SENATE FINANCE COMMITTEE FIRST SPECIAL SESSION May 25, 2017 9:02 a.m. 9:02:26 AM CALL TO ORDER Co-Chair MacKinnon called the Senate Finance Committee meeting to order at 9:02 a.m. MEMBERS PRESENT Senator Lyman Hoffman, Co-Chair Senator Anna MacKinnon, Co-Chair Senator Click Bishop, Vice-Chair (via teleconference) Senator Shelley Hughes Senator Donny Olson MEMBERS ABSENT Senator Peter Micciche Senator Natasha von Imhof ALSO PRESENT Senator Cathy Giessel; Sara Chambers, Deputy Director, Division of Corporations, Business, and Professional Licensing, Department of Commerce, Community and Economic Development, Representative Tammie Wilson. PRESENT VIA TELECONFERENCE Jay Butler, Chief Medical Officer, Department of Health and Social Services, Anchorage. SUMMARY SB 79 OPIOIDS;PRESCRIPTIONS;DATABASE;LICENSES SB 79 was HEARD and HELD in committee for further consideration. 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." 9:03:37 AM SENATOR CATHY GIESSEL, announced that she had listened to the committee's questions from the previous meeting. She wanted to share her thoughts based on her experience. 9:07:08 AM Senator Giessel shared a story of a violent person who acted in an extreme manner. 9:10:39 AM Senator Giessel discussed the history of the Prescription Drug Monitoring Program (PDMP). 9:12:17 AM Senator Giessel explained the history of the Alaska Opioid Policy Task Force. 9:13:01 AM Senator Giessel referenced a presentation titled, "The Science of Opioid Use Disorder" (copy on file). 9:26:01 AM Senator Giessel noted that the bill addressed dosage, or rather only addressed duration. She shared a statement from the Tennessee Board of Nursing. She announced that the morphine milligram equivalent (MME) was used to prescribe opioids. She stated that all clinicians have access to the information. 9:35:18 AM Co-Chair MacKinnon remarked that there was an assertion from the Board of Pharmacy that the manufacturer of the medication had set dosage guidelines. She wondered how that dosage was determined. Senator Giessel replied that Co-Chair MacKinnon remarked that there was an assertion that there was a reliance on the drug company's suggested dosage. She remarked that some may not understand the possibility of overprescribing. Senator Giessel replied that there was a need for continuing education to inform the clinicians. 9:39:49 AM Senator Hughes wondered whether the size of a person was considered in the dosage amount. Senator Giessel replied that size was not considered. Senator Hughes queried the alignment with the bill and the task force's recommendations. Senator Giessel replied that many recommendations were in the bill, but did not know whether the recommendations were the basis of the bill. She deferred to Dr. Butler. 9:41:58 AM JAY BUTLER, CHIEF MEDICAL OFFICER, DEPARTMENT OF HEALTH AND SOCIAL SERVICES, ANCHORAGE (via teleconference), announced that the recommendations of the task force were an important informative factor in the drafting of the bill. Co-Chair MacKinnon queried the seven-day limit decision. Dr. Butler replied that, in general, the discussion in the task force focused on the guidelines from the Center for Disease Control (CDC). Co-Chair MacKinnon remarked that the CDC had a recommended dosage. She wondered why that recommendation was not included in the bill. Dr. Butler replied that the CDC had guidelines. He did not want to be too specific in the dosage. He stressed that the focus was on the size of the prescription. Senator Hughes wondered whether the state boards had adopted CDC guidelines. Senator Giessel replied in the affirmative. 9:50:21 AM SARA CHAMBERS, DEPUTY DIRECTOR, DIVISION OF CORPORATIONS, BUSINESS, AND PROFESSIONAL LICENSING, DEPARTMENT OF COMMERCE, COMMUNITY AND ECONOMIC DEVELOPMENT, explained that the legislature had recently requested opioid guidelines from all boards. She stated that the CDC guidelines had recommended the state of Washington's Interagency Guideline on Opioid Prescriptions, with lowering the morphine equivalent to 90. Senator Hughes wondered whether the board were creating a similar regulation. Ms. Chambers replied that the boards were at different stages of regulation development. She stated that the bill would accommodate the flexibility. Co-Chair MacKinnon queried additional comments. Dr. Butler shared that one in twenty people were still on opioids one year after their first dose. 10:00:10 AM Co-Chair MacKinnon remarked that the bill addressed end of life issues that allowed doctors to keep patients on long term opioid prescriptions. She noted that there were many medications left after someone that she knew had died, and then taken by law enforcement. She wondered whether there was a way to track the opioids. Dr. Butler replied that leftover pills were often put into the community. He stated that there were not mechanisms for tracking dispensed opioids. He remarked he had worked with hospice to provide activated charcoal to neutralize the opioid safe for disposal in a landfill. 10:05:46 AM Co-Chair MacKinnon remarked that there were intermittent drug disposal opportunities in her community. She queried disposal recommendations, and whether that was addressed in the bill. Dr. Butler replied that it was not specifically addressed in the bill. He supported drug take-back activities. 10:11:06 AM Vice-Chair Bishop wondered whether the damage could be reversed. Senator Giessel replied that Vivitrol may be able to reverse the effects of addiction. Co-Chair MacKinnon wondered whether the effects of addiction could be reversed. Dr. Butler replied that it was unknown whether the effects of addiction could be reversed. 10:16:19 AM Senator Olson remarked that many studies noted that the receptors were scarred after drug abuse. Vice-Chair Bishop wondered whether was a way to make a first prescription a lower equivalent. Senator Giessel replied that there should be a clarification that 90 milligrams a day of morphine level equivalent is the maximum dosage. Co-Chair MacKinnon recalled that there was a working day issue, and wondered whether there was adequate language for the expectation of a possible dispensary day closure. Ms. Chambers replied that the Board of Pharmacy allowed some pharmacies to opt-out, because they were not engaging in activity that required reporting. She stated that the opt- out option would extend to the pharmacy's day off from the week. 10:22:19 AM Co-Chair MacKinnon wondered whether the language in the bill was sufficient. Ms. Chambers replied in the affirmative. Co-Chair MacKinnon announced that there was a series of questions that had been submitted to the administration. Senator Olson appreciated the perspective of Senator Giessel's presentation. Co-Chair MacKinnon wanted to involve the boards in the process. 10:26:58 AM Co-Chair Hoffman shared that the main issue in rural Alaska was mail order drugs. He wondered how other states and countries approached the issue. Dr. Butler replied that there should be a multifaceted approach. Senator Giessel stated that the drugs were going into the villages through air freight, and there was a bill that addressed the issue currently in the legislature. SB 79 was HEARD and HELD in committee for further consideration. ADJOURNMENT 10:31:01 AM The meeting was adjourned at 10:31 a.m.