Legislature(2017 - 2018)

2017-03-06 House Journal

Full Journal pdf

2017-03-06                     House Journal                      Page 0407
HB 159                                                                                                                        
HOUSE BILL NO. 159 by the House Rules Committee by request of                                                                   
the Governor, entitled:                                                                                                         
     "An Act relating to the prescription of opioids; establishing the                                                          
     Voluntary Nonopioid Directive Act; relating to the controlled                                                              
     substance prescription database; relating to the practice of                                                               
     dentistry; relating to the practice of medicine; relating to the                                                           
     practice of podiatry; relating to the practice of osteopathy; relating                                                     
     to the practice of nursing; relating to the practice of optometry;                                                         
     relating to the practice of veterinary medicine; related to the duties                                                     
     of the Board of Pharmacy; and providing for an effective date."                                                           
was read the first time and referred to the Health & Social Services                                                            
and Finance Committees.                                                                                                         
The following fiscal note(s) apply:                                                                                             

2017-03-06                     House Journal                      Page 0408
1. Zero, Dept. of Corrections                                                                                                   
2. Zero, Dept. of Health & Social Services                                                                                      
3. Fiscal, Dept. of Commerce, Community, & Economic                                                                             
The Governor's transmittal letter dated March 3 follows:                                                                        
"Dear Speaker Edgmon:                                                                                                           
Under the authority of Article III, Section 18, of the Alaska                                                                   
Constitution, I am transmitting a bill relating to monitoring of                                                                
prescriptions for opioids and relating to the controlled substance                                                              
prescription database.                                                                                                          
Alaska is in the grip of an opioid epidemic. All Alaskans, regardless of                                                        
race, age, religion, or lifestyle are affected. Families are torn apart,                                                        
persons suffering with addiction are frustrated and unable to reach                                                             
their potential, crime has increased, and most significantly, lives are                                                         
lost to this tragic epidemic. Too often the path to opioid addiction is                                                         
through prescription medication. As a society, we must take steps to                                                            
reduce unnecessary exposure to these addictive drugs. Fortunately, we                                                           
have the tools to do that. By increasing awareness, education, and                                                              
monitoring, we can take meaningful steps to address the tragedy of                                                              
First, the bill provides an option for patients to execute a Voluntary                                                          
Nonopioid Directive that would allow a person for any reason to make                                                            
clear the person's desire not to be administered an opioid. This                                                                
confidential information would be provided to the person's health care                                                          
provider or hospital. A person would be able to revoke a voluntary                                                              
nonopioid directive at any time, orally or in writing, and the bill would                                                       
provide for exceptions in the case of emergency treatment.                                                                      
Second, the bill would require health care licensing boards for dentists,                                                       
nurses, physicians, osteopaths, podiatrists, and optometrists to adopt                                                          
regulations for licensure, renewal, and certification by regulation to                                                          
require a licensee or potential licensee to demonstrate continuing                                                              
education in pain management and opioid use and addiction.                                                                      

2017-03-06                     House Journal                      Page 0409
Further, the bill would implement provisions to limit an initial                                                                
prescription for an opioid to not more than a seven-day supply to an                                                            
adult patient for outpatient use. For a prescription to a minor, a                                                              
practitioner would be required to discuss with the parent or guardian                                                           
why the prescription is needed and the risks associated with opioid                                                             
abuse. These provisions would apply to licensed dentists                                                                        
(AS 08.36.355), physicians (AS 08.64.363), and advanced practice                                                                
registered nurses (AS 08.72.170).                                                                                               
For veterinarians, the bill would require registration with the                                                                 
controlled substance prescription database and would require the                                                                
Board of Veterinary Examiners to identify resources and develop                                                                 
educational materials to help licensees identify animal owners who                                                              
may be at risk for abusing an opioid prescribed for a pet.                                                                      
For pharmacists, the bill would require registration with the controlled                                                        
substance prescription database regardless of whether the pharmacist                                                            
has a federal drug enforcement administration registration number.                                                              
Further, the bill would establish a statute to allow a person to request a                                                      
pharmacist to dispense less than the prescribed amount of a schedule II                                                         
or III controlled substance. Any remaining quantity in excess of the                                                            
quantity requested by the person would be void. A pharmacist would                                                              
be required to notify the prescribing practitioner of the dispensed                                                             
amount. In addition, the pharmacist would need to submit information                                                            
on the amount dispensed to the controlled substance prescription                                                                
Other sections of the bill would amend AS 17.30, the controlled                                                                 
substance prescription database. First, the bill would require that the                                                         
database be updated daily rather than the current weekly update                                                                 
requirements. This would provide even more accurate information for                                                             
health care practitioners when they review the database. Next, the bill                                                         
would amend AS 17.30.200(e) to allow as a basis for a board                                                                     
disciplinary action the failure of a pharmacist-in-charge, pharmacist,                                                          
or practitioner to review the database as required under AS 17.30.200.                                                          
In addition, with veterinarians registering with the database, the Board                                                        
of Veterinary Examiners would be notified when a practitioner                                                                   
registers with the database. Another important tool is to authorize the                                                         
Board of Pharmacy to make an unsolicited confidential notification to                                                           
a practitioner's licensing board in addition to the practitioner should                                                         

2017-03-06                     House Journal                      Page 0410
the practitioner's subscribing practices be outside the generally                                                               
recognized standards of practice. Last, the bill would authorize the                                                            
Board of Pharmacy to send practitioners information on how their                                                                
prescribing practices compare to other practitioners in the same                                                                
specialty. These nonpunitive "report cards" will provide valuable                                                               
confidential information to practitioners about how their prescribing                                                           
practices compare with others.                                                                                                  
Addressing the opioid epidemic will require a team effort among                                                                 
health care practitioners, patients, and caregivers across our state. We                                                        
must improve communication among health care professionals, ensure                                                              
that they have the training to recognize circumstances that may                                                                 
contribute to the risk of addiction, and address patient needs                                                                  
compassionately and safely. This bill is an important first step in                                                             
providing patients and professionals with tools to treat patients and                                                           
manage this devastating epidemic.                                                                                               
I urge your prompt and favorable action on this measure.                                                                        
Bill Walker