03/02/2023 03:00 PM House HEALTH & SOCIAL SERVICES

          HB 56-CONTROLLED SUB. DATA: EXEMPT ANIMAL RX                                                                      
                                                                                                                                
4:26:21 PM                                                                                                                    
                                                                                                                                
CHAIR PRAX  announced that  the next order  of business  would be                                                               
HOUSE  BILL  NO.  56, "An  Act  exempting  controlled  substances                                                               
prescribed  or dispensed  by a  veterinarian to  treat an  animal                                                               
from the  requirements of  the controlled  substance prescription                                                               
database."                                                                                                                      
                                                                                                                                
4:26:40 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE RUFFRIDGE, as prime  sponsor, introduced HB 56 via                                                               
a PowerPoint  presentation [hard  copy included in  the committee                                                               
packet].   He stated that  HB 56 would exempt  veterinarians from                                                               
the Prescription  Drug Monitoring  Program (PDMP).   Beginning on                                                               
slide 2,  he stated PDMP had  been established in Alaska  in 2008                                                               
to track the dispensing of  controlled substance medications.  He                                                               
added that  while every  state has a  similar program,  33 states                                                               
have  exempted veterinarians  from participating.   Currently  in                                                               
Alaska  all prescribing-license  types are  required to  register                                                               
with PDMP.   He  continued that license  holders are  required to                                                               
review  PDMP  prior  to  prescribing  controlled  substances  and                                                               
report  daily on  the dispensing  of  all controlled  substances,                                                               
even on days the business is closed.                                                                                            
                                                                                                                                
4:29:11 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE RUFFRIDGE, referring to  slide 3, stated that PDMP                                                               
was  designed  as  a  dispensing  record  to  aid  practitioners,                                                               
especially  in relation  to [Schedule]  II  narcotics, which  are                                                               
highly abusable medications.  He  listed some of the other lower-                                                               
class drugs, which also have to  be reported.  He said pharmacies                                                               
have  an automatic  daily-reporting process,  while veterinarians                                                               
manually  submit  their  daily  reports.   He  stated  that  PDMP                                                               
monitors prescriptions for legal drugs  and would have no control                                                               
over illicit-drug use.  He stated  that the purpose of PDMP is to                                                               
help prevent doctor and pharmacy "shopping."                                                                                    
                                                                                                                                
4:32:21 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  RUFFRIDGE, moving  to the  next slide,  addressed                                                               
the reason  for the  legislation.   He stated  that veterinarians                                                               
are aware of the importance  of PDMP in preventing pharmaceutical                                                               
drug  abuse; however,  they experience  unique difficulties  with                                                               
the program requirements.   He added that there  are some serious                                                               
concerns about the  privacy of information in PDMP.   On slide 5,                                                               
he  pointed out  that  the  program is  designed  to track  human                                                               
prescriptions, not  animal prescriptions.   The data  gathered by                                                               
veterinarians is often  not linked to the animal  owner, and this                                                               
would be  required to accurately  track data.   Veterinarians are                                                               
not   guided   by   the    Health   Insurance   Portability   and                                                               
Accountability  Act  (HIPAA),  nor  are  they  trained  in  human                                                               
medicine.    Before  dispensing  a  controlled  substance  to  an                                                               
individual with  a pet, the  veterinarian is required to  look up                                                               
information on the  individual to see if any  previous drugs have                                                               
been dispensed.   He stated  that many  pet owners are  not aware                                                               
veterinarians would have access  to personal medical information,                                                               
and  this could  be  a concern.   Animal  patients  are not  well                                                               
tracked  because  they  lack the  unique  PDMP  identifiers,  and                                                               
individuals connected to the pet may not be consistent.                                                                         
                                                                                                                                
4:35:12 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  RUFFRIDGE continued  to slide  7 and  stated that                                                               
veterinarians rarely require the  use of [Schedule] II narcotics.                                                               
In a 2017  study, he said, veterinary clinics  accounted for only                                                               
0.34  percent  of all  the  opioids  dispensed.   He  added  that                                                               
veterinary  clinics would  use opioids  only during  surgery, and                                                               
typically  opioid  dispensing  is reserved  for  pharmacies,  not                                                               
veterinarians.      In   summary,  he   stated   that   exempting                                                               
veterinarians  from PDMP  would protect  privacy and  ensure PDMP                                                               
data is clear, usable, and linked only to end users.                                                                            
                                                                                                                                
4:36:21 PM                                                                                                                    
                                                                                                                                
BUD SEXTON, Staff, Representative  Justin Ruffridge, Alaska State                                                               
Legislature,  on   behalf  of  Representative   Ruffridge,  prime                                                               
sponsor, provided the sectional analysis  of HB 56 [copy included                                                               
in  the  committee  packet],  which  read  as  follows  [original                                                               
punctuation provided]:                                                                                                          
                                                                                                                                
     Section 1.  AS 17.30.200(o)  is amended to  remove "and                                                                    
     the   Board   of   Veterinary   Examiners"   from   the                                                                    
     notification requirement when  a practitioner registers                                                                    
     with the database under (n) of this section.                                                                               
                                                                                                                                
     Sec.  2.  AS  17.30.200  is amended  by  adding  a  new                                                                    
     subsection to  read: This section  does not apply  to a                                                                    
     schedule   II,   III,   or  IV   controlled   substance                                                                    
     prescribed  or  dispensed  by a  veterinarian  licensed                                                                    
     under AS 08.98 to treat an animal.                                                                                         
                                                                                                                                
     Sec. 3. AS 08.98.050(a)(10) is repealed which removes                                                                      
     the requirement for Veterinarians under the controlled                                                                     
     substance prescription database.                                                                                           
                                                                                                                                
4:37:42 PM                                                                                                                    
                                                                                                                                
TRACY  WARD,  DVM,  Clinic Director/Veterinarian,  Juneau  Animal                                                               
Rescue,  provided invited  testimony in  support of  HB 56.   She                                                               
shared that  she recently  had been the  president of  the Alaska                                                               
State  Veterinary Medical  Association  (AKVMA).   She  explained                                                               
that Dr. Rachel  Berngartt was scheduled to testify  on behalf of                                                               
the  Alaska Board  of Veterinary  Examiners (BOVE);  however, Dr.                                                               
Berngartt was detained.  She  stated that she would be presenting                                                               
and answering questions on behalf of both AKVMA and BOVE.                                                                       
                                                                                                                                
DR. WARD stated for the record  that both AKVMA and BOVE strongly                                                               
support HB  56.  She  stated that  the Alaska Board  of Pharmacy,                                                               
which administers PDMP,  has recently passed a  motion to support                                                               
the proposed  legislation, as seen on  slide 3.  She  stated that                                                               
PDMP had been amended in  2017 to require mandatory participation                                                               
by all federal permit holders.  As  seen in the photo on slide 4,                                                               
she stated  that representatives  from the prescribing  boards of                                                               
other  agencies had  been consulted  in  drafting the  amendment;                                                               
however, veterinarians had  not been consulted.   In other words,                                                               
advice   was  not   sought  from   BOVE  nor   AKVMA,  but   both                                                               
organizations were included in the requirements.                                                                                
                                                                                                                                
4:40:02 PM                                                                                                                    
                                                                                                                                
DR. WARD, moving  to slide 5, stated that PDMP  is not a workable                                                               
database  for veterinarians  because the  system is  designed for                                                               
human  data.   She  said  this  data is  uninterpretable  because                                                               
veterinarians  are not  trained in  human pharmacology  and would                                                               
not  have   the  knowledge   of  appropriate   doses,  medication                                                               
timeframes,  and refill  requirements.   Moving to  slide 6,  she                                                               
expressed  the  opinion  that  having  access  to  this  data  is                                                               
intrusive and  an invasion of  human privacy, because  humans are                                                               
not  the  patients -  they  are  the  clients.   She  added  that                                                               
veterinarians  are  not  protected  by HIPAA  regulations.    She                                                               
suggested   that   committee   members  consider   how   personal                                                               
medication  history is  being  shared  outside of  client/patient                                                               
privilege.   She maintained veterinarians are  uncomfortable with                                                               
this.                                                                                                                           
                                                                                                                                
DR. WARD,  moving to slide  7, stated, if veterinarians  were not                                                               
monitored through  PDMP in regard to  controlled substances, they                                                               
would  be monitored  through record  keeping with  the DEA.   She                                                               
stated that  every pill  of oral  medication dispensed  and every                                                               
drop of  injectable medication administered  has to  be accounted                                                               
for.   Records would be maintained  and made available to  DEA or                                                               
local  law enforcement  agencies upon  request.   She added  that                                                               
distributors  of controlled  substances are  required to  monitor                                                               
any  pattern  in usage  by  the  DEA's Suspicious  Orders  Report                                                               
System,  and the  vast  majority of  drug  diversions are  caught                                                               
through this process, not PDMP.                                                                                                 
                                                                                                                                
4:44:30 PM                                                                                                                    
                                                                                                                                
DR.  WARD reiterated  that a  very small  amount of  total opioid                                                               
prescriptions would  be dispensed  by veterinarians.   She stated                                                               
that if every  one of these prescriptions were  misused, it would                                                               
be "a  tiny, tiny drop  in the bucket  of the total  opioid abuse                                                               
problems."   She pointed  out in  the graph on  slide 9  that, in                                                               
general,  veterinarians do  not  use the  drugs  of concern,  and                                                               
synthetic opioids are almost never  used.  She added that Vicodin                                                               
or  oxycontin  are  not  used; however,  fentanyl  is  used,  but                                                               
exclusively in the  hospital and would not be sent  home with the                                                               
pet  owner.   She added  that cocaine  or methamphetamine  is not                                                               
used.  She maintained that  veterinarians would not be the source                                                               
of the drugs of concern in the current drug epidemic.                                                                           
                                                                                                                                
DR.  WARD, moving  to  slide 10,  argued  that veterinarians  are                                                               
pursuing the  proposed legislation  because of the  hardship PDMP                                                               
creates.  She stated that  investigations of veterinarians by the                                                               
board of  PDMP are mostly  because of clerical mistakes.   Moving                                                               
to  slide   11,  she  stated  that   since  participation  became                                                               
mandatory,  investigative costs  have increased  threefold.   She                                                               
explained  that this  is not  because veterinarians  are misusing                                                               
drugs, but because  they are required to use  an unwieldy system.                                                               
She explained  that the  board is not  funded by  the government,                                                               
but   by   licensing  fees,   so   the   cost  of   investigating                                                               
veterinarians is  borne by  the veterinarians.   In  other words,                                                               
veterinarians  are charged  with investigating  themselves.   She                                                               
added that Alaska  already has the highest licensing  fees in the                                                               
country.   Moving to slide 12,  she stated that support  of HB 56                                                               
would   allow  veterinarians   to  provide   appropriate  medical                                                               
management,  while  increasing the  efficiency  of  PDMP for  its                                                               
intended purpose.                                                                                                               
                                                                                                                                
4:48:29 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SADDLER  questioned how  exempting  veterinarians                                                               
from PDMP would improve efficiency.                                                                                             
                                                                                                                                
REPRESENTATIVE  RUFFRIDGE responded  that  PDMP  was intended  to                                                               
stop  doctor and  pharmacy "shopping,"  which had  been a  common                                                               
practice prior to  the implementation of the program.   He stated                                                               
that the  inability to track medications  dispensed from multiple                                                               
sources led to the overprescribing  of controlled substances.  He                                                               
stated  that exempting  veterinarians  would clean  up the  data.                                                               
For  example,  a  prescription  for  an animal  can  be  in  PDMP                                                               
multiple times under different pet  names or owners, so this data                                                               
is difficult  to accurately interpret.   In turn the  data cannot                                                               
be trusted, and the purpose of PDMP is not supported.                                                                           
                                                                                                                                
REPRESENTATIVE  SADDLER,  with  a follow-up  question,  requested                                                               
additional   comments   on   PDMP's    intended   use   and   its                                                               
effectiveness.                                                                                                                  
                                                                                                                                
REPRESENTATIVE   RUFFRIDGE   responded   that  the   program   is                                                               
effective.   He added that  unfortunately the overdose  deaths in                                                               
Alaska  are still  increasing,  and this  causes  criticism.   He                                                               
stated  that PDMP  is successfully  adverting people  from doctor                                                               
and  pharmacy "shopping,"  but abuse  of illicit  drugs, such  as                                                               
heroin, oxycodone, and fentanyl, has not been stopped.                                                                          
                                                                                                                                
4:52:03 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  MINA commented  that those  in opposition  of the                                                               
proposed legislation have come to  a position of neutrality.  She                                                               
questioned participation by veterinarians  in addressing the drug                                                               
epidemic.                                                                                                                       
                                                                                                                                
DR.   WARD  expressed   the  opinion   that   the  education   of                                                               
veterinarians is more worthwhile  than requiring participation in                                                               
PDMP.  She  pointed out that speakers from DEA  have been invited                                                               
to  address  [the  drug epidemic]  at  the  state  veterinarians'                                                               
conference.    She stated  that,  even  though veterinary  clinic                                                               
"shopping"  is  very   rare,  as  part  of   the  larger  medical                                                               
community,  veterinarians should  be educated.   She  stated that                                                               
veterinarian  clinics have  been  broken into,  and security  has                                                               
been  increased.   Within the  last five  years clinics  are more                                                               
often  calling  in prescriptions  to  pharmacies,  as opposed  to                                                               
dispensing controlled drugs on the premises.                                                                                    
                                                                                                                                
DR.  WARD, in  response to  a follow-up  question, expressed  the                                                               
understanding  that  currently  xylazine  is in  the  process  of                                                               
becoming  a federally  controlled substance.   She  expressed the                                                               
opinion that this  drug would likely not be a  problem in Alaska,                                                               
because  it is  a tranquillizer  used on  large animals,  such as                                                               
horses, and Alaska has a small proportion of large animals.                                                                     
                                                                                                                                
4:55:55 PM                                                                                                                    
                                                                                                                                
DR.  WARD,  in response  to  Representative  Sumner, stated  that                                                               
veterinarians  use two  opioids.   Hydrocodone  would  be of  the                                                               
primary  concern, but  it is  used in  minor amounts  for chronic                                                               
coughs in  small dogs.  She  added that accessing enough  of this                                                               
drug from a  clinic to cause a serious issue  would be difficult.                                                               
She stated  that buprenorphine  would be  used in  a clinic  as a                                                               
pain medication.  She added that  this drug is also used to treat                                                               
fentanyl addiction.                                                                                                             
                                                                                                                                
4:57:27 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE RUFFRIDGE  asserted that  more work would  be done                                                               
on HB 56.   He stressed the importance of clean  data in PDMP and                                                               
allowing veterinarians to do their job.                                                                                         
                                                                                                                                
4:58:31 PM                                                                                                                    
                                                                                                                                
CHAIR PRAX announced that HB 56 was held over.