SB 78-USE OF DRUGS BY OPTOMETRISTS CHAIRMAN MACKIE called the Senate Labor and Commerce Committee meeting to order at 1:40 p.m. and announced SB 78 to be up for consideration. MR. DAVE GRAY, Staff to Senate Labor and Commerce Committee, said that optometry is a primary health care profession that examines, diagnoses, and treats disorders of the human eye and its appendages utilizing diagnostic and therapeutic medications, methods, and procedures in accordance with professional training in competency. Historically, medical doctors have enjoyed unlimited legislative trust in their scope of practice. However, the methods and procedures used by other limited license health care professionals, such as optometrists, dentists, podiatrists, nurse practitioners, and others, are determined in regulation by their respective state boards. In the past, Alaska's doctors of optometry have had their scope of practice unduly restricted by outdated state statutes. For every new advance in technology, optometry has had to return to the legislature to revise these statutes in order to practice at the highest standard of care. In 1988, the statutes were updated to allow optometrists to use diagnostic drugs. The Alaska Legislature was the last of the 50 states to pass this law. In 1992, the prescribing of therapeutic drugs to treat eye diseases was authorized and Alaska was the 32nd state to pass such legislation. However, due to a compromise, only topical medications were included at that time. Currently, all 50 states authorize optometrists to prescribe drugs; 34 allow oral systemic drugs and 16 states, including Alaska, further restrict to topical drugs only. One state authorizes the use of lasers by optometrists. Last session, a bill was introduced and heard that would expand the scope of optometry to include all medications for the eye, as well as the use of lasers and limited surgical procedures for qualified optometrists. This bill, SB 78, only allows qualified optometrists to prescribe and use medications related to the eye and for emergency anaphylaxis. This change will allow optometrists to practice at the currently accepted standard of care. It will provide Alaskans with improved access to quality, cost effective eye care. CATHERINE REARDON, Director of the Division of Occupational Licensing, Department of Commerce and Economic Development, stated the Division has not taken a position on SB 78 at this time. She noted after the Alaska Medical Board meeting tomorrow, she may have a position to relay to future committees. However she is concerned that the Optometry Board and Alaska Medical Board may have conflicting opinions. Therefore, she prefers to delay taking a position on the legislation until both boards make their positions known. Number 92 DR. JEFF GONNASON made the following comments via teleconference. He has been a licensed optometrist in the State of Alaska since 1976 and was the president of the Alaska State Board of Examiners and Optometry during a previous Administration. The professions of dentistry and optometry have expanded their scopes of practice over the years as technology and methods of treatment became available. Aside from 35 states, Guam and Washington, D.C. also allow optometrists to prescribe oral or systemic drugs. MR. GONESON said SB 78 allows optometrists to work to the full extent of their training. MR. GONNASON said optometrists are trained in the same manner as dentists and, like a dentist, he would like to be able to administer necessary drugs including antibiotics, pain medication and other oral drugs. He noted this bill does not include a request to allow the use of lasers or do limited surgery. Number 159 SENATOR LEMAN asked if this bill would allow optometrists to prescribe or recommend marijuana. He asked what position the Board of Optometrists has taken on the use of marijuana to treat glaucoma. MR. GONNASON replied that studies have shown marijuana does lower pressure in glaucoma patients, but only when taken in high doses. Since other modern drugs do not cause side effects and are more effective, the Board has resolved that the use of marijuana is unnecessary. MR. GONESON assured SENATOR LEMAN that, "No one is interested in prescribing marijuana for the treatment of glaucoma . . . " MR. BARRY CHRISTENSEN, a pharmacist from Ketchikan and the Legislative Chair of the Alaska Pharmaceutical Association (APA), said the APA has not taken a stand on this bill, but does have two concerns about the bill. First, they are concerned that there is currently no listing of optometrists who can prescribe drugs, which makes it difficult for pharmacists to process prescriptions. Second, pharmacists are not familiar with the training and education optometrists receive on drugs and drug interactions. The addition of oral drugs prescribed by optometrists makes this an issue of concern to the APA. SENATOR MACKIE clarified that the APA is concerned that pharmacists may be put in the position of issuing drugs prescribed by optometrists without the regulations in place allowing them to do so. MR. CHRISTENSEN affirmed that was one concern, the other being the necessity of a list of optometrists able to prescribe drugs. SENATOR MACKIE asked MS. CATHERINE REARDON how regulations might alleviate MR. CHRISTENSEN'S concerns. MS. REARDON replied the Board gives particular endorsements for those optometrists with the training and ability to prescribe drugs. She said the division has this information and can provide it to whomever requests it. Number 290 SENATOR LEMAN moved to report SB 78 from committee with individual recommendations. Without objection, SB 78 moved from committee with individual recommendations.