Legislature(2015 - 2016)BUTROVICH 205

03/18/2015 01:30 PM HEALTH & SOCIAL SERVICES

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
-- Public Testimony --
*+ SB 23 IMMUNITY FOR PROVIDING OPIOID OD DRUG TELECONFERENCED
Heard & Held
*+ SB 55 OPTOMETRY & OPTOMETRISTS TELECONFERENCED
Heard & Held
+ Bills Previously Heard/Scheduled TELECONFERENCED
          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.                                                                                          
                                                                                                                                
                                                                                                                                

Document Name Date/Time Subjects
SB23 Sectional Analysis.pdf SHSS 3/18/2015 1:30:00 PM
SB 23
SB23 Sponsor Statement.pdf SHSS 3/18/2015 1:30:00 PM
SB 23
SB23 Hearing Request Memo.pdf SHSS 3/18/2015 1:30:00 PM
SB 23
SB55 Hearing Request Senate HSS.pdf SHSS 3/18/2015 1:30:00 PM
SB 55
SB55 vsn E.pdf SHSS 3/18/2015 1:30:00 PM
SB 55
SB55 Sectional Analysis vsn E.pdf SHSS 3/18/2015 1:30:00 PM
SB 55
SB 55 Support AK Vision Center 2-25-15.pdf SHSS 3/18/2015 1:30:00 PM
SB 55
1AAO_AKSEPS_SB55_Cmte_Ltr_2-26-15_fnl.pdf SHSS 3/18/2015 1:30:00 PM
SB 55
SB55 Support Emails 2-20-15.pdf SHSS 3/18/2015 1:30:00 PM
SB 55
SB55 Support Emails 2-24-15.pdf SHSS 3/18/2015 1:30:00 PM
SB 55
SB55 Support Emails 3-4-15.pdf SHSS 3/18/2015 1:30:00 PM
SB 55
SB55 Support Gonnason 2-19-15.pdf SHSS 3/18/2015 1:30:00 PM
SB 55
SB55 Support Lodestar Eye Care 3-5-15.pdf SHSS 3/18/2015 1:30:00 PM
SB 55
SB23 Sectional Analysis.pdf SHSS 3/18/2015 1:30:00 PM
SB 23
SB 23 Fiscal Note.pdf SHSS 3/18/2015 1:30:00 PM
SB 23
IIPA Letter of Opposition SB 55.pdf SHSS 3/18/2015 1:30:00 PM
SB 55
SB 55 Fiscal Note.pdf SHSS 3/18/2015 1:30:00 PM
SB 55
March 16 2015 letter bill 23.pdf SHSS 3/18/2015 1:30:00 PM
SB23 Administer Naloxone.pdf SHSS 3/18/2015 1:30:00 PM
SB 23
SB23 2014 Alaska State Troopers Report.pdf SHSS 3/18/2015 1:30:00 PM
SB 23
SB23 Alaska Mental Health Trust Letter of Support (1).pdf SHSS 3/18/2015 1:30:00 PM
SB 23
SB23 Alaska Mental Health Trust Letter of Support.pdf SHSS 3/18/2015 1:30:00 PM
SB 23
SB23 Alaska State Medical Association Letter of Support.pdf SHSS 3/18/2015 1:30:00 PM
SB 23
SB23 APD Calls Overdose Deaths an Epidemic.pdf SHSS 3/18/2015 1:30:00 PM
SB 23
SB23 CDC reports spike in heroin deaths.pdf SHSS 3/18/2015 1:30:00 PM
SB 23
SB23 Changing Law from Barrier to Facilitator of Opioid Overdose Prevention.pdf SHSS 3/18/2015 1:30:00 PM
SB 23
SB23 Drug seizures down but arrests up in 2014.pdf SHSS 3/18/2015 1:30:00 PM
SB 23
SB23 Heroin in Alaska From Bush villages to Fairbanks.pdf SHSS 3/18/2015 1:30:00 PM
SB 23
SB23 Heroin reaches into rural Alaska communities.pdf SHSS 3/18/2015 1:30:00 PM
SB 23
SB23 JPD drug take nears Anchorage levels.pdf SHSS 3/18/2015 1:30:00 PM
SB 23
SB23 Kodiak seize $2.2 million in meth, heroin.pdf SHSS 3/18/2015 1:30:00 PM
SB 23
SB23 Legal Interventions to Reduce Overdose Mortality.pdf SHSS 3/18/2015 1:30:00 PM
SB 23
SB23 Overdosed and Overrun - Alaska's heroin epidemic.pdf SHSS 3/18/2015 1:30:00 PM
SB 23
SB23 State Naloxone and Good Samaritan Legislation.pdf SHSS 3/18/2015 1:30:00 PM
SB 23
SB23 States Expand Access to Overdose-Reversal Drug.pdf SHSS 3/18/2015 1:30:00 PM
SB 23
SB23 The Changing Face of Heroin.pdf SHSS 3/18/2015 1:30:00 PM
SB 23
SB23 Valley heroin use 'epidemic'.pdf SHSS 3/18/2015 1:30:00 PM
SB 23
Dr. David Zumbro Senate Bill 55.msg SHSS 3/18/2015 1:30:00 PM
SB55 Support Gonnason 2-19-15.pdf SHSS 3/18/2015 1:30:00 PM
SB 55
ASMA Opposition SB 55.pdf SHSS 3/18/2015 1:30:00 PM
SB 55
ASMA Support for SB 23.pdf SHSS 3/18/2015 1:30:00 PM
SB 23
SB 55 White Paper for Senator Kelly.pdf SHSS 3/18/2015 1:30:00 PM
SB 55
SB 55 Backup Malpractice Fact Sheet.pdf SHSS 3/18/2015 1:30:00 PM
SB 55
SB55 Hearing Request Senate HSS.pdf SHSS 3/18/2015 1:30:00 PM
SB55 vsn E.pdf SHSS 3/18/2015 1:30:00 PM
SB55 Sponsor Statement vsn E.pdf SHSS 3/18/2015 1:30:00 PM
Responses to HSS Committee SB 55.pdf SHSS 3/18/2015 1:30:00 PM
SB 55
SB55 review.pdf SHSS 3/18/2015 1:30:00 PM
SB 55
AK _Sen Stoltze_fnl_3-24_15 SB 55 Geographic.pdf SHSS 3/18/2015 1:30:00 PM
SB 55