Legislature(2021 - 2022)GRUENBERG 120
05/14/2021 08:00 AM House LABOR & COMMERCE
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| Audio | Topic |
|---|---|
| Start | |
| HB204 | |
| Presentation(s): State & Local Workers' Rights Enforcement | |
| HB91 | |
| SB12 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 204 | TELECONFERENCED | |
| *+ | HB 91 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| + | TELECONFERENCED | ||
| + | SB 12 | TELECONFERENCED | |
HB 91-CONTROLLED SUB. DATA: EXEMPT VETERINARIAN
9:17:16 AM
CO-CHAIR FIELDS announced that the next order of business would
be HOUSE BILL NO. 91, "An Act exempting veterinarians from the
requirements of the controlled substance prescription database."
9:17:50 AM
REPRESENTATIVE ADAM WOOL, Alaska State Legislature, introduced
HB 91 as prime sponsor. He explained that the Prescription Drug
Monitoring Program (PDMP) is a nationwide program that mandates
health care professions enter patient information into a
database to track possible opioid abuse. Currently, he said,
veterinarians are required to participate in PDMP; the proposed
legislation would exempt veterinarians from required
participation. When a veterinarian or vet tech enters a pet
owner's information into the PDMP database, he said, he or she
then has complete information on what medication the pet owner
is taking. He said that the interface isn't set up for
veterinarians or pets, so violations are more likely, which
trigger investigations that cost money and time.
9:22:59 AM
ASHLEY CARRICK, Staff, Representative Adam Wool, Alaska State
Legislature, on behalf of Representative Wool, prime sponsor,
presented a PowerPoint titled, "HB 91: VETERINARIAN EXEMPTION
FROM PDMP [hardcopy included in the committee packet]. She
began the presentation with slide 2, "BACKGROUND: THE PDMP
PROGRAM," which read as follows [original punctuation provided]:
Upsilon1 PDMP: Prescription Drug Monitoring Program
Upsilon1 Alaska's PDMP was established by SB 196 in 2008
Upsilon1 In reaction to growing opioid epidemic, the PDMP was
amended in 2017 via HB 159 from Governor Walker to
include veterinary participation requirements
Upsilon1 PDMP reporting is required for all actively licensed
practitioners who hold a Federal Drug Enforcement
Agency registration number and who dispense federally
scheduled II-IV controlled substances in the state
MS. CARRICK presented slide 3, "BACKGROUND: PREVIOUS VERSION OF
HB 91," which read as follows [original punctuation provided]:
HB 184 was introduced by Rep. Tammie Wilson in the
previous Legislature; later carried by Rep. Dave
Talerico
? Had a hearing in HSS prior to adjournment of the
2020 session due to COVID
? A petition of support for veterinary PDMP exemptions
gained over 1,000 Alaskan signatures of support
? AK Veterinary Medical Association (AKVMA), the Board
of Veterinary Examiners (BOVE), and veterinary
practices across the state remain in strong support
MS. CARRICK presented slide 4, "VET SHOPPING: IS THIS A
PROBLEM?", which read as follows [original punctuation
provided]:
? Vet shopping is the practice of soliciting
veterinarians for prescription medications
? A 2014 review of Prescription Monitoring Drug
Programs found less than 10 veterinary shoppers
nationwide
There have been no identified cases of veterinary
shopping in Alaska
? There is a natural barrier to vet shopping since
costs for veterinary care are paid up front by the pet
owner
9:27:15 AM
MS. CARRICK presented slide 5, "STATE BY STATE COMPARISON ON
PDMP REPORTING," which showed a map of the United States with 34
states highlighted in red, and which read as follows [original
punctuation provided]:
? 34 states (shown in red) do not require a dispensing
veterinary practice to report to the state PDMP
? West Virginia just passed legislation
? Currently, Illinois is considering legislation to
exempt vets
MS. CARRICK presented slide 6, "GOALS OF HB 91," which read as
follows [original punctuation provided]:
ALLOWS THE PDMP TO WORK AS DESIGNED TO COMBAT HUMAN
OPIOID ABUSE
REFLECTS CURRENT OPIOID PRESCRIPTION REALTIES FOR
VETERINARY PRACTICE
PROTECTS THE PRIVACY OF HUMAN PATIENTS AND REDUCES
COSTS OF VETERINARY CARE
MS. CARRICK presented slide 7, "GOAL #1: ALLOW THE PDMP TO WORK
AS DESIGNED," which read as follows [original punctuation
provided]:
The PDMP is designed to combat human opioid abuse,
HOWEVER:
Upsilon1 Unlike humans, animals do not have a unique
identifier or human owner
Upsilon1 Unlike humans, animals can change names, birthdays,
or ownership
Upsilon1 There is no Medicaid for animals and owners pay up
front for each visit
Upsilon1 Veterinary data in the PDMP is not easily
interpreted and can complicate effective use of the
PDMP for all participants
Upsilon1 Veterinarians are not trained in human medication-
including timing and dosage amounts
Upsilon1 Animals cannot falsely represent pain or injuries
that may require opioids
9:29:56 AM
CO-CHAIR SPOHNHOLZ asked for clarification on what types of
drugs are required to be reported in PDMP.
9:30:59 AM
REPRESENTATIVE WOOL responded that PDMP allows a veterinarian of
staff access to the data regarding controlled substances that
are prescribed. He said that Xanax, Valium, behavioral health
drugs, and certain drugs to treat addicts are all controlled
substances. He said that commonly-prescribed drugs would be in
the database and accessible by a veterinarian.
REPRESENTATIVE SPOHNHOLZ suggested that it's important to
clarify that medications such as insulin or heart medication
would not be in the PDMP database.
REPRESENTATIVE WOOL agreed that only certain controlled
substances are included in the database.
9:32:59 AM
MS. CARRICK resumed the PowerPoint presentation on HB 91 with
slide 8, "GOAL #2: REFLECT CURRENT OPIOID PRESCRIPTION
REALITIES," which read as follows [original punctuation
provided]:
Veterinarians can prescribe opioids to their animal
patients, HOWEVER:
Upsilon1 Opioid medications prescribed by veterinarians
represented only 0.34% of total opioid prescriptions
in 2017
Upsilon1 The drugs contributing to the opioid crisis are not
the drugs used most often in veterinary medicine
Upsilon1 Animal doses cannot be standardized in Morphine
Milligram Equivalents (MME's) the same as human
medications
9:34:08 AM
REPRESENTATIVE SNYDER discussed the statistic of opioid
medications representing 0.34 percent of total opioid
prescriptions in 2017, and she recalled testimony that the
requirement to enter opioid medications into the database was
encouraging veterinarians to prescribe fewer opioids. She asked
whether the low percentage could be the result of the
requirement.
REPRESENTATIVE WOOL responded that he doesn't know the trend,
but 34 states don't require PDMP database records of opioid
prescriptions by veterinarians.
9:35:48 AM
MS. CARRICK resumed the PowerPoint with slide 9, "GOAL #3:
PROTECT PRIVACY AND REDUCE COSTS OF CARE," which read as follows
[original punctuation provided]:
There are human privacy concerns related to
participation in the PDMP program, SUCH AS:
Upsilon1 In order to prescribe or dispense a controlled
substance to an animal, an owner's medical information
must be queried
Upsilon1 Most owners are unaware that their own prescription
information is available to their veterinarian
Upsilon1 Some of the drugs prescribed to human patients that
can be viewed by veterinarians include:
Upsilon1 Hormones
Upsilon1 Behavioral health medications
Upsilon1 Steroids
Upsilon1 Substance abuse treatment medications
MS. CARRICK presented slide 11, "ALTERNATIVES TO MANDATORY
VETERINARY PARTICIPATION IN PDMP," which read as follows
[original punctuation provided]:
Upsilon1 Continued education for veterinarians on avoiding
opioid prescription misuse
Upsilon1 Research on the prevalence of veterinary shopping
and its relation to the opioid epidemic
Upsilon1 Appropriate outreach to DEA officials if there is
suspected diversion of controlled substances, which is
currently required in Federal law
9:38:31 AM
RACHEL BERNGARTT, DVM, Chair, Board of Veterinary Examiners,
testified in support of HB 91. She shared that she has been a
veterinarian in Alaska for 19 years and is a member of the
Alaska Bar Association. She said that the statistic of 0.34
percent referred to earlier was from a 2017 study; however, the
data is consistent with subsequent years. Over $40,000 was
spent on investigations in the first half of fiscal year 2021,
she said, and expenditures are expected to double by the end of
the year compared to 2020. There were 56 open investigations
related to use of PDMP, she said, which appear to be related to
using a "non-usable" system instead of to illicit prescribing.
Open investigations are usually in the single digits, and
investigations are paid for by the board and funded solely by
licensees; Alaska has one of the most expensive veterinary
licenses in the country, she said, and the cost is expected to
increase again due to the investigation costs. Increased
licensing fees, she said, would exacerbate Alaska's veterinary
shortage.
DR. BERNGARTT explained that because veterinary records aren't
standardized across the profession, there's no program that
interfaces with them. She addressed the opposition to HB 91 by
the American College of Emergency Physicians, which stated that
the risks for misuse would increase if animal clinics were
granted an exemption; there is no support for such a statement,
she said. So-called "doctor shopping" in veterinary medicine is
virtually nonexistent, she said, due to veterinary medicine
commonly requiring up-front payments. She expressed agreement
that addressing the opioid crisis is important, but she said
that requiring veterinarians to use the PDMP database is not the
way to address it.
9:44:03 AM
MARY ANN HOLLICK, DVM, Alaska Veterinary Medical Association,
testified in support of HB 91. She stressed that drugs are
locked up until needed for surgery, that she has not experienced
a human client exhibiting drug-seeking behavior in her 33 years
as a veterinarian, and that the PDMP database has human health
care implications, not veterinary ones. She said that the pain
reliever most used by veterinarians is non-steroidal anti-
inflammatory medication, similar to Advil or Tylenol. There is
no way to track the personal history for an animal, she said,
and her human clients are often upset when asked for a driver's
license or birthday. Veterinarians and staff are educated on
opioid abuse, she said, and veterinarian participation in PDMP
does nothing to reduce the risk for opioid abuse.
9:48:26 AM
MCKAYLA DICK, DVM, President, Alaska Veterinary Medical
Association, testified in support of HB 91. She said that as
health care providers, AKVMA recognizes its responsibility in
contributing to the opioid crisis; however, after years of
participating in PDMP, it's clear that the program is unfit for
veterinary medicine. Designed as a tool to identify duplicate
prescriptions and trends in human medicine, PDMP is
inappropriate for veterinarian use because animals can't fake
illness. In 2014, a nationwide study by Lincoln Memorial
University showed less than 10 cases of drug-shopping in
veterinary medicine within PDMP, she said, and for a pet to be
prescribed a controlled medication, a client must pay up-front
for all services, which can begin at $600. Humans have
identifiers such as birthdays, driver's license numbers, and
social security numbers, she said, while animals don't, so
querying the database for pet patients isn't possible.
Veterinarians who have used the database have found that it
doesn't contain prescription history, even when querying the
human client whose pet has previously been prescribed
medications; the data is lost or not being used. She said PDMP
is a "true invasion of privacy" because it allows veterinarians,
who are untrained in human medicine, to evaluate the medications
of their clients. She said veterinarians are not choosing to
practice in Alaska due in part to high fees, which are
exacerbated by investigations stemming from the use of PDMP.
Allowing PDMP to be used for its intended purpose, she said,
would eliminate an unnecessary burden on veterinarians.
9:54:05 AM
PAM VENTGEN, Executive Director, Alaska State Medical
Association, testified in opposition to HB 91. She said that
opioid abuse is a challenge in Alaska and people with addictions
will go to "great lengths" to feed the addiction. She offered
anecdotes of "bad actors" in human medicine who were caught
illegally overprescribing controlled substances, and she shared
a story of speaking to people who said they have knowledge of
addicts abusing veterinarian-prescribed medication, pointing out
that one person who was in addiction treatment said that there
was a veterinarian also in treatment. She said only licensed
personnel are able to access the database. She said, "If the
PDMP is the problem, we should fix the PDMP, not exempt
prescribers and dispensers."
9:58:18 AM
REPRESENTATIVE SNYDER asked whether there have been efforts to
modify PDMP or reporting practices to better serve the needs of
veterinarians.
REPRESENTATIVE WOOL responded that PDMP is a nationwide program,
and that he questions the veracity of accusations regarding
problems relating to veterinarians, since 34 states have either
never required veterinarians to use it or have exempted them
from the requirement.
REPRESENTATIVE SNYDER clarified her question.
REPRESENTATIVE WOOL deferred to one of the invited testifiers.
9:59:59 AM
DR. BERNGARTT offered that the issue has been discussed within
the regulatory policy task force of the American Association of
Veterinary State Boards. She said Wisconsin has received a
grant to study options for building a different system, but
other states are experiencing problems similar to Alaska's.
10:00:57 AM
REPRESENTATIVE KAUFMAN said his elderly dog had many
prescriptions, and that he didn't like his own name being
associated with his pet's medication. He referred to the
statistic of 0.34 percent of all opioids being prescribed by
veterinarians, and he asked whether there is any evidence to
support the anecdotes of abuse of veterinary medications.
DR. BERNGARTT said that the issue of a veterinarian in substance
abuse recovery is a different problem than those handled through
PDMP. "To say that veterinarians are completely immune to any
sort of substance abuse," she said, "that's a different topic
than what the PDMP does." She said that she assumes the
veterinarian's drug use was discovered through means other than
PDMP. She pointed out that the "bad actors" in medicine were
caught by the Drug Enforcement Agency, not PDMP. She said there
are many ways in which veterinarians can substantially
contribute to fighting the opioid crisis.
[HB 91 was held over.]