Legislature(2015 - 2016)BUTROVICH 205
03/18/2015 01:30 PM HEALTH & SOCIAL SERVICES
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SB 23-IMMUNITY FOR PROVIDING OPIOID OD DRUG 1:33:07 PM CHAIR STEDMAN announced the consideration of SB 23. SENATOR JOHNNY ELLIS, Alaska State Legislature, sponsor of SB 23, introduced the bill. He said fatal drug overdoses have increased more than six-fold in the past three decades and now claim the lives of over 36,000 Americans every year. Specific to this bill is heroin use and, in Alaska, heroin use is here in force. Heroin-related overdoses are claiming more young lives than traffic fatalities, according to the Anchorage Police Department. The 2014 Alaska Troopers' Drug Report identified an increase in heroin abuse and the continued use of other opiates as significant concerns. He noted he and former-Senator Dyson have brought this issue before the legislature over the years; the need for more Methadone clinic funding, the appearance of new drugs, and the rise in drug-related burglaries. SENATOR ELLIS maintained that the abuse and overdose epidemic is largely driven by addiction to prescription opioids, such as OxyContin, Oxycodone, and Vicodin. These drugs have grown more expensive over time so the abusers and addicts seek out a cheaper alternative, such as black tar heroin imported to Alaska by the Mexican drug cartel. He said the face of heroin is also changing; heroin abuse is across all economic levels, is at an epidemic level, and has reached every corner of the state. No community is left unscathed. These highly addictive drugs are extremely deadly. This trend is troubling because prescription opioids are popular among young Alaskans. He pointed out that opioid overdose is reversible through the timely administration of the medication naloxone, but that medication is often not available when needed. Friends and family members are often the ones who are best situated to save the life of the person having the overdose. Currently, medical professionals are wary of prescribing naloxone and lay persons are wary of administering them due to potential civil liability. 1:37:37 PM He summarized that the bill is a simple Good Samaritan bill that removes the civil liability from doctors and trained bystanders. He concluded that SB 23 is an attempt to help reverse the opioid overdose epidemic and he hopes that Alaska becomes the 29th state to have this provision. It is a life and death situation. 1:38:30 PM AMORY LELAKE, Staff, Senator Johnny Ellis, Alaska State Legislature, provided the sectional analysis of SB 23: Section 1. Amends AS 09.65 by adding a new section (09.65.340) to give immunity for prescribing, providing, or administering an opioid overdose drug Subsection (a) exempts a person from civil liability if providing or prescribing an opioid overdose drug if the prescriber or provider is a health care provider or an employee of an opioid overdose program and the person has been educated and trained in the proper emergency use and administration of the opioid overdose drug Subsection (b) except as provided in (c) exempts a person who administers an opioid overdose drug to another person who the person reasonably believes is experiencing an opioid overdose emergency if the person 1. Was prescribed or provided the drug by a health care provider or opioid overdose program and 2. Received education and training in the proper emergency use and administration Subsection (c) does not preclude liability for civil damages that are a result of gross negligence or reckless or intentional misconduct Subsection (d) defines 1. "health care provider" as a licensed physician, advanced nurse practitioner, physician assistant, village health aide, or pharmacist operating within the scope of the health care provider's authority; 2. "opioid" includes the opium and opiate substances and opium and opiate derivatives listed in AS 11.71.140 3. "opioid overdose drug" means a drug that reverses in whole or part the pharmacological effects of an opioid overdose 4. "opioid overdose program" means a program operated or otherwise funded by the federal government, the state, or a municipality that provides opioid overdose drugs to persons at risk of experiencing an opioid overdose or to a family member, friend, or other person in a position to assist a person at risk of experiencing an overdose. 1:42:28 PM CHAIR STEDMAN asked if the committee had any questions. MS. LELAKE read from the sponsor statement: States across the country have enacted laws to increase access to treatment for opioid overdose as a way to combat increasing opioid overdose rates. Senate Bill 23 provides immunity from civil liability to health care providers who prescribe and bystanders who administer opioid overdose drugs like naloxone in cases of opioid overdose. Naloxone (also known by the brand name Narcan) is a medication called an opioid antagonist and is used to counter the effects of opioid overdose, from drugs like OxyContin, morphine, or heroin. Naloxone is extremely safe and effective at reversing opioid overdose. Specifically, naloxone is used in opioid overdose to counteract life-threatening depression of the central nervous system, allowing an overdose victim to breathe normally. Naloxone is not a controlled substance, has NO abuse potential, and has zero effect if administered to someone with no opiates in their system. Naloxone, much like an epi pen for severe allergic emergencies, comes in the form of a nasal spray or is injected in a muscle or vein. The efficacy of naloxone is fundamentally time dependent. Death from overdose typically occurs within 1 to 3 hours, although earlier in some cases, leaving a brief window of opportunity for intervention. Naloxone takes effect immediately and can last between 30 and 90 minutes. Naloxone is both safe and effective. For more than three decades, naloxone has been used by emergency medical personnel to reverse overdoses. It is regularly carried by medical first responders and can be administered by ordinary citizens with little or no formal training. Data from recent pilot programs demonstrate that lay persons are consistently successful in safely administering naloxone and reversing opioid overdose. The problem is, friends or family members of overdose victims, not emergency medical personnel, are most often the actual first responders and are best positioned to intervene within an hour of the onset of overdose symptoms. As a result of rising opioid abuse and overdose, in 2001, New Mexico became the first state to amend its laws to make it easier for medical professionals to prescribe and dispense naloxone without liability concerns, and for lay administrators to use it without fear of legal repercussions. At the urging of organizations including the US Conference of Mayors, the American Medical Association and the American Public Health Organization, a number of states have addressed the epidemic by removing legal barriers to the timely administration of naloxone. These changes come in two general varieties: The first is the approach in SB23 - which encourages the wider prescription and use of naloxone by removing the possibility of negative legal action against prescribers and lay administrators who prescribe the drugs to those who may be able to use to reverse overdose. So far, 27 states and the District of Columbia have made this important change. The second change encourages bystanders to become Good Samaritans by summoning emergency responders without fear of arrest or other negative legal consequences. Thankfully, the legislature wisely took that critical step last year by passing Representative Lance Pruitt's "Make the Call" Good Samaritan bill, House Bill 369. Alaska is among 21 states to have passed similar legislation in recent years. Based partly on these changes to state law, at least 188 community- based overdose prevention programs now distribute naloxone. As of 2010, those programs had provided training and naloxone to over 50,000 people, resulting in over 10,000 overdose reversals. A recent evaluation of one such program in Massachusetts, which trained over 2,900 potential overdose bystanders, reported that opioid overdose death rates were significantly reduced in communities in which the program was implemented compared to those in which it was not. Given the safety and effectiveness of naloxone, many public health advocates question why naloxone is not available over the counter. I point this out because its status as a prescription medication does not mean it is dangerous or difficult to use. Italy, for example, has had naloxone available over the counter since the 1980s without any reported negative consequences. It is understandable that regulators did not foresee the utility of naloxone as a public health intervention carried out by people who are not medical professionals. But, in the midst of our current epidemic of accidental deaths related to illicit and prescription opioids, these restrictions are untenable. One very important thing to point out, Mister Chairman, is that Senate Bill 23 is not the result of a rash of lawsuits over providing or administering lawsuits. I spoke with national experts who told me I would be hard pressed to find any case law related to this issue. SB23 simply removes an unintended barrier to this life-saving drug. Finally, Mister Chairman, Senate Bill 23 is not a replacement for substance abuse treatment. Drug enforcement and rehabilitation are also critical components of this war on addiction. SB23 simply gives doctors and bystanders to overdoses the peace of mind that they will not be held civilly liable for doing the right thing, and perhaps more importantly, Mister Chairman, gives families and loved ones of addicts a life-saving tool against the heartbreak caused by opioid overdose. SB23 is supported by The Alaska State Medical Association, The Alaska Police Department Employees Association, the Alaska Mental Health Trust Authority, the Alaska Mental Health Board and Advisory Board on Alcoholism and Drug Abuse, the Narcotic Drug Treatment Center, and countless families and addicts who could not be here today. 1:49:32 PM SENATOR STOLTZE objected to the idea that the bill is a "Good Samaritan" effort. He noted SB 23 is related to civil immunity and asked if there was any relationship to criminal immunity. MS. LAKE stated that the bill is only related to civil liability and relates to the Good Samaritan Act in that it is about accessing medical personnel for fast treatment. CHAIR STEDMAN opened public testimony. 1:51:31 PM DR. PAULA COLESCOTT, Addiction Specialist, Providence Breakthrough, testified in support of SB 23. She said she has been involved with the overdose population for over eight years. She agreed that there is an avalanche of opioid use and overdose. Patients report that their friends try to resuscitate overdoses by putting them in a tub of cold water and it doesn't work. She spoke of the brain damage as a result of overdose. She opined the bill gives a green light to first responders and physicians who are trained to save the life of someone who is experiencing an accidental overdose. She described cases of overdose. She said naloxone is a safe method of preventing overdoses. She highly encouraged approval of the bill. She concluded that the American Society of Addiction Medicine has published a public policy statement which agrees with the rescue of overdoses. 1:56:38 PM KATE BURKHART, Executive Director, Advisory Board on Alcohol and Drug Abuse and Alaska Mental Health Board, testified in support of SB 23. She said she agrees with the previous testimony. She said she has received numerous letters of support for this bill. She described how SB 23 provides protection and policy guides to physicians and family members. 1:59:05 PM KARA NELSON, Member, Juneau Recovery Community, and Director, Haven House, testified in support of SB 23. She described her personal history with drug addiction and overdose. She related how important the drug naloxone is. She shared a personal story of overdoses. She pointed out that addiction does not discriminate. She testified how important one saved life is. She said the bill will keep people from being afraid of going to jail when saving a life. She concluded that it is a public issue, not a criminal issue. She described her work with Haven House and the fears people have. She noted that Narcan is so important to recovery. 2:04:29 PM CHAIR STEDMAN closed public testimony. SENATOR STOLTZE named supporters of the bill and wished to hear from the criminal division. He supported the direction of the bill away from criminal ramifications. CHAIR STEDMAN held SB 31 in committee.