Legislature(2021 - 2022)BUTROVICH 205
02/16/2021 01:30 PM Senate HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| SB65 | |
| SB70 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | SB 65 | TELECONFERENCED | |
| *+ | SB 70 | TELECONFERENCED | |
SB 70-OPIOID OVERDOSE DRUGS
2:02:56 PM
CHAIR WILSON reconvened the meeting and announced the
consideration of SENATE BILL NO. 70 "An Act relating to opioid
overdose drugs; and providing for an effective date."
Speaking as sponsor, he explained that the bill started as a
disaster declaration by former Governor Bill Walker in Senate
Bill 91, which passed in 2017. The intent was to allow the
medical officer at that time, Dr. Jay Butler, to permit naloxone
to be administered under a four year federal grant. This
committee amended the bill to extend the declaration for four
years to allow for the federal funding.
CHAIR WILSON said the medical office still has funding to
administer this program. Naloxone is not a controlled substance.
It has no potential for abuse. This legislation benefits
Alaskans by saving lives. It translates to direct savings for
emergency services and law enforcement and gives those who
overdose a greater chance of living and an opportunity to get
into treatment.
2:05:09 PM
JASMINE MARTIN, Staff, Senator David Wilson, Alaska State
Legislature, Juneau, Alaska, presented the sectional analysis
for SB 70 on behalf of the sponsor.
Section 1: Repeals language regarding the sunset of the
original authorization.
MS. MARTIN noted that Section 1 is conforming to Section 3.
Section 2: Repeals reporting requirement associated with
Substance Abuse and Mental Health Services Administration
grants and the opioid epidemic.
MS. MARTIN said this was a reporting requirement for the
Department of Health and Social Services (DHSS) related to the
opioid epidemic and these grants.
Section 3: Repeals the sunset date of the original
authorization.
Section 4: Immediate effective date.
2:06:06 PM
SENATOR BEGICH questioned the reasoning to repeal the reporting
requirement since part of the value of the report process was
for the legislature to know the status of the opioid epidemic.
MS. MARTIN answered that reports take a lot of the department's
time, and the information is still available to the legislature
if requested. The report made sense when this was a pilot
program but as it is continuing into perpetuity the idea is not
to make the department continue to report.
CHAIR WILSON said that he put the reporting requirement in the
initial bill and neglected to put an end date. If the program
were to end in June, the department by law still would have to
report to the legislature. He didn't want to have the department
continue to do a report if the federal funds end. The report was
just on the federal funding of the program.
SENATOR BEGICH commented that the bill also repeals the sunset
clause, which implies the program will be continuous. He asked
the reason for repealing the reporting requirement if the
program is going to continue.
CHAIR WILSON replied the department has many reports for
programs that are no longer relevant and he did not want to add
to that for a program that may eventually sunset. He said he was
willing to amend the bill to reinsert the reporting requirement.
SENATOR BEGICH suggested keeping the reporting requirement until
the state is no longer getting federal resources. Otherwise, it
would be difficult for the legislature to keep track on a
regular basis. He offered his view that Section 2 is not
necessary because of Section 3. If the sunset clause is
eliminated, there should be reports.
MS. MARTIN explained that the bill doesn't create a program. It
allows the chief medical officer to issue a standing order, but
it doesn't require it.
SENATOR BEGICH said the legislature wanted a report so it would
know when that authority was exercised. He said he will support
the bill, but he wants to do the right thing with the structure
of the bill.
2:11:41 PM
SENATOR REINBOLD commented on the Opioid crisis, and said the
question of why the report is no longer necessary, needs to be
answered.
CHAIR WILSON explained that he threw in the report requirement
just to follow the federal funding of the new program. If the
committee wants the reports continued into perpetuity, then he
is open to that. The department can speak about the effort
involved with the report.
2:13:53 PM
SENATOR COSTELLO asked if the report is online or printed.
CHAIR WILSON called on Ms. Welton to answer.
2:14:11 PM
THERESA WELTON, Section Chief, Office of Substance Misuse and
Addiction Prevention (OSMAP), Division Public Health, Department
of Health and Social Services (DHSS), Juneau, Alaska, answered
that the reports are available online on the website of her
office and are provided to the legislature by October 1 every
year.
SENATOR COSTELLO asked if the report to the legislature is
printed or online electronically.
MS. WELTON replied both.
SENATOR COSTELLO said if the committee wants to keep the
reporting requirement, the committee could ask for it to be
online.
SENATOR REINBOLD noted that there is no fiscal impact, so she is
leaning toward keeping the report. She agrees with Senator
Costello that an online report is fine. Hiland Mountain
Correctional Center is in her district, and she knows that this
medication is important and has saved lives.
CHAIR WILSON asked Ms. Welton to give her presentation.
2:16:48 PM
MS. WELTON said she would be testifying on the importance of
removing the June 30, 2021 sunset clause to allow for perpetual
authorization of the standing medical order for distribution and
administration of naloxone, an opiate overdose reversal drug, by
any Alaskan.
MS. WELTON said an overdose only takes minutes. If naloxone is
not randomly available to the individual or individuals around
the person who overdosed, that person might have to wait for 20
minutes for EMS (Emergency Management Services) to arrive with
naloxone, which could be too late.
MS. WELTON displayed a graph on slide 3 showing the national
trends of opioid overdoses. Overdoses are increasing
significantly, especially for synthetic opioids, such as
tramadol and fentanyl.
MS. WELTON said too many Alaskans have lost their lives to
overdoses, even though that is preventable with timely
administration of naloxone. In Alaska overdoses were one of the
top 10 causes of death in 2017. Overdoses can cause a
significant medical impact in a person who does not receive
timely administration of naloxone. It takes just three minutes
for someone who overdoses to experience brain damage, a costly
and life-long diagnosis. It takes three-to-four minutes for
paramedics to arrive at a scene in Anchorage. At times people
die within eight minutes of an overdose. In rural areas, it can
take 10-20 minutes and generally much longer for first
responders to appear on the scene. People who survive overdose
with brain damage may also have resulting kidney failure, heart
complications, neurological consequences, and more.
2:19: PM
MS. WELTON said that in the U.S. and in Alaska synthetic
opiates, primarily illicitly manufactured fentanyl, appear to be
the primary driver of the increases in overdose deaths. They
have increased 38.4 percent from the 12 months leading up to
June 2019 compared to the 12 months leading up to May 2020.
Overdoses from May 2020 to September appear to outnumber 2019,
marking the highest overdose death rate in over a decade in
Alaska, next to 2017.
SENATOR BEGICH asked why there is an asterisk after 2019 on
slide 5.
MS. WELTON answered there is a lack of data for the final
quarter of 2019.
SENATOR BEGICH asked if the numbers could be even higher.
2:20:44 PM
MS. WELTON replied that is correct. Continuing with the
presentation, she said 42 states and the District of Columbia
have enacted naloxone standing orders. The World Health
Organization, the U.S. Surgeon General, and the American Society
of Addiction Medicine have officially recommended that naloxone
be accessible to those who are closest to the person using
opiates.
MS. WELTON said the standing medical order currently allows
naloxone to be dispensed to any individuals who are not
prescribers, a practice that would be prohibited. Naloxone is
not a controlled substance, has no potential for abuse, and is
safe to use. By removing the sunset date, local and regional
overdose response programs, first responders, the Department of
Public Safety, the Department of Corrections, and the general
public will continue to have the ability to directly distribute
and use the life-saving drug naloxone.
MS. WELTON said with the foundation of the standing order in
2017, the department was able to start the program Project HOPE,
Harm-reduction Overdose Prevention and Education. Project HOPE
works with community organizations to distribute or administer
NARCAN, otherwise known as naloxone, in Alaska. Since inception,
127 community partners have distributed over 41,000 federally
funded NARCAN kits. Of the 320 documented NARCAN administrations
originating from Project HOPE, overdoses have been reversed at
least 309 times. Alaskan subject-matter experts believe that
when there was a 28 percent decrease in overdose deaths in 2018
compared to 2017, it was largely the result of a maximum
distribution of naloxone by Project HOPE for lay persons to use
across Alaska.
2:23:04 PM
MS. WELTON said that timely administration of naloxone provides
opportunity for recovery, and saving lives saves costs.
According to the Society of Actuaries, 40 percent of the
economic burden of the opioid crisis is driven by lost lifetime
earnings for those who died prematurely. Nearly 33 percent is
for excess healthcare spending, another 15 percent is from lost
productivity in the workforce, and 6 percent is from costs
associated with criminal justice. An estimated 29 percent of the
economic burden is borne by federal, state, and local
governments.
MS. WELTON said the current standing medical order allows
naloxone to be dispensed by any individuals who are not
prescribers. By removing the sunset date, local and regional
overdose response programs, first responders, the Departments of
Public Safety and Corrections, and the general public will
continue to have the ability to directly distribute the life-
saving drug naloxone. Without passage of SB 70, naloxone would
only be available to those with a prescription or by EMS. This
is why it is imperative to continue to make naloxone widely
available to save many lives that otherwise would be lost from
overdose.
2:24:45 PM
SENATOR REINBOLD commented that the bill sounds like a good
idea. She asked how much each kit cost and who picks up the
cost.
MS. WELTON replied the cost for the naloxone kits are borne
entirely by federally-funded grants. The approximate cost of a
kit, which contains two doses of naloxone, additional education
and harm reduction efforts and information for treatment, cost
less than $4. There is no cost to the user or the distributors.
Project HOPE is fully funded for both the substance naloxone and
the coordinator position. The state has full funding for the
next two years for Project HOPE. There are no state funds used
for the kits. The Office of Substance Misuse and Addiction
Prevention (OSMAP) is applying for another federal grant that
will provide complete funding it for five years.
SENATOR REINBOLD commented that at some point she would like the
program to be user paid and not government paid. She suggested
the program needs to be evaluated and perhaps restructured.
2:27:56 PM
SENATOR COSTELLO expressed appreciation for the program and
those who administer it. She said the report is helpful, but it
does not replace a hearing and public testimony and the learning
that happens for the public when legislation that sunsets is
before the committee.
SENATOR BEGICH asked Ms. Welton to describe the experience of
receiving naloxone, as he was sure that it was not pleasant.
MS. WELTON replied it is not a pleasant experience when someone
is administered naloxone in an overdose state. Its biochemistry
blocks the opiate receptors, the "high," and the subsequent
medical event of the cascade of an overdose is stopped in its
tracks. People have a tendency to wake up angry and confused
with an intense headache and potential other medical conditions,
but they are alive. That gives them an opportunity to get into
recovery.
SENATOR BEGICH said her response underscores what the committee
heard from Dr. Butler on the subject. It is very unpleasant
experience. To Senator Reinbold's point, he said he recognizes
and acknowledges that at some point people have to pay the price
for their actions. He offered his belief that the report does
not need to be so lengthy. He noted that the committee heard an
executive order related to the departmental split. He asked if
that split will have any impact on SB 70.
CHAIR WILSON asked if OSMAP would stay in the Department of
Health or be in the Department of Child Services.
MS. WELTON responded that OSMAP would be in the new Department
of Health. The split would not impact OSMAP or Project HOPE.
SENATOR BEGICH wondered whether the chief medical officer would
be in a supervisory role.
SENATOR REINBOLD commented further on the importance of personal
responsibility related to the opioid crisis. She segued to the
covid crisis and the impact that had on all sectors of the
population She asked if there has been an increase in overdoses
and naloxone use since March 2020.
2:34:25 PM
MS. WELTON answered that the state has seen an uptick in
overdose deaths in the first three quarters of 2020 compared to
2019 and definitely to 2018. Due to COVID circumstances, getting
the kits built this past year has been challenging because OSMAP
relies on volunteer groups to put them together and OSMAP has
had to adjust to social distancing. The distribution of NARCAN
kits by partners has also been affected. It could be that not as
much naloxone has been distributed in 2020 or it could be the
circumstance of increased mental health complications as well as
substance misuse. Those numbers are being reviewed and causation
studied.
SENATOR REINBOLD explained that she is trying to look at the
difference between lockdowns and non-lockdowns on regional,
state, and national levels. She has heard suicide is up but she
did not have numbers. She asked how significant the increased
number of deaths is and what type of numbers she had for various
years.
MS. WELTON replied she was using approximate numbers as
represented by the bar graph. For the first three quarters of
2018, there were about 70 overdose deaths and about 100 for the
first three quarters of 2019, a little over 100 for the first
three quarters of 2020. She declined to comment on causation.
SENATOR REINBOLD said she is looking for actual numbers for
overdoses and how much naloxone saved lives. She wants
information from March 2020 when it is available, not just the
first quarter, because she wants to know the impact of the covid
lockdowns.
2:39:05 PM
CHAIR WILSON opened public testimony on SB 70.
2:39:22 PM
KAREN MALCOM-SMITH, founder, David Dylan Foundation, Anchorage,
Alaska, said she is a self-funded advocate for the vast arena of
issues surrounding stigma, including healthcare, education, and
law enforcement. She is a member of the Alaska Mental Health
Advisory Board. Her testimony is strictly personal and does not
represent the board. In June of 2017, just one month short of
NARCAN accessibility to the public without a prescription, her
25-year-old son, Dylan, passed away from an overdose. His
dependency followed a near-fatal ATV accident when he was
irresponsibly cut off without a taper after three months of
morphine and oxycodone. At 25 he relapsed and had just returned
from treatment when he passed away. The man who was with him
called 911 immediately. The first responders were there right
away but did not carry NARCAN. They could possibly have saved
him. In addition to the statistics the committee heard, she
wants to add that nationally, the overdose rate is up almost 38
percent for the first three quarters of 2020.
MS. MALCOM-SMITH said that in her work, she has come into close
contact with families who are experiencing the same loss. She
represents other mothers who have experienced first responders
not carrying NARCAN. Lisa Sauder who runs Bean's Caf? is one of
them. They strongly support SB 70 and strongly encourage that in
the future, it should be mandatory for first responders to carry
NARCAN. She knows eight people whose children's lives would have
been saved. Her son was a stellar human being and citizen who
had a warrior's heart. Police officers and emergency responders
should carry NARCAN.
2:44:37 PM
KATIE BOTZ, representing self, Juneau, Alaska, recalled sitting
in one of the legislative rooms testifying for NARCAN. She lost
a friend around 2017 due to an opioid overdose. He hid his use
of drugs very well. It is important to her that NARCAN get in
the hands of healthcare providers and the police department to
help in cases of opioid overdoses. It is discouraging to hear
cases of police and responders not having it on hand. She asked
the legislature to make it mandatory for healthcare providers
and police officers to have NARCAN on hand.
2:47:35 PM
CHAIR WILSON closed public testimony on SB 70.
SENATOR REINBOLD thanked Ms. Malcom-Smith for her testimony and
for serving on the board of the Alaska Mental Health Advisory
Board and expressed sorrow for her loss. She asked her to send
any numbers that she has about overdoses and the use of NARCAN
or anything about the impact since March to the chair.
2:49:43 PM
CHAIR WILSON said he heard the committee's concerns and he would
offer a committee substitute (CS) that leaves in the reporting
requirement.
CHAIR WILSON held SB 70 in committee for further consideration
| Document Name | Date/Time | Subjects |
|---|---|---|
| SB 65 version B.pdf |
SHSS 2/16/2021 1:30:00 PM |
SB 65 |
| SB 65 Sponsor Statement 2.4.2021.pdf |
HHSS 4/27/2021 3:00:00 PM HHSS 4/29/2021 3:00:00 PM HHSS 5/4/2021 3:00:00 PM HJUD 5/5/2021 1:00:00 PM HJUD 5/17/2021 1:00:00 PM SHSS 2/16/2021 1:30:00 PM |
SB 65 |
| SB 65 Sectional Analysis v. B 2.4.2021.pdf |
HHSS 4/27/2021 3:00:00 PM HHSS 4/29/2021 3:00:00 PM HHSS 5/4/2021 3:00:00 PM SHSS 2/16/2021 1:30:00 PM |
SB 65 |
| SB 65 Letter of Support ASMA 2.11.2021.pdf |
HHSS 4/27/2021 3:00:00 PM HHSS 4/29/2021 3:00:00 PM SHSS 2/16/2021 1:30:00 PM |
SB 65 |
| SB 65 FN Dept of Law.pdf |
HHSS 4/29/2021 3:00:00 PM SHSS 2/16/2021 1:30:00 PM |
SB 65 |
| SB70 v. A.PDF |
SHSS 2/16/2021 1:30:00 PM |
SB 70 |
| SB 70 Sponsor Statement 2.10.21.pdf |
HHSS 3/30/2021 3:00:00 PM SHSS 2/16/2021 1:30:00 PM |
SB 70 |
| SB 70 Sectional Summary v. A 2.10.21.pdf |
SHSS 2/16/2021 1:30:00 PM |
SB 70 |
| SB 70 Naloxone Standing Order Fact Sheet1-21-21.pdf |
HHSS 3/30/2021 3:00:00 PM SHSS 2/16/2021 1:30:00 PM |
SB 70 |
| SB 70 Opioid Leg Report DHSS 9.28.20.pdf |
HHSS 3/30/2021 3:00:00 PM SHSS 2/16/2021 1:30:00 PM |
SB 70 |
| SB 70 FN DHSS.pdf |
HHSS 3/30/2021 3:00:00 PM SHSS 2/16/2021 1:30:00 PM |
SB 70 |
| SB 70 SLA 2017 SB 91.PDF |
HHSS 3/30/2021 3:00:00 PM SHSS 2/16/2021 1:30:00 PM |
SB 70 |
| SB 70 Opioid Leg Report DHSS 2017-18.pdf |
HHSS 3/30/2021 3:00:00 PM SHSS 2/16/2021 1:30:00 PM |
SB 70 |
| SB 70 Opioid Leg Report DHSS 2018-19.pdf |
SHSS 2/16/2021 1:30:00 PM |
SB 70 |
| SB 70 DHSS Invited Testimony - SHSS - 02162021 Clean.pptx |
SHSS 2/16/2021 1:30:00 PM |
SB 70 |
| SB 70 Letters of Support, Redacted, 2.16.21.pdf |
SHSS 2/16/2021 1:30:00 PM |
SB 70 |