Legislature(2017 - 2018)BUTROVICH 205
05/09/2017 03:30 PM Senate HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| HB186 | |
| SB79 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 186 | TELECONFERENCED | |
| + | SB 79 | TELECONFERENCED | |
SB 79-OPIOIDS; PRESCRIPTIONS; DATABASE; LICENSES
3:48:42 PM
CHAIR WILSON announced the consideration of SB 79.
3:49:18 PM
DR. JAY BUTLER, Chief Medical Officer, Alaska Department of
Health and Social Services, Juneau, Alaska, stated that Alaska's
opioid epidemic continues and reported the following statistics:
• More than 90 Alaskans died of an opioid overdose in 2016.
• The 90-overdose deaths are twice the number of Alaskans who
died of acquired immune deficiency syndrome (AIDS) at the
peak of the human immunodeficiency virus (HIV) epidemic.
• Often the overdose deaths occurred among young people.
• Two-thirds of opioid overdoses involved a prescription.
• The majority of people who use heroine and other illicit
opioids report becoming hooked when using prescription
opioid painkillers, often on the advice of a trusted and
generally well-meaning provider.
DR. BUTLER explained that Alaska is responding to the opioid
epidemic as follows:
• Citizens have actioned community collations.
• State government passed SB 91 to increase access Naloxone
opioid-overdose kits.
He conceded that overdose kits do not solve the opioid epidemic
and detailed what SB 79 proposes to do:
• SB 79 adds to the state's multi-faceted approach to
addressing the opioid epidemic and aligns with the current
science on pain management as well as addiction medicine
based on recommendations from:
square4 Centers for Disease Control and Prevention (CDC);
square4 U.S. Surgeon General, U.S. Department of Health &
Social Services;
square4 Professional groups including the American College of
Physicians;
square4 Best practices and learned experiences from the Opioid
Safety Initiative, U.S. Department of Veterans
Affairs.
DR. BUTLER stated that SB 79 addresses three opioid areas:
• Patience,
• Providers,
• Prescription Drug Monitoring Program (PDMP).
He specified that SB 79 provides the following for patients and
health-care providers when an opioid prescription is voluntarily
limited or eliminated:
• Provides for an opioid advance directive for patients that
do not wish to receive opioid medications. The directive is
voluntary and revocable.
• Protects health-care providers with civil liability if an
opioid is withheld by the directive as well as the
inadvertent administering of an opioid in an emergency
situation.
• Provides in state statute the authority of patients to
request a partial-opioid prescription:
square4 Reinforces the authority of the pharmacists to honor a
partial-fill request without the need to immediately
void the remaining portion of the prescription as
provided under the federal Comprehensive Addiction and
Recovery Act of 2016.
He said SB 79 addresses the amount of opioids that providers
dispense as follows:
• Data analysis has shown that persons who receive larger
first-time opioid prescriptions are more likely to become
chronic-opioid users.
• Increased-usage risk particularly occurs for first-time
prescription for more than a five to seven-day supply.
• Alaska Medicaid claims from last year indicate that at
least half of all first-time opioid prescriptions had
claims for more than a 15-day supply.
• Dartmouth study indicates that opioid-prescribing practices
vary from no drugs to 120 pills. 75 percent of all
prescribed pills were never taken and remained in the
patients' homes.
DR. BUTLER related recent situations in Alaska where a student
after surgery returned 120-Vicodin pills and another person
requested drug-disposal bags after accumulating over 250-opioid
pills after hip replacement where the pain was managed within
the first 48 hours.
He explained that SB 79 proposes that first-time opioid
prescriptions observe the following:
• Limited to no more than a 7-day supply.
• Allows a waiver based on the provider's professional
judgement for severe-acute pain, chronic pain, cancer pain,
and palliative care.
• Allows a waiver due to Alaska's travel logistics.
• Seven-day-dispensing limit requires medical record
documentation on why additional opioids are needed.
He disclosed that the concept of accountable justification has
been shown to improve the quality of drug usage. He added that
the bill authorizes professional boards to require that
continuing education be designated for pain management or the
basics of addiction.
He addressed opioid substance-use disorder as follows:
• Nearly 10 percent of adults have some type of substance-use
disorder.
• Addiction is also a chronic-health condition that requires
awareness throughout the medical profession.
• The science of substance dependency and addiction is
evolving fast and has been ignored by too many providers.
• Concerns may be raised by providers regarding continual
medical education (CME) credit:
square4 Free online CME courses are available,
square4 CDC has put out CME programs that focus on how to
manage chronic pain,
square4 Search for additional options for endorsements in
meeting needs.
He addressed the PDMP proposed in SB 79 as follows:
• Emerging data shows reductions in overdose-death rates and
Medicaid expenditures in states that require providers to
use the PDMP database.
• SB 79 authorizes the Department of Commerce to issue
regular-unsolicited reports to prescribers.
• SB 79 provides peer self-comparison reports as non-punitive
feedback for providers' prescribing habits in comparison to
peers. Ten states have peer self-comparison-report
programs.
• PDMP depends on timely data and the bill proposes to
increase reporting intervals from weekly to daily. Twenty-
five states require daily reporting intervals.
• Daily reporting by smaller pharmacies in rural communities
has been addressed and an implementation date in mid-2018
is proposed to provide more time to comply.
• Requires veterinarians to register for the PDMP. Cases
where people have intentionally injured animals in the
Lower 48 to receive opioids have occurred.
DR. BUTLER summarized that addressing Alaska's opioid epidemic
is going take everyone. He quoted U.S. Congressman Hal Rogers as
follows:
There's no silver bullet to stem the tide of
prescription drug abuse in America. The lack of an
easy solution requires all of us to treat the opioid
crisis as a non-partisan issue and adopt an all-hands-
on-deck approach.
He set forth that SB 79 is part of Alaska's call for all-hands-
on-deck to support Alaskans living in recovery and reduce the
number of persons who become newly dependent on opioids while
supporting the care of those that truly need opioids.
4:06:54 PM
SARAH CHAMBERS, Deputy Director of the Division of Corporations,
Business and Professional Licensing (CBPL), Alaska Department of
Commerce, Community and Economic Development, Juneau, Alaska,
provided a sectional analysis on SB 79 as follows:
Sec. 1:
Amends the Board of Dental Examiners statutes by
requiring the board to adopt regulations for renewal
of licensure to include a minimum of two hours of
continuing education in pain management and opioid
misuse and addiction in the previous two years
preceding renewal, unless the licensee has
demonstrated to the satisfaction of the board that the
licensee does not currently hold a valid federal Drug
Enforcement Agency (DEA) registration number.
Sec. 2:
Amends the Board of Dental Examiners statutes by
requiring the board to adopt regulations for licensure
qualifications to include a minimum of two hours of
education in pain management and opioid misuse and
addiction in the two years preceding the application
for a license, unless the applicant has demonstrated
to the satisfaction of the board that the applicant
does not currently hold a valid federal DEA
registration number
Sec. 3:
Amends the Board of Dental Examiners statutes for
disciplinary authority; it allows the board to
discipline, revoke, suspend, reprimand or censure a
license of a dentist, if the board finds a licensee
has prescribed or dispensed an opioid in excess of the
maximum dosage authorized under AS 08.36.355, or
procured, sold, prescribed, or dispensed drugs in
violation of a law, regardless of whether there has
been a criminal action or patient harm.
Sec. 4:
Adds a new section to the Board of Dental Examiners
statutes limiting the dosage for an opioid
prescription to a seven-day supply for an adult or
minor. The dentist must discuss with the parent or
guardian of a minor why the prescription is necessary,
and the risks associated with the opioid use. A
dentist may issue a prescription for greater than a
seven-day supply to an adult or minor patient if, in
the professional judgement of the dentist, more than a
seven-day supply is necessary for chronic-pain
management or a patient who is unable to access a
practitioner within the time necessary for a refill
because of a logistical or travel barrier. The dentist
must document in the patient's medical record the
condition requiring the excess of a seven-day supply
and indicate a non-opioid alternative was not
appropriate to treat the condition. The section
defines "adult" and "minor."
Sec. 5:
Amends the Board of Dental Examiner statutes by adding
a definition of an "opioid."
Sec. 6:
Amends the Medical Board statutes for qualifications
for physician assistants. The board shall adopt
regulations for physician assistant to include
education on pain management and opioid use and
addiction.
Sec. 7:
Amends the Medical Board statutes for qualifications
for physicians. The additional language requires
physician applicants to receive education in pain
management and opioid use and addiction prior to
licensure, unless the applicant has demonstrated to
the satisfaction of the board that the applicant does
not currently hold a valid federal DEA registration
number.
Sec. 8:
Amends the Medical Board statutes for qualifications
for osteopaths. The additional language requires
osteopath applicants to receive education in pain
management and opioid use and addiction prior to
licensure, unless the applicant has demonstrated to
the satisfaction of the board that the applicant does
not currently hold a valid federal DEA registration
number. The language in this section refers to the
physician applicant qualifications in section 8, and
duplication in (4) of the same statute.
Sec. 9:
Amends the Medical Board statutes for qualifications
for podiatrists. The additional language requires
podiatry applicants to receive education in pain
management and opioid use and addiction prior to
licensure, unless the applicant has demonstrated to
the satisfaction of the board that the applicant does
not currently hold a valid federal DEA registration
number. The language in this section refers to the
physician-applicant qualifications in section 8, and
duplication in (3) of the same statute.
Sec. 10:
Amends the Medical Board statutes for qualifications
for foreign graduates. The additional language
requires foreign-graduate applicants to receive
education in pain management and opioid use and
addiction prior to licensure, unless the applicant has
demonstrated to the satisfaction of the board that the
applicant does not currently hold a valid federal DEA
registration number. The language in this section
refers to the physician applicant qualifications in
section 8, and duplication in (a)(2)(B) of the same
statute.
Sec. 11:
Amends the Medical Board statutes for License by
credentials. The amendment includes the addition of
qualifications for licensure of osteopath applicants.
Sec. 12:
Amends the Medical Board statutes by adding a new
subsection for qualifications for licensure by
credentials for physicians, osteopaths and podiatrists
by requiring the board to adopt regulations for
applicants to include requiring the applicant to
demonstrate professional competence in pain management
and addiction disorders. The professional competence
may include professional experience or professional
instruction as proof of professional competence.
Sec. 13:
Amends the Medical Board statutes for continuing
education requirements for renewal of a license. A
licensee of medicine, osteopathy, and podiatry must
receive no less than two hours of education in pain
management and opioid misuse and addiction for every
40 hours of instruction received, unless the licensee
demonstrates to the satisfaction of the board that the
licensee's practice does not include pain management
and opioid treatment or prescribing. An applicant for
renewal may not be exempted from the requirement to
receive at least two hours of instruction on pain
management and opioid misuse and addiction, unless the
person has demonstrated to the satisfaction of the
board that the person does not currently hold a valid
federal DEA registration number.
Sec. 14:
Amends Medical Board disciplinary authority. The board
may impose a disciplinary sanction if the board finds
that a licensee has prescribed or dispensed an opioid
in excess of the maximum dosage.
Sec. 15:
Adds a new section to the Medical Board statutes
limiting the dosage for an opioid prescription to a
seven-day supply for an adult or minor. The licensee
must discuss with the parent or guardian of a minor
why the prescription is necessary, and the risks
associated with the opioid use. A licensee may issue a
prescription for greater than a seven-day supply to an
adult or minor patient if, in the professional
judgement of the licensee, more than a seven-day
supply is necessary for; an acute medical condition,
chronic-pain management, pain associated with cancer,
pain experienced while the patient is in palliative
care, a patient who is unable to access a practitioner
within the time necessary for a refill of the seven-
day supply because of a logistical or travel barrier,
or treatment of a patient's substance abuse or opioid
dependence. The licensee must document in the
patient's medical record the medical condition
requiring the excess of a seven-day supply, and
indicate a non-opioid alternative was not appropriate
to treat the medical condition, or the substance abuse
or opioid dependence. The section defines "adult,"
"emancipated minor," and "minor."
Sec. 16:
Amends Medical Board statute for prescription of drugs
without a physical examination. It adds the board may
not impose disciplinary sanctions on a physician for
prescribing, dispensing, or administering a controlled
substance if the requirements in the new section AS
08.64.363, under Sec. 12 of this document, are met.
4:10:29 PM
Sec. 17:
Amends Medical Board statute by adding and defining
"opioid" to include the opium and opiate substances
and opium and opiate derivatives listed in AS
11.71.140.
Sec. 18:
Amends the Board of Nursing to provide authority to
adopt regulation to comply with new continuing
education requirements.
Sec. 19:
Amends the Board of Nursing statute by giving the
board the authority to deny, suspend, or revoke the
license of a person who: prescribed or dispensed an
opioid in excess of the maximum dosage authorized
under AS 08.68.705; or has procured, sold, prescribed,
or dispensed drugs in violation of a law, regardless
of whether there has been a criminal action or patient
harm.
Sec. 20:
Amends the Board of Nursing statute to include
enforcement authority for failure to meet regarding
enforcement actions for continuing competency
requirements. A license may not be renewed unless the
advanced-practice-registered nurse has completed a
minimum of two hours of education in pain management
and opioid misuse and addiction within the two years
preceding renewal of the license, unless the licensee
has demonstrated to the satisfaction of the board that
the licensee does not currently hold a valid federal
DEA registration number.
Sec. 21:
Adds a new section to article 6 of the Nursing Board
statutes limiting the dosage for an opioid
prescription to a seven-day supply for an adult or
minor. The advance-practice-registered nurse must
discuss with the parent or guardian of a minor why the
prescription is necessary, and the risks associated
with the opioid use. An advanced-practice-registered
nurse may issue a prescription for greater than a
seven-day supply to an adult or minor patient if, in
the professional judgement of the advanced-practice-
registered nurse, more than a seven-day supply is
necessary for: an acute-medical condition, chronic-
pain management, pain associated with cancer, pain
experienced while the patient is in palliative care,
or a patient who is unable to access a practitioner
within the time necessary for a refill of the seven-
day supply because of a logistical or travel barrier.
The advanced-practice-registered nurse must document
in the patient's medical record the condition
requiring the excess of a seven-day supply, and
indicate a non-opioid alternative was not appropriate
to treat the condition. The section defines "adult,"
"emancipated minor," and "minor."
Sec. 22:
Amends Nursing Board statute by adding and defining
"opioid" to include opium and opiate substances and
opium and opiate derivatives listed in AS 11.71.140.
Sec. 23:
Amends the Board of Optometry to require the board to
adopt regulations for advanced-practice-registered
nurses to include education on pain management and
opioid use and addiction.
Sec. 24:
Amends the Board of Optometry statute for
qualifications for licensure by credentials. The
applicant must have received education in pain
management and opioid misuse and addiction adequate
for the practice of optometry and may include
professional experience or professional education,
unless the applicant has demonstrated to the
satisfaction of the board that the applicant does not
currently hold a valid federal DEA registration
number.
Sec. 25:
Amends the Board of Optometry statute for continuing
education requirements for renewal of a license. The
optometrist must complete a minimum of two hours of
education in pain management and opioid misuse and
addiction in the four years preceding renewal, unless
the applicant has demonstrated to the satisfaction of
the board that the applicant does not currently hold a
valid federal DEA registration number.
Sec. 26:
Amends the Board of Optometry disciplinary authority.
The board may impose disciplinary sanctions on an
optometrist who has procured, sold, prescribed, or
dispensed drugs in violation of a law, regardless of
whether there has been a criminal action or patient
harm.
Sec. 27:
Amends powers and duties of the Board of Pharmacy,
08.80.030(b)(13). The current law that takes effect
July 17, 2017, will require pharmacists with a DEA
registration number, to register with the controlled-
substance-prescription database (PDMP). Pharmacists do
not obtain DEA registration numbers, only pharmacies;
therefore, this section removes the DEA registration
number requirement.
Sec. 28:
Amends the Board of Pharmacy statutes to add a new
section to allow the pharmacist filling a prescription
for a schedule II or III controlled substances, to
dispense a lesser quantity than prescribed at the
request of the individual for whom the prescription is
written.
Sec. 29:
Amends the Board of Veterinary Examiners statute under
powers and duties of the board. The board shall
require a licensee who has a federal DEA registration
number to register with the controlled substance
prescription database under AS 17.30.200(o). The
section requires the board to identify resources and
develop educational materials to assist licensees in
identifying an animal owner who may be at risk for
abusing or misusing an opioid.
Sec 30:
The board may deny, suspend, or revoke the license of
a person who: prescribed or dispensed an opioid in
excess of the maximum dosage authorized under AS
08.68.705; or has procured, sold, prescribed, or
dispensed drugs in violation of a law, regardless of
whether there has been a criminal action.
Sec. 31:
The section allows an individual to execute a
voluntary non-opioid directive in a format prescribed
by the Department of Health and Social Services. The
section further provides that a licensed-health-care
providers, hospitals, and employees, and pharmacists
are exempt from licensing board discipline, civil and
criminal liability for failure to administer,
prescribe, or dispense an opioid to an individual who
has executed a voluntary non-opioid directive. The
non-opioid directive does not limit a health-care
provider or pharmacist from prescribing, dispensing,
or administering an opioid overdose drug or an opioid
for the treatment of substance abuse or opioid
dependence.
4:13:59 PM
Sec. 32:
Amends AS 17.300.200(a) to exclude certain facilities
from the requirements of the PDMP. This section
references a section "u" of the PDMP (see section 41)
where by correctional facilities are exempt from the
PDMP except when prescribing opioids to an inmate at
the time of the inmate's release as in-patient
pharmacies and emergency rooms are exempt if they are
only prescribing less than a 24-hour supply of
opioids. (See also section 41).
Sec. 33:
Amends AS 17.300.200(a) to exclude correctional
facilities from the requirements of the controlled
substance prescription database except when
prescribing opioids to an inmate at the time of the
inmate's release.
Sec. 34:
Amends AS 17.30.200(b) as amended by sec. 23, chapter
25, SLA 2016 by substituting "weekly" with "daily."
The change will require the pharmacist-in-charge of a
pharmacy, and each practitioner who dispenses a
schedule II, III, or IV controlled substance, to
submit the information to the controlled substance
prescription database daily instead of weekly.
Sec. 35:
Amends AS 17.30.200(d) as amended chapter 25, SLA 2016
to clarify that to clarify that information contained
in the PDMP can be shared with federal, state, and
local law enforcement that have a valid search warrant
or court order.
Sec. 36:
Amends AS 17.30.200(e) as amended by chapter 25, SLA
2016 to clarify that a pharmacist, the individual
filling a prescription, is required to submit
information into the database; it is the
responsibility of the practitioner, the individual
writing the prescription, to review the database.
Sec. 37:
Amends AS 17.30.200(p) as amended by chapter 25, SLA
2016 to require the Board of Pharmacy shall promptly
notify the Board of Veterinary Examiners when a
practitioner registers with the database under (o) of
the section.
Sec. 38:
Amends AS 17.30.200(q) as amended by, chapter 25, SLA
2016 is amended by allowing the Board of Pharmacy to
provide unsolicited notification to the practitioner's
licensing board if a patient has received one or more
prescriptions for controlled substances in quantities
or with a frequency inconsistent with generally
recognized standards of safe practice. The unsolicited
notification to a practitioner's licensing board under
the section must also be provided to the practitioner,
is considered confidential, may not disclose
confidential information under the section, and may be
in a summary form sufficient to provide notice of the
basis for the unsolicited notification.
4:17:04 PM
Sec. 39:
Amends AS 17.30.200(r) as amended by chapter 25, SLA
2016 to provide guidance so to when the board must
update the requirement that pharmacists and
prescribers must comply with the database on a daily
basis rather than a weekly basis.
Sec. 40:
Amends AS 17.30.200(n) as amended by chapter 25, SLA
2016 to update the definition of opioid to include the
opium and opiate substances and opium and opiate
derivatives listed in AS 11.71.140.
Sec. 41:
Adds a new section (t) to AS 17.30.200, giving the
Board of Pharmacy the authority to issue periodic
unsolicited "report cards" with non-identifiable
information comparing the practitioner's opioid-
prescribing practices with others in the same
occupation. [Information is confidential]. Also adds a
new section (u) to AS 47.17.200, giving the Board of
Pharmacy the ability to exempt in-patient pharmacies
and emergency rooms from the review and submission
requirement of the PDMP when they are dispensing no
more than a 24-hour supply of opioids upon discharge.
Sec. 42:
Amends AS 18.05.040 to give authority for the
Commissioner of Health & Social Services shall adopt
regulations consistent with existing law for
implementation of AS 13.55, Voluntary Non-opioid
Directive Act.
Sec. 43:
Repeals various sections from chapter 25, SLA 2016
related to the July 2018 effective dates for the PDMP
in SB 74.
Sec. 44:
Provides transitional authority for the Department of
Commerce and Economic Development to draft regulations
to implement changes to the PDMP prior to the
effective date of certain sections. This is a
technical fix.
Sections 45, 46, 47, 48, 49, 50:
Relate to the various changes to the PDMP related to
the effective dates under SB 74. This is necessary
because the changes to the PDMP under SB 74 are not in
effect until July 18, 2017.
Sec. 51:
New effective dates from the PDMP (July 1, 2018).
Sec. 52:
The advanced directive sections of the bill (sections
1 and 4) take effect on July 1, 2019.
Sec. 53:
All other provisions of the bill take effect
immediately.
4:19:34 PM
SENATOR MICCICHE noted that the seven-day supply applied to most
of the providers, but asked if veterinarians were also limited
to a seven-day supply.
MS. CHAMBERS noted that optometrists have a four-day limit in
statute and asked Ms. Kraly to address the supply limit for
veterinarians.
4:20:17 PM
STACY KRALY, Chief Assistant Attorney General, Alaska Department
of Law, Juneau, Alaska, addressed opioid supply limits for
veterinarians as follows:
There is a similar provision within the bill as to a
seven-day limit for veterinarians currently that is
not included in the bill.
SENATOR MICCICHE asked if veterinarians are currently
statutorily limited to seven days for opioids.
MR. KRALY replied no and specified as follows:
No, the seven-day limit is being adopted in this
legislation. Other boards, as Ms. Chambers mentioned,
may have other limits and there's other guidelines
that boards may follow, but this specific seven-day
limit is as to boards that we have identified as
having the ability to prescribe opioids, the seven-day
limit is contained in this legislation.
SENATOR MICCICHE noted that he will keep looking because he had
not seen the seven-day limit for veterinarians in the bill.
MS. KRALY answered that she thought the seven-day limit for
veterinarians is an omission in SB 79.
SENATOR GIESSEL confirmed that Senator Micciche did identify an
omission.
CHAIR WILSON asked how many pills are in a seven-day supply. He
noted that the term seven-day supply is identified in the bill,
but the specific number of pills is not addressed.
4:22:19 PM
DR. BUTLER replied that the number of pills is dependent on the
medication.
CHAIR WILSON asked that when a patient is red-flagged by the
database if the patient is notified in addition to the
prescriber and pharmacist.
MS. CHAMBERS answered that patients may request their history
and information at any time. She specified that the idea behind
the practitioner receiving notification is to have the option of
notifying the patient.
SENATOR BEGICH disclosed that opposition to the bill is related
to the shortened time period for prescriptions and its impact on
lifetime suffers of chronic pain. He asked if additions have
recently been made to the bill that addressed patients with
chronic pain.
4:24:22 PM
DR. BUTLER replied that the provision that Senator Begich
referenced is part of the original bill and the topic is
frequently misunderstood. He specified that the bill does
provide for the opportunity for waivers. He pointed out that the
added step is a stop-check procedure for accountable
justification.
SENATOR BEGICH asked if a provider who has a number of chronic-
pain clients could potentially have a bad report card.
DR. BUTLER replied that the report card is not punitive.
SENATOR BEGICH stated that he wanted to be sure that the report
card does not have a dampening effect on providing relief and
not creating any more obstacles for those with chronic pain. He
noted that Senator Micciche brought up a good point regarding
the veterinarian-limit omission and asked if the veterinarian
omission needs to be corrected.
DR. BUTLER answered that he would have to think about Senator
Begich's question prior to answering. He explained that
medication prescriptions for animals varies from humans.
4:27:18 PM
SENATOR MICCICHE noted that Senate Finance is the next committee
of assignment and asked Dr. Butler to address his question at
that time. He pointed out that some Alaskans have chosen to
obtain their opioids through veterinarians and the issue is
something that the Legislature should deal with.
MS. CHAMBERS added that since CBPL regulates the Board of
Veterinary Examiners that she will pose the opioid prescription
limitations to the board.
CHAIR WILSON asked that Ms. Chambers provide the committee with
the information she receives from the Board of Veterinary
Examiners.
MS. CHAMBERS replied that she will provide the committee with
the information that Chair Wilson requested.
CHAIR WILSON addressed the documentation required to prescribe
additional opioids and asked why documentation for all opioid
prescriptions is not required.
4:29:00 PM
DR. BUTLER replied that in general the spirit of the bill is
trying to do what Chair Wilson is suggesting in addition to
keeping the administrative burden as small as possible. He
asserted that the bill's focus is to really try and limit the
prescriptions that are most dangerous which is dispensing the
larger number of pills.
CHAIR WILSON asked if the bill will add to the administrative
costs for the prescribing practitioners.
DR. BUTLER conceded that added documentation will occur. He
specified that new requirements are not being imposed; however,
current requirements are being earmarked to focus on.
MS. CHAMBERS disclosed that the chair for the Board of Pharmacy
members indicated that software makes the reporting change from
weekly to daily minimal for his mom-and-pop pharmacy.
4:32:17 PM
SENATOR GIESSEL said one of the things she thought about for the
PDMP is perhaps having a small registration fee to help offset
some of the cost. She asked if a fee has been considered.
MS. CHAMBERS replied that a fee-proposal notification is about
to be sent to the Legislature for consideration. She revealed
that the fee being considered is very minimal compared to all of
the other fees that are charged. She detailed that the proposed
fee will take the onus off the pharmacists who have been bearing
the weight of the PDMP because they were the ones required to
use it. She noted that two grants have been obtained with a
third application just completed to obtain federal funding for
program expansion like the report-card feature.
DR. BUTLER added that the customer service that providers who
use PDMP are receiving is good.
CHAIR WILSON said his hope is that the added cost from the bill
is not a burden that is ultimately passed on to the end users,
the customers.
4:35:09 PM
CHAIR WILSON opened public testimony.
4:35:23 PM
JONATHAN LARSON, representing self, Dillingham, Alaska,
testified in support of SB 79. He shared his firsthand
experience with the opioid epidemic in Dillingham.
4:37:46 PM
DAN NELSON, Director of Pharmacy, Tanana Chiefs Conference,
Fairbanks, Alaska, testified in support of SB 79. He pointed out
that there is some question as to the definition of a
"practitioner," particularly in section 36. He suggested that
some intent language be put into the bill regarding the
responsibilities of a practitioner versus a pharmacist.
4:39:27 PM
MICHAEL CARSON, Chair, Mat-Su Opioid Task Force, Mat-Su Valley,
Alaska, testified in support of SB 79. He pointed out that 80
percent of heroin users start with pain-opioid pills; 75 percent
of those individuals get the pills from family members or
friends. He said there has been a spike in heroin use over the
past 5 years and disclosed that in 2016 there were 128-drug
overdoses in the state with 40 percent attributed to heroin. He
noted that fentanyl is a new drug in the mix that is 25 to 50
times more powerful than heroine. He said the Mat-Su Opioid Task
Force is very much in favor of the seven-day supply based on the
newest research that recently came out.
4:41:48 PM
ROBIN MINARD, Director or Public Affairs, Mat-Su Health
Foundation, Wasilla, Alaska, testified in support of SB 79. She
said the Mat-Su Health Foundation believes SB 79 will save
lives. She disclosed that 26 people died from heroin in Alaska
in 2016 and 83 from prescription opioids. She set forth that the
provisions from SB 79 can help ensure that the state's
statistics are better in the future. She said limiting the
quantity of opioid drugs that can initially be prescribed,
requiring training for prescribers, and fully utilizing the PDMP
will help ensure that all Alaskans have the opportunity for a
healthy life.
4:43:55 PM
DAVID REES, representing self, Eagle River, Alaska, testified in
support of SB 79. He disclosed that he has submitted testimony
that addresses personal issues regarding prescription opioids,
specifically regarding chronic-pain management. He noted his
family's concern regarding the bill's impact on access for
individuals that use opioids for chronic pain as well as
potentially higher costs.
4:46:19 PM
TRACEY WIESE, Co-Chair, Alaska Advanced Practice Registered
Nurse Alliance (APRN), Anchorage, Alaska, testified in support
of SB 79. She said APRN supports most of the bill, but noted
concerns about some of the language in the bill. She stated that
APRN supports Senator Giessel's suggested amendments to ensure
that nurse practitioners are listed specifically as licensed-
individual practitioners. She said APRN's concern revolves
around the educational requirement and specified that the
language as currently written describes education for opioids,
addictions, and recovery. She set forth that the concern
pertains to the education language that could be interpreted as
the provider needing education in opioids, addictions, and
recovery rather than one or the other. She added that another
concern relates to undue burden of sole proprietors, providers
who have small businesses. She said APRN suggests that language
be introduced that states "opiates" or a specific scheduled drug
that was specifically for opiates. She added that APRN suggests
that a sunset clause be included for the educational requirement
so that the issue can be revisited in the upcoming years to see
if the legislatively-mandated-educational requirement is
necessary for providers.
4:49:38 PM
TOM CHARD, Executive Director, Alaska Behavioral Health
Association, Juneau, Alaska, testified in support of SB 79. He
specified that the association represents all of the state's
mental health and drug-and-alcohol providers, both tribal and
non-tribal. He set forth that the association appreciates the
Legislature's efforts paid to the opioid epidemic. He said the
association sees the epidemic's effect on individuals, families,
and communities. He emphasized that the association appreciates
the prevention and early intervention approach that the SB 79 is
taking. He called attention to the continued education
requirements in the bill and opined that prescribers will
benefit from the provision.
4:52:14 PM
CHAIR WILSON closed public testimony on SB 79, and asked if
there were amendments.
4:52:27 PM
SENATOR GIESSEL moved Amendment 1:
30-GS1021\O.1
Bruce
5/5/17
AMENDMENT 1
OFFERED IN THE SENATE BY SENATOR GIESSEL
TO: CSSB 79(L&C)
Page 6, line 26:
Delete "AS 11.71.140"
Insert "AS 11.71.140 - 11.71.170"
Page 15, line 6:
Delete "AS 11.71.140"
Insert "AS 11.71.140 - 11.71.170"
Page 19, line 14:
Delete "AS 11.71.140"
Insert "AS 11.71.140 - 11.71.170"
Page 27, line 28:
Delete "AS 11.71.140"
Insert "AS 11.71.140 - 11.71.170"
Page 32, line 20:
Delete "AS 11.71.140"
Insert "AS 11.71.140 - 11.71.170"
SENATOR VON IMHOF objected for the purposes of discussion.
SENATOR GIESSEL explained Amendment 1 as follows:
Looking at the bill I noted that if you turn to page
6, line 26, though this is repeated in multiple places
in the bill, it calls out AS 11.71.140; this
identifies schedule IA controlled substances which
contain opioids in that list, but also in AS
11.71.160, that's schedule IIIA, there are also
opioids identified. Simply for completeness I offer
the amendment which adds AS 11.71.160 to the line that
identifies the schedules that contain opioids. I have
consulted with Dr. Butler on this and he acknowledges
that this additional section does contain opioids as
well.
SENATOR BEGICH noted a procedural question and asked if the
committee ever moved the legislation itself prior to moving an
amendment. He inquired if the legislation has to be before the
committee.
SENATOR GIESSEL replied that not if the bill is in its first
hearing.
SENATOR BEGICH asked to confirm Senator Giessel's statement.
SENATOR VON IMHOF removed her objection.
4:53:52 PM
At ease
4:55:31 PM
CHAIR WILSON called the committee back to order. He asked if
there was any other discussion on Amendment 1, and if the
objection was maintained.
SENATOR VON IMHOF said she removed her objection.
CHAIR WILSON announced that hearing no further objection,
Amendment 1 passes. He asked if there were any further
amendments.
4:55:54 PM
SENATOR GIESSEL moved Amendment 2:
30-GS1021\O.2
Bruce
5/5/17
AMENDMENT 2
OFFERED IN THE SENATE BY SENATOR GIESSEL
TO: CSSB 79(L&C)
Page 21, line 18:
Delete "four"
Insert "two [FOUR]"
SENATOR VON IMHOF objected for purposes of discussion.
SENATOR GIESSEL explained Amendment 2 as follows:
Page 21, line 18, this section refers to optometry, it
refers to their continuing education requirements
which are identical to the other clinicians in this
bill; however, on line 18 it says that, "In the four
years preceding the application for renewal, all of
the professional licensees renew every two years." So
this very old piece of statute needs to be updated to
reflect every two-year license renewal; it does in
effect double the amount of continuing education that
is identified in this bill but that's not a problem
either.
SENATOR VON IMHOF announced that she removed her objection.
CHAIR WILSON announced that hearing no further objection,
Amendment 2 passes. He asked if there were any further
amendments.
4:56:54 PM
SENATOR GIESSEL moved Amendment 3:
30-GS1021\O.4
Bruce
5/5/17
AMENDMENT 3
OFFERED IN THE SENATE BY SENATOR GIESSEL
TO: CSSB 79(L&C)
Page 1, line 7, following "pharmacists;":
Insert "relating to the definition of 'practitioner';"
Page 26, following line 6:
Insert a new bill section to read:
"* Sec. 31. AS 11.71.900(19) is amended to read:
(19)"practitioner" means
(A) a physician, dentist, advanced practice registered
nurse, veterinarian, scientific investigator, or other
person licensed, registered, or otherwise permitted to
distribute, dispense, conduct research with respect
to, or to administer or use in teaching or chemical
analysis a controlled substance in the course of
professional practice or research in the state;
(B) a pharmacy, hospital, or other institution
licensed, registered, or otherwise permitted to
distribute, dispense, conduct research with respect
to, or to administer a controlled substance in the
course of professional practice or research in the
state;"
Renumber the following bill sections accordingly.
Page 29, line 2:
Delete "sec. 33"
Insert "sec. 34"
Page 34, line 10:
Delete "secs. 31 and 42"
Insert "secs. 32 and 43"
Page 34, line 16:
Delete "sec. 34"
Insert "sec. 35"
Page 34, line 17:
Delete "sec. 39"
Insert "sec. 40"
Page 34, line 19:
Delete "secs. 34 and 39"
Insert "secs. 35 and 40"
Page 35, line 10:
Delete "Section 32"
Insert "Section 33"
Page 35, line 12:
Delete "Section 33"
Insert "Section 34"
Page 35, line 14:
Delete "Section 35"
Insert "Section 36"
Page 35, line 16:
Delete "Section 36"
Insert "Section 37"
Page 35, line 18:
Delete "Sections 37 and 38"
Insert "Sections 38 and 39"
Page 35, line 20:
Delete "Section 41"
Insert "Section 42"
Page 35, line 22:
Delete "Section 1, 2, 6 - 13, 18, 20, 23 - 25, 34, and
39"
Insert "Sections 1, 2, 6 - 13, 18, 20, 23 - 25, 35,
and 40"
Page 35, line 24:
Delete "Sections 31 and 42"
Insert "Sections 32 and 43"
Page 35, line 25:
Delete "secs. 45 - 53"
Insert "secs. 46 - 54"
SENATOR VON IMHOF objected for the purposes of discussion.
SENATOR GIESSEL noted that the amendment has an error, but that
it would be corrected. She explained Amendment 3 as follows:
Page 6, line 15, a statute is identified, AS
11.71.900; this statute again is in the controlled
substances section of criminal law just as the
identification of those two schedules for drugs were.
This is the definition section and it calls out the
definition of the word "practitioner." In the
definition which you see identified here in the
amendment being inserted into section 31, "advanced
practice registered nurse" is left out of the
definition of "practitioner." As you can see on the
printed amendment, a "practitioner" means, "A
physician, dentist, advanced practice registered nurse
(is added), veterinarian, scientific investigator, or
other person;" essentially this is updating the
definition of "practitioner" in criminal law under
controlled substances.
4:58:48 PM
SENATOR MICCICHE asked if Amendment 3 essentially becomes a
conceptual amendment.
SENATOR GIESSEL answered no and explained as follows:
No, actually what I was calling out, and erroneously
so, the first place that this appears in the bill is
on page 6, line 15. You see on line 15 it says, "There
has the meaning given in AS 11.71.900." So, I said
what does the definition say? So, I looked it up and
the drafter chose to insert this amendment, which is
amending the definition of practitioner, into section
31, then renumber the rest of the bill sections
accordingly. So, my mistake for saying the amendment
was drafted incorrectly.
SENATOR MICCICHE asked if the amendment replaces the old section
31 with section 32.
SENATOR GIESSEL answered yes.
SENATOR BEGICH asked if the title change is in the very first
piece and is part of the title change.
SENATOR GIESSEL answered yes.
SENATOR VON IMHOF removed her objection.
CHAIR WILSON announced that hearing no further objection,
Amendment 3 passes. He asked if there were any further
amendments.
5:00:20 PM
SENATOR VON IMHOF moved to report the CS for SB 79, version O as
amended, from committee with individual recommendations and
attached fiscal note(s).
SENATOR GIESSEL commented that she appreciated Senator Micciche
identifying the apparent deficiency related to veterinarians.
She said she looked forward to Senator Micciche addressing the
veterinarian issue appropriately in the Senate Finance
Committee.
SENATOR MICCICHE stated appreciation for the legislation and
shared the following:
I was home for a day and I went to the Freedom House
grand opening which is a project by a young woman who
has a severe addiction for many years. All I can say
is it is an amazing facility, she's an amazing young
woman, but what I want to highlight is it's so easy to
become addicted to opioids, but so impossibly
difficult to turn your life around. So if this gets in
the way of a single Alaskan, which I hope it has a
much more substantial effect, even though there's an
inconvenience to providers, I strongly support this
legislation.
SENATOR BEGICH clarified that he supports the legislation, but
will be signing "amend" based on the comments from Senator
Micciche.
5:02:00 PM
At ease.
5:03:14 PM
CHAIR WILSON called the committee back to order. He announced
that without objection CSSB 79(HSS) moved from the Senate Health
and Social Services Standing Committee.
SENATOR BEGICH commented on the cycle of addiction as follows:
I wanted to also echo my support of the legislation,
but also in particular because in my family, two of my
nephews are opiate addicts and the inability of them
to break that cycle is shocking to me. One of them has
been in the correctional system, has taken advantage
of the drugs that are provided, I'm trying to remember
the name of it, Vivitrol, which has been successful
and for a year after he's out, he will be able to get
his Vivitrol prescription and then it will run out, it
will be $1200 a month and he will not be able to pay
it, so he will become an addict again; I have actually
spoken to him recently, he's going to do everything he
can to keep that from happening, but that is an
inevitable problem with addiction if you can't stop
the process. So if this does what I hope Senator
Micciche and I both believe that if it stops anybody
from ever entering the system, it saves not just
lives, but it saves our culture, it saves everything
about what we value and for me this is very deeply
personal. I want to just encourage us to get this
thing through as fast as we can and stop the cycle of
addiction.
SENATOR GIESSEL commented on the encouraging evidence related to
Vivitrol as follows:
I would just add an encouraging note, the research
evidence does tend to favor that after a year to 16 or
18 months on Vivitrol, actually the cycle can be
broken and certainly with strong family support such
as your relatives have, there is a high likelihood
that they will emerge successful.
CHAIR WILSON stated that he appreciated the administration's
support in trying to curb in any possible way the opioid
epidemic throughout Alaska's communities. He said he did not
think that there is one Alaskan that the opioid epidemic has not
touched in some way, shape or form of whether increased cost of
someone's taxes to pay for law enforcement or knowing someone
personally, or dealing with some type of issue related to the
opioid epidemic. He thanked testifiers as well as members in the
other body that are also working on the opioid issues to help
stem the epidemic.
[CSSB 79(HSS) was reported from the Senate Health and Social
Services Standing Committee.]