Legislature(2013 - 2014)CAPITOL 106
01/31/2013 03:00 PM House HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| HB53 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 53 | TELECONFERENCED | |
HB 53-CONSULTATION FOR OPIATE PRESCRIPTION
3:06:49 PM
CHAIR HIGGINS announced that the only order of business would be
HOUSE BILL NO. 53, "An Act establishing a consultation
requirement with respect to the prescription of opiates under
certain circumstances."
3:07:14 PM
REPRESENTATIVE PRUITT moved to adopt committee substitute (CS)
for HB 53, labeled 28-LS0177\C, Martin, 1/30/13, as the working
document. There being no objection, it was so ordered.
3:07:37 PM
REPRESENTATIVE KELLER, as the sponsor of proposed HB 53,
explained that the proposed bill was about prescription of pain
medications. He opined that many people had used some of the
opiates, including Darvon and OxyContin. He clarified that the
proposed CS, Version C, was an important work in progress, and
he asked that the Department of Health and Social Services not
yet take a position on the proposed bill, but instead offer
insights and suggestions.
3:09:15 PM
REPRESENTATIVE KELLER explained that testimony to the Alaska
Health Care Commission, on which he served, described "the very
negative effects on people who take too much of this category of
drugs." He reported that data suggested that some patients who
had received "too big a dose of these pain meds for six months
have like a 1 or 2 percent chance of ever going back to work.
It just rearranges their whole lives." He expressed his desire
to ensure that innocent people were not hurt with an inadvertent
overdose. He reported that opiates were addictive, naturally-
occurring alkaloids found in the opium poppy. He declared that
ever increasing dosage was a warning signal. He explained that
the proposed bill used 120 mg of morphine equivalent as a
baseline level of concern, as any amount above this would
require consultations for prescription.
3:12:06 PM
REPRESENTATIVE SEATON asked if the proposed bill included pain
medications other than opiates, and he questioned whether
OxyContin was included in the definition of opiates.
3:12:40 PM
REPRESENTATIVE KELLER replied that the proposed bill included a
spectrum of drugs, which included OxyContin and Darvon. He
reiterated that an opiate was an alkaloid found in the opium
poppy, and he opined that there were also synthetic versions of
the alkaloid.
3:13:17 PM
REPRESENTATIVE PRUITT directed attention to the handout titled,
"What are Opiates?" [Included in members' packets]
3:13:38 PM
JIM POUND, Staff, Representative Wes Keller, Alaska State
Legislature, shared that the original proposed bill had been 4
pages, but, as it had generated a lot of interest, the proposed
CS was now expanded to 15 pages. He said that testimony and
language from many members of the medical profession, primarily
the Alaska Board of Nursing, the Alaska State Medical Board, the
State of Alaska Board of Dental Examiners, and the Alaska Board
of Pharmacy, had been lumped together. He declared that it was
difficult to track individuals when prescriptions were obtained
from many doctors. He reported that the Alaska Prescription
Drug Monitoring Program had been created in 2008, and was
administered in the Department of Commerce, Community & Economic
Development. He described that this database listed the
patients and the "doctors who are licensed to issue opiate-type
painkillers." He declared the intent of the proposed bill was
for the database to be checked before a prescription was filled,
as these drugs were "just as addictive in the long run as their
on-the-street brothers, heroin and opium." He reported that
this problem was growing in Alaska and across the rest of the
U.S. He said that these prescriptions were initially taken for
pain management, but that the dosages were being increased. He
pointed out that the definition in Version C, 120 mg of morphine
equivalent, would be the standard.
3:17:21 PM
MR. POUND shared that Version C also included language for
maintenance methadone users, those who were addicted to drugs
but were enrolled in a "clean-up process" in clinics. He
acknowledged that, although these did not fall into the
guidelines of pain management, it was necessary to have
communication between the methadone clinics and the primary care
physicians. He shared that the proposed CS added some
exemptions to pain management programs, including an "end-of-
life situation." He pointed out that, with Version C, there was
now a four week window before pain management consultation was
required for opiate pain killer prescriptions.
3:19:47 PM
REPRESENTATIVE TARR asked if there would be testimony from the
boards mentioned earlier.
MR. POUND replied that there would not be testimony from the
boards today.
3:20:30 PM
REPRESENTATIVE SEATON directed attention to Version C, page 3,
line 3, and asked for more information.
MR. POUND replied that this new language was added to existing
language and would ensure that the medical professionals check
with the Alaska Prescription Drug Monitoring Program database to
avoid prescription of additional pain medication to individuals
already receiving them.
3:21:18 PM
REPRESENTATIVE SEATON asked to identify the four week exclusion.
MR. POUND replied that this was included in the general
language.
3:21:47 PM
REPRESENTATIVE KELLER offered his belief that there would be
testimony about the aforementioned database from the providers,
as it was a relatively new system in Alaska. He reported that
the database had been paid for with federal funding. He
explained that Version C listed the database use requirements
for each medical provider, which made parts of the bill appear
repetitive.
3:23:09 PM
MR. POUND, in response an earlier question regarding the four
week window from Representative Seaton, directed attention to
page 3, line 10 of Version C.
3:23:30 PM
REPRESENTATIVE SEATON asked to clarify that, although the
consultation was after four weeks, failure to complete a
required check of the data base for any level of pain medication
prior to prescription could result in a revocation, suspension,
or reprimand for the provider's medical license.
MR. POUND expressed his agreement.
REPRESENTATIVE SEATON opined that this was not a workable
solution, and he offered his belief that funding for the
database would expire in August, 2013. He asked if there was a
fiscal note to expand or extend the database.
3:25:13 PM
MR. POUND expressed his anticipation that there would be a
fiscal note for the continuation of the database.
3:25:37 PM
REPRESENTATIVE KELLER explained that there was a presumption
that the database would continue to function, which was
incumbent on funding by Department of Commerce, Community &
Economic Development.
3:26:13 PM
MR. POUND, in response to a question from Representative Tarr,
said that he would try to get representatives from all the
aforementioned boards to testify.
REPRESENTATIVE TARR directed attention to the definition of
opiate in statute, and suggested that this was an opportunity to
align the language in the proposed bill more specifically with
the definition.
MR. POUND read: "opiate means (a) a substance having an
addiction forming and addiction sustaining capability similar to
morphine or being capable of conversion into a drug having
addiction forming or addiction sustaining capability."
3:27:54 PM
REPRESENTATIVE TARR suggested an alignment of the definitions to
alleviate any uncertainty in Version C.
3:28:11 PM
CHAIR HIGGINS, directing attention to page 3, line 3, noted his
background in the health profession as a dentist, and suggested
that the pharmacists initiate the search on the database.
3:29:26 PM
REPRESENTATIVE SEATON mentioned that of the 18 pain management
specialists in Alaska, only 4 were outside of Anchorage. He
questioned whether these specialists would qualify according to
the definition in Version C, page 4, line 23. He noted that
Version C did not ensure that a currently licensed pain
management specialist would qualify under the proposed bill as
new regulations would be adopted. He expressed his concern that
there would be sufficient certified pain management specialists
in Alaska.
3:31:52 PM
REPRESENTATIVE KELLER expressed his belief that there would be
more qualified specialists than currently, as each of the
medical boards would list standards for pain management
specialists that would include these minimum qualifications
listed on page 4, line 23.
3:32:57 PM
CHAIR HIGGINS opened public testimony.
3:33:29 PM
The committee took a brief at-ease.
3:34:48 PM
CHAIR HIGGINS brought the committee back to order.
3:35:05 PM
PATRICIA SENNER, Interim Director of Professional Practice,
Alaska Nurses Association, stated that proposed HB 53 was
fashioned after the far more extensive regulations developed by
five State of Washington boards and commissions. She noted that
the referral requirement was only one provision of the pain
management regulations that were addressed by that group and
that there were specific guidelines for assessment of patients
with chronic pain, which included a pain plan. She said that
the State of Washington did not require a referral to the data
base, as it was not yet reliable enough. She suggested that, as
nurse anesthetists were involved in pain management in Alaska,
this group should also be included in the proposed bill. She
expressed three concerns with the proposed bill: how can a
required referral be made, as it currently takes months for an
appointment with a pain management specialist; how could pain
management specialists conduct telephone consultations for
controlled substances with rural regions; as 11 of the 18
current pain management specialists were anesthesiologists,
there would be a need for nurse anesthetists. She expressed
that, as the proposed bill included exemptions for palliative,
hospice care, and end of life care, it also recognize non-
terminal cancer patients, and she asked for cancer patients to
be excluded. She opined that, as the prescription drug data
base was new, it often lagged real time in its display of data,
and it could be difficult to access from rural areas. She
offered her belief that the data base was not yet ready to be a
requirement, and she suggested that the aforementioned boards
propose some pain management guidelines and regulations.
3:39:45 PM
REPRESENTATIVE SEATON asked if doctors in the State of
Washington were no longer accepting pain management patients
because of the complex regulations.
MS. SENNER said that she had also heard this, especially for
general practitioners.
3:41:00 PM
LEON CHANDLER, MD, said that the American Association of Pain
Management had asked him to testify, although he was not a
member of the association. He reported that he had started pain
management in 1988 in Alaska, and that the complications were
onerous in the best of circumstances. He offered his help with
the proposed bill, but he expressed his concern for the
unintended consequences throughout Alaska. He acknowledged that
at least four pain management doctors would not see any patients
who required medical management for pain control. He declared
that the problem was with those individuals who were drug
seeking. He stated that he had worked with the Drug Enforcement
Agency and he pointed to the difficulty for enforcement of these
regulations. He directed attention to the three pedestals
required to manage these problems: the prescribing physician,
the pharmacy, and the regulatory agency. He noted that there
was no longer a Drug Enforcement Agency official in Alaska. He
declared that, although the goals of the proposed bill were
admirable, there was the need for a mechanism to measure the
goals for their impact on the intent of the bill. He
recommended inserting a sunset clause in the proposed bill, in
case the bill proved to be more of a hindrance than a help. He
predicted more difficulties when primary care physicians would
no longer write prescriptions. He affirmed that a goal of the
medical community was to care for the public. He offered his
belief that addictive medications could blend into chemical
dependency, and not just addictive personalities. He suggested
that the proposed bill be closely scrutinized before it was
passed as it could influence the medical care system in Alaska.
3:46:07 PM
EMILY NENON, Alaska Government Relations Director, American
Cancer Society Cancer Action Network, commented that there were
many pieces of this complex issue which needed to be addressed.
She highlighted that cancer related pain for long term cancer
survivors could be chronic, and it could be necessary for
opiates to maintain a quality of life, even when there was not
active treatment for cancer.
3:47:29 PM
JUDITH DEARBORN, President, Alaska Association of Nurse
Anesthetists, offered some background on certified registered
nurse anesthetists (CRNA), describing them as a "type of advance
practice registered nurse, prepared at the masters or doctoral
level with specialized education in anesthesia and pain
management." She reported that, although Alaska statute
recognized CRNAs as "nurse anesthetists," the Alaska Board of
Nursing recognized this group of 99 currently active members in
Alaska as "certified registered nurse anesthetists." She
pointed out that, of the nine Alaska boroughs with anesthesia
services, four had anesthesia only provided by CRNAs. In rural
communities with CRNAs providing the only available pain
management, it would be much more costly for patients to travel
elsewhere for service from other providers. She directed
attention to the November 1, 2012 directive from the Centers for
Medicare and Medicaid Services (CMS) which ruled that, as of
January 1, 2013, chronic pain management service provided by
CRNAs would be eligible for reimbursement for all authorized
Medicare services performed under the specific state law and
scope of practice. She reported that the Medicare program in
Alaska had approved chronic pain management services as within
the scope of practice by CRNAs in Alaska. Directing attention
to Version C, page 8, line 16, she requested that "nurse
anesthetist" be replaced by "certified registered nurse
anesthetists."
3:50:57 PM
ANNA NELSON, Executive Director, Interior AIDS Association
(IAA), said that her organization supported the efforts to curb
the abuse and over prescription of opiates. She reported that
her program was one of two methadone programs in Alaska, and
treated people "with long term, chronic addiction to opiates."
She stated that the requirement for consultation with primary
care providers in proposed HB 53 did "not acknowledge the
reality of much of the addict population, most of whom have no
health insurance and hence no primary provider." She remarked
that some primary care providers had contributed to the initial
addiction, whether well-meaning or negligent. She suggested
removal of the consultant requirement from the proposed bill, as
its passage would create a major barrier to treatment for opiate
addiction. She offered her belief that it contradicted some of
the efforts to curb prescription drug abuse. She clarified that
methadone, when administered in a supervised treatment program,
was tightly regulated and initial treatment dosages were limited
by federal regulations. As federal regulations required that
the initial dosage be no more than 30 mg, this would make it
difficult for a primary care physician to establish a base line
dosage. She said that patients were seen by the program almost
daily, were tested for other drugs, and were required to
participate in counseling and education to help change their
lives. She suggested that the primary care providers consult
with the addiction trained medical professionals, pointing out
that methadone programs were required by federal law to be
licensed, accredited, and registered. She noted that the
methadone programs were also closely monitored by the State of
Alaska's Division of Behavioral Health. She concluded by
stating that the proposed bill did not add accountability and it
interfered with the treatment for addiction.
3:54:08 PM
REPRESENTATIVE SEATON asked for clarification of her reference
to a 30 mg equivalent, and how that related to the proposed
bill.
MS. NELSON, directing attention to Version C, page 14, line 5,
said that the consultation by a health care professional with
the patient's primary care provider was meaningless, as federal
regulations had determined the initial dosage to be 30 mg, which
would then be slowly adjusted by the physician from the
methadone program to meet the needs of the patient.
3:55:39 PM
LARRY STINSON, M.D., Advanced Pain Centers of Alaska, offered
his support in principle to proposed HB 53. He suggested that
treatment programs and cancer programs be exempt from these
requirements. He stated that there was a "true problem
nationwide and in the state with overprescribing and overdose of
narcotics. It's the number one accidental killer of people in
the country, ahead of motor vehicle accidents." He pointed out
that an equivalent to 120 mg of morphine was a significant
amount of medication. He reported that, of his several thousand
patients, only a handful received an equivalent amount of
medication, and only for very specific circumstances. He
expressed concern that any physician would feel "shackled" by
this legislation, and he questioned their practice. He reported
that certification as a pain specialist required many years of
training and practice. He applauded the intentions of proposed
HB 53. He referred to an upcoming report from the State of
Washington, which stated that 85 percent of the primary care
providers were very satisfied with similar State of Washington
legislation that limited prescriptions to an equivalent of 120
mg of morphine. He added that the data also reflected a
decrease in suicides, emergency room deaths, and domestic
violence. He observed that some aspects of the proposed bill
did need modification. He declared that there was a serious
problem, and it was not appropriate to ignore this problem. He
offered his belief that proposed HB 53 "goes a long way" toward
protecting the public.
3:59:51 PM
REPRESENTATIVE SEATON asked for suggestions to improve the bill
as it was written. He directed attention to Version C, page 3,
line 3, and asked if this language should be modified.
4:00:59 PM
DR. STINSON, in response to Representative Seaton, opined that
the current language would be cumbersome as written, and would
be difficult to perform. He questioned whether the data base
was currently reliable enough "to make it worthwhile." He
offered his belief that, for patients exceeding the 120 mg
equivalent threshold, it would be appropriate to check the data
base monthly. He said that the daily use of 180 mg equivalent
increased the risk for death, so it would be beneficial to check
for any other prescriptions.
4:02:32 PM
REPRESENTATIVE REINBOLD asked that Dr. Stinson submit written
testimony.
4:03:42 PM
REPRESENTATIVE TARR, referring to testimony that prescription
overdose was the number one killer, asked if this was the result
of an individual receiving prescriptions from several providers,
or overusing a single prescription.
4:04:22 PM
DR. STINSON replied that patients often become so tolerant of
medication that the dosage was continually increased to gain the
benefits. He reported that there was not the same tolerance for
the side effects to opioids, which could include respiratory
depression.
4:05:47 PM
REPRESENTATIVE REINBOLD asked to clarify that there would be
withdrawal treatment available should the proposed bill limit
prescriptions to 120 mg equivalents of morphine.
DR. STINSON said that he would often taper medication for
patients. He noted that the University of Washington had an
access telephone line with pain experts to give guidance for the
tapering of pain medication regimens. He expressed his support
for the methadone clinics.
4:07:12 PM
REPRESENTATIVE SEATON asked what the optimum prescription dosage
was to require a check of the database.
DR. STINSON replied that, based on the State of Washington
epidemiologic data, it would be appropriate for prescriptions of
120 mg equivalents of morphine to be checked monthly on the data
base as this was the point "where bad things started happening
in increasing frequency." He declared that acute pain and
chronic pain were "two different things." He explained that
pain medication following major surgery could be waived, but
that ongoing use of opioid medications should be monitored.
4:10:20 PM
REPRESENTATIVE NAGEAK relayed his own experiences with pain and
how he managed it. He extolled the need to keep moving. He
acknowledged the "high" feeling from medication, and the desire
to maintain this feeling.
4:12:49 PM
JAY CALDWELL, Medical Director, Narcotic Drug Treatment Center,
agreed with Ms. Nelson that the general idea of the proposed
bill was "headed in the right direction." He opined that there
had been a miscalculation in proposed Section 47.37.175 on page
14, line 5 of Version C. He stated that there were only two
health care professional categories for treatment. One category
was certified for office based opiate treatment for opiate
dependent clients, and the other category was at the federally
mandated and operated methadone clinics. He stated that no
other physicians in Alaska were authorized to treat drug abuse
by patients. He stated that pain management physicians and
family practice physicians do not treat drug dependence or
abuse. He noted that this proposed section only applied to
about 30 physicians, in addition to the 2 physicians at the
methadone clinics. He pointed out that the patients at the
methadone clinic "are an entirely different breed of patients
than in any kind of family or private practice." He said that
many of the patients had become opiate dependent as a result of
pain. He explained that the difference between dependence and
addiction was a behavioral statement. Individuals who were
addicted attempted to maintain opiate levels through anti-social
methods, whereas dependence was a chemical statement, not
everyone who was dependent was an addict, and not all addicts
were necessarily dependent. He said that many of the addicts at
the methadone treatment centers had been rejected, or felt they
had been rejected, by their physicians. He suggested an
elimination of the aforementioned proposed section. He
acknowledged that opiates were diverted in both private
practice, and in pain medicine clinics whereas, methadone
clinics only distributed methadone in a liquid, which was "very,
very, very carefully monitored." He reported that the clients
received methadone daily for the first three months. He
explained that the subsequent weekly dosage, which could be
taken from the clinic, was only allowable after extensive
social, psychological, and nursing evaluations. He pointed out
that regular, unannounced urine testing revealed any other
medications. He emphasized that the regulations for discussion
between the methadone clinic physicians and the primary care
physicians was "not even close to being appropriate and I'm sure
you will correct that." He expressed support for the remainder
of the proposed bill.
4:20:59 PM
REPRESENTATIVE KELLER asked to clarify that the two methadone
clinics should be exempt. He also asked if the methadone clinic
contacted a patient's primary care doctor.
DR. CALDWELL replied that the vast majority of the clients did
not have a primary care physician. He reported that the clinic
would coordinate an appointment with a physician, or the
Anchorage Neighborhood Health Center, for any detection of other
medical problems. He noted that the clinic insisted that any
pregnant women speak with an obstetrician or health care
provider. He offered his belief that the methadone clinics had
greater regulation, testing, and control than any others.
4:23:45 PM
BOB TWILLMAN, Director of Policy and Advocacy, American Academy
of Pain Management, stated that the American Academy of Pain
Management was opposed to proposed HB 53, although it was
sympathetic to the intent to provide "good care for people who
are on high dose, long term, opioid therapy." He expressed
concern that this method of intervention would not be workable,
would have unintended negative consequences, and, based on the
Academy's experiences with similar legislation in the State of
Washington, would not achieve the goal. He stated that numerous
reports suggested that primary care providers would no longer
provide pain medication. He offered his belief that this was
due to fear by primary care providers for lack of clarity for
the rules. He suggested studying the long term results in the
State of Washington prior to passing legislation. He pointed
out that there were "access problems for people with pain in
Washington." He briefed that pain specialists had expressed
concern that their appointments were filled with consultations,
with the referring primary care physicians assuming that the
pain specialist would take care of the patient. The pain
specialists declared that the primary care doctors would not
take the patients back. He suggested some other interventions,
including full funding of the prescription monitoring program, a
requirement that all dispensers of pain medication register to
access data from the program, and to allow delegates of the
dispensers to obtain the reports from the program. He suggested
that the monitoring program send unsolicited reports to
prescribers if any suspicious behavior was detected, and he
endorsed continuing education programs for prescribers about
pain management and substance abuse screening, diagnosis, and
treatment. He observed that a commission, task force, or
interim study committee would be a better alternative to
immediate legislation.
4:27:36 PM
REPRESENTATIVE REINBOLD asked that the proposed solutions be
submitted in writing.
4:27:59 PM
RON GREENE, Clinical Director, Narcotic Drug Treatment Center,
shared that there had been not been an overdose in this
methadone program, which he attributed to the regular,
unscheduled urine tests. He declared that the majority of
people take prescriptions as prescribed; however, there was a
portion of the population that had problems with addiction to
medication.
4:28:59 PM
REPRESENTATIVE KELLER asked about the largest methadone dosage
prescribed in the program.
MR. GREENE replied that the initial dosage was 30 mg, but this
dosage could be increased after consultation if there were still
signs of withdrawal. He declared that there was not a limit to
the amount of methadone. In response to Representative Keller,
he pointed out that there was always a risk for death with
prescription medication, but since inception of the program in
1974, he had not heard of any overdose deaths in the program.
He declared that about 10 percent of the methadone deaths
occurred after the initial dose, hence the federal regulations
limiting this to 30 mg.
4:31:30 PM
BARRY CHRISTENSEN, Alaska Pharmacist Association, said that
pharmacists filled narcotic prescriptions daily, and as these
reports were then submitted each month to a central data base,
the posted data would be at least a month old. He expressed
concern that proposed HB 53 would require pharmacists to check
the data base for every opioid prescription, which included
cough syrup and pain pills. He questioned the procedure should
the website not be operating or the pharmacy not have internet
access. He asked about continued funding for the data base
program. He asked that the Alaska Board of Pharmacy be involved
with the writing of the regulations regarding pharmacists.
4:33:54 PM
REPRESENTATIVE REINBOLD asked if the governor had budgeted any
funding for this program.
MR. CHRISTENSEN replied that he did not know.
4:34:13 PM
REPRESENTATIVE SEATON, referring to Version C, page 13, line 25,
asked if his association had any comment for making this a
mandatory program and its effect.
MR. CHRISTENSEN replied that, as Version C had just been
released, there had not been any discussion. He said that
although he used the data base whenever he had a concern, the
association was also concerned with a requirement to check on
every opiate prescription.
4:35:59 PM
CHAIR HIGGINS left public testimony open.
4:36:23 PM
REPRESENTATIVE SEATON asked that the sponsor review page 13,
line 28, "or providing medical care to a person," for any
unintended consequences.
4:37:29 PM
REPRESENTATIVE KELLER, in response to Representative Tarr, said
that, as the sponsor for proposed HB 53, he would accumulate all
the suggestions in a proposed blank committee substitute.
4:38:15 PM
CHAIR HIGGINS expressed his agreement.
[HB 53 was held over.]
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB053 Sponsor Statement.pdf |
HHSS 1/31/2013 3:00:00 PM HHSS 3/26/2013 3:00:00 PM |
HB 53 |
| HB053 Ver A.pdf |
HHSS 1/31/2013 3:00:00 PM HHSS 3/26/2013 3:00:00 PM |
HB 53 |
| HB053 CSHB Ver C.pdf |
HHSS 1/31/2013 3:00:00 PM HHSS 3/26/2013 3:00:00 PM |
HB 53 |
| HB053 Sectional Analysis - CSHB-C .pdf |
HHSS 1/31/2013 3:00:00 PM HHSS 3/26/2013 3:00:00 PM |
HB 53 |
| HB053 Fiscal Note-DCCED-CBPL-01-24-13.pdf |
HHSS 1/31/2013 3:00:00 PM HHSS 3/26/2013 3:00:00 PM |
HB 53 |
| HB053 Fiscal Note-DHSS-MAA-1-25-13.pdf |
HHSS 1/31/2013 3:00:00 PM HHSS 3/26/2013 3:00:00 PM |
HB 53 |
| HB053 Supporting Documents - InteriorAidsLetter 20130128.PDF |
HHSS 1/31/2013 3:00:00 PM HHSS 3/26/2013 3:00:00 PM |
HB 53 |
| HB053 Background - Alaska Opioid Prescribing Policies.pdf |
HHSS 1/31/2013 3:00:00 PM HHSS 3/26/2013 3:00:00 PM |
HB 53 |
| HB053 Background - What are Opiates.pdf |
HHSS 1/31/2013 3:00:00 PM HHSS 3/26/2013 3:00:00 PM |
HB 53 |
| HB053 Background - What is Prescription Drug Abuse.pdf |
HHSS 1/31/2013 3:00:00 PM HHSS 3/26/2013 3:00:00 PM |
HB 53 |
| HB053 Background - Opiate Addiction.pdf |
HHSS 1/31/2013 3:00:00 PM HHSS 3/26/2013 3:00:00 PM |
HB 53 |
| HB053 Background - Opiate Definition.pdf |
HHSS 1/31/2013 3:00:00 PM HHSS 3/26/2013 3:00:00 PM |
HB 53 |
| HB053 Background - Nonmedical Use of Opiates.pdf |
HHSS 1/31/2013 3:00:00 PM HHSS 3/26/2013 3:00:00 PM |
HB 53 |
| HB053 Background - Substance Abuse in Alaska.pdf |
HHSS 1/31/2013 3:00:00 PM HHSS 3/26/2013 3:00:00 PM |
HB 53 |