Legislature(2013 - 2014)CAPITOL 106
03/26/2013 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 | |
| + | TELECONFERENCED |
HB 53-CONSULTATION FOR OPIATE PRESCRIPTION
3:05:23 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." [In front of the committee was Version
28-LS0177\C, adopted as the working document on January 31,
2013.]
3:05:31 PM
REPRESENTATIVE REINBOLD moved to adopt the proposed committee
substitute (CS) for HB 53, labeled 28-LS0177\Y, Martin, 3/25/13,
as the working document. There being no objection, it was so
ordered.
3:05:53 PM
REPRESENTATIVE KELLER, as the sponsor of proposed HB 53, said
that he appreciated the careful consideration by the committee
and that he hoped to move the bill out of committee this
session. He directed attention to the two letters in opposition
to the proposed bill. [Included in members' packets] He
expressed his respect for both the groups, and declared that he
wanted to resolve these differences, and move the proposed bill
forward.
3:07:34 PM
CHAIR HIGGINS asked that Representative Keller address the
changes in the proposed CS, Version Y.
REPRESENTATIVE KELLER, in response, said that there had been
some misunderstanding based on the original document, Version A.
He asked to first address the opposition to hopefully clarify
some of these concerns.
REPRESENTATIVE KELLER, in reference to the letter in opposition
to proposed HB 53 from the Pharmaceutical Research and
Manufacturers of America (PhRMA) [Included in members' packets],
said that PhRMA shared his concern with "the growing non-medical
use of prescription drugs." He clarified that this, however,
was not the intent of proposed HB 53, as the bill was focused on
the legal use or misuse of prescription drugs, although it did
indirectly address the illegal abuse. He expressed his
agreement with the statement in the letter, "PhRMA believes that
all participants in the drug manufacturing and distribution
system must participate in the efforts to reduce the abuse of
prescription drugs." He stated that the direct intent of the
proposed bill was to address medical use and the resulting
addictions. He directed attention to the reference in the
letter to the State of Washington legislation, which had created
a difficulty for patients to access pain treatment. He stated
that there was "raw evidence" that the addiction problem was
increasing. He asked that PhRMA reconsider its concerns,
especially for the shortage of pain specialists in Alaska, which
he declared had been addressed in Version Y. He pointed to page
3, paragraph 1, of the opposition letter, which read:
"Therefore, education about the possibility of addiction and how
to work with patients to prevent addiction would be much more
beneficial." He declared that this was a goal of proposed
Version Y. He stated that there was now a lot of information
on-line. He directed attention to another letter of opposition,
and expressed agreement that there had been an oversight in the
original bill, Version A, but that this had now been addressed.
3:12:08 PM
JIM POUND, Staff, Representative Wes Keller, Alaska State
Legislature, explained that Version Y corrected changes that had
been "inadvertently missed" in the previous working document.
He noted some of the changes included in Version C: page 3,
line 3, a medical professional could designate a member of staff
to check the database, and the language "or more" was added to
the milligrams of morphine equivalent; page 3, line 12, changed
from four weeks to six weeks after major surgery as this was a
more realistic time frame; page 4, line 27, allowed the
controlling boards to write regulations to administer pain
management in each of their areas of expertise; page 4, line 30,
allowed the individual boards to determine the continuing
education requirements for a pain management specialist; page 7,
lines 14 and 17, added "or more"; page 8, line 1, changed
language for end of life care and the need for larger doses of
opiates for a longer period of time for cancer patients; page 8,
[line 18] used language in existing statute to define nurse
anesthetist; page 9, line 28, explained the guidelines of
regulations for nurse practitioners and anesthetists; page 13,
[line 2] listed grounds for denial; page 14, [line 12] included
failure to check the database; and pages 16 and 17 included
requirements for the methadone clinics. He noted that the
clinics were not included as pain management specialists, were
required to provide their patient information to the database
for access by local emergency rooms, and would require that the
physician in charge of the methadone clinic act as a primary
care physician for any methadone program patient without a
primary care physician.
3:18:37 PM
REPRESENTATIVE SEATON, referring to page 3, lines 11 and 12,
offered his belief that the proposed bill only applied to a
patient after 6 weeks, and he asked if there was any application
to the patient prior to this time period.
MR. POUND expressed his agreement that there was not application
until that point.
REPRESENTATIVE SEATON pointed to the exclusions on page 3, lines
24, 26, 27, and 30, and to page 4, line 3, as well as other
areas in the proposed bill, and asked to whom the proposed bill
would apply.
3:21:00 PM
MR. POUND, in response, said that there were situations and
individuals who took more than 120 mg/day of opiates for pain
relief, and that the proposed bill would let the medical
professionals make the decision for the necessary dosage and for
the necessity for consultation with the pain management
specialist.
3:22:29 PM
REPRESENTATIVE SEATON, pointing to all the exemptions, asked
about the scope of patients included under the proposed bill.
3:23:56 PM
REPRESENTATIVE KELLER explained that the proposed bill was
attempting to accommodate all the interests in the medical
profession, and that the remaining patients were those on an
increasing dosage of pain medication opiates and were in danger
with a risk to their life. He stated that a dosage above 120
mg/day increased the risk for death and that the proposed bill
applied to those people "inadvertently being lead into the trap
of addiction."
3:25:34 PM
REPRESENTATIVE SEATON asked how often that dentists were
prescribing more than six weeks of opiate drugs to Alaskans in
the aforementioned category.
REPRESENTATIVE KELLER suggested that he ask the dentists, and
that this was the intent of the new database.
3:26:34 PM
CHAIR HIGGINS, in response as a dentist, explained that a high
dosage of opiates for a long period of time was necessary for
pain management of temporomandibular joint disorders, and that
most of these patients were referenced to oral surgeons.
REPRESENTATIVE SEATON stated that he was seeking to understand
the breadth of the problem.
CHAIR HIGGINS, in response as a dentist, said that he might see
one or two of these patients each year, and he suggested
multiplying that by the number of dentists in Alaska. He
pointed out that once he had done whatever he felt possible, he
would then recommend the patient for surgery. He stated that
occasionally pain management was the only solution.
REPRESENTATIVE SEATON commented that he would like to get an
idea of the extent of this problem within all the medical
professions.
3:29:26 PM
REPRESENTATIVE KELLER suggested that Representative Seaton ask
the Department of Health and Social Services.
REPRESENTATIVE REINBOLD opined that "this is a tough issue to
talk about because we're not experts." She stated that she did
not "want to shackle providers, yet, I am really concerned.
I've heard of many cases out in the community where kids'll
break their leg skiing and end up getting addicted to these."
She declared it to be a serious issue. She expressed her hope
that the bill had not been so watered down as to not be
effective, and she offered her belief that the six week time
period was a long time. She asked for expert, well rounded
testimony that could also offer other options to discourage the
use of opiates.
3:30:46 PM
REPRESENTATIVE TARR asked the sponsor if he would seek
adjustments to the fiscal note if the database was not funded.
REPRESENTATIVE KELLER replied that the database was, overall, a
very useful tool and that the database was in danger from lack
of funding. He shared that he had not chosen to offer a bill to
include funding for the database, offering his belief that the
use of the database was broader, bigger, and more important than
the proposed bill. He declared a need for the legislature to
address funding for the database.
3:32:24 PM
CHAIR HIGGINS pointed out the importance of the database to the
proposed bill. He stated that, should funding for the database
disappear, the proposed bill was negated. He shared that
funding for the database would be terminated on June 30, 2013,
and that he was not aware of any proposal to continue funding.
He suggested that Representative Keller table the proposed bill
until funding for the database could be obtained, opining that
this was bad legislation without the database, and that funding
for the database could be difficult.
REPRESENTATIVE KELLER replied that he would prefer to have the
proposed bill moved forward, as it brought more awareness for
the significance of the database. He affirmed that he did not
view a hold on the proposed bill as a hostile act.
3:34:18 PM
REPRESENTATIVE SEATON directed attention to page 3, line 5, and
asked when these grounds for discipline would go into effect.
3:36:08 PM
REPRESENTATIVE KELLER expressed his agreement that some
clarification language could be necessary. He opined that the
intent was to not indiscriminately prescribe medication without
knowledge of the current prescription dosage levels for the
patient. He stated that a patient under the care of a physician
could have good reason for long term dosage for pain management.
He offered his belief that there should be a consequence to the
treating physician if a high dosage was prescribed without
checking the database.
3:37:23 PM
REPRESENTATIVE SEATON asked to clarify that consultation with a
pain management specialist was required for any usage more than
six weeks; and, if you were a dentist, it was necessary to check
the controlled substance prescription database, although he was
unsure what was to be verified in the database.
3:38:05 PM
CHAIR HIGGINS clarified that this database check would be
required for all health care providers, although page 3 of the
proposed bill only referenced dentists.
CHAIR HIGGINS explained that the database was key to the
proposed bill, and that his understanding for the intent of the
proposed bill was for the health care provider to check the
database to ensure that the patient was not already receiving a
prescription of more than 120 mg/day of opiate from another
provider. He clarified that this was not limited to a database
check after six weeks. After six weeks of prescription, it
became necessary for the patient to confer with a pain
management specialist before any more prescription could be
written.
REPRESENTATIVE KELLER expressed his agreement.
CHAIR HIGGINS directed attention to page 10, line 8, which
offered regulations which defined procedures for board approval
of advanced nurse practitioners and nurse anesthesiologists as
pain management specialists. He asked how it would be
guaranteed that 30 percent of a practice was for pain management
care, as stated in the proposed bill. He also asked how it had
been determined that 30 percent was the optimal amount of time.
3:40:25 PM
MR. POUND replied that, as many medical professionals worked 30
percent of their time in pain management, this had been adopted
as the benchmark.
CHAIR HIGGINS asked how it had been determined that these
medical professionals worked 30 percent of their time in pain
management.
MR. POUND offered his belief that this was in response to
questions from the [state] medical board.
REPRESENTATIVE KELLER declared that the intent of the sponsor
was to give discretion to the various boards to set "appropriate
and responsible levels." He directed attention to page 10, line
5, which discussed continuing education "in an amount specified
by the board." He declared that this was a good faith effort
for the various boards to adjust the appropriate levels of
training, in order to stop the increase of addiction related to
opiates.
3:41:57 PM
REPRESENTATIVE SEATON stated that he was unclear for the intent
of page 10, lines 8-9. He directed attention to page 9, line
28, which allowed the board "to adopt regulations to define the
procedure for the board to approve" a nurse anesthetist or
advanced nurse practitioner as a pain specialist; yet, moving on
to page 10, lines 1-5, he pointed out that it was also necessary
to obtain a certification in pain management from an accredited
agency, with a minimum of three years of clinical experience in
pain management, and to receive continuing education. He asked
the reason for all of the above to be denied if a person was not
in a practice which consisted of 30 percent of pain management.
REPRESENTATIVE KELLER suggested that Representative Seaton ask
the professionals.
3:43:53 PM
The committee took an at-ease from 3:43 p.m. to 3:47 p.m.
3:47:27 PM
CHAIR HIGGINS brought the committee back to order.
3:47:51 PM
MARJORIE POWELL, PhRMA, announcing that she represented the
pharmacists, asked to make some additional points, beyond those
addressed in the PhRMA letter titled, "In Opposition of Alaska
House Bill 53, March 26, 2013," which is included in members'
packets. She said that PhRMA was concerned whenever anyone
abused prescription medicine, especially when those patients who
had temporary or permanent pain became addicted and abused
medication. She explained that some chronic pain was treated
with stable doses of medications, although, over time, patients
could need increased dosages. She declared that PhRMA was
concerned that there had not been consistent provider education
to identify those individuals with a tendency toward addiction,
and to offer an alternative treatment to prevent the development
of addiction. She relayed that PhRMA had worked with groups to
develop provider educational material for all health care
professionals who prescribe potentially addictive medications.
She declared the importance for the ability to prescribe,
identify, and work with these medications. She pointed out that
there were techniques which could be applied by a general
practitioner. She declared that PhRMA supported the National
Governors Association, which, when reviewing the abuse of
prescription drugs, had determined the importance for
educational materials to all health care providers. She
recommended that, as Alaska only had 18 accredited pain
specialists, there should be a more general requirement for all
health care providers to obtain educational training and
techniques for identification and interaction with those
patients at risk of addiction. She pointed out that many
Alaskans would not have access to pain specialists. She
reported that the pharmaceutical industry was researching abuse
resistant formulas for medications.
3:54:12 PM
MS. POWELL said that states with operating databases which were
accessible to medical providers other than the prescribers had
determined this "to be very helpful in identifying patients who
may be, in fact, coming to a doctor just to try and get the pain
medication." She declared that one of the problems for
databases in many states was that Veterans Affairs data was not
currently included as federal regulations prohibited the release
of this data. She noted that there was an effort to adjust this
regulation. She emphasized the necessity for funding the
database and for a regular update to the information. She
extolled the benefit for offering more continuing medical
education on long term pain to all health care professionals.
She shared a personal anecdote about her family members with
chronic pain, noting that this legislation would require all of
them to see a pain specialist, necessitating very difficult and
painful travel.
3:58:18 PM
LESLEY DEJARAY, Nurse Practitioner, said that she wanted to
share the realities of working as a nurse practitioner in rural
Alaska. She explained that the services in the region were
limited, and that the majority of service was in Anchorage. She
pointed to the six week requirement in the proposed bill, and
stated that a referral request would not even be scheduled in a
foreseeable time span. She noted that the usual time frame for
a scheduled appointment with a specialist was about twelve
weeks. She expressed her support for the database.
4:01:09 PM
PATRICIA SENNER, Alaska Nurses Association, expressed her
gratitude for the inclusion of nurse anesthetists to the
proposed bill, as they were commonly the pain management
specialists. She declared her agreement with many of the points
made by PhARMA. She reported that the Alaska Nurses Association
was in support of the prescription drug monitoring system. She
stated that each person accessing the database should have their
own access code. She suggested that the financing for the
database be split between the licensing fees and a public
protection department.
4:03:48 PM
REPRESENTATIVE SEATON asked if she would support inclusion of
the provision requiring that 30 percent of a current practice
was in pain management care, or would the provision for
accredited certification as a pain management specialist, three
years of clinical practice, and continuing education be
sufficient.
MS. SENNER replied that, as the role of nurse anesthetists would
often only have 10 percent of its practice in pain management
care, she would support elimination of this requirement.
4:05:21 PM
CHAIR HIGGINS expressed agreement for the importance of the
database, although he would not support an increase to his
dental professional fees.
4:05:55 PM
JOE CHANDLER, M.D., AA Spine & Pain Clinic, reported that he had
shared the proposed bill with other providers, including those
in his clinic, and asked for their feedback. He emphasized that
he had not received any good responses, and he pointed to 50
problems in the bill. He questioned the unexpected consequences
from the proposed bill, and, pointing to similar problems which
resulted after passage of a similar bill in the State of
Washington, stated that these problems needed to first be
resolved. He emphasized that the proposed bill needed a sunset
clause, as there was not any secure database funding. He
declared that the proposed bill should not be passed out of
committee.
4:08:53 PM
REPRESENTATIVE KELLER asked Dr. Chandler for his determination
to whether there was a problem with addiction and abuse of
opiates, and if so, would a solution best be addressed through
the use of a prescription database. He asked if there were any
other creative solutions.
4:10:02 PM
DR. CHANDLER offered his belief that the regulation of people
was difficult. He expressed his agreement with the problem of
addiction to prescription drugs, and he declared that the
database was very important. Regarding addiction, he explained
that 2 percent of the population was genetically programed
toward addiction, which he deemed to be quite rare. He noted
that those with mental health issues were "all thrown onto the
streets fifty years ago. We have no mental health care in the
country now, and that's why we have such a homeless problem."
He declared that all the people on the street with chronic pain,
cancer, and other medical issues needed care. He declared that
an obligation of medicine was to take care of people, and that
the proposed bill could become another "insane... medical care"
regulation, especially without a sunset clause to get rid of it.
4:12:24 PM
REPRESENTATIVE REINBOLD expressed her concern with opiate
addiction, and said "I've even heard about it in kids, ya know,
just breaking their leg." She declared that she did not "want
to shackle the providers" but there was a need to address the
opiate issues. She offered her belief that the first line
providers did not understand the long term consequences and
effects to families and communities. She expressed her belief
for mandatory continuing medical education (CME) for providers.
DR. CHANDLER, in response, said that "common sense is not very
common." He offered an example of several patients in rural
Alaska who all took medications over 120 mg. He was able to
consult with them using Skype, whereas the regulations required
a face-to-face meeting with the primary care provider. He
declared that these face-to-face meetings were not feasible for
patients in rural Alaska, other than through Skype or some
similar communication. He expressed concern for unenforceable
and unintended consequences from the proposed bill. He
questioned how people could get the three years of experience
necessary to be a provider. He declared that people without
access to pain providers would have problems. He announced that
it was not possible to regulate common sense. He reported that
the current educational curriculum in medical schools for pain
management was less than one week. He asked what would be used
to measure the effects of the proposed bill. He reported that,
as the recidivism rate for addicts was between 92-96 percent,
there was little funding and the problems would not be resolved
quickly.
4:17:38 PM
REPRESENTATIVE REINBOLD asked Dr. Chandler to "send us a list,
if you could help us salvage this bill; if not, if you could
help us solve this problem." She suggested mandatory CMEs, or
fundraising for the database.
DR. CHANDLER affirmed that it was "a very good thing you're
trying to do." He pointed out that his medical practice was for
chronic pain, and that addiction was a much more difficult issue
to deal with. He opined that, of his 7,000 active patients, at
least half had medication dosages in excess of those referenced
in the proposed bill. He reported that his patients, once
referred to his clinic, would never return to their primary
physician, thereby consigning to his clinic the responsibility
for primary care, as most of the patients received Medicare or
had no ability to make payments. He pointed out that the
problem was far more extensive than merely solving "the problem
of kids that are addicted." He declared that addiction was a
problem throughout the country, and that he did not have any
answers.
4:19:38 PM
REPRESENTATIVE SEATON asked if Dr. Chandler would forward to the
committee the suggestions he had collected.
DR. CHANDLER agreed to summarize and then submit them.
4:20:17 PM
DR. CHANDLER, in response to Representative Tarr, said that
almost 100 percent of his patients with pain medications in
excess of 120 mg/day were under long term care management.
4:21:33 PM
REPRESENTATIVE KELLER, directing attention to page 5, line 10,
clarified that there were other means for becoming a pain
management specialist, and that this left broad discretion to
the board.
DR. CHANDLER replied that it had been suggested to him that a
pain specialist should have a minimum of 50 percent or more of
business in pain management.
4:23:48 PM
JUDITH DEARBORN, President, Alaska Association of Nurse
Anesthetists, expressed appreciation that nurse anesthetists and
nurse practitioners were included in the proposed bill. She
pointed out that nurse anesthetists were more practiced in acute
and chronic pain management.
4:25:42 PM
REPRESENTATIVE TARR asked if her association would now support
the proposed bill.
MS. DEARBORN, in response, said that although the association
had been most concerned with inclusion, it had concerns with the
proposed bill, emphasizing that the bill should be reviewed more
clearly and carefully.
4:26:30 PM
EVA STASSEN, Family Nurse Practitioner, American Association of
Nurse Practitioners, Alaska Nurse Practitioner Association,
reported that nurse practitioners in Alaska provided a lot of
primary care, especially in rural Alaska. She shared that they
had a lot of chronic pain patients. She pointed to the
difficulty of access to pain management specialists. She asked
how the specialists would be reimbursed for services, including
telephonic conversations. She asked if there was any data for
costs involved to implement the new programs. She acknowledged
a problem for the proposed bill with the loss of the database.
She affirmed that the database needed to be updated much more
often, and that there needed to be a separate sign on for each
designee. She asked who the designees should include. She
noted a conflict with the database rule to check the database
before prescriptions. She asked about the described penalties
for not checking the database, stating that this should not be
grounds for license revocation. She asked what would happen if
the treating prescriber did not agree with the recommendation of
the pain specialist. She asked if patients on a stable, non-
escalating dose for a long period of time would be grandfathered
in, or now be required to see a pain specialist. She asked what
was defined as a reasonable attempt to obtain a consultation.
She confirmed that there was a problem with abuse of pain
medications, and that the database was a good starting point.
4:33:15 PM
CHAIR HIGGINS asked who would be in control of the database.
4:33:47 PM
DON HABEGER, Director, Division of Corporations, Business, and
Professional Licensing, Department of Commerce, Community &
Economic Development, explained that his division raised the
licensee fees when an adjustment for a program was necessary.
He clarified that the prescription drug database was overseen by
the Board of Pharmacy, and that its federal grant funding would
be depleted on August 31, 2013, and that the Board of Pharmacy
would then be required to notice the legislature that the
funding would cease. He relayed that the database could then
become an unfunded mandate, although the Board of Pharmacy had
already informed his division that it did not wish to support
the database through licensing fees. He reported that
regulations for fee increases had determined that the cost could
not be shared across programs, but had to be self-funded by the
licensees. He concluded that, if there were no changes, the
database program would cease at the end of August.
4:36:27 PM
REPRESENTATIVE TARR asked if the database costs could be spread
across the licensing fees of the many health care providers
affected by this proposed bill.
MR. HABEGER replied that it would be necessary to change the law
to allow this, and, if possible, it would also require a
discussion with the remainder of the targeted licensees.
4:37:39 PM
REPRESENTATIVE SEATON directed attention to page 16, lines 9 and
12, and asked if this was irrelevant or illegal as federal
statutes required an initial baseline dosage of 30 mg. He
directed attention to page 16, line 27 of Version Y, which read:
"a health care professional who oversees the administration of
an opiate to a patient for treatment of drug abuse shall conduct
an in-person consultation with the patient's primary care
provider..." Noting that this consultation needed to be six
months after the start of treatment and every six months after
that, he observed that it was difficult to schedule these
interviews with a primary care provider, offering his opinion
that this was not a "workable scenario." He addressed page 17,
line 4, which offered an alternative to a primary care provider
for the patient screening, and he stated that this did not
exclude, or address, the requirements previously mentioned for
an in-person consultation.
4:40:41 PM
REPRESENTATIVE SEATON noted that other questions had been raised
regarding the sharing of data, in concern for compliance with
Health Insurance Portability and Accountability Act (HIPAA). He
shared that a question had also been raised for who had a
greater understanding, physicians or administrators, for the
prescribed dosages. He noted that this also required
consideration for the differences in treatment for drug abuse
and pain management.
4:42:20 PM
CHAIR HIGGINS left public testimony open.
[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 Y.pdf |
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 |
| HB053 Opposing Document - PhRMA.pdf |
HHSS 3/26/2013 3:00:00 PM |
HB 53 |