HB 56-CONTROLLED SUB. DATA: EXEMPT ANIMAL RX  4:26:21 PM CHAIR PRAX announced that the next order of business would be HOUSE BILL NO. 56, "An Act exempting controlled substances prescribed or dispensed by a veterinarian to treat an animal from the requirements of the controlled substance prescription database." 4:26:40 PM REPRESENTATIVE RUFFRIDGE, as prime sponsor, introduced HB 56 via a PowerPoint presentation [hard copy included in the committee packet]. He stated that HB 56 would exempt veterinarians from the Prescription Drug Monitoring Program (PDMP). Beginning on slide 2, he stated PDMP had been established in Alaska in 2008 to track the dispensing of controlled substance medications. He added that while every state has a similar program, 33 states have exempted veterinarians from participating. Currently in Alaska all prescribing-license types are required to register with PDMP. He continued that license holders are required to review PDMP prior to prescribing controlled substances and report daily on the dispensing of all controlled substances, even on days the business is closed. 4:29:11 PM REPRESENTATIVE RUFFRIDGE, referring to slide 3, stated that PDMP was designed as a dispensing record to aid practitioners, especially in relation to [Schedule] II narcotics, which are highly abusable medications. He listed some of the other lower- class drugs, which also have to be reported. He said pharmacies have an automatic daily-reporting process, while veterinarians manually submit their daily reports. He stated that PDMP monitors prescriptions for legal drugs and would have no control over illicit-drug use. He stated that the purpose of PDMP is to help prevent doctor and pharmacy "shopping." 4:32:21 PM REPRESENTATIVE RUFFRIDGE, moving to the next slide, addressed the reason for the legislation. He stated that veterinarians are aware of the importance of PDMP in preventing pharmaceutical drug abuse; however, they experience unique difficulties with the program requirements. He added that there are some serious concerns about the privacy of information in PDMP. On slide 5, he pointed out that the program is designed to track human prescriptions, not animal prescriptions. The data gathered by veterinarians is often not linked to the animal owner, and this would be required to accurately track data. Veterinarians are not guided by the Health Insurance Portability and Accountability Act (HIPAA), nor are they trained in human medicine. Before dispensing a controlled substance to an individual with a pet, the veterinarian is required to look up information on the individual to see if any previous drugs have been dispensed. He stated that many pet owners are not aware veterinarians would have access to personal medical information, and this could be a concern. Animal patients are not well tracked because they lack the unique PDMP identifiers, and individuals connected to the pet may not be consistent. 4:35:12 PM REPRESENTATIVE RUFFRIDGE continued to slide 7 and stated that veterinarians rarely require the use of [Schedule] II narcotics. In a 2017 study, he said, veterinary clinics accounted for only 0.34 percent of all the opioids dispensed. He added that veterinary clinics would use opioids only during surgery, and typically opioid dispensing is reserved for pharmacies, not veterinarians. In summary, he stated that exempting veterinarians from PDMP would protect privacy and ensure PDMP data is clear, usable, and linked only to end users. 4:36:21 PM BUD SEXTON, Staff, Representative Justin Ruffridge, Alaska State Legislature, on behalf of Representative Ruffridge, prime sponsor, provided the sectional analysis of HB 56 [copy included in the committee packet], which read as follows [original punctuation provided]: Section 1. AS 17.30.200(o) is amended to remove "and the Board of Veterinary Examiners" from the notification requirement when a practitioner registers with the database under (n) of this section. Sec. 2. AS 17.30.200 is amended by adding a new subsection to read: This section does not apply to a schedule II, III, or IV controlled substance prescribed or dispensed by a veterinarian licensed under AS 08.98 to treat an animal. Sec. 3. AS 08.98.050(a)(10) is repealed which removes the requirement for Veterinarians under the controlled substance prescription database. 4:37:42 PM TRACY WARD, DVM, Clinic Director/Veterinarian, Juneau Animal Rescue, provided invited testimony in support of HB 56. She shared that she recently had been the president of the Alaska State Veterinary Medical Association (AKVMA). She explained that Dr. Rachel Berngartt was scheduled to testify on behalf of the Alaska Board of Veterinary Examiners (BOVE); however, Dr. Berngartt was detained. She stated that she would be presenting and answering questions on behalf of both AKVMA and BOVE. DR. WARD stated for the record that both AKVMA and BOVE strongly support HB 56. She stated that the Alaska Board of Pharmacy, which administers PDMP, has recently passed a motion to support the proposed legislation, as seen on slide 3. She stated that PDMP had been amended in 2017 to require mandatory participation by all federal permit holders. As seen in the photo on slide 4, she stated that representatives from the prescribing boards of other agencies had been consulted in drafting the amendment; however, veterinarians had not been consulted. In other words, advice was not sought from BOVE nor AKVMA, but both organizations were included in the requirements. 4:40:02 PM DR. WARD, moving to slide 5, stated that PDMP is not a workable database for veterinarians because the system is designed for human data. She said this data is uninterpretable because veterinarians are not trained in human pharmacology and would not have the knowledge of appropriate doses, medication timeframes, and refill requirements. Moving to slide 6, she expressed the opinion that having access to this data is intrusive and an invasion of human privacy, because humans are not the patients - they are the clients. She added that veterinarians are not protected by HIPAA regulations. She suggested that committee members consider how personal medication history is being shared outside of client/patient privilege. She maintained veterinarians are uncomfortable with this. DR. WARD, moving to slide 7, stated, if veterinarians were not monitored through PDMP in regard to controlled substances, they would be monitored through record keeping with the DEA. She stated that every pill of oral medication dispensed and every drop of injectable medication administered has to be accounted for. Records would be maintained and made available to DEA or local law enforcement agencies upon request. She added that distributors of controlled substances are required to monitor any pattern in usage by the DEA's Suspicious Orders Report System, and the vast majority of drug diversions are caught through this process, not PDMP. 4:44:30 PM DR. WARD reiterated that a very small amount of total opioid prescriptions would be dispensed by veterinarians. She stated that if every one of these prescriptions were misused, it would be "a tiny, tiny drop in the bucket of the total opioid abuse problems." She pointed out in the graph on slide 9 that, in general, veterinarians do not use the drugs of concern, and synthetic opioids are almost never used. She added that Vicodin or oxycontin are not used; however, fentanyl is used, but exclusively in the hospital and would not be sent home with the pet owner. She added that cocaine or methamphetamine is not used. She maintained that veterinarians would not be the source of the drugs of concern in the current drug epidemic. DR. WARD, moving to slide 10, argued that veterinarians are pursuing the proposed legislation because of the hardship PDMP creates. She stated that investigations of veterinarians by the board of PDMP are mostly because of clerical mistakes. Moving to slide 11, she stated that since participation became mandatory, investigative costs have increased threefold. She explained that this is not because veterinarians are misusing drugs, but because they are required to use an unwieldy system. She explained that the board is not funded by the government, but by licensing fees, so the cost of investigating veterinarians is borne by the veterinarians. In other words, veterinarians are charged with investigating themselves. She added that Alaska already has the highest licensing fees in the country. Moving to slide 12, she stated that support of HB 56 would allow veterinarians to provide appropriate medical management, while increasing the efficiency of PDMP for its intended purpose. 4:48:29 PM REPRESENTATIVE SADDLER questioned how exempting veterinarians from PDMP would improve efficiency. REPRESENTATIVE RUFFRIDGE responded that PDMP was intended to stop doctor and pharmacy "shopping," which had been a common practice prior to the implementation of the program. He stated that the inability to track medications dispensed from multiple sources led to the overprescribing of controlled substances. He stated that exempting veterinarians would clean up the data. For example, a prescription for an animal can be in PDMP multiple times under different pet names or owners, so this data is difficult to accurately interpret. In turn the data cannot be trusted, and the purpose of PDMP is not supported. REPRESENTATIVE SADDLER, with a follow-up question, requested additional comments on PDMP's intended use and its effectiveness. REPRESENTATIVE RUFFRIDGE responded that the program is effective. He added that unfortunately the overdose deaths in Alaska are still increasing, and this causes criticism. He stated that PDMP is successfully adverting people from doctor and pharmacy "shopping," but abuse of illicit drugs, such as heroin, oxycodone, and fentanyl, has not been stopped. 4:52:03 PM REPRESENTATIVE MINA commented that those in opposition of the proposed legislation have come to a position of neutrality. She questioned participation by veterinarians in addressing the drug epidemic. DR. WARD expressed the opinion that the education of veterinarians is more worthwhile than requiring participation in PDMP. She pointed out that speakers from DEA have been invited to address [the drug epidemic] at the state veterinarians' conference. She stated that, even though veterinary clinic "shopping" is very rare, as part of the larger medical community, veterinarians should be educated. She stated that veterinarian clinics have been broken into, and security has been increased. Within the last five years clinics are more often calling in prescriptions to pharmacies, as opposed to dispensing controlled drugs on the premises. DR. WARD, in response to a follow-up question, expressed the understanding that currently xylazine is in the process of becoming a federally controlled substance. She expressed the opinion that this drug would likely not be a problem in Alaska, because it is a tranquillizer used on large animals, such as horses, and Alaska has a small proportion of large animals. 4:55:55 PM DR. WARD, in response to Representative Sumner, stated that veterinarians use two opioids. Hydrocodone would be of the primary concern, but it is used in minor amounts for chronic coughs in small dogs. She added that accessing enough of this drug from a clinic to cause a serious issue would be difficult. She stated that buprenorphine would be used in a clinic as a pain medication. She added that this drug is also used to treat fentanyl addiction. 4:57:27 PM REPRESENTATIVE RUFFRIDGE asserted that more work would be done on HB 56. He stressed the importance of clean data in PDMP and allowing veterinarians to do their job. 4:58:31 PM CHAIR PRAX announced that HB 56 was held over.