Legislature(2017 - 2018)BELTZ 105 (TSBldg)

03/14/2017 01:30 PM LABOR & COMMERCE

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
Heard & Held
-- Public Testimony --
Heard & Held
-- Public Testimony --
Heard & Held
-- Public Testimony --
Bills Previously Heard/Scheduled:
-- Public Testimony --
Moved SSSB 4 Out of Committee
Moved SB 16 Out of Committee
Moved SB 32 Out of Committee
        SB 79-OPIOIDS; PRESCRIPTIONS; DATABASE; LICENSES                                                                    
2:11:23 PM                                                                                                                    
CHAIR COSTELLO  announced the consideration  of SB 79.  She noted                                                               
that the bill was introduced on  behalf of Governor Walker. SB 79                                                               
helps address  a major issue  facing Alaska, an  opioid epidemic.                                                               
It is a  national epidemic. She provided an example  from the New                                                             
York Times about  a farmer who lost two children  to opioids. She                                                             
said  this  type  of  addiction  can lead  to  heroin  abuse  and                                                               
staggering problems across the country.  Deaths related to opioid                                                               
abuse have increased three-fold in the past seven years.                                                                        
She  said  SB  79  looks  at a  strategy  in  Alaska  to  prevent                                                               
prescription pain  killer abusers from becoming  heroin users. In                                                               
2008 the legislature established  a controlled substance database                                                               
known as  the Alaska Prescription  Drug Monitoring  Program. Last                                                               
year the legislature  identified ideas to help  combat this issue                                                               
through managing  patient data. She  shared another example  of a                                                               
parent in Juneau  who lost a son in January.  She maintained that                                                               
the state  has a moral  obligation to address this  issue because                                                               
of the tremendous impact it is having on Alaska.                                                                                
She said  this is the  first hearing of SB  79. The intent  is to                                                               
hear  from  the sponsor,  take  members'  questions, take  public                                                               
testimony, and then hold the bill for further consideration.                                                                    
2:13:20 PM                                                                                                                    
DR. JAY BUTLER,  Chief Medical Officer, Department  of Health and                                                               
Social  Services,  commented  that   Chair  Costello  has  nicely                                                               
outlined the  reason for hearing  SB 79. He noted  the increasing                                                               
number of deaths  due to opioid overdose, which  has mirrored the                                                               
increase  in  the  rate of  prescribing  opioid  pain  relievers.                                                               
Alaska  is at  a  point where  many people  are  dependent on  or                                                               
addicted  to  opioids and  are  more  susceptible to  heroin  and                                                               
fentanyl abuse.  About 80 percent  of those using  heroin started                                                               
their addiction by using prescription painkillers.                                                                              
DR.  BUTLER  spoke  of  an  increase  in  rates  of  hepatitis  C                                                               
associated with drug  use and more emergency  room admissions. He                                                               
emphasized  that  "all statistics  are  people  with tears  wiped                                                               
away." He  said that,  today, most everyone  has been  touched by                                                               
the opioid epidemic.                                                                                                            
2:15:13 PM                                                                                                                    
DR. BUTLER  highlighted the need  to address  overdose, treatment                                                               
of  addiction,  addiction  as a  chronic  health  condition,  and                                                               
prevention,  including   limiting  legal  and   illegal  opioids,                                                               
involving   law   enforcement,   curbing   overprescribing,   and                                                               
addressing  why people  self-medicate. The  bill is  part of  the                                                               
larger response and is designed  to encourage more evidence-based                                                               
prescribing  and  limit  the flood  of  opioid  painkillers  into                                                               
communities. It intends  to increase access to  treatment and de-                                                               
stigmatization  by improving  provider  knowledge.  SB 79  aligns                                                               
with guidelines  in SB 74 by  healthcare boards, as well  as with                                                               
the Centers  for Disease Control Pain  Management Guidelines, the                                                               
Surgeon General's Report on Alcohol  Drugs and Health, and recent                                                               
statements  from   the  American  Medical  Association   and  the                                                               
American Dental Association.                                                                                                    
2:16:50 PM                                                                                                                    
DR. BUTLER said SB 79 provides  an option for patients who do not                                                               
wish to be prescribed opioids  to communicate their preference to                                                               
their providers by way of  a voluntary, revocable, opioid advance                                                               
directive. This was a suggestion  from the recovery community. It                                                               
also allows patients  to request from pharmacists,  less than the                                                               
total prescribed amount.                                                                                                        
He  said  SB   79  requires  that  five   percent  of  providers'                                                               
continuing education credits be  committed to pain management and                                                               
addiction.   The  bill   sets  limits   on  the   initial  opioid                                                               
prescription to  a seven-day  supply. Exceptions  can be  made by                                                               
providers in certain instances.                                                                                                 
SB  79  includes  changes to  the  Prescription  Drug  Monitoring                                                               
Program (PDMP), a centralized database  where providers can go to                                                               
look  at a  patient's prescription  history. The  bill authorizes                                                               
the  Pharmacy  Board  to issue  routine,  periodic,  confidential                                                               
reports to  prescribers to provide feedback  on their prescribing                                                               
practices.  He referred  to a  recent report  in the  New England                                                             
Journal of  Medicine that,  using the  Medicare Part  D database,                                                             
looked  at  prescribing  habits  of  emergency  room  physicians.                                                               
People  who received  opioids in  the  emergency department  were                                                               
more likely to  have dependency a year later. There  was a three-                                                               
fold variation in the rate  of prescribing opioids, which clearly                                                               
demonstrated a  lack of  agreement among providers  as to  how to                                                               
manage acute pain.                                                                                                              
He named states  that have been effective in  reducing the number                                                               
of  excessive  prescriptions  due  to  the  non-punitive  reports                                                               
issued to providers.                                                                                                            
2:20:20 PM                                                                                                                    
DR. BUTLER  spoke of two  controversial aspects of the  bill. One                                                               
requires veterinarians who prescribe  opioids to register and use                                                               
the  PDMP. The  second  controversial aspect  is requiring  daily                                                               
updates of the PDMP to make it a more useful tool.                                                                              
2:21:25 PM                                                                                                                    
CHAIR  COSTELLO  noted  that   Public  Safety  Commissioner  Walt                                                               
Monegan is present and showing support for the bill.                                                                            
DR. BUTLER continued  to say that 25 states  have the requirement                                                               
of daily updates of the PDMP.                                                                                                   
He stressed that  the bill does not place blame.  The goal is for                                                               
everyone  to be  responsible  for owning  the  problem and  doing                                                               
their part to address it.                                                                                                       
2:22:52 PM                                                                                                                    
CHAIR COSTELLO requested the sectional analysis.                                                                                
2:23:13 PM                                                                                                                    
DR. BUTLER presented the following sectional analysis for SB 79:                                                                
     Sec.  1  Adds a  new  Chapter  55, Voluntary  Nonopioid                                                                  
     Directive   Act,   to   AS  13,   Decedents'   estates,                                                                    
     guardianships,  transfers,  trusts,   and  health  care                                                                    
     decisions,  that provides  an  option  for patients  to                                                                    
     execute  a  Voluntary  Nonopioid Directive  that  would                                                                    
     allow a  person in recovery  (or for other  reasons) to                                                                    
     make clear  the person's desire not  to be administered                                                                    
     an  opioid. A  person, guardian,  conservator or  other                                                                    
     appointed person  may revoke  a directive at  any time.                                                                    
     The person would  provide this confidential information                                                                    
     to  a  health  care  provider or  hospital  on  a  form                                                                    
     provided  by   the  Department  of  Health   of  Social                                                                    
     Services. The  department would  promulgate regulations                                                                    
     on  procedures,  confidentiality,  and  exemptions  for                                                                    
     emergency or substance  misuse treatment. Providers are                                                                    
     not  liable for  following  a directive.  Prescriptions                                                                    
     are  assumed to  be valid;  pharmacists are  not liable                                                                    
     for dispensing a  controlled substance in contradiction                                                                    
     to  a  directive.  The  directive  does  not  alter  an                                                                    
     advance  health care  directive, limit  opioid overdose                                                                    
     drugs,  or  limit  treatment  for  substance  abuse  or                                                                    
     opioid dependence.                                                                                                         
CHAIR COSTELLO  asked if there  are alternatives to  opioids that                                                               
doctors can use.                                                                                                                
DR. BUTLER  said there are.  He described the evolution  over the                                                               
past  20  years where  opioids  have  become  the first  line  of                                                               
treatment for all  pain. He noted the influence  of market forces                                                               
and  the four-fold  increase in  prescribing and  abuse, with  no                                                               
decrease  in the  level of  pain. Physical  dependency is  also a                                                               
He shared  that there  are updated  clinical guidelines  for back                                                               
pain  by the  American College  of Physicians.  Now, opioids  are                                                               
given as the  third line of pain relief,  starting with something                                                               
like Tylenol and physical therapy.                                                                                              
2:26:11 PM                                                                                                                    
CHAIR COSTELLO  noted that  the bill will  be in  committee again                                                               
for further discussion.                                                                                                         
SENATOR HUGHES  thanked Dr. Butler and  expressed appreciation of                                                               
the  Governor's concern  about the  opioid crisis.  She discussed                                                               
liberal prescribing  practices in  the 90s  and noted  that today                                                               
most  doctors  use  opioids  as  a last  resort.  She  asked  how                                                               
extensive overprescribing is today.                                                                                             
DR. BUTLER opined that all  providers use more opioids today than                                                               
five  years ago.  He said  overprescribing is  spread across  the                                                               
profession nationally, but primary  care providers prescribe more                                                               
than  half of  all opioids.  He  pointed out  that Oxycodone  was                                                               
heavily  marketed   to  primary  care  providers.   Heroin  users                                                               
switched to  Oxycodone before  2010 because  it was  so prevalent                                                               
and cheap. In the 90s there was a trend to be "pain free."                                                                      
He  discussed  the  importance  of  pain and  noted  that  it  is                                                               
subjective. It also can be debilitating and needs to be managed.                                                                
SENATOR HUGHES  asked Dr.  Butler if  he has  access to  the PDMP                                                               
data to see who may be overprescribing.                                                                                         
2:31:23 PM                                                                                                                    
DR. BUTLER said he does not. He explained that PDMP monitoring                                                                  
falls to the Pharmacy Board under SB 74, however, Public Health                                                                 
can access de-identified data for public health purposes.                                                                       
SENATOR HUGHES asked if law enforcement has access to the PDMP                                                                  
with a warrant from the DEA.                                                                                                    
DR. BUTLER said yes.                                                                                                            
2:32:17 PM                                                                                                                    
DR. BUTLER continued the sectional analysis of SB 79:                                                                           
     Sec. 2-25  Amend AS 08,  Business and  Professions, for                                                                  
     the  Boards   of  Dentistry,  Medicine,   Nursing,  and                                                                    
     Optometry to:                                                                                                              
     Require  two (2)  hours of  pain management  and opioid                                                                    
     misuse and addiction instruction;                                                                                          
    Disciplinary actions for prescribing or dispensing an                                                                       
     opioid in excess  of the maximum dosage  allowed by law                                                                    
     or violated a  law related to drugs,  regardless of any                                                                    
     criminal action;                                                                                                           
    Set    the    maximum   dosage   for    initial   opioid                                                                    
     prescriptions  at a  seven-day  supply  unless, in  the                                                                    
     practitioner's professional  judgment, it  is necessary                                                                    
     for chronic pain  management or a patient  is unable to                                                                    
     access   a  practitioner   in   time   to  refill   the                                                                    
     prescription; and                                                                                                          
    Require, for a minor under 18 years of age, the                                                                             
     practitioner discuss  with the  parent or  guardian why                                                                    
     the   prescription   is   necessary,  and   the   risks                                                                    
     associated with opioid use.                                                                                                
He provided an example of a 15-year-old who was prescribed                                                                      
He continued the sectional analysis of SB 79.                                                                                   
     Sec. 26-27 Amend AS 08.80 for the Board of Pharmacy to                                                                   
    Register with the Prescription Drug Monitoring                                                                              
     Database  (PDMP)   with  or  without  a   federal  Drug                                                                    
     Enforcement Administration registration number; and                                                                        
     Allow pharmacists to dispense less than the prescribed                                                                     
     amount of a schedule II or III controlled substance at a                                                                   
     person's request; the pharmacists would inform the                                                                         
     prescribing   practitioner   and   the   Prescription   Drug                                                               
     Monitoring Database.                                                                                                       
2:35:21 PM                                                                                                                    
     Sec. 28  Amends AS  08.98 for  the Board  of Veterinary                                                                  
     Medicine to:                                                                                                               
     Register   with   the  Prescription   Drug   Monitoring                                                                    
     Database  if  the  veterinarian   has  a  federal  Drug                                                                    
     Enforcement Administration number; and                                                                                     
     Identify   resources    and   educational    materials   for                                                               
     veterinarians to identify clients at risk for opioid misuse                                                                
     or diversion of prescribed opioids.                                                                                        
     Sec. 29-36  Amend AS  17.30, Controlled  Substances, to                                                                  
     change   the  frequency   pharmacists  report   to  the                                                                    
     Prescription  Drug Monitoring  Database from  weekly to                                                                    
     daily;  remove the  prohibition on  sharing information                                                                    
     with  the federal  government. The  pharmacy board  may                                                                    
     provide  a  confidential  unsolicited  notification  in                                                                    
     summary form to a  practitioner's licensing board which                                                                    
     includes   the   basis   for  the   notification.   The                                                                    
     notification must  be provided  to the  practitioner as                                                                    
     Sec.  37 Directs  the Department  of Health  and Social                                                                  
     Services   to  draft   regulations  to   implement  the                                                                    
     Voluntary Nonopioid Directive Act.                                                                                         
     Sec. 38 Repeals  sunset dates in sections 52  and 73 of                                                                  
     Ch. 25, SLA 2016 (SB 74).                                                                                                  
     Sec. 39-40 Set an  immediate effective date and provide                                                                  
     an effective date for regulations.                                                                                         
2:37:29 PM                                                                                                                    
CHAIR COSTELLO thanked Dr. Butler  and opened public testimony on                                                               
SB 79.                                                                                                                          
2:37:52 PM                                                                                                                    
DANIEL NELSON,  Director of  Pharmacy, Tanana  Chiefs Conference,                                                               
presented  concerns  about SB  79.  He  agreed with  the  overall                                                               
intention of  the bill and  noted a consensus amongst  the entire                                                               
medical community that opioid addiction is a huge problem.                                                                      
He addressed specific  concerns in the bill. He  pointed out that                                                               
SB  74 from  last year  will not  be implemented  until July  17,                                                               
2017, and it contains several  provisions that will significantly                                                               
positively impact  the inappropriate  prescribing of  opioids. It                                                               
would  make some  things in  SB 79  unnecessary. Also,  there has                                                               
been a lack of participation in  drafting the bill by medical and                                                               
pharmaceutical  communities. Another  concern  is  in Section  31                                                               
where there is  a removal on the prohibition of  sharing the PDMP                                                               
information with  the federal  government, which  would undermine                                                               
public trust  in PDMP.  The requirement of  daily updates  to the                                                               
PDMP  is unnecessary  and onerous.  Finally,  the voluntary  non-                                                               
opioid directive is  unnecessary; no one is  precluded from doing                                                               
that  now,  and  the  partial  filling  of  controlled  substance                                                               
prescriptions can be requested now.                                                                                             
MR. NELSON stated support for  the mandatory continuing education                                                               
CHAIR  COSTELLO noted  Department of  Health and  Social Services                                                               
Commissioner Davidson was present.                                                                                              
2:41:13 PM                                                                                                                    
SENATOR GARDNER requested Mr. Nelson repeat the last sentence.                                                                  
MR. NELSON  restated that the  mandatory continuing  education is                                                               
SENATOR STEVENS  asked for clarification about  partially filling                                                               
a prescription at the patient's request.                                                                                        
MR. NELSON  explained that a  pharmacist can fill  a prescription                                                               
using a lower quantity drug, at the patient's request.                                                                          
SENATOR  STEVENS  asked  if   pharmacists  would  be  comfortable                                                               
overriding a physician.                                                                                                         
MR. NELSON said only in that situation.                                                                                         
2:43:28 PM                                                                                                                    
MICHAEL CARSON, Chair, Mat-Su Opiate  Task Force, stated that the                                                               
Task Force  supports limiting opioid prescriptions  to seven days                                                               
and imposing  stricter rules tied  to the PDMP. He  thanked Chair                                                               
Costello for her introduction and  confirmed that fatal overdoses                                                               
have tripled  in the state due  to the increase of  heroin abuse;                                                               
fentanyl mixed  with heroin is  a factor.  He said 80  percent of                                                               
heroin users started with opioids.  He concluded that the goal is                                                               
to turn off the prescription spigot.                                                                                            
2:45:50 PM                                                                                                                    
LEIF HOLM, Chair, Board of  Pharmacy, voiced concerns with SB 79.                                                               
He  concurred  with  Mr.  Nelson's testimony.  He  agreed  it  is                                                               
necessary  to  find  ways  to  combat  the  opioid  epidemic.  He                                                               
maintained  that the  bill unfairly  singles out  pharmacists and                                                               
looks to correct  SB 74, which has yet to  take effect. He stated                                                               
that  pharmacists have  consistently spearheaded  actions against                                                               
the opioid  epidemic, especially  in finding funding  sources for                                                               
and using the PDMT. He  questioned issues related to the partial-                                                               
fill  provision. He  concluded that  he opposes  the bill  in its                                                               
current form.                                                                                                                   
SENATOR GARDNER asked if partial  fill and voiding the balance of                                                               
a prescription  is state law, and  what needs to change  to allow                                                               
retention of the remaining prescription.                                                                                        
MR. HOLM  related that  since July 2016  partial fills  have been                                                               
allowed without voiding the balance  of a prescription. He stated                                                               
support for that.                                                                                                               
SENATOR GARDNER  asked how  the bill could  be written  to ensure                                                               
that a partial fill does not void the remaining amount.                                                                         
MR. HOLM suggested eliminating the  phrase, "the remainder of the                                                               
prescription is voided."                                                                                                        
2:49:55 PM                                                                                                                    
BARRY  CHRISTENSEN,   Co-Chair,  Legislative   Committee,  Alaska                                                               
Pharmacists Association, voiced concern  with SB 79. He concurred                                                               
with the previous  testifiers, Mr. Holm and Mr.  Nelson. He spoke                                                               
of the  poor timing, given  the passage of  SB 74. He  shared the                                                               
many contributions pharmacists  have made to this  issue and said                                                               
many pharmacists  feel that  the Governor's  press release  put a                                                               
negative spin on them.                                                                                                          
He voiced concern about patients  being scared, due to tightening                                                               
legislation, to  refill medications for chronic  pain management.                                                               
He shared the  risks related to patients  suddenly quitting their                                                               
pain meds.                                                                                                                      
GERALD BROWN, Pharmacist, testified in  opposition to parts of SB
79. He said  many items in SB  79 are similar to those  in SB 74.                                                               
He  suggested not  holding the  pharmacist in  charge liable  for                                                               
failing  to check  the database,  as  written in  Section 32.  He                                                               
pointed out the  real control of abuse is when  "the pen hits the                                                               
paper." He commented on revisiting page 2 of the bill.                                                                          
CHAIR  COSTELLO noted  the people  available to  answer questions                                                               
and invited them  back the next time the bill  is heard. She said                                                               
she is keeping public testimony open.                                                                                           
2:55:25 PM                                                                                                                    
SCOTT WATTS, Pharmacist,  testified in opposition to  parts of SB
79.  He  voiced appreciation  for  what  the  bill is  trying  to                                                               
accomplish.   He  suggested   that  more   input  from   pharmacy                                                               
associations  would help  correct  some of  the  problems in  the                                                               
bill. He said  that daily monitoring of the database  can be done                                                               
electronically at  his pharmacy if  the bill passes,  however, it                                                               
may be  more difficult for  some pharmacies. He  suggested having                                                               
some implementation time for that.                                                                                              
He pointed  out that prescribers  can check the PDMP  database in                                                               
their offices in  advance. He said pharmacists  don't always have                                                               
the  time  to check  the  PDMP  database,  and they  have  better                                                               
avenues to see about prescribing data  and usage. He did not want                                                               
to see daily  checking of the database being  a requirement. They                                                               
are willing  to maintain and enter  the data in PDMP.  He said he                                                               
liked  the  ability  to  decrease  the number  of  pills  in  the                                                               
2:57:39 PM                                                                                                                    
SENATOR  GARDNER  asked  if  the  database  is  confidential  and                                                               
requires logging in every time.                                                                                                 
MR. WATTS said correct. Pharmacists  are waiting for SB 74, which                                                               
allows for an agent to monitor the database.                                                                                    
SENATOR  HUGHES asked  if there  could be  software to  interface                                                               
with PDMP to flag problems.                                                                                                     
MR. WATTS said there has been talk of that, but it is expensive.                                                                
SENATOR COSTELLO  held SB 79  in committee with  public testimony                                                               

Document Name Date/Time Subjects
SB 64 - Sponsor Statement.pdf SL&C 3/14/2017 1:30:00 PM
SB 64
SB 64 - Sectional Analysis Ver. J.pdf SL&C 3/14/2017 1:30:00 PM
SB 64
SB 64 - Fiscal Note DEC.pdf SL&C 3/14/2017 1:30:00 PM
SB 64
SB 64 - Fiscal Note DNR.pdf SL&C 3/14/2017 1:30:00 PM
SB 64
SB 64 - Support Background - Fact Sheet.pdf SL&C 3/14/2017 1:30:00 PM
SB 64
SB 64 - Support Background - Uniform Law Commission.PDF SL&C 3/14/2017 1:30:00 PM
SB 64
SB 64 - Support Letter - Cook Inlet Housing Auth..pdf SL&C 3/14/2017 1:30:00 PM
SB 64
SB 64 - Supporting Document - DOD Response Memo.pdf SL&C 3/14/2017 1:30:00 PM
SB 64
SB 64 - Opposition Letter - DOD.pdf SL&C 3/14/2017 1:30:00 PM
SB 64
SB 79 - Sponsor Statement.pdf SL&C 3/14/2017 1:30:00 PM
SB 79
SB 79 - Sectional Analysis.pdf SL&C 3/14/2017 1:30:00 PM
SB 79
SB 79 - Fiscal Note DHSS.pdf SL&C 3/14/2017 1:30:00 PM
SB 79
SB 79.pdf SL&C 3/14/2017 1:30:00 PM
SB 79
SB 64.PDF SL&C 3/14/2017 1:30:00 PM
SB 64
SB 37.pdf SL&C 3/14/2017 1:30:00 PM
SB 37
SB 37 - Sponsor Statement.pdf SL&C 3/14/2017 1:30:00 PM
SB 37
SB 37 - Sectional Analysis.pdf SL&C 3/14/2017 1:30:00 PM
SB 37
SB 37 - Fiscal Note DCCED.pdf SL&C 3/14/2017 1:30:00 PM
SB 37
SB 37 - Support Letter - AKPhA.pdf SL&C 3/14/2017 1:30:00 PM
SB 37
SB 37 - Support Letter - Board of Pharmacy.pdf SL&C 3/14/2017 1:30:00 PM
SB 37
SB 37 - Supporting Background -DSCSA FDA.pdf SL&C 3/14/2017 1:30:00 PM
SB 37
SB 79 - Public Testimony.tif SL&C 3/14/2017 1:30:00 PM
SB 79
SB 79 - Supporting Background - Medicaid Reform PDMP Pharmacy FAQs.pdf SL&C 3/14/2017 1:30:00 PM
SB 79
SB 79 -Supporting Background - AKPDMP Report 29th Legislature.pdf SL&C 3/14/2017 1:30:00 PM
SB 79
SB 79 -Supporting Background - Medicaid Reform Controlled Substance Advisory Committee.pdf SL&C 3/14/2017 1:30:00 PM
SB 79
SB 79 - Support Background - Benefits and Harms of Opioids Guide from CDC.pdf SL&C 3/14/2017 1:30:00 PM
SB 79
SB 79 - Support Background - DHSS Bulletin.pdf SL&C 3/14/2017 1:30:00 PM
SB 79
SB 79 - Support Background - Guidelines for Prescribing Opioids from CDC.pdf SL&C 3/14/2017 1:30:00 PM
SB 79
SB 79 - Support Background - PDMP Guide from CDC.pdf SL&C 3/14/2017 1:30:00 PM
SB 79