HB 159-OPIOIDS;PRESCRIPTIONS;DATABASE;LICENSES  3:07:44 PM CHAIR SPOHNHOLZ announced that the first 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." 3:08:04 PM REPRESENTATIVE EDGMON moved to adopt the proposed committee substitute (CS) for HB 159, labeled 30-GH1021\J, Bruce, 4/6/17, as the working draft. CHAIR SPOHNHOLZ objected for discussion. 3:08:34 PM JAY BUTLER, M.D., Chief Medical Officer/Director, Central Office, Division of Public Health (DPH), Department of Health and Social Services (DHSS), said that Version J incorporated 4 amendments to address the core intent of HB 159 - to address the floor of legal prescription opioids in Alaska's communities and to improve patient safety. The first amendment incorporated under Version J, he noted, would align language under HB 159 with the federal Comprehensive Addiction and Recovery Act (CARA) to allow partial prescription fills without requiring voiding of the remaining portion of the prescriptions, as addressed on page 24, Section 8, of Version J. Second, Version J would clarify the role and responsibilities of the prescribing providers and pharmacists filling the prescriptions. He stated, "The intention of the bill all along was that the responsibility to check [the] prescription drug monitoring program (PDMP) prior to writing new prescriptions for schedule II and III medications falls to the prescribers; whereas ... the responsibility for ... populating the prescription drug monitoring program with ... unfilled prescriptions falls to the pharmacist." DR. BUTLER said the third amendment made under Version J would address the implementation of the PDMP update frequency; it would delay implementation of daily updates until July 2018 in order to address the potential administrative burden on some of the smaller pharmacies. Finally, he said there is an amendment under Version J that would clarify the liability waiver for advance directives that include not just failure to administer an opioid but also the inadvertent administration of opioids to a person who has an opioids advance directive on his/her medical record. He said the related language is in Section 31, on page 27, of Version J. 3:11:15 PM REPRESENTATIVE SULLIVAN-LEONARD directed attention to page 28, Sections 32 and 33, and asked for clarification regarding the justification for amended language related to correctional facilities. 3:11:46 PM DR. BUTLER replied that the reason for specifically calling out correctional facilities is to make clear the goal of the updated PDMP was never to include patients already institutionalized. He said much of the focus has been on people who are hospitalized. He said it was pointed out to his division that it may not be clear that people who are in correctional facilities are similarly institutionalized. He said he thinks that what often has driven the over prescription of opioids has been misapplication of data on hospitalized patients, which shows people in a hospital receiving opioid medications are at remarkably low risk of having subsequent substance misuse or addiction as opposed to those who receive the drugs on an outpatient basis. He said the change in language to include the correctional facility is to clarify that someone who is begin treated in the infirmary of a correctional facility during a prolonged incarceration is being viewed similarly. He specified, however, that someone being discharged from a correctional facility on outpatient opioids would need to be monitored under the PDMP. 3:13:52 PM CHAIR SPOHNHOLZ removed her objection to the motion to adopt the proposed committee substitute (CS) for HB 159, labeled 30- GH1021\J, Bruce, 4/6/17, as the working draft. There being no further objection, Version J was before the committee as the working draft. 3:14:08 PM CHAIR SPOHNHOLZ noted that an issue had been brought to her attention regarding hospitals and emergency rooms that dispense less than a 24-hour supply of opioids to patients leaving a hospital. She said this relates to [Sections 32 and 33], about which Representative Sullivan-Leonard just queried. She said these supplies are dispensed as prepackaged supplies of medicine and requiring such a small supply to be reported to the PDMP would be an "overly onerous burden on inpatient hospital pharmacies." CHAIR SPOHNHOLZ moved to adopt Amendment 1, labeled 30- GH1021\J.1, Bruce, 4/6/17, which read as follows: Page 28, lines 5 - 7: Delete "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" Insert "under the circumstances described in (u)  of this section [THOSE ADMINISTERED TO A PATIENT AT A HEALTH CARE FACILITY]" Page 28, lines 13 - 15: Delete "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" Insert "dispensed or administered under the  circumstances described in (u) of this section [ADMINISTERED TO A PATIENT AT A HEALTH CARE FACILITY]" Page 29, lines 7 - 9: Delete "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" Insert "dispensed or administered under the circumstances described in (u) of this section" Page 32, line 22: Delete "a new subsection" Insert "new subsections" Page 32, following line 30: Insert a new subsection to read: "(u) A practitioner or a pharmacist is not required to comply with the requirements of (a) and (b) of this section if a controlled substance is (1) administered to a patient at (A) a health care facility; or (B) a correctional facility; (2) dispensed to a patient for an outpatient supply of 24 hours or less at a hospital (A) inpatient pharmacy; or (B) emergency department." Page 35, following line 11: Insert a new bill section to read: "* Sec. 51. Section 41 of this Act takes effect on the effective date of secs. 21 and 23, ch. 25, SLA 2016." Renumber the following bill sections accordingly. Page 35, line 15: Delete "secs. 45 - 52" Insert "secs. 45 - 53" CHAIR SPOHNHOLZ objected for purposes of discussion. She asked Dr. Butler if he had seen Amendment 1. DR. BUTLER said he had not seen the text of Amendment 1 but understood the concept of it. In response to a follow-up question, he reiterated that the focus of HB 159 is to address the flood of opioids into Alaska's communities, and Amendment 1 would address small dispensing of medication. He said the current law surrounding the PDMP does not require that prescribers "check the PDMP" if dispensing less than a three-day supply. He said the intent behind this is to incentivize the subscription of smaller amounts [of opioids] and to reduce the administrative burden. He surmised that Amendment 1 could achieve a similar aim, as concerns the administrative burden on hospital pharmacies, which dispense small amounts through the emergency departments. He indicated that the administration would not object [to Amendment 1]. 3:16:20 PM CHAIR SPOHNHOLZ removed her objection to the motion to adopt Amendment 1. There being no further objection, Amendment 1 was adopted. 3:16:45 PM REPRESENTATIVE EDGMON moved to report CSHB 159, Version 30- GH1021\J, Bruce, 4/6/17, as amended, out of committee with individual recommendations and the accompanying fiscal notes. There being no objection, CSHB 159(HSS) was moved from House Health and Social Services Standing Committee.