Legislature(2017 - 2018)BUTROVICH 205
03/13/2017 01:30 PM Senate HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| SB53 | |
| SB91 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | SB 91 | TELECONFERENCED | |
| *+ | SB 53 | TELECONFERENCED | |
SB 91-EXTEND DISASTER EMERGENCY: OPIOID EPIDEMIC
1:56:58 PM
CHAIR WILSON announced the consideration of SB 91.
1:57:17 PM
DR. JAY BUTLER, Chief Medical Officer, Department of Health and
Social Services (DHSS), Juneau, Alaska, provided an overview of
SB 91 as follows:
In late 2016, DHSS competed for and was awarded a
five-year grant by the Federal Substance Abuse and
Mental Health Services Administration to support an
opioid overdose prevention program that included the
distribution of Naloxone, a drug that can be
lifesaving when administered to someone who has
stopped breathing due to an opioid overdose.
The grant funds have been used to acquire the nasal
spray form of the drug that is part of a rescue kit
distributed through Alaska Project HOPE, "HOPE"
standing for, "harm reduction overdose prevention and
education." We worked with law enforcement in terms of
how they might be able to best carry the kits to best
administer them if needed during an emergency
situation.
Project HOPE has prioritized partnerships with staff
of organizations that do not have medical direction,
meaning that they would have someone who could issue a
prescription for the drug and those who are most
likely to be present when an overdose occurs such as
for certain first responders and persons involved in
recovery support.
To provide the kits under a standing-medical order,
the department explored a number of options. We were
advised by the attorney general's office that the best
option would be for the state-medical officer to issue
a standing order and the authority for the standing
order would require a disaster declaration. Governor
Walker issued the declaration on February 14 with an
anticipated legislative concurrent resolution that
would extend the declaration for longer than the 30-
day deration defined by Alaska statute.
No state funds are required to support Project HOPE.
Since the declaration, 12 organizations have already
received the training including some that have
received training-the-trainer training and are able to
provide the kits and nearly 800 kits have been
dispensed so far. This past Thursday we returned that
the opinion of Legislative Legal is that a bill is
required to extend the declaration and to continue the
distribution of the kits under the standing order.
2:00:15 PM
DR. BUTLER addressed the sectional analysis of SB 91 as follows:
Section 1:
Includes the findings of the extent of the public-health threat.
Acknowledges and describes the governor's disaster declaration,
and the need for legislation to extend the declaration.
Section 2:
Extends the February 14, 2017 disaster declaration for 1 year to
February 14, 2018.
Section 3:
Makes the effective date retroactive to March 15, 2017 when the
current disaster declaration expires.
SENATOR MICCICHE asserted that he is an active supporter of
dealing the state's opioid crisis. He asked for an explanation
of the emergency declaration's criteria under federal law. He
inquired if the emergency declaration was actually appropriate.
2:01:36 PM
STACY KRALY, Chief Assistant Attorney General, Alaska Department
of Law, Juneau, Alaska, addressed the emergency declaration from
SB 91 as follows:
This is a state emergency declaration, not a federal
declaration. Under current state statute there is a
mechanism under the public-health authorizations under
Title 18 and also under the Military and Veterans
Affair statutory authorizations under Title 26 that
provides for the issuance of a declaration of an
emergency.
If you look in particular under AS 18.15.390 which are
the powers of the department in a public-health
disaster, the department can work with the Department
of Military and Veterans Affairs to initiate a public-
health emergency under the auspices and authorities
that Military and Veterans Affairs as under AS
26.23.020; so they kind of work in conjunction with
each other generally and under emergency declaration
are done for flooding, that's the most recent one that
happened, ice jams and flooding and that sort of thing
so there would be an emergency declaration through the
Department of Veterans and Military Affairs that would
provide the department authorization to provide
certain services and funding in many cases to address
this emergency, an earthquake or something like that.
What has also happened though is that the Legislature
through the public health statutes, like I said under
Title 18, has given the department the authority to
use the mechanisms of a disaster declaration for
purposes of a public-health emergency and that is what
we have done under this context; so they work together
a little bit different. We use the same framework and
format under the emergency declaration for the
Veterans and Military Affairs, but it is used for a
public health emergency which is what we've done in
this context.
SENATOR MICCICHE asked if the federal grants that are funding
the program requires a disaster declaration.
2:04:19 PM
MS. KRALY answered no. She continued as follows:
What we were very clear in the emergency declaration
when we crafted it for the governor's office is that
there were going to be no additional funds that were
going to be administered generally when an emergency
happens like I was explaining previously; say the
flood, there's a need for an expenditure, some
financial outlay by the Legislature to help address
the emergency. This grant was applied for and was
received long before this declaration was received, so
there's no addition fiscal outlay or request being
made as a result of this declaration.
CHAIR WILSON stated the following:
Our offices looked into this a little bit and working
with the department and the state as well and first we
want to thank the governor for raising awareness to
this issue. We all want here to save lives and we
understand, but I do want to put this in perspective,
if we will have a conversation to make sure we have
clearness upon what is needed and what is being asked
for.
CHAIR WILSON asked if Alaska has already received the $4
million.
DR. BUTLER answered yes.
CHAIR WILSON asked him to verify that the declaration is not
needed for the expenditure of the $4 million.
DR. BUTLER answered correct.
CHAIR WILSON summarized as follows:
Really what is being asked for is that the medical
director could have these special privileges to help
dispense Naloxone throughout the Alaska communities
and this would allow him to do that both allow this
position to do that for the one year until the end
date of this declaration.
2:06:11 PM
DR. BUTLER answered correct.
CHAIR WILSON asked if a bill could be drafted rather than an
emergency declaration.
DR. BUTLER answered that he supported any means in addressing
opioid overdose prevention.
CHAIR WILSON noted that Dr. Butler had the emergency declaration
privilege within the 30 days. He asked if SB 91 extends the
privilege for 30 days or would the bill be a stop-gap if the
Legislature does not act within the 30-day timeframe.
DR. BUTLER answered as follows:
The current disaster declaration will expire on March
15, so if there is a gap period it means we would stop
the dispensing of the kit until we can get a
resolution for this issue.
SENATOR VON IMHOF asked him to verify that the state received
the federal Substance Abuse and Mental Health Services
Administration (SAMHSA) grant of $4.1 million.
DR. BUTLER answered correct.
SENATOR VON IMHOF assumed that the program's success required as
many caregivers as possible to have access to the kits in order
to deliver Naloxone.
DR. BUTLER specified that the persons who may be administering
Naloxone did not have to be a health-care provider.
2:08:21 PM
SENATOR VON IMHOF asked to confirm that Naloxone requires a
doctor's approval of some sort in order to administer, something
that is not always time efficient and not always possible in
emergency situations.
DR. BUTLER answered correct.
SENATOR VON IMHOF stated that one way to circumvent the doctor's
approval is by claiming an emergency disaster. She asked if
circumventing approval by a doctor was the intent of the
emergency disaster declaration.
DR. BUTLER specified that the disaster declaration allows the
standing order to be created to be able to provide that pre-
existing prescriptive authority so that the kits could be
available to people who are most likely to be present.
SENATOR VON IMHOF asked him to verify that a blanket authority
would be extended to the on-the-ground health-care providers
that are in the emergency situation
DR. BUTLER answered correct.
SENATOR VON IMHOF replied that she understood the reasoning
behind getting 800 kits out and distributed as quickly as
possible without having the cumbersome aspect of having an
individual doctor's approval each time. She stated that the
question remained if an emergency declaration is required versus
the statute process. She asked Dr. Butler if he would support
extending the declaration 30 days to buy time for the committee
to write up a statute for a 1-year authority period.
2:10:08 PM
DR. BUTLER reiterated that he supported however the authority
can be established to distribute the kits. He pointed out that
the funding is for five years and asked if the prescriptive
authority can be considered for a longer period.
SENATOR GIESSEL quoted the statute that cited the declaration of
disaster under AS 26.23.020 and commented as follows:
"This emergency declaration allows the allocation of
medicine or supplies to address the emergency;" it is
only for 30 days, it is a standing order as Dr. Butler
has pointed out. The medication in the overdose kit is
a prescription medication, consequently he, as the
state's medical officer, can write a blanket
prescription allowing the training of personnel, of
citizens in the proper use of these, it's a nasal
spray, but it does require the prescription. To extend
this only for 30 days does not really address the
problem and the state medical director has provided us
with some information about the size of this problem
and it will take more than just another 30 days to
address it properly.
SENATOR BEGICH asked to confirm that the legislation would do
what Senator Giessel referenced in statute.
SENATOR GIESSEL answered yes.
2:12:54 PM
CHAIR WILSON asked Dr. Butler to explain the numbers that are
referenced in the bill on page 1, lines 9-13.
DR. BUTLER confirmed that heroin-associated deaths more than
quadrupled from 2009 to 2015, from 7 deaths to 38 deaths in
2015.
CHAIR WILSON noted that in 2014 approximately 500 doses of
Naloxone was given out. He asked Dr. Butler if he knew how many
kits are planned to be administered for the first year.
DR. BUTLER replied that the goal is to distribute 5,000 kits.
2:16:32 PM
CHAIR WILSON noted constituency concerns that wide availability
of Naloxone may have a negative impact on society as a "Get out
of death for free card." He asked if there is concern that the
$4 million will just be used for Naloxone rather than putting
funds further upstream to get to people before they use opioids.
DR. BUTLER specified that Naloxone can save a life, but does not
cure the addiction. He concurred that Naloxone is not the only
approach to address the opioid epidemic. He set forth that
access to treatment and the stigma often associated with
addiction must also be addressed. He added that how pain is
being managed with opioids is another area that must be
assessed.
2:20:51 PM
SENATOR MICCICHE asked how other states are dealing with the
opioid epidemic.
DR. BUTLER replied that like Alaska, other states are also
taking a multi-faceted approach that includes allowing the state
medical officer to issue a standing order, address drug
monitoring programs, continued medical education to providers on
pain management and addiction, and limiting the number of opioid
pills that can be dispensed.
SENATOR MICCICHE asked if there is a "good samaritan" law that
covers someone administering Naloxone.
2:24:06 PM
MS. KRALY replied that she would take a look at the general
"good samaritan" laws of the statutes and provide a more
thorough answer of how those would apply.
CHAIR WILSON asked if training certificates will be provided to
show that a person was well trained for administering Naloxone.
He opined that certification would apply to "good samaritan"
laws that a person was trained within the authority of what they
do.
DR. BUTLER explained that the kits have pre-packaged Naloxone
nasal spray to simplify administering the drug. He detailed that
training is fairly simple and provided a step-by-step process
for administering Naloxone.
SENATOR MICCICHE asked if the state was in the right place
"mechanically" in training for administering Naloxone.
2:28:05 PM
ANDREW JONES, Section Chief, Emergency Programs: Health
Emergency Response Operations, EMS and Trauma, Division of
Public Health, Department of Health and Social Services,
Anchorage, Alaska, announced his availability to address how the
overdose kits are administered.
CHAIR WILSON asked Mr. Jones to address Senator Micciche's
inquiry on Naloxone.
MR. JONES explained that Health Emergency Response Operations,
Emergency Medical Services (EMS) and the Trauma System have a
comprehensive and customized training program to meet the needs
of Alaskans. He detailed that training is hands-on, one-on-one
that is similar to CPR training. He noted that individuals that
receive training get a card to show that they were trained. He
revealed that training-on-training has an application process
and the thorough training takes a few hours to complete.
He explained that the intent of the program was to compliment SB
23 and one of the parts of the bill says, "An employer or
volunteer of the overdose program with training can administer
the lifesaving drug." He said the intent was for the state to
create an umbrella-program with a goal to get the kits into the
hands of the non-profits, the peer-recovery groups, the people
who are in connection with individuals who are either going
through recovery or may actually be using on a day-to-day basis.
He addressed Senator Micciche regarding a disaster declaration
and specified that the two things that are always analyzed and
asked is: loss of life, and loss of property. He said the $4
million federal grant will assist with getting the medication
out in an efficient and quick manner to save lives.
2:30:36 PM
CHAIR WILSON asked if DHSS would come back in 2018 after the
declaration is done and ask the Legislature to issue the medical
director's position the same clearance to authorize dispensing.
He asked if responding to the request would be best done through
a bill process or continue a year-to-year process.
DR. BUTLER opined that the most efficient response would be the
bill process.
SENATOR VON IMHOF said she was pleased the state received the $4
million SAMHSA grant; however, she posed that using a
declaration of disaster emergency to implement the program opens
the door to potential risk of open-ended funding in the future.
She noted that legal opinion was sought and pointed out that
there is a risk. She said as a person sitting on the Senate
Finance Committee, she acknowledged the risk and asserted that
she would like to explore an alternative option if the same
thing can be accomplished.
2:33:27 PM
DR. BUTLER reiterated that his objective is to maintain the
program and save lives in whatever way that is optimal.
MS. KRALY explained that the emergency declaration that was
signed by Governor Walker was very narrowly crafted to
specifically address the concerns that Senator von Imhof raised.
She revealed that an emergency declaration was the quickest way
to get the kits into Alaska's communities.
2:36:42 PM
SENATOR GIESSEL noted that the Mat-Su has an opioid response
team, a community group that has come together to address the
issue in the Mat-Su Valley. She disclosed that Anchorage is
forming a similar group. She asked Mr. Jones if he knows if a
response team is formulating in Fairbanks.
MR. JONES answered that a Fairbanks has a collation as well as
numerous collations throughout the state. He said the intent is
to provide tools and capabilities to empower communities for a
long-term response.
SENATOR GIESSEL asked Mr. Jones what Naloxone's side effects are
and the result if the drug is mistakenly administered to someone
that is not having an opioid overdose.
MR. JONES answered that the side effects are minimal, unless the
person is allergic specifically to Naloxone, a situation that
has very few cases of occurrence in the U.S. He said most of the
times what ends up happening if an individual is overdosing and
it is not an opioid, the person probably will not wakeup and
that's when CPR is administered.
SENATOR GIESSEL asked Mr. Jones if he knew much about the
state's "good samaritan" laws in reference to liability for
Naloxone.
2:39:21 PM
MR. JONES revealed that one of the statutes as a result of last
year's legislation from SB 23 addressed liability and gross
negligence. He explained that gross negligence would occur if a
person had an overdose kit but did not administer Naloxone. He
added that administering CPR is covered under the "good
samaritan" law, as long as gross negligence is not applied.
SENATOR GIESSEL asked Dr. Butler if he could elaborate on
Naloxone's side effects and liability related to the "good
samaritan" law.
DR. BUTLER concurred with Mr. Jones that nothing will happen to
a person that is administered Naloxone if the individual is not
experiencing an opioid overdose. He detailed that the person
will not wake up, but 9-1-1 should be called and CPR
administered by someone that is trained.
2:41:17 PM
CHAIR WILSON opened public testimony.
2:41:47 PM
KARA NELSON, representing self, Juneau Recovery Community
Organization, Juneau, Alaska, testified in support of SB 91. She
said the opioid epidemic is an emergency and people are dying.
She asserted that Naloxone is needed. She revealed that she has
been trained in administering Naloxone and has done so in
overdose situations.
2:44:55 PM
MICHAEL CARSON, Vice President, MyHouse Mat-Su, Wasilla, Alaska,
testified in support of SB 91. He noted that he is also the
chairman of the Mat-Su Opioid Task Force. He detailed that
MyHouse is one of the non-profits that would benefit from the
wide distribution of Naloxone kits. He concurred that the
state's heroine increase has, "Gone up through the roof."
2:48:27 PM
MIKE COONS, representing self, Palmer, Alaska, testified in
opposition of SB 91. He revealed that he was a paramedic for 22
years. He opined that distributing Naloxone will be a failure
and may even add to increased deaths of opioids by enabling
addicts. He said he objected to the use of federal funds to pay
for the $4.1 million grant to the state for disaster relief.
CHAIR WILSON clarified that the $4.1 million comes from a SAMHSA
grant.
MR. COONS replied that the grant still comes from taxpayer
dollars.
2:51:27 PM
JOHN GREEN, representing himself, Wasilla, Alaska, testified in
support of SB 91. He revealed that his daughter died from a
heroin addiction. He set forth that recovery resources should be
made available in order to save lives.
2:54:12 PM
CHAIR WILSON closed public testimony.
He asked Dr. Butler about the "after effect." He remarked that
the possible side effects from receiving Naloxone was
overlooked. He asked Dr. Butler if an individual's state of mind
and behavior is affected from Naloxone.
DR. BUTLER replied that Naloxone does not cure addiction. He
emphasized that addiction is a chronic health condition that
requires management. He noted that the community coalitions play
an important role in addiction recovery.
CHAIR WILSON asked Dr. Butler to address the effects of what
happens to a person right after receiving Naloxone.
2:56:55 PM
DR. BUTLER replied that the effects are dependent on the
situation.
CHAIR WILSON inquired if there is a risk of the person being
aggressive after being administered Naloxone. He asked if the
effects from Naloxone and the risks are being covered in
training.
DR. BUTLER explained that the acute effects that are experienced
by the person who receives the Naloxone is going to be driven
somewhat by the dose and strength of the opioid. He added that
the amount of Naloxone administered is important to get someone
to start breathing again, but to avoid going into acute
withdrawal. He pointed out that acute withdrawal is very
unpleasant with the possibility for vomiting.
SENATOR BEGICH noted that typically a "findings section" is not
included in legislation and recommended that the section be
eliminated from the bill.
2:59:59 PM
CHAIR WILSON detailed that his intent is to introduce a
committee substitute at the next committee meeting. He said he
hoped to get the bill out of committee as soon as possible so
that the work of DHSS is not hindered. He commented on the bill
as follows:
I don't think anyone here in the committee doesn't
think that every life is valuable to be saved and we
thank the administration for putting this forth and
this plan together. I think that we've all had our own
experiences with this issue one way or another, but we
just want to make sure that we are looking at this as
a whole. It is my viewpoint that we are addressing not
just down-the-river, but we can go further upstream as
possible.
CHAIR WILSON held SB 91 in committee for future consideration.