SB 162-HYDROCODONE PRESCRIPTION BY OPTOMETRISTS  4:25:18 PM CHAIR HIGGINS announced that the next order of business would be SENATE BILL NO. 162, "An Act authorizing a licensed optometrist to prescribe a pharmaceutical agent containing hydrocodone." 4:25:22 PM DAVE SCOTT, Staff, Senator Donald Olson, Alaska State Legislature, stated that the proposed bill created an exception in law in case of federal action. Currently, optometrists were entitled to prescribe hydrocodone for four day prescriptions. The proposed bill did not change the scope of the practice of optometry, however, as the U.S. Food and Drug Administration (FDA) was considering a change for hydrocodone from Schedule III to Schedule II, there would be a lapse in allowable coverage by optometrists. He pointed out that there was a difference between living in the bush and urban communities, especially with access to optometrists. He noted that often a generalist doctor needed to administer to eye injuries in rural Alaska, until the patient could visit an eye specialist. He stated that the mechanics of the proposed bill were to allow optometrists in Alaska to continue to prescribe oxycodone in the event the FDA decided to make any change. 4:28:26 PM REPRESENTATIVE NAGEAK asked about the cost of hydrocodone versus other similar alternative prescriptions. MR. SCOTT replied that he did not know the costs. REPRESENTATIVE NAGEAK asked about the availability for hydrocodone versus the alternative prescriptions in the bush communities. MR. SCOTT replied that he did not know the availability. 4:29:29 PM CHAIR HIGGINS [opened public testimony]. RACHEL REINHARDT, MD, American Academy of Ophthalmologists, stated that she was the current president of the Washington Academy of Eye Physicians and Surgeons. She reported that, after several years of research, the FDA had recommended to the U.S. Drug Enforcement Administration (DEA) to change hydrocodone containing narcotics to a more restricted class. She shared that the agencies concluded that there was a national crisis with a 300 percent increase in prescription narcotics over the past 20 years, and that hydrocodone was "at the top of that list." She relayed that there had also been a 500 percent increase for prescription narcotic deaths in the United States. These prescription narcotic deaths now outnumbered the combined total deaths from illegal narcotics, with Alaska ranking fifth in the nation. She pointed out that one step toward a solution was to restrict the number of providers who can prescribe these narcotics. She addressed a possible concern that some rural patients would suffer, stating that there were numerous alternatives. She relayed that she prescribed other narcotics such as codeine, as well as non-narcotic pain medications. She relayed that a lot of painful eye conditions were treated with bandages, contact lenses, and drops. She referred to a list of 15 non-narcotic pain medications as alternatives for moderate to severe pain. She expressed her understanding to the concern for rural areas. She addressed the proposed limitations to prescriptions, which, although it sounded helpful, still allowed access to the narcotics by a non-patient. She stated that the medical community at large was responsible for the drug epidemic, and this state of emergency had led to the "conscious, intentional effort" to reclassify some drugs to a more restrictive class, and thereby limit the number of providers allowed to prescribe. She declared that this was about protecting patients. She reported that prescription narcotic deaths were the number one cause of unintentional death in the United States, surpassing car accidents. She requested opposition to SB 162. REPRESENTATIVE KELLER pointed out that the Alaska State Legislature had been working on a proposed bill for a database of opioid prescriptions, which did not appear to having funding to continue beyond July 1, 2014. He expressed his frustration with this. DR. REINHARDT replied that an increase to the number of providers for these prescriptions would necessitate a database. She stated that there also needed to be regular wide spread distribution of medications for overdose. She offered to voluntarily stop prescription of Vicodin [hydrocodone] just to make a point to the dangers of prescription drug abuse. 4:38:15 PM JEFF GONNASON, OD, Alaska Optometric Association, explained that a controlled substance was a drug or chemical which was regulated by the government, and classified according to schedules for the potential of abuse. He said that each schedule had a more restrictive prescription procedure, including tighter record keeping and databases to track the medication to prevent abuse. He reported that the Alaska State Legislature, in 2000, had voted to authorize Alaska optometrists to prescribe medications, including schedule II narcotics, although this was subsequently vetoed by the governor. He noted that a later law allowed prescriptions for Schedules III, IV, and V narcotics, with a maximum 4-day supply, only for eye conditions. He stated that this compromise had been acceptable as eye pain was often acute, but resolved itself in less than four days. He noted that hydrocodone combination drugs were included in Schedule III. In response to an earlier question, he said that these generic drugs were not very expensive. He declared that there had been zero instances of abuse, and zero complaints or actions by the state board or any other drug enforcement agency against any Alaska optometrist. He emphasized that these drugs were important for managing severe eye pain. He pointed out that the proposed reclassification of the drugs would "once again be the federal government regulation overriding our state law." He stated that this drug was the best tool for managing acute eye pain. He stressed that the national drug abuse problem had nothing to do with Alaska optometrists. He said that, as optometry was qualified and well trained, people did not come to them for illicit drugs. He expressed his disagreement with Dr. Reinhardt, stating that the federal purpose was "to tighten the abuse potential from problematic users," which he claimed did not include optometry because of the restrictions. He offered an anecdote about an incident in a rural community. He opined that the proposed bill did not make any changes from the current practice by optometrists in Alaska. CHAIR HIGGINS asked if there was a medical doctor for prescriptions in the bush communities. DR. GONNASON replied that very often there was not a medical doctor in the villages. He declared that he could go to a bush clinic and not be allowed to give antibiotics, whereas a health aide was allowed to give them. 4:44:46 PM DAVID KARPIK, OD, President, Alaska Optometric Association, stated that the Alaska Optometric Association supported SB 162. He declared that the proposed bill was merely "a technical addition to existing optometry law." He relayed that strong measures already existed to prevent abuse by prescribers, and tighter record keeping and tracking requirements also worked toward this. He expressed his agreement with the problem for addictions to prescription medications however, infrequent, short term prescriptions were not contributing to this addiction problem. He said there had been no complaints of abusive prescribing of controlled substance toward optometrists in Alaska in the seven years since statute had allowed the prescription of controlled substances. He concluded that the proposed bill maintained the opportunity for "continued, compassionate relief of their eye related pain in an acute setting." 4:47:56 PM MR. SCOTT reported that the sponsor was well aware of the concern for the abuse of prescription drugs. He noted that his concern was assuaged by the four day limit on prescriptions. He pointed out that Rural Alaska, without roads, was far more inaccessible than rural Washington. 4:48:40 PM CHAIR HIGGINS closed public testimony, and said that SB 162 would be held over.