SB 162-HYDROCODONE PRESCRIPTION BY OPTOMETRISTS  2:02:55 PM CHAIR STEDMAN announced that the next order of business would be SB 162. He said it is the first hearing on SB 162. The intent today is to have the sponsor introduce the bill, take public testimony, and set the bill aside for further review. 2:03:34 PM DAVID SCOTT, Staff, Senator Donny Olson, Alaska State Legislature, Juneau, Alaska, presented SB 162 on behalf of the sponsor. He explained that the bill would retain licensed optometrists' authority to prescribe hydrocodone to patients. Currently, on the federal level, there is an effort to reschedule hydrocodone from Schedule III to Schedule II. The sponsor does not want there to be a lapse in optometrists' ability to treat their patients. He emphasized that SB 162 does not increase the scope of the practice of optometry. He noted that the sponsor is aware of the concern regarding the nationwide epidemic of prescription painkiller abuse. He drew attention to page 1, lines 13 and 14, of the bill which state that the prescription cannot exceed four days. He highlighted new language on page 1, lines 11 and 12 that ensures there is no lapse in the current practice of optometry to prescribe hydrocodone. CHAIR STEDMAN said there is one zero fiscal note from the Department of Commerce, Community and Economic Development (DCCED). SENATOR MEYER asked what kind of drug hydrocodone is. MR. SCOTT explained is commonly referred to Vicodin when it is mixed with acetaminophen and is a painkiller. SENATOR MEYER asked if the bill only pertains to optometrists. MR. SCOTT said yes. Other medical professionals already can prescribe hydrocodone. SENATOR MEYER questioned if the bill should be broadened to other medical professions. MR. SCOTT explained that physicians already can prescribe these medications. Hydrocodone is the only painkiller optometrists can prescribe. 2:07:11 PM SENATOR MICCICHE agreed with the previous answer. He inquired if the bill limits the prescription to one four-day quantity. MR. SCOTT read from page 1, lines 13 and 14, "the pharmaceutical agent . . . is prescribed in a quantity that does not exceed four days of prescribed use if it is a controlled substance." CHAIR STEDMAN opened public testimony. 2:07:56 PM MICHAEL BENNETT, Optometrist, Juneau, Alaska, testified in support of SB 162. He clarified that when the initial pharmaceutical bill for optometry was passed in 2007, optometrists were restricted to Schedule III narcotics, of which Vicodin is the drug of choice. They were not authorized to prescribe Schedule II narcotics, such as oxycontin, with even more abuse potential. He explained that if the FDA moves hydrocodone into a Schedule II classification, optometrists would not have a drug to prescribe for acute, severe pain. He pointed out that hydrocodone is used relatively infrequently in eye care practice. It is used for eye trauma. Eyes heal quickly and only a short-term prescription is required. If pain management is required for longer periods, the patient is referred to a higher level of care. It is also used for chemical injuries and an acute form of glaucoma frequently found in American Eskimos. He emphasized that SB 162 is not an expansion of prescriptive authority that has been in place for seven years. There have been no reports of issues or incidents to the state board or to the DEA. 2:10:55 PM RACHEL REINHARDT, Ophthalmologist, American Academy of Ophthalmology, Seattle, Washington, testified in opposition to SB 162. She said there is a national crisis for drug overdose deaths related to prescription narcotics. The FDA is making the recommendation to change hydrocodone-containing narcotics to a more restrictive class - Schedule II. There has been a 300 percent increase in the sale of these prescriptions since 1999 and a five-fold increase in the death rate. Alaska ranks fifth of all states for prescription narcotic overdose deaths, more than twice the national average for the death rate for prescription overdoses. Hydrocodone is the number one drug abused. The point is to restrict the number of providers who can prescribe hydrocodone. She contested the uses of hydrocodone for optometrists. She noted a similar bill was defeated in Washington and maintained that SB 162 is premature. She concluded that $72 billion is spent every year on medical costs associated with prescription overdoses. The bill sets a precedent for mid-level providers to request an exception, undercutting the research related to drug deaths. 2:17:14 PM STEVEN DOBSON, Optometrist, Alaska Optometric Association, Anchorage, Alaska, testified in support of SB 162. He said optometrists have been able to prescribe a limited quantity of hydrocodone for the past seven years for the management of acute, severe ocular pain due to injuries or infections. He maintained that the potential for abuse is with chronic, long- term recurrent pain management conditions. The bill would allow optometrists to continue to prescribe hydrocodone compounds for a limited period and for limited use without expanding their current scope of practice. He stressed that this medication is a god-send for extreme ocular pain. He shared a story of a patient's pain and the benefit of relief. 2:20:13 PM SENATOR MICCICHE shared the concern for hydrocodone abuse. He asked if there is another compound that could be used. DR. DOBSON said in the case he just gave there is no substitute. He pointed out that due to the geographic broadness of Alaska, optometrists are often the front line for urgent eye care emergencies. He agreed that there is a problem with prescription drug abuse, but maintained that it is not from optometric urgent eye care because it is so specific and for such a limited amount of time. 2:21:47 PM JEFF GONNASON, Optometrist, Alaska Optometry Association, Anchorage, Alaska, testified in support of SB 162. He defined a controlled substance as a drug or chemical that is regulated by the government. He said they are classified according to Schedules, with Schedule I being the highest for potential for abuse. For example, Schedule II drugs require more restrictive regulations than Schedule III drugs to help prevent abuse. Fourteen years ago the Alaska Legislature authorized qualified optometrists to prescribe medication including Schedule II drugs, but the governor at the time vetoed the bill. In 2007, a new bill was signed into law with the current restrictions of only Schedule III, IV, and V, not including Schedule II, and a restriction of only supplying a maximum 4-day supply of a controlled substance. He explained that Alaska therapeutic optometrists have a registered DEA number on file with the state. There have been no instances of abuse or complaints or actions by the state board or any other drug enforcement agency. The bill is necessary because the FDA is recommending reclassifying hydrocodone and a vital tool for managing pain will be taken away. He noted that he met with two ophthalmologists who had no objection to the bill; neither wanted to rekindle old turf battles. He concluded that SB 162 does not change anything; it keeps status quo. 2:25:54 PM CHAIR STEDMAN closed public testimony. CHAIR STEDMAN held SB 162 in committee.