Legislature(2017 - 2018)BUTROVICH 205

03/08/2017 01:30 PM HEALTH & SOCIAL SERVICES

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01:36:06 PM Start
01:36:23 PM Presentation: Alaska Opioid Task Force
03:00:54 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ Presentation: Alaska Opioid Policy Task Force TELECONFERENCED
                 WEAT6HALASKA STATE LEGISLATURE                                                                               
      SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                    
                         March 8, 2017                                                                                          
                           1:36 p.m.                                                                                            
                                                                                                                                
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Senator David Wilson, Chair                                                                                                     
Senator Cathy Giessel                                                                                                           
Senator Peter Micciche                                                                                                          
Senator Tom Begich                                                                                                              
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
Senator Natasha von Imhof                                                                                                       
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
PRESENTATION: Alaska Opioid Task Force                                                                                          
                                                                                                                                
     - HEARD                                                                                                                    
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
No previous action to record                                                                                                    
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
MICHAEL DUXBURY, Captain                                                                                                        
Statewide Drug Enforcement Unit                                                                                                 
Alaska State Troopers                                                                                                           
Department of Public Safety (DPS)                                                                                               
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Addressed the Alaska Opioid Policy Task                                                                   
Force.                                                                                                                          
                                                                                                                                
KATE BURKHART, Executive Director                                                                                               
Advisory Board on Alcoholism and Drug Abuse                                                                                     
Alaska Department of Health and Social Services                                                                                 
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Addressed the Alaska Opioid Policy Task                                                                   
Force.                                                                                                                          
                                                                                                                                
ANDY JONES, Chief                                                                                                               
Section of Rural and Community Health Systems                                                                                   
Division of Public Health                                                                                                       
Alaska Department of Health and Social Services                                                                                 
Anchorage, Alaska                                                                                                               
POSITION  STATEMENT: Provided  operational information  regarding                                                             
drug-disposal bags and drug-overdose kits.                                                                                      
                                                                                                                                
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
1:36:06 PM                                                                                                                    
CHAIR DAVID WILSON  called the Senate Health  and Social Services                                                             
Standing Committee meeting  to order at 1:36 p.m.  Present at the                                                               
call to order were Senators  Giessel, Micciche, Begich, and Chair                                                               
Wilson.                                                                                                                         
                                                                                                                                
                                                                                                                                
^PRESENTATION: Alaska Opioid Task Force                                                                                         
 PRESENTATION: Alaska Opioid Policy Task Force Recommendations                                                              
                                                                                                                              
1:36:23 PM                                                                                                                    
CHAIR WILSON announced  that the committee is  hearing the Alaska                                                               
Opioid Policy Task Force's recommendations.                                                                                     
                                                                                                                                
1:36:54 PM                                                                                                                    
MICHAEL  DUXBURY,  Captain,   Statewide  Drug  Enforcement  Unit,                                                               
Alaska State  Troopers, Anchorage, Alaska, disclosed  that he has                                                               
been employed with the troopers since 1989.                                                                                     
                                                                                                                                
1:37:03 PM                                                                                                                    
KATE BURKHART,  Executive Director, Advisory Board  on Alcoholism                                                               
and Drug Abuse, Alaska Department  of Health and Social Services,                                                               
Juneau, Alaska, noted  that she had the pleasure  of staffing the                                                               
task force.                                                                                                                     
                                                                                                                                
She  presented a  PowerPoint presentation  on the  "Alaska Opioid                                                               
Policy Task  Force Recommendations."  She commenced with  page 2,                                                               
"Alaska Opioid Policy Task Force" and referenced as follows:                                                                    
                                                                                                                                
   · The task force is a partnership of the Alaska Division of                                                                  
     Public Health, Advisory Board on  Alcoholism and Drug Abuse,                                                               
     and   Alaska  Mental   Health   Trust   Authority.  It   was                                                               
     established     to     develop     evidence-based     policy                                                               
     recommendations  for preventing  opioid  misuse, abuse,  and                                                               
     overdose  deaths  based  on information  from  experts  from                                                               
     diverse   sectors,  people   in   recovery,  and   community                                                               
     coalitions, and the public.                                                                                                
   · 20-volunteers served on the task force, representing people                                                                
     in  recovery,  family  members,  for-profit  and  non-profit                                                               
     treatment providers, tribal  health providers, rural Alaskan                                                               
     communities, Alaska  Native peoples, health  care providers,                                                               
     law   enforcement,    and   public   safety.    Ex   officio                                                               
     representatives  from   the  Governor's  Office,   House  of                                                               
     Representatives, and Senate also served.                                                                                   
   · The task force met every two weeks by video and                                                                            
     teleconference between May to November 2016 in open, public                                                                
     meetings.                                                                                                                  
                                                                                                                                
MS.  BURKHART summarized  that the  task force  came together  to                                                               
help  create   evidence-based  policy  recommendations   to  help                                                               
communities and  the state address  the opioid epidemic  and find                                                               
strategies that would work across different sectors in Alaska.                                                                  
                                                                                                                                
She referenced page 3, "Alaska  Opioid Policy Task Force Members"                                                               
and  noted  that members  hailed  from  all  over the  state  and                                                               
included people  from a variety of  disciplines, professions, and                                                               
experiences. She  said the  task force members  all came  with an                                                               
understanding that  the process  would be open  and participatory                                                               
that included Alaskans.                                                                                                         
                                                                                                                                
1:40:12 PM                                                                                                                    
SENATOR  MICCICHE addressed  the  various  member categories  and                                                               
noted that  one member  was listed as  "family member."  He asked                                                               
Ms. Burkhart to describe what a "family member" is.                                                                             
                                                                                                                                
MS.  BURKHART detailed  that  a "family  member"  is someone  who                                                               
themselves does  not experience an  opioid-use disorder,  but has                                                               
had a family member who has.                                                                                                    
                                                                                                                                
She referenced page 4, "Alaska  Opioid Policy Task Force Process"                                                               
and   detailed   that   the  process   was   open,   public   and                                                               
participatory. She detailed as follows:                                                                                         
                                                                                                                                
   · Public comment at every meeting.                                                                                           
   · Presenters included:                                                                                                       
        ƒLocal, state, and federal law enforcement;                                                                            
        ƒAddiction medicine experts;                                                                                           
        ƒState   and    federal   developers    of   prescribing                                                               
          guidelines;                                                                                                           
        ƒHarm-reduction providers;                                                                                             
        ƒFederal officials from The Substance Abuse and Mental                                                                 
          Health Services Administration (SAMHSA), and the                                                                      
          Veterans Administration;                                                                                              
        ƒMedication-assisted-treatment providers;                                                                              
        ƒAlaska Department of Corrections;                                                                                     
        ƒResidential-treatment providers;                                                                                      
        ƒEmergency-room providers;                                                                                             
        ƒEmergency-room physicians;                                                                                            
        ƒEarly-childhood development and adverse-childhood-                                                                    
          experiences experts.                                                                                                  
   · Community and stakeholder engagement:                                                                                      
        ƒMedical   providers,    recovery   networks,   business                                                               
          community, and community coalitions.                                                                                  
                                                                                                                                
MS. BURKHART summarized that the  task force met in open meetings                                                               
with  public comment  at every  meeting except  for the  last two                                                               
when recommendations were finalized.                                                                                            
                                                                                                                                
1:42:05 PM                                                                                                                    
CAPTAIN DUXBURY set forth that one  of the components of the task                                                               
force for  the law enforcement professionals  was the recognition                                                               
that the state  cannot solely arrest, treat,  educate, or prevent                                                               
its way out  of the problem. He said all  of the stakeholders had                                                               
to come to the table in order  for the task force to approach the                                                               
problem in a  different light because the problem  effects a vast                                                               
swath of the state's culture                                                                                                    
                                                                                                                                
MS.  BURKHART addressed  the  task  force's presentation  process                                                               
from   specialists.   She   noted  that   an   addiction-medicine                                                               
specialist helped  start the process  with an explanation  of how                                                               
opioid use effects the brain  and how the addiction process plays                                                               
out.                                                                                                                            
                                                                                                                                
1:45:50 PM                                                                                                                    
She  referenced a  graphic display  on page  5, "Data  Snapshot,"                                                               
that addressed  opioid overdoses  and deaths. She  specified that                                                               
the  data came  from the  Division of  Public Health.  She opined                                                               
that everyone has  reached consensus about the  impact opioids is                                                               
having every day in Alaska.                                                                                                     
                                                                                                                                
She referenced page  6, "Public Health Framework  - Public Health                                                               
Practice Paradigms" as follows:                                                                                                 
                                                                                                                                
   1. Environmental controls and social determinants:                                                                           
        ƒReduce the need to self-medicate, control access to                                                                   
          addictive substances, and promote protective factors.                                                                 
   2. Chronic disease screening and management:                                                                                 
        ƒDiagnose and treat addictions and substance use                                                                       
          disorders.                                                                                                            
   3. Acute health event control and prevention:                                                                                
        ƒPrevent life-threatening adverse outcomes.                                                                            
                                                                                                                                
MS.  BURKHART noted  that  the  task force  decided  early on  to                                                               
approach the opioid problem from  a public-health perspective, an                                                               
approach  that  gets  to  Captain  Duxbury's  comments  that  the                                                               
problem is  not a  one-solution problem.  She disclosed  that the                                                               
framework  used by  the task  force was  from the  Association of                                                               
State and Territorial Health Officials (ASTHO).                                                                                 
                                                                                                                                
CAPTAIN DUXBURY  asserted that the  model Ms.  Burkhart explained                                                               
works well when  everyone comes to the table, but  said the model                                                               
does not negate the fact that  law enforcement's job has to be to                                                               
interdict with  people that are  profiting off of  other people's                                                               
misery and weakness.                                                                                                            
                                                                                                                                
SENATOR  MICCICHE addressed  the  diagram on  page  5 that  says,                                                               
"Remove  stigma."  He  remarked  that  when  he  was  growing  up                                                               
"stigma" was an effective deterrent. He commented as follows:                                                                   
                                                                                                                                
     I'm  just wondering  how you  balance that.  Removal of                                                                    
     any stigma whatsoever with the  fact that we still want                                                                    
     successful young people to realize  that it is socially                                                                    
     unacceptable  and extremely  personally destructive  to                                                                    
     engage in using drugs.                                                                                                     
                                                                                                                                
1:49:40 PM                                                                                                                    
MS.  BURKHART answered  that she  agreed with  Senator Micciche's                                                               
balancing-act analogy. She asserted  that using evidence and data                                                               
drives  policy that  helps determine  where the  balance is.  She                                                               
opined  that stigma  or  the social  consequences  is actually  a                                                               
barrier.  She  said  for the  larger  population,  programs  that                                                               
provide  credible  information  and  the tools  that  align  with                                                               
social  values work  better.  She noted  that  kids start  making                                                               
better choices  when the  alcohol messaging  started to  focus on                                                               
the  health, social,  educational,  and employment  consequences.                                                               
She opined  that the continued  "Just don't do it"  messaging for                                                               
marijuana and illicit drugs does not resonate with kids.                                                                        
                                                                                                                                
1:52:00 PM                                                                                                                    
CAPTAIN   DUXBURY  admitted   that  his   opinion  is   based  on                                                               
experience. He opined  that social media has an  influence on how                                                               
people  think where  600 or  1,000 friends  share everything.  He                                                               
asserted  that  the  state  cannot  arrest its  way  out  of  the                                                               
problem.  He set  forth  that people  have to  be  told what  the                                                               
consequences are to realize that  their actions will "Erase pages                                                               
off of your resume."                                                                                                            
                                                                                                                                
SENATOR  BEGICH  remarked that  he  thought  "remove stigma"  was                                                               
removing  the stigma  of going  into treatment  and acknowledging                                                               
that he or  she has an issue, not trying  to destigmatize the use                                                               
of drugs.                                                                                                                       
                                                                                                                                
MS.  BURKHART concurred  with Senator  Begich's distinction.  She                                                               
opined that  there is an  element that in  order to seek  help an                                                               
individual has to know that they are not being judged.                                                                          
                                                                                                                                
SENATOR BEGICH  replied that  he thinks being  judged is  okay in                                                               
opioid distinctions where a person has to go treatment.                                                                         
                                                                                                                                
1:55:07 PM                                                                                                                    
SENATOR MICCICHE commented as follows:                                                                                          
                                                                                                                                
     My point  is I also hear  a lot more these  days of the                                                                    
     substance abuse as being a  disease. Although I believe                                                                    
     some  folks  may actually  have  a  tendency to  become                                                                    
     addicted  and  abuse  substances more  easily,  I  also                                                                    
     think in some ways it's a  little bit of a release from                                                                    
     personal responsibility  and that's where I  talk about                                                                    
     the relationship with  stigma. Ultimately there's still                                                                    
     a personal responsibility.                                                                                                 
                                                                                                                                
CAPTAIN  DUXBURY  addressed  page   7,  "Reducing  &  Controlling                                                               
Access" on  take-back prescription-drug  programs and  noted that                                                               
law enforcement  is involved. He  added that law  enforcement can                                                               
also  create  a larger  footprint  by  keeping some  prescription                                                               
medications in homes away from children.                                                                                        
                                                                                                                                
SENATOR GIESSEL asked  Andy Jones to explain  how the medication-                                                               
disposal envelope works.                                                                                                        
                                                                                                                                
1:58:45 PM                                                                                                                    
ANDY JONES,  Section Chief, Emergency Programs:  Health Emergency                                                               
Response Operations, EMS and Trauma,  Alaska Department of Health                                                               
and  Social Services,  Anchorage, Alaska,  explained that  25,000                                                               
"MedsAway" bags  from Mallinckrodt Pharmaceuticals  were donated.                                                               
He detailed  that each bag is  capable to dispose of  45 pills, 6                                                               
ounces of  liquid, or  6 patches. He  specified that  water mixed                                                               
with carbon in  the bags deactivates the drugs. He  said the goal                                                               
is to push the bags to  the state's public health centers as well                                                               
as non-profits,  pharmacies, and hospitals where  a drug-takeback                                                               
is an everyday thing rather than an annual occurrence.                                                                          
                                                                                                                                
CHAIR WILSON asked that senior centers be included as well.                                                                     
                                                                                                                                
MR. JONES answered yes.                                                                                                         
                                                                                                                                
2:01:19 PM                                                                                                                    
CAPTAIN DUXBURY added  that the Alaska State  Troopers respond to                                                               
situations where people  need to get rid of medication  due to an                                                               
in-home expected death.                                                                                                         
                                                                                                                                
He set forth  that increased screening and  security prevents the                                                               
importation   of  opioids.   He  provided   the  committee   with                                                               
historical information on the effects  of methamphetamine as well                                                               
as  the current  problem with  opioids on  native populations  in                                                               
Western Alaska.                                                                                                                 
                                                                                                                                
He said the  threats that come to Alaska  are twofold: interstate                                                               
and  intrastate.   He  noted  that  troopers   are  dealing  with                                                               
interstate drugs that are gang  related and cartel influenced. He                                                               
pointed out that there's a saying  that says, "Bring half as much                                                               
drugs to  Alaska, but  make three  time as  much money."  He said                                                               
populations are taken advantage of  where a small amount of drugs                                                               
in a small area affects everybody.                                                                                              
                                                                                                                                
He explained  that drug  distribution methods  include commercial                                                               
airlines,   common   carriers,   shipping   parcels,   commercial                                                               
carriers, and  private vehicles that include  airplanes, boats or                                                               
automobiles.  He summarized  that  the Alaska  State Troopers  is                                                               
getting together  with other agencies and  through the governor's                                                               
Five Point program to address drug distribution.                                                                                
                                                                                                                                
2:05:15 PM                                                                                                                    
MS.  BURKHART  disclosed that  the  task  force also  recommended                                                               
efforts to make  full and effective use of  the Prescription Drug                                                               
Monitoring  Program (PDMP).  She  said SB  74  from the  previous                                                               
legislature  made some  enhancements  to PDMP  as  well as  bills                                                               
recently  introduced  by the  governor  that  included how  often                                                               
information  is uploaded  to the  PDMP. She  added that  the task                                                               
force had  long discussions  on alternatives  to pharmacological-                                                               
pain management.                                                                                                                
                                                                                                                                
CAPTAIN DUXBURY  addressed the  emergency regulation  to schedule                                                               
drugs  that come  into the  state that  are highly  addictive and                                                               
harm people. He  suggested that a process be  established where a                                                               
drug is emergency  scheduled and then brought  to the Legislature                                                               
for ratification. He said Tramadol  is drug that was scheduled by                                                               
the  federal government  but not  by the  state. He  detailed the                                                               
Tramadol's harmful effects on Alaska's villages.                                                                                
                                                                                                                                
2:08:25 PM                                                                                                                    
MS. BURKHART pointed out that  the current Legislature introduced                                                               
bills  that addressed  "Pink"  and Tramadol.  She  said the  task                                                               
force  suggested that  an emergency  response  modeled after  the                                                               
Drug Enforcement  Agency (DEA) would  allow for a  more immediate                                                               
response  to emerging  drug threats,  but the  response would  be                                                               
subject to legislative ratification.                                                                                            
                                                                                                                                
SENATOR  GIESSEL  noted  that  Tramadol  was  taken  off  of  the                                                               
referenced bill by  House Finance. She said she  was hopeful that                                                               
Tramadol  could  be placed  back  into  the  bill when  the  bill                                                               
returns to the Senate.                                                                                                          
                                                                                                                                
CAPTAIN  DUXBURY  stated that  he  believes  the DEA's  emergency                                                               
scheduling is a  great process. He noted that the  drug U47700 is                                                               
having  an  effect  in  Anchorage's  intercity.  He  opined  that                                                               
emergency scheduling  would make it  possible to get a  handle on                                                               
things a little sooner.                                                                                                         
                                                                                                                                
SENATOR BEGICH asked if legislation  was introduced to create the                                                               
emergency regulatory power.                                                                                                     
                                                                                                                                
MS. BURKHART replied yes.                                                                                                       
                                                                                                                                
2:11:18 PM                                                                                                                    
She  referenced page  8,  "Reducing Risk  of  Misuse, Abuse,  and                                                               
Dependence"   and    revealed   that   the   task    force   made                                                               
recommendations related  to evidence and  research-based policies                                                               
that promote  healthy childhood development, and  to help prevent                                                               
adverse  childhood  experiences  in  order to  avoid  a  road  to                                                               
addiction.                                                                                                                      
                                                                                                                                
CAPTAIN DUXBURY  referenced his experiences in  drug education to                                                               
avoid  drugs.  He noted  that  some  people have  questioned  the                                                               
effectiveness  of  the  Drug Abuse  Resistance  Education  (DARE)                                                               
program. He opined that evidence-based  education about drugs for                                                               
children  can be  a vehicle  to make  better decisions.  He noted                                                               
that  a  DARE  program  in   the  past  helped  develop  positive                                                               
relationships with  youngsters and  not having a  similar program                                                               
is a detriment.                                                                                                                 
                                                                                                                                
2:15:27 PM                                                                                                                    
MS. BURKHART added that the  task force also made recommendations                                                               
on the  importance of nutrition and  having health-care providers                                                               
for a better start.                                                                                                             
                                                                                                                                
She  referenced  page  9, "Screening  and  Referral"  task  force                                                               
recommendations as follows:                                                                                                     
                                                                                                                                
   · Expanding  Screening, Brief  Intervention,  and Referral  to                                                               
     Treatment (SBIRT) to identify someone that is struggling                                                                   
     with drugs or alcohol.                                                                                                     
   · Information,  tools, and  reimbursement for  pain management                                                               
     specialists to screen for depression, mental health                                                                        
     disorders contributing to pain, refer to treatment.                                                                        
   · Health-plan  reimbursement for  clinical assessment  of risk                                                               
     of opioid abuse, overdoes.                                                                                                 
   · Crisis Intervention  Team training, Mental Health  First Aid                                                               
     awareness education for law enforcement/public safety                                                                      
     officers.                                                                                                                  
   · Public safety  assisted addiction and recovery  models; e.g.                                                               
     Gloucester Model.                                                                                                          
   · Up-to-date information  about treatment  providers available                                                               
     from Aging & Disability resource Centers, Alaska 211, etc.                                                                 
                                                                                                                                
2:18:14 PM                                                                                                                    
CAPTAIN  DUXBURY  explained that  the  Alaska  State Troopers  is                                                               
experiencing an  issue with  the "Title  47" system.  He provided                                                               
detailed  information  on  the Gloucester  Model  (GM)  where  an                                                               
individual presents  their drugs  to the police  in order  to get                                                               
help.  He opined  that having  a "large  hammer" for  felony drug                                                               
possession is  needed to  hold over someone  in order  to provide                                                               
the impetus for the GM  program to work, something that currently                                                               
does not exist.                                                                                                                 
                                                                                                                                
MS. BURKHART  said the idea  of public-safety  assisted addiction                                                               
and recovery  models relies  on having  access to  treatment. She                                                               
noted  that  most of  the  task  force's recommendations  require                                                               
additional work.                                                                                                                
                                                                                                                                
2:23:42 PM                                                                                                                    
She  referenced  page  10, "Opioid  Use  Disorder  Treatment"  as                                                               
follows:                                                                                                                        
                                                                                                                                
   · Adopt   a  "chronic   disease   management"  framework   for                                                               
     substance-use disorder treatment policy and reform.                                                                        
   · Review  of  involuntary  commitment  to  treatment  statutes                                                               
     (Title 47) as they relate to opioids.                                                                                      
   · Access to drug courts, therapeutic justice alternatives.                                                                   
   · Education/continuing     education    for     health    care                                                               
     professionals   about   state-prescribing   guidelines   and                                                               
     addiction medicine; that is part of Governor Walkers' 5-                                                                   
     Point plan.                                                                                                                
                                                                                                                                
CAPTAIN DUXBURY  added that  there needs  to be  a constitutional                                                               
and legal balance to accomplish the things noted on page 10.                                                                    
                                                                                                                                
2:27:37 PM                                                                                                                    
MS. BURKHART referenced page 11,  "Opioid Use Disorder Treatment"                                                               
and revealed that the levels of  care related to the treatment is                                                               
considered one  of the  highest levels  of care  with significant                                                               
practice   guidelines  and   regulations.   She  continued   with                                                               
recommendations as follows:                                                                                                     
                                                                                                                                
   · Comprehensive withdrawal management services in a variety                                                                  
     of health-care settings, specifically including rural and                                                                  
     correctional settings.                                                                                                     
   · Reimbursement for full costs of medication assisted                                                                        
     treatment     that    included     medication,    medication                                                               
     administration and monitoring.                                                                                             
   · Psychosocial treatment along with medication assisted                                                                      
     treatment, when clinically indicated.                                                                                      
   · Health-plan   reimbursement    of   inpatient,   residential                                                               
     substance use disorder treatment.                                                                                          
                                                                                                                                
CHAIR  WILSON  pointed  out correctional  involvement  and  noted                                                               
previous complications  due to overdosing.  He asked if  the task                                                               
force addressed  treatment within  the Department  of Corrections                                                               
(DOC).                                                                                                                          
                                                                                                                                
MS. BURKHART  answered yes. She  noted that the task  force spent                                                               
an entire session with the medical staff from DOC.                                                                              
                                                                                                                                
CAPTAIN  DUXBURY referenced  page 13,  "Overdose Prevention"  and                                                               
detailed the  Alaska State Troopers' involvement  with Andy Jones                                                               
at DHSS regarding the use of naloxone for drug overdoses.                                                                       
                                                                                                                                
2:34:45 PM                                                                                                                    
SENATOR GIESSEL  asked that  Andy Jones describe  what is  in the                                                               
naloxone overdose kits.                                                                                                         
                                                                                                                                
MR.  JONES explained  that the  overdose kits  have two  doses of                                                               
naloxone,  a   set  of   gloves,  a   CPR  barrier   device,  and                                                               
instructions that  detail signs  and symptoms  of an  overdose as                                                               
well as how to deliver the  overdose drug. He noted that the cost                                                               
for the  two doses is  $75. He detailed the  naloxone application                                                               
process to the committee.                                                                                                       
                                                                                                                                
2:39:21 PM                                                                                                                    
MS.  BURKHART said  another  recommendation  related to  overdose                                                               
prevention  is  ensuring  that health  plans  have  processes  to                                                               
identify high-risk prescriptions.                                                                                               
                                                                                                                                
She referenced page 14, "Syringe Exchange" as follows:                                                                          
                                                                                                                                
   · Reimbursement of syringe exchange programs that provide                                                                    
     disease prevention supplies, STI screening and prevention,                                                                 
     and safe disposal of syringes and needles.                                                                                 
   · Access to appropriate syringe/needle disposal services.                                                                    
                                                                                                                                
She referenced page 15, "Recovery" as follows:                                                                                  
                                                                                                                                
   · Health plan reimbursement of peer-support services.                                                                        
   · Supports for second-chance employers that are willing to                                                                   
     hire people in recovery.                                                                                                   
   · Support services for individuals in recovery reentering the                                                                
     community from residential treatment or incarceration.                                                                     
   · Access to recovery networks for people in recovery from                                                                    
     opioid addiction, including those receiving medication                                                                     
     assisted treatment.                                                                                                        
   · Access to 12-step and other group recovery models in                                                                       
     correctional institutions.                                                                                                 
                                                                                                                                
2:42:04 PM                                                                                                                    
CAPTAIN DUXBURY pointed  out that Vigor Alaska in  Ketchikan is a                                                               
company  that   provides  second   chances  for   individuals  in                                                               
recovery.  He noted  that he  had applied  Vigor's techniques  in                                                               
other areas as well.                                                                                                            
SENATOR  GIESSEL  noted  that another  company,  Donlin  Mine  in                                                               
Southwest Alaska, has a similar story to Vigor Alaska.                                                                          
                                                                                                                                
MS. BURKHART  said the task  force observed that Alaska  does not                                                               
have a  way to support  and spread the recovery  information. She                                                               
said the task  force suggested that more  employers be encouraged                                                               
to become involved.                                                                                                             
                                                                                                                                
2:46:31 PM                                                                                                                    
CAPTAIN DUXBURY  opined that SB  91, [crime reform bill  from the                                                               
29th  Legislature],  has  impacted  the  Alaska  State  Troopers'                                                               
ability to  convince folks to get  treatment or a program  with a                                                               
therapeutic court due to diminished  consequences for some of the                                                               
crimes.  He said  the troopers  are concentrating  on the  higher                                                               
scheduled drugs  that create  the most  damage and  finding those                                                               
folks  that are  making  the  most money  off  of other  people's                                                               
misery; however,  "small folks"  are able to  carry 2.5  grams of                                                               
heroin,  enough for  25 doses.  He  asserted that  there are  not                                                               
enough troopers  to address  the increase  in people  stealing to                                                               
buy drugs.  He added  that helping  individuals who  are affected                                                               
from the  "ancillary crime" in  the need to  pay for drugs  is an                                                               
issue being addressed as well.                                                                                                  
                                                                                                                                
SENATOR MICCICHE  opined that  adverse childhood  experiences are                                                               
tied together  with suicide,  domestic violence,  sexual assault,                                                               
drug abuse, and alcoholism.                                                                                                     
                                                                                                                                
2:50:13 PM                                                                                                                    
MS.  BURKHART  agreed  with  Senator  Micciche  that  it  is  all                                                               
intertwined. She said  very few people start with  heroin and the                                                               
addiction process is  a progression. She said  when talking about                                                               
wellness the whole person has to be addressed.                                                                                  
                                                                                                                                
She referenced  page 16,  "Collaboration" between  state, tribal,                                                               
federal, and community partners working together as follows:                                                                    
                                                                                                                                
   · Address   barriers   to   coordination   of   care   between                                                               
     prescribers and behavioral health providers.                                                                               
   · Strengthen evidence-based substance abuse prevention.                                                                      
   · Mitigate the collateral consequences of incarceration for                                                                  
     drug-related offenses.                                                                                                     
                                                                                                                                
She summarized that  the task force anticipates  that the answers                                                               
will come  through collaboration.  She asserted that  a framework                                                               
provided by the task force will help foster collaboration.                                                                      
                                                                                                                                
2:53:46 PM                                                                                                                    
She referenced page 17, "Next Steps" and detailed as follows:                                                                   
                                                                                                                                
   · The Alaska Opioid Policy Task Force (AOPTF) was formed to                                                                  
     develop recommendations  within a  discrete time  period. It                                                               
     is  not a  formal  state  organization. Members  contributed                                                               
     their  time  and  expertise  in   addition  to  their  usual                                                               
     function with their respective organizations.                                                                              
   · Going forward, AOPTF leadership and interested members will                                                                
    work with federal, state, tribal, and local partners to:                                                                    
     ƒSupport implementation of recommendations;                                                                               
     ƒShare information about the recommendations, the research                                                                
        and evidence upon which they are based, and emerging                                                                    
        science related to opioid misuse/abuse prevention and                                                                   
        treatment;                                                                                                              
     ƒAssist in coordination of opioid misuse/abuse prevention                                                                 
        and treatment system efforts.                                                                                           
                                                                                                                                
MS. BURKHART  summarized that the  task force was never  meant to                                                               
be  a perpetual  entity because  the task  force's purpose  is to                                                               
provide recommendations.                                                                                                        
                                                                                                                                
CHAIR  WILSON  thanked  the  task  force's  efforts  in  bringing                                                               
forward  their  recommendations.  He addressed  page  6,  "Public                                                               
Health  Framework" and  asked  Ms.  Burkhart hypothetically  what                                                               
percentage she  would choose to put  resources into environmental                                                               
controls and  social determinants, chronic disease  screening and                                                               
management, or acute health event control and prevention.                                                                       
                                                                                                                                
2:56:48 PM                                                                                                                    
MS.  BURKHART replied  that  the task  force  did not  prioritize                                                               
their recommendations.  She opined that prioritization  should be                                                               
based on a partnership with  Alaskans. She remarked that the task                                                               
force's recommendations  are strong  and noted  that many  of the                                                               
recommendations have no costs.                                                                                                  
                                                                                                                                
SENATOR  BEGICH addressed  page 9,  "Screening and  Referral." He                                                               
noted  that he  does SBIRT  training.  He opined  that the  SBIRT                                                               
model works  and is a  fairly low-cost intervention.  He detailed                                                               
that the  Gloucester Model  is a low-cost  casework model  out of                                                               
Massachusetts  that has  been replicated  throughout the  country                                                               
and is  a good, shared  responsibility model which  allows people                                                               
not to  be afraid of law  enforcement and law enforcement  not to                                                               
be afraid others.  He said he wanted to  reassure Captain Duxbury                                                               
that  while  it is  true  that  the  Office of  Juvenile  Justice                                                               
rejected  DARE  in  the  1990s, DARE  "retooled"  and  became  an                                                               
evidence-based  practice over  time. He  addressed DOC's  reentry                                                               
efforts and revealed that DOC  is using evidence-based approaches                                                               
as well.  He commended the  task force for  their recommendations                                                               
and agreed  that many  of the  evidenced-based approaches  do not                                                               
cost a lot of money.                                                                                                            
                                                                                                                                
CAPTAIN  DUXBURY  thanked Senator  Begich  for  his comments  and                                                               
concurred that DARE  is a revamped program  that teaches teachers                                                               
how to teach youngsters.                                                                                                        
                                                                                                                                
3:00:54 PM                                                                                                                    
There being  no further  business to  come before  the committee,                                                               
Chair  Wilson adjourned  the Senate  Health  and Social  Services                                                               
Committee at 3:00 p.m.                                                                                                          

Document Name Date/Time Subjects
AOPTF Presentation to Senate HSS 3-8-17.pptx SHSS 3/8/2017 1:30:00 PM
Opioid Task Force Recommendations 2017