HB 268-OPIOID PRESCRIPTION INFORMATION  4:44:17 PM REPRESENTATIVE TARR announced that the final order of business would be SPONSOR SUBSTITUTE FOR HOUSE BILL NO. 268, "An Act relating to the prescription of opioids; relating to the Department of Health and Social Services; 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; and relating to the practice of optometry." 4:44:51 PM CLAIRE GROSS, Staff, Representative Les Gara, Alaska State Legislature, declared that Alaska was in the midst of an opioid crisis, as three of five drug overdoses in the state involved opioids. She reported that Alaska had twice the national rate for prescription opioid overdose deaths. She stated that many people being prescribed opioid drugs were still unaware of the high potential for addiction or the associated health risk. The proposed bill, HB 268, was a patient information bill, had a narrow scope, and put little or no new burden on prescribers. The principal intent was to ensure that every patient being prescribed an outpatient supply of an opioid be made aware of the associated risk and be informed about alternative treatment options if reasonable options existed. She stated that the guidelines from the Centers for Disease Control and Prevention (CDC) for opioid prescribers asked that they provide this same information when they prescribed. She noted that the proposed bill would have medical providers with the authority to prescribe opioids make a brief oral statement, in their own words, which stated the reason for prescribing the opioid, that opioid use can lead to addiction, that the risk of addiction increased with time, that opioid addiction may pose potentially life threatening health risks, and offer reasonable alternatives to opioid medication therapy. She added that, along with the oral statement, the prescriber would give the patient a short hand-out prepared by the Department of Health and Social Services that provided appropriate information conveying the potential addictive and health risks of opioids. She noted that this hand-out would also be available on the department's website and could be printed in the provider's office. She reported that the addition of the term "outpatient supply" to refer to opioid prescriptions would exempt emergency departments and in-patient facilities from the requirements of the proposed bill. The bill does not apply to patients receiving hospice care or substance abuse opioid dependence treatment. She stated that the new committee substitute removed discussion about heroin use and its relation to opioid abuse from the provider's oral statement and kept the focus on opioid medication. She listed the Department of Health and Social Services, the Alaska Mental Health Board, and the Alaska Dental Society as supporters of the proposed bill. She read part of a letter from Dr. Ann Zink [Included in members' packets]: HB 268 appears to be legislating something that we believe physicians should be doing for their patients. As emergency physicians we fully embrace the importance of the risk-benefit- alternative discussion between provider and patient any time a potentially hazardous test or treatment is being considered. The decision to use opioids or not certainly falls into this category. Our hope is that with all the attention being paid to opioids by both the house of medicine and society in general, these conversations are already happening. HB 268 may help encourage a conversation we believe in and is in line with many other steps this body and others have taken end this epidemic. 4:48:40 PM REPRESENTATIVE EASTMAN asked if prescribing an outpatient supply only dealt with the initial prescription for a new patient. MS. GROSS said that the intent had been for the initial visit and prescription, and that an amendment could clarify this ambiguity. REPRESENTATIVE EASTMAN asked about a conceptual amendment. REPRESENTATIVE TARR suggested to ask Legislative Legal Services to provide clarity. 4:50:43 PM CLAIRE RADFORD, Attorney, Legislative Legal Counsel, Legislative Legal Services, Legislative Affairs Agency, acknowledged that the proposed bill was not clear, and that she could draft an amendment. REPRESENTATIVE TARR asked if this was preferable as a drafted amendment or as a conceptual amendment. MS. RADFORD opined that the single word would need to be added in the different sections. REPRESENTATIVE TARR directed attention to page 4 [line 4] and asked if this could read "before prescribing the initial outpatient supply..." REPRESENTATIVE EASTMAN suggested that it could read "before initially prescribing an outpatient supply..." MS. RADFORD replied, "yes, that's correct." 4:52:09 PM REPRESENTATIVE EASTMAN offered conceptual Amendment 1, adding the word "initially" between the words "before prescribing" on page 4, line 4. REPRESENTATIVE TARR objected for discussion. She said that it would also need to be added on page 6, line 31; page 8, line 29; and page 11, line 1. 4:53:13 PM REPRESENTATIVE TARR removed her objection. 4:53:26 PM REPRESENTATIVE EASTMAN withdrew conceptual Amendment 1. REPRESENTATIVE EASTMAN offered conceptual Amendment 2, which would add the word "initially" [on page 6, line 31; page 8, line 29; and page 11, line 1] and would allow Legislative Legal Services the latitude to make any conforming amendments for consistency. REPRESENTATIVE TARR objected for discussion. REPRESENTATIVE SADDLER opined that this was a reasonable limitation, as the warning would be as effective given once as it would be given multiple times. 4:54:33 PM REPRESENTATIVE EASTMAN stated that his intent with conceptual Amendment 2 was to ensure that this was for the initial prescription to a particular patient. 4:55:28 PM REPRESENTATIVE TARR removed her objection to proposed conceptual Amendment 2. There being no further objection, it was so ordered. MS. RADFORD asked if Legislative Legal Services could have conforming authority to make those changes. REPRESENTATIVE TARR said "yes." 4:55:56 PM REPRESENTATIVE SADDLER asked if there were current laws preventing habitual, without good cause, overprescribing of opioids. MS. GROSS said that she would defer. 4:56:54 PM SARA CHAMBERS, Deputy Director, Juneau Office, Division of Corporations, Business, and Professional Licensing, Department of Commerce, Community & Economic Development, referenced the passage of House Bill 159 in 2017, one of many bills to combat the opioid crisis, and included a seven day limitation [to opioid prescription] which could be overridden by a prescriber if the prescriber was documenting the rationale for pursuing greater than a seven day supply. She stated that there was an evolution for different tools to combat this opioid crisis. She reported that the boards overseeing the licensees prescribing had codes of ethics, regulations, and other guidelines that indicate how patients should be informed prior to any course of action. 4:58:32 PM REPRESENTATIVE EASTMAN stated that he was not enthusiastic about the proposed bill, although he acknowledged that the concern was well placed because opioid medications were not measuring up to the expectations for living better lives. He pointed to the requirements on page 4, line 14, for doctors to list any reasonable non-opioid alternative to the prescription as well as oral and written information. He stated that he did not think "the prescription matches the problem." He suggested that "requiring every prescriber to be listing out all the drugs that they didn't prescribe and the reasons maybe why they didn't" was more paperwork and regulation and not the solution to solve this problem. 5:00:28 PM REPRESENTATIVE SADDLER expressed his agreement that opioid use and addiction in Alaska, as well as the rest of the nation, was "a real problem." He declared that the proposed bill did not deal with the prescription of opioids, per se, as nothing in the proposed bill changed the authority for writing prescriptions by doctors and dentists. He referenced House Bill 159 and its seven-day limitations. He stated that there were other restrictions, as physicians may prescribe subject to the constraints of the normal, ethical, professional practice of medicine, as informed by the Medical Board. He declared that the proposed bill did not deal with this. He offered his belief that people already realized that opioid drugs were addictive and that a doctor would make some offer of information to the patient. He shared his own experience upon receiving prescriptions from doctors. He stated that the proposed bill was essentially a "placebo bill" as it "has no real effect." 5:02:19 PM REPRESENTATIVE JOHNSTON stated that, although she had originally had concerns with the proposed bill, the sponsor had addressed those concerns. She reported that several physicians had visited her office in the past week and that they had declared support for this bill, while pointing out that, even though there was a new emphasis among doctors, there was not enough being done. These doctors stated that there was not any harm in the proposed bill, and that "there could be some good." She declared her support for the proposed bill. 5:03:12 PM REPRESENTATIVE EDGMON moved to report CSSSHB 268, Version 30- LS1081\R, Radford, 2/9/18, as amended, out of committee with individual recommendations and the accompanying fiscal notes. 5:03:30 PM REPRESENTATIVE EASTMAN objected. 5:03:39 PM A roll call vote was taken. Representatives Kito, Edgmon, Saddler (alternate), Johnston, Claman (alternate), and Tarr voted in favor of CSSSHB 268, Version 30-LS1081\R, Radford, 2/9/18, as amended. Representative Eastman voted against it. Therefore, CSSSHB 268 (HSS) was reported out of the House Health and Social Services Standing Committee by a vote of 6 yeas - 1 nay.