Legislature(2017 - 2018)BUTROVICH 205

05/09/2017 03:30 PM HEALTH & SOCIAL SERVICES

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
-- Please Note Time --
+= HB 186 FOOD DONATIONS TELECONFERENCED
Moved HB 186 Out of Committee
-- Public Testimony --
+ SB 79 OPIOIDS;PRESCRIPTIONS;DATABASE;LICENSES TELECONFERENCED
Moved CSSB 79(HSS) Out of Committee
-- Public Testimony --
        SB 79-OPIOIDS; PRESCRIPTIONS; DATABASE; LICENSES                                                                    
                                                                                                                                
3:48:42 PM                                                                                                                    
CHAIR WILSON announced the consideration of SB 79.                                                                              
                                                                                                                                
3:49:18 PM                                                                                                                    
DR.  JAY  BUTLER, Chief  Medical  Officer,  Alaska Department  of                                                               
Health and Social Services, Juneau,  Alaska, stated that Alaska's                                                               
opioid epidemic continues and reported the following statistics:                                                                
                                                                                                                                
 • More than 90 Alaskans died of an opioid overdose in 2016.                                                                    
   • The 90-overdose deaths are twice the number of Alaskans who                                                                
     died of acquired immune deficiency syndrome (AIDS) at the                                                                  
    peak of the human immunodeficiency virus (HIV) epidemic.                                                                    
   • Often the overdose deaths occurred among young people.                                                                     
   • Two-thirds of opioid overdoses involved a prescription.                                                                    
   • The majority of people who use heroine and other illicit                                                                   
     opioids report becoming hooked when using prescription                                                                     
     opioid painkillers, often on the advice of a trusted and                                                                   
     generally well-meaning provider.                                                                                           
                                                                                                                                
                                                                                                                                
DR.  BUTLER explained  that Alaska  is responding  to the  opioid                                                               
epidemic as follows:                                                                                                            
                                                                                                                                
   • Citizens have actioned community collations.                                                                               
   • State government passed SB 91 to increase access Naloxone                                                                  
     opioid-overdose kits.                                                                                                      
                                                                                                                                
He conceded that  overdose kits do not solve  the opioid epidemic                                                               
and detailed what SB 79 proposes to do:                                                                                         
                                                                                                                                
   • SB 79 adds to the state's multi-faceted approach to                                                                        
     addressing the opioid epidemic and aligns with the current                                                                 
     science on pain management as well as addiction medicine                                                                   
     based on recommendations from:                                                                                             
                                                                                                                                
        square4 Centers for Disease Control and Prevention (CDC);                                                               
        square4 U.S. Surgeon General, U.S. Department of Health &                                                               
          Social Services;                                                                                                      
        square4 Professional groups including the American College of                                                           
          Physicians;                                                                                                           
        square4 Best practices and learned experiences from the Opioid                                                          
          Safety Initiative, U.S. Department of Veterans                                                                        
          Affairs.                                                                                                              
                                                                                                                                
DR. BUTLER stated that SB 79 addresses three opioid areas:                                                                      
                                                                                                                                
   • Patience,                                                                                                                  
   • Providers,                                                                                                                 
   • Prescription Drug Monitoring Program (PDMP).                                                                               
                                                                                                                                
He specified that SB 79 provides the following for patients and                                                                 
health-care providers when an opioid prescription is voluntarily                                                                
limited or eliminated:                                                                                                          
                                                                                                                                
   • Provides for an opioid advance directive for patients that                                                                 
     do not wish to receive opioid medications. The directive is                                                                
     voluntary and revocable.                                                                                                   
   • Protects health-care providers with civil liability if an                                                                  
     opioid is withheld by the directive as well as the                                                                         
     inadvertent administering of an opioid in an emergency                                                                     
     situation.                                                                                                                 
   • Provides in state statute the authority of patients to                                                                     
     request a partial-opioid prescription:                                                                                     
                                                                                                                                
        square4 Reinforces the authority of the pharmacists to honor a                                                          
          partial-fill  request without  the need  to immediately                                                               
          void  the  remaining  portion of  the  prescription  as                                                               
          provided under the  federal Comprehensive Addiction and                                                               
          Recovery Act of 2016.                                                                                                 
                                                                                                                                
He said SB 79 addresses the amount of opioids that providers                                                                    
dispense as follows:                                                                                                            
                                                                                                                                
   • Data analysis has shown that persons who receive larger                                                                    
     first-time opioid prescriptions are more likely to become                                                                  
     chronic-opioid users.                                                                                                      
   • Increased-usage risk particularly  occurs  for  first-time                                                                 
     prescription for more than a five to seven-day supply.                                                                     
   • Alaska Medicaid claims from  last  year  indicate that  at                                                                 
     least half of all first-time opioid prescriptions had                                                                      
     claims for more than a 15-day supply.                                                                                      
   • Dartmouth study indicates that opioid-prescribing practices                                                                
     vary from no drugs to 120 pills. 75 percent of all                                                                         
     prescribed pills were never taken and remained in the                                                                      
     patients' homes.                                                                                                           
                                                                                                                                
DR. BUTLER  related recent situations  in Alaska where  a student                                                               
after  surgery  returned  120-Vicodin pills  and  another  person                                                               
requested drug-disposal  bags after accumulating  over 250-opioid                                                               
pills after  hip replacement  where the  pain was  managed within                                                               
the first 48 hours.                                                                                                             
                                                                                                                                
He  explained   that  SB  79  proposes   that  first-time  opioid                                                               
prescriptions observe the following:                                                                                            
                                                                                                                                
   • Limited to no more than a 7-day supply.                                                                                    
   • Allows a waiver  based   on  the  provider's  professional                                                                 
     judgement for severe-acute pain, chronic pain, cancer pain,                                                                
     and palliative care.                                                                                                       
   • Allows a waiver due to Alaska's travel logistics.                                                                          
   • Seven-day-dispensing  limit   requires    medical   record                                                                 
     documentation on why additional opioids are needed.                                                                        
                                                                                                                                
He disclosed  that the concept  of accountable  justification has                                                               
been shown  to improve the quality  of drug usage. He  added that                                                               
the  bill   authorizes  professional   boards  to   require  that                                                               
continuing  education be  designated for  pain management  or the                                                               
basics of addiction.                                                                                                            
                                                                                                                                
He addressed opioid substance-use disorder as follows:                                                                          
                                                                                                                                
   • Nearly 10 percent of adults have some type of substance-use                                                                
     disorder.                                                                                                                  
   • Addiction is also a chronic-health condition that requires                                                                 
     awareness throughout the medical profession.                                                                               
   • The science of  substance   dependency  and  addiction  is                                                                 
     evolving fast and has been ignored by too many providers.                                                                  
   • Concerns may be raised  by  providers regarding  continual                                                                 
     medical education (CME) credit:                                                                                            
                                                                                                                                
        square4 Free online CME courses are available,                                                                          
        square4 CDC has put out CME programs that focus on how to                                                               
          manage chronic pain,                                                                                                  
        square4 Search for additional options for endorsements in                                                               
          meeting needs.                                                                                                        
                                                                                                                                
He addressed the PDMP proposed in SB 79 as follows:                                                                             
                                                                                                                                
   • Emerging data shows reductions in overdose-death rates and                                                                 
     Medicaid expenditures in states that require providers to                                                                  
     use the PDMP database.                                                                                                     
   • SB 79 authorizes the Department of Commerce to issue                                                                       
     regular-unsolicited reports to prescribers.                                                                                
   • SB 79 provides peer self-comparison reports as non-punitive                                                                
     feedback for providers' prescribing habits in comparison to                                                                
     peers.   Ten   states   have   peer   self-comparison-report                                                               
     programs.                                                                                                                  
   • PDMP depends on timely data and the bill proposes to                                                                       
     increase reporting intervals from weekly to daily. Twenty-                                                                 
     five states require daily reporting intervals.                                                                             
   • Daily reporting by smaller pharmacies in rural communities                                                                 
     has been addressed and an implementation date in mid-2018                                                                  
     is proposed to provide more time to comply.                                                                                
   • Requires veterinarians to register for the PDMP. Cases                                                                     
     where people have intentionally injured animals in the                                                                     
     Lower 48 to receive opioids have occurred.                                                                                 
                                                                                                                                
DR. BUTLER  summarized that  addressing Alaska's  opioid epidemic                                                               
is going take everyone. He  quoted U.S. Congressman Hal Rogers as                                                               
follows:                                                                                                                        
                                                                                                                                
     There's  no   silver  bullet  to   stem  the   tide  of                                                                    
     prescription  drug abuse  in America.  The  lack of  an                                                                    
     easy solution  requires all of  us to treat  the opioid                                                                    
     crisis as a non-partisan  issue and adopt an all-hands-                                                                    
     on-deck approach.                                                                                                          
                                                                                                                                
He set forth  that SB 79 is part of  Alaska's call for all-hands-                                                               
on-deck to  support Alaskans  living in  recovery and  reduce the                                                               
number of  persons who  become newly  dependent on  opioids while                                                               
supporting the care of those that truly need opioids.                                                                           
                                                                                                                                
4:06:54 PM                                                                                                                    
SARAH CHAMBERS, Deputy Director  of the Division of Corporations,                                                               
Business and Professional Licensing  (CBPL), Alaska Department of                                                               
Commerce,  Community and  Economic  Development, Juneau,  Alaska,                                                               
provided a sectional analysis on SB 79 as follows:                                                                              
                                                                                                                                
     Sec. 1:                                                                                                                
     Amends  the  Board  of  Dental  Examiners  statutes  by                                                                    
     requiring the  board to  adopt regulations  for renewal                                                                    
     of  licensure to  include  a minimum  of  two hours  of                                                                    
     continuing  education  in  pain management  and  opioid                                                                    
     misuse  and   addiction  in  the  previous   two  years                                                                    
     preceding    renewal,   unless    the   licensee    has                                                                    
     demonstrated to the satisfaction  of the board that the                                                                    
     licensee does  not currently hold a  valid federal Drug                                                                    
     Enforcement Agency (DEA) registration number.                                                                              
                                                                                                                              
     Sec. 2:                                                                                                                
     Amends  the  Board  of  Dental  Examiners  statutes  by                                                                    
     requiring the board to  adopt regulations for licensure                                                                    
     qualifications  to include  a minimum  of two  hours of                                                                    
     education  in pain  management  and  opioid misuse  and                                                                    
     addiction in  the two  years preceding  the application                                                                    
     for a  license, unless  the applicant  has demonstrated                                                                    
     to  the satisfaction  of the  board that  the applicant                                                                    
     does   not  currently   hold   a   valid  federal   DEA                                                                    
     registration number                                                                                                        
                                                                                                                                
     Sec. 3:                                                                                                                
     Amends  the  Board  of Dental  Examiners  statutes  for                                                                    
     disciplinary   authority;  it   allows  the   board  to                                                                    
     discipline,  revoke, suspend,  reprimand  or censure  a                                                                    
     license of  a dentist,  if the  board finds  a licensee                                                                    
     has prescribed or dispensed an  opioid in excess of the                                                                    
     maximum  dosage  authorized   under  AS  08.36.355,  or                                                                    
     procured,  sold,  prescribed,  or  dispensed  drugs  in                                                                    
     violation  of a  law, regardless  of whether  there has                                                                    
     been a criminal action or patient harm.                                                                                    
                                                                                                                              
     Sec. 4:                                                                                                                
     Adds a  new section  to the  Board of  Dental Examiners                                                                    
     statutes   limiting   the    dosage   for   an   opioid                                                                    
     prescription  to a  seven-day  supply for  an adult  or                                                                    
     minor.  The dentist  must discuss  with  the parent  or                                                                    
     guardian of a minor  why the prescription is necessary,                                                                    
     and  the  risks  associated  with  the  opioid  use.  A                                                                    
     dentist  may issue  a prescription  for greater  than a                                                                    
     seven-day supply  to an adult  or minor patient  if, in                                                                    
     the professional judgement of  the dentist, more than a                                                                    
     seven-day   supply   is  necessary   for   chronic-pain                                                                    
     management  or a  patient  who is  unable  to access  a                                                                    
     practitioner  within the  time necessary  for a  refill                                                                    
     because of a logistical  or travel barrier. The dentist                                                                    
     must  document  in  the patient's  medical  record  the                                                                    
     condition requiring  the excess  of a  seven-day supply                                                                    
     and   indicate  a   non-opioid   alternative  was   not                                                                    
     appropriate  to   treat  the  condition.   The  section                                                                    
     defines "adult" and "minor."                                                                                               
                                                                                                                                
     Sec. 5:                                                                                                                
     Amends the Board of Dental  Examiner statutes by adding                                                                    
     a definition of an "opioid."                                                                                               
                                                                                                                                
     Sec. 6:                                                                                                                
     Amends  the Medical  Board statutes  for qualifications                                                                    
     for  physician   assistants.  The  board   shall  adopt                                                                    
     regulations   for   physician  assistant   to   include                                                                    
     education  on  pain  management   and  opioid  use  and                                                                    
     addiction.                                                                                                                 
                                                                                                                                
     Sec. 7:                                                                                                                
     Amends  the Medical  Board statutes  for qualifications                                                                    
     for  physicians.   The  additional   language  requires                                                                    
     physician  applicants  to  receive  education  in  pain                                                                    
     management  and  opioid  use  and  addiction  prior  to                                                                    
     licensure,  unless the  applicant  has demonstrated  to                                                                    
     the satisfaction  of the board that  the applicant does                                                                    
     not  currently hold  a valid  federal DEA  registration                                                                    
     number.                                                                                                                    
                                                                                                                              
     Sec. 8:                                                                                                                
     Amends  the Medical  Board statutes  for qualifications                                                                    
     for  osteopaths.   The  additional   language  requires                                                                    
     osteopath  applicants  to  receive  education  in  pain                                                                    
     management  and  opioid  use  and  addiction  prior  to                                                                    
     licensure,  unless the  applicant  has demonstrated  to                                                                    
     the satisfaction  of the board that  the applicant does                                                                    
     not  currently hold  a valid  federal DEA  registration                                                                    
     number.  The language  in this  section  refers to  the                                                                    
     physician  applicant qualifications  in section  8, and                                                                    
     duplication in (4) of the same statute.                                                                                    
                                                                                                                                
     Sec. 9:                                                                                                                
     Amends  the Medical  Board statutes  for qualifications                                                                    
     for  podiatrists.  The   additional  language  requires                                                                    
     podiatry  applicants  to   receive  education  in  pain                                                                    
     management  and  opioid  use  and  addiction  prior  to                                                                    
     licensure,  unless the  applicant  has demonstrated  to                                                                    
     the satisfaction  of the board that  the applicant does                                                                    
     not  currently hold  a valid  federal DEA  registration                                                                    
     number.  The language  in this  section  refers to  the                                                                    
     physician-applicant  qualifications in  section 8,  and                                                                    
     duplication in (3) of the same statute.                                                                                    
                                                                                                                                
     Sec. 10:                                                                                                               
     Amends  the Medical  Board statutes  for qualifications                                                                    
     for   foreign   graduates.  The   additional   language                                                                    
     requires   foreign-graduate   applicants   to   receive                                                                    
     education  in  pain  management   and  opioid  use  and                                                                    
     addiction prior to licensure,  unless the applicant has                                                                    
     demonstrated to the satisfaction  of the board that the                                                                    
     applicant does  not currently hold a  valid federal DEA                                                                    
     registration  number.  The  language  in  this  section                                                                    
     refers  to the  physician  applicant qualifications  in                                                                    
     section  8, and  duplication in  (a)(2)(B) of  the same                                                                    
     statute.                                                                                                                   
                                                                                                                                
     Sec. 11:                                                                                                               
     Amends  the  Medical  Board  statutes  for  License  by                                                                    
     credentials.  The amendment  includes  the addition  of                                                                    
     qualifications for licensure of osteopath applicants.                                                                      
                                                                                                                                
     Sec. 12:                                                                                                               
     Amends  the  Medical Board  statutes  by  adding a  new                                                                    
     subsection   for   qualifications  for   licensure   by                                                                    
     credentials for physicians,  osteopaths and podiatrists                                                                    
     by  requiring  the  board   to  adopt  regulations  for                                                                    
     applicants  to  include   requiring  the  applicant  to                                                                    
     demonstrate professional competence  in pain management                                                                    
     and  addiction disorders.  The professional  competence                                                                    
     may  include  professional experience  or  professional                                                                    
     instruction as proof of professional competence.                                                                           
                                                                                                                                
     Sec. 13:                                                                                                               
     Amends  the  Medical   Board  statutes  for  continuing                                                                    
     education  requirements for  renewal  of  a license.  A                                                                    
     licensee  of medicine,  osteopathy,  and podiatry  must                                                                    
     receive no  less than  two hours  of education  in pain                                                                    
     management and  opioid misuse  and addiction  for every                                                                    
     40 hours  of instruction received, unless  the licensee                                                                    
     demonstrates to the satisfaction  of the board that the                                                                    
     licensee's  practice does  not include  pain management                                                                    
     and opioid  treatment or prescribing. An  applicant for                                                                    
     renewal  may not  be exempted  from the  requirement to                                                                    
     receive  at  least two  hours  of  instruction on  pain                                                                    
     management and opioid misuse  and addiction, unless the                                                                    
     person  has demonstrated  to  the  satisfaction of  the                                                                    
     board that the  person does not currently  hold a valid                                                                    
     federal DEA registration number.                                                                                           
                                                                                                                                
     Sec. 14:                                                                                                               
     Amends Medical Board  disciplinary authority. The board                                                                    
     may impose  a disciplinary sanction if  the board finds                                                                    
     that a  licensee has prescribed or  dispensed an opioid                                                                    
     in excess of the maximum dosage.                                                                                           
                                                                                                                                
     Sec. 15:                                                                                                               
     Adds  a  new  section  to the  Medical  Board  statutes                                                                    
     limiting  the dosage  for an  opioid prescription  to a                                                                    
     seven-day supply  for an adult  or minor.  The licensee                                                                    
     must discuss  with the  parent or  guardian of  a minor                                                                    
     why  the  prescription  is  necessary,  and  the  risks                                                                    
     associated with the opioid use.  A licensee may issue a                                                                    
     prescription for greater than  a seven-day supply to an                                                                    
     adult  or   minor  patient  if,  in   the  professional                                                                    
     judgement  of  the  licensee,  more  than  a  seven-day                                                                    
     supply is  necessary for;  an acute  medical condition,                                                                    
     chronic-pain management,  pain associated  with cancer,                                                                    
     pain  experienced while  the patient  is in  palliative                                                                    
     care, a patient who is  unable to access a practitioner                                                                    
     within the  time necessary for  a refill of  the seven-                                                                    
     day supply  because of a logistical  or travel barrier,                                                                    
     or treatment  of a patient's substance  abuse or opioid                                                                    
     dependence.   The  licensee   must   document  in   the                                                                    
     patient's   medical   record  the   medical   condition                                                                    
     requiring  the  excess  of   a  seven-day  supply,  and                                                                    
     indicate a  non-opioid alternative was  not appropriate                                                                    
     to treat the medical  condition, or the substance abuse                                                                    
     or  opioid  dependence.  The section  defines  "adult,"                                                                    
     "emancipated minor," and "minor."                                                                                          
                                                                                                                                
     Sec. 16:                                                                                                               
     Amends Medical Board statute  for prescription of drugs                                                                    
     without a  physical examination. It adds  the board may                                                                    
     not impose  disciplinary sanctions  on a  physician for                                                                    
     prescribing, dispensing, or  administering a controlled                                                                    
     substance  if the  requirements in  the new  section AS                                                                    
     08.64.363, under Sec. 12 of this document, are met.                                                                        
                                                                                                                                
4:10:29 PM                                                                                                                    
                                                                                                                                
     Sec. 17:                                                                                                               
     Amends  Medical Board  statute by  adding and  defining                                                                    
     "opioid"  to include  the opium  and opiate  substances                                                                    
     and  opium   and  opiate   derivatives  listed   in  AS                                                                    
     11.71.140.                                                                                                                 
                                                                                                                                
     Sec. 18:                                                                                                               
     Amends  the Board  of Nursing  to provide  authority to                                                                    
     adopt   regulation  to   comply  with   new  continuing                                                                    
     education requirements.                                                                                                    
                                                                                                                                
     Sec. 19:                                                                                                               
     Amends  the  Board of  Nursing  statute  by giving  the                                                                    
     board  the authority  to deny,  suspend, or  revoke the                                                                    
     license  of a  person who:  prescribed or  dispensed an                                                                    
     opioid  in  excess  of the  maximum  dosage  authorized                                                                    
     under AS 08.68.705; or  has procured, sold, prescribed,                                                                    
     or dispensed  drugs in violation  of a  law, regardless                                                                    
     of whether there has been  a criminal action or patient                                                                    
     harm.                                                                                                                      
                                                                                                                                
     Sec. 20:                                                                                                               
     Amends  the   Board  of  Nursing  statute   to  include                                                                    
     enforcement  authority for  failure  to meet  regarding                                                                    
     enforcement    actions   for    continuing   competency                                                                    
     requirements. A  license may not be  renewed unless the                                                                    
     advanced-practice-registered  nurse   has  completed  a                                                                    
     minimum of  two hours  of education in  pain management                                                                    
     and opioid  misuse and addiction  within the  two years                                                                    
     preceding renewal  of the license, unless  the licensee                                                                    
     has demonstrated to the satisfaction  of the board that                                                                    
     the licensee  does not currently  hold a  valid federal                                                                    
     DEA registration number.                                                                                                   
                                                                                                                                
     Sec. 21:                                                                                                               
     Adds a  new section to  article 6 of the  Nursing Board                                                                    
     statutes   limiting   the    dosage   for   an   opioid                                                                    
     prescription  to a  seven-day  supply for  an adult  or                                                                    
     minor.   The  advance-practice-registered   nurse  must                                                                    
     discuss with the parent or  guardian of a minor why the                                                                    
     prescription  is necessary,  and  the risks  associated                                                                    
     with  the opioid  use. An  advanced-practice-registered                                                                    
     nurse  may  issue a  prescription  for  greater than  a                                                                    
     seven-day supply  to an adult  or minor patient  if, in                                                                    
     the  professional judgement  of the  advanced-practice-                                                                    
     registered  nurse,  more  than a  seven-day  supply  is                                                                    
     necessary  for:  an acute-medical  condition,  chronic-                                                                    
     pain  management,  pain  associated with  cancer,  pain                                                                    
     experienced while  the patient  is in  palliative care,                                                                    
     or a  patient who  is unable  to access  a practitioner                                                                    
     within the  time necessary for  a refill of  the seven-                                                                    
     day supply  because of a logistical  or travel barrier.                                                                    
     The  advanced-practice-registered  nurse must  document                                                                    
     in   the  patient's   medical   record  the   condition                                                                    
     requiring  the  excess  of   a  seven-day  supply,  and                                                                    
     indicate a  non-opioid alternative was  not appropriate                                                                    
     to treat  the condition.  The section  defines "adult,"                                                                    
     "emancipated minor," and "minor."                                                                                          
                                                                                                                                
     Sec. 22:                                                                                                               
     Amends  Nursing Board  statute by  adding and  defining                                                                    
     "opioid"  to include  opium and  opiate substances  and                                                                    
     opium and opiate derivatives listed in AS 11.71.140.                                                                       
                                                                                                                                
     Sec. 23:                                                                                                               
     Amends the Board  of Optometry to require  the board to                                                                    
     adopt   regulations  for   advanced-practice-registered                                                                    
     nurses  to include  education  on  pain management  and                                                                    
     opioid use and addiction.                                                                                                  
                                                                                                                                
     Sec. 24:                                                                                                               
     Amends   the    Board   of   Optometry    statute   for                                                                    
     qualifications  for   licensure  by   credentials.  The                                                                    
     applicant   must  have   received  education   in  pain                                                                    
     management  and opioid  misuse  and addiction  adequate                                                                    
     for  the   practice  of   optometry  and   may  include                                                                    
     professional  experience   or  professional  education,                                                                    
     unless   the   applicant   has  demonstrated   to   the                                                                    
     satisfaction of  the board that the  applicant does not                                                                    
     currently  hold   a  valid  federal   DEA  registration                                                                    
     number.                                                                                                                    
                                                                                                                                
     Sec. 25:                                                                                                               
     Amends the  Board of  Optometry statute  for continuing                                                                    
     education requirements  for renewal  of a  license. The                                                                    
     optometrist  must complete  a minimum  of two  hours of                                                                    
     education  in pain  management  and  opioid misuse  and                                                                    
     addiction in  the four years preceding  renewal, unless                                                                    
     the applicant  has demonstrated to the  satisfaction of                                                                    
     the board that the applicant  does not currently hold a                                                                    
     valid federal DEA registration number.                                                                                     
                                                                                                                                
     Sec. 26:                                                                                                               
     Amends the  Board of Optometry  disciplinary authority.                                                                    
     The  board  may  impose disciplinary  sanctions  on  an                                                                    
     optometrist  who  has  procured, sold,  prescribed,  or                                                                    
     dispensed drugs  in violation of  a law,  regardless of                                                                    
     whether  there has  been a  criminal action  or patient                                                                    
     harm.                                                                                                                      
                                                                                                                                
     Sec. 27:                                                                                                               
     Amends  powers and  duties of  the  Board of  Pharmacy,                                                                    
     08.80.030(b)(13).  The current  law  that takes  effect                                                                    
     July  17, 2017,  will  require pharmacists  with a  DEA                                                                    
     registration number,  to register with  the controlled-                                                                    
     substance-prescription database  (PDMP). Pharmacists do                                                                    
     not obtain  DEA registration numbers,  only pharmacies;                                                                    
     therefore,  this section  removes the  DEA registration                                                                    
     number requirement.                                                                                                        
                                                                                                                                
     Sec. 28:                                                                                                               
     Amends  the Board  of Pharmacy  statutes to  add a  new                                                                    
     section to allow the  pharmacist filling a prescription                                                                    
     for  a schedule  II  or III  controlled substances,  to                                                                    
     dispense  a  lesser  quantity than  prescribed  at  the                                                                    
     request of the individual  for whom the prescription is                                                                    
     written.                                                                                                                   
                                                                                                                                
     Sec. 29:                                                                                                               
     Amends the Board of  Veterinary Examiners statute under                                                                    
     powers  and  duties  of  the  board.  The  board  shall                                                                    
     require a  licensee who has a  federal DEA registration                                                                    
     number  to  register   with  the  controlled  substance                                                                    
     prescription  database   under  AS   17.30.200(o).  The                                                                    
     section requires  the board  to identify  resources and                                                                    
     develop  educational materials  to assist  licensees in                                                                    
     identifying  an animal  owner who  may be  at risk  for                                                                    
     abusing or misusing an opioid.                                                                                             
                                                                                                                                
     Sec 30:                                                                                                                
     The board may  deny, suspend, or revoke  the license of                                                                    
     a  person who:  prescribed  or dispensed  an opioid  in                                                                    
     excess  of  the  maximum  dosage  authorized  under  AS                                                                    
     08.68.705;  or  has   procured,  sold,  prescribed,  or                                                                    
     dispensed drugs  in violation of  a law,  regardless of                                                                    
     whether there has been a criminal action.                                                                                  
                                                                                                                                
     Sec. 31:                                                                                                               
     The  section   allows  an   individual  to   execute  a                                                                    
     voluntary non-opioid  directive in a  format prescribed                                                                    
     by the  Department of Health  and Social  Services. The                                                                    
     section  further provides  that a  licensed-health-care                                                                    
     providers,  hospitals, and  employees, and  pharmacists                                                                    
     are exempt  from licensing board discipline,  civil and                                                                    
     criminal   liability   for   failure   to   administer,                                                                    
     prescribe, or  dispense an opioid to  an individual who                                                                    
     has  executed  a  voluntary non-opioid  directive.  The                                                                    
     non-opioid  directive  does  not  limit  a  health-care                                                                    
     provider  or pharmacist  from prescribing,  dispensing,                                                                    
     or administering  an opioid overdose drug  or an opioid                                                                    
     for  the   treatment  of  substance  abuse   or  opioid                                                                    
     dependence.                                                                                                                
                                                                                                                                
4:13:59 PM                                                                                                                    
                                                                                                                                
     Sec. 32:                                                                                                               
     Amends AS  17.300.200(a) to exclude  certain facilities                                                                    
     from  the  requirements  of   the  PDMP.  This  section                                                                    
     references a section  "u" of the PDMP  (see section 41)                                                                    
     where by  correctional facilities  are exempt  from the                                                                    
     PDMP except  when prescribing opioids  to an  inmate at                                                                    
     the  time   of  the  inmate's  release   as  in-patient                                                                    
     pharmacies and  emergency rooms are exempt  if they are                                                                    
     only  prescribing   less  than  a  24-hour   supply  of                                                                    
     opioids. (See also section 41).                                                                                            
                                                                                                                                
     Sec. 33:                                                                                                               
     Amends   AS  17.300.200(a)   to  exclude   correctional                                                                    
     facilities  from  the  requirements of  the  controlled                                                                    
     substance    prescription    database    except    when                                                                    
     prescribing opioids  to an  inmate at  the time  of the                                                                    
     inmate's release.                                                                                                          
                                                                                                                                
     Sec. 34:                                                                                                               
     Amends AS  17.30.200(b) as amended by  sec. 23, chapter                                                                    
     25,  SLA 2016  by substituting  "weekly" with  "daily."                                                                    
     The change  will require the pharmacist-in-charge  of a                                                                    
     pharmacy,  and   each  practitioner  who   dispenses  a                                                                    
     schedule  II,  III,  or  IV  controlled  substance,  to                                                                    
     submit  the  information  to the  controlled  substance                                                                    
     prescription database daily instead of weekly.                                                                             
                                                                                                                                
     Sec. 35:                                                                                                               
     Amends AS 17.30.200(d) as amended  chapter 25, SLA 2016                                                                    
     to clarify  that to clarify that  information contained                                                                    
     in  the PDMP  can be  shared with  federal, state,  and                                                                    
     local law enforcement that have  a valid search warrant                                                                    
     or court order.                                                                                                            
                                                                                                                                
     Sec. 36:                                                                                                               
     Amends AS  17.30.200(e) as amended  by chapter  25, SLA                                                                    
     2016  to  clarify  that a  pharmacist,  the  individual                                                                    
     filling   a  prescription,   is   required  to   submit                                                                    
     information    into   the    database;   it    is   the                                                                    
     responsibility  of  the  practitioner,  the  individual                                                                    
     writing the prescription, to review the database.                                                                          
                                                                                                                                
     Sec. 37:                                                                                                               
     Amends AS  17.30.200(p) as amended  by chapter  25, SLA                                                                    
     2016 to  require the Board  of Pharmacy  shall promptly                                                                    
     notify  the  Board  of   Veterinary  Examiners  when  a                                                                    
     practitioner registers  with the database under  (o) of                                                                    
     the section.                                                                                                               
                                                                                                                                
     Sec. 38:                                                                                                               
     Amends AS  17.30.200(q) as amended by,  chapter 25, SLA                                                                    
     2016 is  amended by allowing  the Board of  Pharmacy to                                                                    
     provide unsolicited notification  to the practitioner's                                                                    
     licensing board if  a patient has received  one or more                                                                    
     prescriptions for  controlled substances  in quantities                                                                    
     or  with   a  frequency  inconsistent   with  generally                                                                    
     recognized standards of  safe practice. The unsolicited                                                                    
     notification to a  practitioner's licensing board under                                                                    
     the section must also be  provided to the practitioner,                                                                    
     is   considered   confidential,    may   not   disclose                                                                    
     confidential information under the  section, and may be                                                                    
     in a summary  form sufficient to provide  notice of the                                                                    
     basis for the unsolicited notification.                                                                                    
                                                                                                                                
4:17:04 PM                                                                                                                    
                                                                                                                                
     Sec. 39:                                                                                                               
     Amends AS  17.30.200(r) as amended  by chapter  25, SLA                                                                    
     2016  to provide  guidance so  to when  the board  must                                                                    
     update   the    requirement   that    pharmacists   and                                                                    
     prescribers must  comply with  the database on  a daily                                                                    
     basis rather than a weekly basis.                                                                                          
                                                                                                                                
     Sec. 40:                                                                                                               
     Amends AS  17.30.200(n) as amended  by chapter  25, SLA                                                                    
     2016 to update the definition  of opioid to include the                                                                    
     opium  and  opiate  substances  and  opium  and  opiate                                                                    
     derivatives listed in AS 11.71.140.                                                                                        
                                                                                                                                
     Sec. 41:                                                                                                               
     Adds  a new  section (t)  to AS  17.30.200, giving  the                                                                    
     Board  of  Pharmacy  the authority  to  issue  periodic                                                                    
     unsolicited   "report   cards"  with   non-identifiable                                                                    
     information   comparing   the  practitioner's   opioid-                                                                    
     prescribing   practices  with   others   in  the   same                                                                    
     occupation. [Information is  confidential]. Also adds a                                                                    
     new section  (u) to AS  47.17.200, giving the  Board of                                                                    
     Pharmacy  the ability  to exempt  in-patient pharmacies                                                                    
     and  emergency rooms  from  the  review and  submission                                                                    
     requirement  of the  PDMP when  they are  dispensing no                                                                    
     more than a 24-hour supply of opioids upon discharge.                                                                      
                                                                                                                                
     Sec. 42:                                                                                                               
     Amends  AS   18.05.040  to   give  authority   for  the                                                                    
     Commissioner of  Health &  Social Services  shall adopt                                                                    
     regulations   consistent   with    existing   law   for                                                                    
     implementation  of   AS  13.55,   Voluntary  Non-opioid                                                                    
     Directive Act.                                                                                                             
                                                                                                                                
     Sec. 43:                                                                                                               
     Repeals  various sections  from  chapter  25, SLA  2016                                                                    
     related to the  July 2018 effective dates  for the PDMP                                                                    
     in SB 74.                                                                                                                  
                                                                                                                                
     Sec. 44:                                                                                                               
     Provides transitional  authority for the  Department of                                                                    
     Commerce and Economic  Development to draft regulations                                                                    
     to  implement   changes  to  the  PDMP   prior  to  the                                                                    
     effective  date   of  certain   sections.  This   is  a                                                                    
     technical fix.                                                                                                             
                                                                                                                                
     Sections 45, 46, 47, 48, 49, 50:                                                                                       
     Relate to  the various changes  to the PDMP  related to                                                                    
     the  effective dates  under SB  74.  This is  necessary                                                                    
     because the changes to the PDMP  under SB 74 are not in                                                                    
     effect until July 18, 2017.                                                                                                
                                                                                                                                
     Sec. 51:                                                                                                               
     New effective dates from the PDMP (July 1, 2018).                                                                          
                                                                                                                                
     Sec. 52:                                                                                                               
     The advanced  directive sections of the  bill (sections                                                                    
     1 and 4) take effect on July 1, 2019.                                                                                      
                                                                                                                                
     Sec. 53:                                                                                                               
     All   other  provisions   of  the   bill  take   effect                                                                    
     immediately.                                                                                                               
                                                                                                                                
4:19:34 PM                                                                                                                    
SENATOR MICCICHE noted that the  seven-day supply applied to most                                                               
of the  providers, but asked  if veterinarians were  also limited                                                               
to a seven-day supply.                                                                                                          
                                                                                                                                
MS. CHAMBERS  noted that  optometrists have  a four-day  limit in                                                               
statute  and asked  Ms. Kraly  to  address the  supply limit  for                                                               
veterinarians.                                                                                                                  
                                                                                                                                
4:20:17 PM                                                                                                                    
STACY KRALY, Chief Assistant  Attorney General, Alaska Department                                                               
of  Law,  Juneau,  Alaska, addressed  opioid  supply  limits  for                                                               
veterinarians as follows:                                                                                                       
                                                                                                                                
     There is  a similar provision  within the bill as  to a                                                                    
     seven-day  limit for  veterinarians  currently that  is                                                                    
     not included in the bill.                                                                                                  
                                                                                                                                
SENATOR   MICCICHE   asked   if   veterinarians   are   currently                                                               
statutorily limited to seven days for opioids.                                                                                  
                                                                                                                                
MR. KRALY replied no and specified as follows:                                                                                  
                                                                                                                                
     No,  the  seven-day  limit is  being  adopted  in  this                                                                    
     legislation. Other  boards, as Ms.  Chambers mentioned,                                                                    
     may  have other  limits  and  there's other  guidelines                                                                    
     that  boards may  follow, but  this specific  seven-day                                                                    
     limit  is  as to  boards  that  we have  identified  as                                                                    
     having the ability to  prescribe opioids, the seven-day                                                                    
     limit is contained in this legislation.                                                                                    
                                                                                                                                
SENATOR MICCICHE noted  that he will keep looking  because he had                                                               
not seen the seven-day limit for veterinarians in the bill.                                                                     
                                                                                                                                
MS.  KRALY answered  that  she thought  the  seven-day limit  for                                                               
veterinarians is an omission in SB 79.                                                                                          
                                                                                                                                
SENATOR GIESSEL  confirmed that Senator Micciche  did identify an                                                               
omission.                                                                                                                       
                                                                                                                                
CHAIR WILSON asked  how many pills are in a  seven-day supply. He                                                               
noted that the  term seven-day supply is identified  in the bill,                                                               
but the specific number of pills is not addressed.                                                                              
                                                                                                                                
4:22:19 PM                                                                                                                    
DR. BUTLER replied  that the number of pills is  dependent on the                                                               
medication.                                                                                                                     
                                                                                                                                
CHAIR  WILSON asked  that when  a patient  is red-flagged  by the                                                               
database  if  the   patient  is  notified  in   addition  to  the                                                               
prescriber and pharmacist.                                                                                                      
                                                                                                                                
MS.  CHAMBERS answered  that patients  may request  their history                                                               
and information at  any time. She specified that  the idea behind                                                               
the practitioner receiving notification is  to have the option of                                                               
notifying the patient.                                                                                                          
                                                                                                                                
SENATOR BEGICH disclosed  that opposition to the  bill is related                                                               
to the shortened time period  for prescriptions and its impact on                                                               
lifetime  suffers of  chronic pain.  He asked  if additions  have                                                               
recently  been made  to  the bill  that  addressed patients  with                                                               
chronic pain.                                                                                                                   
                                                                                                                                
4:24:22 PM                                                                                                                    
DR.  BUTLER  replied  that  the  provision  that  Senator  Begich                                                               
referenced  is  part  of  the  original bill  and  the  topic  is                                                               
frequently  misunderstood.  He  specified   that  the  bill  does                                                               
provide for the opportunity for  waivers. He pointed out that the                                                               
added   step   is   a  stop-check   procedure   for   accountable                                                               
justification.                                                                                                                  
                                                                                                                                
SENATOR BEGICH asked  if a provider who has a  number of chronic-                                                               
pain clients could potentially have a bad report card.                                                                          
                                                                                                                                
DR. BUTLER replied that the report card is not punitive.                                                                        
                                                                                                                                
SENATOR BEGICH stated  that he wanted to be sure  that the report                                                               
card does  not have  a dampening effect  on providing  relief and                                                               
not creating any  more obstacles for those with  chronic pain. He                                                               
noted that  Senator Micciche  brought up  a good  point regarding                                                               
the  veterinarian-limit omission  and asked  if the  veterinarian                                                               
omission needs to be corrected.                                                                                                 
                                                                                                                                
DR. BUTLER  answered that  he would have  to think  about Senator                                                               
Begich's  question   prior  to   answering.  He   explained  that                                                               
medication prescriptions for animals varies from humans.                                                                        
                                                                                                                                
4:27:18 PM                                                                                                                    
SENATOR MICCICHE noted that Senate  Finance is the next committee                                                               
of assignment  and asked  Dr. Butler to  address his  question at                                                               
that  time. He  pointed out  that  some Alaskans  have chosen  to                                                               
obtain  their  opioids through  veterinarians  and  the issue  is                                                               
something that the Legislature should deal with.                                                                                
                                                                                                                                
MS.  CHAMBERS  added  that  since CBPL  regulates  the  Board  of                                                               
Veterinary Examiners  that she will pose  the opioid prescription                                                               
limitations to the board.                                                                                                       
                                                                                                                                
CHAIR WILSON asked  that Ms. Chambers provide  the committee with                                                               
the  information  she  receives  from  the  Board  of  Veterinary                                                               
Examiners.                                                                                                                      
                                                                                                                                
MS. CHAMBERS  replied that  she will  provide the  committee with                                                               
the information that Chair Wilson requested.                                                                                    
                                                                                                                                
CHAIR WILSON  addressed the  documentation required  to prescribe                                                               
additional  opioids and  asked why  documentation for  all opioid                                                               
prescriptions is not required.                                                                                                  
                                                                                                                                
4:29:00 PM                                                                                                                    
DR. BUTLER  replied that  in general  the spirit  of the  bill is                                                               
trying  to do  what Chair  Wilson  is suggesting  in addition  to                                                               
keeping  the  administrative  burden  as small  as  possible.  He                                                               
asserted that  the bill's focus  is to  really try and  limit the                                                               
prescriptions  that are  most dangerous  which is  dispensing the                                                               
larger number of pills.                                                                                                         
                                                                                                                                
CHAIR WILSON  asked if  the bill will  add to  the administrative                                                               
costs for the prescribing practitioners.                                                                                        
                                                                                                                                
DR.  BUTLER  conceded that  added  documentation  will occur.  He                                                               
specified that  new requirements are not  being imposed; however,                                                               
current requirements are being earmarked to focus on.                                                                           
                                                                                                                                
MS. CHAMBERS disclosed  that the chair for the  Board of Pharmacy                                                               
members indicated  that software makes the  reporting change from                                                               
weekly to daily minimal for his mom-and-pop pharmacy.                                                                           
                                                                                                                                
4:32:17 PM                                                                                                                    
SENATOR GIESSEL said one of the  things she thought about for the                                                               
PDMP is  perhaps having a  small registration fee to  help offset                                                               
some of the cost. She asked if a fee has been considered.                                                                       
                                                                                                                                
MS. CHAMBERS  replied that a  fee-proposal notification  is about                                                               
to be  sent to  the Legislature  for consideration.  She revealed                                                               
that the fee being considered is  very minimal compared to all of                                                               
the other fees  that are charged. She detailed  that the proposed                                                               
fee will take the onus off  the pharmacists who have been bearing                                                               
the weight  of the PDMP  because they  were the ones  required to                                                               
use  it. She  noted that  two grants  have been  obtained with  a                                                               
third application  just completed  to obtain federal  funding for                                                               
program expansion like the report-card feature.                                                                                 
                                                                                                                                
DR. BUTLER  added that  the customer  service that  providers who                                                               
use PDMP are receiving is good.                                                                                                 
                                                                                                                                
CHAIR WILSON said  his hope is that the added  cost from the bill                                                               
is not  a burden that is  ultimately passed on to  the end users,                                                               
the customers.                                                                                                                  
                                                                                                                                
4:35:09 PM                                                                                                                    
CHAIR WILSON opened public testimony.                                                                                           
                                                                                                                                
4:35:23 PM                                                                                                                    
JONATHAN   LARSON,   representing   self,   Dillingham,   Alaska,                                                               
testified  in  support   of  SB  79.  He   shared  his  firsthand                                                               
experience with the opioid epidemic in Dillingham.                                                                              
                                                                                                                                
4:37:46 PM                                                                                                                    
DAN  NELSON,  Director  of Pharmacy,  Tanana  Chiefs  Conference,                                                               
Fairbanks, Alaska, testified in support  of SB 79. He pointed out                                                               
that  there  is   some  question  as  to  the   definition  of  a                                                               
"practitioner,"  particularly in  section 36.  He suggested  that                                                               
some  intent  language  be  put   into  the  bill  regarding  the                                                               
responsibilities of a practitioner versus a pharmacist.                                                                         
                                                                                                                                
4:39:27 PM                                                                                                                    
MICHAEL CARSON,  Chair, Mat-Su Opioid Task  Force, Mat-Su Valley,                                                               
Alaska, testified  in support of  SB 79.  He pointed out  that 80                                                               
percent of heroin users start  with pain-opioid pills; 75 percent                                                               
of  those  individuals  get  the pills  from  family  members  or                                                               
friends. He  said there has been  a spike in heroin  use over the                                                               
past  5 years  and disclosed  that  in 2016  there were  128-drug                                                               
overdoses in the  state with 40 percent attributed  to heroin. He                                                               
noted that  fentanyl is a new  drug in the  mix that is 25  to 50                                                               
times more powerful than heroine.  He said the Mat-Su Opioid Task                                                               
Force is very much in favor  of the seven-day supply based on the                                                               
newest research that recently came out.                                                                                         
                                                                                                                                
4:41:48 PM                                                                                                                    
ROBIN  MINARD,   Director  or   Public  Affairs,   Mat-Su  Health                                                               
Foundation, Wasilla, Alaska,  testified in support of  SB 79. She                                                               
said  the  Mat-Su Health  Foundation  believes  SB 79  will  save                                                               
lives. She  disclosed that 26  people died from heroin  in Alaska                                                               
in 2016 and 83 from prescription  opioids. She set forth that the                                                               
provisions  from  SB   79  can  help  ensure   that  the  state's                                                               
statistics  are  better in  the  future.  She said  limiting  the                                                               
quantity  of  opioid  drugs that  can  initially  be  prescribed,                                                               
requiring training for prescribers,  and fully utilizing the PDMP                                                               
will help  ensure that  all Alaskans have  the opportunity  for a                                                               
healthy life.                                                                                                                   
                                                                                                                                
4:43:55 PM                                                                                                                    
DAVID REES, representing self, Eagle  River, Alaska, testified in                                                               
support of  SB 79. He  disclosed that he has  submitted testimony                                                               
that  addresses personal  issues regarding  prescription opioids,                                                               
specifically  regarding  chronic-pain  management. He  noted  his                                                               
family's  concern  regarding  the  bill's impact  on  access  for                                                               
individuals  that  use  opioids  for  chronic  pain  as  well  as                                                               
potentially higher costs.                                                                                                       
                                                                                                                                
4:46:19 PM                                                                                                                    
TRACEY  WIESE,  Co-Chair,  Alaska  Advanced  Practice  Registered                                                               
Nurse Alliance  (APRN), Anchorage,  Alaska, testified  in support                                                               
of SB  79. She  said APRN  supports most of  the bill,  but noted                                                               
concerns about some of the language  in the bill. She stated that                                                               
APRN supports  Senator Giessel's  suggested amendments  to ensure                                                               
that  nurse practitioners  are listed  specifically as  licensed-                                                               
individual  practitioners.  She   said  APRN's  concern  revolves                                                               
around  the  educational  requirement   and  specified  that  the                                                               
language as  currently written  describes education  for opioids,                                                               
addictions,  and  recovery.  She   set  forth  that  the  concern                                                               
pertains to the  education language that could  be interpreted as                                                               
the  provider  needing  education  in  opioids,  addictions,  and                                                               
recovery rather  than one  or the other.  She added  that another                                                               
concern relates  to undue burden  of sole  proprietors, providers                                                               
who have small  businesses. She said APRN  suggests that language                                                               
be introduced that states "opiates"  or a specific scheduled drug                                                               
that was specifically  for opiates. She added  that APRN suggests                                                               
that a sunset clause be  included for the educational requirement                                                               
so that the  issue can be revisited in the  upcoming years to see                                                               
if   the    legislatively-mandated-educational   requirement   is                                                               
necessary for providers.                                                                                                        
                                                                                                                                
4:49:38 PM                                                                                                                    
TOM   CHARD,  Executive   Director,   Alaska  Behavioral   Health                                                               
Association, Juneau,  Alaska, testified in  support of SB  79. He                                                               
specified  that the  association  represents all  of the  state's                                                               
mental  health and  drug-and-alcohol providers,  both tribal  and                                                               
non-tribal.  He set  forth that  the association  appreciates the                                                               
Legislature's efforts  paid to the  opioid epidemic. He  said the                                                               
association sees the epidemic's  effect on individuals, families,                                                               
and communities.  He emphasized that the  association appreciates                                                               
the prevention and early intervention  approach that the SB 79 is                                                               
taking.   He  called   attention  to   the  continued   education                                                               
requirements  in  the  bill  and  opined  that  prescribers  will                                                               
benefit from the provision.                                                                                                     
                                                                                                                                
4:52:14 PM                                                                                                                    
CHAIR WILSON closed public testimony on SB 79, and asked if                                                                     
there were amendments.                                                                                                          
                                                                                                                                
4:52:27 PM                                                                                                                    
SENATOR GIESSEL moved Amendment 1:                                                                                              
                                                                                                                                
                                                 30-GS1021\O.1                                                                  
                                                        Bruce                                                                   
                                                       5/5/17                                                                   
                                                                                                                                
                                                                                                                                
                          AMENDMENT 1                                                                                       
                                                                                                                                
                                                                                                                                
     OFFERED IN THE SENATE         BY SENATOR GIESSEL                                                                           
     TO: CSSB 79(L&C)                                                                                                           
                                                                                                                                
                                                                                                                                
     Page 6, line 26:                                                                                                           
     Delete "AS 11.71.140"                                                                                                      
     Insert "AS 11.71.140 - 11.71.170"                                                                                          
                                                                                                                                
     Page 15, line 6:                                                                                                           
     Delete "AS 11.71.140"                                                                                                      
     Insert "AS 11.71.140 - 11.71.170"                                                                                          
                                                                                                                                
     Page 19, line 14:                                                                                                          
     Delete "AS 11.71.140"                                                                                                      
     Insert "AS 11.71.140 - 11.71.170"                                                                                          
                                                                                                                                
     Page 27, line 28:                                                                                                          
     Delete "AS 11.71.140"                                                                                                      
     Insert "AS 11.71.140 - 11.71.170"                                                                                          
                                                                                                                                
     Page 32, line 20:                                                                                                          
     Delete "AS 11.71.140"                                                                                                      
     Insert "AS 11.71.140 - 11.71.170"                                                                                          
                                                                                                                                
SENATOR VON IMHOF objected for the purposes of discussion.                                                                      
                                                                                                                                
SENATOR GIESSEL explained Amendment 1 as follows:                                                                               
                                                                                                                                
     Looking at  the bill I noted  that if you turn  to page                                                                    
     6, line 26, though this  is repeated in multiple places                                                                    
     in  the   bill,  it  calls   out  AS   11.71.140;  this                                                                    
     identifies  schedule  IA  controlled  substances  which                                                                    
     contain  opioids   in  that   list,  but  also   in  AS                                                                    
     11.71.160,  that's   schedule  IIIA,  there   are  also                                                                    
     opioids  identified. Simply  for  completeness I  offer                                                                    
     the amendment which adds AS  11.71.160 to the line that                                                                    
     identifies the  schedules that contain opioids.  I have                                                                    
     consulted with  Dr. Butler on this  and he acknowledges                                                                    
     that this  additional section  does contain  opioids as                                                                    
     well.                                                                                                                      
                                                                                                                                
SENATOR  BEGICH noted  a  procedural question  and  asked if  the                                                               
committee ever  moved the legislation  itself prior to  moving an                                                               
amendment. He  inquired if the  legislation has to be  before the                                                               
committee.                                                                                                                      
                                                                                                                                
SENATOR GIESSEL  replied that  not if  the bill  is in  its first                                                               
hearing.                                                                                                                        
                                                                                                                                
SENATOR BEGICH asked to confirm Senator Giessel's statement.                                                                    
                                                                                                                                
SENATOR VON IMHOF removed her objection.                                                                                        
                                                                                                                                
4:53:52 PM                                                                                                                    
At ease                                                                                                                         
                                                                                                                                
4:55:31 PM                                                                                                                    
CHAIR  WILSON called  the committee  back to  order. He  asked if                                                               
there  was  any other  discussion  on  Amendment  1, and  if  the                                                               
objection was maintained.                                                                                                       
                                                                                                                                
SENATOR VON IMHOF said she removed her objection.                                                                               
                                                                                                                                
CHAIR  WILSON  announced  that   hearing  no  further  objection,                                                               
Amendment  1  passes.   He  asked  if  there   were  any  further                                                               
amendments.                                                                                                                     
                                                                                                                                
4:55:54 PM                                                                                                                    
SENATOR GIESSEL moved Amendment 2:                                                                                              
                                                                                                                                
                                                 30-GS1021\O.2                                                                  
                                                        Bruce                                                                   
                                                       5/5/17                                                                   
                                                                                                                                
                                                                                                                                
                          AMENDMENT 2                                                                                       
                                                                                                                                
                                                                                                                                
     OFFERED IN THE SENATE         BY SENATOR GIESSEL                                                                           
     TO: CSSB 79(L&C)                                                                                                           
                                                                                                                                
     Page 21, line 18:                                                                                                          
     Delete "four"                                                                                                              
     Insert "two [FOUR]"                                                                                                        
                                                                                                                                
SENATOR VON IMHOF objected for purposes of discussion.                                                                          
                                                                                                                                
SENATOR GIESSEL explained Amendment 2 as follows:                                                                               
                                                                                                                                
     Page 21, line 18, this  section refers to optometry, it                                                                    
     refers  to  their   continuing  education  requirements                                                                    
     which  are identical  to the  other clinicians  in this                                                                    
     bill; however,  on line 18  it says that, "In  the four                                                                    
     years  preceding the  application for  renewal, all  of                                                                    
     the professional  licensees renew every two  years." So                                                                    
     this very old  piece of statute needs to  be updated to                                                                    
     reflect  every two-year  license  renewal;  it does  in                                                                    
     effect double  the amount of continuing  education that                                                                    
     is identified  in this  bill but  that's not  a problem                                                                    
     either.                                                                                                                    
                                                                                                                                
SENATOR VON IMHOF announced that she removed her objection.                                                                     
                                                                                                                                
CHAIR WILSON announced that hearing no further objection,                                                                       
Amendment 2 passes. He asked if there were any further                                                                          
amendments.                                                                                                                     
                                                                                                                                
4:56:54 PM                                                                                                                    
SENATOR GIESSEL moved Amendment 3:                                                                                              
                                                                                                                                
                                                 30-GS1021\O.4                                                                  
                                                        Bruce                                                                   
                                                       5/5/17                                                                   
                                                                                                                                
                                                                                                                                
                          AMENDMENT 3                                                                                       
                                                                                                                                
                                                                                                                                
     OFFERED IN THE SENATE         BY SENATOR GIESSEL                                                                           
     TO: CSSB 79(L&C)                                                                                                           
                                                                                                                                
                                                                                                                                
     Page 1, line 7, following "pharmacists;":                                                                                  
     Insert "relating to the definition of 'practitioner';"                                                                     
                                                                                                                                
     Page 26, following line 6:                                                                                                 
     Insert a new bill section to read:                                                                                         
        "* Sec. 31. AS 11.71.900(19) is amended to read:                                                                        
     (19)"practitioner" means                                                                                                   
     (A) a physician,  dentist, advanced practice registered                                                                    
     nurse, veterinarian, scientific  investigator, or other                                                                    
     person licensed, registered,  or otherwise permitted to                                                                    
     distribute,  dispense,  conduct research  with  respect                                                                    
     to, or  to administer  or use  in teaching  or chemical                                                                    
     analysis  a  controlled  substance  in  the  course  of                                                                    
     professional practice or research in the state;                                                                            
     (B)   a  pharmacy,   hospital,  or   other  institution                                                                    
     licensed,   registered,  or   otherwise  permitted   to                                                                    
     distribute,  dispense,  conduct research  with  respect                                                                    
     to,  or to  administer  a controlled  substance in  the                                                                    
     course  of professional  practice  or  research in  the                                                                    
     state;"                                                                                                                    
                                                                                                                                
     Renumber the following bill sections accordingly.                                                                          
                                                                                                                                
     Page 29, line 2:                                                                                                           
     Delete "sec. 33"                                                                                                           
     Insert "sec. 34"                                                                                                           
                                                                                                                                
     Page 34, line 10:                                                                                                          
     Delete "secs. 31 and 42"                                                                                                   
     Insert "secs. 32 and 43"                                                                                                   
                                                                                                                                
     Page 34, line 16:                                                                                                          
     Delete "sec. 34"                                                                                                           
     Insert "sec. 35"                                                                                                           
                                                                                                                                
     Page 34, line 17:                                                                                                          
     Delete "sec. 39"                                                                                                           
     Insert "sec. 40"                                                                                                           
                                                                                                                                
     Page 34, line 19:                                                                                                          
     Delete "secs. 34 and 39"                                                                                                   
     Insert "secs. 35 and 40"                                                                                                   
                                                                                                                                
     Page 35, line 10:                                                                                                          
     Delete "Section 32"                                                                                                        
     Insert "Section 33"                                                                                                        
                                                                                                                                
     Page 35, line 12:                                                                                                          
     Delete "Section 33"                                                                                                        
     Insert "Section 34"                                                                                                        
                                                                                                                                
     Page 35, line 14:                                                                                                          
     Delete "Section 35"                                                                                                        
     Insert "Section 36"                                                                                                        
                                                                                                                                
     Page 35, line 16:                                                                                                          
     Delete "Section 36"                                                                                                        
     Insert "Section 37"                                                                                                        
                                                                                                                                
     Page 35, line 18:                                                                                                          
     Delete "Sections 37 and 38"                                                                                                
     Insert "Sections 38 and 39"                                                                                                
                                                                                                                                
     Page 35, line 20:                                                                                                          
     Delete "Section 41"                                                                                                        
     Insert "Section 42"                                                                                                        
                                                                                                                                
     Page 35, line 22:                                                                                                          
     Delete "Section 1, 2, 6 - 13,  18, 20, 23 - 25, 34, and                                                                    
     39"                                                                                                                        
     Insert "Sections  1, 2, 6  - 13, 18,  20, 23 -  25, 35,                                                                    
     and 40"                                                                                                                    
                                                                                                                                
     Page 35, line 24:                                                                                                          
     Delete "Sections 31 and 42"                                                                                                
     Insert "Sections 32 and 43"                                                                                                
                                                                                                                                
     Page 35, line 25:                                                                                                          
     Delete "secs. 45 - 53"                                                                                                     
     Insert "secs. 46 - 54"                                                                                                     
                                                                                                                                
SENATOR VON IMHOF objected for the purposes of discussion.                                                                      
                                                                                                                                
SENATOR GIESSEL noted that the amendment has an error, but that                                                                 
it would be corrected. She explained Amendment 3 as follows:                                                                    
                                                                                                                                
     Page  6,   line  15,  a   statute  is   identified,  AS                                                                    
     11.71.900;  this statute  again  is  in the  controlled                                                                    
     substances  section   of  criminal  law  just   as  the                                                                    
     identification of  those two schedules for  drugs were.                                                                    
     This is  the definition  section and  it calls  out the                                                                    
     definition   of  the   word   "practitioner."  In   the                                                                    
     definition  which  you  see   identified  here  in  the                                                                    
     amendment  being inserted  into  section 31,  "advanced                                                                    
     practice  registered   nurse"  is   left  out   of  the                                                                    
     definition  of "practitioner."  As you  can see  on the                                                                    
     printed   amendment,   a   "practitioner"   means,   "A                                                                    
     physician, dentist, advanced  practice registered nurse                                                                    
     (is added),  veterinarian, scientific  investigator, or                                                                    
     other  person;"   essentially  this  is   updating  the                                                                    
     definition  of  "practitioner"  in criminal  law  under                                                                    
     controlled substances.                                                                                                     
                                                                                                                                
4:58:48 PM                                                                                                                    
SENATOR  MICCICHE  asked if  Amendment  3  essentially becomes  a                                                               
conceptual amendment.                                                                                                           
                                                                                                                                
SENATOR GIESSEL answered no and explained as follows:                                                                           
                                                                                                                                
     No, actually  what I was  calling out,  and erroneously                                                                    
     so, the  first place that  this appears in the  bill is                                                                    
     on page 6, line 15. You  see on line 15 it says, "There                                                                    
     has  the meaning  given in  AS 11.71.900."  So, I  said                                                                    
     what does  the definition say?  So, I looked it  up and                                                                    
     the drafter  chose to insert  this amendment,  which is                                                                    
     amending the  definition of practitioner,  into section                                                                    
     31,  then  renumber  the  rest  of  the  bill  sections                                                                    
     accordingly. So,  my mistake  for saying  the amendment                                                                    
     was drafted incorrectly.                                                                                                   
                                                                                                                                
SENATOR MICCICHE asked if the  amendment replaces the old section                                                               
31 with section 32.                                                                                                             
                                                                                                                                
SENATOR GIESSEL answered yes.                                                                                                   
                                                                                                                                
SENATOR BEGICH  asked if the  title change  is in the  very first                                                               
piece and is part of the title change.                                                                                          
                                                                                                                                
SENATOR GIESSEL answered yes.                                                                                                   
                                                                                                                                
SENATOR VON IMHOF removed her objection.                                                                                        
                                                                                                                                
CHAIR  WILSON  announced  that   hearing  no  further  objection,                                                               
Amendment  3  passes.   He  asked  if  there   were  any  further                                                               
amendments.                                                                                                                     
                                                                                                                                
5:00:20 PM                                                                                                                    
SENATOR VON IMHOF moved to report the  CS for SB 79, version O as                                                               
amended,  from  committee  with  individual  recommendations  and                                                               
attached fiscal note(s).                                                                                                        
                                                                                                                                
SENATOR GIESSEL  commented that she appreciated  Senator Micciche                                                               
identifying  the apparent  deficiency  related to  veterinarians.                                                               
She said  she looked forward  to Senator Micciche  addressing the                                                               
veterinarian   issue   appropriately   in  the   Senate   Finance                                                               
Committee.                                                                                                                      
                                                                                                                                
SENATOR  MICCICHE stated  appreciation  for  the legislation  and                                                               
shared the following:                                                                                                           
                                                                                                                                
     I was  home for a day  and I went to  the Freedom House                                                                    
     grand opening which  is a project by a  young woman who                                                                    
     has a  severe addiction for  many years. All I  can say                                                                    
     is it  is an amazing  facility, she's an  amazing young                                                                    
     woman, but what I want to  highlight is it's so easy to                                                                    
     become   addicted  to   opioids,   but  so   impossibly                                                                    
     difficult to turn your life  around. So if this gets in                                                                    
     the way  of a  single Alaskan,  which I  hope it  has a                                                                    
     much more  substantial effect,  even though  there's an                                                                    
     inconvenience  to providers,  I  strongly support  this                                                                    
     legislation.                                                                                                               
                                                                                                                                
SENATOR BEGICH  clarified that he  supports the  legislation, but                                                               
will  be  signing "amend"  based  on  the comments  from  Senator                                                               
Micciche.                                                                                                                       
                                                                                                                                
5:02:00 PM                                                                                                                    
At ease.                                                                                                                        
                                                                                                                                
5:03:14 PM                                                                                                                    
CHAIR WILSON  called the  committee back  to order.  He announced                                                               
that without objection CSSB 79(HSS)  moved from the Senate Health                                                               
and Social Services Standing Committee.                                                                                         
                                                                                                                                
SENATOR BEGICH commented on the cycle of addiction as follows:                                                                  
                                                                                                                                
     I wanted  to also echo  my support of  the legislation,                                                                    
     but also in particular because  in my family, two of my                                                                    
     nephews are  opiate addicts and  the inability  of them                                                                    
     to break that cycle is shocking  to me. One of them has                                                                    
     been in  the correctional  system, has  taken advantage                                                                    
     of the drugs that are  provided, I'm trying to remember                                                                    
     the  name of  it, Vivitrol,  which has  been successful                                                                    
     and for a  year after he's out, he will  be able to get                                                                    
     his Vivitrol prescription and then  it will run out, it                                                                    
     will be  $1200 a month and  he will not be  able to pay                                                                    
     it, so he will become  an addict again; I have actually                                                                    
     spoken to him recently, he's  going to do everything he                                                                    
     can  to  keep  that  from happening,  but  that  is  an                                                                    
     inevitable  problem with  addiction if  you can't  stop                                                                    
     the  process.  So if  this  does  what I  hope  Senator                                                                    
     Micciche and  I both believe  that if it  stops anybody                                                                    
     from  ever  entering  the system,  it  saves  not  just                                                                    
     lives, but  it saves  our culture, it  saves everything                                                                    
     about  what we  value and  for me  this is  very deeply                                                                    
     personal.  I want  to  just encourage  us  to get  this                                                                    
     thing through as  fast as we can and stop  the cycle of                                                                    
     addiction.                                                                                                                 
                                                                                                                                
SENATOR GIESSEL commented on the  encouraging evidence related to                                                               
Vivitrol as follows:                                                                                                            
                                                                                                                                
     I  would just  add  an encouraging  note, the  research                                                                    
     evidence does tend to favor that  after a year to 16 or                                                                    
     18  months  on  Vivitrol,  actually the  cycle  can  be                                                                    
     broken and  certainly with  strong family  support such                                                                    
     as  your relatives  have, there  is  a high  likelihood                                                                    
     that they will emerge successful.                                                                                          
                                                                                                                                
CHAIR  WILSON stated  that  he  appreciated the  administration's                                                               
support  in  trying  to  curb  in any  possible  way  the  opioid                                                               
epidemic  throughout Alaska's  communities.  He said  he did  not                                                               
think that there is one Alaskan  that the opioid epidemic has not                                                               
touched in some  way, shape or form of whether  increased cost of                                                               
someone's taxes  to pay  for law  enforcement or  knowing someone                                                               
personally, or  dealing with  some type of  issue related  to the                                                               
opioid epidemic. He thanked testifiers  as well as members in the                                                               
other body  that are also  working on  the opioid issues  to help                                                               
stem the epidemic.                                                                                                              
                                                                                                                                
[CSSB  79(HSS) was  reported from  the Senate  Health and  Social                                                               
Services Standing Committee.]                                                                                                   

Document Name Date/Time Subjects
SB 79 version O.pdf SHSS 5/9/2017 3:30:00 PM
SB 79
SB 79 Fiscal Note DHSS-PHAS-3-6-17.pdf SHSS 5/9/2017 3:30:00 PM
SB 79
SB 79 Fiscal Note DOC-HRDO-3-6-17.pdf SHSS 5/9/2017 3:30:00 PM
SB 79
SB 79 DCCED-CBPL-3-6-17.pdf SHSS 5/9/2017 3:30:00 PM
SB 79
SB 79 Sectional Analysis Version O 4.17.17.pdf SHSS 5/9/2017 3:30:00 PM
SB 79
SB 79 Summary of Amendments 4.17.17.pdf SHSS 5/9/2017 3:30:00 PM
SB 79
SB 79 Supporting Document - LOS from Alaska Dental Society.pdf SHSS 5/9/2017 3:30:00 PM
SB 79
SB 79 Supporting Document - LOS from MSHF.pdf SHSS 5/9/2017 3:30:00 PM
SB 79
Giessel Amdt # 1.pdf SHSS 5/9/2017 3:30:00 PM
SB 79
Giessel Amdt # 2.pdf SHSS 5/9/2017 3:30:00 PM
SB 79
Giessel Amdt # 3.pdf SHSS 5/9/2017 3:30:00 PM
SB 79
SB 79 HB 159 Supporting Document - LOS from ASHNHA.pdf SHSS 5/9/2017 3:30:00 PM
HB 159
SB 79
HB 186 Ver J 3.20.17.pdf SHSS 5/9/2017 3:30:00 PM
HB 186
HB 186 Fiscal Note 4.5.17.pdf SHSS 5/9/2017 3:30:00 PM
HB 186
HB 186 Sectional Analysis ver J 3.20.17.pdf SHSS 5/9/2017 3:30:00 PM
HB 186
HB 186 Sponsor Statement 3.20.17.pdf SHSS 5/9/2017 3:30:00 PM
HB 186
HB 186 Support Letter - Fairbanks Community Food Bank 3.20.17.pdf SHSS 5/9/2017 3:30:00 PM
HB 186
HB 186 Supporting Documents - Feeding America Alaska Stats 3.20.17.pdf SHSS 5/9/2017 3:30:00 PM
HB 186