03/30/2021 03:00 PM House HEALTH & SOCIAL SERVICES

                  SB 70-OPIOID OVERDOSE DRUGS                                                                               
                                                                                                                                
3:06:20 PM                                                                                                                    
                                                                                                                                
CO-CHAIR SNYDER announced that the  first order of business would                                                               
be CS  FOR SENATE BILL  NO. 70(HSS),  "An Act relating  to opioid                                                               
overdose drugs; and providing for an effective date."                                                                           
                                                                                                                                
3:07:01 PM                                                                                                                    
                                                                                                                                
SENATOR  DAVID   WILSON,  Alaska  State  Legislature,   as  prime                                                               
sponsor, presented CSSB 70(HSS).   He explained that CSSB 70(HSS)                                                               
allows  the  state  medical  officer   to  continue  to  issue  a                                                               
statewide standing  order for the  opioid overdose  reversal drug                                                               
Naloxone, also called  Narcan.  He explained this is  to remove a                                                               
four-year  sunset  clause on  a  previous  bill  from 2017.    By                                                               
removing the  sunset date, local and  regional response programs,                                                               
first  responders, the  Department  of Public  Safety (DPS),  the                                                               
Department of Corrections (DOC), and  the public will continue to                                                               
have the  ability to directly  distribute and have access  to the                                                               
life saving drug, Naloxone, he stated.                                                                                          
                                                                                                                                
SENATOR WILSON  said Naloxone is  not a controlled  substance and                                                               
has no  potential for abuse.   He stated that CSSB  70(HSS) would                                                               
benefit the many  friends and family of the people  who would die                                                               
of overdose without this life-saving medication.                                                                                
                                                                                                                                
3:09:21 PM                                                                                                                    
                                                                                                                                
JASMIN  MARTIN,   Staff,  Senator  David  Wilson,   Alaska  State                                                               
Legislature,  presented the  sectional  summary  of CSSB  70(HSS)                                                               
which read as follows [original punctuation provided]:                                                                          
                                                                                                                                
      Section 1: Repeals language regarding the sunset of                                                                       
     the original authorization.                                                                                                
        Section 2: Changes the reporting requirement to                                                                         
     reference opioid overdose drugs distribution.                                                                              
       Section 3: Repeals the sunset date of the original                                                                       
     standing order authorization.                                                                                              
     Section 4: Immediate effective date.                                                                                       
                                                                                                                                
SENATOR  WILSON  commented  that  the Department  of  Health  and                                                               
Social Services (DHSS) had a presentation for the committee.                                                                    
                                                                                                                                
3:10:40 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  PRAX asked  if there  was  an expense  associated                                                               
with the  annual report  from Section  2, and  if the  report was                                                               
necessary and added value.                                                                                                      
                                                                                                                                
SENATOR  WILSON answered  yes, and  that in  the original  Senate                                                               
Bill 91 from the Thirtieth  Alaska State Legislature, there was a                                                               
reporting mechanism.   He explained that there was  an attempt to                                                               
remove  the  requirement,  but   the  Senate  Health  and  Social                                                               
Services Standing Committee felt that the report was useful.                                                                    
                                                                                                                                
3:12:03 PM                                                                                                                    
                                                                                                                                
CO-CHAIR SNYDER observed that the  language changed components of                                                               
the report, so now it  referenced the various Substance Abuse and                                                               
Mental  Health  Services   Administration  (SAMHSA)  grants,  and                                                               
specifically  opioid overdose  drug distribution.   She  asked if                                                               
there were  any particular metrics  that might be lost  with that                                                               
wording change.                                                                                                                 
                                                                                                                                
SENATOR WILSON said that question  had been asked previously, and                                                               
it was his  understanding that the same items  would be measured.                                                               
He said  the difference was  because of language  associated with                                                               
the emergency declaration.                                                                                                      
                                                                                                                                
3:13:19 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE MCCARTY  said he thought  this was put  into place                                                               
before COVID-19  and asked  if the term  "opioid epidemic"  was a                                                               
SAMHSA classification for grant purposes.                                                                                       
                                                                                                                                
SENATOR  WILSON  answered  that  in  2017  Governor  Bill  Walker                                                               
introduced  an emergency  declaration on  the opioid  epidemic in                                                               
Alaska.  He said it was all SAMHSA funding.                                                                                     
                                                                                                                                
3:14:39 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SPOHNHOLZ commented  that  at the  time that  the                                                               
legislature passed Senate  Bill 91, there were  still rising case                                                               
counts as  related to  opioid overdoses, the  country was  in the                                                               
middle  of a  national  opioid  epidemic, and  that  is why  that                                                               
language  was  utilized.    She explained  that  there  has  been                                                               
progress with the  opioid epidemic and therefore  the language is                                                               
no  longer used  the same  way.   She  said it  was learned  that                                                               
having Naloxone available saves lives.                                                                                          
                                                                                                                                
REPRESENTATIVE MCCARTY  stated that  the sunset  is based  on the                                                               
standing  order.   He asked  if the  chief medical  officer could                                                               
decide  to  change the  standing  order  "without worrying  about                                                               
legislative action."                                                                                                            
                                                                                                                                
SENATOR  WILSON answered  yes.    He explained  the  idea of  the                                                               
sunset was  because that  is when the  funds ended  federally for                                                               
the program.   Because  this was a  successful program  and there                                                               
was a  continuation of  the federal funding,  his office  felt it                                                               
was a  good practice [and  sought to  continue the program].   He                                                               
also shared  that if a  better drug  or treatment were  to become                                                               
available, the  Chief Medical Officer  could update  the protocol                                                               
if needed.                                                                                                                      
                                                                                                                                
3:16:59 PM                                                                                                                    
                                                                                                                                
CO-CHAIR SNYDER introduced a presentation from DHSS.                                                                            
                                                                                                                                
3:18:28 PM                                                                                                                    
                                                                                                                                
THERESE WELTON,  Chief, Office of Substance  Misuse and Addiction                                                               
Prevention, Division  of Public Health, Department  of Health and                                                               
Social Services,  presented a PowerPoint, entitled  "SB 70 Opioid                                                               
Overdose Drugs" [hard copy included in the committee packet].                                                                   
                                                                                                                                
MS. WELTON  introduced slide  2, which outlined  the steps  of an                                                               
overdose,  which she  said takes  only  minutes to  happen.   She                                                               
explained that if  Naloxone is not immediately  available, it may                                                               
take  over 20  minutes for  Emergency Medical  Services (EMS)  to                                                               
arrive,  which may  be too  late.   She moved  slide to  3, which                                                               
showed a graph  of the increase in opioid deaths since 1999.                                                                    
                                                                                                                                
3:19:50 PM                                                                                                                    
                                                                                                                                
MS. WELTON  moved to slide 4  and stated that "too  many Alaskans                                                               
have lost their lives to  overdose" even though it is preventable                                                               
with the administration  of Naloxone.  She  shared that overdoses                                                               
were one of the top ten leading causes of death in 2017.                                                                        
                                                                                                                                
3:20:18 PM                                                                                                                    
                                                                                                                                
The committee took a brief at-ease at 3:20 p.m.                                                                                 
                                                                                                                                
[Due to  technical difficulties, the audio  following the at-ease                                                               
is not available   Information from slides 5-7  has been provided                                                               
from the secretary's log notes and committee packet documents.]                                                                 
                                                                                                                                
MS. WELTON said overdose can  cause significant medical impact on                                                               
a person when that person  does not receive timely administration                                                               
of Naloxone.   She  emphasized that it  takes just  three minutes                                                               
for a person who overdosed  to experience brain damage, and eight                                                               
minutes to  die.   She shared  that it only  takes three  to four                                                               
minutes for  paramedics to arrive  on scene in Anchorage,  but in                                                               
rural  areas it  can take  much  longer for  first responders  to                                                               
arrive on the  scene.  She said that people  who survive overdose                                                               
with brain injury can have [many long-term complications].                                                                      
                                                                                                                                
MS. WELTON presented  slide 5 and informed  the committee members                                                               
that in  the U.S. and Alaska  synthetic opioids appear to  be the                                                               
primary driver  of the increases  in overdose  deaths, increasing                                                               
38.4 percent  from the 12-month  period leading up to  June 2019,                                                               
compared with the 12-month period leading up to May 2020.                                                                       
                                                                                                                                
MS.  WELTON  presented   slide  6  and  said   the  World  Health                                                               
Organization  (WHO),  the  U.S.  Surgeon General,  and  the  U.S.                                                               
Society of  Addiction Medicine have recommended  that Naloxone is                                                               
accessible to those closest to a person using opiates.                                                                          
                                                                                                                                
MS.  WELTON presented  slide  7 and  explained  that the  current                                                               
standing   order  allows   Naloxone  to   be  dispensed   to  any                                                               
individuals  who   are  not   prescribers,  which   is  generally                                                               
prohibited.   She  stressed  that Naloxone  is  not a  controlled                                                               
substance, has  no potential for abuse  and is safe to  use.  She                                                               
argued  that by  removing  the sunset  date,  local and  regional                                                               
response  programs,  first  responders,  DPS  and  DOC,  and  the                                                               
general public will continue to be able to use Naloxone.                                                                        
                                                                                                                                
3:23:54 PM                                                                                                                    
                                                                                                                                
MS.  WELTON  presented  slide  8 and  shared  that  all  Naloxone                                                               
distributed  to  community  partners  is  100  percent  federally                                                               
funded by the SAMHSA grant program.   She shared this was used to                                                               
form  Project  HOPE,  which stands  for  Harm  reduction,  Opioid                                                               
Prevention,  and   Education,  which  works  to   distribute  and                                                               
administer Narcan  [the brand name  for Naloxone] in  Alaska with                                                               
127 community partners.   Thus far Project HOPE has  been part of                                                               
309 documented overdose-reversals, she shared.                                                                                  
                                                                                                                                
MS.  WELTON presented  slide 9  and said  that administration  of                                                               
Naloxone provides  opportunity for recovery, and  she argued that                                                               
saving  lives saves  costs.   She  said that  40  percent of  the                                                               
economic burden of  the opioid crisis is driven  by lost lifetime                                                               
earnings;  33  percent  is  by  excess  healthcare  spending;  15                                                               
percent  is from  lost  productivity  in the  work  force, and  6                                                               
percent is from criminal justice costs.                                                                                         
                                                                                                                                
MS.  WELTON presented  slide  10 and  said  the current  standing                                                               
medical order allows Naloxone to  be dispensed to any individuals                                                               
who  are  not  prescribers,  which is  generally  prohibited  for                                                               
medication.    She  reiterated  that   it  is  not  a  controlled                                                               
substance and  has no  potential for  abuse and  is safe  to use.                                                               
She said that  by removing the sunset  date, [interested parties]                                                               
will  be  able  to  distribute   and  use  the  life-saving  drug                                                               
Naloxone.   She shared  that the  report in  CSSB 70  (HSS) would                                                               
still provide information  on the opiate epidemic  and the opiate                                                               
overdose drug distribution.                                                                                                     
                                                                                                                                
MS.  WELTON closed  her presentation  with  slide 11.   She  said                                                               
without passage of CSSB 70(HSS)  Naloxone would be available only                                                               
to those  with a prescription  from a medical  provider submitted                                                               
to   a  pharmacy,   which  she   argued  makes   the  legislation                                                               
imperative.                                                                                                                     
                                                                                                                                
3:26:54 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  MCCARTY  referenced slide  5.    He observed  the                                                               
increase from  2018 to 2019 in  opioid death rates in  Alaska and                                                               
asked if it was because of an increase in Fentanyl use.                                                                         
                                                                                                                                
MS. WELTON answered that that is the preliminary thought.                                                                       
                                                                                                                                
CO-CHAIR   SNYDER  commented   that  she   wished  to   move  the                                                               
legislation out of committee after public testimony.                                                                            
                                                                                                                                
3:28:47 PM                                                                                                                    
                                                                                                                                
CO-CHAIR SNYDER opened public testimony on CSSB 70(HSS).                                                                        
                                                                                                                                
3:29:04 PM                                                                                                                    
                                                                                                                                
VENUS WOODS, Director, HIV Prevention  and Education, Alaska AIDS                                                               
Assistance Association  ("Four A's"), testified in  favor of CSSB
(HSS).   She said  the legislation was  important for  Four A's                                                               
and shared  that the organization  runs Anchorage's  only syringe                                                               
service  program.    She  explained  that  the  program  provides                                                               
overdose education and  gives out Narcan kits.   She said without                                                               
SB 70,  Four A's would  no longer be able  to give out  the kits,                                                               
and she believed overdose deaths would increase.                                                                                
                                                                                                                                
3:30:30 PM                                                                                                                    
                                                                                                                                
CO-CHAIR SNYDER closed public testimony.                                                                                        
                                                                                                                                
REPRESENTATIVE  SPOHNHOLZ commented  that  the  program has  been                                                               
very  effective,  and  that it  creates  an  opportunity  anytime                                                               
somebody  doesn't  die  from  an  overdose  to  find  a  path  to                                                               
recovery.  She  said the program has become  the standard nation-                                                               
wide.   She said  it was  initially [set  to sunset  after] four-                                                               
years because it was a new thing  that hadn't yet been done.  She                                                               
emphasized the  program has  proven to  be effective,  very safe,                                                               
and is  recommended by the  U.S. Surgeon General,  and therefore,                                                               
she believed it made sense to move CSHB 70(HSS) from committee.                                                                 
                                                                                                                                
[Discussion of CSSB 70(HSS) was concluded later in the meeting.]                                                                
                  SB 70-OPIOID OVERDOSE DRUGS                                                                               
4:33:32 PM                                                                                                                    
                                                                                                                                
CO-CHAIR SNYDER announced that the  final order of business would                                                               
be a return  to CS FOR SENATE BILL NO.  70(HSS), "An Act relating                                                               
to opioid overdose drugs; and providing for an effective date."                                                                 
                                                                                                                                
4:34:08 PM                                                                                                                    
                                                                                                                                
CO-CHAIR ZULKOSKY moved  to report CSSB 70(HSS)  out of committee                                                               
with  individual  recommendations  and  the  accompanying  fiscal                                                               
notes.  There being no objection, CSSB 70(HSS) was reported out                                                                 
of the House Health and Social Services Standing Committee.