Legislature(2021 - 2022)DAVIS 106
04/28/2022 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| SB132 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| += | SB 132 | TELECONFERENCED | |
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
April 28, 2022
3:05 p.m.
MEMBERS PRESENT
Representative Liz Snyder, Co-Chair
Representative Ivy Spohnholz
Representative Zack Fields
Representative Ken McCarty
Representative Mike Prax
Representative Christopher Kurka
MEMBERS ABSENT
Representative Tiffany Zulkosky, Co-Chair
COMMITTEE CALENDAR
SENATE BILL NO. 132
"An Act exempting veterinarians from the requirements of the
controlled substance prescription database."
- HEARD & HELD
PREVIOUS COMMITTEE ACTION
BILL: SB 132
SHORT TITLE: CONTROLLED SUB. DATA: EXEMPT VETERINARIAN
SPONSOR(s): SENATOR(s) HOLLAND
04/28/21 (S) READ THE FIRST TIME - REFERRALS
04/28/21 (S) HSS, L&C
02/03/22 (S) HSS AT 1:30 PM BUTROVICH 205
02/03/22 (S) Heard & Held
02/03/22 (S) MINUTE(HSS)
02/08/22 (S) HSS AT 1:30 PM BUTROVICH 205
02/08/22 (S) Moved SB 132 Out of Committee
02/08/22 (S) MINUTE(HSS)
02/09/22 (S) HSS RPT 4DP
02/09/22 (S) DP: WILSON, REINBOLD, BEGICH, HUGHES
02/23/22 (S) L&C AT 1:30 PM BELTZ 105 (TSBldg)
02/23/22 (S) Heard & Held
02/23/22 (S) MINUTE(L&C)
03/02/22 (S) L&C AT 1:30 PM BELTZ 105 (TSBldg)
03/02/22 (S) Moved SB 132 Out of Committee
03/02/22 (S) MINUTE(L&C)
03/04/22 (S) L&C RPT 2NR 1DP
03/04/22 (S) NR: COSTELLO, REVAK
03/04/22 (S) DP: GRAY-JACKSON
03/04/22 (S) FIN REFERRAL ADDED AFTER L&C
03/17/22 (S) FIN AT 9:00 AM SENATE FINANCE 532
03/17/22 (S) Heard & Held
03/17/22 (S) MINUTE(FIN)
03/22/22 (S) FIN AT 9:00 AM SENATE FINANCE 532
03/22/22 (S) Moved SB 132 Out of Committee
03/22/22 (S) MINUTE(FIN)
03/23/22 (S) FIN RPT 7DP
03/23/22 (S) DP: STEDMAN, BISHOP, HOFFMAN, WILSON,
WIELECHOWSKI, OLSON, VON IMHOF
03/28/22 (S) TRANSMITTED TO (H)
03/28/22 (S) VERSION: SB 132
04/04/22 (H) READ THE FIRST TIME - REFERRALS
04/04/22 (H) HSS, L&C
04/14/22 (H) HSS AT 3:00 PM DAVIS 106
04/14/22 (H) Scheduled but Not Heard
04/19/22 (H) HSS AT 3:00 PM DAVIS 106
04/19/22 (H) -- MEETING CANCELED --
04/26/22 (H) HSS AT 3:00 PM DAVIS 106
04/26/22 (H) Heard & Held
04/26/22 (H) MINUTE(HSS)
04/28/22 (H) HSS AT 3:00 PM DAVIS 106
WITNESS REGISTER
TRACY WARD, DVM, President
Alaska State Veterinary Medical Association
Juneau, Alaska
POSITION STATEMENT: Gave a PowerPoint presentation during the
hearing on SB 132.
HAL GEIGER, DVM, Member
Board of Veterinary Examiners
Division of Corporations, Business and Professional Licensing
Department of Commerce, Community & Economic Development (DCCED)
Juneau, Alaska
POSITION STATEMENT: Share in giving a PowerPoint presentation
during the hearing on SB 132.
SARA CHAMBERS, Director
Division of Corporations, Business and Professional Licensing
Department of Commerce, Community & Economic Development
Juneau, Alaska
POSITION STATEMENT: Provided information and answered questions
during the hearing on SB 132.
LAURA CARRILLO, Executive Administrator
Alaska Board of Pharmacy
Division of Corporations, Business and Professional Licensing
Department of Commerce, Community & Economic Development
Juneau, Alaska
POSITION STATEMENT: Answered questions during the hearing on SB
132.
NELSON PRIDDY, DVM
Anchorage, Alaska
POSITION STATEMENT: Gave invited testimony during the hearing
on SB 132.
JON BASLER, DVM, Medical Director/Owner
College Village Animal Clinic
Anchorage, Alaska
POSITION STATEMENT: Gave invited testimony in support of SB
132.
JUDITH MASTELLER, DVM, representing self
Wasilla, Alaska
POSITION STATEMENT: Testified during the hearing on SB 132.
JUDY MONTALBANO
Alaska Veterinary Association
North Pole, Alaska
POSITION STATEMENT: Testified in support of SB 132.
KRYSTAL TODD, Veterinarian Technician
North Pole Veterinary Hospital
North Pole, Alaska
POSITION STATEMENT: Testified during the hearing on SB 132.
DAWN BROWN, DVM, representing self
Salcha, Alaska
POSITION STATEMENT: Testified in support of SB 132.
DEBORAH MERSCH, DVM, Small Animal Veterinarian
Soldotna, Alaska
POSITION STATEMENT: Testified during the hearing on SB 132.
PETER NICHOLSON, DVM, representing self
Anchorage, Alaska
POSITION STATEMENT: Testified during the hearing on SB 132.
JAMES DELKER, DVM
Alaska Veterinary Association
Soldotna, Alaska
POSITION STATEMENT: Testified during the hearing on SB 132.
SUZE NOLAN, Licensed Veterinary Technician, Manager
North Pole Veterinary Hospital
North Pole, Alaska
POSITION STATEMENT: Testified during the hearing on SB 132.
MERCEDES PINTO, DVM, representing self
Fairbanks, Alaska
POSITION STATEMENT: Testified in support of SB 132.
ALLI PEARMINE, Licensed Veterinary Technician, representing self
North Pole, Alaska
POSITION STATEMENT: Testified during the hearing on SB 132.
ACTION NARRATIVE
3:05:30 PM
CO-CHAIR SNYDER called the House Health and Social Services
Standing Committee meeting to order at 3:05 p.m.
Representatives Prax, McCarty, Spohnholz, Fields, and Snyder
were present at the call to order. Representative Kurka arrived
as the meeting was in progress.
SB 132-CONTROLLED SUB. DATA: EXEMPT VETERINARIAN
3:06:41 PM
CO-CHAIR SNYDER announced that the only order of business would
be SENATE BILL NO. 132, "An Act exempting veterinarians from the
requirements of the controlled substance prescription database."
3:08:18 PM
TRACY WARD, DVM, President, Alaska State Veterinary Medical
Association (AKVMA), addressing SB 132, began a PowerPoint
presentation, titled "Why It Makes Sense to Exempt Veterinarians
from the Prescription Drug Monitoring Program" [hard copy
included in the committee packet]. She told the committee that
ASVMA supports SB 132 [as stated on slide 2]. She directed
attention to an overview of the history of the Prescription Drug
Monitoring Program (PDMP) on slide 3, which read as follows
[original punctuation provided]:
2008: Alaska's PDMP established by SB 196.
2017: In reaction to growing opioid epidemic, the PDMP
was amended by via HB 159 to include all DEA permit
holders, including veterinarians.
Neither AKVMA nor BOVE were consulted regarding this
amendment.
PDMP reporting is required for all actively licensed
practitioners who hold a Federal Drug Enforcement
Agency registration number and who prescribe,
administer, or dispense federally scheduled II IV
controlled substances in the state.
DR. WARD added that participating in the PMDP requires two main
duties: querying the system to examine the controlled substance
prescription history for a patient (both humans and animals);
and entering controlled substance prescriptions made by the
practitioner. She argued that the PMDP is not an effective
database for veterinarians with reasons given on slide 4, which
read as follows [original punctuation provided]:
The PDMP was established for human medicine. Querying
of PDMP data for animals is not possible with the PDMP
(and reported drugs for an animal are not visible in
the PDMP database).
A query is made on the individual(s) that bring the
animal to the veterinarian and human data is obtained,
not animal data.
Human data obtained from the PDMP query is not usable
for the veterinarian. Veterinarians are not trained in
human medicine to understand what the dosages mean.
DR. WARD emphasized that animals lack any unique identifying
data, and because veterinarians are not trained in human
pharmacology, the human data within the PDMP cannot be properly
interpreted to make prescription decisions around medications
for animals, and vice versa for physicians. She explained that
veterinarians are not bound to Health Insurance Portability and
Accountability Act (HIPAA) guidelines because their patients are
animals; therefore, giving veterinarians access to this
information via the PDMP would be a violation of the owner's
medical privacy. She asked the committee to consider whether
they would want someone who was not their medical practitioner
to have access to a list medications they were on, which include
those listed on slide 5, which read as follows [original
punctuation provided]:
Examples of some common medications seen include, but
are not limited to: Adderall, Ritalin, anabolic
steroids such as testosterone, postpartum depression
medications, sex hormones, Xanax, Klonopin, Valium,
Ativan, Domar, and sleep aids like Ambien and Lunesta.
DR. WARD mentioned that a common concern was how veterinary
prescriptions of controlled substances would be monitored if the
PMDP exemption was granted. She answered this question on slide
6, which read as follows [original punctuation provided]:
Veterinarians who prescribe or dispense controlled
substances are licensed through Drug Enforcement
Agency (DEA). There is already a significant level of
accountability, record keeping, and medication storage
requirements that veterinarians must adhere to.
Distributors of controlled substances monitor
utilization patterns of veterinarians. The Suspicious
Order Monitoring System is in place and data is
gathered by distribution companies who are required by
the DEA to monitor and report unusual purchase
patterns a veterinarian may have. Distributors are
required to flag purchases that fall outside of norms
for either previous purchase history or the norms for
practices of similar size/type. DEA oversight is to
control/prevent diversion from licensed professionals
to drug dealers and users.
DR. WARD, reporting that Alaska is not the only state to
consider exempting veterinarians, referred to slide 7, which
read as follows [original punctuation provided]:
34 other states have exempted veterinarians from
participating in the PDMP.
10 states formerly mandated veterinary reporting but
repealed their inclusion due to the problems
experienced, lack of identified benefits to veterinary
participation, and demonstration that exempting
veterinarians does not decrease protection of public
healthy [sic] and safety. These states are Alabama,
Arizona, Idaho, Illinois, Kansas, Kentucky, Louisiana,
New Mexico, West Virginia (2021), and Wyoming.
Missouri implemented the PDMP in 2021 but did not
require veterinarians to participate.
DR. WARD reported that veterinarians do not prescribe the main
drugs of concern, such as oxycontin, Vicodin, and methadone, and
opioids that are prescribed are either used only in hospital or
have a very low potential for abuse. She further illustrated
that veterinarians are not a primary concern as a source of
drugs, as shown on slide 8, which read as follows [original
punctuation provided]:
The Board of Pharmacy reported that veterinarians in
Alaska from 20162018 prescribed .3% to 1% of total
Morphine Milligram Equivalents (MMEs).
Opioid medications prescribed by veterinarians
(728,223) were only 0.34% of the total opioid
prescriptions (214 million) that were dispensed by
U.S. retail pharmacies in 2017.
There is a natural barrier to vet shopping since costs
for veterinary care are paid up front by the pet
owner.
There have been no identified cases of veterinary
shopping in Alaska.
DR. WARD continued to argue that veterinarians are not a primary
source of drug misuse, as shown on slide 9, which read as
follows [original punctuation provided]:
There are numerous letters and testimony on file from
veterinarians, medical doctors (including ER
physicians), and animal owners supporting SB 132, for
all of the reasons enumerated previously
There is one letter of opposition, from the Board of
Alaska's ER Physicians. The literature cited in the
letter of opposition is primarily an Editorial (not a
research trial) in a medical journal, and a paper
citing an increase in "possible" veterinary shopping
behavior from 0.19% to 0.64%
We do not believe that Alaska should be governed based
on the precautionary principle, i.e., that something
MIGHT happen in the future, and so we should legislate
to prevent this possibility.
There is NO credible evidence to support that
veterinary drugs are contributing to the opioid crisis
and significant evidence to suggest that they are not.
DR. WARD, in concluding her portion of the presentation,
emphasized that AKVMA urges a yes vote on SB 132 and skipped to
slide 12, which lists reasons and read as follows [original
punctuation provided]:
An Exemption of Veterinarians from participating in
the PDMP:
Will allow veterinarians to provide the appropriate,
timely, medical management appropriate for each
patient.
Will increase the efficiency of the PDMP system for
its intended purpose, by allowing for accurate
interpretation of data and trends in human medicine.
Will allow continued judicious use of controlled
substances that is already practiced by veterinarians.
Will eliminate unnecessary and disproportionate
business burdens for veterinarians.
3:20:18 PM
HAL GEIGER, DVM, Member, Board of Veterinary Examiners, Division
of Corporations, Business and Professional Licensing, Department
of Commerce, Community & Economic Development (DCCED), gave part
of the PowerPoint presentation begun by Dr. Ward. He first
shared that he is a retired biostatistician and has served as
the public member on the Board of Veterinary Examiners (BOVE)
for two terms. He stressed that he is not and has never been a
part of the veterinary profession but has had a lot of
experience with databases and how they work. He reported that
the PDMP "is not working, has not been working, and we're not
able to make it work" for veterinarians. He explained that the
board has repeatedly found the information in the database to be
incomplete, corrupted, and unreliable, and there is no way to
extract a summary of information that would actually be useful
for veterinarians. He emphasized that the purpose of tracking
and monitoring the prescription of opioids is already being met
through U.S Drug Enforcement Administration (DEA) oversight.
DR. GEIGER opined that there is no logical connection between
tracking the diversion of drugs from a veterinary hospital and
the PDMP. He referred to the bar chart on slide 10 of the
PowerPoint that illustrates the "BOVE Investigative Costs for
Veterinarians" and shows that the amount of money going into
PDMP investigations has more than tripled in five years. He
reported that during his time on the board the amount of PDMP
investigations has grown to be "pages and pages" worth, the
majority of which ended up being coding errors or violations of
unknown origin. He shared that the requirement for
veterinarians to log in to the database every day and report
that they did not prescribe any controlled substances led to
veterinarians receiving superfluous violations, such as the
woman who received a violation for not logging in every day
during her maternity leave.
3:25:51 PM
The committee took a brief at-ease. [During the at-ease, Co-
Chair Snyder passed the gavel to Representative Spohnholz.]
3:25:55 PM
DR. GEIGER reported that the veterinarian license in Alaska is
the most expensive in the nation, and he described putting these
funds towards maintenance of the PDMP and its many
investigations as wasteful. He addressed the concerns of "vet
shopping," or harming a dog to receive painkillers from a
veterinarian, by sharing a personal anecdote about the $300 bill
he received when he took his dog to be treated after an
accident. He compared that to the street price of heroin, which
he stated is about $15-20, and posited that in this case a drug
seeker would "just go buy the drug" [off the street].
DR. GEIGER reported that the PDMP system had not identified a
single case of drug diversion or misconduct and described the
PDMP protocols as a waste of time and money for veterinarians
and BOVE. He referred to previous testimony from Sara Chambers
and clarified that while the department had facilitated
conversations about how to use the PDMP, he and other members of
BOVE believe that the current system is a complete failure and
cannot be made "workable." He acknowledged DCCED's efforts to
make the system work but opined that the many conversations
between the department and BOVE have not "born fruit," citing a
conversation he had with a veterinarian who said the PDMP was a
factor in their retirement. He asked the committee to consider
what its goal is for requiring veterinarians to use the PDMP and
whether there is a simpler and less expensive way to achieve the
same outcome.
3:31:15 PM
REPRESENTATIVE FIELDS stated that he wanted to address other
statutory requirements for veterinarians and asked whether there
are veterinarians who acquire opioid prescriptions for their
patients through pharmacies.
3:32:04 PM
DR. WARD explained that most prescriptions veterinarians make
would be filled at a pharmacy, but the veterinarian is still
required to make an entry into the PDMP for every prescription.
REPRESENTATIVE FIELDS asked whether eliminating the requirement
for the veterinarian to query the system if the drug was going
through a pharmacy would relieve the burden.
DR. WARD replied that it would, but questioned who would be
required to do the querying instead.
REPRESENTATIVE SPOHNHOLZ clarified that pharmacists are
responsible for making a query when a controlled substance is
prescribed to their pharmacy but asked for more information from
the department.
3:33:32 PM
SARA CHAMBERS, Director, Division of Corporations, Business and
Professional Licensing, Department of Commerce, Community &
Economic Development, prefaced her remarks by stating that the
administration does not have a position on SB 132, and her
division "works to implement statute."
REPRESENTATIVE FIELDS restated his question on whether shifting
the responsibility of queries from veterinarians to pharmacies
would allow adequate government oversight.
LAURA CARRILLO, Executive Administrator, Alaska Board of
Pharmacy, Division of Corporations, Business and Professional
Licensing, Department of Commerce, Community & Economic
Development, explained that current statute requires the
prescriber of the controlled substance to make the query; moving
that responsibility to pharmacists would require a statute
change.
REPRESENTATIVE SPOHNHOLZ asked whether the pharmacist is also
responsible for checking the PDMP.
MS. CARRILLO answered that pharmacists are not required by
statute to check; however, the majority have reported that they
do query the PDMP [when controlled substances are prescribed].
3:35:38 PM
REPRESENTATIVE MCCARTY asked what has been done to make the
system work.
MS. CHAMBERS opined that all parties involved believe the
statute is "clunky" in how it has been applied to veterinarians.
MS. CARRILLO explained that there have been a series of meetings
between the Board of Pharmacy and BOVE to address the many
questions regarding how veterinarians should use the PDMP, and
opportunities to address these questions were ongoing.
REPRESENTATIVE MCCARTY used the metaphor of placing a police
officer in the Gulf of Alaska to prevent traffic accidents to
explain the [in]effectiveness of preventing opioid misuse
through requiring veterinarians to use the PDMP. In response to
Representative Spohnholz, he clarified that his metaphor was
intended to scrutinize the statute put into law by a previous
legislature and not the department's actions in enforcing that
statute. He asked whether the DEA had any input on the issue.
MS. CARRILLO reported that the DEA had given feedback to BOVE
that it is helpful to have veterinarians participate in the PDMP
because registration with DEA allows veterinarians to prescribe
scheduled drugs.
REPRESENTATIVE MCCARTY asked whether veterinarians are required
to have a DEA registration.
MS. CARRILLO explained that only veterinarians that choose to
prescribe a controlled substance are required to register with
the DEA.
REPRESENTATIVE MCCARTY asked whether the DEA was reporting a
problem with the controlled substances veterinarians prescribe.
MS. CARRILLO explained that the PDMP is meant to be a tool used
in conjunction with other measures to promote judicious
prescribing and to serve as a support for existing regulations
that help veterinarians detect "doctor shopping." She stated
that the information in the PDMP could be used to help
veterinarians report to law enforcement if they suspect a client
to be at risk for opioid abuse, but that the system itself is
not currently linked to DEA access.
3:42:34 PM
The committee took a brief at-ease.
3:43:24 PM
REPRESENTATIVE SPOHNHOLZ noted that she was the only legislator
in the room who voted on House Bill 159 in 2017, and she
provided insight into the intent of requiring participation in
the PDMP. She clarified that the initial focus of the
legislation had been to prevent overprescribing of scheduled
substances and identify practitioners who may be prescribing
"outside of best practices." She contextualized the importance
of the PDMP within the opioid crisis affecting Alaska at the
time of the legislation and explained that implementing the PDMP
wasn't just about preventing diversion of controlled substances
but understanding the roots of the epidemic and providing
education to prescribers about best practices. She opined that
the DEA was not effective in preventing the issues with opioids
and asked whether there had been any substantive changes in DEA
regulation of controlled substances since the PDMP legislation
was put into place in 2017.
MS. CARRILLO replied that she did not have any feedback from the
DEA on PDMP requirements or specific schedules to query. She
explained that the DEA agent who spoke to the department did
bring up the issue of Tramadol being highly diverted in rural
Alaska.
MS. CHAMBERS stated that she would reach out to the DEA to
inquire about how its enforcement regulations have changed in
Alaska since 2017.
REPRESENTATIVE SPOHNHOLZ commented that the information from the
DEA would add important context to the discussion.
REPRESENTATIVE MCCARTY said he supports the use of the PDMP for
human patients and questioned whether the increase in Tramadol
diversion in the Bush is being attributed directly to
veterinarians.
MS. CARRILLO explained that the increase is being seen for
Tramadol generally and not specifically in veterinary
prescriptions of it.
3:49:06 PM
REPRESENTATIVE KURKA expressed that he had a question for the
veterinarians.
REPRESENTATIVE SPOHNHOLZ continued with questions for the
department, stating that the committee would return to the
veterinarians for questions after.
3:49:48 PM
REPRESENTATIVE PRAX referenced the department's statement that
there had been biweekly meetings to address the issues with the
PDMP over the past five years. He then referred to Dr. Gieger's
testimony that there had not been a single case of drug
diversion from a veterinarian in that time and questioned
whether fixing the problems for veterinary participation in the
PDMP were even possible since a solution had not been reached by
this point.
MS. CHAMBERS reported that the inability to fix the PDMP after
constant work to do so has been a large contributing factor to
the frustration many stakeholders are expressing. She said that
there are multiple responsible parties involved that have had to
implement what was laid out in statute, and she listed the many
ways the department has collaborated with the different boards
to find workable solutions, including making recommendations to
the legislature. She argued that all involved parties have
spent "quite a bit of time" trying to find ways to fix the PDMP
so that the statute can be implemented as currently written.
She posited that now they are faced with the existential
question of whether or not veterinarians should be included at
all and, if so, how statute needs to be changed to make the
system usable and fluid. She stressed that unless a policy call
is made by the legislature to remove veterinary participation,
the department will have to continue working on ways to
implement the current statute. She noted that the department is
working actively on a request for a third-party analyst to speak
with all of the stakeholders for the purpose of preparing a
detailed report for the legislature. She stated that the
various parties responsible for implementing participation in
the PDMP needed to know whether the legislature intended the
PDMP to be a tool used for education, enforcement, or both.
3:55:24 PM
REPRESENTATIVE PRAX shared his understanding that while some of
the PDMP violations from veterinarians have been from "providers
not using the system correctly," the majority of the issues stem
from the fundamental differences in treating humans versus
animals. He posited that even if the system were made more
convenient to use, the underlying issues would remain, and he
asked for the administration's opinion on that.
MS. CHAMBERS reiterated that the department worked with the
boards to create instructions to make veterinary use of the PDMP
more straight forward. She explained that the purpose of the
PDMD was to create a link between drugs being prescribed to
animals and the humans picking up the prescriptions. She
acknowledged that the system was not "perfect, smooth, or
ideal," but that it was usable for veterinarians with the
instructions the department created. She posited that the tools
worked only if practitioners used them but that the discussion
around whether the tools were being used or whether the tools
were useful had created an impasse.
3:58:51 PM
REPRESENTATIVE SPOHNHOLZ asked whether [prescriptions for]
testosterone and sex hormones are required to be entered into
the PDMP.
MS. CARRILLO confirmed that they are schedule 3 drugs and that
any prescriber of those drugs would have to make a query.
REPRESENTATIVE MCCARTY mentioned the large number of board
meetings that have been held and $200,000 in investigations, and
he commented on a need for additional funding. He asked whether
these costs were covered by licensees through additional
licensing fees.
MS. CHAMBERS noted that PDMP board meetings only started a year
ago.
REPRESENTATIVE MCCARTY restated his understanding that a lot of
meetings had been held.
MS. CHAMBERS confirmed that there had been a lot of meetings and
emphasized that the complexity of the issue required a lot of
discussion and the ability to join together when making
legislative recommendations. She addressed the $200,000 spent
on investigations, stating that this number reflects all
investigations; PDMP violations are a subset of that. She
explained that the increase in investigations was due to
veterinarians incurring violations by not following statute, but
that they were not paying for the investigations through their
licenses because the state was able to find federal funds for
that purpose. She opined that the high cost of licensing fees
for veterinarians was because of the nature of Alaska's economy.
4:04:09 PM
REPRESENTATIVE KURKA questioned what percentage of the total
amount of "problem opioids" being prescribed were coming from
veterinarians.
4:05:16 PM
DR. WARD stated her understanding that the main opioids of
concern for human addiction were oxycontin, Vicodin, methadone,
fentanyl, and heroine, which she clarified that no practitioners
were prescribing. She explained that the only opioid used in
veterinary practice was fentanyl and that it was almost
exclusively used in hospital. She stated that in the past there
had been occasional use of take-home fentanyl patches which have
become very rare since fentanyl overdoses have become a national
concern. She did not know a precise percentage of prescriptions
made for fentanyl by veterinarians, but anecdotally shared that
she had never done so during her career and hypothesized that
most general veterinary practitioners would say the same. She
stated that fentanyl was only ever prescribed in hospital for
very specialized surgeries and emphasized that the occurrence of
prescriptions for problematic opioids from veterinarians was so
rare that the percentage would be "infinitesimal."
4:07:03 PM
DR. GEIGER commented on the concerns raised about the diversion
of Tramadol and stated that it is "nearly never used" in
veterinary practice. He further explained that because it is a
schedule 4 drug, it is not required to be entered into the PDMP
and as such cannot be tracked by the PDMP, underscoring his
point that there needs to be a better connection between the
goal for PDMP participation and the requirements in statute.
4:08:11 PM
REPRESENTATIVE FIELDS mentioned a provision in the bill that
would remove the requirement to report to the PDMP every day,
and he suggested another step that could be taken would be to
allow veterinarians to specify when they had not prescribed a
controlled substance, and that would decrease the regulatory
burden.
DR. WARD explained that only veterinarians who are dispensing
the drug directly are required to make daily reports to the
PDMP, which she described as a small percentage of
veterinarians.
REPRESENTATIVE FIELDS asked whether exempting those
veterinarians who are required to make a daily report would be a
viable option.
DR. WARD confirmed that it could be possible, but stated her
concern that the focus of the questions has been on how to make
the system easier for veterinarians to use, which addresses only
one of the many reasons veterinarian participation did not make
sense. She stated that this approach of trying to "fix" the
system by creating fewer entry and query requirements would not
solve the many other issues with using the PDMP, such as
physicians and veterinarians being unable to interpret each
other's data. She reiterated that veterinarians make a very
small contribution to the total number of controlled substance
prescriptions, arguing that making the system less onerous but
maintaining the participation requirement will not have any
positive benefit to public health.
4:11:23 PM
REPRESENTATIVE KURKA shared his understanding that there has
been no evidence of drug abuse through "vet shopping" and asked
whether there had ever been any deaths linked to veterinarian
scoured opioids.
DR. WARD explained that fewer than ten examples of veterinarian
shopping nationwide were recorded annually and none of these
cases occurred in Alaska. She reported that there have been no
instances of which she was aware where someone died from opioids
obtained through a veterinary prescription.
DR. GEIGER shared that there have been instances of
veterinarians who had committed suicide using opioids obtained
through their practice, but participation in the PDMP could not
track or prevent those kinds of incidents.
REPRESENTATIVE FIELDS sought confirmation that amendments would
not be brought forward in this meeting.
REPRESENTATIVE SPOHNHOLZ confirmed that is correct.
4:13:47 PM
NELSON PRIDDY, DVM, began his invited testimony by sharing his
background. He shared his worry that the facts of the issue are
being ignored and stated that veterinarians are not and have
never been a source of addictive opioids. He summarized his
position, saying that the participation requirements for
veterinarians in the PDMP do a poor job of solving a problem
that does not exist. He argued against Director Chamber's
previous claim that some veterinarians agree the PDMP could be
made workable, reporting that in his daily experience working
with veterinarians across the state he has never come across one
practitioner who believes the PDMP is workable for
veterinarians. He relayed a conversation he had with a
practicing emergency care physician with extensive experience in
the opioid crisis who reported that knowing the source of drugs
would help and cited their concern for fentanyl tablets and
tramadol.
DR. PRIDDY explained that the prescription of fentanyl tablets
by veterinarians is non-existent and that the most widely used
drug formulary for veterinarians did not even create an oral
form of fentanyl. He also emphasized that tramadol is used
infrequently by veterinarians, referencing recent studies that
showed the ineffectiveness of tramadol for animal patients. He
said that the requirement to report to the PDMP was "literally
rammed down the throat of veterinarians," and he shared that he
was a member of BOVE when the statute was changed in 2017. He
stated that the primary concern was to prevent drug diversion
from veterinarians, but there have been no examples in Alaska of
drug diversion from animals to humans in the last five years of
data. He expressed his frustration with the legislative process
regarding SB 132 and opined that certain committees have been
"sitting" on the legislation.
DR. PRIDDY urged for the abolition of the PDMP requirement for
veterinarians and stated that the money used to upkeep these
requirements could be used instead to fund prevention and
treatment techniques for people with opioid addictions.
4:21:11 PM
JON BASLER, DVM, Medical Director/Owner, College Village Animal
Clinic, began his invited testimony by sharing his experience in
the field, including work in rural Alaska, and he urged the
committee to support SB 132. He spoke to his personal
experience reporting to the PDMP and explained that it is the
consensus of all the veterinarians at his clinic that the PDMP
provided no useful information to veterinarians in the
prevention of prescription misuse by their patients' owners. He
said there are often discrepancies between what is on an
animal's medical record and what can be found in a PDMP search
and that, in his experience, the PDMP cannot accurately track
controlled substance prescriptions for animals. He shared that
the top areas of concern for opioid diversion within veterinary
clinics are missing stock, use by staff, and stolen medication
sent without approval of a veterinarian, but none of these are
prevented by the use of the PDMP. He opined that the DEA
regulations already in place for tracking controlled substances
are effective and accurate. He argued that the PDMP
requirements for "zero day recording" create more work and
stress for veterinary technicians, an already understaffed and
overworked position in Alaska. He reiterated that the PDMP does
not work for veterinarians, their patients, or in preventing
drug diversion, and he encouraged the committee to join the 30
states that have already exempted veterinarians. He offered
more information to any interested legislators on his day-to-day
reality using the PDMP and urged the committee to pass SB 132.
4:27:04 PM
REPRESENTATIVE SPOHNHOLZ closed invited testimony and commented
on the shortage of veterinarians in Alaska.
4:27:35 PM
REPRESENTATIVE SPOHNHOLZ opened public testimony on SB 132.
4:27:54 PM
JUDITH MASTELLER, DVM, representing self, stated that she had
never seen a veterinarian prosecuted for killing a person
through misuse of prescription drugs. She spoke to her history
as a veterinarian and shared that she had never prescribed any
of the opioids of concern. She described the vast difference in
dosage for a small cat or dog with what would be given for human
use and opined that addicts seeking drugs through a veterinarian
doesn't make sense. She asked why there was such a focus on
veterinarians when there was no evidence that they contribute to
the opioid problem. She stated that with the severe shortage of
veterinarians and technicians, clinics are turning away patients
and do not have time to waste on PDMP entries.
4:31:19 PM
JUDY MONTALBANO, DVM, Alaska Veterinary Association, stated that
she was a veterinarian in Alaska for 26 years and now works as a
professor in a veterinary medicine program. She underscored the
"tremendous" shortage of veterinary staff in the state. She
explained that she was often met with hesitancy from Alaska
residents to divulge medical records to veterinarians and shared
her concern over possible lawsuits from pet owners over illegal
access to records. She opined that veterinary participation in
the PDMP does not improve human health and puts unfair onus on
veterinarians.
4:34:14 PM
KYRSTAL TODD, Veterinarian Technician, North Pole Veterinary
Hospital, stated that the current implementation of the PDMP is
unrealistic for the veterinarian field. She emphasized the
intensity of the workload already placed on veterinarian
technicians and stated that the extra burden of reporting to the
PDMP has caused her to consider leaving her career. She
expressed her belief that having access to her human clients'
medical information is a HIPAA violation and described having
that access through the PDMP as an "overreach." She stated that
veterinarians should be exempt from the PDMP until it can be
rectified to allow participation without having access to human
medical records.
4:35:49 PM
DAWN BROWN, DVM, representing self, agreed with the previous
testifier's comments on not being entitled to or even desire to
access the medical history of her human clients. She emphasized
the infrequency with which she prescribes any drugs that could
be misused. She expressed her sadness and frustration with how
long the bill has been in committee and referenced the wide
community and bipartisan support for SB 132. She urged
committee members to move the bill to a floor vote.
4:37:23 PM
DEBORAH MERSCH, DVM, Small Animal Veterinarian, described
veterinarians as compassionate and well-educated individuals who
deserve respect from their clients and elected officials. She
expressed her frustration with the legislative process and the
perceived disrespect shown by legislators in regard to
veterinarians' concerns about the PDMP, and specifically with
the delays in public testimony. She acknowledged the
seriousness of the opioid epidemic in Alaska but stated that
veterinarians should not be held solely responsible and that
their participation in the PDMP did nothing to curb abuse.
REPRESENTATIVE SPOHNHOLZ reminded everyone that the committee
was actively hearing the bill and apologized for the delay in
public testimony.
4:40:24 PM
PETER NICHOLSON, DVM, representing self, highlighted the main
problem of veterinary participation in the PDMP is that they are
tracking individuals with no legal identification. He compared
the process to a hypothetical scenario where someone is asked to
run a Department of Motor Vehicles (DMV) without birth
certificates or vehicle identification numbers. He alluded to
other issues with pet identification, such as name changes, that
make the accurate tracking of patients through a database
difficult. He stated that veterinarian participation in the
PDMP is well-intentioned but had been shown to be ineffectual in
practice. He reiterated that there was a fundamental inability
for the PDMP to function as intended for veterinarians.
4:42:52 PM
JAMES DELKER, DVM, Alaska Veterinary Association, reported that
he had letters of support for SB 132 from several physicians,
including ones with experience in the opioid crisis, who state
that they have never treated an overdose from opioids received
through a veterinarian. He expressed his frustration with the
legislative process and opined that the facts of the situation
are being ignored. He cited two senators who support the
removal of veterinarians from the PDMP. He expressed additional
frustration with the lack of veterinarian input in the
implementation of the PDMP from the beginning and claimed that
association members are left out of collaborative efforts from
the DCCED. He emphasized that the problem being "solved" by
PDMP participation does not exist and characterized money spent
on these investigations as a waste.
REPRESENTATIVE SPOHNHOLZ explained that the postponement of
public testimony on SB 132 resulted from the House of
Representatives being called to a floor session during the usual
meeting time for the House Health and Social Services Standing
Committee; it was not the intent of the chairs or any committee
members to delay the bill. She expressed her interest in the
testimony that was being brought forth and reminded those
listening that at the end of a session, floor meetings can run
long. She emphasized that the co-chairs had not delayed the
hearing on SB 132 in the spirit of obstructionism.
4:47:03 PM
SUZE NOLAN, Licensed Veterinary Technician, Manager, North Pole
Veterinary Hospital, explained that veterinarians are regulated
by multiple systems designed to address misuse of controlled
substances and stressed that the drugs with the most abuse
concern are not used in the veterinary profession. She
described the PDMP as meaningless for use with non-human
patients and stated that because veterinarians cannot
meaningfully use the data in the PDMP, they should be exempt
from participation.
4:47:55 PM
MERCEDES PINTO, DVM, representing self, stated that she recently
left private practice and cited PDMP compliance as part of the
reason for her transition to working at an animal rescue. She
explained that she does not have training in human medicine and
cannot interpret the data within the PDMP; therefore, the
information about the human clients' drug history has no impact
on her decisions in terms of what she prescribes her animal
patients. She reported that as a shelter veterinarian, there
are no humans associated with her patients to query, which
causes her to unintentionally violate the system, and she
reported that as a result, she is now under investigation by the
board. She reiterated that the system does not work and urged
the committee to support the exemption of veterinarians.
4:50:05 PM
ALLI PEARMINE, representing self, stated that in her 17 years of
experience as a veterinary technician she had never seen drug
seeking through veterinarians. She underscored previous
comments that participation in the PDMP does not make sense for
veterinarians and stated that the passage of SB 132 would allow
veterinarians to better fulfill their duties.
4:51:09 PM
REPRESENTATIVE SPOHNHOLZ, after ascertaining that there was no
one else who wished to testify, closed public testimony on SB
132.
4:51:24 PM
REPRESENTATIVE SPOHNHOLZ announced that SB 132 was held over.
4:51:35 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 4:51 p.m.
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