to provide the appropriate,
timely, medical management appropriate for each
patient.
Will increase the efficiency of the PDMP system for
its intended purpose, by allowing for accurate
interpretation of data and trends in human medicine.
Will allow continued judicious use of controlled
substances that is already practiced by veterinarians.
Will eliminate unnecessary and disproportionate
business burdens for veterinarians.
4:20:25 PM
CHAIR WILSON opened public testimony on SB 51.
4:20:40 PM
SUZE NOLAN, Manager, North Pole Veterinary Hospital, North Pole,
Alaska, testified in support of SB 51. She said she is the
practice manager for a veterinary hospital with nine doctors.
She supports all the statements provided by the invited
testifiers. She asked for a yes vote on SB 51.
4:21:46 PM
MELISSA BECKER, representing self, Fairbanks, Alaska, testified
in support of SB 51. She said that as a veterinarian she has no
interest in looking up pet owners' information before treating
their pets. She does not dispense schedule II and III controlled
substances. The PDMP does not work for animals because animals
in shelters do not have owners, and children sometimes bring in
their pets. Also, an animal's name is easily changed, and there
is no way to prove it is the same animal.
4:23:00 PM
CHAIR WILSON closed public testimony on SB 51.
4:23:23 PM
CHAIR WILSON held SB 51 in committee.