03/06/2018 03:00 PM House HEALTH & SOCIAL SERVICES

             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.