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." 9:14:56 AM DOCTOR JAY BUTLER, CHIEF MEDICAL OFFICER, DIVISION OF PUBLIC HEALTH, DEPARTMENT OF HEALTH AND SOCIAL SERVICES, (DHSS) explained the reason for the legislation. He shared that more than 90 Alaskans died of an opioid overdose the year prior, which was more than twice the number of Alaskans who died of AIDS at the peak of the HIV epidemic. He stated that an opioid overdose represented nearly one in every forty deaths that occurred in the state the year prior. He shared that two-thirds of those deaths involved a prescription opioid. He remarked that the majority of those people who use heroin and other illicit opioids report that they first became addicted using prescription opioids. He stressed that often the opioids were obtained from a trusted and well-meaning health care provider. He stressed that the state was responding to the opioid epidemic through community coalitions, citizen action, and state government. He shared that SB 91 was passed and signed into law in March 2017, which authorized increased access to the life-saving drug Naloxone. Co-Chair MacKinnon acknowledged Senator Giessel's participation in the bill process. 9:16:59 AM Dr. Butler echoed stated that there were many people who were saved by the Naloxone kits. He remarked that the kits, however, did not address some of the underlying issues surrounding the opioid epidemic. He stated that the kits did not support those in recovery who wanted to maintain their sobriety. He remarked that the kits also did not address some of the underlying factors in the increase of opioid use and addiction. 9:33:19 AM Senator von Imhof wondered what happened to the reports, and what occurred with a pattern and whether there was action on those trends. Dr. Butler replied that the intent of the bill was for authorization for the Department of Commerce, Community and Economic Development (DCCED) to issue the report card. He stressed that there was currently no legal authority to issue that report. He stated that the information to the provider was solely for that provider. Senator von Imhof surmised that the bill would create a database that showed all the prescriptive drug behavior for all health care providers in the state. Dr. Butler replied that there would not be a new database, but enhancing the existing database. He stated that the database was for controlled substances only. 9:36:22 AM Senator Hughes expressed concern about the opioid epidemic in the state. She wanted to ensure that the bill was addressed the real problem. She felt that there might be "a few bad apples" in the state who were over-prescribing. She remarked that the Division of Public Health did not have the authority to forward names to the board, but rather could only recognize trends. She wondered whether the data showed that most prescribers were contributing to the problem, or was it only a few prescribers. She wondered whether the suspicious activity should be investigated, and then forward that information to the appropriate boards. Dr. Butler agreed that there were remarkable efforts and a robust recovery community in the Mat-Su. He stated that the broader nationwide data showed that more than half of the prescribed opioids came from primary care providers. He stated that the authority to pursue problematic providers was within the boards in DCCED. 9:42:16 AM Senator Hughes wondered whether the various boards could look at the Prescription Drug Monitoring Program (PDMP) to determine the outliers. She understood that the boards did not have that authority. Dr. Butler replied that there was an issue with staffing. The PDMP manager was currently in recruitment. He stated that there were red flagged criteria for behavior related to the number of prescribers and the number of pharmacies visited over a set period of time. Senator Hughes felt that there needed to be an examination of the over-prescribers that were shown in the database. She wondered whether there needed to be a specific name assigned in the database, rather than locations and trends. Dr. Butler deferred to Ms. Chambers. 9:45:08 AM SARA CHAMBERS, DEPUTY DIRECTOR, DIVISION OF CORPORATIONS BUSINESS AND PROFESSIONAL LICENSING, DEPARTMENT OF COMMERCE, COMMUNITY AND ECONOMIC DEVELOPMENT, responded that the boards were recently given authority to get the high-level trending non-specific information, and authority to issue license discipline if the prescription drugs were not used within generally safe practices. She agreed that that the boards did not have the ability to view the PDMP and transmit the information on a specific prescriber, unless there was a subpoena. She stated that the legislation expanded the ability to provide information, through a subpoena, to a law enforcement agency. She stressed that the PDMP was not currently used as a punitive investigative tool, but remarked that it could change with a policy change. Senator Hughes surmised that the board could only pursue an individual person after a filed complaint. She wondered whether the courts were ever used in investigating a complaint. Ms. Chambers replied in the affirmative. Senator Hughes hoped that there would be a report to see whether the PDMP manager could have greater investigative authority. Senator Micciche felt that the most valuable aspect of the bill was the daily prescription limit. He queried more information about the four-day and seven-day limits. He remarked that there was data showing that a ten-day prescription could result in addiction. Ms. Chambers replied that the Optometry Board currently had a four-day limit in statute, so that board was not included in the bill. She stated that the seven-day limit extended to all other practitioners, except for veterinarians. Senator Micciche felt that the limit could be successful. 9:52:20 AM Vice-Chair Bishop wondered whether the bill would be addressed in the afternoon. Co-Chair MacKinnon replied in the negative. Vice-Chair Bishop queried the background of opioids. Dr. Butler responded that opium had been used medicinally for thousands of years. He remarked, however, that opium had been known to result in addiction and physical dependency for thousands of years. He stated that there was approval in the 1990s that were introduced. Co-Chair MacKinnon discussed committee business. Senator Olson requested more information about the boards. Co-Chair MacKinnon CLOSED public testimony. SB 79 was HEARD and HELD in committee for further consideration. 10:00:36 AM RECESSED 2:18:10 PM RECONVENED