Legislature(2015 - 2016)CAPITOL 120
02/08/2016 01:00 PM House JUDICIARY
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| Audio | Topic |
|---|---|
| Start | |
| SB23 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | SB 23 | TELECONFERENCED | |
| + | HJR 19 | TELECONFERENCED | |
| + | TELECONFERENCED |
SB 23-IMMUNITY FOR PROVIDING OPIOID OD DRUG
2:40:14 PM
CHAIR LEDOUX announced that the only order of business would be
(S)CS FOR SENATE BILL NO. 23(JUD), "An Act relating to opioid
overdose drugs and to immunity for prescribing, providing, or
administering opioid overdose drugs."
CHAIR LEDOUX reminded the committee that the House of
Representatives decided that committees would not take
legislation unless it directly impacts the budget in the form of
revenue or budget bills. She opined that SB 23 is the one
exception to that decision because this bill is important and
with every day of delay a life may be lost.
[Audience applause]
2:42:03 PM
SENATOR JOHNNY ELLIS, Alaska State Legislature, advised that
Representative Lynn Gattis is a cross-sponsor on SB 23, and she
would like to testify under public testimony. He offered his
appreciation to those working behind the scenes, including Chair
LeDoux who made certain this bill would be heard today, and he
extended that her actions transcend politics as usual or any
type of partisanship in this building.
CHAIR LEDOUX interjected that this bill transcends politics or
anything else that goes on in this building.
2:43:06 PM
SENATOR ELLIS described this bill as literally involving life or
death. He stated that he knew there was a breakthrough in the
subject of opioid addiction and medically assisted treatment
when he heard presidential candidates on both sides of the aisle
discussing this issue in presidential forums and debates. As
with Alaska, New Hampshire has an epidemic of opioid abuse and
overdose. He acknowledged that the Anchorage Police Department
advised that in Alaska, heroin use is back in force and heroin
related overdoses are claiming more young lives than traffic
fatalities. He noted that Dr. Jay Butler, Chief Medical Officer
and Director, Division of Public Health, Alaska Department of
Health and Social Services (DHSS) testified in the House Health
and Social Services Standing Committee that in 2015, 54 Alaskans
died of opioid pain killer overdoses, another 34 Alaskans died
of heroin overdoses, and 8 of those deaths were in Juneau. He
expressed that the support from Juneau of friends and family of
heroin addicts, opioid addicts, and overdosed deaths has been
overwhelming and much appreciated. The abuse and overdose
epidemic is largely driven by addiction to prescription opioids,
such as OxyContin and Vicodin, which has become more expensive
and harder to come by in recent years. Therefore, he explained,
leading addicts to turn to the much more wildly available and
less expensive opiate of heroin. He conveyed that people tend
to think that heroin abuse is a problem plaguing the poor, but
this epidemic hits the affluent particularly hard all over the
state. For approximately 12 years he has tried to gather
support for treatment in methadone clinics in Fairbanks and
Anchorage, and suboxone through private physicians in
communities without methadone clinics, he remarked. He said
that he read an opinion piece 25 years ago in the New York Times
indicating that the future number one drug problem would be the
abuse of prescription drugs. He acknowledged that doctors have
since apologized and have discussed the "loose prescriptions" of
opioids leading to people switching to "black tar heroin,"
smuggled into Alaska by the Mexican drug cartel addicting
Alaskans all across the state.
2:46:30 PM
SENATOR ELLIS reiterated that heroin and other opioid abuse has
reached epidemic levels in Alaska, as with the rest of the
nation. Everyone knows, he said, that these highly addictive
drugs are extremely deadly and are killing Alaskans at alarming
rates. Luckily, he noted, opioid overdose is typically
reversible through the timely administration of the medication
naloxone, and provision of emergency care, yet it is often not
available where and when it is needed. He advised that this
bill seeks to make this life-saving, safe miracle drug more
widely available because overdose often occurs when the victim
is with friends or family members who may be best situated to
act to save his or her life by administering naloxone or Narcan.
He advised that the bill came to him with the idea to join most
other states due to medical professionals being wary of
prescribing and lay person's worry of administering opioid
overdose drugs due to potential civil liability. The bill
removes civil liability from a doctor who prescribes, and a lay
person who administers, naloxone in cases of opioid overdose, he
explained. He pointed out that contained within the committee
packets are numerous letters of support from around the state
with no known opposition to the bill.
2:48:22 PM
SARAH EVANS, Staff, Senator Johnny Ellis, Alaska State
Legislature, explained that the bill discusses naloxone, also
known as Narcan, which is a medication called an opioid
antagonist and is used to counter the effect of opioid overdose
from drugs such as, OxyContin, morphine or heroin. She
described naloxone as extremely safe and effective at reducing
opioid overdose to counteract the life threatening depression of
the central nervous system by allowing the overdose victim to
breathe normally. She explained that in the event a person has
too many opioids in their system, the opioids cover all of the
brain receptors, thereby causing a person to physically stop
breathing. At that point, she further explained, their lips and
nails turn blue with many signs of distress in not being able to
breathe. She related that once naloxone is administered into a
person, the naloxone clears off the receptors causing the person
to no longer feel the effects of the drug, and they are revived.
She said that naloxone is not a controlled substance, it has no
abuse potential, and with zero effect if administered to someone
without opiates in their system. She said naloxone is liken to
an EpiPen, except it is safer because it will do nothing to the
person if there are no opiates in their system. The sponsor
would like naloxone in the hands of family members, friends, or
addicts themselves because typically an overdose occurs within
one to three hours, although earlier in some cases, leaving a
brief window of opportunity for intervention. Naloxone takes
effect immediately and can last between 30 and 90 minutes, she
said.
2:50:50 PM
MS. EVANS turned to Section 1, of the bill and said it basically
allows a pharmacist to dispense naloxone to any person in front
of the pharmacist requesting it because a prescription is not
necessary for naloxone or Narcan. She referred to [Section 1,
AS 08.80.030(b)(13), page 2, lines 24-26], which read:
(13) establish standards for the
independent dispensing by a pharmacist of an opioid
drug under AS 17.20.085, including the completion of
an opioid training program approved by the board.
MS. EVANS explained that the language reads that education and
training must be administered to the person being dispensed
naloxone.
2:52:03 PM
CHAIR LEDOUX inquired as to whether there are any other opioid
overdose drugs other than naloxone.
MS. EVANS replied not currently, not in the manner the bill
defines an opioid overdose drug, it is strictly naloxone. She
noted that naloxone can be administered in three different ways.
2:52:30 PM
REPRESENTATIVE LYNN asked whether this is an expensive drug and
whether it is covered by a typical insurance program.
MS. EVANS answered that the sponsor left it up to pharmacists
and doctors to supply naloxone in one of the three different
ways. Certain insurance companies, including Medicaid, only
cover a certain way to administer naloxone, and the different
ways are more or less expensive. She explained the three ways
as follows: a nasal injector involving two doses, and CVS
recently advised it would require approximately $50; the auto-
injector, similar to the EpiPen can be more expensive; and a
muscle injection by using a syringe and inserting it into a
meaty part of the arm or thigh.
MS. EVANS, in response to Representative Lynn's comment, agreed
that it is similar to insulin.
MS. EVANS reiterated that the bill leaves it up to the
pharmacist or doctor to dispense naloxone to a person based upon
their insurance and the training necessary for that manner of
administering naloxone.
2:54:12 PM
REPRESENTATIVE CLAMAN surmised that the language means that if
medical technology advances and produce another drug with the
same benefit, the legislature would not have to come back for
the pharmacist to be able to administer the new drug.
MS. EVANS replied that it is the sponsor's hope, although, the
sponsor does not foresee any new medications coming out because
doctors have said that this is such a safe drug. Although, she
noted, the sponsor is hoping for FDA approved easier ways for
the public to administer naloxone.
CHAIR LEDOUX offered that at some point there may be a generic
form of the drug.
2:55:02 PM
MS. EVANS referred to Sec. 2, [AS 08.80.168(b)(1), page 2, line
29], which read:
(1) "opioid overdose drug" has the
meaning given in AS 17.20.085;
MS. EVANS explained that the provision defines an opioid
overdose drug in the correct sections. She then referred to
page 4, lines 24-25, [AS 09.65.340(d)(3)], which read:
(3) "opioid overdose drug" means a drug
that reverses in whole or in part the pharmacological
effects of an opioid overdose;
2:55:32 PM
MS. EVANS referred to Sec. 3, [AS 08.80.168(c), page 3, lines 2-
5], which read:
(c) A pharmacist may independently dispense an
opioid overdose drug if the pharmacist has completed
an opioid overdose drug training program approved by
the board and otherwise complies with the standards
established by the board under AS 08.80.030(b).
MS. EVANS explained that it refers to the Board of Pharmacy.
2:55:51 PM
MS. EVANS referred to Sec. 4, [AS 08.80.480(27), page 3, lines
12-13], which read:
(27) ... ; the independent dispensing
of opioid overdose drugs;
MS. EVANS said the provision was amended under the practice of
pharmacy.
2:56:12 PM
MS. EVANS referred to Sec. 5, [AS 09.65] and advised that the
added section offers civil immunity to health care professionals
to prescribe, provide, and administer opioid overdose drugs
except as provided in [AS 09.65.340](c) of this section, which
read:
(c) This section does not preclude liability
for civil damages that are the result of gross
negligence or reckless or intentional misconduct.
MS. EVANS described (c) as typical language with a medication
wherein if a person does not believe a person is experiencing an
overdose and administers the drug, they would not be covered
under civil liability.
2:57:28 PM
CHAIR LEDOUX pointed to Ms. Evans' previous testimony that there
is zero effect if naloxone is administered to someone without
opiates in their system. In that regard, Chair LeDoux
understood the drug to be perfectly harmless.
MS. EVANS agreed, and offered that the drafter of the bill,
Megan Wallace, Legislative Legal and Research Services,
previously answered the same question and advised that it is
typical language to include in a bill where there is a
medication given by lay persons.
2:57:54 PM5,
MS. EVANS explained that the bill includes an education
component within Sec. 5, [AS 09.65.340(a)(2)], page 3, lines 29-
31, and page 4, lines 1-3, which read:
(2) each person to whom the opioid
overdose drug is prescribed or provided has been
educated and trained in the proper emergency use and
administration of the opioid overdose drug by the
health care provider of the opioid overdose program;
education and training under this paragraph may be
provided by any reasonable means, including through
the use of electronic, video, or automated education
or training resources.
MS. EVANS explained that when a person administers, prescribes,
or provides an opioid overdose drug they can only do so if they
also provide training and education on how to administer the
drug. The language electronic, video, or automated education or
training resources was added because this has passed in 41 other
states and the District of Columbia, she said, and these states
have prepared "really great" educational programs. She
explained that the bill allows people to use these other means
showing how to safely administer the drug, and to call 911.
2:59:52 PM
CHAIR LEDOUX surmised that under this bill, a doctor doesn't
actually have to prescribe naloxone.
MS. EVANS replied no, they do not. Under the language regarding
prescribing and providing through health care professionals, a
pharmacist could directly dispense the drug, she said. Many
times, she offered, doctors deal directly with clients who are
addicts, or family members of addicts, and they can prescribe
and provide the training of any opioid overdose drug at that
time.
3:00:41 PM
REPRESENTATIVE GRUENBERG pointed to AS 08.80.050 relating to
Board of Pharmacy, and paraphrased that, "the board shall comply
with the Administrative Procedures Act (APA) in its activities."
He asked whether, when setting these standards to establish the
training program, it will require adoption of a regulation in
accord with the APA.
MS. EVANS answered "That's my understanding," and a person in
the room from the Alaska Pharmacy Association could speak to the
difficulty of adopting a regulation. She opined that it is very
easy for the board to "make up" these regulations and rules and
the training program.
REPRESENTATIVE GRUENBERG said he would ask that person at the
appropriate time whether they must go through a certain
procedure. He asked whether there was an accompanying
concurrent resolution for the title change.
CHAIR LEDOUX advised that her staff has provided HCR 22,
changing the title.
MS. EVANS responded that the title change came into place
because the sponsor asked the Board of Pharmacy to make some
changes.
REPRESENTATIVE GRUENBERG noted that sections 1-4 of the bill
were added in the House of Representatives necessitating the
title change. He asked whether other changes were made in the
House of Representatives.
MS. EVANS replied yes, other than allowing the pharmacist to
dispense and having the training component, under the definition
of health care provider the sponsor added "nurse" as someone who
could provide training and dispense naloxone.
3:03:32 PM
REPRESENTATIVE GRUENBERG opined that Ms. Evans was referring to
the language at least on page 5, lines 14-16, and asked whether
it was defined in any other section in the bill.
MS. EVANS, in response to Representative Gruenberg, pointed to
[AS 09.65.340(d)(1)], page 4, lines 19-21, [page 5, lines 14-
16], which read:
(1) "health care provider" means a
licensed physician, advanced nurse practitioner,
physician assistant, nurse, village health aide, or
pharmacist operating within the scope of the health
care provider's authority;
MS. EVANS then referred to [Sec. 5, AS 09.65. 340(a)(2)], page
4, lines 1-3, which read:
(2) ... overdose program; education and
training under this paragraph may be provided by any
reasonable means, including through the use of
electronic, video or automated education or training
resources.
MS. EVANS explained that the House Health and Social Services
Standing Committee wanted more language as to how the training
component could be performed, and those were the only new parts.
3:04:57 PM
REPRESENTATIVE KELLER asked whether, in previous hearings, there
had been a discussion regarding the definition of "opioid
overdose drugs," because there are also "opioid addiction
drugs." He offered concern that there could be confusion there,
and there would be a liability release because of the fact that
it takes gross negligence, or whatever. He asked that Ms. Evans
be very clear during further testimonies as to the
pharmacological effects of the opioid overdose, and to clarify
that definition.
MS. EVANS responded that Dr. Paula Colescott will speak to that
issue as her Anchorage practice involves addiction medicine.
She opined that Dr. Colescott will testify that the opioid
overdose drug, as defined, narrows it to naloxone.
REPRESENTATIVE KELLER commented that the House Judiciary
Standing Committee must have the language as tight as possible,
thereby not creating a problem while trying to fix a problem.
3:06:55 PM
REPRESENTATIVE GRUENBERG asked Representative Keller whether he
was referring to the standard of tort immunity ... the gross
negligence standard.
REPRESENTATIVE KELLER responded no, in that his concern has to
do with how that would apply to the definitions used in this
bill. He opined that the definition in this bill means a drug
that reverses in whole or in part the pharmacological effect of
an opioid overdose. He explained, "If I read this the first
time and I thought methadone, frankly, you know, ... is there a
danger of somebody else out there that is authorized to give
naloxone ... if they could have that confusion." He asked that
the definition be "nailed down".
CHAIR LEDOUX opened invited testimony.
3:08:47 PM
PAULA COLESCOTT, M.D., First Care Medical Center, said she is a
practicing addiction specialist, and offered excitement
regarding SB 23 as it can begin to save lives of opiate
dependent people. She explained that many of her clients start
with prescription opiates and when they are no longer able to
secure those, transition over to heroin or another opiate off
the street. Any of these opiates, the synthetics, can cause an
increase in tolerance wherein a person finds themselves using
more and more to get the same effect they desire. However, she
noted, as the person increases doses, very often the respiratory
does not keep pace with that tolerance and the person can easily
overdose. She opined that she doesn't have a client who has not
witnessed an overdose in front of them, which is common in the
community commonly using injectables, or even oral opiates.
Often, in response to witnessing an overdose, the person is put
into a tub of cold water to resuscitate or they are dragged
outside in the cold, and it often is not successful. She
expressed that this community could benefit from [naloxone], and
being taught about it. In her office, she explained, there are
folks that are put on replacement opiate therapy to stabilize
the brain while taking them through the recovery process of
rebuilding their lives. Suboxone, Buprenorphine, or methadone
are lifesaving agents if people have access through Medicaid or
private insurance, she described. However, not everyone has
that type of access and they will then defer to a needle
exchange program where they'll inject heroin but they will not
contract HIV, or Hepatitis C and, she noted, that the program
has proven to be beneficial. These agents, naloxone, which is
what will be in either the nasal or auto-injectable forms, act
within minutes and can last up to 30-60 minutes. She described
it as a very rapid acting agent, at an acceptable dose, that
would hopefully restore the ability of that person to breathe
until emergency help arrives. She explained that usually two
doses are in the nasal or injectable kit, and the GoodRx app
offers approximate over-the-counter retail prices, as follows:
the nasal product is $136; and Evzio (naloxone hydrochloride
injection) similar to an EpiPen is $757, which would vary with
Medicaid or insurance.
3:13:57 PM
DR. COLESCOTT, in response to a previous question, answered that
the agents that immediately reverse opiate intoxication, failure
to breathe, or an individual turning blue, not breathing not
responsive, are agents that have been used over four years in
the emergency room (ER) setting. Narcan is routinely injected
in the ER, and this is an agent that you don't need to give IV,
but "you can actually have the person ... injected into the
nasal passage" and it will be absorbed and, she reiterated, it
begins to have an onset within a few minutes that can be
lifesaving for these people. Obviously, she said, the response
could be a bit more rapid if you inject Evzio, but more pricey.
She remarked that she is unaware of any other good opiate
reversal agents used routinely in the ER. Again, the importance
of this bill is that these are situations in which emergent ...
3:15:17 PM
[Technical difficulties]
3:15:39 PM
DR. COLESCOTT explained that both the nasal and injectable
application would have an immediate effect that could be
lifesaving. In the event a person is not breathing, the
[immediate goal] is to restore respirations to prevent
undesirable neurologic outcomes within 10-15 minutes. She
emphasized that in order to avoid anoxic brain injury or injury
to the brain due to lack of oxygen it has to be onsite, has to
be immediately available to people at risk for overdosing.
3:16:43 PM
CHAIR LEDOUX asked whose insurance company a family member or
friend would submit the naloxone insurance claim, and noted that
they would not necessarily have a prescription. Usually,
without a prescription the insurance companies won't pay for it.
She stressed that her question is not a reason to not pass the
bill, but the discussion has been around significant amounts of
money. She asked whether there is a way the insurance companies
will pay for it.
DR. COLESCOTT responded that within her circumstances in the
methadone clinic, it would be dispensed to "probably all the
people on methadone" through the medical director's standing
order. The clients she sees for Buprenorphine, for instance, or
anyone that failed to progress through the program and stops
Buprenorphine, would be given a prescription because they put
themselves at risk of resuming heroin and overdosing. In that
setting, she would personally write the prescription or in the
clinics, dealing with large numbers of people, it would be by
standing order from the medical director, she explained.
3:18:24 PM
CHAIR LEDOUX put forth Representative Keller's concern that
there not be confusion between methadone and naloxone. She
opined that methadone is not a narcotic reversal medication.
DR. COLESCOTT agreed, and explained that methadone is an opioid,
a synthetic opioid, first synthesized in Germany, and after
World War II the United States received the rights to methadone.
Two biochemists in New York then theorized that in giving a
heroin addict the correct dose of an opiate lasting all day, it
would somehow stabilize the brain, stop cravings, they wouldn't
inject, and they would feel normal. She explained that from
that research the federal government stepped in and began
developing federally run methadone clinics for opioid dependent
people. These drugs would never be given [under this bill] and
are only prescribed by a physician or practitioner with the DEA
schedule permit. She further explained that methadone
stimulates receptors as an opiate, is very long acting, treats
pain, and can be used to stabilize the brain in people that are
shooting up heroin 4-6 times a day. If there is something on
the receptor that has caused over stimulation, such as
methadone, oxycodone, hydrocodone, or morphine, and that person
is not breathing, naloxone will knock the opiate off the
receptor and restore breathing immediately.
3:21:02 PM
REPRESENTATIVE CLAMAN opined that before naloxone could be
dispensed, the state would have a particular drug identified by
the Board of Pharmacy. He said, to the extent there was another
drug meeting the definition, people would still need to rely on
the regulations being issued by Board of Pharmacy. He
continued, "Rather than saying, 'Oh look, this is what the
statute says ... the statute' ... you still are left in the
regulation."
DR. COLESCOTT replied "Yes, that is my understanding." She
replied to Chair LeDoux that she did not have further testimony,
and that [the bill] would be something that could be very
helpful to people that are trapped in this process.
3:22:12 PM
REPRESENTATIVE GRUENBERG pointed out that the language at the
beginning of the bill deals with pharmacists and the training
program for them; however, pharmacists are not the only health
care professionals who can prescribe these drugs. He pointed to
the health care providers listed on page 4, lines 19-21, and
also page 5, lines 14-16, [text provided previously] and noted
that pharmacists are only one profession and they are well
covered at the beginning of the bill. He further noted that the
other professions do not appear to be similarly covered and
asked whether the bill should contain similar language covering
the other professionals so they do not get in trouble and
disciplined.
REPRESENTATIVE GRUENBERG further asked whether the sponsor is
careful and sure these other people will not be criminally
liable, and should the bill give civil liability.
3:24:12 PM
CHAIR LEDOUX pointed out that those are questions for the bill
sponsor or Legislative Legal and Research Services.
DR. COLESCOTT commented that Representative Gruenberg is correct
and that maybe it could be broadly worded to include health
providers/pharmacists. In response to the notion of civil
liability, she said, she recently attended the annual conference
of the American Society of Addiction Medicine (ASAM) and there
was great discussion regarding this issue. The overarching
opinion was that for physicians to ... or when a physician
prescribes something in the ordinary practice that is a
legitimate reason for dispensing a drug there is no increased
civil liability at all. She stressed that for prescribing
something lifesaving there would not be any increased civil
liability, but there's been enough concern that in this setting
people have wanted to be exempt from this. She opined that it
should obviously be included in this.
3:25:57 PM
REPRESENTATIVE GRUENBERG stated he would like a "real expert" to
determine whether there are other types of health care providers
not listed in the bill, such as a dentist, naturopath, or
whoever, and further stated that he wants to be certain that
anyone who legitimately does this should be covered.
[CHAIR LEDOUX closed invited testimony and opened public
testimony to allow Representative Lynn Gattis to testify.]
3:26:54 PM
REPRESENTATIVE LYNN GATTIS, Alaska State Legislature,
paraphrased written testimony as follows: [original punctuation
provided]
For the record my name is Lynn Gattis, I represent
district 7, the greater Wasilla area. I want to thank
Senator Ellis for his tremendous work on this bill and
for reaching across the aisle to work with me on it.
I strongly support SB23 for the simple reason that
it's literally a life-saver.
- Across Alaska, and certainly the Matsu, heroin
abuse is having a deadly impact on Alaskan
communities.
- Too many people are getting caught in a terrible
addiction, and too many people are dying.
- There is one last line of protection we can offer
addicts, families, and friends - Narcan.
- SB23 gives addicts and loved ones the opportunity
to have lifesaving medication with them if the worst
does occur.
- We need to stop treating addiction as something
we hide under the rug. Let me be clear - I don't
condone any drug use or substance abuse. I also don't
think we can stand by and do nothing while people are
dying.
- What Senate Bill 23 does is give mothers and
grandparents, even addicts themselves, a chance to
save their loved ones.
- This bill would allow pharmacies to offer Narcan,
and a mom or grandma to go and purchase it over the
counter - just like you would Sudafed today.
- To finish my comments Madam Chair, to me this is
a life-saving bill. We have a medicine that can save
lives and has no adverse impacts, no high to be
obtained.
- Even if we save just one life - this bill would
do its job. So let's allow Alaska that opportunity.
Thank you for your time Madam Chair and I'm available
for any questions.
3:30:14 PM
TERRIA WALTERS, offered testimony, as follows:
My name is Terria Walters, and I am a person in long-
term recovery from heroin and meth, and I am also a
recovery advocate and started a program ... a ministry
called (indisc.) Ministries where I help addicts and
inmates transition back into the community after
incarceration.
I wanted to share a little bit about how I support
this bill ... or why I support this bill. Um ...
while I was in my addiction I watched many many people
that I cared about ... um, overdose. And as Dr.
Colescott stated that most ... the solution a lot of
the time was to take that individual that was
overdosing and put them in a cold bath ... um, with
ice in it to ... to get them revived, lips would be
turning blue. And of course all of us that was
watching this happen would be freaking out because we
didn't know what to do ... um, other than ... um, put
down ... immerse them into ... um, a bathtub ... um,
with ice and cold water. Um ... I um ... I have also
OD'd, but thanks to the grace of God I ... um, did not
die. Um ... and a ... eventually I came out of ...
um, the overdoses. And my addiction started with pain
pills. Um ... and then a ... overprescribing of
methadone by my pain management doctor where I was
taking ... um, a ... seven 10 milligram methadone
pills a ... three times a day ... a with 210
milligrams of methadone for pain management.
Eventually I ended up getting off of that that. Um
... once I got clean and sober ... um, in 2000 ...
April 2, 2005 is my clean date and I will be
celebrating 11 years clean and sober on April 2nd of
this year.
CHAIR LEDOUX congratulated Ms. Walters.
3:32:07 PM
MS. WALTERS continued her testimony, as follows:
Um ...thank you so much. Um ... I ... um want to
share that I also ... the reason why I support this is
because I have had loss of my friends and an ex-
boyfriend that overdosed four years ago and died. Um
... I think that this a ... this um ... medication is
essential to ... um, the ... you know ... a ... people
eventually getting their ... you know ... not ODing
and then ... a ... being unable to be pulled out it.
Um ... I don't know ... if some of you know who I am
and some of you don't. Um ... but I am also a mother
of an addict that was murdered on June 22, 2015, it'll
be seven months here pretty soon where I ... or eight
months here pretty soon where I've had to deal with
... um, the murder of my son by somebody that was also
a heroin addict that went to great lengths to ...
support his drug addiction.
Um ... while we have lack of a ... treatment services
in this state, including medical detox ... um, a lot
of individuals continue to use drugs because ... um,
and some of them really don't want to because I know
I've been there and I deal them ... a ... a ... daily
on the ... um, through private message and phone
calls. Parents of addicts trying to get their
children help but unfortunately they continue to use
... they're turned away from hospitals. Ultimately,
... um, if they get a strong batch and ... do a dose
that ... the same amount that they get from somebody
else ... sometimes that ... that heroin would be a lot
stronger than the batch that they did before.
Ultimately, possibly, leading to ... um, a drug
overdose.
Um ... sorry, I'm trying ... this ... um, this bill
... um, is essential to ... to be passed to stop this.
While we push for recovery services that include ...
um, eventual abstinence from all substances ... all
substances including suboxone and methadone, which are
both narcotics. I'm not a fan of the maintenance
program but I'll only ... tapering. I'm more of a fan
of medical detox coupled with an Evzio shot. Um ...
as a person of long-term recovery, I support this
bill. Um ... I'm not sure if you guys are well aware
of the Evzio shots, but it is also a blocker and it
does not ... um, it's not a narcotic like methadone
and suboxone.
Um ... basically because of my own experiences and
what I deal with on a daily basis, and then the loss
of my own child, and friends that have lost their
children to overdoses, I think that this is ... um, as
a person that lives this lifestyle ... lives this
lifestyle and also deals with it in the community.
This medication would save lives and ... um, not hurt
their family members where they are having to bury
their children, or their husbands, or their wives.
CHAIR LEDOUX thanked Ms. Walters and related that her testimony
is quite compelling.
3:35:33 PM
CHAIR LEDOUX closed public testimony and opened invited
testimony.
3:35:44 PM
KARA NELSON, Director, Haven House Juneau, offered testimony, as
the follows:
My name is Kara Nelson and I am the director of Haven
House Juneau. Well, thank you very much. This ...
it's an honor to be here. I've followed SB 23 for
quite some time, and have come a long ways since our
early testimonies, I think. Um ... and as you can
see, thank you for allowing Terria to go ... she had
to go to work, but she is such a powerful voice in
this ... um, cause of recovery and long-term recovery
as well as every life matters.
So, I've testified prior about my own story ... um,
overdosing three times myself. Today I am a person of
long-term recovery and what that means for me is that
I have not taken a drink or a drug since June 1, 2011.
Ironically, that's also the day I was released from
Lemon Creek Correctional Center. And so it's my ...
by the grace of God, after 20 plus years of active
addiction, and several overdoses, I am here today
serving my community.
Um ... you know, this has been a long process of
watching our legislative ... kind of this new era that
is coming towards us with criminal justice and the
recovery movement coming together. And that's how I
see it because most of the people I work with, as well
as myself ... you know we were incarcerated for our
substance abuse and mental health disorders without
the proper supports around that. Every life does
matter.
3:37:17 PM
MS. NELSON continued her testimony, as follows:
On 12/10/15, we had our very first relapse in our home
as well as overdose. When I got the call about 2:00
a.m., I was in Anchorage with several women who were
striving to be the best that they could ever be in
their life. They were very confident, who were moving
forward and this is a disease. And without having
those supports there, this woman overdosed, was gone
literally about one-half hour, overdosed, her friend
had the sense to call the police. They came, they
revived her by Narcan, and then of course had to do
that several times afterwards. What we know about
(indisc.) on Narcan is ... I wish I would have brought
with me, but Evzio ... um, shot. I actually have one
at my house -it's a very simple ... I've seen several
people utilize the nasal spray as well as the EpiPen.
It's just a little box, stick it on your thigh, five
seconds, administer the drug. Um ... I've been to
several different ... I mean, since then I've been to
several different ... um, national ... you know,
rallies and different things, really highlighting that
right now we're still treating it, because we're
having these different conversations about ... and I
know this isn't necessary on this bill. But, in the
different conversations surrounding this bill, what
I've seen is ... you know, kind of like people are
still treating it as a moral issue and not a medical
issue. And so, to come in here and hear the different
dialogue from last year is very rewarding, it's very
hopeful, and very ... um, I just want to say thank you
to every person that has been involved. Obviously
Johnny Ellis is one of our personal heroes in the
recovery community because we know that this works and
our lives do matter. If I hadn't come back out of
those overdoses, if this woman hadn't been revived by
Narcan, she wouldn't have been with her daughter
yesterday, as she was still striving for long-term
recovery. You know, this is not a choice that we're
making. We want to continue ... people want to have
help and sometimes those helps are not available. So,
I am in support of SB 23, I'm in support of naloxone
and Narcan. I also know, and my colleague said this
last time, I'm going to say it again, the only side
effects of Narcan is life. And it's that simple.
CHAIR LEDOUX related that Ms. Nelson's testimony was compelling.
3:39:57 PM
REPRESENTATIVE GRUENBERG asked Ms. Nelson to explain how the
medication is simple to administer.
MS. NELSON explained that one way to administer Narcan is with
an EpiPen, which is in a little box, the bottom is pulled off,
place it on the thigh, click it, count 5-4-3-2-1, administered.
At that point, she said, some of the education would be that
people will then go back into an overdose after a period of
time, again 5-4-3-2-1, although by then the hope is that they
would be at a medical facility.
REPRESENTATIVE CLAMAN noted he had to leave for another
appointment and expressed that he strongly supports this bill
and would sign "do pass."
3:41:27 PM
MICHELE MORGAN, said she is representing herself and said she
runs the Juneau Sports Association where people out of high
school and play softball with "us older people," and families.
She expressed that last year four of their softball players died
and no one talked about why they died. Their parents would have
loved to testify but they are too broken and cannot speak. Ms.
Morgan offered testimony, as follows:
When our first softball player died, his name is Ryan.
He was 24 years old, he was with a party of about
seven people, they'd just played in the championship
game of softball and they were partying afterwards. A
friend that was there called Ryan's dad and said
"Ryan's not doing well," and the dad asked, "Well,
what are you guys doing?" He said, "Oh, we're just
drinking a few beers, you know we played in the
championship game. The dad assumed ... he said, "Just
watch him if he's drank too much call me, I'm in
Sitka, if he gets worse we'll have someone come over."
So they called again, and Ryan's dad sent his sister
over, and Ryan had overdosed, he was dead.
3:43:02 PM
MS. MORGAN emphasized that there were seven people in the room
and they reached out to get help but they were using so they
were high, and they were afraid and didn't know what to do. She
stressed that if naloxone had been in the hands of our community
last year, Ryan would be here, and his mom and sisters wouldn't
be broken. She said her main purpose in starting Juneau's Stop
Heroin Start Talking purpose was to get people talking about
this and to save our children. She said she appreciates the
support the program has received, and she thanked Senator Ellis
and the bill's co-sponsors for putting this out there. She
referred to the question of pricing, and said that the
Washington Health and Social Services purchases Narcan nasal
spray in bulk and the cost is $14 for two doses, which it hands
out. She said the Juneau Police Department (JPD) advised that
200-400 people in Juneau are using heroin every day, a town of
36,000 people runs out to be 1 in 80 people doing heroin every
day.
3:44:15 PM
MS. MORGAN stated that it is about $9 a hit of heroin in
Seattle, and $100 in Juneau. She remarked that a person doing
four hits of heroin a day in Juneau will burn through their
family, friends, everyone, and could become a criminal to
support their habit. People from all over the state are
reaching out to just talk about this issue, and she stressed
that if "we can get this out there for one kid, I think Ryan
would have been alive right now."
3:45:29 PM
CHAIR LEDOUX closed invited testimony and opened public
testimony.
3:46:07 PM
GARY MILLER, offered testimony, as follows:
My name is Gary Miller, I live here in Juneau, I'm
here representing myself. On May 17th last year my
daughter died of a drug overdose with heroin. We have
her ashes interred out at the Shrine of St. Therese.
I visit her at night so I can cry in private. I bring
her a red rose that was her favorite flower. And I
tell her how much I love her and how much I miss her.
This bill will save other parents from going through
the grief that my wife and I live with. It'll also
give other addicts another opportunity to live, so
please pass this bill. Thanks.
CHAIR LEDOUX thanked Mr. Miller and offered him her condolences.
3:47:15 PM
KATHERINE BOTZ, said that she is representing herself, that she
is 28-years old, and that she sees her generation suffering from
heroin overdoses and dying from it. She said she lost a friend
last September due to a heroin overdose, and that he was not
only a friend, he was a co-worker, and almost like another
brother of hers. His family knew me, my family knew him, and
they would hang out quite a bit. She then paraphrased a letter
his mother wanted to share, as follows:
After Verner's (indisc.) death, one of his friends
told me he broke a rule - do not do alone, always have
others with you. We think that he may have abused
with another person and the reaction was to put him in
his truck and drive him to Fred Meyers and leave him
there. We will never know. I think that my comment
would be, to give these users a fighting chance.
Please.
MS. BOTZ said that as a 28-year old person, she is seeing
friends die, her classmates die, co-workers die, and of this
generation, she does not want to be the last one standing.
MS. BOTZ then said that JPD has confiscated almost $4 million of
drug money, and Kodiak confiscated approximately $3 million of
drug money. She said that families and friends are wondering
where that money is going, and how to help people who are using,
help drug addicts, and facilities and health clinics as well.
3:51:15 PM
TERRA BURNS, Community United for Safety and Protection (CUSP),
said she represents the Community United for Safety and
Protection (CUSP). She stated she is a lifelong Alaskan and has
always had people in her community that she cared about and have
been narcotics users. Ms. Burns advised that she has received
harm reduction training and is trained to administer Narcan in
Canada, Oregon, California, and New York. Within many of those
states Narcan is freely given out by people involved in harm
reduction education and, she said, that commonly it is included
in shooting kits if needed. She stressed that Alaska should
have Narcan available as it saves lives as she used it once to
reverse an overdose. She noted she has also been in the
position of attempting to resuscitate when Narcan was not
available. Public comments have been to not allow Narcan due to
how hard it is on the person administering the drug but, she
emphasized, it is much harder not to have it. As an individual
and representative of CUSP, she strongly supports this bill and
having this lifesaving measure available to Alaskans would be a
new public treasure, she said.
3:53:07 PM
MS. BURNS, in response to Representative Gruenberg, advised she
had read the bill.
REPRESENTATIVE GRUENBERG referred to [Sec. 09.65.340(a)(2),
[text provided previously], and restated that each person to
whom the drug is prescribed or provided must have been educated
and trained in the proper emergency use and administration of
the drug in order to receive the tort immunity. He then
referred to a previous witness's statement in that its
application is easy and similar to a diabetic. In reference to
other states, he asked whether the person administering the drug
must receive special training.
MS. BURNS opined no, and advised that she is most familiar with
the State of New York's policy in that people can be trained to
become peer educators, carry Narcan across state lines, and can
also hand Narcan out to people "so, you know, there's always
somebody, you know, telling you how to do it when they give it
to you." Also, she advised that the instructions with Narcan
are quite clear and that she is most familiar with the nasal
administration. She noted that even though she had not received
training in five-seven years, a couple of years ago she read the
instructions and successfully administered Narcan.
3:55:52 PM
REPRESENTATIVE GRUENBERG referred to [Sec. 5, AS 09.65.340(a)]
page 3, lines 18-23, which read:
(a) Except as provided in (c) of this
section, a person is not liable for civil damages
resulting from an act or omission in prescribing or
providing an opioid overdose drug to a person at risk
of experiencing an opioid overdose or to a family
member, friend, caregiver, or other person in a
position to administer an opioid overdose drug to a
person at risk of experiencing an opioid overdose if
REPRESENTATIVE GRUENBERG offered concern that if the above-list
of people must have "a bunch of training," the people available
to administer the drug may be dissuaded from administering it.
He surmised that the people in New York are not required to
obtain training, rather they just administer the [Narcan].
MS. BURNS opined that the nasal administration is more commonly
used, the least expensive option, and is covered by more health
insurance companies. She reiterated that Narcan is not
difficult to use, and she used the example of a doctor providing
an EpiPen and providing an explanation [of administration], or
reading the instructions.
3:57:16 PM
DONNA BALDWIN, advised that she is one of four long-term
recovery coaches in Juneau, and in response to Chair LeDoux
stated she is testifying on her own behalf. She stressed that
watching the process of SB 23 in action, because it didn't
happen for so many years, is a miracle and that the committee is
"awesome to do this work because it is so needed." She opined
that if a person is "not living in that, you don't know that it
exists," she said, and is thankful her children are still with
her, and that she does not want to see any more parents tell
their story about their lost children. She pointed out that the
Juneau Police Department (JPD) wants to help these people and
believes it really is a disease, and that our mistakes don't
define who individuals are but what is done to make a difference
does. She stressed that while this is a good beginning, it is
by no means the end of the problem. She emphasized that more
support and recovery facilities are needed because every single
day treatment is unavailable for people asking for help. She
added that "we've even brought addicts into our own homes to
detox because there was nowhere to bring them." She asked that
the legislature not stop here.
4:01:30 PM
ANDREA ROBINSON, offered testimony, as follows:
Hi, I'm Andrea Robinson from the Haven House in
Juneau, I'm also in recovery. Um ... I have overdosed
three times myself and I'm very grateful to be here.
Um ... but in November of 2014, on my three-year olds
birthday, my brother overdosed. They found him
underneath the parking garage, right down there. His
girlfriend found him. Um ... thankfully she called
the ambulance, he got the Narcan shot, ah ... they
brought him back. They had to do it several more
times. And then they did it at the ER, and thankfully
he got that or else he wouldn't be here today. Um ...
I'm grateful for it, I definitely think that it could
save a lot of lives. Everybody in our house, I know
... I mean just living in a sober house, I think that
we should have that available just because for all
recovery addicts there is no telling if ... I mean, I
could relapse tomorrow and if we didn't have that in
our house ... you know, one of us could just ... I
mean we wouldn't really know what to do except call
911, and who's to say they would be there right away.
Um ... I think it should be available in all places,
halfway houses, everywhere. Um ... so yeah, I just
want to thank you guys for this and ... yeah, thank
you.
4:03:19 PM
REPRESENTATIVE MILLETT thanked Ms. Robinson for being brave and
sharing because the legislature needs to hear from people going
through this and have experience with it. She emphasized the
importance of this issue and that the legislature is not going
to give up on anyone going through any type of addiction. She
reiterated that the legislature is here, with Senator Johnny
Ellis's help, to support her and she again thanked Ms. Robinson
for testifying as it is an emotional issue.
4:04:17 PM
CHAIR LEDOUX closed public testimony after ascertaining no one
further wished to testify.
CHAIR LEDOUX emphasized that this is an important bill and asked
whether there were comments from the committee.
REPRESENTATIVE GRUENBERG noted he had offered several questions
that had not yet been answered by the lawyers.
4:04:57 PM
MEGAN WALLACE, Attorney, Legislative Legal Counsel, Legislative
Legal and Research Services, Legislative Affairs Services, asked
Representative Gruenberg to please repeat the specific
questions.
4:05:48 PM
REPRESENTATIVE GRUENBERG referred to page 3, lines 29-31, and
page 4, lines 1-3, [text provided previously] and asked for
clarification that under the bill in order to receive
immunization from tort liability, the person administering the
drug must have been educated and trained in the proper emergency
use and administration of the opioid overdose drug.
[CHAIR LEDOUX passed the gavel to Representative Millett.]
MS. WALLACE answered that is correct. She said the prescribing
or providing health care provider would have to prescribe it or
provide it to a person who has had that education and training.
REPRESENTATIVE GRUENBERG referred to the definition of health
care provider, and noted that the chair of the House State
Affairs Standing Committee said it does not include, for
example, a paramedic or ambulance driver. He said he has been
given several definitions of health care providers from other
parts of the code, for example, AS 09.55.560 lists approximately
20 different professions under health care provider. He pointed
out that some of whom are probably not appropriate, but some
probably are. Also, AS 21.07.250 goes to the opposite extreme
and paraphrased, "Health care provider means a person licensed
in this state or another state of the United States to provide
medical care services, whatever that is defined in here." He
asked whether Ms. Wallace had a comment.
MS. WALLACE explained that the bill would only apply to health
care providers as defined in the bill. She further explained
that defining a health care provider is a policy choice and the
sponsor or committee can make that decision.
4:08:43 PM
REPRESENTATIVE MILLETT announced, for the record, that she is
sitting as chair of the House Judiciary Standing Committee while
Representative LeDoux stepped out.
4:08:52 PM
REPRESENTATIVE GRUENBERG questioned whether the bill only
applies to immunity from civil damages, and not to immunity from
criminal damages or damages or actions that may be taken by a
licensing board.
MS. WALLCE responded that is correct. The bill only applies to
civil immunity and does not affect any criminal law and does not
affect any licensing or regulatory action that a board or other
committee could take, she said.
[REPRESENTATIVE MILLETT passed the gavel back to Chair LeDoux.]
4:09:35 PM
CHAIR LEDOUX announced she had returned to the committee and was
in possession of the gavel.
REPRESENTATIVE GRUENBERG offered that he does not know the
interplay between this law and federal law, and asked whether
someone immunized under state law could still face some sort of
action under federal law since the federal law is so involved in
this area.
MS. WALLACE commented that she has not looked deeply into that
issue and does not want to misstate the law, but did note that
in order for a federal civil action to impose damages on a
health care provider there would have to be some sort of federal
jurisdiction and normally these kinds of civil damages claims
are governed by state jurisdiction. She advised she could not
think of anything that would allow a federal court original
jurisdiction over a civil damages case relating to Alaska law.
REPRESENTATIVE GRUENBERG commented that he was not trying to be
difficult but rather to be certain "we do what we need to."
4:10:54 PM
REPRESENTATIVE LYNN offered a scenario of several people in a
home where someone experiences an overdose, and asked whether
anyone in that room could give the medication while not having
had any type of training. He stressed that he would give the
medication even if he didn't have the training.
MS. EVANS responded that the House Health, Education and Social
Services Standing Committee tried to expand how the training
could be implemented, and referred to page 4, lines 1-3 [text
previously provided]. She explained that the availability of
Narcan over the counter is a law in 41 other states, plus the
District of Columbia. "There's so much out there about how to
educate and train the public on how to administer naloxone that
that's why we put that information in there and ... so it would
be a quick easy way to get the training out there and available
for all persons," she stated.
4:12:54 PM
REPRESENTATIVE LYNN restated his question and asked the
consequences of him never having had any of this training
whatsoever, happens to be at a party, sees a person overdosing,
and administers the medication.
MS. EVANS stated that "The correct answer would be that you
would not be provided civil immunity the way this bill is
written." She offered that she didn't think anyone would go
after him.
REPRESENTATIVE LYNN agreed that probably no one would go after
him because a life had been saved. Nonetheless, why require all
of the training when it really isn't needed if he gives the
medication without training which, he reiterated, he would do.
4:13:54 PM
MS. WALLACE answered that there are some civil immunities for
rendering emergency aid in AS 09.65.090. She explained that a
person rendering emergency aid without training may have
immunity under that section.
MS. WALLACE, in response to Representative Lynn, advised that he
was correct that it is the Good Samaritan law.
MS. EVANS offered that last session the Good Samaritan House
Bill 369 passed, allowing a good samaritan to summon emergency
responders or act on something such as SB 23, without any
negative legal consequences.
4:14:52 PM
CHAIR LEDOUX asked why the bill is written so that the person
administering [Narcan] has to have the education.
CHAIR LEDOUX then announced that, although she had originally
intended to pass the bill out of committee today, the bill would
be held over. She thanked everyone for their testimony, and
particularly thanked Senator Ellis and Ms. Evans for their work
on the bill.