SB 51-CONTROLLED SUB. DATA: EXEMPT VETERINARIAN  2:10:14 PM CHAIR BJORKMAN 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." 2:10:43 PM SENATOR LÖKI TOBIN, District I, Alaska State Legislature, Juneau, Alaska, sponsor of SB 51, paraphrased the following sponsor statement: [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 over 30 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. 2:13:51 PM TREVOR BAILLY, Staff, Senator Löki Tobin, Alaska State Legislature, Juneau, Alaska, presented the sectional analysis for SB 51. [Original punctuation provided.] Senate Bill 51  "Controlled Substances Data Exemption for  Veterinarians"  Version: 33-LS0339\A  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. 2:15:30 PM CHAIR BJORKMAN invited Dr. Berngartt to put herself on the record and begin her presentation. 2:15:42 PM DR. RACHEL BERNGARTT, Chair, Board of Veterinary Examiners, Juneau, Alaska, presented a slideshow on exempting veterinarians from the prescription drug monitoring program during the hearing on SB 51. DR. BERNGARTT displayed slides 2 and 3 and paraphrased the following: SB 51: AN ACT EXEMPTING VETERINARIANS FROM THE REQUIREMENTS OF THE CONTROLLED SUBSTANCE PRESCRIPTION DATABASE. THE ALASKA STATE VETERINARY MEDICAL ASSOCIATION (AKVMA) SUPPORTS SB 51. THE ALASKA BOARD OF VETERINARY EXAMINERS (BOVE) SUPPORTS SB 51. THE ALASKA BOARD OF PHARMACY SUPPORTS EXEMPTING VETERINARIANS FROM PARTICIPATING IN THE PDMP 2.18.2022 Board of Pharmacy Meeting Voted and Passed Motion to Support 2:17:19 PM DR. BERNGARTT reviewed slide 4, Background: The PDMP." It read: 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. DR. BERNGARTT reported that the Alaska State Medical Association expressed that it did not oppose exempting veterinarians from the Prescription Drug Monitoring Program (PDMP). 2:18:25 PM DR. BERNGARTT spoke to the following points on slide 5, Why It Makes Sense to Exempt." It read: 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. 2:20:31 PM DR. BERNGARTT spoke to the following points on slide 6, Why It Makes Sense to Exempt." It read: 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. 2:21:58 PM DR. BERNGARTT spoke to the following points on slide 7, Why It Makes Sense to Exempt." It read: 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. 2:23:24 PM DR. BERNGARTT spoke to the following points on slide 8, Why It Makes Sense to Exempt." It read: 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. 2:23:50 PM DR. BERNGARTT spoke to the following points on slide 9, Why It Makes Sense to Exempt." It read: Veterinarians are not a source of the drugs of primary concern. Synthetic opioids excluding methadone overdose deaths increased 97-fold  Psychostimulants with abuse potential (primarily methamphetamine) overdose deaths increased 59-fold Cocaine increased 6.4-fold Rx opioid deaths increased 4.9-fold  Opioid medications prescribed by veterinarians (728,223) were only 0.34% of the total opioid prescriptions (214 million) that were dispensed by U.S. retail pharmacies in 2017. 2:24:53 PM DR. BERNGARTT spoke to the following on slide 10, Why It Makes Sense to Exempt." It read: 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). 2:25:39 PM DR. BERNGARTT spoke to the following points on slide 11, Why It Makes Sense to Exempt." It read: 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. 2:26:20 PM DR. BERNGARTT reviewed the following summary of SB 51 on slide 12: AKVMA and BOVE ASK FOR SUPPORT of SB 51 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. 2:27:23 PM SENATOR BISHOP moved to adopt the committee substitute (CS) for SB 51 as the working document. 2:27:38 PM CHAIR BJORKMAN objected for purposes of an explanation. 2:27:45 PM At ease. 2:28:07 PM CHAIR BJORKMAN reconvened the meeting. 2:28:09 PM SENATOR BISHOP restated his previous motion and moved to adopt the committee substitute (CS) for SB 51, work order 33-LS0339\B, as the working document. CHAIR BJORKMAN objected for the purpose of explanation. He invited Ms. Achee to walk through the changes in the CS. 2:28:42 PM LAURA ACHEE, Staff, Senator Jesse Bjorkman, Alaska State Legislature, Juneau, Alaska, reviewed the explanation of changes from version A to version B for SB 51. In addition to issues related to the PDMP, the Alaska Board of Veterinary Examiners has asked that the statute be expanded to include additional means by which qualified veterinarians can be certified. Like many industries in Alaska, veterinary medicine has shortages; these changes could even help in the important task of attracting veterinarians to the state. CHAIR BJORKMAN asked Ms. Achee to review the changes in the CS. MS. ACHEE reviewed the following changes in the CS for SB 51: Section 1 would amend AS 08.98.050(b) to authorize the Board of Veterinary Examiners to adopt a certification process for veterinarians to become licensed to practice in Alaska. Section 2 would amend AS 08.98.165(a) to allow the board to accept certification through the Program for the Assessment of Veterinary Education Equivalence in place of attending an accredited program in the United States. The language in this section would also allow the boards the discretion to approve other certification processes. Section 3 would amend AS 08.98.184 to contain the same changes as in Section 2. The remainder of the sections are unchanged. 2:31:47 PM DR. CIARA VOLLARO, Member, Alaska Board of Veterinary Examiners, Anchorage, Alaska, provided invited testimony on SB 51. She paraphrased from the following prepared testimony: In order to improve the quality and availability of veterinary services in the state of Alaska, the board is requesting statutory changes to licensing requirements for foreign veterinary graduates. Currently the Alaska statutes mandate educational commission for foreign veterinary graduate certification. This program is the original program developed in 1971 by the American Veterinary Medical Association to ensure competency equivalent to graduates of American and Canadian veterinary schools. The American Association of Veterinary State Boards (AAVSB) created a similar certification program entitled PAVE, Program for the Assessment of Veterinary Education Equivalence in 2001. The AAVSB supervises the veterinary state boards of all states and is an organization Alaska actually utilizes in the veterinary licensing process. Forty-six United States states and territories, all Canadian provinces and territories, Australia and New Zealand recognize this newer program. The two programs, the educational commission for foreign veterinary graduates certification and PAVE are very similar in their requirements and require years to complete the many phases to prove competency. Furthermore, like any student from an American credited veterinary school, Canadians still have to pass the National American Veterinary Licensing Exam, which is mandatory for veterinary licensing throughout the United States. Most state veterinary legislations only specify the educational commission for veterinary graduate certification in their statutes and regulations initially, resulting in having to go through legislative updates to add PAVE. When making this change, states have adopted different strategies and wording. The Board of Veterinary Examiners are requesting the amendment to these statutes to include PAVE or another certification approved by the board to prevent the need to provide statutes again in the future. The wording requested mimics 23 other states. In conclusion, the outdated statute unnecessarily creates a barrier to Alaska increasing the ability of veterinarians to provide care to the public. To date, at least two veterinary internal medicine specialists are known who are licensed in other US states that did not apply for an Alaskan license because they graduated from a foreign veterinary college and have received certification from PAVE. That means it is unknown exactly how many veterinarians Alaska has missed out on licensing because state requirements are outdated by not including PAVE. 2:34:50 PM CHAIR BJORKMAN removed his objection. He found no further objection and the CS for SB 51, work order 33-LS0339\B, was adopted as the working document. CHAIR BJORKMAN said the committee would hear public testimony during the next hearing of the bill. He reminded the public that written testimony may be submitted to slac@akleg.gov. CHAIR BJORKMAN held SB 51 in committee.