HB 56-CONTROLLED SUB. DATA: EXEMPT ANIMAL RX  2:09:14 PM CHAIR BJORKMAN reconvened the meeting and announced the consideration of HOUSE BILL NO. 56 "An Act exempting controlled substances prescribed or dispensed by a veterinarian to treat an animal from the requirements of the controlled substance prescription database." He noted that the companion bill, SB 51, was heard on March 24, 2023 and held in committee. 2:10:28 PM REPRESENTATIVE JUSTIN RUFFRIDGE, District 7, Alaska State Legislature, Juneau, Alaska, sponsor of HB 56, stated that he became aware of this bill while serving as chair of the Board of Pharmacy. The Veterinary Medical Association approached the Board of Pharmacy to look into issues underlying the Prescription Drug Monitoring Program (PDMP) and how that aligned with veterinary use of that program. He said medical providers, particularly those with the Alaska State Medical Association, are at least neutral to HB 56 for a couple reasons: 1. Veterinarians do not use opioids very much as a dispenser. They use opiates inside their clinics and sometimes during surgery, but are not high users of opiate medications. Drugs of abuse are not dispensed out of veterinary practices with any regularity. In fact, less than .34 percent of all opiates dispensed nationwide come through a veterinary practice. 2. The main reason for supporting HB 56 is the issue of privacy. The veterinarian is required to query the Prescription Drug Monitoring Program and look up the pet owners data if a controlled substance is to be used in the animal's care to determine if a veterinary prescription is appropriate. Veterinarians are not trained in human medication and do not spend any time learning about human medication. Human data is not relevant to making a decision about dispensing a prescription to a pet. Being required to access this database, gives veterinarians access to human information that they do not need. REPRESENTATIVE RUFFRIDGE opined that imposing the PDMP requirements on veterinarians was an oversight in the state's haste to solve some of the problems with the current opiate crisis. He said he and others who signed on as co-sponsors do not believe that HB 56 would worsen the opiate crisis. He reminded the committee that they heard the companion bill earlier in the session, and noted that two local veterinarians were available to deliver a brief presentation. 2:14:18 PM SENATOR GRAY-JACKSON asked whether there was any difference between HB 56 and the similar bill proposed last year. REPRESENTATIVE RUFFRIDGE answered that they are the same. 2:14:52 PM SENATOR DUNBAR asked whether this presentation was different from the one that the committee heard when they considered the companion bill. REPRESENTATIVE RUFFRIDGE answered that he didn't know because he was not part of the earlier presentation. SENATOR DUNBAR stated that he supported the bill before and supports it now, and didnt need to hear it again. 2:15:41 PM SENATOR MERRICK asked why the effective dates differ between the House and Senate versions of the bill. REPRESENTATIVE RUFFRIDGE answered there wasn't a reason. CHAIR BJORKMAN invited Dr. Berngartt and Dr. Ward to begin the presentation. 2:17:15 PM TRACY WARD, DMV, Past President, Alaska State Veterinary Medical Association, Juneau, Alaska, presented the slideshow to exempt veterinarians from the Prescription Drug Monitoring Program, in support of HB 56. She stated this is the same slideshow presented previously and if everyone is comfortable, they could skip the presentation and go straight to questions. CHAIR BJORKMAN said it would be helpful to hear the presentation, why the bill is important to veterinarians statewide, how this bill simplifies processes and makes veterinarian businesses run better, and how it protects the private medical information of people who happen to own pets and want them to be treated. DR. WARD began the presentation on slides 2 and 3. She read the following: HB 56: AN ACT EXEMPTING VETERINARIANS FROM THE REQUIREMENTS OF THE CONTROLLED SUBSTANCE PRESCRIPTION DATABASE. THE ALASKA STATE VETERINARY MEDICAL ASSOCIATION (AKVMA) SUPPORTS HB 56. THE ALASKA BOARD OF VETERINARY EXAMINERS (BOVE) SUPPORTS HB 56. THE ALASKA BOARD OF PHARMACY SUPPORTS EXEMPTING VETERINARIANS FROM PARTICIPATING IN THE PDMP 3 2.18.2022 Board of Pharmacy Meeting Voted and Passed Motion to Support DR. WARD advanced to slide 4 and paraphrased the following: Background: The PDMP.  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. WARD reviewed slide 5: Why it Makes Sense to Exempt:  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. 2:21:22 PM DR. WARD advanced to slide 6: Why it Makes Sense to Exempt:  Querying 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. DR. WARD reviewed slide 7: Why It Makes Sense to Exempt:  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. 2:23:37 PM RACHEL BERNGARTT, DVM, Chair, Board of Veterinary Examiners, Juneau, Alaska, continued the presentation to exempt veterinarians from the Prescription Drug Monitoring Program, in support of HB 56. She mentioned that one big step forward this year was that the Alaska State Medical Association does not oppose exempting veterinarians from the PDMP. DR. BERNGARTT paraphrased slide 8: 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.  2:24:40 PM DR. BERNGARTT reviewed slide 9: Why It Makes Sense to Exempt:  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. DR. BERNGARTT advanced to slide 10: Why It Makes Sense to Exempt:  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).  2:26:49 PM DR. BERNGARTT advanced to slide 11: Why It Makes Sense to Exempt: 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.  2:28:07 PM DR. BERNGARTT advanced to slide 12: AKVMA and BOVE ask for Support  of HB 56  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.  2:28:58 PM CHAIR BJORKMAN thanked the presenters and held HB 56 in committee.