SB 51-CONTROLLED SUB. DATA: EXEMPT VETERINARIAN  3:51:04 PM CHAIR WILSON reconvened the meeting and announced the consideration of SENATE BILL NO. 51 "An Act exempting veterinarians from the requirements of the controlled substance prescription database; and providing for an effective date." 3:51:32 PM TREVOR BAILLY, Staff, Senator Löki Tobin, Alaska State Legislature, Juneau, Alaska, presented the following sponsor statement for SB 51 on behalf of the sponsor: [Original punctuation provided.] In 2008, in response to the nationwide opioid epidemic, the Alaska State Legislature created the Prescription Drug Monitoring Program (PDMP). This program created a database of prescriptions for controlled substances in Alaska, with the stated intent was to place obstacles in front of individuals seeking opioids from multiple providers. In 2016, the Legislature expanded the program to include veterinarians. Unfortunately, the program failed to account for the major differences between the practice of human medicine and veterinary medicine. SB 51 addresses this conflict by exempting veterinarians from the Prescription Drug Monitoring Program. Eliminating the requirement for veterinarians in Alaska to use the PDMP does not cause deregulation. Veterinarians will continue to be covered by federal statutes and regulated by the Drug Enforcement Agency (DEA) and the Alaska Board of Veterinary Examiners. Additionally, provisions in state statute will continue to limit the number of opioids a veterinarian can prescribe to a seven-day prescription, with two exceptions. Those exceptions are if the prescription is part of long-term chronic care, or if there is logistical or travel barrier to returning within seven days. Prescription drug monitoring is not unique to Alaska. All 50 states have some variation of prescription drug monitoring, with 34 states exempting veterinarians. Previously, 10 of those states mandated veterinarians be part of prescription drug monitoring efforts; however, those states soon realized that including veterinarians had no clear benefit. Instead, these states found that including veterinarians in their prescription drug monitoring programs placed unnecessary time-consuming barriers on those who practice veterinary medicine. In Alaska, the PDMP fails to be effective because animal patients do not have identifiers such as social security numbers. As a result, veterinarians must try to get the private health data of those who seek care for their animals prior to treating the animal. This is both inefficient and an invasion of privacy. Senate Bill 51 seeks to correct an overexpansion of the Prescription Drug Monitoring Program to ensure continued access to veterinary care in Alaska. 3:54:13 PM MR. BAILLY presented the following sectional analysis for SB 51: [Original punctuation provided.] Section 1 Deletes the requirement that the Board of Veterinary Examiners to notify the Board of Pharmacy when a practitioner registers with the controlled substance prescription database. Section 2 Creates a new subsection in the controlled substance prescription database statutes that exempts veterinarians from the requirements of the controlled substance prescription database. Section 3 Repeals the subsection that requires veterinarians register with the controlled substance prescription database. Section 4 The act takes effect immediately upon passage. MR. BAILEY commented that SB 51 is an iteration of legislation from the 32nd legislature. Although SB 51 may look substantially different from the previous bill, it still has the same legislative purpose and intent. The legislative legal department made SB 51 clear and succinct while meeting the goals of the previous legislation. 3:55:20 PM CHAIR WILSON announced invited testimony on SB 51. 3:55:55 PM RACHEL BERNGARTT, DMV, JD, Chair, Board of Veterinary Examiners, Juneau, Alaska, introduced herself as a doctor of veterinary medicine and a lawyer. 3:56:16 PM TRACY WARD, DVM, Past-President, Board of Veterinary Examiners, Juneau, Alaska, stated she is a veterinarian that practices animal rescue. 3:56:32 PM DR. BERNGARTT turned to slides 2 - 3 and said SB 51 exempts veterinarians from the controlled substance prescription database requirements. The Alaska State Veterinary Medical Association (AKVMA) and the Board of Veterinary Examines (BOVE) support SB 51. Also, the Alaska Board of Pharmacy, which administers the PDMP, passed a motion on February 18, 2022, that supports the exemption of veterinarians from participation. 3:57:01 PM DR. WARD turned to slide 4 and said the PDMP was established with voluntary participation in 2008. In 2016, House Bill 159 was amended due to the increase in opioid use in the US. The amendment mandated participation for all actively licensed practitioners who held a drug enforcement agency (DEA) license to prescribe, administer, or dispense controlled substances on the federal II, III, or IV drug schedules. The change went into effect in 2017. The committee that was formed to discuss the amendment included all affected boards except AKVMA and BOVE. 3:58:24 PM DR. WARD turned to slide 5 and spoke to the following points: [Original punctuation provided.] 2008: Alaska's PDMP established by SB 196. 2017: In reaction to growing opioid epidemic, the PDMP was amended by via HB 159 to include all DEA permit holders, including veterinarians. Neither AKVMA nor BOVE were consulted regarding this amendment. PDMP reporting is required for all actively licensed practitioners who hold a Federal Drug Enforcement Agency registration number and who prescribe, administer, or dispense federally scheduled II IV controlled substances in the state. 4:00:02 PM DR. WARD moved to slides 5 - 7 and discussed why it makes sense to exempt veterinarians from the PDMP: [Original punctuation provided.] The PDMP is not an effective database for  veterinarians or our patients.  • The PDMP was established for human medicine. Querying of PDMP data for animals is not possible with the PDMP (and reported drugs for an animal are not visible in the PDMP database). • A query is made on the individual(s) that bring the animal to the veterinarian and human data is obtained, not animal data. • Human data obtained from the PDMP query is not usable for the veterinarian. Veterinarians are not trained in human medicine to understand what the dosages mean. Querying of human PDMP information is invasion into an  individual's medical privacy.  • Clients find it intrusive when the veterinarian is required to query their private health data in the PDMP • An individual's private medication information becomes known to the veterinarian for certain drugs, such as narcotics, sedatives, and stimulants. Examples of some common medications seen include, but are not limited to: Adderall, Ritalin, anabolic steroids such as testosterone, postpartum depression medications, sex hormones, Xanax, Klonopin, Valium, Ativan, Domar, and sleep aids like Ambien and Lunesta. Veterinarians are monitored by the Drug Enforcement  Agency and must adhere to controlled substance  regulations.    • Veterinarians who prescribe or dispense controlled substances are licensed through the Drug Enforcement Agency (DEA). There is already a significant level of accountability, record keeping, and medication storage requirements that veterinarians must adhere to. • Distributors of controlled substances monitor utilization patterns of veterinarians. The Suspicious Order Monitoring System is in place and data is gathered by distribution companies who are required by the DEA to monitor and report unusual purchase patterns a veterinarian may have. Distributors are required to flag purchases that fall outside of norms for either previous purchase history or the norms for practices of similar size/type. DEA oversight is to control/prevent diversion from licensed professionals to drug dealers and users. 4:03:03 PM DR. BERNGARTT moved to slide 8 and spoke about why it makes sense from a licensing perspective to exempt veterinarians from the PDMP: [Original punctuation provided.] 33 other states have exempted veterinarians from participating in the PDMP. • 10 states formerly mandated veterinary reporting but repealed their inclusion due to the problems experienced, lack of identified benefits to veterinary participation, and demonstration that exempting veterinarians does not decrease protection of public health and safety. These states are Alabama, Arizona, Idaho, Illinois, Kansas, Kentucky, Louisiana, New Mexico, West Virginia (2021), and Wyoming. • Missouri was the last state to implement a PDMP in 2021 and did not require veterinarians to participate. 4:04:23 PM DR. BERNGARTT turned to slide 9 and said the drugs most often implicated in overdose and death are not drugs veterinarians prescribe. The graph depicts trends in US drug overdose deaths from 1999 - 2021. She noted a correction to the synthetic opioids category stating deaths have increased 97-fold, excluding methadone overdose. Fentanyl and oxycodone are synthetic opioids that are increasing deaths the most. Veterinarians do not prescribe these two drugs for dispensing. Veterinary fentanyl is administered directly to the animal at the hospital. Oxycodone does not have veterinary usage. It is important to remember that veterinarians do not dispense the drugs that cause problems in the US. She said opioid medications prescribed by veterinarians (728,223) were only 0.34 percent of the total opioid prescriptions (214 million) dispensed by US retail pharmacies in 2017. 4:06:11 PM DR. BERNGARTT said the PDMP is just one tool for monitoring veterinary drug use. There is a natural barrier that prevents drug seekers from using veterinarians for doctor shopping. Veterinarians require upfront payment for services. If a person cannot pay for veterinary services, a pet will not receive the diagnostic services necessary for a vet to consider dispensing an opiate. Also, if a vet dispensed a drug, it may not be a sought-after drug. Exempting veterinarians from the PDMP is not expected to make them a source for doctor shopping. 4:08:09 PM SENATOR KAUFMAN said one of the objections he has heard is that the .34 percent of opioid medication prescribed by veterinarians would increase if veterinarians were exempt. He asked if it would be possible for a person to visit several veterinary locations with a dog in obvious pain, pay for services, and receive desirable opioids. 4:08:58 PM DR. WARD said anything is possible, but it would be improbable. Given the current veterinary shortage, the wait time to see a vet is 3 - 14 days. A visit to the vet for an animal in pain costs approximately $500 - 800. Rarely are opioids a vet's first choice for an animal in pain. A vet usually admits an animal if it is in enough pain to receive an opioid. The medication is dispensed to the animal by the vet. She estimated that animal owners had gone home with something other than a non-steroidal anti-inflammatory less than five times since beginning her practice. She stated that it is virtually impossible to visit several vets in a short amount of time to receive opioids. 4:10:44 PM SENATOR KAUFMAN asked whether veterinarians typically act as the dispensary for the medications they prescribe and, if so, would the passage of SB 51 create any tracking issues. 4:11:12 PM DR. BERNGARTT said approximately 60 veterinarians directly dispense prescription-controlled substances from their clinics. The clinics may use the substances in their practice but also directly dispense them. 4:12:04 PM SENATOR KAUFMAN asked if veterinarians dispense a controlled substance in a potency of interest to someone. He also asked if there would be a control mechanism to track dispersion if veterinarians were not in the PDMP. 4:12:27 PM DR. WARD said 60 veterinarians in Alaska dispense drugs. The other 350 licensed veterinarians in Alaska send written prescriptions to pharmacies. Record keeping takes place at the pharmacy. SENATOR KAUFMAN asked whether SB 51 would create a tracking gap if veterinarians who dispense controlled substances did not have to report using the PDMP. 4:13:35 PM DR. WARD replied that there is a small potential gap. Most of the 60 Alaskan clinics dispense schedule IV drugs, such as phenobarbital, for seizure control. Only a handful of clinics dispense opioid class schedule II drugs. 4:14:20 PM SENATOR DUNBAR asked how a vet would be caught if one of the 60 that distribute controlled substances did so illegally. 4:14:55 PM CHAIR WILSON interjected that it might be helpful if Ms. Robb discussed the utilization of the PDMP because the Drug Enforcement Agency does not review the PDMP for bad actors. 4:15:28 PM DR. BERNGARTT said a vet who engages in nefarious behavior with illicit drug consumption or distribution would not be captured by the PDMP because a vet who diverts drugs would not be entering those controlled substances into the data base. She said she is aware that the DEA caught one vet in eight years, and it was through drug log requirements. 4:16:56 PM DR. BERNGARTT moved to slides 10 - 11 and spoke about the following points: [Original punctuation provided.] The unwieldy PDMP leads to costly and burdensome investigations of veterinarians by the Alaska Board of Veterinary Examiners. Costly and onerous requirements for monitoring veterinarians have been placed on the board of veterinary examiners (BOVE). Licensing fees for veterinarians will likely increase as a result of the cost to conduct needless investigations of veterinarians with DEA licenses. The cost of doing business will be passed on to consumers. Alaska has the highest licensing fees for veterinarians in the country. Licensing fees are expected to increase in the State of Alaska as a result of the cost of PDMP investigations. Charging veterinarians for the cost of enforcement of an unusable PDMP system, and regulations with which they are unable to comply, is not responsible stewardship of resources. 4:19:34 PM DR. BERNGARTT moved to slide 12, AKVMA and BOVE Ask For Support of SB 51, and read the following: [Original punctuation provided.] An Exemption of Veterinarians from participating in the PDMP: Will allow veterinarians to provide the appropriate, timely, medical management appropriate for each patient. Will increase the efficiency of the PDMP system for its intended purpose, by allowing for accurate interpretation of data and trends in human medicine. Will allow continued judicious use of controlled substances that is already practiced by veterinarians. Will eliminate unnecessary and disproportionate business burdens for veterinarians. 4:20:25 PM CHAIR WILSON opened public testimony on SB 51. 4:20:40 PM SUZE NOLAN, Manager, North Pole Veterinary Hospital, North Pole, Alaska, testified in support of SB 51. She said she is the practice manager for a veterinary hospital with nine doctors. She supports all the statements provided by the invited testifiers. She asked for a yes vote on SB 51. 4:21:46 PM MELISSA BECKER, representing self, Fairbanks, Alaska, testified in support of SB 51. She said that as a veterinarian she has no interest in looking up pet owners' information before treating their pets. She does not dispense schedule II and III controlled substances. The PDMP does not work for animals because animals in shelters do not have owners, and children sometimes bring in their pets. Also, an animal's name is easily changed, and there is no way to prove it is the same animal. 4:23:00 PM CHAIR WILSON closed public testimony on SB 51. 4:23:23 PM CHAIR WILSON held SB 51 in committee.