02/21/2014 01:30 PM Senate HEALTH & SOCIAL SERVICES

        SB 162-HYDROCODONE PRESCRIPTION BY OPTOMETRISTS                                                                     
                                                                                                                                
2:02:55 PM                                                                                                                    
CHAIR STEDMAN announced that the  next order of business would be                                                               
SB 162.  He said it  is the first hearing  on SB 162.  The intent                                                               
today  is to  have the  sponsor introduce  the bill,  take public                                                               
testimony, and set the bill aside for further review.                                                                           
                                                                                                                                
2:03:34 PM                                                                                                                    
DAVID   SCOTT,  Staff,   Senator   Donny   Olson,  Alaska   State                                                               
Legislature, Juneau,  Alaska, presented SB  162 on behalf  of the                                                               
sponsor.  He  explained  that  the  bill  would  retain  licensed                                                               
optometrists'  authority to  prescribe  hydrocodone to  patients.                                                               
Currently,  on  the   federal  level,  there  is   an  effort  to                                                               
reschedule  hydrocodone from  Schedule  III to  Schedule II.  The                                                               
sponsor  does not  want  there  to be  a  lapse in  optometrists'                                                               
ability to treat  their patients. He emphasized that  SB 162 does                                                               
not increase the scope of the practice of optometry.                                                                            
                                                                                                                                
He noted that  the sponsor is aware of the  concern regarding the                                                               
nationwide  epidemic of  prescription painkiller  abuse. He  drew                                                               
attention to  page 1, lines  13 and 14,  of the bill  which state                                                               
that the prescription cannot exceed four days.                                                                                  
                                                                                                                                
He  highlighted new  language on  page 1,  lines 11  and 12  that                                                               
ensures there  is no lapse  in the current practice  of optometry                                                               
to prescribe hydrocodone.                                                                                                       
                                                                                                                                
CHAIR  STEDMAN  said there  is  one  zero  fiscal note  from  the                                                               
Department  of  Commerce,   Community  and  Economic  Development                                                               
(DCCED).                                                                                                                        
                                                                                                                                
SENATOR MEYER asked what kind of drug hydrocodone is.                                                                           
                                                                                                                                
MR. SCOTT  explained is commonly  referred to Vicodin when  it is                                                               
mixed with acetaminophen and is a painkiller.                                                                                   
                                                                                                                                
SENATOR MEYER asked if the bill only pertains to optometrists.                                                                  
                                                                                                                                
MR.  SCOTT  said yes.  Other  medical  professionals already  can                                                               
prescribe hydrocodone.                                                                                                          
                                                                                                                                
SENATOR  MEYER questioned  if  the bill  should  be broadened  to                                                               
other medical professions.                                                                                                      
                                                                                                                                
MR. SCOTT  explained that physicians already  can prescribe these                                                               
medications. Hydrocodone is the  only painkiller optometrists can                                                               
prescribe.                                                                                                                      
                                                                                                                                
2:07:11 PM                                                                                                                    
SENATOR MICCICHE agreed with the  previous answer. He inquired if                                                               
the bill limits the prescription to one four-day quantity.                                                                      
                                                                                                                                
MR. SCOTT read from page 1,  lines 13 and 14, "the pharmaceutical                                                               
agent .  . .  is prescribed  in a quantity  that does  not exceed                                                               
four days of prescribed use if it is a controlled substance."                                                                   
                                                                                                                                
CHAIR STEDMAN opened public testimony.                                                                                          
                                                                                                                                
2:07:56 PM                                                                                                                    
MICHAEL  BENNETT,  Optometrist,   Juneau,  Alaska,  testified  in                                                               
support  of   SB  162.  He   clarified  that  when   the  initial                                                               
pharmaceutical   bill  for   optometry   was   passed  in   2007,                                                               
optometrists were restricted to  Schedule III narcotics, of which                                                               
Vicodin  is the  drug  of  choice. They  were  not authorized  to                                                               
prescribe  Schedule II  narcotics, such  as oxycontin,  with even                                                               
more  abuse  potential.  He  explained  that  if  the  FDA  moves                                                               
hydrocodone  into  a  Schedule  II  classification,  optometrists                                                               
would not have a drug to prescribe for acute, severe pain.                                                                      
                                                                                                                                
He pointed  out that hydrocodone is  used relatively infrequently                                                               
in  eye care  practice.  It is  used for  eye  trauma. Eyes  heal                                                               
quickly and only  a short-term prescription is  required. If pain                                                               
management  is  required  for  longer  periods,  the  patient  is                                                               
referred to a higher level of  care. It is also used for chemical                                                               
injuries  and  an acute  form  of  glaucoma frequently  found  in                                                               
American Eskimos.                                                                                                               
                                                                                                                                
He emphasized  that SB  162 is not  an expansion  of prescriptive                                                               
authority  that has  been in  place for  seven years.  There have                                                               
been no reports  of issues or incidents to the  state board or to                                                               
the DEA.                                                                                                                        
                                                                                                                                
2:10:55 PM                                                                                                                    
RACHEL   REINHARDT,   Ophthalmologist,    American   Academy   of                                                               
Ophthalmology,  Seattle, Washington,  testified in  opposition to                                                               
SB 162.  She said there  is a  national crisis for  drug overdose                                                               
deaths related to  prescription narcotics. The FDA  is making the                                                               
recommendation  to change  hydrocodone-containing narcotics  to a                                                               
more  restrictive class  -  Schedule  II. There  has  been a  300                                                               
percent increase  in the sale  of these prescriptions  since 1999                                                               
and a  five-fold increase in  the death rate. Alaska  ranks fifth                                                               
of  all states  for prescription  narcotic overdose  deaths, more                                                               
than  twice  the   national  average  for  the   death  rate  for                                                               
prescription  overdoses.  Hydrocodone  is  the  number  one  drug                                                               
abused. The point is to restrict  the number of providers who can                                                               
prescribe hydrocodone.                                                                                                          
                                                                                                                                
She  contested  the uses  of  hydrocodone  for optometrists.  She                                                               
noted a  similar bill was  defeated in Washington  and maintained                                                               
that  SB 162  is premature.  She  concluded that  $72 billion  is                                                               
spent every  year on medical  costs associated  with prescription                                                               
overdoses. The bill  sets a precedent for  mid-level providers to                                                               
request an  exception, undercutting the research  related to drug                                                               
deaths.                                                                                                                         
                                                                                                                                
2:17:14 PM                                                                                                                    
STEVEN  DOBSON,   Optometrist,  Alaska   Optometric  Association,                                                               
Anchorage,  Alaska,  testified in  support  of  SB 162.  He  said                                                               
optometrists have  been able to  prescribe a limited  quantity of                                                               
hydrocodone  for  the past  seven  years  for the  management  of                                                               
acute,  severe ocular  pain  due to  injuries  or infections.  He                                                               
maintained that  the potential for  abuse is with  chronic, long-                                                               
term recurrent  pain management conditions. The  bill would allow                                                               
optometrists to  continue to prescribe hydrocodone  compounds for                                                               
a  limited period  and for  limited use  without expanding  their                                                               
current scope of practice. He  stressed that this medication is a                                                               
god-send  for  extreme  ocular  pain.  He shared  a  story  of  a                                                               
patient's pain and the benefit of relief.                                                                                       
                                                                                                                                
2:20:13 PM                                                                                                                    
SENATOR  MICCICHE shared  the concern  for hydrocodone  abuse. He                                                               
asked if there is another compound that could be used.                                                                          
                                                                                                                                
DR. DOBSON said in the case  he just gave there is no substitute.                                                               
He pointed  out that due  to the geographic broadness  of Alaska,                                                               
optometrists  are  often  the  front line  for  urgent  eye  care                                                               
emergencies. He agreed that there  is a problem with prescription                                                               
drug abuse, but maintained that  it is not from optometric urgent                                                               
eye care because it is so  specific and for such a limited amount                                                               
of time.                                                                                                                        
                                                                                                                                
2:21:47 PM                                                                                                                    
JEFF   GONNASON,  Optometrist,   Alaska  Optometry   Association,                                                               
Anchorage, Alaska, testified  in support of SB 162.  He defined a                                                               
controlled substance as  a drug or chemical that  is regulated by                                                               
the  government.  He  said  they   are  classified  according  to                                                               
Schedules, with  Schedule I being  the highest for  potential for                                                               
abuse. For  example, Schedule II  drugs require  more restrictive                                                               
regulations  than  Schedule  III  drugs to  help  prevent  abuse.                                                               
Fourteen years  ago the  Alaska Legislature  authorized qualified                                                               
optometrists  to  prescribe   medication  including  Schedule  II                                                               
drugs, but the  governor at the time vetoed the  bill. In 2007, a                                                               
new bill  was signed  into law with  the current  restrictions of                                                               
only Schedule  III, IV, and V,  not including Schedule II,  and a                                                               
restriction  of  only  supplying  a maximum  4-day  supply  of  a                                                               
controlled substance.                                                                                                           
                                                                                                                                
He  explained   that  Alaska  therapeutic  optometrists   have  a                                                               
registered DEA number on file with  the state. There have been no                                                               
instances of  abuse or complaints  or actions by the  state board                                                               
or  any other  drug  enforcement agency.  The  bill is  necessary                                                               
because the  FDA is recommending reclassifying  hydrocodone and a                                                               
vital tool  for managing pain will  be taken away. He  noted that                                                               
he  met with  two ophthalmologists  who had  no objection  to the                                                               
bill; neither wanted  to rekindle old turf  battles. He concluded                                                               
that SB 162 does not change anything; it keeps status quo.                                                                      
                                                                                                                                
2:25:54 PM                                                                                                                    
CHAIR STEDMAN closed public testimony.                                                                                          
                                                                                                                                
CHAIR STEDMAN held SB 162 in committee.