HB 184-CONTROLLED SUB. DATA: EXEMPT VETERINARIAN  4:27:34 PM CHAIR ZULKOSKY announced that the final order of business would be HOUSE BILL NO. 184, "An Act exempting veterinarians from the requirements of the controlled substance prescription database." 4:27:59 PM REPRESENTATIVE DAVE TALERICO, Alaska State Legislature, introduced HB 184 and paraphrased from the Sponsor Statement [Included in members' packets], which read: HB 184 is proposed to exempt Veterinarians from Prescription Drug Monitoring Programs (PDMPs). Prescription Drug Monitoring Programs (PDMPs) were designed for use in human medicine to identify doctor shopping by human patients and monitor trends in prescribing practices by health care providers. Veterinarians want to be part of the solution of the opioid crisis, but PDMPs have not been an effective mechanism to do this. By mandating that veterinarians query and report the owner's name and date of birth, there are significant concerns about potential violations of privacy of human medical information. Veterinarians are not trained in privacy regulations concerning human medical data, nor are they trained in appropriate medications, doses, or prescribing practices for human medicine. As we have talked informally with pet owners and others in the general public, they are not aware that their veterinarian would have access to any part of their medical information and are dismayed to learn this. Animal patients themselves cannot be effectively tracked through PDMPs. Animals do not have a unique identifier such as a social security number or even date of birth. The animal's name may be changed over time, the date of birth is often not known, and the owner may change over time. One national survey found that fewer than 10 cases of veterinary shopping occur annually in the United States and concluded that "veterinarians are a de minimus source of controlled substances." Even those few cases of veterinary shopping are typically identified by the veterinarians themselves, not through PDMPs. In 2017 veterinarians prescribed 0.34% of all the opioids dispensed by retail pharmacies in the country (source IQVIA National Prescription Audit). Exempting veterinarians from the PDMP will not diminish the judicious use of controlled substances that is already practiced by veterinarians and regulated by the Drug Enforcement Agency and the state licensing board. Exempting veterinarians from the PDMP will allow veterinarians to provide timely and appropriate medical management for each individual patient. It may save state funds and increase the efficiency of the PDMP for its intended purpose by allowing for more accurate interpretation of prescription data and prescribing trends in human medicine. Over 30 states currently exempt veterinarians from PDMP requirements. Several of those states originally required veterinarians to report to the PDMP but have since exempted veterinarians for many of the same reasons described above. 4:31:04 PM CHAIR ZULKOSKY asked about the percentage rate in commercial pharmacies. REPRESENTATIVE TALERICO stated that, in 2017, veterinarians prescribed 0.34 percent of all the opioids dispensed by retail pharmacies in the country. In response to Chair Zulkosky, he said that he did not have the hard number for this percentage. 4:32:00 PM REPRESENTATIVE SPOHNHOLZ asked what percentage veterinarians were of the total prescribers in the country. REPRESENTATIVE TALERICO deferred to later testifiers. REPRESENTATIVE CLAMAN asked about the percentage of prescription dispensing veterinarians in Alaska relative to the rest of the country. REPRESENTATIVE TALERICO replied that he did not know. REPRESENTATIVE CLAMAN asked whether the veterinarians were also the dispensers. REPRESENTATIVE TALERICO offered his belief that it was necessary to be a licensed pharmacy to dispense an opioid. 4:34:52 PM DR. SARAH COBURN, President, Alaska State Veterinary Medical Association (AKVMA), stated the AKVMA was "a professional association dedicated to promoting the excellence and professionalism of Alaska veterinarians in advancing the health and well being of animals in the public." She declared support of the proposed bill, as it would exempt veterinarians from participating in the state Prescription Drug Monitoring Program (PDMP). She stated that the veterinary community wanted to contribute to solutions to the opioid crisis, but participation in a program designed for use by humans was not appropriate. She reported that more than 30 states exempted veterinarians from the PDMP requirements, and some states have now enacted legislation which removed veterinarians from participation because their inclusion has not proven to be helpful in addressing the human opioid epidemic. DR. COBURN listed numerous reasons for not requiring veterinarians to search or report information into the PDMP, including that animal patients cannot be effectively tracked, and veterinarians are not trained to evaluate human prescription information or in privacy regulations concerning human medical data. She added that most pet owners were not aware that the licensed veterinary technician was the delegated person to access the personal medical prescription history, considered an invasion of privacy by many people. She expressed concern that information entered the PDMP for animal patients would skew the data and place a disproportionate cost and burden on veterinary clinics as small business owners. She pointed out that the information had to be submitted manually as the veterinary software did not interface with the PDMP. She pointed out that exempting veterinarians would not diminish the effectiveness of the PDMP program. She acknowledged that although opioids were used by veterinarians, these were used for surgical procedures and anesthesia. She pointed out that veterinarians still had to meet strict security, record keeping, and storage requirements of controlled substances. She added that the DEA monitored the flow of controlled substances. She concluded, offering her belief the exemption of veterinarians from using the PDMP would not weaken the success of the program or affect the judicious and highly regulated use of controlled substances by veterinarians. She reiterated that the AKVMA supported HB 184. REPRESENTATIVE CLAMAN asked if the statistics she referenced were for Alaska. DR. COBURN said that these were recent statistics from the PDMP annual report for each profession in Alaska. REPRESENTATIVE CLAMAN asked if veterinary clinics were considered retail pharmacies. DR. COBURN said, "they are not." 4:42:53 PM DR. JIM DELKER, Alaska State Veterinary Medical Association, in response to Representative Claman, he said that a prescription for a pet could be filled either by the veterinarian or a pharmacist. He declared that most veterinarians had the pharmacy fill the prescription for opiates to relieve the veterinarian of the pressures to report. In response to Representative Claman, he said that who dispensed a medication would depend on the drug. He pointed out that the drugs indicated in more drug overdoses such as oxycontin, Percocet, and Vicodin were not commonly dispensed by veterinarians. REPRESENTATIVE CLAMAN asked for clarity for the difference between prescribing and dispensing. DR. DELKER said that he would write a prescription to the pharmacy for a medication they did not carry, noting that a controlled substance had to have a written prescription, whereas an antibiotic did not. REPRESENTATIVE CLAMAN asked if veterinarians dispensed small quantities of opioid medication from their clinic. DR. DELKER replied that the majority of those were sent to a retail pharmacy. CHAIR ZULKOSKY asked if Alaska veterinarians could dispense opioids within the clinic. DR. COBURN said, "yes." CHAIR ZULKOSKY asked about the percentage of opioids dispensed from a clinic before using a commercial pharmacy. DR. COBURN said that she would follow up for the number. She stated that opioids were in limited use as take-home medications, that most opioids were used in the hospital related to surgical procedures and were not to be dispensed. CHAIR ZULKOSKY pointed out that the PDMP illuminated the data for opioid prescriptions. She expressed her understanding that there were conditions for opioids dispensed in a clinic. She asked how often Alaska veterinarians used commercial pharmacies versus directly dispensing controlled substances. DR. COBURN said that she would research that. CHAIR ZULKOSKY shared an anecdote that animal owners had intentionally harmed an animal in order to drug shop for controlled substances, and she asked if there was mandatory reporting in Alaska for suspicion of animal abuse. DR. COBURN stated that there was not mandatory reporting but that it was authorized to report without any privacy concerns. She declared that animal abuse was illegal in Alaska, and that ethical conduct would lead a veterinarian to report to an appropriate authority if there was concern for intentional injury. She stated that, as it was necessary to have a veterinarian-client/patient relationship, the standard of care in veterinary medicine was for an in-person physical examination of the animal to establish that relationship. She shared that the PDMP was not designed for animal data. CHAIR ZULKOSKY asked about the training or guidance provided to veterinarians to utilize the PDMP. 4:52:23 PM MS. CHAMBERS explained that when the PDMP became mandatory for all prescribing professions and pharmacists, which included veterinarians, the Board of Veterinary Examiners had the authority and ability to work with the Board of Pharmacy to write the regulations to figure these out. She declared that it had been a struggle for the Board of Veterinary Examiners to wrestle with these issues for how to make it work. She reported that these efforts to make it work did not progress, and, since 2018, there had not been an attempt at a regulations project or a move to adapt the technology. CHAIR ZULKOSKY reiterated that there was not broad support provided to users of the PDMP by the Department to ensure they had what was necessary to access or provide information. MS. CHAMBERS pointed out that the PDMP was primarily designed for human use. When the Board of Veterinary Examiners reviewed the statutes, they realized that, with the way the law was written and the way the technology was set up, it was necessary for more work to understand how to advise their licensees. She stated that it was not possible for her department to train licensees until the Board of Veterinary Examiners worked through these problems with regulation and technology changes. 4:55:49 PM DR. SCOTT FLAMME, Board of Veterinary Examiners, reported that he had been practicing in Fairbanks for the past 17 years. He declared that 38 states had now exempted veterinarians from the PDMP. He acknowledged the difficulty for using a data base for animal data that was designed for humans, and shared that other states had this same struggle. He emphasized that it "just does not work." He declared that veterinarians cared about the opioid epidemic and wanted to do their part to help prevent addiction and to prevent any harm to Alaskans. He pointed out that veterinarians in Alaska only prescribed 0.34 percent of the controlled substances. He offered an analogy of buying a $60,000 pickup truck to plow a driveway that was 12 feet long and 5 feet wide., adding that it did not make any sense as the data was not helpful. DR. FLAMME stated that the PDMP was costly to the public, and that the public was shocked when it learned that veterinarians who had no training in human medicine or privacy laws were mandated to access the private health data before prescribing to an animal patient. He added that the public was equally dismayed when their PDMP risk scores were altered because of an animal prescription, as the assessments included a mix of human and animal data. He stated that the cost to the public would be borne out with an increase in the shortage of veterinarians. He pointed out that the Board of Veterinary Medical Examiners was mandated to investigate and discipline veterinarians who failed to correctly use the PDMP, while paying for those investigations. He noted that Alaska had the highest licensing fees for veterinarians in the United States. He urged support for HB 184. 5:00:21 PM HB 184 was held over.