Legislature(2021 - 2022)BUTROVICH 205

02/16/2021 01:30 PM Senate HEALTH & SOCIAL SERVICES

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Heard & Held
-- Invited & Public Testimony --
Heard & Held
-- Invited & Public Testimony --
**Streamed live on AKL.tv**
                  SB  70-OPIOID OVERDOSE DRUGS                                                                              
2:02:56 PM                                                                                                                    
CHAIR   WILSON   reconvened   the  meeting   and   announced   the                                                              
consideration  of SENATE BILL  NO. 70 "An  Act relating  to opioid                                                              
overdose drugs; and providing for an effective date."                                                                           
Speaking  as sponsor,  he explained  that  the bill  started as  a                                                              
disaster  declaration by  former  Governor Bill  Walker in  Senate                                                              
Bill  91, which  passed  in  2017. The  intent  was  to allow  the                                                              
medical officer at  that time, Dr. Jay Butler,  to permit naloxone                                                              
to  be  administered  under  a   four  year  federal  grant.  This                                                              
committee  amended the  bill to  extend the  declaration for  four                                                              
years to allow for the federal funding.                                                                                         
CHAIR  WILSON  said  the  medical  office  still  has  funding  to                                                              
administer this  program. Naloxone is not a  controlled substance.                                                              
It  has  no   potential  for  abuse.  This   legislation  benefits                                                              
Alaskans  by saving  lives. It  translates to  direct savings  for                                                              
emergency  services  and  law  enforcement  and  gives  those  who                                                              
overdose  a greater  chance of living  and an  opportunity  to get                                                              
into treatment.                                                                                                                 
2:05:09 PM                                                                                                                    
JASMINE  MARTIN,   Staff,  Senator  David  Wilson,   Alaska  State                                                              
Legislature,  Juneau,  Alaska, presented  the  sectional  analysis                                                              
for SB 70 on behalf of the sponsor.                                                                                             
     Section 1: Repeals language regarding the sunset of the                                                                    
     original authorization.                                                                                                    
MS. MARTIN noted that Section 1 is conforming to Section 3.                                                                     
     Section 2: Repeals reporting requirement associated with                                                                   
     Substance Abuse and Mental Health Services Administration                                                                  
     grants and the opioid epidemic.                                                                                            
MS.  MARTIN  said  this  was  a   reporting  requirement  for  the                                                              
Department  of Health and  Social Services  (DHSS) related  to the                                                              
opioid epidemic and these grants.                                                                                               
     Section 3: Repeals the sunset date of the original                                                                         
     Section 4: Immediate effective date.                                                                                       
2:06:06 PM                                                                                                                    
SENATOR BEGICH  questioned the reasoning  to repeal  the reporting                                                              
requirement  since part  of the  value of the  report process  was                                                              
for the legislature to know the status of the opioid epidemic.                                                                  
MS. MARTIN  answered that reports  take a lot of  the department's                                                              
time, and  the information is  still available to  the legislature                                                              
if  requested.  The  report  made  sense when  this  was  a  pilot                                                              
program but  as it is continuing  into perpetuity the idea  is not                                                              
to make the department continue to report.                                                                                      
CHAIR WILSON  said that  he put the  reporting requirement  in the                                                              
initial bill  and neglected  to put  an end  date. If  the program                                                              
were to  end in June,  the department by  law still would  have to                                                              
report to the  legislature. He didn't want to  have the department                                                              
continue to do a  report if the federal funds end.  The report was                                                              
just on the federal funding of the program.                                                                                     
SENATOR BEGICH  commented that  the bill  also repeals  the sunset                                                              
clause, which  implies the  program will  be continuous.  He asked                                                              
the  reason  for  repealing  the   reporting  requirement  if  the                                                              
program is going to continue.                                                                                                   
CHAIR  WILSON  replied   the  department  has  many   reports  for                                                              
programs that  are no longer relevant  and he did not  want to add                                                              
to that for a  program that may eventually sunset.  He said he was                                                              
willing to amend the bill to reinsert  the reporting requirement.                                                               
SENATOR BEGICH  suggested keeping the reporting  requirement until                                                              
the state  is no longer getting  federal resources.  Otherwise, it                                                              
would  be  difficult  for  the legislature  to  keep  track  on  a                                                              
regular  basis.  He  offered  his  view  that  Section  2  is  not                                                              
necessary  because   of  Section  3.  If  the   sunset  clause  is                                                              
eliminated, there should be reports.                                                                                            
MS. MARTIN  explained that the bill  doesn't create a  program. It                                                              
allows the  chief medical officer  to issue a standing  order, but                                                              
it doesn't require it.                                                                                                          
SENATOR BEGICH  said the legislature  wanted a report so  it would                                                              
know when  that authority was exercised.  He said he  will support                                                              
the bill, but  he wants to do  the right thing with  the structure                                                              
of the bill.                                                                                                                    
2:11:41 PM                                                                                                                    
SENATOR  REINBOLD commented  on the  Opioid crisis,  and said  the                                                              
question of  why the report  is no longer  necessary, needs  to be                                                              
CHAIR WILSON  explained that  he threw  in the report  requirement                                                              
just to  follow the  federal funding  of the  new program.  If the                                                              
committee  wants the reports  continued into  perpetuity,  then he                                                              
is  open  to that.  The  department  can  speak about  the  effort                                                              
involved with the report.                                                                                                       
2:13:53 PM                                                                                                                    
SENATOR COSTELLO asked if the report is online or printed.                                                                      
CHAIR WILSON called on Ms. Welton to answer.                                                                                    
2:14:11 PM                                                                                                                    
THERESA  WELTON, Section  Chief,  Office of  Substance Misuse  and                                                              
Addiction Prevention  (OSMAP), Division Public  Health, Department                                                              
of Health  and Social  Services (DHSS),  Juneau, Alaska,  answered                                                              
that  the reports  are  available  online on  the  website of  her                                                              
office  and are provided  to the  legislature  by October  1 every                                                              
SENATOR  COSTELLO  asked  if  the report  to  the  legislature  is                                                              
printed or online electronically.                                                                                               
MS. WELTON replied both.                                                                                                        
SENATOR  COSTELLO  said  if  the   committee  wants  to  keep  the                                                              
reporting  requirement,  the committee  could  ask  for  it to  be                                                              
SENATOR REINBOLD noted  that there is no fiscal impact,  so she is                                                              
leaning  toward  keeping  the  report.  She  agrees  with  Senator                                                              
Costello  that   an  online  report   is  fine.   Hiland  Mountain                                                              
Correctional Center  is in her district,  and she knows  that this                                                              
medication is important and has saved lives.                                                                                    
CHAIR WILSON asked Ms. Welton to give her presentation.                                                                         
2:16:48 PM                                                                                                                    
MS.  WELTON said  she would  be  testifying on  the importance  of                                                              
removing the  June 30, 2021 sunset  clause to allow  for perpetual                                                              
authorization of  the standing medical order for  distribution and                                                              
administration of  naloxone, an opiate overdose reversal  drug, by                                                              
any Alaskan.                                                                                                                    
MS. WELTON  said an  overdose only takes  minutes. If  naloxone is                                                              
not randomly  available to  the individual  or individuals  around                                                              
the person  who overdosed, that person  might have to wait  for 20                                                              
minutes for  EMS (Emergency  Management Services)  to arrive  with                                                              
naloxone, which could be too late.                                                                                              
MS.  WELTON displayed  a graph  on  slide 3  showing the  national                                                              
trends   of    opioid   overdoses.   Overdoses    are   increasing                                                              
significantly,   especially  for   synthetic   opioids,  such   as                                                              
tramadol and fentanyl.                                                                                                          
MS.  WELTON  said too  many  Alaskans  have  lost their  lives  to                                                              
overdoses,   even  though   that   is  preventable   with   timely                                                              
administration of  naloxone. In Alaska  overdoses were one  of the                                                              
top  10   causes  of  death  in   2017.  Overdoses  can   cause  a                                                              
significant  medical  impact in  a  person  who does  not  receive                                                              
timely administration  of  naloxone. It takes  just three  minutes                                                              
for someone  who overdoses  to experience  brain damage,  a costly                                                              
and  life-long  diagnosis.  It  takes  three-to-four  minutes  for                                                              
paramedics  to arrive  at a scene  in Anchorage.  At times  people                                                              
die within  eight minutes of an  overdose. In rural areas,  it can                                                              
take  10-20   minutes  and   generally  much   longer  for   first                                                              
responders  to appear on  the scene.  People who survive  overdose                                                              
with brain  damage may also  have resulting kidney  failure, heart                                                              
complications, neurological consequences, and more.                                                                             
2:19: PM                                                                                                                      
MS.  WELTON  said  that  in  the  U.S.  and  in  Alaska  synthetic                                                              
opiates, primarily  illicitly manufactured fentanyl,  appear to be                                                              
the  primary driver  of  the increases  in  overdose deaths.  They                                                              
have  increased 38.4  percent from  the  12 months  leading up  to                                                              
June  2019 compared  to  the 12  months leading  up  to May  2020.                                                              
Overdoses from  May 2020  to September  appear to outnumber  2019,                                                              
marking  the highest  overdose  death  rate in  over  a decade  in                                                              
Alaska, next to 2017.                                                                                                           
SENATOR  BEGICH asked  why  there  is an  asterisk  after 2019  on                                                              
slide 5.                                                                                                                        
MS.  WELTON  answered  there is  a  lack  of  data for  the  final                                                              
quarter of 2019.                                                                                                                
SENATOR BEGICH asked if the numbers could be even higher.                                                                       
2:20:44 PM                                                                                                                    
MS.  WELTON   replied  that  is   correct.  Continuing   with  the                                                              
presentation,  she said  42 states  and the  District of  Columbia                                                              
have   enacted  naloxone   standing  orders.   The  World   Health                                                              
Organization, the  U.S. Surgeon General, and the  American Society                                                              
of Addiction  Medicine have  officially recommended  that naloxone                                                              
be  accessible  to those  who  are  closest  to the  person  using                                                              
MS.  WELTON  said  the standing  medical  order  currently  allows                                                              
naloxone  to  be   dispensed  to  any  individuals   who  are  not                                                              
prescribers,  a practice  that would  be  prohibited. Naloxone  is                                                              
not a  controlled substance,  has no potential  for abuse,  and is                                                              
safe  to use.  By removing  the  sunset date,  local and  regional                                                              
overdose response  programs, first  responders, the  Department of                                                              
Public  Safety, the  Department  of Corrections,  and the  general                                                              
public will  continue to have  the ability to directly  distribute                                                              
and use the life-saving drug naloxone.                                                                                          
MS.  WELTON said  with the  foundation  of the  standing order  in                                                              
2017, the department  was able to start the program  Project HOPE,                                                              
Harm-reduction  Overdose Prevention  and  Education. Project  HOPE                                                              
works  with community  organizations to  distribute or  administer                                                              
NARCAN, otherwise  known as naloxone, in Alaska.  Since inception,                                                              
127  community partners  have  distributed  over 41,000  federally                                                              
funded NARCAN kits.  Of the 320 documented  NARCAN administrations                                                              
originating  from Project  HOPE, overdoses  have been reversed  at                                                              
least  309  times. Alaskan  subject-matter  experts  believe  that                                                              
when there  was a 28 percent  decrease in overdose deaths  in 2018                                                              
compared  to  2017,  it  was  largely  the  result  of  a  maximum                                                              
distribution of  naloxone by Project  HOPE for lay persons  to use                                                              
across Alaska.                                                                                                                  
2:23:04 PM                                                                                                                    
MS. WELTON  said that timely  administration of naloxone  provides                                                              
opportunity   for  recovery,   and  saving   lives  saves   costs.                                                              
According  to  the  Society  of   Actuaries,  40  percent  of  the                                                              
economic burden  of the opioid crisis  is driven by  lost lifetime                                                              
earnings  for those  who died  prematurely. Nearly  33 percent  is                                                              
for excess  healthcare spending, another  15 percent is  from lost                                                              
productivity  in  the  workforce,  and  6 percent  is  from  costs                                                              
associated with criminal  justice. An estimated 29  percent of the                                                              
economic   burden  is   borne  by   federal,   state,  and   local                                                              
MS.  WELTON  said  the  current   standing  medical  order  allows                                                              
naloxone  to  be   dispensed  by  any  individuals   who  are  not                                                              
prescribers.  By  removing the  sunset  date, local  and  regional                                                              
overdose response  programs, first responders, the  Departments of                                                              
Public  Safety  and  Corrections,  and  the  general  public  will                                                              
continue  to have  the ability  to directly  distribute the  life-                                                              
saving drug  naloxone. Without  passage of  SB 70, naloxone  would                                                              
only be  available to those  with a prescription  or by  EMS. This                                                              
is  why it  is  imperative to  continue  to make  naloxone  widely                                                              
available to  save many  lives that otherwise  would be  lost from                                                              
2:24:45 PM                                                                                                                    
SENATOR  REINBOLD  commented that  the  bill  sounds like  a  good                                                              
idea.  She asked  how much  each  kit cost  and who  picks up  the                                                              
MS.  WELTON replied  the  cost for  the  naloxone  kits are  borne                                                              
entirely  by federally-funded  grants. The  approximate cost  of a                                                              
kit, which  contains two doses  of naloxone, additional  education                                                              
and harm  reduction efforts  and information  for treatment,  cost                                                              
less than $4.  There is no cost  to the user or  the distributors.                                                              
Project HOPE is  fully funded for both the substance  naloxone and                                                              
the  coordinator position.  The  state has  full  funding for  the                                                              
next two  years for Project  HOPE. There  are no state  funds used                                                              
for  the  kits.  The Office  of  Substance  Misuse  and  Addiction                                                              
Prevention  (OSMAP) is  applying  for another  federal grant  that                                                              
will provide complete funding it for five years.                                                                                
SENATOR REINBOLD commented  that at some point she  would like the                                                              
program to  be user  paid and not  government paid.  She suggested                                                              
the program needs to be evaluated and perhaps restructured.                                                                     
2:27:56 PM                                                                                                                    
SENATOR  COSTELLO  expressed  appreciation  for  the  program  and                                                              
those who  administer it. She said  the report is helpful,  but it                                                              
does not replace  a hearing and public testimony  and the learning                                                              
that  happens for  the  public when  legislation  that sunsets  is                                                              
before the committee.                                                                                                           
SENATOR  BEGICH asked  Ms. Welton  to describe  the experience  of                                                              
receiving naloxone, as he was sure that it was not pleasant.                                                                    
MS. WELTON  replied it is not  a pleasant experience  when someone                                                              
is administered  naloxone in an  overdose state.  Its biochemistry                                                              
blocks  the  opiate  receptors,  the "high,"  and  the  subsequent                                                              
medical event  of the  cascade of  an overdose  is stopped  in its                                                              
tracks.  People have  a tendency  to  wake up  angry and  confused                                                              
with an intense  headache and potential other  medical conditions,                                                              
but they  are alive. That  gives them an  opportunity to  get into                                                              
SENATOR BEGICH  said her response  underscores what  the committee                                                              
heard  from Dr.  Butler  on the  subject.  It  is very  unpleasant                                                              
experience.  To Senator Reinbold's  point,  he said he  recognizes                                                              
and acknowledges that  at some point people have to  pay the price                                                              
for their  actions.  He offered  his belief that  the report  does                                                              
not need to  be so lengthy. He  noted that the committee  heard an                                                              
executive order  related to  the departmental  split. He  asked if                                                              
that split will have any impact on SB 70.                                                                                       
CHAIR  WILSON asked  if  OSMAP would  stay  in  the Department  of                                                              
Health or be in the Department of Child Services.                                                                               
MS. WELTON  responded that  OSMAP would be  in the new  Department                                                              
of Health. The split would not impact OSMAP or Project HOPE.                                                                    
SENATOR BEGICH  wondered whether  the chief medical  officer would                                                              
be in a supervisory role.                                                                                                       
SENATOR REINBOLD  commented further on the importance  of personal                                                              
responsibility  related to the  opioid crisis.  She segued  to the                                                              
covid  crisis and  the  impact  that had  on  all  sectors of  the                                                              
population She  asked if there has  been an increase  in overdoses                                                              
and naloxone use since March 2020.                                                                                              
2:34:25 PM                                                                                                                    
MS.  WELTON  answered  that  the  state  has  seen  an  uptick  in                                                              
overdose deaths  in the first three  quarters of 2020  compared to                                                              
2019 and definitely  to 2018. Due to COVID  circumstances, getting                                                              
the kits built  this past year has been challenging  because OSMAP                                                              
relies  on volunteer  groups to  put them together  and OSMAP  has                                                              
had to  adjust to  social distancing.  The distribution  of NARCAN                                                              
kits by partners  has also been affected. It could  be that not as                                                              
much naloxone  has been  distributed in  2020 or  it could  be the                                                              
circumstance of  increased mental health complications  as well as                                                              
substance misuse.  Those numbers are being reviewed  and causation                                                              
SENATOR  REINBOLD explained  that  she is  trying to  look at  the                                                              
difference  between  lockdowns   and  non-lockdowns  on  regional,                                                              
state, and  national levels. She has  heard suicide is  up but she                                                              
did  not have  numbers. She  asked how  significant the  increased                                                              
number of deaths  is and what type of numbers she  had for various                                                              
MS.  WELTON   replied  she  was   using  approximate   numbers  as                                                              
represented  by the  bar graph.  For the first  three quarters  of                                                              
2018, there  were about 70 overdose  deaths and about 100  for the                                                              
first three  quarters of  2019, a  little over  100 for  the first                                                              
three quarters of 2020. She declined to comment on causation.                                                                   
SENATOR  REINBOLD  said she  is  looking  for actual  numbers  for                                                              
overdoses   and  how  much   naloxone  saved   lives.  She   wants                                                              
information from  March 2020  when it is  available, not  just the                                                              
first quarter, because  she wants to know the impact  of the covid                                                              
2:39:05 PM                                                                                                                    
CHAIR WILSON opened public testimony on SB 70.                                                                                  
2:39:22 PM                                                                                                                    
KAREN MALCOM-SMITH,  founder, David  Dylan Foundation,  Anchorage,                                                              
Alaska, said she  is a self-funded advocate for the  vast arena of                                                              
issues surrounding  stigma, including  healthcare, education,  and                                                              
law  enforcement. She  is a  member  of the  Alaska Mental  Health                                                              
Advisory Board.  Her testimony is  strictly personal and  does not                                                              
represent  the board. In  June of  2017, just  one month  short of                                                              
NARCAN accessibility  to  the public without  a prescription,  her                                                              
25-year-old  son,  Dylan,  passed   away  from  an  overdose.  His                                                              
dependency  followed  a  near-fatal   ATV  accident  when  he  was                                                              
irresponsibly  cut  off without  a  taper  after three  months  of                                                              
morphine and  oxycodone. At 25 he  relapsed and had  just returned                                                              
from  treatment when  he passed  away. The  man who  was with  him                                                              
called  911 immediately.  The first  responders  were there  right                                                              
away but  did not  carry NARCAN.  They could  possibly have  saved                                                              
him.  In addition  to  the  statistics  the committee  heard,  she                                                              
wants to  add that nationally, the  overdose rate is up  almost 38                                                              
percent for the first three quarters of 2020.                                                                                   
MS. MALCOM-SMITH  said that in her  work, she has come  into close                                                              
contact  with families  who are  experiencing the  same loss.  She                                                              
represents  other mothers  who have  experienced first  responders                                                              
not carrying  NARCAN. Lisa Sauder who  runs Bean's Caf?  is one of                                                              
them. They strongly  support SB 70 and strongly  encourage that in                                                              
the future, it  should be mandatory for first  responders to carry                                                              
NARCAN. She knows  eight people whose children's  lives would have                                                              
been saved.  Her son  was a  stellar human  being and citizen  who                                                              
had a  warrior's heart. Police  officers and emergency  responders                                                              
should carry NARCAN.                                                                                                            
2:44:37 PM                                                                                                                    
KATIE BOTZ,  representing self,  Juneau, Alaska, recalled  sitting                                                              
in one  of the legislative rooms  testifying for NARCAN.  She lost                                                              
a friend  around 2017 due  to an opioid  overdose. He hid  his use                                                              
of drugs  very well.  It is important  to her  that NARCAN  get in                                                              
the hands  of healthcare  providers and  the police department  to                                                              
help in  cases of  opioid overdoses.  It is  discouraging  to hear                                                              
cases of  police and responders not  having it on hand.  She asked                                                              
the  legislature to  make it  mandatory  for healthcare  providers                                                              
and police officers to have NARCAN on hand.                                                                                     
2:47:35 PM                                                                                                                    
CHAIR WILSON closed public testimony on SB 70.                                                                                  
SENATOR REINBOLD  thanked Ms. Malcom-Smith  for her  testimony and                                                              
for serving  on the  board of  the Alaska  Mental Health  Advisory                                                              
Board and  expressed sorrow  for her loss.  She asked her  to send                                                              
any numbers  that she has  about overdoses  and the use  of NARCAN                                                              
or anything about the impact since March to the chair.                                                                          
2:49:43 PM                                                                                                                    
CHAIR WILSON said  he heard the committee's concerns  and he would                                                              
offer a  committee substitute  (CS) that  leaves in the  reporting                                                              
CHAIR WILSON held SB 70 in committee for further consideration                                                                  

Document Name Date/Time Subjects
SB 65 version B.pdf SHSS 2/16/2021 1:30:00 PM
SB 65
SB 65 Sponsor Statement 2.4.2021.pdf HHSS 4/27/2021 3:00:00 PM
HHSS 4/29/2021 3:00:00 PM
HHSS 5/4/2021 3:00:00 PM
HJUD 5/5/2021 1:00:00 PM
HJUD 5/17/2021 1:00:00 PM
SHSS 2/16/2021 1:30:00 PM
SB 65
SB 65 Sectional Analysis v. B 2.4.2021.pdf HHSS 4/27/2021 3:00:00 PM
HHSS 4/29/2021 3:00:00 PM
HHSS 5/4/2021 3:00:00 PM
SHSS 2/16/2021 1:30:00 PM
SB 65
SB 65 Letter of Support ASMA 2.11.2021.pdf HHSS 4/27/2021 3:00:00 PM
HHSS 4/29/2021 3:00:00 PM
SHSS 2/16/2021 1:30:00 PM
SB 65
SB 65 FN Dept of Law.pdf HHSS 4/29/2021 3:00:00 PM
SHSS 2/16/2021 1:30:00 PM
SB 65
SB70 v. A.PDF SHSS 2/16/2021 1:30:00 PM
SB 70
SB 70 Sponsor Statement 2.10.21.pdf HHSS 3/30/2021 3:00:00 PM
SHSS 2/16/2021 1:30:00 PM
SB 70
SB 70 Sectional Summary v. A 2.10.21.pdf SHSS 2/16/2021 1:30:00 PM
SB 70
SB 70 Naloxone Standing Order Fact Sheet1-21-21.pdf HHSS 3/30/2021 3:00:00 PM
SHSS 2/16/2021 1:30:00 PM
SB 70
SB 70 Opioid Leg Report DHSS 9.28.20.pdf HHSS 3/30/2021 3:00:00 PM
SHSS 2/16/2021 1:30:00 PM
SB 70
SB 70 FN DHSS.pdf HHSS 3/30/2021 3:00:00 PM
SHSS 2/16/2021 1:30:00 PM
SB 70
SB 70 SLA 2017 SB 91.PDF HHSS 3/30/2021 3:00:00 PM
SHSS 2/16/2021 1:30:00 PM
SB 70
SB 70 Opioid Leg Report DHSS 2017-18.pdf HHSS 3/30/2021 3:00:00 PM
SHSS 2/16/2021 1:30:00 PM
SB 70
SB 70 Opioid Leg Report DHSS 2018-19.pdf SHSS 2/16/2021 1:30:00 PM
SB 70
SB 70 DHSS Invited Testimony - SHSS - 02162021 Clean.pptx SHSS 2/16/2021 1:30:00 PM
SB 70
SB 70 Letters of Support, Redacted, 2.16.21.pdf SHSS 2/16/2021 1:30:00 PM
SB 70