Legislature(2015 - 2016)CAPITOL 106

01/26/2016 03:00 PM House HEALTH & SOCIAL SERVICES

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03:02:12 PM Start
03:02:26 PM SB23
04:59:30 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
Heard & Held
-- Public Testimony --
Scheduled but Not Heard
-- Testimony <Invitation Only> --
          SB 23-IMMUNITY FOR PROVIDING OPIOID OD DRUG                                                                       
3:02:26 PM                                                                                                                    
CHAIR SEATON announced  that the first order of  business would be                                                              
CS  FOR  SENATE BILL  NO.  23(JUD),  "An  Act relating  to  opioid                                                              
overdose  drugs and  to immunity  for  prescribing, providing,  or                                                              
administering opioid overdose drugs."                                                                                           
3:04:19 PM                                                                                                                    
SENATOR JOHNNY  ELLIS, Alaska State  Legislature, shared  that the                                                              
proposed bill represented  life or death.  He  explained that many                                                              
presidential nominees  from both parties had been  discussing this                                                              
issue  of  opioid   addiction.    He  reported   that  fatal  drug                                                              
overdoses had increased  by more than six times in  the past three                                                              
decades, and  now killed  more than  36,000 Americans  every year.                                                              
In Alaska,  heroin use  and fatal drug  overdose now  claimed more                                                              
lives  than traffic  fatalities.   The Alaska  State Troopers  had                                                              
identified the increase  in heroin abuse and the  continued use of                                                              
other opiates as  a significant concern.  This  abuse epidemic was                                                              
largely driven by  the addiction to prescription  opioids, and, as                                                              
these were  now more difficult  to obtain,  the use of  heroin was                                                              
increasing.   He  referenced an  article  he had  read many  years                                                              
ago,  forecasting  that the  biggest  drug  problems in  the  U.S.                                                              
would be  abuse of  prescription drugs,  with a subsequent  switch                                                              
to "black  tar heroin."   He pointed out  that there has  not been                                                              
much funding for  methadone clinics to attempt to  wean people off                                                              
3:08:15 PM                                                                                                                    
SENATOR ELLIS  stated that heroin  abuse had exploded in  the last                                                              
decade, "had  moved from the inner  city and people of  color, low                                                              
income  folks," and  was now in  the white,  affluent suburbs  and                                                              
rural  areas.   He lamented  that  it had  taken this  demographic                                                              
change for the problem  to get attention.  Between  2006 and 2013,                                                              
the  number  of  first time  heroin  users  nearly  doubled,  with                                                              
almost  80  percent   of  heroin  users  stating   that  they  had                                                              
previously abused  prescription opioids.  He reported  that heroin                                                              
and  other opioid  abuse had  reached epidemic  levels in  Alaska,                                                              
pointing  out  that  this  was not  an  urban  phenomenon.    Drug                                                              
seizures  and  overdoses  had  occurred  throughout  Alaska.    He                                                              
relayed  the  police  claim  that  thefts  and  prostitution  were                                                              
increasing because of  heroin use.  He reported that  data in 2011                                                              
from the  Centers for  Disease Control  and Prevention  Youth Risk                                                              
Behavior  Survey  showed  that 15.8  percent  of  Alaska  students                                                              
reported use of  prescription pills for pain  medication that they                                                              
stole from parents.   These pills were more popular  than alcohol,                                                              
tobacco,  or  marijuana.    He shared  that  opioid  overdose  was                                                              
typically  reversible through  the  timely  administration of  the                                                              
medication,  Naloxone,  and  the   provision  of  emergency  care.                                                              
However, Naloxone  is often not available when  needed as overdose                                                              
most  often  occurs  with  friends  or family.    He  shared  that                                                              
medical professionals  were wary of prescribing  Naloxone, without                                                              
any relief  from potential civil  liability, and lay  persons were                                                              
wary of  administering it.   He stated  that proposed SB  23 would                                                              
remove  the civil liability  from  a doctor who  prescribes  and a                                                              
lay person  who administers Naloxone  in those cases of  an opioid                                                              
overdose.   He noted that Alaska  would be the 43rd state  to pass                                                              
this bill.   He called  this a "life or  death step forward."   He                                                              
noted that the  proposed bill was supported by,  among others, the                                                              
Alaska  State Medical  Association, the  Alaska Police  Department                                                              
Employee's  Association,  the  Advisory Board  on  Alcoholism  and                                                              
Drug  Abuse,  the  Alaska  Mental Health  Board,  and  the  Alaska                                                              
Mental Health Trust  Authority.  He stated that there  was not any                                                              
known opposition.                                                                                                               
3:12:40 PM                                                                                                                    
SENATOR  ELLIS   suggested  two   amendments  for   consideration,                                                              
stating  that  the  first  amendment would  add  language  to  the                                                              
proposed  bill  that  any  pharmacist   who  dispenses  an  opioid                                                              
overdose  drug must  educate and  train  each person  to whom  the                                                              
overdose drug  was dispensed on how  to administer the  drug.  The                                                              
second proposed  amendment  would allow pharmacists  in Alaska  to                                                              
prescribe  an  opioid  overdose   drug  once  the  pharmacist  had                                                              
completed an opioid overdose drug training program.                                                                             
3:13:56 PM                                                                                                                    
SARAH   EVANS,  Staff,   Senator   Johnny   Ellis,  Alaska   State                                                              
Legislature,  shared   that  heroin  had  wreaked   havoc  on  her                                                              
hometown  of Dillingham.   She  reported that  many states  across                                                              
the country  had enacted laws  that increased access  to treatment                                                              
for  opioid overdose  as  a means  to combat  increasing  overdose                                                              
rates.   She declared that proposed  SB 23 provided  immunity from                                                              
civil  liability to  health care  providers who  prescribe and  to                                                              
by-standers  who   administer  opioid  overdose  drugs,   such  as                                                              
Naloxone,  in cases  of overdose.   She described  Naloxone  as an                                                              
opioid  antagonist,  which was  used  to  counter the  effects  of                                                              
opioid overdoses.   She declared that Naloxone  was extremely safe                                                              
and effective  at reversing  these overdoses.   She discussed  the                                                              
use of Naloxone  in treatment of opioid overdose,  stating that it                                                              
allowed  an overdose  victim to  breathe normally.   She  reported                                                              
that Naloxone  was not  a controlled substance,  and had  no abuse                                                              
potential.  It  would have zero effect if administered  to someone                                                              
with no  opiates in  their system.   Naloxone  was available  as a                                                              
nasal  spray or  as an  injectable  into a  muscle or  vein.   The                                                              
efficiency was  time dependent,  as death from overdose  typically                                                              
occurred from  one to three hours,  leaving this brief  window for                                                              
intervention.   Naloxone takes effect  immediately and  would last                                                              
between  30 to  90 minutes.   She  stated that  Naloxone had  been                                                              
used by  emergency medical  professionals for  more than  30 years                                                              
to reverse overdoses,  and was regularly carried  by medical first                                                              
responders.  She  noted that it could be administered  by ordinary                                                              
citizens with little  to no formal training.   She referenced data                                                              
from recent  pilot programs  which demonstrated  that lay  persons                                                              
were  consistently successful  at  safely administering  Naloxone.                                                              
She  pointed  out, however,  that  family  and friends  were  most                                                              
often the actual  first responders, and were in  the best position                                                              
to intervene  within an  hour of  the overdose.   She shared  that                                                              
New Mexico  had amended its  laws in 2001,  the first state  to do                                                              
so, to make it  easier for medical professionals  to prescribe and                                                              
dispense  Naloxone   without  liability  concerns,   and  for  lay                                                              
administers to  use it  without fear of  legal repercussions.   At                                                              
the  urging  of  many  organizations,   which  included  the  U.S.                                                              
Conference  of Mayors  and  the  American Medical  Association,  a                                                              
number  of  states  had addressed  the  issue  by  removing  legal                                                              
barriers  to   the  timely  administration   of  Naloxone.     She                                                              
explained  that  there had  been  two  approaches  to this:    the                                                              
first,  made   by  41  states   and  the  District   of  Columbia,                                                              
encouraged the wide  prescription and use of  Naloxone by removing                                                              
the possibility  of negative legal action against  prescribers and                                                              
administers  of  the  drug  to reverse  an  overdose;  the  second                                                              
encouraged  bystanders  to  become Good  Samaritans  by  summoning                                                              
emergency  responders   without  any  fear  of  arrest   or  other                                                              
negative  legal consequences.   She  relayed that  House Bill  369                                                              
had been  passed previously, similar  to legislation passed  in 33                                                              
other states.   She  reported that  currently 188 community  based                                                              
overdose  prevention programs  now distributed  Naloxone, and  had                                                              
provided training  in Naloxone  use to  more than 150,000  people,                                                              
resulting in  more than 26,000  overdose referrals.   She declared                                                              
that proposed  SB 23  was not  a replacement  for substance  abuse                                                              
treatment,  drug enforcement,  or  rehabilitation,  as these  were                                                              
also critical  components to fight  addiction.  The  proposed bill                                                              
allowed bystanders  and doctors the peace  of mind to not  be held                                                              
civilly liable for  doing the right thing, providing  a lifesaving                                                              
tool for an opioid overdose.                                                                                                    
3:19:13 PM                                                                                                                    
MS.  EVANS paraphrased  from  the Sectional  Analysis  for SB  23,                                                              
which read:                                                                                                                     
     Section  1. Amends  AS  09.65 by  adding  a new  section                                                                 
     (09.65.340)   to   give   immunity    for   prescribing,                                                                   
     providing, or administering an opioid overdose drug                                                                        
     Subsection  (a) exempts  a person  from civil  liability                                                                 
     if providing  or prescribing an opioid overdose  drug if                                                                   
     the  prescriber or provider  is a  health care  provider                                                                   
     or an  employee of  an opioid  overdose program and  the                                                                   
     person  has  been educated  and  trained in  the  proper                                                                   
         emergency use and administration of the opioid                                                                         
     overdose drug                                                                                                              
     Subsection (b) except as provided in (c) exempts a                                                                       
     person who administers an opioid overdose drug to                                                                          
     another person who the person reasonably believes is                                                                       
     experiencing an opioid overdose emergency if the                                                                           
     1. Was prescribed or provided the drug by a health                                                                         
     care provider or opioid overdose program and                                                                               
     2. Received education and training in the proper                                                                           
     emergency use and administration                                                                                           
3:20:50 PM                                                                                                                    
REPRESENTATIVE  WOOL,  in reference  to  the drug  being  provided                                                              
during  overdose,  asked  whether   immunity  was  granted  to  an                                                              
administering individual who was not trained.                                                                                   
MS.  EVANS  replied  that,  under the  current  iteration  of  the                                                              
proposed  bill, immunity  was not  included for  anyone not  given                                                              
the proper training,  but there had been a discussion  to re-write                                                              
the proposed bill to cover more administers.                                                                                    
CHAIR  SEATON directed  attention to  the proposed  bill, page  2,                                                              
line  12.   He  asked   to  broaden   the  health  care   provider                                                              
definition,  to  include  all  formats  to  be  used  in  clinical                                                              
settings.   He acknowledged  that this was  not quite the  same as                                                              
the question posed  by Representative Wool, and he  asked that the                                                              
discussion of  the proposed bill  include the use of  both epipens                                                              
and nasal sprays.                                                                                                               
3:24:06 PM                                                                                                                    
REPRESENTATIVE STUTES  asked that the proposed bill  be amended to                                                              
include anyone  who was present and  knew there was an  option for                                                              
MS.  EVANS acknowledged  that  a  change to  the  language of  the                                                              
proposed  bill  was  necessary,  and asked  to  include  that  the                                                              
training  was more  widely available.   She  stated that  Naloxone                                                              
was easy  to administer, and that  the training only  took between                                                              
3 to 15 minutes  to learn to administer and the  subsequent steps.                                                              
She  reported  that  the  top  three things  to  look  for  in  an                                                              
overdose  were   blue  lips  and   blue  fingernails,   no  verbal                                                              
recognition, and no response to a physical shake.                                                                               
3:26:00 PM                                                                                                                    
SENATOR ELLIS  noted that  the U.S.  Food and Drug  Administration                                                              
(FDA) had just  approved administration of Naloxone  through nasal                                                              
spray.  He  offered his belief  that the existing language  of the                                                              
proposed   bill   already   covered  the   different   means   for                                                              
administration of the drug.                                                                                                     
3:26:43 PM                                                                                                                    
REPRESENTATIVE VAZQUEZ  asked whether subsection (a)  also offered                                                              
regulatory liability.                                                                                                           
SENATOR  ELLIS  replied   that  he  was  not  familiar   with  the                                                              
difference  between civil  and regulatory  liability and  he asked                                                              
for legal advice.                                                                                                               
3:27:58 PM                                                                                                                    
REPRESENTATIVE TARR  asked whether a standard  follow-up procedure                                                              
to an  overdose included  a discussion  with  the family for  this                                                              
MS. EVANS replied  that some doctors did prescribe  this to family                                                              
members of addicts.                                                                                                             
SENATOR ELLIS clarified  that this was not a  standard or required                                                              
3:29:20 PM                                                                                                                    
REPRESENTATIVE   WOOL   asked   for   clarification   whether   an                                                              
administrator  was protected  for liability  if there  was not  an                                                              
opioid overdose  and Naloxone was  administered.  He asked  if the                                                              
drug could cause other problems.                                                                                                
MS.  EVANS replied  that Naloxone  was "extremely  safe," even  if                                                              
there were not any opiates in the body.                                                                                         
3:30:27 PM                                                                                                                    
MS. EVANS  moved on  and paraphrased  from Subsection  (c)  of the                                                              
proposed bill, which read:                                                                                                      
      Subsection (c) does not preclude liability for civil                                                                    
        damages that are a result of gross negligence or                                                                        
     reckless or intentional misconduct                                                                                         
MS.  EVANS stated  that the  remainder  of the  proposed bill  are                                                              
3:31:16 PM                                                                                                                    
REPRESENTATIVE  STUTES expressed  some confusion about  subsection                                                              
(c), as  Ms. Evans  had just  declared that  the drug  was totally                                                              
safe  and would  not  cause any  reaction,  regardless of  whether                                                              
there were any drugs in a person's system.                                                                                      
MS.  EVANS  offered  her  belief  that  subsection  (c)  had  been                                                              
included for  legal purposes.   She  reaffirmed that Naloxone  was                                                              
"a very safe drug."                                                                                                             
CHAIR SEATON  suggested that this  had been included to  cover the                                                              
possibility  that "somebody  is mad  at somebody  else and  sticks                                                              
them  in  the neck  with  an  epipen,"  an action  of  intentional                                                              
misconduct which would not be waived.                                                                                           
REPRESENTATIVE STUTES  responded that  this was difficult  for her                                                              
to perceive and she would like to hear a legal response.                                                                        
REPRESENTATIVE  VAZQUEZ directed  attention to  page 2, and  read:                                                              
"this section does  not preclude liability for  civil damages that                                                              
are  the result  of gross  negligence or  reckless or  intentional                                                              
3:34:10 PM                                                                                                                    
MEGAN   WALLACE,   Attorney,  Legislative   Legal   and   Research                                                              
Services,   Legislative  Affairs   Agency,   responded  that   the                                                              
exceptions  to  an  immunity  statute   for  gross  negligence  or                                                              
reckless  or  intentional  misconduct  allowed  for  civil  damage                                                              
suits  to  move  forward.   She  described,  during  an  act  when                                                              
someone  had  intentionally  hurt someone  else,  this  subsection                                                              
would allow the action for damages to move forward.                                                                             
REPRESENTATIVE  VAZQUEZ asked  whether the  proposed bill  allowed                                                              
pharmacists  to  dispense  Naloxone to  family  members,  friends,                                                              
care givers and personal physicians.                                                                                            
MS.  EVANS  explained  that  currently   a  pharmacist  could  not                                                              
prescribe the drug,  but could fill a prescription  from a doctor.                                                              
She stated that  an upcoming proposed amendment would  allow for a                                                              
pharmacist  to prescribe  the  drug.   She  referenced an  earlier                                                              
bill,  Senate  Bill 71,  that  changed  the procedure  allowing  a                                                              
pharmacist to administer vaccine.                                                                                               
REPRESENTATIVE VAZQUEZ  suggested that an amendment  was necessary                                                              
to allow for third party prescription.                                                                                          
3:38:04 PM                                                                                                                    
CHAIR  SEATON  directed  attention  to  page  3, line  1,  of  the                                                              
proposed  bill, and  offered his  belief that  should a  physician                                                              
"wish to put a  prescription out for a standing  order, the entire                                                              
family could be trained" by the pharmacist.                                                                                     
REPRESENTATIVE  WOOL  asked  whether  any  states  had  this  drug                                                              
available   without   prescription,   comparing  Maloxone   to   a                                                              
defibrillator which could be maintained at home.                                                                                
MS. EVANS  offered her  belief that all  states mandated  the need                                                              
for a prescription,  although this would change  with the upcoming                                                              
proposed amendment  which would allow pharmacists  to dispense the                                                              
drug without a prescription.                                                                                                    
SENATOR   ELLIS   reported   that   Italy  did   not   require   a                                                              
MS. EVANS added  that the drug has  been sold over the  counter in                                                              
Italy "since the 1980s with zero issues ever."                                                                                  
SENATOR ELLIS noted that all states require prescriptions.                                                                      
REPRESENTATIVE  VAZQUEZ pointed  out that in  one of the  articles                                                              
[included in  members' packets] the  drug was now  offered without                                                              
a  prescription  in selected  Rhode  Island pharmacies,  and  that                                                              
another  state  had  provided  Naloxone   to  all  of  its  police                                                              
MS.  EVANS  stated   that  it  is  common  for   police  officers,                                                              
emergency  medical   technicians,  and  fire  fighters   to  carry                                                              
Naloxone, even in Alaska.                                                                                                       
3:43:16 PM                                                                                                                    
BRADLEY GRIGG, Treatment  & Recovery Section Manager,  Division of                                                              
Behavioral Health,  Department of  Health and Social  Services, in                                                              
response  to  a  question  by  Representative   Vazquez  regarding                                                              
regulatory liability, he asked to defer to Dr. Butler.                                                                          
3:45:44 PM                                                                                                                    
MICHELE STUART  MORGAN, Juneau Stop  Heroin Start  Talking, shared                                                              
a story about  softball players in  Juneau who had died  of heroin                                                              
overdoses.    She  reported  that  the  Juneau  Police  Department                                                              
estimated that  200 - 400 people  were taking heroin every  day in                                                              
Juneau, and  offered an  analogy of  the proposed  bill to  a fire                                                              
extinguisher that could save another person.                                                                                    
REPRESENTATIVE TARR  asked about the origin of the  drugs, as well                                                              
as  any recognition  by  parents, in  order  to better  understand                                                              
this problem.                                                                                                                   
MS.  MORGAN discussed  the cost  and  the marketing  of heroin  in                                                              
Juneau.    She remarked  that  the  use  of  the drugs,  with  the                                                              
resulting addiction, often start as a result of sports injuries.                                                                
3:51:02 PM                                                                                                                    
PAULA  COLESCOTT, M.D.,  reported that  she is  a substance  abuse                                                              
physician and  has dealt  primarily in  addiction since  2007, and                                                              
the majority  of her practice is  with individuals who  are heroin                                                              
or  opioid dependent.    Within her  review  of the  data and  the                                                              
literature  regarding  Alaska, she  noted  that between  2008  and                                                              
2012 there  were 72 drug  overdoses, and  it does not  include the                                                              
23 overdoses  in 2013.   She said  her work  in a substance  abuse                                                              
center   where   they  do   partial   hospitalization,   intensive                                                              
outpatient  care,  and  outpatient  care  and  do  provide  either                                                              
Vivitrol,  which  is  an  injectable,  long  acting  agent  called                                                              
Naltrexone, as well  as supplying Suboxone.  She  shared instances                                                              
of overdoses  as related to her  by other addicts.  She  said that                                                              
many users  know about  the overdose  reversal drugs,  noting that                                                              
she currently  had two patients  on long term injectable  reversal                                                              
agents.   She expressed  concern for  the current overdose  deaths                                                              
as there  was now a  transition from  opium analgesics  to heroin,                                                              
and that  the purity of  heroin was now  erratic, hence  even more                                                              
deadly.    She  relayed  that  there   were  synthetic  drugs  now                                                              
available  that were  very  dangerous.   She  reported that  there                                                              
were  often cases  where she  gave  intravenous overdose  reversal                                                              
drugs for  restoring respiration  that were  double the  dosage of                                                              
the nasal  sprays.  She reported  that these reversal  drugs acted                                                              
immediately and  were lifesaving.   She mused  that she  could not                                                              
visualize  that  there would  be  any  legal implication,  as  any                                                              
physician  offering  appropriate  medication for  the  appropriate                                                              
reason  will not  be affected  by a  medical board  investigation.                                                              
She stated  that opiate  withdrawal does not  kill people,  it was                                                              
the  opiate  that  kills.   She  expressed  her  support  for  the                                                              
proposed bill.                                                                                                                  
3:59:58 PM                                                                                                                    
REPRESENTATIVE  WOOL asked  about  blocking  agents and  reversing                                                              
agents, and  whether Naloxone had  a wide application  of blockage                                                              
to opioids.                                                                                                                     
DR.   COLESCOTT  explained   the  treatment   procedures  for   an                                                              
overdose,  and answered that  it is  a reversal  agent for  any of                                                              
the opiates.                                                                                                                    
REPRESENTATIVE TARR asked about the increase in use.                                                                            
DR. COLESCOTT  said that the  increased use of prescription  drugs                                                              
has increased  this dependence on  opiates.  She reported  that 29                                                              
percent  of the  substance abuse  assessments at  her clinic  were                                                              
opiate  related, and  included many  patients using  a mixture  of                                                              
DR. COLESCOTT,  in response to  Representative Tarr, said  that an                                                              
extended use pattern was common, and she offered some examples.                                                                 
4:08:31 PM                                                                                                                    
SARAH  SPENCER, Medical  Doctor,  South Peninsula  Hospital,  said                                                              
she is board  certified in addiction medicine and  that she offers                                                              
treatments  to people  with  addictions.   She  reported that  she                                                              
distributes Naloxone  rescue kits to her patients,  starting about                                                              
six months  prior.   She stated  that these  rescue kits  are also                                                              
kept in  stock in the  emergency room,  although only one  in five                                                              
people  would seek  treatment for  their addiction.   She  pointed                                                              
out that  the EMS response  time could  be prolonged and  this was                                                              
the  time period  these  medicines  could be  most  helpful.   She                                                              
relayed there  were not many  medications that allowed  for "third                                                              
party  prescribing."     She   compared  these  prescriptions   to                                                              
sexually   transmitted  diseases,   for  which   she  would   give                                                              
prescriptions to  individuals to share  with their partners.   She                                                              
noted that  she was not able  to legally give the  Naloxone except                                                              
to the  individual.   She suggested  community education  seminars                                                              
as a means to  spread the programs for people to  learn how to use                                                              
the medication,  as  well as to  sometimes be  enabled to  receive                                                              
the  prescription.   She noted  that in  some states,  pharmacists                                                              
are allowed to  write the prescriptions.  She  lauded the proposed                                                              
bill as a way  to allow for these distributions.   She pointed out                                                              
that the  places with the highest  distribution of Naloxone  had a                                                              
reduction  in overdose  death rates  of 50 -  80 percent,  without                                                              
any  change  in  the  use of  opiates.    She  declared  that  the                                                              
medication  has  been  shown  to   be  incredibly  safe,  with  no                                                              
increase in risk  taking behavior.  She shared that  there has not                                                              
been  any deaths  among  those patients  that  had  refused to  be                                                              
taken  to the  hospital after  receiving Naloxone.   She  declared                                                              
there  was  almost  unanimous  support  for  increased  access  to                                                              
Naloxone by almost  every major medical association  in the United                                                              
DR.  SPENCER, in  response  to Chair  Seaton,  offered her  belief                                                              
that  the language  in the  proposed bill  would work  in all  the                                                              
situations  she had  described.   She  pointed out  that a  person                                                              
overdosing is  not able to give  themselves the medication,  so it                                                              
is  necessary for  someone  else to  be  involved; therefore,  the                                                              
medication should be available to anyone around a user.                                                                         
CHAIR  SEATON  asked to  ensure  that  the medical  community  was                                                              
secure with  making these  prescriptions.  He  stated that  it was                                                              
necessary  to ensure  a protocol  or a standing  order which  gave                                                              
the statutory  authority  and the  comfort level  to doctors.   He                                                              
wanted  to  know what  language  was  sufficient for  the  medical                                                              
DR. SPENCER offered  her belief that the language  of the proposed                                                              
bill  covered  the  needs.    She   suggested  that  an  amendment                                                              
allowing a pharmacist  to prescribe would be welcome,  would allow                                                              
the  pharmacist to  counsel its  use, and  would increase  access,                                                              
especially for those without insurance.                                                                                         
4:21:24 PM                                                                                                                    
REPRESENTATIVE  WOOL  asked  what   the  mechanism  would  be  for                                                              
distribution by a pharmacist.                                                                                                   
4:21:56 PM                                                                                                                    
REPRESENTATIVE  VAZQUEZ relayed  that the  literature indicates  a                                                              
blanket  prescription  is  available,   although  she  was  unsure                                                              
whether any statutory changes were necessary.                                                                                   
CHAIR  SEATON spoke  about  the  possibility of  a  protocol or  a                                                              
standing order.                                                                                                                 
4:22:40 PM                                                                                                                    
DANIEL NELSON,  Alaska Pharmacist Association, offered  support to                                                              
the  proposed  bill  by  the  Alaska  Pharmacist  Association  and                                                              
opined that pharmacists  everywhere would also support  this bill.                                                              
He shared  that this was a  national epidemic and  pharmacists are                                                              
doing  their  best  "to  become  part  of  the  solution  and  not                                                              
furthering  the problem."   He  reported that  although there  are                                                              
risks  associated  with  many  drugs  dispensed  from  pharmacies,                                                              
there is not any  risk with Naloxone.  He offered  his belief that                                                              
this is a great  service to the community and creates  a win - win                                                              
situation.     He   explained   that  a   standing   order  is   a                                                              
communication  between  a  licensed  medical  practitioner  and  a                                                              
health  care provider  that allowed  for the  prescription.   This                                                              
would be under  the supervising physician's license,  although the                                                              
supervising   physician  would   not   need  to   have  a   direct                                                              
interaction with the patient.                                                                                                   
CHAIR  SEATON  asked  to  clarify   that,  as  a  pharmacist,  the                                                              
language in  the proposed bill is  enough to make  him comfortable                                                              
to exercise the established protocol.                                                                                           
DR.  NELSON replied  that  the proposed  amendment  does make  the                                                              
standing order  no longer  necessary as a  requirement.   He spoke                                                              
in support of  the elimination of another  unnecessary, artificial                                                              
barrier that did nothing to protect patient safety.                                                                             
CHAIR  SEATON  asked what  sort  of  training, if  any,  regarding                                                              
administering Naloxone should be included in the proposed bill.                                                                 
DR. NELSON  offered his  belief that the  Board of Pharmacy  could                                                              
clarify any necessary  training, and it could be  satisfied with a                                                              
video  teleconference,  webinar,   or  something  similar  with  a                                                              
competency  test at  the conclusion.   He  opined that  it is  not                                                              
important for this to be done in-person.                                                                                        
CHAIR  SEATON  directed  attention  to  page  2,  line  3  of  the                                                              
proposed bill,  which read:  "educated  and trained in  the proper                                                              
emergency  use and administration  of the  opioid overdose  drug."                                                              
He  asked to  ensure that  pharmacists are  comfortable that  this                                                              
statutory language  gives them the authority to  use technology to                                                              
provide training to the person receiving the prescription.                                                                      
DR.  NELSON expressed  his  agreement  and reiterated  his  strong                                                              
support of the bill and the [upcoming] proposed amendment.                                                                      
4:30:35 PM                                                                                                                    
DR.  JAY  BUTLER,  Chief  Medical  Officer/Director,  Division  of                                                              
Public Health,  Central Office,  Department  of Health and  Social                                                              
Services,   reported  that,   in   2015,  54   Alaskans  died   of                                                              
prescription pain  reliever overdose, and  33 more died  of heroin                                                              
overdose.   He shared  that he  rarely used  the term  "epidemic,"                                                              
defined by  the Centers for  Disease Control and  Prevention (CDC)                                                              
as  "an increase,  often  sudden,  in the  number  of  cases of  a                                                              
disease  above what  is  expected."   He  expressed his  agreement                                                              
that the data  on the health effects  of opioid use in  Alaska now                                                              
reflected "an  epidemic of disability  and death caused  by heroin                                                              
and non-medical  use of prescription  opioid pain relievers."   To                                                              
address  this epidemic,  he  proposed  a three  pronged  strategy:                                                              
prevent, reduce,  and reverse.  He relayed that  opioid dependency                                                              
could  be  prevented  by  ensuring safe  and  appropriate  use  of                                                              
prescribed  opioids for  their important  role  in managing  acute                                                              
pain and providing  comfort care.  He stated that  the majority of                                                              
people using  heroin first began by  using opioids in the  form of                                                              
prescription  pain relievers.    He expressed  his agreement  that                                                              
there  are   economic  drivers   increasing  the  use   of  heroin                                                              
throughout Alaska  and the  rest of the  country.  He  stated that                                                              
dependency  could be  reduced  by recognizing  this  as a  medical                                                              
condition    requiring   medication    assisted   treatment    and                                                              
counseling.     He  declared  that  respiratory   depression,  the                                                              
mechanism of death  in opioid overdose, could be  reversed through                                                              
timely  administration of  Naloxone.   He  reported  that a  major                                                              
problem from opioid  use is tolerance, as a higher  dose is needed                                                              
over time;  therefore, the  margin of  safety becomes  narrower at                                                              
higher doses.   He stated that  Naloxone needs to  be administered                                                              
as  soon as  possible  after  an overdose  to  be  effective.   He                                                              
shared  that  a  number of  states  have  instituted  measures  to                                                              
increase access  to Naloxone so  that it could be  administered by                                                              
any  bystander,  as soon  as  the  overdose is  recognized,  while                                                              
waiting  for  the arrival  of  emergency  medical treatment.    He                                                              
declared  that  proposed  SB  23   seeks  to  remove  barriers  to                                                              
Naloxone use in  Alaska, while providing protection  against civil                                                              
liability.  He commented  that there are a number  of good on-line                                                              
public training materials for administering Naloxone.                                                                           
4:35:56 PM                                                                                                                    
CHAIR SEATON  asked for  clarification to  the possibility  of the                                                              
state medical  officer offering  a broad license  [to pharmacists]                                                              
throughout the state.                                                                                                           
DR. BUTLER  replied that  Rhode Island has  this system,  and that                                                              
he would follow up on this possibility.                                                                                         
CHAIR  SEATON  expressed  his  appreciation  for  the  support  in                                                              
finding something  safe, effective,  and available throughout  the                                                              
4:37:10 PM                                                                                                                    
GARY MILLER shared  an anecdote of the drug overdose  death of his                                                              
daughter,  and   declared  that  the  proposed  bill   offered  an                                                              
opportunity to save other lives.                                                                                                
4:38:55 PM                                                                                                                    
TRACY   WIESE,    Family   Nurse   Practitioner,    Alaska   Nurse                                                              
Practitioner   Association,   stated   that   the   Alaska   Nurse                                                              
Practitioner  Association  was   "absolutely  in  support  of  the                                                              
bill."   The  Association  encourages  that registered  nurses  be                                                              
specifically  included within the  bill language.   She  said that                                                              
as a  prescriber, the  proposed  bill would make  her feel  better                                                              
from a liability perspective.                                                                                                   
4:40:42 PM                                                                                                                    
LYNN HARTZ, Family  Nurse Practitioner, Alaska  Nurse Practitioner                                                              
Association, spoke  in support of  the proposed bill,  noting that                                                              
the  number  of deaths  from  opioid  pain reliever  overdose  had                                                              
surpassed  the number  of  deaths  from motor  vehicle  accidents.                                                              
She offered  her belief that  all of the  health care  programs in                                                              
this area would benefit from SB 23.                                                                                             
4:42:22 PM                                                                                                                    
KATIE BOTZ  shared an  anecdote of  the loss of  a friend  and co-                                                              
worker by overdose.   She offered her belief that  this would help                                                              
friends to help friends.                                                                                                        
4:45:15 PM                                                                                                                    
JANEY  HOVENDEN,  Director, Division  of  Corporations,  Business,                                                              
and Professional  Licensing, Department  of Commerce,  Community &                                                              
Economic Development, was available for questions.                                                                              
4:45:28 PM                                                                                                                    
SARA  CHAMBERS,  Operations  Manager,  Division  of  Corporations,                                                              
Business,  and  Professional Licensing,  Department  of  Commerce,                                                              
Community & Economic Development, was available for questions.                                                                  
CHAIR SEATON  noted that the  committee had been  discussing civil                                                              
liabilities and  regulatory liability, asked whether  they had any                                                              
answers   regarding  regulatory   liability,  how   it  would   be                                                              
affected,  or not  affected, by  this  bill, and  what that  would                                                              
MS. HOVENDEN  answered said  that she would  respond by  e-mail to                                                              
the questions for regulatory liability.                                                                                         
MS. CHAMBERS  replied they  would want to  consult with  the State                                                              
Medical Board,  the Board  of Pharmacy, and  the Board  of Nursing                                                              
to better provide a comprehensive response.                                                                                     
CHAIR SEATON agreed.   He said he wanted it on  the record that he                                                              
will  be looking  for  the email  and hard  copy  response to  put                                                              
before the committee for discussion.                                                                                            
REPRESENTATIVE VAZQUEZ  noted that the  current draft of  the bill                                                              
exempts  individuals  from  civil   liability,  but  it  does  not                                                              
address  the possibility  of  regulatory action  by  the Board  of                                                              
Pharmacy or the Board of Nursing, and so forth.                                                                                 
4:47:36 PM                                                                                                                    
CHRISTINA LOVE,  Advocate and Recovery  Coach, AWARE,  shared that                                                              
she  had  once  had an  unintentional  overdose,  noting  that  an                                                              
unintentional overdose  is the leading cause of  preventable death                                                              
in the  U.S.   She declared  that many  opioid users  do not  have                                                              
family or health  care, and that  there is not a 24  hour pharmacy                                                              
in Juneau.   She stated  that expanded  access to this  drug would                                                              
"send a  statement to  the public,"  "We are  worth it,  and every                                                              
life matters."   She declared that  "the only side effect  to this                                                              
drug is life."   She mused that many lives would  have been saved,                                                              
had the proposed bill been passed in the last year.                                                                             
4:49:37 PM                                                                                                                    
JANET  MCCABE,  Chair,  Partners  For Progress,  stated  that  her                                                              
organization is in  full support of proposed SB  23, and expressed                                                              
her support  for this  early session  hearing for  the bill.   She                                                              
declared that  untreated overdoses are  taking lives in  rural and                                                              
urban communities.   She  shared an update  regarding the  work by                                                              
her organization  with a family  nurse practitioner for use  of an                                                              
injectable  opioid antagonist  drug to  help cut  the craving  for                                                              
opioids, as well  as alcohol.  She offered her belief  that it was                                                              
best  for those  with a  record of  being serious  addicts to  use                                                              
this  drug  before  release  from  prison,  so  that  it  was  not                                                              
necessary to  detox.   She opined  that this could  save a  lot of                                                              
money as it would reduce the incidence of recidivism.                                                                           
CHAIR SEATON asked about the length of action for this drug.                                                                    
MS. MCCABE  replied  that it was  injected every  month, and  that                                                              
its cost was covered by Medicaid.                                                                                               
4:53:49 PM                                                                                                                    
CHAIR SEATON  closed public testimony  after ascertaining  that no                                                              
one further  wished to testify.   He advised  that SB 23  would be                                                              
held over.                                                                                                                      
CHAIR SEATON  declared that this  proposed bill is  an opportunity                                                              
to step up to  prevention, and keep people from dying.   He stated                                                              
that  there would  be an  additional  investigation into  changing                                                              
the  opioid  prescriptions  data  base to  require  the  immediate                                                              
posting  of   opioid  prescriptions,  instead  of   the  currently                                                              
required monthly posting.   He pointed out that there  is not even                                                              
a  requirement  to check  the  database  before prescribing.    He                                                              
suggested  that there  be  a "push  system"  and  a civil  penalty                                                              
administered  through the  occupational licensing  boards for  not                                                              
checking the  database prior  to prescriptions.   He allowed  that                                                              
over  prescription   of   opioids  was  a   problem  with   severe                                                              
4:58:09 PM                                                                                                                    
REPRESENTATIVE  WOOL reflected on  the approximately  80 overdoses                                                              
in  the past  year, noting  that  there were  almost 60  overdoses                                                              
from  prescription drugs.   He  declared  that prescription  drugs                                                              
are   still  part   of  the   equation,  and   opined  that   over                                                              
prescription  and lack  of training  all fit  together "as  far as                                                              
[SB 23 was held over.]                                                                                                          

Document Name Date/Time Subjects
SB 23 Version E.pdf HHSS 1/26/2016 3:00:00 PM
SB 23
SB 23 Sponsor Statement.pdf HHSS 1/26/2016 3:00:00 PM
SB 23
SB 23 Sectional Analysis.pdf HHSS 1/26/2016 3:00:00 PM
SB 23
SB 23 Explanation of Changes_A to E.pdf HHSS 1/26/2016 3:00:00 PM
SB 23
SB 23 Fiscal Note _2016_DCCED-CBPL_01-22-16.pdf HHSS 1/26/2016 3:00:00 PM
SB 23
SB 23 Fiscal Note_2016_DOC-HRS-01-22-16.pdf HHSS 1/26/2016 3:00:00 PM
SB 23
SB 23 Fiscal Note 2015 2-032515-CED-N.PDF HHSS 1/26/2016 3:00:00 PM
SB 23
SB 23 Backgound_Leg Legal Memo regarding DOC applicability.PDF HHSS 1/26/2016 3:00:00 PM
SB 23
SB 23 Background_Legal Interventions to Reduce Overdose Mortality.pdf HHSS 1/26/2016 3:00:00 PM
SB 23
SB 23 Background_Administer Naloxone.pdf HHSS 1/26/2016 3:00:00 PM
SB 23
SB 23 Background_Juneau's Heroin Heartbreak.pdf HHSS 1/26/2016 3:00:00 PM
SB 23
SB 23 Background_NCSL Drug Overdose.pdf HHSS 1/26/2016 3:00:00 PM
SB 23
SB 23 Background_States Expand Access to Overdose-Reversal Drug.pdf HHSS 1/26/2016 3:00:00 PM
SB 23
SB 23 Background_State Naloxone and Good Samaritan Legislation.pdf HHSS 1/26/2016 3:00:00 PM
SB 23
SB 23 Background_Five OD in Juneau over wkend.pdf HHSS 1/26/2016 3:00:00 PM
SB 23
SB 23 Suport_Narcotic Drug Treatment Center Letter of Support.pdf HHSS 1/26/2016 3:00:00 PM
SB 23
SB 23 Support_ ABADA AMHB Letter of Support.pdf HHSS 1/26/2016 3:00:00 PM
SB 23
SB 23 Support_ Alaska Mental Health Trust Letter of Support.pdf HHSS 1/26/2016 3:00:00 PM
SB 23
SB 23 Support_Alaska State Medical Association Letter of Support.pdf HHSS 1/26/2016 3:00:00 PM
SB 23
SB 23 Support_Assorted public emails.pdf HHSS 1/26/2016 3:00:00 PM
SB 23
SB 23 Support_APDEA Letter of Support.pdf HHSS 1/26/2016 3:00:00 PM
SB 23
SB 23 Support_Lisa Reynolds Letter of Support March 16 2015.pdf HHSS 1/26/2016 3:00:00 PM
SB 23
SB 23 Support_ Megan Ritter letter of support.pdf HHSS 1/26/2016 3:00:00 PM
SB 23
SB 23 Support_ANPA Letter of Support.pdf HHSS 1/26/2016 3:00:00 PM
SB 23
HB 237 Version A.pdf HHSS 1/26/2016 3:00:00 PM
HHSS 3/15/2016 3:00:00 PM
HB 237
HB 237 Sponsor Statement_01.25.2016.pdf HHSS 1/26/2016 3:00:00 PM
HHSS 3/15/2016 3:00:00 PM
HB 237
HB 237 Fiscal Note_DCCED-CBPL_01-22-16.pdf HHSS 1/26/2016 3:00:00 PM
HHSS 3/15/2016 3:00:00 PM
HB 237
HB 237 Fiscal Note_DPS_DSS_01-13-16.pdf HHSS 1/26/2016 3:00:00 PM
HHSS 3/15/2016 3:00:00 PM
HB 237
HB 237 Sectional Analysis.pdf HHSS 1/26/2016 3:00:00 PM
HHSS 3/15/2016 3:00:00 PM
HB 237
HB 237 Background_Compact FAQ_FSMB.pdf HHSS 1/26/2016 3:00:00 PM
HHSS 3/15/2016 3:00:00 PM
HB 237
HB 237 Background_Compact - state map and home page_FSMB.pdf HHSS 1/26/2016 3:00:00 PM
HHSS 3/15/2016 3:00:00 PM
HB 237
HB 237 Background_Medical Licensing timeframes_Research report_10.16.2015.pdf HHSS 1/26/2016 3:00:00 PM
HHSS 3/15/2016 3:00:00 PM
HB 237