HB 114 - INHALANT ABUSE Number 0752 CHAIR ROKEBERG announced that the next order of business would be HOUSE BILL NO. 114, "An Act relating to abuse of inhalants." [Before the committee was CSHB 114(HES).] CHAIR ROKEBERG called an at-ease from 2:31 p.m. to 2:33 p.m. Number 0696 REPRESENTATIVE MARY KAPSNER, Alaska State Legislature, sponsor, explained that HB 114 targets the problem of inhalant abuse, which has been neglected in Alaska for many years; it will provide public safety officials, medical personnel, and the courts leverage to place individuals who abuse inhalants into rehabilitation. She added that HB 114 classifies inhalant abuse as a class B misdemeanor that is punishable by a fine of $300, which can be waived if the individual agrees to go into treatment. REPRESENTATIVE KAPSNER noted that a treatment center in Bethel is under construction and is expected to open on August 31, 2001. She said that currently there are only two inhalant abuse treatment centers in the nation: one is in North Dakota, and the other is in Texas. The lack of treatment centers for inhalant abuse has been a source of frustration across the nation, she explained. People who suffer from inhalant abuse need to go to treatment, but most treatment facilities do not have accommodations specific to the needs of inhalant abusers. She stated that most people who suffer abuse need at least 30 days to "detox" because inhalants penetrate all of the major organs. She mentioned that 24 other states have passed laws addressing inhalant abuse, which is a very big problem in Alaska but not much bigger than elsewhere in the nation. REPRESENTATIVE KAPSNER then announced that the original version of HB 114 classified inhalant abuse as a class B misdemeanor. She amended her explanation of the legislation to say that CSHB 114(HES) classifies the behavior as a violation. She noted that this change ensured that inhalant abusers - often very young children - wouldn't be criminalized or put through the legal system. With regard to national statistics, she reported that a survey of eighth-graders indicated that 19.6 percent of all eighth-graders have tried inhalants; she added that an Alaskan survey done in 1988 indicated that 25 percent of seventh- through twelfth-graders have tried inhalants. She noted that inhalant abuse is an international problem, and she mentioned a case wherein some Canadian kids were taken away from their families for "huffing" gas. She explained that inhalant abuse is sometimes referred to as "sniffing" or "huffing." Number 0487 REPRESENTATIVE MEYER made a motion to adopt the proposed committee substitute (CS) for HB 114, version 22-LS0130\J, Luckhaupt, 4/16/01, as a work draft. There being no objection, Version J was before the committee. REPRESENTATIVE OGAN asked whether Version J included nitrous oxide as an inhalant. He mentioned that he has heard that at "rave concerts," balloons full of nitrous oxide are sold, and that nitrous oxide causes stupefaction. REPRESENTATIVE KAPSNER affirmed that Version J would include nitrous oxide, sometimes referred to as "whippets." She pointed out that language [in Section 1] reads in part: (a) Under circumstances not otherwise proscribed under AS 11.71, a person commits the offense of abuse of inhalants if the person smells or inhales any inhalant, other than an alcoholic beverage, with the intent of causing intoxication, inebriation, excitement, stupefaction, or dulling of the brain or nervous system. REPRESENTATIVE OGAN said he wanted it on record that Version J includes nitrous oxide. Number 0346 JIM HENKELMAN, Statewide Outreach Coordinator, Inhalant Intervention Project, Yukon-Kuskokwim Health Corporation (YKHC), said that the YKHC is in support of HB 114, and has federal funding for construction and initial treatment process for the inhalant abuse treatment center. He added, however, that [the YKHC] feels there is a real need to both bring this problem to the attention of the public and allow public safety and health officials some recourse for addressing the problem of inhalant abuse. MR. HENKELMAN remarked that often [the YKHC] receives comments from people who say that when they have contacted law enforcement for help with an inhalant abuse problem, they are told that nothing can be done because it is not illegal to inhale substances. He predicted that passage of HB 114 will allow law enforcement to intervene. He added that [the YKHC's] biggest concern is for the youth; inhalants are substances that are abused by very young children - as young as age four. He mentioned that he has heard of instances when babies have been given inhalant-type substances to "settle them down." MR. HENKELMAN described his surprise at learning the extent to which inhalants are a "gateway" substance to other substances. A survey done a couple of years ago at the Ernie Turner Center indicated that 70 percent of the residents in treatment had started their substance abuse by using inhalants, and 50 percent of those people said that they would go back to using inhalants if alcohol wasn't available. After one looks at the unbelievably serious damage that can be caused even the first time somebody "inhales," it is obvious that early intervention has a better chance of preventing long-term substance abuse, especially among young children. MR. HENKELMAN, with regard to the residential inhalant abuse treatment center, explained that the grand opening is scheduled for August 31, 2001. [The YKHC] expects to take the first group of young people into the residential treatment program at the beginning of September. He explained that [the YKHC] has, to date, been involved in statewide outreach work, including making contact with communities, assisting them as they "build their capacity to deal with the inhalant problem within their community," and training communities in the referral process if residential treatment is indicated. REPRESENTATIVE JAMES asked, "How do you treat something like this?" TAPE 01-67, SIDE A Number 0001 MR. HENKELMAN, after noting that it is difficult because inhalants are very different, went on to explain that it takes four to six weeks just to get the toxins out of the fatty tissues. And, unlike with a lot of other substances, almost always, as soon as somebody starts using inhalants, there are some deficits that occur: brain damage takes place, and one of the first things to deteriorate is impulse control. So a lot of times, "you're" dealing with young people who have begun to lose their good judgment; thus a lot of behavior problems arise, which is evident in school. He added that attention-deficit issues become evident as well. Key to the treatment of inhalant abuse is a really good assessment, he explained, in order to determine exactly what the deficits are and how extensive the damage is. REPRESENTATIVE KAPSNER added that the Division of Juvenile Justice has indicated that sometimes there is confusion as to whether some of their clients have FAS (fetal alcohol syndrome) or are inhalant abuse sufferers because these two problems have a lot of the same symptoms. She explained, however, that one of the differences is that FAS children have almost no early childhood memories, whereas inhalant abusers have childhood memories up until the point when they began abusing inhalants. Inhalants affect every major organ, she reiterated, and there are repercussions for the offspring of inhalant abusers as well because reproductive organs are affected too. REPRESENTATIVE JAMES added that "this isn't something that just happened lately, either; this has been going on for a long time." She recalled a foster child that she took care of 38 years ago who was 15 at the time. The child's record indicated that she had been getting "Ds" and maybe an occasional "C" in school; the records also indicated that this was all that the child was capable of attaining, even though she was working very hard in school. Representative James found out by talking to this child that when she was a little girl, she and others would sniff gasoline until they passed out. This was a long time ago, Representative James remarked, and now "we're" hearing a lot about it. She surmised that similar behavior had been going on long before that as well. REPRESENTATIVE KAPSNER pointed out that inhaling substances is extremely addictive. REPRESENTATIVE JAMES noted that another dangerous behavior that young children engage in is to go around in circles until they get dizzy and fall down. She said that she remembered an incident when she was growing up of a neighbor child who had done this and died as a result of "water on the brain." She added that her mother put a stop to her doing this because it is so very dangerous. She warned, however, that even though it is such a dangerous behavior, kids love to do it. REPRESENTATIVE MEYER commented that he has heard speculation that some people substitute inhalants for alcohol when the latter is not available. Number 0397 MR. HENKELMAN confirmed this as being accurate. He added that inhalant abuse can in part be attributed to limited access of alcohol in some areas of Alaska. Inhalants are readily available: they can be found in the refrigerator, under the kitchen counter, and in the gas tank. These substances have a lot of the same effects [as alcohol], but the physical damage to the body is so much more severe. He noted that one problem officials face is that the actual cause of some of the physical problems experienced by inhalant abusers is not very well documented. For example, if somebody is sniffing glue, two or three days later the lungs begin to fill up with fluid and he/she starts having serious respiratory problems. At the hospital, the respiratory problems are treated, but no one investigates to see if the cause is inhalant abuse. REPRESENTATIVE MEYER asked what prompts people to use inhalants. MR. HENKELMAN explained that many of the reasons are the same ones that prompt people to try alcohol and drugs; particularly for young people, he opined, it is a method of escape, it gives a feeling of power, and it clearly is mind-altering. He said that according to people he has talked with, using inhalants can cause visual and auditory hallucinations, it can give a person the feeling of being in whole different world, and it can impart a feeling of euphoria. He added that when young children begin abusing inhalants, they get addicted when they are young, and they don't have any understanding that they are inflicting incredible damage on themselves. REPRESENTATIVE MEYER asked whether inhalant addiction is treated the same way alcohol or drug addiction is treated. MR. HENKELMAN explained that some of the same principles can be used, but it generally takes longer to treat inhalant addiction. In addition, a more comprehensive assessment has to be done in order to identify the deficits; then the addicted person will need help building skills to compensate for those deficits, and this type of help is not a part of "regular" substance abuse treatment, he noted. REPRESENTATIVE JAMES asked how the treatment process works for a four-year-old who is sniffing things. Number 0603 MR. HENKELMAN, with regard to a child that young, said that probably the best method of treatment is to limit access. One type of problem encountered by [the YKHC] is calls from people asking for someone to come "fix my child because they're sniffing"; the parents don't realize that they can control the situation by limiting the child's access to these substances, and by becoming more aware of what's going on with the child. He added that with a child that age, it is really the parents' responsibility to deal with the situation. MR. HENKELMAN said [the YKHC] would like to see communities develop the ability to support the parents. Part of the problem is that all too often, it is the dynamics in the home that contribute to a child's getting into an inhalant abuse situation to start with. Such support would include helping the parents cope with the behavior problems associated with a child who is suffering from inhalant abuse or other substance abuse; such support will require a combined effort on the part of the families, the mental health programs, the Division of Family and Youth Service (DFYS), community wellness counselors, and substance abuse counselors. REPRESENTATIVE COGHILL asked how such children will be detained if the need arises, and if people other than law enforcement would have the authority to remove a child from his/her home. REPRESENTATIVE KAPSNER offered that on page 2, line 11, there is language that relates to that. REPRESENTATIVE COGHILL said there appears to be a contradiction between language on page 4, line 30, which says "the person remains incapacitated by alcohol for more than 48 hours after admission as a patient", and page 5, line 16, which says, "12 hours". CHAIR ROKEBERG noted that these two sections of HB 114 merely add the word "inhalants" to the existing statute. MR. HENKELMAN offered that the language on page 5 is referring to a detention facility [whereas language on page 6 is referring to a treatment or health facility]. Number 0920 ROBERT BUTTCANE, Legislative and Administrative Liaison, Division of Juvenile Justice, Department of Health and Social Services (DHSS), explained that "we're" talking about two phases of an involuntary and emergency commitment provision. Section 9 on page 5 relates to an emergency custody period of 12 hours. Contrastingly, Section 6 on page 4 relates to people who have presented themselves to treatment programs for treatment and detoxification, and may, upon examination and approval, stay in that status for up to 48 hours. Therefore, these are two different actions and provisions that are not inconsistent, but are, instead, two parts of a continuum. CHAIR ROKEBERG remarked that this is a crime that is being considered a violation, and that many of the provisions in Version J relate primarily to minors. He asked how the issue of inhalant abuse by adults is being addressed. MR. BUTTCANE concurred that Section 1 is creating a new crime that is a violation, as opposed to a "jailable" offense. Therefore, any person - adult or juvenile - would be subject to sanctions if he/she were to abuse these substances. Section 3 ensures that a juvenile offender would be treated the same as an adult, but, he added, language on page 2 [lines 3-5] mandates what the court will do once a person has been convicted of this violation, which shall be to place the offender on probation and require that he/she successfully complete an inhalant abuse treatment program. CHAIR ROKEBERG noted that inhalant abuse treatment programs are [not] readily available in Alaska. MR. BUTTCANE mentioned that [the DHSS] has submitted fiscal notes "based on what we might project to provide treatment." REPRESENTATIVE JAMES, with regard to conviction and sentencing, asked how four-year-olds would be treated. MR. BUTTCANE confirmed that they would be treated the same as adults, but added that there are some practical issues that would be taken into account. If a four-year-old is found to be abusing substances, while "we may initially grab hold" of the child and start intervention, the focus will shift to what's going on within the family and the community; thus other intervention mechanisms will be implemented, he explained. He said that while it is possible that a law enforcement officer could cite a four-year-old, it's doubtful that such a case would actually be prosecuted. REPRESENTATIVE KAPSNER noted that Version J provides that a law enforcement officer "may" take the child, rather than "shall", as was provided for in an earlier version. Number 1206 MR. BUTTCANE noted that Section 4 on page 3 of Version J speaks to services for minors. What "we're" trying to do, he explained, is give some authority to local law enforcement agencies to make interventions, which they could do by taking a juvenile into protective custody and then returning him/her to the parent. This, then, is that fine line between being able to effectively intervene without necessarily effecting a criminal arrest, which would be inappropriate in the case of a four-year- old. "This" is looked at, really, as a medical issue more than as a criminal issue, but, he noted, there are some criminal processes that can be put into play if necessary. After intervention by local law enforcement, a process of assessment/referral/treatment/detoxification can be triggered, he reported. CHAIR ROKEBERG referred to language in Section 4 that said a peace officer may take into protective custody a minor who is not otherwise subject to arrest. He asked what sort of scenario is affected by this language. MR. BUTTCANE used the example of a minor who steals a snow machine and then sniffs the gasoline until he/she becomes intoxicated by the fumes; when a law enforcement official comes upon this situation, the minor will be subject to arrest for stealing the snow machine instead of simply being placed into protective custody for being under the influence of an inhalant. Mr. Buttcane informed the committee that [Section 4] has been reviewed both by the Department of Law and Legislative Legal Services, and therefore [the DHSS] believes [Section 4] is consistent with other provisions of law. REPRESENTATIVE KAPSNER mentioned that HB 114 has a further referral to the House Finance Committee. Number 1438 ALVIA "STEVE" DUNNAGAN, Lieutenant, Division of Alaska State Troopers, Department of Public Safety (DPS), testified via teleconference and said simply that from an enforcement standpoint, Section 4 is quite easily read and understood. It pretty much guarantees that if law enforcement personnel have a serious reason to arrest somebody, they could do so rather than worrying solely about inhalant use. CHAIR ROKEBERG called an at-ease from 3:06 p.m. to 3:07 p.m. CHAIR ROKEBERG noted that page 2, line 5, includes language that requires the defendant to successfully complete an inhalant abuse treatment program, but he pointed out that such programs are not available everywhere in Alaska. REPRESENTATIVE KAPSNER explained that the facility that is being built in Bethel will be a statewide facility. CHAIR ROKEBERG inquired, then, whether everyone subject to this legislation would be flown to Bethel. MR. HENKELMAN replied, "That's correct. CHAIR ROKEBERG, after wishing the sponsor good luck on that point when HB 114 goes to the House Finance Committee, suggested instead that the court could be granted flexibility with regard to requiring the defendant to successfully complete an inhalant abuse treatment program; currently the language in Version J mandates it, he added. Number 1502 MR. BUTTCANE opined: If we did that, the department's fiscal note probably would be zeroed out; if this were a discretionary thing, what it would do, essentially, would be limit treatment to the facility being built in Bethel, which is funded through federal programs. So if we did it as a discretionary thing, the department would not have to submit this.... CHAIR ROKEBERG posited that it has to be discretionary for the court, and he noted that he is not trying to speak to the treatment issue other than the practical matter of its availability. He said the legislature can't force the judge to mandate a treatment program that doesn't exist unless the person is flown a thousand miles. REPRESENTATIVE JAMES suggested changing the language [on page 2, line 3,] to "may", instead of "shall". CHAIR ROKEBERG noted that such a change would give flexibility regarding probation too. He then asked what AS 12.55.085 addresses. MR. BUTTCANE explained that AS 12.55.085 is part of the sentencing/probation statute. MR. HENKELMAN, in response to a question from Chair Rokeberg, stated that the facility in Bethel is for youths 10 to 17 years of age. Number 1578 DON DAPCEVICH, Division of Alcoholism and Drug Abuse (DADA), Department of Health and Social Services (DHSS), in response to the question of how and where adults are going to be treated, explained that the adult treatment is accounted for in the fiscal note for the DHSS, to take care of some possibility to provide some services outside of the Bethel area on an outpatient basis. He added that both youths and adults would be able to make use of such services. CHAIR ROKEBERG pointed out that the fiscal note mentions treatment for 30 juveniles and 30 adults. MR. BUTTCANE remarked that that portion of the fiscal note is merely asking for recognition that these people are in the system now, and are currently being treated, and that the DHSS is not simply creating a new treatment group. REPRESENTATIVE KOOKESH stated that he is a co-sponsor of HB 114, which he feels is an important bill, and he would really appreciate the committee's favorable consideration in reporting this legislation out of committee. Number 1714 REPRESENTATIVE JAMES made a motion to adopt Amendment 1, on page 2, line 3, to change "shall" to "may". There being no objection, Amendment 1 was adopted. Number 1756 REPRESENTATIVE JAMES moved to report CSHB 114, version 22- LS0130\J, Luckhaupt, 4/16/01, as amended, out of committee with individual recommendations and the accompanying fiscal notes. There being no objection, CSHB 114(JUD) was reported from the House Judiciary Standing Committee.