HB 159-OPIOIDS;PRESCRIPTIONS;DATABASE;LICENSES  4:15:36 PM CHAIR SPOHNHOLZ announced that the final order of business would be HOUSE BILL NO. 159, "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." 4:16:02 PM JAY C. BUTLER, M.D., Chief Medical Officer/Director, Central Office, Division of Public Health (DPH), Department of Health and Social Services (DHSS), stated that HB 159 is an approach aimed to improve the care of persons living with addiction and to address some of the primary prevention possibilities, as related to legal prescription of opioids in the community, by supporting more rational pain management practices throughout the state. He said the division would like to address concerns expressed by various stakeholders by suggesting an amendment to the proposed bill. DR. BUTLER said one concern relates to a section in HB 159 that would authorize pharmacists to partially fill prescriptions for opioids; part of the desired amendment would align the language more with the federal Comprehensive Addiction and Recovery Act (CARA), by deleting language that would immediately void any unfilled portion of the prescription, which would, as a result, require the pharmacist to notify the prescriber. A second part of the amendment would clarify the roles of the prescriber and the dispenser. Regarding the prescription drug monitoring program (PDMP), he said the intent of Senate Bill 74 last year and the proposed HB 159 before the committee was and is that the prescribers check the PDMP prior to issuing prescriptions for schedule II or schedule III controlled substances, and the role of the pharmacist is to populate the PDMP when the dispensing is done. DR. BUTLER said the third part of the desired amendment would address concerns related to the daily updates of the PDMP, recognizing that even the weekly update required under Senate Bill 74 has not been implemented. The amendment would specify that the implementation to daily update would not occur until 2018. He said the fourth component of the amendment would address the waiver of liability under the opioid advance directive. He stated, "In the bill that I presented to you a couple of weeks ago, it specified waiving liability for not administering an opioid when a directive was in place. This broadens the waiver of liability to include in the instance where perhaps ... [an] opioid is inadvertently administered to someone, with an advance directive." DR. BUTLER said the key points of the requested amendment were based on feedback of a number of stakeholders, but he specifically acknowledged the Pharmacy Association for its helpful guidance and "a number of providers" for their input, as well. 4:19:54 PM CHAIR SPOHNHOLZ moved to adopt Amendment 1, [which is a typed amendment not drafted by Legislative Legal and Research Services, dated at top-right] "AM 3/28/2017" and read as follows [original punctuation provided]: Page 1, line 3, following "dentistry;": Insert "relating to the practice of pharmacy;" Page 2, lines 2 - 3: Delete all material and insert: "(b) The commissioner shall adopt regulations to implement this chapter. The regulations under this chapter shall" Page 2, line 25, following "opioid": Insert ", or for inadvertent administration of an opioid," Page 15, line 14: Delete "a" Insert "[A]" Delete "diagnosis" Insert "[DIAGNOSIS]" Page 15, line 16: Delete "a" Insert "[A]" Page 15, line 17: Delete "diagnosis" Insert "[DIAGNOSIS]" Page 16, following line 24: Insert a new bill section to read: "* Sec. 19. AS 08.68.100(a), as amended by sec. 10, ch. 25, SLA 2016, is amended to read: (a) The board shall (1) adopt regulations necessary to implement this chapter, including regulations (A) pertaining to practice as an advanced practice registered nurse [PRACTITIONER] and a certified registered nurse anesthetist; regulations for an advanced practice registered nurse who holds a valid federal Drug Enforcement Administration registration number must address training in pain management and opioid use and addiction; (B) necessary to implement AS 08.68.331 - 08.68.336 relating to certified nurse aides in order to protect the health, safety, and welfare of clients served by nurse aides; (C) pertaining to retired nurse status; and (D) establishing criteria for approval of practical nurse education programs that are not accredited by a national nursing accrediting body; (2) approve curricula and adopt standards for basic education programs that prepare persons for licensing under AS 08.68.190; (3) provide for surveys of the basic nursing education programs in the state at the times it considers necessary; (4) approve education programs that meet the requirements of this chapter and of the board, and deny, revoke, or suspend approval of education programs for failure to meet the requirements; (5) examine, license, and renew the licenses of qualified applicants; (6) prescribe requirements for competence before a former nurse may resume the practice of nursing under this chapter; (7) define by regulation the qualifications and duties of the executive administrator and delegate authority to the executive administrator that is necessary to conduct board business; (8) develop reasonable and uniform standards for nursing practice; (9) publish advisory opinions regarding whether nursing practice procedures or policies comply with acceptable standards of nursing practice as defined under this chapter; (10) require applicants under this chapter to submit fingerprints and the fees required by the Department of Public Safety under AS 12.62.160 for criminal justice information and a national criminal history record check; the department shall submit the fingerprints and fees to the Department of Public Safety for a report of criminal justice information under AS 12.62 and a national criminal history record check under AS 12.62.400; (11) require that a licensed advanced practice registered nurse [PRACTITIONER] who has a federal Drug Enforcement Administration registration number register with the controlled substance prescription database under AS 17.30.200(o)." Renumber the following bill sections accordingly. Page 18, line 15: Delete "a" Insert "[A]" Delete "diagnosis" Insert "[DIAGNOSIS]" Page 18, line 18: Delete "a" Insert "[A]" Delete "diagnosis" Insert "[DIAGNOSIS]" Page 19, following line 15: Insert a new bill section to read: "* Sec. 24. AS 08.72.140 is amended to read: Sec. 08.72.140. Qualifications for licensure. An applicant for licensure as an optometrist (1) shall be a graduate of a school or college of optometry recognized by the board; (2) may not have committed an act in any jurisdiction that would have constituted a violation of this chapter or regulations adopted under this chapter at the time the act was committed; (3) may not have been disciplined by an optometry licensing entity in another jurisdiction and may not be the subject of a pending disciplinary proceeding conducted by an optometry licensing entity in another jurisdiction; however, the board may consider the disciplinary action and, in the board's discretion, determine if the person is qualified for licensure; (4) shall have successfully completed (A) the written and practical portions of an examination on ocular pharmacology approved by the board that tests the licensee's or applicant's knowledge of the characteristics, pharmacological effects, indications, contraindications, and emergency care associated with the prescription and use of pharmaceutical agents; (B) a nontopical therapeutic pharmaceutical agent course of at least 23 hours approved by the board or an examination approved by the board on the treatment and management of ocular disease; and (C) an optometry and nontopical therapeutic pharmaceutical agent injection course of at least seven hours approved by the board or equivalent training acceptable to the board; and (5) shall meet other qualifications for licensure as established under this chapter and regulations adopted by the board under AS 08.72.050 regulations for qualifications for licensees who hold a valid federal Drug Enforcement Administration number must address training in pain management and opioid use and addiction." Renumber the following bill sections accordingly. Page 23, line 9, following "prescribed.", through line 16: Delete all material. Page 23, line 17: Delete "(c)" Insert "(b)" Page 24, lines 20 - 29: Delete all material and insert: "* Sec. 31. AS 17.30.200(a), as amended by sec. 21, ch. 25, SLA 2016, is amended to read: (a) The controlled substance prescription database is established in the Board of Pharmacy. The purpose of the database is to contain data as described in this section regarding every prescription for a schedule II, III, or IV controlled substance under federal law dispensed in the state to a person other than those administered to a patient at a health care facility or a correctional facility, except when prescribing opioids to an inmate at the time of the inmate's release." Page 25, line 8: Delete "daily [WEEKLY]" Insert "weekly" Page 25, following line 23: Insert a new bill section to read: "* Sec. 33. AS 17.30.200(b), as amended by sec. 32, of this Act, is amended to read: (b) The pharmacist-in-charge of each licensed or registered pharmacy, regarding each schedule II, III, or IV controlled substance under federal law dispensed by a pharmacist under the supervision of the pharmacist-in-charge, and each practitioner who directly dispenses a schedule II, III, or IV controlled substance under federal law other than those administered to a patient at a health care facility or a correctional facility, except when prescribing opioids to an inmate at the time of the inmate's release, shall submit to the board, by a procedure and in a format established by the board, the following information for inclusion in the database on at least a daily [WEEKLY] basis: (1) the name of the prescribing practitioner and the practitioner's federal Drug Enforcement Administration registration number or other appropriate identifier; (2) the date of the prescription; (3) the date the prescription was filled and the method of payment; this paragraph does not authorize the board to include individual credit card or other account numbers in the database; (4) the name, address, and date of birth of the person for whom the prescription was written; (5) the name and national drug code of the controlled substance; (6) the quantity and strength of the controlled substance dispensed; (7) the name of the drug outlet dispensing the controlled substance; and (8) the name of the pharmacist or practitioner dispensing the controlled substance and other appropriate identifying information." Renumber the following bill sections accordingly. Page 27, lines 21 - 25: Delete all material and insert: "(e) The failure of a pharmacist-in-charge or a [,] pharmacist [, OR PRACTITIONER] to register or submit information to the database as required under this section is grounds for the board to take disciplinary action against the license or registration of the pharmacy or pharmacist. The failure of a practitioner to register or review the database as required by this section is grounds for the practitioner's [OR FOR ANOTHER] licensing board to take disciplinary action against the [A] practitioner." Page 29, line 23: Delete all material and insert: "* Sec. 40. Sections 22, 24, 26, 28, 30, 32, 52, and 73, ch. 25, SLA 2016, are repealed." Page 29, line 27: Delete "and the Department of Commerce, Community, and Economic Development" Page 29, following line 30: Insert a new subsection to read: "(b) The Department of Commerce, Community, and Economic Development may adopt regulations necessary to implement the changes made by this Act. The regulations take effect under AS 44.62 (Administrative Procedure Act), but not before the effective date of the relevant provision of this Act implemented by the regulation." Page 29, line 31: Delete "(b)" Insert "(c)" Page 30, line 3: Delete "28" Insert "30" Page 30, line 5: Delete "28" Insert "30" Page 30, line 6: Delete all material and insert: "* Sec. 43. Section 28 of this Act takes effect on the effective date of sec. 12, ch. 25, SLA 2016. * Sec. 44. Section 31 of this Act takes effect on the effective date of sec. 21, ch. 25, SLA 2016. * Sec. 45. Section 32 of this Act takes effect on the effective date of sec. 23, ch. 25, SLA 2016. * Sec. 46. Section 34 of this Act takes effect on the effective date of sec. 25, ch. 25, SLA 2016. * Sec. 47. Section 35 of this Act takes effect on the effective date of sec. 27, ch. 25, SLA 2016. * Sec. 48. Sections 36 and 37 of this Act take effect on the effective date of sec. 34, ch. 25, SLA 2016. * Sec. 49. Sections 2, 3, 7 - 14, 19, 21, 24 - 26, 33, and 38 of this Act take effect July 1, 2018. * Sec. 50. Sections 1 and 40 of this Act take effect July 1, 2019. * Sec. 51. Except as provided in secs. 43 - 50 of this Act, this Act takes effect immediately under AS 01.10.070(c)." 4:20:13 PM REPRESENTATIVE SULLIVAN-LEONARD objected to the motion to adopt Amendment 1, for the purpose of discussion. 4:20:31 PM STACIE KRALY, Chief Assistant Attorney General/Statewide Section Supervisor, Human Services Section, Civil Division (Juneau), Department of Law, offered details related to proposed changes to HB 159 under Amendment 1. As shown in Amendment 1, she said the first change would be to the bill title to include "relating to the practice of pharmacy". She explained that many of the changes that would be made under the proposed Amendment 1 would be technical changes to add something that was not meant to be omitted. Ms. Kraly stated that the second change, on page 2, lines 2-3, of HB 159, would address the advance directive language and provide that the commissioner would adopt the regulations. She said another change would be on page 2, line 25, and provide additional immunity for a prescriber who inadvertently administers an opioid when a person has an advance directive "that's been adopted by this statute." She said the next two changes, on page 15, line 14 and [17], were recommended by the American Cancer Association because it felt that a person may need opioid pain management after a diagnosis, so the language should not limit that to diagnosis. MS. KRALY, regarding the change that would be made under Amendment 1, on page 16, following line 24, of HB 159, explained that two practitioners had been omitted inadvertently for purposes of participation in the PDMP and the changes to the continuing medical education provisions. The proposed change would correct one of those omissions, address the inclusion of advanced practice nurses, and make conforming edits to change the nomenclature as was changed in legislation last year "to make sure that we're talking about advanced practice nurses - registered nurses." Ms. Kraly pointed to the changes on pages 18, lines 15 and 18, of HB 159, which again would delete "diagnosis" to broaden the construct for the exceptions for administering opioids to include, for example, post-cancer treatment, when a diagnosis has already been addressed. She next said that the new section proposed to be added on page 19, following line 15, addresses one of the omissions advertently made. The new language would include optometrists in participation of PDMPs, as well as in the continuing medical education (CME) requirements. MS. KRALY said the change proposed to page 23, line 9, would mean that a request for a prescription to be partially filled would not void the prescription. 4:26:45 PM DR. BUTLER added that this is the portion of the proposed amendment about which he had previously said would align the language with CARA. 4:26:54 PM MS. KRALY moved on to the change that would be made on page 24, lines 20-29. She explained that this part of Amendment 1 would relate to when an opioid is being prescribed, so the PDMP would apply to a prescription issued to an inmate upon release from [a correctional facility]. 4:27:58 PM DR. BUTLER noted that this part of Amendment 1 also would update language to specify this pertains to schedule II, III, and IV drugs. He offered his understanding that the old language had included federal schedule I drugs, which are illegal substances. MS. KRALY added that the language [that would be Section 31] is replacing Section 29. MS. KRALY moved on to the proposed change to page 25, line 8, to reinstate a requirement for certain information to be submitted weekly to "the board." She said the plan is to stay with a weekly requirement for one year, then go to daily. She said the change proposed for language on page 25, line 23, also addresses the change from daily to weekly. She admitted it may seem confusing, but the reason for the repetition is for drafting and effective date purposes. MS. KRALY directed attention to the proposed change to page 27, lines 21-25. She explained the change was requested on behalf of both pharmacists and prescribers, and it would clarify that pharmacists must register with the PDMP and submit information on the PDMP, whereas a prescriber registers and reviews the PDMP. 4:30:58 PM MS. KRALY said Amendment 1 proposes technical changes on page 29, line 23, regarding a delayed effective date and the timing of repeals. She stated that the purpose of the deletion proposed on page 29, line 27 and the insertion proposed on page 29, following line 30 is to ensure that the Department of Commerce, Community & Economic Development (DCCED) has sufficient time to draft regulations that will become effective "upon adoption of future effective dates." In other words, this transitional language would allow DCCED to continue working on regulations, even though certain provisions of the bill are not effective. In response to Chair Spohnholz, she offered clarification as to the numbering in this portion of the bill as it would be amended by Amendment 1. She said, "When you have it all in there, it'll make sense." MS. KRALY next talked about the effective date sections of the bill, Sections 43-48, all of which she said relate to conforming edits and changes that need to be made as a result of Senate Bill 74 "and the rolling effective dates of how the PDMP will operate." She said it is important to coordinate the effective dates so that "everybody's going into effect at the same time." She said Section 49 would provide an effective date of July 1, 2018, and this would deal with the changes to the occupational licensing boards, as to the CMEs and the obligations of the boards to implement changes for participation in the PDMP, "so that they all apply at the same time." Section 50 would provide an effective date of July 1, 2019, to Sections 1 and 40 of HB 159, which deal with the opioid advance directive. Section 51 addresses everything else in the bill and gives it an immediate effective date. 4:36:29 PM REPRESENTATIVE EASTMAN asked about the aforementioned proposed exemption that would result in not collecting date from a correctional facility, except at the end of the inmate's term. MS. KRALY explained that the purpose of having the PDMP is to ensure that people are not "doctor shopping" or being over- prescribed, and since a correctional facility is a confined environment, the purpose of the PDMP is lost, because the facility is a controlled environment. When inmates are released, they are no longer in that controlled environment, and when they are given a prescription, that information is in the PDMP, so that when they visit a doctor or pick up a prescription, the provider or pharmacist knows how recently an opioid prescription has been given. REPRESENTATIVE EASTMAN suggested the need to compare the prescribing habits of a provider in a correctional facility to that of his/her peers. 4:40:04 PM DR. BUTLER replied, "A lot of the focus is on the outpatient use." He said that looking back at the history of the opioid epidemic, one of the original reviews of the risk of addiction and substance misuse was based on an analysis of hospitalized patients and showed that the risk of "problem use" after being administered an opioid after hospitalization was extremely low. Unfortunately, he said, those data were misapplied to outpatient settings. He said he thinks it is still fair to say that the risk is low in the setting of a patient that is institutionalized, which is one reason why, when a patient is being prepared for release, "if there's going to be ... a drug taken with them when they leave the institution, as a discharge medication, we would definitely want visibility on that." 4:41:31 PM REPRESENTATIVE JOHNSTON referred to advance practice registered nurses, and she said that made her think about physician assistants. She surmised that may be part of the title with the practice of medicine, but said she wondered how that might be addressed. DR. BUTLER responded that physician assistants are included and are regulated under the [Alaska State] Medical Board. In response to a follow-up question, he confirmed that is different from the [Alaska Board of] Nursing. 4:42:41 PM The committee took a brief at-ease. 4:43:29 PM CHAIR SPOHNHOLZ asked Representative Sullivan-Leonard if she maintained her objection to the motion to adopt Amendment 1. 4:43:38 PM REPRESENTATIVE SULLIVAN-LEONARD removed her objection. There being no further objection, Amendment 1 was adopted. 4:43:50 PM CHAIR SPOHNHOLZ [opened public testimony on HB 159]. 4:43:53 PM JOSHUA STREAM, M.D., Providence Alaska Medical Center (PAMC), stated that he is an anesthesiologist, who is fellowship trained in acute pain management and is the chair of the Pain Management Council at PAMC. He related that the council is an interdisciplinary group comprising medical providers, clinical leaders, and administrators all dedicated to improving pain management for the benefit of PAMC's patients. He emphasized his support of HB 159, especially its proposal of opioid dispensing limits and provider education. DR. STREAM said during his experience working with patients and providers of every specialty he has seen inappropriate pain management daily, which results in patients being hurt. He said the mismanagement almost always involves the over prescription of and overreliance on opioids, which is a huge patient safety issue. He explained that beyond addiction and dependence, opioids have many acute side effects that result in hospital readmission, poor pain control, "and everything else that entails." Dr. Stream said this mismanagement occurs both in hospitals and in the community. DR. STREAM said he has spent years committing his practice to provider education regarding safe and effective pain management, because "a lot of providers seem to be stuck in a different sort of practice from decades past," which he explained was the reason the council was created in 2015. Over the past two years, he related, the council has spearheaded comprehensive efforts in provider education that have had a dramatic impact on prescribing practices. One result has been the improvement of pain management in PAMC over the past year or so, with people less dependent on opioids across all specialties, including pediatrics, surgery, internal medicine, emergency medicine, urology, obstetrics and gynecology, and orthopedics. DR. STREAM stated that ensuring consistent and appropriate education for providers outside PAMC has been a struggle, and HB 159 would open the door to achieving that goal. He said he thinks it is appropriate to address the patient's perspective with support and treatment for opioid addiction and recovery, but he opined that would only be a Band-Aid over what he sees as the real issue: the lack of provider education. Dr. Stream stated, "We need to stem the tide of inappropriate opioids flooding through our pharmacies and into the patients' bodies, and the only way to do this is by mandating and overseeing provider education to ensure the best, safest outcomes for all patients in Alaska, not just those that happen to be at our hospital." He posited that as it is medical professionals that helped to create the current opioid crisis, it is their responsibility to help "turn it around," and HB 159 is "a step in the right direction." 4:46:41 PM MICHAEL CARSON, Chair, Mat-Su Opioid Task Force, testified in support of HB 159. He reported that 80 percent of heroin users started with opioid use; 75 percent of those individuals got those pills from grandparents, parents, or friends or stole them. He suggested the state look at a program, called "Mind Your Meds," which he said would "cut the spigot off." He informed the committee that heroin is now being mixed with fentanyl, the latter of which is 50-100 times more powerful than morphine. He said the newest data, as of March 18, 2017, published from the Medical Science Department of the University of Arkansas, concludes that an initial 10-day prescription of pain medication can translate to one in five patients becoming long-term users. He said, "Dr. Martin's last statement with that conclusion was we ... didn't really expect that." He said addiction is powerful and deadly: 90 people die of overdoses every day, nationally. He said consumers of medicine, as well as all people in the medical field, need to be aware of the addiction potential of pain medication. He related that the Mat-Su Opioid Task Force is in full support of HB 159 and all the amendments that have been addressed. 4:49:17 PM REPRESENTATIVE TARR asked how there could be a partnership between task forces such as Mr. Carson chairs and legislators. MR. CARSON responded that the Mat-Su Opioid Task Force meets the first Tuesday of each month, and Dr. Butler will be presenting at the next meeting. He mentioned that his task force, along with another, and Dr. Butler had a conversation with Governor Bill Walker. He said the information [related to HB 159] would be presented at the next task force meeting. He stated, "We will do whatever it takes to get this information out and be able to provide the information for our community." He said the task force has identified five top priorities, and one of them is prevention. He said the task force is hoping to get information out to schools and to engage civic groups, in order to have "all the stakeholders at the table to be able to find a solution to this plague." REPRESENTATIVE TARR said she would welcome hearing any ideas that come out of the next task force meeting. She said the bill focuses heavily on "the prescription side of things" and "removing the supply," but she said she thinks groups such as the Mat-Su Opioid Task Force are more in touch with the families and people affected [by opioid addiction]. MR. CARSON said the task force just launched a new web site, matsuopiatetaskforce.com, which provides a resource list of all Southcentral Alaska providers. A future plan is to develop a page on the web site that would list all nonclinical support. He announced that Anchorage would have its first task force meeting on 4/11/17. He indicated the Mat-Su Opioid Task Force has reached out to Bristol Bay, and Copper River Valley has been in contact with Mr. Carson's task force. He invited committee members to reach out through the web site, including to give feedback or ask questions. 4:53:26 PM CHRISTINA LOVE, Community Resources Coordinator, Aiding Women in Abuse and Rape Emergencies (AWARE Inc.), stated that she is a person in long-term recovery from use of intravenous (IV) heroin and other mind altering substances. She related that in her capacity as resources coordinator, she works with women and children that have been physically and sexually harmed; she is the disability response team coordinator for Juneau; and she was on the opioid task force. She stated strong agreement with the nonopioid directive, rational pain management practices, and continuing care education for prescribers. She said she has been thinking of her own experience and that of the people with whom she works, all the various prescribers in Alaska, and the powerful idea that "right now, someone is being overprescribed - right this very moment." She said this includes not being given the necessary information by a prescriber. MS. LOVE named several medical institutions in Alaska and indicated that each has a file on her that highlights that she is allergic to opioids and, if she were to be given them, she would die. She clarified that she has painted a clear picture for every doctor and nurse with whom she has come into contact describing what her life looked like prior to coming into recovery. She said when she was using, she could not even lift her arms, because of the many track marks; she was on multiple drugs; she was living on the street; her life had no meaning; she tried to end her life several times with overdoses. She continued as follows: And coming into recovery, even with that picture, when I had my daughter in 2003, I had to over and over and over tell them that I could not have opioids. When I sprained my ankle, they tried to give me a shot of Dilaudid, and I had to tell them over and over and over. When I had my wisdom teeth pulled, I had to tell them over and over and over that "I may be in discomfort, I may be in pain, but I will not die, you know?" And so, they would tell me something like, "Well, I'm going to leave it up to pharmacy for you anyway, in case you want it." And I had to explain to them again, "I am strong enough today to say no, but ... maybe tomorrow looks totally different," but say, "this is a lifelong illness for me, and it does not always mean that I will be as strong as I am today; and if I were to relapse, that is exactly what my life would look like." MS. LOVE said she has seen this happen a hundred times, where people she works with or loved ones that have had, perhaps, three years of recovery, "went in for the same dental procedure that I have, and they have not made it back." She emphasized that the importance of HB 159 is one of life and death. She described the beginning of her addiction as when she was prescribed oxycodone following knee surgery. She said, "It lead to a place of unspeakable horrors ..., and I never want to be back there again." She said she wants the right to have that information in her file so that she does not have to repeatedly have that conversation. MS. LOVE said there are many wonderful providers. She said she spent the last four years of her recovery educating herself about addiction and recovery, and she still has so much to learn. She stated that she cannot even imagine giving a health care provider all the information he/she would need in just two hours. She thanked the committee for considering the issue, giving her the opportunity to testify, and for HB 159. 4:57:26 PM REPRESENTATIVE SULLIVAN-LEONARD remarked that after listening to Ms. Love's testimony, it seems as if health care providers are focused solely on opioids for pain relief. She asked Ms. Love if she was ever offered anything else for the relief of pain besides opioids. MS. LOVE answered no. She said, "We had thought about making ... a safety plan." She explained that when her daughter was born, there were many complications, and she had to have someone come stay with her to dole out her medications as needed and then discard the rest. Now that she has read more on the issue, she is aware of alternative options, but she had not been aware of them when her daughter was born, and she had been in recovery for one year. She indicated that [the alternatives] she knows a lot more about now would have been wonderful options then. 4:58:43 PM KARA NELSON, Director, Haven House, testified that she is in long-term recovery and has not taken a drink or drugs since 2011, on the day she was released from Lemon Creek Correctional Center. She said Haven House is a faith-based, peer-led recovery house for women coming home after incarceration. She said she works often with Ms. Love, as well as with many other women and men in the community. She stated that she is in full support of HB 159, particularly the voluntary nonopioid directive. She related having had a difficult time expressing an opposing view to a doctor treating her daughter, who she described as having some issues related to recovery. Ms. Nelson talked about a woman from Haven House that had been in recovery, went to the dentist, was prescribed opioids by her dentist, who wanted her to have them just in case she needed them, even though she had explained her addiction and need to not have them prescribed. The woman ended up taking the opioids and within a couple days was shooting heroin, but luckily came to Ms. Nelson for help. Ms. Nelson said those just beginning recovery cannot face making a decision [about opioid use for pain], and she said in the woman's case, "that could have been avoided in that moment." Ms. Nelson indicated that although her doctors know that she is in recovery, she has been offered medication that would not be in support of her recovery. She said she has to repeatedly remind her doctors. She indicated that while she supports the education piece proposed under HB 159, she thinks two hours of training within two years of a renewal is "super minimal" when considering [the enormity of the issue]. MS. NELSON echoed Ms. Love's remark that there are many educated providers that have the best intention. She said the recovery environment is changing at a rapid pace, in terms of recovery communities, addiction, and available information. She said she has to keep up [with the information] daily, so she cannot imagine going to school to be a doctor, coming back years later to get updates on best practices. Ms. Nelson concluded, "We have 249 million prescriptions that were prescribed in 2013; that's every single ... adult in the United States of America with a bottle of prescribed opioids." She asserted that that statistic is crazy, and she said HB 159 is one tool that could "bring health and wellness to our people." 5:03:53 PM CHAIR SPOHNHOLZ expressed appreciation to Ms. Nelson and Ms. Love for sharing their personal experiences in recovery to shine light on a subject that is "complicated, challenging, often intractable for many, and yet completely preventable." 5:04:17 PM CHAIR SPOHNHOLZ announced that public testimony would be left open and HB 159 is held over.