03/21/2017 01:30 PM Senate LABOR & COMMERCE
| Audio | Topic |
|---|---|
| Start | |
| SB71 | |
| HB48 | |
| SB79 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| + | HB 48 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | SB 79 | TELECONFERENCED | |
| += | SB 71 | TELECONFERENCED | |
ALASKA STATE LEGISLATURE
SENATE LABOR AND COMMERCE STANDING COMMITTEE
March 21, 2017
1:33 p.m.
MEMBERS PRESENT
Senator Mia Costello, Chair
Senator Shelley Hughes, Vice Chair
Senator Kevin Meyer
Senator Berta Gardner
MEMBERS ABSENT
Senator Gary Stevens
COMMITTEE CALENDAR
SENATE BILL NO. 71
"An Act relating to limitations on certain commercial fishing
loans made by the Department of Commerce, Community, and
Economic Development."
- MOVED SB 71 OUT OF COMMITTEE
HOUSE BILL NO. 48
"An Act relating to the composition of the State Board of
Registration for Architects, Engineers, and Land Surveyors;
extending the termination date of the State Board of
Registration for Architects, Engineers, and Land Surveyors; and
providing for an effective date."
- HEARD & HELD
SENATE BILL NO. 79
"An Act relating to the prescription of opioids; establishing
the Voluntary Nonopioid Directive Act; relating to the
controlled substance prescription database; relating to the
practice of dentistry; relating to the practice of medicine;
relating to the practice of podiatry; relating to the practice
of osteopathy; relating to the practice of nursing; relating to
the practice of optometry; relating to the practice of
veterinary medicine; related to the duties of the Board of
Pharmacy; and providing for an effective date."
- HEARD & HELD
CONFIRMATION HEARINGS
ITEM REMOVED FROM AGENDA
PREVIOUS COMMITTEE ACTION
BILL: SB 71
SHORT TITLE: COMMERCIAL FISHING LOANS
SPONSOR(s): SENATOR(s) STEVENS
02/27/17 (S) READ THE FIRST TIME - REFERRALS
02/27/17 (S) L&C, FIN
03/16/17 (S) L&C AT 1:30 PM BELTZ 105 (TSBldg)
03/16/17 (S) Heard & Held
03/16/17 (S) MINUTE(L&C)
03/21/17 (S) L&C AT 9:30 AM BELTZ 105 (TSBldg)
03/21/17 (S) L&C AT 1:30 PM BELTZ 105 (TSBldg)
BILL: HB 48
SHORT TITLE: ARCHITECTS, ENGINEERS,SURVEYORS: EXTEND BD
SPONSOR(s): REPRESENTATIVE(s) KITO
01/18/17 (H) READ THE FIRST TIME - REFERRALS
01/18/17 (H) L&C, FIN
02/08/17 (H) L&C AT 3:15 PM BARNES 124
02/08/17 (H) Heard & Held
02/08/17 (H) MINUTE(L&C)
02/10/17 (H) L&C AT 3:15 PM BARNES 124
02/10/17 (H) Moved HB 48 Out of Committee
02/10/17 (H) MINUTE(L&C)
02/13/17 (H) L&C RPT 6DP
02/13/17 (H) DP: SULLIVAN-LEONARD, JOSEPHSON, BIRCH,
KNOPP, STUTES, KITO
02/22/17 (H) FIN AT 1:30 PM HOUSE FINANCE 519
02/22/17 (H) Moved HB 48 Out of Committee
02/22/17 (H) MINUTE(FIN)
02/24/17 (H) FIN RPT 9DP
02/24/17 (H) DP: GARA, WILSON, KAWASAKI, PRUITT,
ORTIZ, THOMPSON, GUTTENBERG, TILTON,
02/24/17 (H) SEATON
03/06/17 (H) TRANSMITTED TO (S)
03/06/17 (H) VERSION: HB 48
03/08/17 (S) READ THE FIRST TIME - REFERRALS
03/08/17 (S) L&C, FIN
03/21/17 (S) L&C AT 1:30 PM BELTZ 105 (TSBldg)
BILL: SB 79
SHORT TITLE: OPIOIDS; PRESCRIPTIONS; DATABASE; LICENSES
SPONSOR(s): RULES BY REQUEST OF THE GOVERNOR
03/06/17 (S) READ THE FIRST TIME - REFERRALS
03/06/17 (S) L&C, HSS, FIN
03/14/17 (S) L&C AT 1:30 PM BELTZ 105 (TSBldg)
03/14/17 (S) Heard & Held
03/14/17 (S) MINUTE(L&C)
03/16/17 (S) L&C AT 1:30 PM BELTZ 105 (TSBldg)
03/16/17 (S) Scheduled but Not Heard
03/21/17 (S) L&C AT 9:30 AM BELTZ 105 (TSBldg)
03/21/17 (S) L&C AT 1:30 PM BELTZ 105 (TSBldg)
WITNESS REGISTER
REPRESENTATIVE SAM KITO
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Sponsor of SB 48.
KRIS CURTIS, Legislative Auditor
Legislative Audit Division
Juneau, Alaska
POSITION STATEMENT: Presented information related to HB 48.
ALYSIA JONES, Executive Administrator
Board of Registration for Architects, Engineers, and Land
Surveyors
Division of Corporations, Businesses, and Professional Licensing
Department of Commerce, Community and Economic Development
Juneau, Alaska
POSITION STATEMENT: Answered questions related to HB 48.
SARA CHAMBERS, Operations Manager
Division of Corporations, Businesses, and Professional Licensing
Department of Commerce, Community and Economic Development
Juneau, Alaska
POSITION STATEMENT: Answered questions related to HB 48 and SB
79.
COLIN MAYNARD, PE, SE
Alaska Board of Architects, Engineers, and Land Surveyors
Anchorage, Alaska
POSITION STATEMENT: Provided information related to HB 48.
MICHELLE ALPERS, Landscape Architect
Engineering Public Works Department
City and Borough of Juneau and
Member
Alaska Professional Design Council
Juneau, Alaska
POSITION STATEMENT: Presented information related to HB 48.
JAY BUTLER, Chief Medical Officer
Department of Health and Social Services (DHSS)
Anchorage, Alaska
POSITION STATEMENT: Provided information related to SB 79.
CAPTAIN MIKE DUXBURY
Alaska State Trooper
Department of Public Safety
Anchorage, Alaska
POSITION STATEMENT: Answered questions about SB 79.
STACIE KRALY, Chief Assistant Attorney General
Civil Division
Human Services Section
Department of Law
Juneau, Alaska
POSITION STATEMENT: Answered questions related to SB 79.
SCOTT ADAMS, representing himself
Homer, Alaska
POSITION STATEMENT: Voiced concern with parts of SB 79.
ACTION NARRATIVE
1:33:38 PM
CHAIR MIA COSTELLO called the Senate Labor and Commerce Standing
Committee meeting to order at 1:33 p.m. Present at the call to
order were Senators Hughes, Meyer, and Chair Costello. Senator
Gardner arrived shortly thereafter.
SB 71-COMMERCIAL FISHING LOANS
CHAIR COSTELLO announced the consideration of SB 71. She said
this is the third hearing and the intent is to look to the will
of the committee. She noted those available to answer questions.
1:34:49 PM
CHAIR HUGHES moved to report SB 71 from committee with
individual recommendations and attached fiscal notes.
CHAIR COSTELLO announced that without objection, SB 71 moved
from the Senate Labor and Commerce Standing Committee.
1:35:14 PM
At ease
HB 48-ARCHITECTS, ENGINEERS, SURVEYORS: EXTEND BD
1:36:22 PM
CHAIR COSTELLO brought the meeting back to order and announced
the first hearing of HB 48.
1:36:44 PM
REPRESENTATIVE SAM KITO, Alaska State Legislature, sponsor of SB
48, explained that the bill extends the termination date of the
State Board of Registration for Architects, Engineers, and Land
Surveyors (AELS) of which he is a licensee as a civil engineer.
The Division of Legislative Audit found that the AELS Board
meets the public need and recommends an eight-year extension. He
noted that the bill also changes the status of the current
landscape architect seat from a nonvoting temporary to a full,
voting member. The bill contains no additional costs.
1:38:47 PM
CHAIR COSTELLO welcomed Senator Gardner.
CHAIR HUGHES asked why the landscape architect seat has been a
non-voting member for 20 years.
REPRESENTATIVE KITO explained the interest in keeping that
position temporary until there were licensed landscape
architects in Alaska. He said the Board has tried twice to
change this provision since there are now about 50 landscape
architects in Alaska.
1:40:58 PM
SENATOR MEYER asked if the audit found a surplus in the Board's
budget.
REPRESENTATIVE KITO confirmed there is a surplus. The budget is
calculated annually, but adjusted every two years. The fees are
adjusted accordingly in that two-year cycle.
SENATOR MEYER suggested the fees could or should be reduced if
there actually is a $1.6 million surplus.
REPRESENTATIVE KITO said that is how it works. If there is a
surplus the subsequent biennium fee will be adjusted.
CHAIR COSTELLO noted those available to answer questions.
1:43:26 PM
KRIS CURTIS, Legislative Auditor, Legislative Audit Division,
explained the results of the sunset review dated April 2016. She
said, overall, the audit found that the Board is serving the
public's interest and they recommended an eight-year extension,
the maximum allowed. The audit had no recommendations.
She reported on the schedule of revenue expenditures on page 7
of the audit report, as of February 2016. At the end of FY13
there was a deficit and the fees were increased; at the end of
February 2016 there was a surplus of over $1.6 million. They
discussed this with the Division of Corporations, Business, and
Professional Licensing the decision was to re-evaluate the fees.
She referred to page 8 of the audit - the schedule of license
fees - and page 5 - a list of all occupations that are licensed
by the AELS Board and the count of the numbers of licensees or
registrants.
MS. CURTIS noted the audit also discussed Board composition. All
occupations that are licensed by the Board are represented
except for the landscape architect. They interviewed 7 of 10
Board members about that issue and found that all 7 were in
support of making the landscape architect position permanent.
CHAIR COSTELLO asked how many members are on the Board.
MS. CURTIS said 10.
CHAIR COSTELLO asked if the even number of members is a problem.
MS. CURTIS said they did not have an opinion on that and did not
come out with a recommendation. She said it was a policy call.
She explained the reasons for interviewing 7 members.
1:46:51 PM
SENATOR GARDNER referred to page 7 of the audit and asked for
examples of other revenue sources. She also asked whether the
fluctuation in spending is related to the number of complaints
that are investigated.
MS. CURTIS said they did not have an explanation for the other
fund sources; that information comes from the agency. The
fluctuation is mainly in the area of services under direct
expenditures. The agency may be able to answer that question,
she said.
1:47:58 PM
SENATOR MEYER asked if Legislative Audit recommended an 8-year
extension because they are comfortable with the Board.
MS. CURTIS answered yes.
SENATOR MEYER asked about a concern on page 4 regarding
registrants completing continuing education.
MS. CURTIS said it is not a concern now due to a new licensing
system that includes continuing education documentation.
1:49:20 PM
ALYSIA JONES, Executive Administrator, Board of Registration for
Architects, Engineers, and Land Surveyors, Division of
Corporations, Businesses, and Professional Licensing, Department
of Commerce, Community and Economic Development (DCCED),
introduced herself.
SARA CHAMBERS, Operations Manager, Division of Corporations,
Businesses, and Professional Licensing, Department of Commerce,
Community and Economic Development (DCCED), introduced herself.
SENATOR MEYER questioned the $1.6 million surplus.
1:50:30 PM
MS. CHAMBERS explained that all fees paid by registrants stay
with their boards. An annual review is done to adjust the fees
for the next biannual renewal. They try to keep the fees level
to limit investigative costs.
1:52:05 PM
SENATOR MEYER asked for examples of typical complaints.
MS. CHAMBERS shared several examples, such as violations of
licensing laws and the use of an inappropriate person for a job.
1:53:02 PM
MS. JONES listed several other examples, such as building
violations, or unlicensed persons.
SENATOR MEYER asked if it is a serious offense if a person
claims to be a professional engineer (PE) and is not.
MS. JONES said yes.
1:54:39 PM
CHAIR HUGHES said PEs are paying for the cost of investigation
of those who claim to be a PE and are not. She asked if there is
a way to recoup those costs.
MS. CHAMBERS replied that there is no provision currently in
statute to recoup those costs.
1:55:24 PM
SENATOR GARDNER referred to page 7, income licensing fees, and
asked what the other sources of income are.
1:55:42 PM
MS. CHAMBERS explained that those are third-party travel
reimbursements for associations that fund travel for Board
members and staff to maintain their education and for
collaboration with other state boards.
She said the latest financial information through the end of the
second quarter of this fiscal year lists the Board surplus as
$1.1 million.
1:56:15 PM
CHAIR COSTELLO opened public testimony on HB 48.
1:56:24 PM
COLIN MAYNARD, PE, SE, Alaska Board of Architects, Engineers,
and Land Surveyors, said he has been on the Board the last five
years and served as chair during the audit. The Board was
pleased with the audit results. He discussed the resolution of
the continuing education issue. He described an incident ten
years ago regarding internet renewals that caused a surplus and
another example that caused a deficit.
CHAIR COSTELLO noted that the audit suggested an eight-year
extension and posited that it may indicate that the concern
about fluctuating fees has been addressed.
2:00:46 PM
MICHELLE ALPERS, Landscape Architect, Engineering Public Works
Department, City and Borough of Juneau, Member, Alaska
Professional Design Council stated support for the provision in
SB 48 to make the seat on the Board for landscape architects a
permanent voting position.
2:02:31 PM
CHAIR COSTELLO closed public testimony and held HB 48 in
committee for further consideration.
2:02:39 PM
At ease
SB 79-OPIOIDS; PRESCRIPTIONS; DATABASE; LICENSES
2:05:29 PM
CHAIR COSTELLO reconvened the meeting and announced the
consideration of SB 79. She noted it is the second hearing on
the bill. The intention is to look at a sectional analysis and
take members' questions. She noted a letter from Ms. Chambers
pertaining to the bill.
2:06:35 PM
SARA CHAMBERS, Operations Manager, Division of Corporations,
Businesses, and Professional Licensing, Department of Commerce,
Community and Economic Development (DCCED), explained that the
letter is in response to a concern by Senator Hughes that when a
person receives a prescription that meets a threshold the Board
of Pharmacy has set as a policy call - visiting five pharmacies
or five prescribers within three months - it gives a red flag to
the prescriber. In the Prescription Drug Monitoring Program
(PDMP), at the behest of the Board of Pharmacy, there is a red
flag alert to potential problems.
2:07:41 PM
CHAIR COSTELLO noted the letter does not indicate the type of
prescriptions.
MS. CHAMBERS offered her understanding that it is only for
scheduled drugs.
CHAIR COSTELLO used an example of someone with cancer who would
use those drugs frequently and thus be targeted.
MS. CHAMBERS said it is only an alert and does not require any
action. It is for the prescriber to determine a legitimate need
or not for the drugs.
2:09:50 PM
CHAIR HUGHES voiced concern about all the requirements put on
pharmacists and providers. She wondered if the Prescription Drug
Monitoring Program (PDMP) could be monitored by one office, such
as the chief medical officer, instead of by providers or
pharmacists, in order to target over-prescribers.
2:12:27 PM
JAY BUTLER, Chief Medical Officer, Department of Health and
Social Services (DHSS), stated that the question about how to
get information back to providers in the most effective way to
influence prescribing practices is at the center of the
discussion. The current practice of tracking doctor shoppers is
not the solution. The approach in SB 79 is intended to be non-
punitive and educational, such as providing a report card to
providers and then comparing that amount to the average of all
providers in the state.
He stated that the prescribing rates today are not lower than
they were ten years ago. He maintained that the level of
prescribing is not acceptable. He said that prescription use of
opioids is one of the major risk factors for heroin use. He
referred to the Centers for Disease Control and Prevention
report on risk factors of long-term opioid use. One factor is
having a prescription for longer than 10 days. The Annals of
Surgery study found that 72 percent of all opioid pills
prescribed are not taken. For the most common procedures, the
majority of patients could be managed by a one to three day
supply of pain medication.
2:17:06 PM
CHAIR HUGHES asked Dr. Butler if he has data that shows that
more doctors are prescribing more opioids in 2017 than in 2007.
DR. BUTLER said Alaska data is extrapolated from national data;
it indicates that more than half of opioid prescriptions are
written by primary care providers. He pointed to the marketing
of opioids to primary care physicians in the late 90s. He said
he does not have the authority to look at PDMP data.
2:19:32 PM
CHAIR HUGHES questioned whether overprescribing is happening
generally or by a few doctors. She asked if it would be helpful
if he could tell who is overprescribing.
2:21:34 PM
DR. BUTLER said if someone has the authority to look at the PDMP
it would be helpful. He challenged the concept that "it's the
bad actors" who are overprescribing. He said he does not believe
there are many over-prescribers who intend to do harm; it's due
to a lack of knowledge.
2:23:47 PM
CHAIR HUGHES said the bill is here partly due to the
requirements of the Board of Pharmacy, but she did not want to
overburden the pharmacists. Other states have allowed the DEA to
monitor the PDMP and find out if it is prevalent across the
board. She asked if he could find out information from other
states.
DR. BUTLER said they already have that information and
recommendations for best practices, such as from the Pew
Charitable Trust. He said he respects the concern about
confidentiality and patient privacy that has led Alaska to be
very careful with PDMP data. Some of the lessons learned from
other states has gone into the drafting of the bill.
2:25:46 PM
CHAIR HUGHES said she would like to know: the percentage of
providers in other states that are over-prescribers; and what
happens to someone who has been found to over prescribe.
2:26:35 PM
MS. CHAMBERS stressed the importance of first defining
overprescribing. The bill sets the limit of a prescription
supply at seven days. Overprescribing used to be considered the
number of prescriptions.
She said there are penalties in the bill for overprescribing,
but without a further definition of overprescribing it would be
hard to enforce.
2:28:11 PM
CHAIR HUGHES asked if there is some exception to the 7-day
prescription supply for those who live in rural areas and have
trouble getting to a pharmacy.
MS. CHAMBERS said the bill makes exceptions for that and allows
for professional discretion when prescribing, and there are
electronic prescription options. These provisions are concepts
that the Joint Committee on Prescriptive Guidelines came up
with.
She agreed that lack of awareness about overprescribing is a
topic the State Medical Board is aware of. They said more
education is also needed about alternatives to opioids.
2:31:35 PM
CHAIR COSTELLO referred to the data on deaths related to heroin
and synthetic opioids in the State of Alaska Epidemiology
Bulletin dated November 7, 2016. Fifty percent were in Anchorage
and Mat-Su. She asked about the connection between heroin use
and opioid addiction.
2:32:33 PM
DR. BUTLER described the opioid epidemic in terms of three waves
of a tsunami. The first wave was the increase in the number of
overdose deaths related to prescription opioids. That wave has
not fully receded. The second wave appeared in about 2010 when
heroin became cheaper and more available. The third wave
appeared two years ago and is driven by fentanyl and synthetic
opioids. That wave differs because there is not an increase in
prescriptions for fentanyl. These substances are readily
available and can be ordered on the internet.
He noted that half of deaths are in Anchorage and Mat-Su, but
that is also where 40 percent of the state's population resides.
The problem is spread throughout the United States, including
small Alaskan villages.
2:35:52 PM
CHAIR COSTELLO referred to drug representatives in the
pharmaceutical industry that lobby doctors. She asked if there
is any information about "performance targets" for doctors. She
asked if they have considered the pharmaceutical company's role
in this epidemic.
2:37:26 PM
DR. BUTLER said it's important that prescribers receive
information from sources other than pharmaceutical companies. He
spoke of fines to drug companies for not communicating dangers
of opioid dependency to physicians.
He said they would like to go toward "academic detailing," which
is based on the concept of what is evidence based in medical
literature. The goal is to learn from past experiences and look
at alternatives for pain management.
2:39:30 PM
SENATOR GARDNER said she has a disabled veteran constituent with
chronic pain who thinks the bill will punish people in pain. She
asked for assurance that there is a provision that addresses
this type of exception.
2:41:12 PM
DR. BUTLER said it is left to the provider's professional
judgement as to whether a larger dispensing is indicated. He
said there are exceptions listed in the bill.
2:42:40 PM
SENATOR GARDNER talked about a partial prescription as requested
by a patient. She asked if patients that are in charge of their
own pain management use less.
DR. BUTLER said he believes that is true.
SENATOR GARDNER voiced concern about the voiding of leftover
pain medication from a partial prescription. She asked Dr.
Butler if he would support an amendment to allow the rest of the
prescription to be used.
2:44:23 PM
DR. BUTLER said yes. The bill attempts to allow pharmacists to
fill only part of the prescription at the patient's request.
Federal law already allows that to happen while not voiding the
second half of the prescription.
2:45:32 PM
CHAIR HUGHES asked how much illegal street activity is
attributed to prescription drugs versus heroin.
2:46:07 PM
CAPTAIN MIKE DUXBURY, Alaska State Trooper, Department of Public
Safety (DPS), said it depends on the location. He said pills are
cheaper in Anchorage than in Western Alaska. He provided an
example of supply and demand depending on location.
He emphasized how hard it is for doctors and pharmacists to
understand the lengths a person might go to get drugs. Some
people travel to other towns for doctor and pharmacy shopping.
2:49:08 PM
CHAIR HUGHES referred to page 7 - a report on the Prescription
Drug Monitoring Program (PDMP). She asked what would trigger 18
warrants for law enforcement to have access to PDMP in 2016.
2:50:01 PM
CAPTAIN DUXBURY said they work closely with the Department of
Law to get those warrants. Probable cause is what is used to
obtain a search warrant. They see a great deal of opioid abuse
where heroin becomes the next step.
He described the drug problem as a "balloon theory". If you
squeeze a balloon in your hands it will pop out somewhere else.
The bill would provide a gradual reduction of, and better
control of, consumption. He added that heroin addiction has a
very high death rate due to contaminated drugs.
CHAIR HUGHES asked what would cause the DEA to get involved. She
also inquired if State Troopers have the tools to go after drug
dealers of prescription pills and heroin.
2:53:35 PM
CAPTAIN DUXBURY spoke of a lack of officers and the difficulty
of going after small players, causing them to have to go after
the big ones. They work closely with the DEA because of the
DEA's resources and expertise.
2:55:15 PM
SENATOR GARDNER asked about the 7-day limitation and how it
relates to the 10-day prescription, which is considered a risk
factor.
DR. BUTLER said there is no magic to the length of a 7-day
prescription. He noted that CDC recommends no more than a 3-day
supply; more than a 7-day supply is rarely needed. It is up to
the professional's judgement.
2:56:18 PM
SENATOR GARDNER observed that there is a zero fiscal note from
the department, and asked if there will be a financial impact to
practitioners, pharmacists, and others.
DR. BUTLER said it would be a burden, but the payoff of patient
safety and reduced cost due to death and disability is good.
MS. CHAMBERS noted a fiscal note for the Department of Commerce,
Community and Economic Development (DCCED) to cover the
regulations required by the various boards that are affected by
the changes due to the bill.
SENATOR GARDNER said many parts of SB 74 have not gone into
effect, including requirements for those who write the
prescriptions to look up patient history in PDMP first. She
asked if it makes sense to hold off on changing requirements of
pharmacists.
2:58:26 PM
DR. BUTLER clarified that the intention of Section 32 is to have
a seamless process where the prescriber is mandated to check the
database before prescribing a Schedule II or Schedule III drug,
and the pharmacist would populate the database. He summarized
that the prescriber is subject to disciplinary action for not
reviewing the database prior to prescribing; it is not meant
that the pharmacist must review the database before dispensing.
3:00:20 PM
CHAIR COSTELLO said that is not clear in the bill.
3:00:38 PM
SENATOR GARDNER said she understands that the pharmacist is also
a practitioner because they can give immunizations, but that
isn't the bill's intent.
DR. BUTLER suggested the Department of Law address the question.
3:01:29 PM
STACIE KRALY, Chief Assistant Attorney General, Civil Division,
Human Services Section, Department of Law, explained that under
the Prescription Drug Monitoring Program, the pharmacist is not
considered a prescriber. Rather, the pharmacist populates the
data within the PDMP.
SENATOR GARDNER commented that it's all about the context of the
language.
CHAIR COSTELLO asked how it is determined whether or not a
prescriber reviewed the database.
MS. KRALEY explained that when a practitioner signs into the
PDMP it's apparent that they've accessed the information. Prior
to Senate Bill 74 the PDMP was a voluntary program. That bill
made the PDMP mandatory and changed from a 30-day lookup to a 7-
day lookup. SB 79 mandates a one-day look up. She noted that
Senate Bill 74 also allowed for a licensed delegate, such as a
licensed pharmacy tech or licensed R.N., to have access to the
PDMP. She described the changes that Senate Bill 74 made as
critical and acknowledged that is was still in the
implementation phase.
3:05:48 PM
SENATOR GARDNER asked what proportion of providers and
pharmacists are currently registered with the PDMP.
MS. CHAMBERS responded that she does not have the Board of
Pharmacy's PDMP report with her. There is no data on how many
would be required to register and they are not currently
required to track that information.
3:07:22 PM
SENATOR GARDNER asked how prescribers and patients will be made
aware of the non-opioid directive.
3:07:46 PM
DR. BUTLER responded that DHSS would do public outreach. The
directive could also be included on the medical record. The bill
would provide a waiver for civil or criminal liability for
failure to prescribe or dispense an opioid. The intention is to
have the directive be a communications tool and avoid creation
of liability.
3:08:56 PM
SENATOR GARDNER wondered about marketing drugs and whether
advertising contributes to the problem.
DR. BUTLER shared a story from two years ago that affirmed that
it does.
CHAIR COSTELLO asked if the department could help with the
educational aspect.
DR. BUTLER said yes. There is a broad range of educational
messages, including changing expectations of the patient and the
provider of what will happen when someone requires a
prescription for a pain medication.
3:10:50 PM
CHAIR HUGHES noted there has been a decline in antibiotic
prescriptions. She asked if states were involved in that
process.
DR. BUTLER said it varied by state; some states received grants
from the federal government and some grants went to universities
with medical schools. One of the most effective education
methods is direct counseling to providers.
3:12:03 PM
SENATOR MEYER asked about people getting pain medication from
veterinarians and whether that is a factor in addiction.
DR. BUTLER said there have been several reports of people
getting opioids from a veterinarian.
3:14:06 PM
SENATOR MEYER said opioid addiction is a nationwide problem. He
asked if Alaska is doing what other states are doing to address
it.
DR. BUTLER said SB 79 mirrors the 2016 STEP Act in
Massachusetts. Other states that provided information were Utah,
Arizona, and Ohio; they use the concept of non-punitive report
cards to providers.
3:15:50 PM
CHAIR COSTELLO opened public testimony on SB 79. She noted a
letter from Delta Junction.
3:16:17 PM
SCOTT ADAMS, representing himself, expressed concern with SB 79.
He said he has a problem with the 7-day supply limit; it should
be defined by the doctor and contributing circumstances. He
described his situation in a rural setting and his prescriptions
cannot be electronically faxed. He suggested when people have
chronic pain or cancer there should be an exception to the
supply limit.
3:19:18 PM
CHAIR COSTELLO closed public testimony on SB 79 and thanked
those who testified.
She referred to a letter from Delta Junction and asked why an
education campaign couldn't be the solution to the opioid issue
rather than record keeping. SB 74 would have reporting
requirements.
3:20:19 PM
DR. BUTLER stated that clinical guidelines are not making a
difference soon enough. A single answer is not the solution; a
multiple approach is needed to address the broader issues of
substance abuse.
3:22:15 PM
SENATOR GARDNER suggested the previous caller could have been
told about the exceptions in the bill.
DR. BUTLER agreed with both of Mr. Adams' points.
CHAIR COSTELLO suggested comparing Senate Bill 74 and SB 79.
CHAIR HUGHES asked for a list of special provisions/exceptions
in the bill.
CHAIR COSTELLO held SB 79 in committee.
3:23:33 PM
There being no further business to come before the committee,
Chair Costello adjourned the Senate Labor and Commerce Standing
Committee at 3:23 p.m.
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