Legislature(2015 - 2016)BELTZ 105 (TSBldg)

04/01/2015 01:30 PM JUDICIARY

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
Bills Previously Heard/Scheduled:
+ SB 23 IMMUNITY FOR PROVIDING OPIOID OD DRUG TELECONFERENCED
Moved CSSB 23(JUD) Out of Committee
*+ SB 82 ALCOHOL/SUBST ABUSE PROGRAM MITIGATION TELECONFERENCED
Moved SB 82 Out of Committee
+ Bills Previously Heard/Scheduled: TELECONFERENCED
= HCR 3 ENDORSING ANWR LEASING
Moved SCS CSHCR 3(JUD) Out of Committee
          SB  23-IMMUNITY FOR PROVIDING OPIOID OD DRUG                                                                      
                                                                                                                                
1:33:23 PM                                                                                                                    
CHAIR  MCGUIRE announced  the  consideration of  SB  23. "An  Act                                                               
relating   to    immunity   for   prescribing,    providing,   or                                                               
administering opioid overdose drugs."                                                                                           
                                                                                                                                
1:33:38 PM                                                                                                                    
DR.  PAULA   COLESCOTT,  MD,  Addiction   Specialist,  Providence                                                               
Breakthrough,   testifying   via  teleconference,   spoke   about                                                               
unintentional  drug  overdoses   from  prescription  opiates  and                                                               
heroin.   [Due  to   a  poor   connection,   the  testimony   was                                                               
indiscernible.  The sponsor  noted that  Dr. Colescott  supported                                                               
the legislation.]                                                                                                               
                                                                                                                                
1:35:46 PM                                                                                                                    
SENATOR  JOHNNY ELLIS,  Alaska State  Legislature, sponsor  of SB
23, said  he and  former Senator Dyson  talked about  the growing                                                               
problem of  opioid addiction  for over a  decade. It  has reached                                                               
epidemic proportions  in the  state and  the problem  is growing.                                                               
Fatal drug  overdoses have  increased more  than six-fold  in the                                                               
past  three  decades and  now  claim  the  lives of  over  36,000                                                               
Americans  every   year.  According   to  the   Anchorage  Police                                                               
Department,  heroin-related  overdoses  are claiming  more  young                                                               
lives than  traffic fatalities. The  2014 Alaska  State Troopers'                                                               
Drug  Report  identified an  increase  in  heroin abuse  and  the                                                               
continued use  of other opiates  as significant concerns  for law                                                               
enforcement.                                                                                                                    
                                                                                                                                
He  reported that  the abuse  and overdose  epidemic was  largely                                                               
driven by  addiction to prescription  opioids such  as OxyContin,                                                               
Oxycodone,  and  Vicodin. Because  these  drugs  have grown  more                                                               
expensive  over time,  abusers and  addicts  have sought  cheaper                                                               
alternatives,  such as  black  tar heroin  which  is imported  to                                                               
Alaska by the Mexican drug cartel.                                                                                              
                                                                                                                                
SENATOR ELLIS said that heroin  abuse crosses all economic levels                                                               
and  has left  no community  untouched. This  trend is  troubling                                                               
because prescription  opioids are  popular among  young Alaskans.                                                               
According to 2011  data from the Centers for  Disease Control and                                                               
the  Prevention  Youth  Risk Behavior  Survey,  15.8  percent  of                                                               
Alaska students  reported having used prescription  drugs without                                                               
a prescription.  These drugs are  more popular among  high school                                                               
students  than  alcohol,  tobacco,  and  marijuana.  Fortunately,                                                               
opioid overdose  is reversible through the  timely administration                                                               
of  the medication  Naloxone, but  that medication  is often  not                                                               
available when needed.  Friends and family members  are often the                                                               
ones who are best  situated to save the life of  a person who has                                                               
overdosed,  but medical  professionals  are  wary of  prescribing                                                               
Naloxone  and lay  persons are  wary of  administering it  due to                                                               
potential civil liability.                                                                                                      
                                                                                                                                
SB  23  removes the  civil  liability  from doctors  and  trained                                                               
bystanders.  He expressed  hope  that Alaska  would  be the  29th                                                               
state  to  provide  this  protection.   The  bill  has  attracted                                                               
bipartisan   support  along   with  the   Alaska  State   Medical                                                               
Association, the Alaska  Police Department Employees Association,                                                               
the  Alaska  Mental Health  Trust  Authority,  the Alaska  Mental                                                               
Health Board  and Advisory  Board on  Alcoholism and  Drug Abuse,                                                               
the  Narcotic  Treatment  Center,   and  countless  families  and                                                               
addicts. He noted that during  a previous committee hearing, Rick                                                               
Svobodny  testified that  the  Department of  Law  (DOL) and  the                                                               
Administration support the legislation.                                                                                         
                                                                                                                                
CHAIR MCGUIRE stated her intention to become a co-sponsor.                                                                      
                                                                                                                                
1:43:58 PM                                                                                                                    
SENATOR COGHILL moved to adopt  the proposed committee substitute                                                               
for SB 23, labeled 29-LS0058\E, as the working document.                                                                        
                                                                                                                                
SENATOR COSTELLO objected for discussion purposes.                                                                              
                                                                                                                                
1:44:37 PM                                                                                                                    
MATTHEW  MOSER,  Staff,  Senator   Johnny  Ellis,  described  the                                                               
changes  in  version  E.  Bill   sections  1  and  2  change  the                                                               
definition  of  "opioid  overdose  program" so  that  it  is  not                                                               
limited to  state, federal or  municipally funded  programs. Sec.                                                               
09.65.340(a)(1)(A) authorizes health  care providers to prescribe                                                               
an  opioid overdose  drug directly  or to  a person  who is  in a                                                               
position to  administer an  opioid overdose drug  to a  person at                                                               
risk of experiencing an  opioid overdose. Sec. 09.65.340(a)(1)(B)                                                               
authorizes  an  employee  or  volunteer  of  an  opioid  overdose                                                               
program, or other  person in a position to  administer the opioid                                                               
overdose drug,  to receive a  supply, possess, and  supply opioid                                                               
overdose  drugs to  persons  at risk  of  experiencing an  opioid                                                               
overdose.                                                                                                                       
                                                                                                                                
SENATOR COSTELLO removed  her objection and version  E was before                                                               
the committee.                                                                                                                  
                                                                                                                                
CHAIR  MCGUIRE  asked if  the  Alaska  State Troopers  and  local                                                               
police would be  authorized to carry the opioid  overdose drug in                                                               
their care kits.                                                                                                                
                                                                                                                                
MR. MOSER replied it's already a  common part of the EMT tool kit                                                               
and he suspects this would allow troopers to carry it.                                                                          
                                                                                                                                
SENATOR COGHILL  asked how broad  the interpretation will  be for                                                               
"at risk" in this context.                                                                                                      
                                                                                                                                
SENATOR  ELLIS  replied it's  a  good  question, but  it  doesn't                                                               
matter because there are no negative  side effects if a person is                                                               
administered Naloxone when  they're not in jeopardy  of heroin or                                                               
opioid overdose.                                                                                                                
                                                                                                                                
SENATOR COGHILL asked  what it takes to be  trained to administer                                                               
the overdose drug.                                                                                                              
                                                                                                                                
MR. MOSER explained that the drug  may be administered as a nasal                                                               
spray or  by injection  that is  similar to  an EpiPen,  which is                                                               
commonly used for  allergic reactions. The lay  person would also                                                               
be made aware of the symptoms of an overdose.                                                                                   
                                                                                                                                
SENATOR ELLIS  added that the  prescription EpiPen  with Naloxone                                                               
has the injection instructions are  on the pen. That is basically                                                               
when the  training would  occur. He  said that  for years  he and                                                               
former Senator  Dyson pointed out  to their colleagues  the gross                                                               
underfunding   of  the   Methadone  clinics   in  Fairbanks   and                                                               
Anchorage. Those  programs are still underfunded  and the waiting                                                               
lists are even  longer in light of the current  epidemic. He said                                                               
he's heard  from some parents  who are taking  desperate measures                                                               
to help their teenage daughter or  son at home because they can't                                                               
get them into a treatment program.                                                                                              
                                                                                                                                
SENATOR  COGHILL  asked  what  the procedure  is  for  getting  a                                                               
prescription.                                                                                                                   
                                                                                                                                
MR. MOSER  replied it would  be available through  a prescription                                                               
from a doctor or an  opioid overdose reversal program. He offered                                                               
to follow  up with  information from  a program  in Massachusetts                                                               
that reported about 2,000 overdose reversals.                                                                                   
                                                                                                                                
1:55:10 PM                                                                                                                    
CHAIR  MCGUIRE referenced  the presentation  the committee  heard                                                               
[on   2/4/15   about   medication   assisted   treatment   (MAT),                                                               
specifically Vivitrol, to treat  opioid addictions. It blocks the                                                               
effects of opioids and removes the pleasure index.]                                                                             
                                                                                                                                
MR. MOSER replied it sounds like  a promising tool to address the                                                               
addiction  itself  as  opposed   to  Naltrexone  that  treats  an                                                               
overdose.                                                                                                                       
                                                                                                                                
SENATOR ELLIS  added that  his staff member  Amory LeLake  is the                                                               
expert and she would follow up with specifics.                                                                                  
                                                                                                                                
CHAIR MCGUIRE said she understands  that the group that delivered                                                               
the MAT  presentation is  looking at a  million dollar  grant for                                                               
the treatment of opioid addiction.                                                                                              
                                                                                                                                
SENATOR ELLIS agreed that Vivitrol  holds promise for the future.                                                               
He  noted  that  a  doctor  in  the  MatSu  Valley  is  currently                                                               
prescribing Vivitrol within his practice.                                                                                       
                                                                                                                                
CHAIR  MCGUIRE said  she found  it particularly  interesting that                                                               
someone with  an opioid addiction  could receive an  injection of                                                               
Vivitrol when they leave prison  and they would be protected from                                                               
the craving for 30 days. They  wouldn't be looking for their drug                                                               
dealer immediately.                                                                                                             
                                                                                                                                
SENATOR  ELLIS agreed  that without  treatment in  prison or  the                                                               
community  the addict  would be  looking for  their dealer  right                                                               
away.                                                                                                                           
                                                                                                                                
1:58:41 PM                                                                                                                    
KATE BURKHART, Executive Director,  Advisory Board on Alcohol and                                                               
Drug Abuse and Alaska Mental  Health Board, stated support for SB
23 on behalf of the boards.  She said the bill speaks directly to                                                               
the concerns raised by physicians  engaged in medication assisted                                                               
treatment  to help  people recover  from opioid  addiction. These                                                               
physicians asked  if it was  within their professional  ethics to                                                               
prescribe this  medication when it  could be viewed  as promoting                                                               
illicit drug  use. SB 23  provides the guidance  these physicians                                                               
were looking  for. Prescribing this  drug is within the  scope of                                                               
practice to take care of their patients. It will save lives.                                                                    
                                                                                                                                
2:03:07 PM                                                                                                                    
KARA NELSON,  Director, Haven House, Executive  Committee, Juneau                                                               
Reentry  Coalition,   and  Member,  Juneau   Recovery  Community,                                                               
testified  in  support  of  SB 23.  She  described  her  personal                                                               
history  with  drug  addiction  and  overdose.  She  related  how                                                               
important the  drug Naloxone is.  She pointed out  that addiction                                                               
does  not discriminate.  She testified  how  important one  saved                                                               
life is. She  said the bill will keep people  from worrying about                                                               
going to  jail for trying  to save a life.  It is not  a criminal                                                               
issue.  She described  her work  with Haven  House. She  stressed                                                               
that Narcan  is very  important to recovery  and so  is community                                                               
support. Vivitrol is  a good product but it has  to be surrounded                                                               
with recovery-oriented systems of care, she said.                                                                               
                                                                                                                                
2:18:27 PM                                                                                                                    
CHAIR MCGUIRE thanked Ms. Nelson for coming forward.                                                                            
                                                                                                                                
SENATOR COGHILL referenced  page 3, lines 2-3, and  noted that an                                                               
opioid overdose  drug may be  prescribed directly or  by standing                                                               
order or protocol  to a person at risk. He  asked if "protocol to                                                               
a person  at risk" includes an  addict who says he/she  is trying                                                               
to  recover and  needs  to have  the drug  available  in case  of                                                               
relapse.                                                                                                                        
                                                                                                                                
MR. MOSER  said that's his  understanding. The standing  order of                                                               
protocol can also  relate to a pharmacist who  has authority from                                                               
a  physician  to  prescribe  the  drug.  He  suggested  that  Ms.                                                               
Burkhardt might be able to supplement the answer.                                                                               
                                                                                                                                
2:20:26 PM                                                                                                                    
MS. BURKHARDT said her reading  of prescription by standing order                                                               
or  protocol would  allow  the medical  director  of a  treatment                                                               
program  to have  a standing  order  that all  patients that  are                                                               
receiving  treatment  for  opioid  addiction  could  receive  the                                                               
prescription. It  would also allow  a physician to  prescribe the                                                               
drug individually.                                                                                                              
                                                                                                                                
SENATOR COGHILL expressed satisfaction with the explanation.                                                                    
                                                                                                                                
SENATOR COSTELLO interpreted the language  on page 2, line 13, to                                                               
mean that  a person  who received education  and training  in the                                                               
administration of  the drug would  not be civilly liable,  but an                                                               
untrained  person   who  had  no   training  doesn't   have  that                                                               
protection.                                                                                                                     
                                                                                                                                
MR.  MOSER  agreed  that  proper  education  and  training  is  a                                                               
required component of administering the drug.                                                                                   
                                                                                                                                
MS. BURKHARDT added that the  training that's anticipated is very                                                               
similar  to the  patient education  a person  receives for  other                                                               
prescription medications. She noted  that the EpiPen for allergic                                                               
reactions was referenced earlier.                                                                                               
                                                                                                                                
SENATOR   COSTELLO  said   she   was   envisioning  a   bystander                                                               
administering the drug.                                                                                                         
                                                                                                                                
MR.  MOSER  offered  his  belief  that  the  civil  liability  is                                                               
extended  to both  the  physician and  someone  who has  received                                                               
training to administer the drug.  He noted that other states have                                                               
removed the civil liability altogether.  He said it speaks to the                                                               
safety of  the drug that it's  been available in Italy  without a                                                               
prescription since the 1990s.                                                                                                   
                                                                                                                                
CHAIR MCGUIRE described the bill as a first step.                                                                               
                                                                                                                                
2:26:19 PM                                                                                                                    
SENATOR COGHILL  motioned to  report the CS  for SB  23(JUD) from                                                               
committee  with  individual  recommendations  and  attached  zero                                                               
fiscal note.                                                                                                                    
                                                                                                                                
2:26:51 PM                                                                                                                    
CHAIR MCGUIRE  announced that without objection,  CSSB 23(JUD) is                                                               
reported from the Senate Judiciary Standing Committee.                                                                          

Document Name Date/Time Subjects
1 CSSB23 Version E.pdf SJUD 4/1/2015 1:30:00 PM
SB 23
2 CSSB23 (JUD) Sectional Analysis.pdf SJUD 4/1/2015 1:30:00 PM
SB 23
3 CSSB23 (JUD) Explanation of Changes.pdf SJUD 4/1/2015 1:30:00 PM
SB 23
4 SB23 Supporting Doc_State Naloxone and Good Samaritan Legislation.pdf SJUD 4/1/2015 1:30:00 PM
SB 23
4.1 SB23 Supporting Doc_Legal Interventions to Reduce Overdose Mortality.pdf SJUD 4/1/2015 1:30:00 PM
SB 23
4.2 SB23 Supporting Doc_The Changing Face of Heroin.pdf SJUD 4/1/2015 1:30:00 PM
SB 23
4.3 SB23 Supporting Doc_ States Expand Access to Overdose-Reversal Drug.pdf SJUD 4/1/2015 1:30:00 PM
SB 23
4.4 SB23 Supporting Doc_2014 Alaska State Troopers Report.pdf SJUD 4/1/2015 1:30:00 PM
SB 23
4.5 SB23 Supporting Doc_ Administer Naloxone.pdf SJUD 4/1/2015 1:30:00 PM
SB 23
4.6 SB23 Supporting Doc_ Leg Legal Memo RE DOC applicability.pdf SJUD 4/1/2015 1:30:00 PM
SB 23
4.7 SB23 Supportig Doc_ APD Calls Overdose Deaths an Epidemic.pdf SJUD 4/1/2015 1:30:00 PM
SB 23
4.8 SB23 Supporting Doc_Changing Law from Barrier to Facilitator of Opioid Overdose Prevention.pdf SJUD 4/1/2015 1:30:00 PM
SB 23
8 SB43 Supporting Doc_AS 09.65.070.pdf SJUD 4/1/2015 1:30:00 PM
SB 43
4.9 SB23 Supporting Doc_Overdosed and Overrun - Alaska's heroin epidemic.pdf SJUD 4/1/2015 1:30:00 PM
SB 23
4.10 SB23 Supporting Doc_Valley heroin use 'epidemic'.pdf SJUD 4/1/2015 1:30:00 PM
SB 23
4.11 SB23 Supporting Doc_ JPD drug take nears Anchorage levels.pdf SJUD 4/1/2015 1:30:00 PM
SB 23
4.12 SB23 Supporting Doc_ADN Article 6 arrested in Kenai Peninsula meth heroin bust.pdf SJUD 4/1/2015 1:30:00 PM
SB 23
5 SB23 Letter of Support_ Alaska State Medical Association.pdf SJUD 4/1/2015 1:30:00 PM
SB 23
5.1 SB23 Letter of Support_Alaska Mental Health Trust Letter of Support.pdf SJUD 4/1/2015 1:30:00 PM
SB 23
5.2 SB23 Letter of Support_ABADA AMHB.pdf SJUD 4/1/2015 1:30:00 PM
SB 23
5.3 SB23 Letter of Support_Narcotic Drug Treatment Center.pdf SJUD 4/1/2015 1:30:00 PM
SB 23
5.4 SB23 Letter of Support_APDEA.pdf SJUD 4/1/2015 1:30:00 PM
SB 23
6 SB23 Fiscal Note #1.pdf SJUD 4/1/2015 1:30:00 PM
SB 23
6.1 SB23 Fiscal Note #2.pdf SJUD 4/1/2015 1:30:00 PM
SB 23
1 SB82 Version A.PDF SJUD 4/1/2015 1:30:00 PM
SB 82
2 SB82 Sponsor Statement.pdf SJUD 4/1/2015 1:30:00 PM
SB 82
3 SB82 Supporting Doc_ Presentation 24.7 Sobriety program.ppt SJUD 4/1/2015 1:30:00 PM
SB 82
3.1 SB82 Supporting Doc_ADN article.docx SJUD 4/1/2015 1:30:00 PM
SB 82
3.2 SB82 Supporting Doc_WA Program.pdf SJUD 4/1/2015 1:30:00 PM
SB 82
4 SB82 Fiscal Note #1.pdf SJUD 4/1/2015 1:30:00 PM
SB 82
4.1 SB82 Fiscal Note #2.pdf SJUD 4/1/2015 1:30:00 PM
SB 82
1 HCR3 Version H.pdf SJUD 4/1/2015 1:30:00 PM
HCR 3
2 HCR3 Sponsor Statement.pdf SJUD 4/1/2015 1:30:00 PM
HCR 3
3 HCR3 Supporting Doc_RLS Memo.pdf SJUD 4/1/2015 1:30:00 PM
HCR 3
4 HCR 3 Amendment #1.pdf SJUD 4/1/2015 1:30:00 PM
HCR 3