Legislature(2017 - 2018)SENATE FINANCE 532

05/23/2017 01:30 PM FINANCE

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Audio Topic
01:32:41 PM Start
01:34:46 PM SB79
03:05:30 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
Heard & Held
-- Testimony <Invitation Only> --
Board of Nursing - Jennifer Stukey, LPN
Board of Dental Examiners - Dr. Thomas Wells,
Board Chair
Board of Optometry - Dr. Paul Barney, Chair
Board of Veterinary Examiners - Dr. James Hagee
Board of Pharmacy - Leif Holm, Chairman
+ Bills Previously Heard/Scheduled TELECONFERENCED
                 SENATE FINANCE COMMITTEE                                                                                       
                   FIRST SPECIAL SESSION                                                                                        
                       May 23, 2017                                                                                             
                         1:32 p.m.                                                                                              
1:32:41 PM                                                                                                                    
CALL TO ORDER                                                                                                                 
Co-Chair  MacKinnon  called  the  Senate  Finance  Committee                                                                    
meeting to order at 1:32 p.m.                                                                                                   
MEMBERS PRESENT                                                                                                               
Senator Lyman Hoffman, Co-Chair                                                                                                 
Senator Anna MacKinnon, Co-Chair                                                                                                
Senator Click Bishop, Vice-Chair (via teleconference)                                                                           
Senator Shelley Hughes                                                                                                          
Senator Peter Micciche                                                                                                          
Senator Donny Olson                                                                                                             
MEMBERS ABSENT                                                                                                                
Senator Natasha von Imhof                                                                                                       
ALSO PRESENT                                                                                                                  
Doctor  Jay Butler,  Chief  Medical  Officer, Department  of                                                                    
Health and Social Services;  Sara Chambers, Deputy Director,                                                                    
Division of Business  and Professional Licensing, Department                                                                    
of   Commerce,    Community   and    Economic   Development;                                                                    
Representative Tammie  Wilson; Representative  Cathy Tilton;                                                                    
Representative Lora Reinbold;  Representative Justin Parish;                                                                    
Representative Dan Ortiz.                                                                                                       
PRESENT VIA TELECONFERENCE                                                                                                    
Jennifer  Stukey, Representative,  Board of  Nursing; Doctor                                                                    
Thomas Wells,  President, Board of Dental  Examiners; Doctor                                                                    
Paul Barney, Chair, Board of  Optometry; Doctor James Hagee,                                                                    
Chairman, Board  of Veterinary;  Leif Holm,  Chairman, Board                                                                    
of Pharmacy.                                                                                                                    
SB 79     OPIOIDS;PRESCRIPTIONS;DATABASE;LICENSES                                                                               
          SB 79 was HEARD and HELD in committee for further                                                                     
SENATE BILL NO. 79                                                                                                            
     "An  Act  relating  to  the  prescription  of  opioids;                                                                    
     establishing  the  Voluntary Nonopioid  Directive  Act;                                                                    
     relating  to  the   controlled  substance  prescription                                                                    
     database;  relating  to   the  practice  of  dentistry;                                                                    
     relating to  the practice of medicine;  relating to the                                                                    
     practice  of  podiatry;  relating to  the  practice  of                                                                    
     osteopathy;  relating  to   the  practice  of  nursing;                                                                    
     relating to the practice  of optometry; relating to the                                                                    
     practice of veterinary medicine;  related to the duties                                                                    
     of  the  Board  of   Pharmacy;  and  providing  for  an                                                                    
     effective date."                                                                                                           
1:34:46 PM                                                                                                                    
JENNIFER  STUKEY,  REPRESENTATIVE,  BOARD  OF  NURSING  (via                                                                    
teleconference),  stated that  she  had  worked with  opioid                                                                    
abuse and  addressed the  issue of  possible overprescribing                                                                    
of opioids. She  believed that the bill would  be helpful to                                                                    
combat the opioid addiction epidemic.                                                                                           
Senator Micciche wondered if there  was an "opioid awareness                                                                    
class." Ms.  Stukey replied that  she would like to  have an                                                                    
opioid  awareness  class.  She   stressed  that  Alaska  was                                                                    
different  than  the   lower  48,  so  there   should  be  a                                                                    
continuing education course.                                                                                                    
Senator Micciche  assumed that  creation of the  class would                                                                    
not be  easy, but noted that  there did not seem  to be that                                                                    
shared concern. Ms. Stukey replied  that the creation of the                                                                    
course would not be a difficult process.                                                                                        
Co-Chair MacKinnon wondered where  the education should come                                                                    
from at  the state level.  She noted  that there would  be a                                                                    
variety  of  professions  that  would  be  affected  by  the                                                                    
legislation.  Ms.  Stukey  replied  that  the  state  should                                                                    
provide that  education to ensure that  all professions were                                                                    
in line.  She stated  that there was  an opioid  summit that                                                                    
may be a good place to start the education.                                                                                     
Co-Chair MacKinnon wondered who  should influence the state.                                                                    
Ms.  Stukey  responded  that the  Board  of  Medicine  could                                                                    
influence the state.                                                                                                            
1:40:14 PM                                                                                                                    
Co-Chair   Hoffman   queried   the   seven-day   limit   for                                                                    
prescription opioid. Ms.  Stukey replied that it  was a very                                                                    
good idea. She  felt that there were  exceptions for chronic                                                                    
pain and end of life services.                                                                                                  
Co-Chair  MacKinnon wondered  who would  be the  appropriate                                                                    
party  to set  the standard  for maximum  doses. Ms.  Stukey                                                                    
replied   that   medical    doctors   had   guidelines   for                                                                    
prescribing,  so  that  decision   should  be  left  to  the                                                                    
Senator Micciche  remarked that  there were  some physicians                                                                    
who may  be too focused on  the comfort of the  client, that                                                                    
they may be  ignoring the adverse effects of  the overuse of                                                                    
opioids. He noted  that the Board of  Medicine had expressed                                                                    
concern over  what the seven-day  supply would  provide. Ms.                                                                    
Stukey  replied  that  the   education  was  important,  and                                                                    
stressed that the addition  of addiction understanding would                                                                    
help physicians to prescribe opioids in a better manner.                                                                        
Co-Chair MacKinnon  wondered whether  Ms. Stukey  had worked                                                                    
in  a  hospital  environment.  Ms.  Stukey  replied  in  the                                                                    
Co-Chair MacKinnon recalled that  there was an assessment in                                                                    
the hospital  for a  level of pain.  She wondered  who would                                                                    
provide  information  about   that  assessment.  Ms.  Stukey                                                                    
replied  that  the  Board  of Medicine  would  be  the  best                                                                    
1:45:22 PM                                                                                                                    
DOCTOR THOMAS  WELLS, PRESIDENT,  BOARD OF  DENTAL EXAMINERS                                                                    
(via  teleconference),  stated  that  the bill  was  a  good                                                                    
start. He shared that the board  had no comment on the bill.                                                                    
He stated that  he looked forward to  regulations that would                                                                    
enforce the issue.                                                                                                              
Co-Chair  MacKinnon noted  the ambiguity  in the  bill about                                                                    
education and  a seven-day supply  limit. She  remarked that                                                                    
only a  doctor would have  influence on a  seven-day supply.                                                                    
Dr. Wells replied that there were guidelines for dosages.                                                                       
Co-Chair  MacKinnon  queried  the guidelines  to  limit  the                                                                    
opioid  prescriptions.  Dr.  Wells  replied  that  the  drug                                                                    
companies provided dosage guidelines.                                                                                           
Co-Chair MacKinnon wondered whether  the pharma // Dr. Wells                                                                    
replied in the negative.                                                                                                        
Senator  Olson  queried  the frequency  of  prescribing  the                                                                    
amount that  would cause addiction.  Dr. Wells  replied that                                                                    
it depended on the practitioner.  He asserted that there was                                                                    
a  population  who  may  receive dental  work  in  order  to                                                                    
receive narcotics.                                                                                                              
1:50:28 PM                                                                                                                    
Senator Olson  wondered whether there  was ever  a complaint                                                                    
of  an overprescribing  licensee. Dr.  Wells replied  in the                                                                    
Senator Olson  queried the  lack of  requirement in  the law                                                                    
for the dental community. Dr.  Wells replied that it was not                                                                    
a burden.  He stressed  that many  addicts used  dentists to                                                                    
get drugs.                                                                                                                      
Senator  Olson  surmised  that Dr.  Wells  agreed  with  the                                                                    
course. Dr. Wells agreed.                                                                                                       
Senator  Hughes wondered  whether there  were some  dentists                                                                    
who  would  see  a  benefit   to  the  education,  and  curb                                                                    
overprescribing. Dr.  Wells replied that many  dentists were                                                                    
Senator  Hughes  surmised  that a  dentist  would  typically                                                                    
prescribe more than seven days'  worth of opioids. Dr. Wells                                                                    
replied   that   the   issue   was   more   about   repeated                                                                    
Senator  Micciche  felt that  the  value  of the  class  was                                                                    
whether or not there needed to be an opioid prescription.                                                                       
Co-Chair Hoffman  stressed that there were  some people that                                                                    
have chronic  pain, so they  need the opioids to  treat that                                                                    
pain. He wondered whether a  person in a rural village would                                                                    
be required to travel to receive a prescription.                                                                                
1:56:52 PM                                                                                                                    
DOCTOR  PAUL   BARNEY,  CHAIR,   BOARD  OF   OPTOMETRY  (via                                                                    
teleconference),  stated  that  optometrists already  had  a                                                                    
four-day  limitation   on  prescription  opioids.   He  also                                                                    
supported the  education element. He  was in support  of the                                                                    
Co-Chair MacKinnon  wondered how  the board  established the                                                                    
four-day   limitation.   Dr.   Barney   replied   that   the                                                                    
legislative  process resulted  in the  decision to  limit to                                                                    
four days.                                                                                                                      
Senator Micciche  wondered whether  the recent  bill removed                                                                    
the four-day  limit. Dr.  Barney replied  that the  bill did                                                                    
remove the  four-day limit. He  stated that the  board would                                                                    
put a four-day limit in regulation.                                                                                             
Senator Olson  remarked that  bill referenced  the seven-day                                                                    
2:01:13 PM                                                                                                                    
DOCTOR  JAMES  HAGEE,  CHAIRMAN, BOARD  OF  VETERINARY  (via                                                                    
teleconference), stated  that the veterinary  profession was                                                                    
trained to  deal with animals.  He stated that the  issue in                                                                    
the  veterinary profession  was that  drugs were  prescribed                                                                    
for the pets  could get diverted for human  use. He stressed                                                                    
that most  opioid use in  veterinary medicine  was dispensed                                                                    
in  house  as injectables.  He  understood  that the  people                                                                    
could  consume  the  drugs  that   were  prescribed  to  the                                                                    
animals. He felt that the  education would be very important                                                                    
for veterinarians.                                                                                                              
Senator Olson  wondered queried the number  of veterinarians                                                                    
who  had a  Drug Enforcement  Agency (DEA)  number, and  how                                                                    
many prescriptions they could  write. Dr. Hagee replied that                                                                    
the  person who  held the  license was  responsible for  the                                                                    
Senator   Olson   wondered   whether   veterinarians   could                                                                    
prescribe  Schedule 1  or 2  drugs. Dr.  Hagee replied  that                                                                    
veterinarians  could  not  prescribe Schedule  1  drugs.  He                                                                    
stated  that they  could prescribe  Schedule 2,  3, 4  and 5                                                                    
could be  prescribed. He stated  that most Schedule  2 drugs                                                                    
were injectables. The  Schedule 3 and 4  could be dispensed.                                                                    
He   hoped  that   the  veterinary   community  would   stop                                                                    
prescribing opioids.                                                                                                            
2:07:49 PM                                                                                                                    
LEIF    HOLM,    CHAIRMAN,    BOARD   OF    PHARMACY    (via                                                                    
teleconference),   replied  that   the  pharmacy   had  been                                                                    
involved of the prescription  drug management program (PDMP)                                                                    
and its  use in curbing abuse  in the state. He  stated that                                                                    
he agreed with most of the changes in PDMP.                                                                                     
Vice-Chair Bishop  queried the difference between  a generic                                                                    
and  brand name  drug. Mr.  Holm replied  that there  was no                                                                    
clinical difference between the drugs.                                                                                          
Vice-Chair Bishop  queried the  amount of  continuing opioid                                                                    
education  was required  by  pharmacists.  Mr. Holm  replied                                                                    
that there was no requirement.                                                                                                  
Co-Chair MacKinnon  queried the challenges  that pharmacists                                                                    
face  moving from  a monthly  to daily  reporting. Mr.  Holm                                                                    
replied that there would not  be a heavy burden, except that                                                                    
one must remember to do it every day.                                                                                           
2:14:40 PM                                                                                                                    
Senator Hughes surmised that changing  from monthly to daily                                                                    
reporting would  not address the  state opioid  problem. Mr.                                                                    
Holm  replied that  he wanted  to see  the effect  before he                                                                    
could respond to that question.                                                                                                 
Senator Hughes wondered whether  an addiction could occur in                                                                    
less than seven days. Mr.  Holm replied that addiction could                                                                    
occur with the first dose.                                                                                                      
Co-Chair  MacKinnon  remarked that  there  was  an issue  of                                                                    
"doctor shopping" to  receive the drug. She  remarked that a                                                                    
daily report would prove that  an individual who was "doctor                                                                    
shopping."  Mr. Holm  felt that  the  daily reporting  would                                                                    
only  report those  who were  newly addicted.  He felt  that                                                                    
month  long  or week-long  patterns  would  show a  seasoned                                                                    
Co-Chair MacKinnon queried the  practice as a business owner                                                                    
for  pharmacists  who might  identify  an  addict. Mr.  Holm                                                                    
replied that the pharmacy would contact the physician.                                                                          
Co-Chair  MacKinnon  wondered  whether  the  PDMP  could  be                                                                    
accessed  in   the  pharmacy.  Mr.   Holm  replied   in  the                                                                    
2:20:21 PM                                                                                                                    
Senator Hughes wondered  whether a patient must  return to a                                                                    
physician  for  a  physical prescription.  She  stated  that                                                                    
there may  be an electronic prescription  required. Mr. Holm                                                                    
replied  that all  prescriptions  could  be electronic,  but                                                                    
must be approved through the  DEA. He guessed that a village                                                                    
may not have  the electronic prescriptions, so  there may be                                                                    
need to provide more than the limit.                                                                                            
Senator Hughes  wondered how  many pharmacies  would require                                                                    
the patient  to return  to the physician.  Mr. Holm  did not                                                                    
Senator Hughes remarked that there  may be some with chronic                                                                    
pain that  required opioids. She  remarked that there  was a                                                                    
concern about  those people being  under scrutiny.  Mr. Holm                                                                    
replied  that there  may be  a  concern. He  stated that  he                                                                    
witnessed patients  with high quantities  of opioid  use, so                                                                    
there  could be  a  stigma with  the  seven-day mandate.  He                                                                    
remarked  that  there would  be  no  use for  the  seven-day                                                                    
mandate, if a physician was  allowed to go beyond that limit                                                                    
based on  their professional judgment. He  stressed that the                                                                    
reporting in  the PDMP  would be  more beneficial,  and make                                                                    
major headway in reducing the opioid epidemic.                                                                                  
2:27:37 PM                                                                                                                    
Senator Hughes  remarked that  there was  a letter  from the                                                                    
Medical Board  about whether the Pharmacy  Board could limit                                                                    
the prescribing  of opioids.  Mr. Holm  replied that  he was                                                                    
not aware of that guideline.                                                                                                    
Senator Hughes replied that it  would be helpful to have the                                                                    
State Medical Board clarify their position on the bill.                                                                         
2:31:07 PM                                                                                                                    
DOCTOR  JAY BUTLER,  CHIEF  MEDICAL  OFFICER, DEPARTMENT  OF                                                                    
HEALTH AND SOCIAL SERVICES, introduced himself.                                                                                 
Vice-Chair Bishop  remarked that wondered whether  there was                                                                    
curriculum  already   available,  or  would   the  education                                                                    
requirements  be  "site  specific  to  Alaska."  Dr.  Butler                                                                    
replied that  there were many materials  that were available                                                                    
for education.                                                                                                                  
Senator Hughes  wondered whether  Dr. Butler could  speak to                                                                    
the letter from the State  Medical Board. Dr. Butler replied                                                                    
in  the  affirmative.  The  question  of  the  role  of  the                                                                    
Pharmacy  and  Medical  Boards should  be  deferred  to  the                                                                    
chairs of those two boards.                                                                                                     
Senator Hughes felt that the boards should work together.                                                                       
Co-Chair  MacKinnon replied  that  the  State Medical  Board                                                                    
chose  not   to  participate  in  the   day's  meeting,  and                                                                    
submitted a letter instead.                                                                                                     
Dr. Butler  felt that interdepartmental  collaboration would                                                                    
improve government efficiency.                                                                                                  
2:35:31 PM                                                                                                                    
Senator  Micciche   wondered  whether   the  state   was  in                                                                    
"extraordinary times" as it related  to drug and opioid use.                                                                    
Dr. Butler replied in the affirmative.                                                                                          
Senator Micciche surmised that  most street users began with                                                                    
prescription drugs. Dr. Butler agreed.                                                                                          
Senator  Micciche  wondered   whether  prescription  opioids                                                                    
killed twice as many Alaskans  as street opioids. Dr. Butler                                                                    
replied that it was often use of more than one drug.                                                                            
Senator  Micciche stressed  that there  were several  people                                                                    
who felt the bill was  inconvenient. Dr. Butler replied that                                                                    
the day's  meeting reflected the  conversations he  had with                                                                    
multiple colleagues.                                                                                                            
Senator  Micciche felt  that there  might be  a generational                                                                    
difference   in  prescribing   for   pain  management.   The                                                                    
requirements  of   the  bill  were   a  reminder   that  the                                                                    
prescription could encourage addiction.                                                                                         
2:42:48 PM                                                                                                                    
SARA  CHAMBERS, DEPUTY  DIRECTOR, DIVISION  OF BUSINESS  AND                                                                    
PROFESSIONAL  LICENSING, DEPARTMENT  OF COMMERCE,  COMMUNITY                                                                    
AND  ECONOMIC  DEVELOPMENT,  reinforced  the  importance  of                                                                    
interdepartmental collaboration in solving the problem.                                                                         
Co-Chair  MacKinnon  wondered  whether there  was  merit  in                                                                    
state  standardized  curriculum  and  whether  there  was  a                                                                    
fiscal  note  that  would   reflect  that  development.  Ms.                                                                    
Chambers replied  that she did  not anticipate  developing a                                                                    
curriculum, but understood the  benefit of an Alaska-focused                                                                    
Co-Chair MacKinnon  wanted to know the  recommendation about                                                                    
how the curriculum would be delivered.                                                                                          
2:47:46 PM                                                                                                                    
Senator  Hughes remarked  that she  knew of  people who  had                                                                    
problems with  opioids. She also noted  that physicians were                                                                    
concerns  about  whether  the  legislature  would  "hit  the                                                                    
target." She remarked that there  was not current data about                                                                    
overprescribing problems.  She felt that the  problem should                                                                    
be  targeting the  over  prescribers.  She wondered  whether                                                                    
there was  a way  to stop the  addicts who  were "shopping."                                                                    
She wondered whether the boards  currently could regulate on                                                                    
their own, or  were in need of the statutory  language.  Dr.                                                                    
Butler agreed that there needed  to be guidelines for opioid                                                                    
2:53:49 PM                                                                                                                    
Ms. Chambers  continued that the  boards worked  together to                                                                    
come together on common guidelines.                                                                                             
Senator  Hughes wondered  whether  the  boards were  already                                                                    
working towards regulation,  before the bill's introduction.                                                                    
Ms.  Chambers replied  that the  Medical and  Nursing Boards                                                                    
had overarching regulations.                                                                                                    
Senator  Hughes  queried  the expectation  of  reduction  in                                                                    
opioid  related deaths  and the  opioid problem.  Dr. Butler                                                                    
replied  that there  was a  hope that  the bill  would be  a                                                                    
major step  in the  right direction to  address some  of the                                                                    
roots of  the problem,  including the  volume of  opioids in                                                                    
the community and pain management.                                                                                              
3:00:12 PM                                                                                                                    
Senator  Hughes stressed  that she  was  concerned with  the                                                                    
Co-Chair Hoffman  wondered whether  the language  related to                                                                    
allowing a  patient in a rural  area to receive more  than a                                                                    
seven-day dose. He  would consult the tribal  entities to be                                                                    
sure that the language was adequate.                                                                                            
Senator Micciche remarked that  the boards would determine a                                                                    
seven-day dose. He stressed the necessity of the bill.                                                                          
Co-Chair MacKinnon wondered whether  America had the highest                                                                    
opioid  usage  in  the  world. Dr.  Butler  replied  in  the                                                                    
3:05:30 PM                                                                                                                    
Co-Chair  MacKinnon surmised  that  health  care costs  were                                                                    
driven by  four factors: providers,  hospitals, prescription                                                                    
drugs, and insurance providers. Dr.  Butler felt that it was                                                                    
a broad, reasonable assessment.                                                                                                 
Co-Chair  MacKinnon  remarked  that the  state  provided  60                                                                    
percent of the overall health care in Alaska.                                                                                   
Senator Micciche  wanted to compare  what was passed  out of                                                                    
the house.                                                                                                                      
Co-Chair  MacKinnon  replied that  the  work  could be  done                                                                    
later in the day.                                                                                                               
Ms. Chambers stated  that she had a  comparison available to                                                                    
the committee.                                                                                                                  
Co-Chair MacKinnon wondered  whether the comparison included                                                                    
the amendments. Ms. Chambers replied in the affirmative.                                                                        
SB  79  was   HEARD  and  HELD  in   committee  for  further                                                                    
The meeting was adjourned at 3:08 p.m.                                                                                          

Document Name Date/Time Subjects
SB 79 Hb 159 Public Testimony Todd.pdf SFIN 5/23/2017 1:30:00 PM
HB 159
SB 79
SB 79 HB 159 Supporting Document - LOS from ASHNHA.pdf SFIN 5/23/2017 1:30:00 PM
HB 159
SB 79
SB 79 State Medical Board Position Statement.pdf SFIN 5/23/2017 1:30:00 PM
SB 79
SB 79 Supporting Document - LOS from Alaska Dental Society.pdf SFIN 5/23/2017 1:30:00 PM
SB 79
SB 79 Supporting Document - LOS from AML.pdf SFIN 5/23/2017 1:30:00 PM
SB 79
SB 79 Supporting Document - LOS from MSHF.pdf SFIN 5/23/2017 1:30:00 PM
SB 79