04/03/2014 03:00 PM House HEALTH & SOCIAL SERVICES

        SB 162-HYDROCODONE PRESCRIPTION BY OPTOMETRISTS                                                                     
                                                                                                                                
4:25:18 PM                                                                                                                    
                                                                                                                                
CHAIR HIGGINS announced that the  next order of business would be                                                               
SENATE BILL NO.  162, "An Act authorizing  a licensed optometrist                                                               
to prescribe a pharmaceutical agent containing hydrocodone."                                                                    
                                                                                                                                
4:25:22 PM                                                                                                                    
                                                                                                                                
DAVE   SCOTT,  Staff,   Senator   Donald   Olson,  Alaska   State                                                               
Legislature, stated  that the proposed bill  created an exception                                                               
in law in  case of federal action.   Currently, optometrists were                                                               
entitled  to prescribe  hydrocodone for  four day  prescriptions.                                                               
The proposed  bill did not  change the  scope of the  practice of                                                               
optometry,  however, as  the U.S.  Food  and Drug  Administration                                                               
(FDA) was considering a change  for hydrocodone from Schedule III                                                               
to Schedule II,  there would be a lapse in  allowable coverage by                                                               
optometrists.    He  pointed  out that  there  was  a  difference                                                               
between  living in  the bush  and  urban communities,  especially                                                               
with access  to optometrists.   He noted that often  a generalist                                                               
doctor  needed to  administer to  eye injuries  in rural  Alaska,                                                               
until the patient could visit an  eye specialist.  He stated that                                                               
the mechanics of the proposed  bill were to allow optometrists in                                                               
Alaska to  continue to prescribe  oxycodone in the event  the FDA                                                               
decided to make any change.                                                                                                     
                                                                                                                                
4:28:26 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE NAGEAK asked about  the cost of hydrocodone versus                                                               
other similar alternative prescriptions.                                                                                        
                                                                                                                                
MR. SCOTT replied that he did not know the costs.                                                                               
                                                                                                                                
REPRESENTATIVE   NAGEAK   asked   about  the   availability   for                                                               
hydrocodone  versus the  alternative  prescriptions  in the  bush                                                               
communities.                                                                                                                    
                                                                                                                                
MR. SCOTT replied that he did not know the availability.                                                                        
                                                                                                                                
4:29:29 PM                                                                                                                    
                                                                                                                                
CHAIR HIGGINS [opened public testimony].                                                                                        
                                                                                                                                
RACHEL  REINHARDT,  MD,  American  Academy  of  Ophthalmologists,                                                               
stated  that she  was  the current  president  of the  Washington                                                               
Academy  of Eye  Physicians  and Surgeons.    She reported  that,                                                               
after several years  of research, the FDA had  recommended to the                                                               
U.S. Drug Enforcement Administration  (DEA) to change hydrocodone                                                               
containing  narcotics to  a more  restricted class.   She  shared                                                               
that  the agencies  concluded that  there was  a national  crisis                                                               
with a  300 percent increase  in prescription narcotics  over the                                                               
past  20 years,  and that  hydrocodone was  "at the  top of  that                                                               
list."   She  relayed  that there  had also  been  a 500  percent                                                               
increase for  prescription narcotic deaths in  the United States.                                                               
These prescription  narcotic deaths now outnumbered  the combined                                                               
total deaths  from illegal narcotics,  with Alaska  ranking fifth                                                               
in the nation.   She pointed out that one  step toward a solution                                                               
was to restrict  the number of providers who  can prescribe these                                                               
narcotics.   She  addressed a  possible concern  that some  rural                                                               
patients  would   suffer,  stating   that  there   were  numerous                                                               
alternatives.   She relayed that  she prescribed  other narcotics                                                               
such as codeine,  as well as non-narcotic pain  medications.  She                                                               
relayed that  a lot of  painful eye conditions were  treated with                                                               
bandages, contact lenses,  and drops.  She referred to  a list of                                                               
15 non-narcotic pain medications  as alternatives for moderate to                                                               
severe pain.  She expressed  her understanding to the concern for                                                               
rural  areas.     She  addressed  the   proposed  limitations  to                                                               
prescriptions, which, although it  sounded helpful, still allowed                                                               
access to  the narcotics by a  non-patient.  She stated  that the                                                               
medical  community   at  large  was  responsible   for  the  drug                                                               
epidemic, and this state of  emergency had led to the "conscious,                                                               
intentional  effort"   to  reclassify   some  drugs  to   a  more                                                               
restrictive  class, and  thereby  limit the  number of  providers                                                               
allowed  to  prescribe.    She   declared  that  this  was  about                                                               
protecting  patients.   She reported  that prescription  narcotic                                                               
deaths were  the number one  cause of unintentional death  in the                                                               
United  States,   surpassing  car   accidents.     She  requested                                                               
opposition to SB 162.                                                                                                           
                                                                                                                                
REPRESENTATIVE  KELLER   pointed  out   that  the   Alaska  State                                                               
Legislature had  been working on  a proposed bill for  a database                                                               
of opioid prescriptions,  which did not appear  to having funding                                                               
to continue  beyond July 1,  2014.  He expressed  his frustration                                                               
with this.                                                                                                                      
                                                                                                                                
DR.  REINHARDT  replied  that  an   increase  to  the  number  of                                                               
providers for  these prescriptions would necessitate  a database.                                                               
She  stated that  there also  needed  to be  regular wide  spread                                                               
distribution  of  medications  for  overdose.    She  offered  to                                                               
voluntarily stop  prescription of  Vicodin [hydrocodone]  just to                                                               
make a point to the dangers of prescription drug abuse.                                                                         
                                                                                                                                
4:38:15 PM                                                                                                                    
                                                                                                                                
JEFF GONNASON, OD, Alaska  Optometric Association, explained that                                                               
a  controlled  substance  was  a   drug  or  chemical  which  was                                                               
regulated  by   the  government,  and  classified   according  to                                                               
schedules  for  the  potential  of  abuse.   He  said  that  each                                                               
schedule   had  a   more   restrictive  prescription   procedure,                                                               
including  tighter  record keeping  and  databases  to track  the                                                               
medication to prevent  abuse.  He reported that  the Alaska State                                                               
Legislature, in 2000, had voted  to authorize Alaska optometrists                                                               
to  prescribe  medications,   including  schedule  II  narcotics,                                                               
although this was subsequently vetoed  by the governor.  He noted                                                               
that a  later law  allowed prescriptions  for Schedules  III, IV,                                                               
and  V narcotics,  with  a  maximum 4-day  supply,  only for  eye                                                               
conditions.  He  stated that this compromise  had been acceptable                                                               
as eye  pain was often  acute, but  resolved itself in  less than                                                               
four  days.   He noted  that hydrocodone  combination drugs  were                                                               
included in  Schedule III.   In response to an  earlier question,                                                               
he said  that these generic  drugs were  not very expensive.   He                                                               
declared that  there had been  zero instances of abuse,  and zero                                                               
complaints  or actions  by  the  state board  or  any other  drug                                                               
enforcement   agency  against   any  Alaska   optometrist.     He                                                               
emphasized that  these drugs were  important for  managing severe                                                               
eye pain.   He pointed out that the  proposed reclassification of                                                               
the drugs would "once again  be the federal government regulation                                                               
overriding our  state law."   He  stated that  this drug  was the                                                               
best tool  for managing  acute eye  pain.   He stressed  that the                                                               
national  drug  abuse  problem  had nothing  to  do  with  Alaska                                                               
optometrists.  He said that,  as optometry was qualified and well                                                               
trained,  people did  not come  to them  for illicit  drugs.   He                                                               
expressed his  disagreement with Dr. Reinhardt,  stating that the                                                               
federal  purpose  was  "to  tighten   the  abuse  potential  from                                                               
problematic users,"  which he claimed  did not  include optometry                                                               
because of  the restrictions.   He offered  an anecdote  about an                                                               
incident in a rural community.   He opined that the proposed bill                                                               
did  not   make  any  changes   from  the  current   practice  by                                                               
optometrists in Alaska.                                                                                                         
                                                                                                                                
CHAIR  HIGGINS   asked  if  there   was  a  medical   doctor  for                                                               
prescriptions in the bush communities.                                                                                          
                                                                                                                                
DR.  GONNASON replied  that very  often there  was not  a medical                                                               
doctor in the villages.   He declared that he could  go to a bush                                                               
clinic and not  be allowed to give antibiotics,  whereas a health                                                               
aide was allowed to give them.                                                                                                  
                                                                                                                                
4:44:46 PM                                                                                                                    
                                                                                                                                
DAVID  KARPIK,  OD,  President,  Alaska  Optometric  Association,                                                               
stated that  the Alaska Optometric Association  supported SB 162.                                                               
He  declared  that the  proposed  bill  was merely  "a  technical                                                               
addition  to existing  optometry law."   He  relayed that  strong                                                               
measures  already existed  to prevent  abuse by  prescribers, and                                                               
tighter  record keeping  and  tracking  requirements also  worked                                                               
toward this.   He  expressed his agreement  with the  problem for                                                               
addictions  to  prescription   medications  however,  infrequent,                                                               
short term prescriptions were not  contributing to this addiction                                                               
problem.    He said  there  had  been  no complaints  of  abusive                                                               
prescribing  of  controlled   substance  toward  optometrists  in                                                               
Alaska  in  the  seven  years   since  statute  had  allowed  the                                                               
prescription  of controlled  substances.   He concluded  that the                                                               
proposed   bill  maintained   the  opportunity   for  "continued,                                                               
compassionate  relief  of their  eye  related  pain in  an  acute                                                               
setting."                                                                                                                       
                                                                                                                                
4:47:56 PM                                                                                                                    
                                                                                                                                
MR.  SCOTT  reported that  the  sponsor  was  well aware  of  the                                                               
concern for the  abuse of prescription drugs.  He  noted that his                                                               
concern was assuaged by the four  day limit on prescriptions.  He                                                               
pointed  out  that Rural  Alaska,  without  roads, was  far  more                                                               
inaccessible than rural Washington.                                                                                             
                                                                                                                                
4:48:40 PM                                                                                                                    
                                                                                                                                
CHAIR HIGGINS closed public testimony, and said that SB 162                                                                     
would be held over.