Legislature(2015 - 2016)CAPITOL 120

02/08/2016 01:00 PM House JUDICIARY

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02:39:47 PM Start
02:40:14 PM SB23
04:16:28 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
-- Delayed to 20 min. Following Floor Session --
Heard & Held
-- Public & Invited Testimony --
<Bill Hearing Canceled>
-- Public & Invited Testimony --
+ Bills Previously Heard/Scheduled TELECONFERENCED
          SB 23-IMMUNITY FOR PROVIDING OPIOID OD DRUG                                                                       
2:40:14 PM                                                                                                                    
CHAIR LEDOUX  announced that the  only order of business  would be                                                              
(S)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."                                                                                           
CHAIR   LEDOUX  reminded   the   committee  that   the  House   of                                                              
Representatives   decided   that   committees   would   not   take                                                              
legislation unless  it directly impacts the budget in  the form of                                                              
revenue  or budget  bills.   She  opined  that SB  23  is the  one                                                              
exception  to that  decision because  this bill  is important  and                                                              
with every day of delay a life may be lost.                                                                                     
[Audience applause]                                                                                                             
2:42:03 PM                                                                                                                    
SENATOR  JOHNNY  ELLIS,  Alaska State  Legislature,  advised  that                                                              
Representative Lynn  Gattis is a  cross-sponsor on SB 23,  and she                                                              
would  like to testify  under public  testimony.   He offered  his                                                              
appreciation to  those working behind the scenes,  including Chair                                                              
LeDoux who  made certain this  bill would  be heard today,  and he                                                              
extended  that her  actions  transcend politics  as  usual or  any                                                              
type of partisanship in this building.                                                                                          
CHAIR LEDOUX  interjected  that this bill  transcends politics  or                                                              
anything else that goes on in this building.                                                                                    
2:43:06 PM                                                                                                                    
SENATOR ELLIS described  this bill as literally  involving life or                                                              
death.   He stated that  he knew there  was a breakthrough  in the                                                              
subject  of  opioid addiction  and  medically  assisted  treatment                                                              
when he heard  presidential candidates on both sides  of the aisle                                                              
discussing  this issue  in presidential  forums and  debates.   As                                                              
with Alaska,  New Hampshire  has an epidemic  of opioid  abuse and                                                              
overdose.   He acknowledged that  the Anchorage Police  Department                                                              
advised that  in Alaska, heroin  use is  back in force  and heroin                                                              
related  overdoses  are claiming  more  young lives  than  traffic                                                              
fatalities.  He  noted that Dr. Jay Butler, Chief  Medical Officer                                                              
and  Director, Division  of Public  Health,  Alaska Department  of                                                              
Health and  Social Services (DHSS)  testified in the  House Health                                                              
and Social Services  Standing Committee that in  2015, 54 Alaskans                                                              
died of  opioid pain  killer overdoses,  another 34 Alaskans  died                                                              
of heroin  overdoses, and 8  of those deaths  were in Juneau.   He                                                              
expressed that  the support from  Juneau of friends and  family of                                                              
heroin  addicts, opioid  addicts,  and overdosed  deaths has  been                                                              
overwhelming  and  much  appreciated.    The  abuse  and  overdose                                                              
epidemic is largely  driven by addiction to  prescription opioids,                                                              
such as  OxyContin and  Vicodin, which  has become more  expensive                                                              
and harder to come  by in recent years.  Therefore,  he explained,                                                              
leading  addicts to  turn to the  much more  wildly available  and                                                              
less expensive  opiate of  heroin.  He  conveyed that  people tend                                                              
to think  that heroin abuse  is a problem  plaguing the  poor, but                                                              
this epidemic  hits the  affluent particularly  hard all  over the                                                              
state.    For  approximately  12  years he  has  tried  to  gather                                                              
support  for  treatment  in methadone  clinics  in  Fairbanks  and                                                              
Anchorage,   and   suboxone   through    private   physicians   in                                                              
communities  without  methadone clinics,  he  remarked.   He  said                                                              
that he read an  opinion piece 25 years ago in  the New York Times                                                            
indicating that  the future number  one drug problem would  be the                                                              
abuse of  prescription drugs.   He acknowledged that  doctors have                                                              
since apologized  and have discussed the "loose  prescriptions" of                                                              
opioids  leading  to  people  switching  to  "black  tar  heroin,"                                                              
smuggled  into  Alaska  by  the   Mexican  drug  cartel  addicting                                                              
Alaskans all across the state.                                                                                                  
2:46:30 PM                                                                                                                    
SENATOR ELLIS  reiterated that heroin  and other opioid  abuse has                                                              
reached  epidemic  levels  in Alaska,  as  with  the rest  of  the                                                              
nation.   Everyone  knows, he  said, that  these highly  addictive                                                              
drugs are  extremely deadly and  are killing Alaskans  at alarming                                                              
rates.     Luckily,  he  noted,   opioid  overdose   is  typically                                                              
reversible  through the  timely administration  of the  medication                                                              
naloxone, and  provision of  emergency care,  yet it is  often not                                                              
available  where and  when it  is needed.   He  advised that  this                                                              
bill  seeks  to make  this  life-saving,  safe miracle  drug  more                                                              
widely available  because  overdose often  occurs when the  victim                                                              
is with  friends or  family members  who may  be best situated  to                                                              
act to save his  or her life by administering  naloxone or Narcan.                                                              
He advised that  the bill came to  him with the idea  to join most                                                              
other  states   due  to  medical   professionals  being   wary  of                                                              
prescribing  and  lay  person's   worry  of  administering  opioid                                                              
overdose  drugs  due  to  potential civil  liability.    The  bill                                                              
removes civil  liability from a  doctor who prescribes, and  a lay                                                              
person who administers,  naloxone in cases of  opioid overdose, he                                                              
explained.   He pointed  out that  contained within the  committee                                                              
packets  are numerous  letters of  support from  around the  state                                                              
with no known opposition to the bill.                                                                                           
2:48:22 PM                                                                                                                    
SARAH   EVANS,  Staff,   Senator   Johnny   Ellis,  Alaska   State                                                              
Legislature,  explained  that the  bill discusses  naloxone,  also                                                              
known  as  Narcan,   which  is  a  medication   called  an  opioid                                                              
antagonist and  is used to counter  the effect of  opioid overdose                                                              
from  drugs  such   as,  OxyContin,  morphine  or   heroin.    She                                                              
described  naloxone as extremely  safe and  effective at  reducing                                                              
opioid overdose  to counteract the life threatening  depression of                                                              
the  central nervous  system by  allowing the  overdose victim  to                                                              
breathe normally.   She explained that  in the event a  person has                                                              
too many  opioids in their  system, the  opioids cover all  of the                                                              
brain  receptors,  thereby causing  a  person to  physically  stop                                                              
breathing.  At  that point, she further explained,  their lips and                                                              
nails turn blue  with many signs of distress in not  being able to                                                              
breathe.   She related that once  naloxone is administered  into a                                                              
person, the naloxone  clears off the receptors  causing the person                                                              
to no longer feel  the effects of the drug, and  they are revived.                                                              
She said  that naloxone is not  a controlled substance,  it has no                                                              
abuse potential,  and with zero effect if administered  to someone                                                              
without opiates  in their system.   She said naloxone is  liken to                                                              
an EpiPen,  except it is safer because  it will do nothing  to the                                                              
person  if there  are no  opiates in  their system.   The  sponsor                                                              
would like  naloxone in the hands  of family members,  friends, or                                                              
addicts  themselves because  typically an  overdose occurs  within                                                              
one to  three hours,  although earlier  in some  cases, leaving  a                                                              
brief  window of  opportunity for  intervention.   Naloxone  takes                                                              
effect immediately  and can  last between 30  and 90  minutes, she                                                              
2:50:50 PM                                                                                                                    
MS. EVANS turned  to Section 1, of the bill and  said it basically                                                              
allows a  pharmacist to dispense  naloxone to any person  in front                                                              
of  the pharmacist  requesting it  because a  prescription is  not                                                              
necessary for  naloxone or  Narcan.  She  referred to  [Section 1,                                                              
AS 08.80.030(b)(13), page 2, lines 24-26], which read:                                                                          
                    (13)   establish    standards   for   the                                                               
     independent  dispensing  by a  pharmacist  of an  opioid                                                               
     drug  under AS  17.20.085, including  the completion  of                                                               
     an opioid training program approved by the board.                                                                      
MS. EVANS  explained that  the language  reads that education  and                                                              
training  must  be  administered  to the  person  being  dispensed                                                              
2:52:03 PM                                                                                                                    
CHAIR LEDOUX  inquired as  to whether there  are any  other opioid                                                              
overdose drugs other than naloxone.                                                                                             
MS.  EVANS replied  not  currently,  not in  the  manner the  bill                                                              
defines an  opioid overdose  drug, it is  strictly naloxone.   She                                                              
noted that naloxone can be administered in three different ways.                                                                
2:52:30 PM                                                                                                                    
REPRESENTATIVE LYNN  asked whether this  is an expensive  drug and                                                              
whether it is covered by a typical insurance program.                                                                           
MS. EVANS  answered  that the sponsor  left it  up to  pharmacists                                                              
and  doctors to  supply naloxone  in  one of  the three  different                                                              
ways.    Certain insurance  companies,  including  Medicaid,  only                                                              
cover  a certain  way to  administer naloxone,  and the  different                                                              
ways are  more or less  expensive.  She  explained the  three ways                                                              
as  follows:  a  nasal  injector  involving  two  doses,  and  CVS                                                              
recently advised it would require approximately $50; the auto-                                                                  
injector,  similar to  the EpiPen  can  be more  expensive; and  a                                                              
muscle  injection by  using  a syringe  and  inserting  it into  a                                                              
meaty part of the arm or thigh.                                                                                                 
MS. EVANS,  in response to  Representative Lynn's  comment, agreed                                                              
that it is similar to insulin.                                                                                                  
MS.  EVANS  reiterated   that  the  bill  leaves  it   up  to  the                                                              
pharmacist or doctor  to dispense naloxone to a  person based upon                                                              
their  insurance and  the training  necessary for  that manner  of                                                              
administering naloxone.                                                                                                         
2:54:12 PM                                                                                                                    
REPRESENTATIVE  CLAMAN surmised  that the  language means  that if                                                              
medical  technology advances  and  produce another  drug with  the                                                              
same benefit,  the  legislature would  not have  to come back  for                                                              
the pharmacist to be able to administer the new drug.                                                                           
MS. EVANS  replied that  it is the  sponsor's hope,  although, the                                                              
sponsor does  not foresee any  new medications coming  out because                                                              
doctors have  said that this is  such a safe drug.   Although, she                                                              
noted,  the sponsor  is hoping for  FDA approved  easier ways  for                                                              
the public to administer naloxone.                                                                                              
CHAIR LEDOUX  offered that  at some point  there may be  a generic                                                              
form of the drug.                                                                                                               
2:55:02 PM                                                                                                                    
MS. EVANS  referred to Sec. 2,  [AS 08.80.168(b)(1), page  2, line                                                              
29], which read:                                                                                                                
               (1) "opioid overdose drug" has the                                                                           
     meaning given in AS 17.20.085;                                                                                         
MS.  EVANS  explained   that  the  provision  defines   an  opioid                                                              
overdose  drug in  the correct  sections.   She  then referred  to                                                              
page 4, lines 24-25, [AS 09.65.340(d)(3)], which read:                                                                          
            (3) "opioid overdose drug" means a drug                                                                             
     that reverses in whole or in part the pharmacological                                                                      
     effects of an opioid overdose;                                                                                             
2:55:32 PM                                                                                                                    
MS. EVANS referred  to Sec. 3, [AS 08.80.168(c), page  3, lines 2-                                                              
5], which read:                                                                                                                 
          (c) A pharmacist may independently dispense an                                                                        
     opioid  overdose drug  if the  pharmacist has  completed                                                                   
     an  opioid overdose  drug training  program approved  by                                                                   
     the  board and  otherwise  complies with  the  standards                                                                   
     established by the board under AS 08.80.030(b).                                                                            
MS. EVANS explained that it refers to the Board of Pharmacy.                                                                    
2:55:51 PM                                                                                                                    
MS. EVANS  referred to  Sec. 4, [AS  08.80.480(27), page  3, lines                                                              
12-13], which read:                                                                                                             
                    (27) ... ; the independent dispensing                                                                   
     of opioid overdose drugs;                                                                                              
MS. EVANS  said the  provision was amended  under the  practice of                                                              
2:56:12 PM                                                                                                                    
MS. EVANS  referred to  Sec. 5,  [AS 09.65]  and advised  that the                                                              
added section offers  civil immunity to health  care professionals                                                              
to  prescribe,  provide,  and  administer  opioid  overdose  drugs                                                              
except as  provided in  [AS 09.65.340](c)  of this section,  which                                                              
               (c) This section does not preclude liability                                                                     
     for  civil   damages  that  are  the  result   of  gross                                                                   
     negligence or reckless or intentional misconduct.                                                                          
MS.  EVANS described  (c) as  typical language  with a  medication                                                              
wherein if a person  does not believe a person  is experiencing an                                                              
overdose  and administers  the  drug, they  would  not be  covered                                                              
under civil liability.                                                                                                          
2:57:28 PM                                                                                                                    
CHAIR LEDOUX pointed  to Ms. Evans' previous testimony  that there                                                              
is  zero effect  if naloxone  is administered  to someone  without                                                              
opiates  in   their  system.     In  that  regard,   Chair  LeDoux                                                              
understood the drug to be perfectly harmless.                                                                                   
MS.  EVANS agreed,  and  offered  that the  drafter  of the  bill,                                                              
Megan   Wallace,   Legislative   Legal  and   Research   Services,                                                              
previously  answered the  same  question and  advised  that it  is                                                              
typical  language   to  include  in  a  bill  where   there  is  a                                                              
medication given by lay persons.                                                                                                
2:57:54 PM5,                                                                                                                  
MS.  EVANS   explained  that  the   bill  includes   an  education                                                              
component within  Sec. 5, [AS 09.65.340(a)(2)], page  3, lines 29-                                                              
31, and page 4, lines 1-3, which read:                                                                                          
                    (2) each person to whom the opioid                                                                          
     overdose  drug  is  prescribed   or  provided  has  been                                                                   
     educated  and trained  in the proper  emergency use  and                                                                   
     administration  of  the  opioid  overdose  drug  by  the                                                                   
     health  care provider  of the  opioid overdose  program;                                                                   
     education  and  training  under this  paragraph  may  be                                                                   
     provided  by  any reasonable  means,  including  through                                                                   
     the  use of  electronic, video,  or automated  education                                                                   
     or training resources.                                                                                                     
MS. EVANS  explained that when  a person administers,  prescribes,                                                              
or provides  an opioid overdose drug  they can only do  so if they                                                              
also  provide training  and  education on  how  to administer  the                                                              
drug.  The  language electronic, video, or automated  education or                                                              
training resources  was added because this has passed  in 41 other                                                              
states and  the District of Columbia,  she said, and  these states                                                              
have   prepared  "really   great"  educational   programs.     She                                                              
explained that  the bill  allows people to  use these  other means                                                              
showing how to safely administer the drug, and to call 911.                                                                     
2:59:52 PM                                                                                                                    
CHAIR  LEDOUX surmised  that  under this  bill,  a doctor  doesn't                                                              
actually have to prescribe naloxone.                                                                                            
MS. EVANS replied  no, they do not.  Under the  language regarding                                                              
prescribing  and providing  through health  care professionals,  a                                                              
pharmacist  could directly  dispense  the drug,  she  said.   Many                                                              
times, she  offered, doctors  deal directly  with clients  who are                                                              
addicts,  or family  members of  addicts, and  they can  prescribe                                                              
and  provide the  training of  any  opioid overdose  drug at  that                                                              
3:00:41 PM                                                                                                                    
REPRESENTATIVE  GRUENBERG  pointed  to AS  08.80.050  relating  to                                                              
Board of Pharmacy,  and paraphrased that, "the  board shall comply                                                              
with the Administrative  Procedures Act (APA) in  its activities."                                                              
He asked  whether, when setting  these standards to  establish the                                                              
training  program, it  will require  adoption of  a regulation  in                                                              
accord with the APA.                                                                                                            
MS.  EVANS answered  "That's my  understanding," and  a person  in                                                              
the room from  the Alaska Pharmacy Association could  speak to the                                                              
difficulty of adopting  a regulation.  She opined that  it is very                                                              
easy for  the board to "make  up" these regulations and  rules and                                                              
the training program.                                                                                                           
REPRESENTATIVE  GRUENBERG said  he would  ask that  person at  the                                                              
appropriate  time   whether  they   must  go  through   a  certain                                                              
procedure.     He  asked   whether  there   was  an   accompanying                                                              
concurrent resolution for the title change.                                                                                     
CHAIR  LEDOUX  advised  that  her   staff  has  provided  HCR  22,                                                              
changing the title.                                                                                                             
MS.  EVANS  responded  that  the  title  change  came  into  place                                                              
because  the sponsor  asked the  Board  of Pharmacy  to make  some                                                              
REPRESENTATIVE  GRUENBERG  noted that  sections  1-4  of the  bill                                                              
were  added in  the  House  of Representatives  necessitating  the                                                              
title change.   He asked  whether other  changes were made  in the                                                              
House of Representatives.                                                                                                       
MS.  EVANS replied  yes,  other than  allowing  the pharmacist  to                                                              
dispense and having  the training component, under  the definition                                                              
of health care  provider the sponsor added "nurse"  as someone who                                                              
could provide training and dispense naloxone.                                                                                   
3:03:32 PM                                                                                                                    
REPRESENTATIVE GRUENBERG  opined that  Ms. Evans was  referring to                                                              
the language  at least on page  5, lines 14-16, and  asked whether                                                              
it was defined in any other section in the bill.                                                                                
MS. EVANS,  in response  to Representative  Gruenberg, pointed  to                                                              
[AS  09.65.340(d)(1)], page  4, lines  19-21, [page  5, lines  14-                                                              
16], which read:                                                                                                                
                    (1) "health care provider" means a                                                                          
     licensed   physician,   advanced   nurse   practitioner,                                                                   
     physician  assistant,  nurse,  village health  aide,  or                                                                   
     pharmacist  operating  within the  scope  of the  health                                                                   
     care provider's authority;                                                                                                 
MS. EVANS  then referred  to [Sec. 5,  AS 09.65. 340(a)(2)],  page                                                              
4, lines 1-3, which read:                                                                                                       
                    (2) ... overdose program; education and                                                                     
     training  under this  paragraph may  be provided by  any                                                                   
     reasonable   means,  including   through   the  use   of                                                                   
     electronic,  video or  automated  education or  training                                                                   
MS.  EVANS explained  that the  House Health  and Social  Services                                                              
Standing Committee  wanted more  language as  to how the  training                                                              
component could be performed, and those were the only new parts.                                                                
3:04:57 PM                                                                                                                    
REPRESENTATIVE KELLER  asked whether, in previous  hearings, there                                                              
had  been  a  discussion  regarding   the  definition  of  "opioid                                                              
overdose  drugs,"   because  there  are  also   "opioid  addiction                                                              
drugs."  He offered  concern that there could  be confusion there,                                                              
and there  would be a liability  release because of the  fact that                                                              
it takes gross negligence,  or whatever.  He asked  that Ms. Evans                                                              
be   very   clear   during   further   testimonies   as   to   the                                                              
pharmacological  effects of  the opioid overdose,  and to  clarify                                                              
that definition.                                                                                                                
MS. EVANS  responded that Dr. Paula  Colescott will speak  to that                                                              
issue  as  her Anchorage  practice  involves  addiction  medicine.                                                              
She  opined  that  Dr. Colescott  will  testify  that  the  opioid                                                              
overdose drug, as defined, narrows it to naloxone.                                                                              
REPRESENTATIVE   KELLER  commented   that   the  House   Judiciary                                                              
Standing Committee  must have the  language as tight  as possible,                                                              
thereby not creating a problem while trying to fix a problem.                                                                   
3:06:55 PM                                                                                                                    
REPRESENTATIVE  GRUENBERG asked  Representative Keller  whether he                                                              
was  referring to  the standard  of  tort immunity  ... the  gross                                                              
negligence standard.                                                                                                            
REPRESENTATIVE  KELLER responded  no, in that  his concern  has to                                                              
do  with how  that would  apply to  the definitions  used in  this                                                              
bill.   He opined that  the definition in  this bill means  a drug                                                              
that reverses  in whole or in  part the pharmacological  effect of                                                              
an  opioid overdose.   He  explained, "If  I read  this the  first                                                              
time and  I thought methadone, frankly,  you know, ...  is there a                                                              
danger  of somebody  else out  there  that is  authorized to  give                                                              
naloxone ...  if they could have  that confusion."  He  asked that                                                              
the definition be "nailed down".                                                                                                
CHAIR LEDOUX opened invited testimony.                                                                                          
3:08:47 PM                                                                                                                    
PAULA COLESCOTT,  M.D., First Care  Medical Center, said she  is a                                                              
practicing   addiction   specialist,    and   offered   excitement                                                              
regarding  SB  23  as  it  can  begin  to  save  lives  of  opiate                                                              
dependent people.   She explained  that many of her  clients start                                                              
with prescription  opiates  and when  they are  no longer  able to                                                              
secure  those, transition  over to  heroin or  another opiate  off                                                              
the street.   Any of these  opiates, the synthetics, can  cause an                                                              
increase  in tolerance  wherein  a person  finds themselves  using                                                              
more and more  to get the same  effect they desire.   However, she                                                              
noted, as the  person increases doses, very often  the respiratory                                                              
does not keep pace  with that tolerance and the  person can easily                                                              
overdose.  She opined  that she doesn't have a client  who has not                                                              
witnessed an  overdose in front  of them,  which is common  in the                                                              
community  commonly  using  injectables,  or  even  oral  opiates.                                                              
Often, in  response to witnessing  an overdose, the person  is put                                                              
into  a tub  of cold  water  to resuscitate  or  they are  dragged                                                              
outside  in  the cold,  and  it  often  is  not successful.    She                                                              
expressed that this  community could benefit from  [naloxone], and                                                              
being taught  about it.  In  her office, she explained,  there are                                                              
folks  that are  put on  replacement opiate  therapy to  stabilize                                                              
the  brain  while taking  them  through  the recovery  process  of                                                              
rebuilding  their lives.   Suboxone,  Buprenorphine, or  methadone                                                              
are lifesaving  agents if people  have access through  Medicaid or                                                              
private  insurance,  she described.    However, not  everyone  has                                                              
that  type  of  access  and  they will  then  defer  to  a  needle                                                              
exchange program  where they'll  inject heroin  but they  will not                                                              
contract  HIV, or Hepatitis  C and,  she noted,  that the  program                                                              
has proven  to be beneficial.   These  agents, naloxone,  which is                                                              
what will  be in either  the nasal  or auto-injectable  forms, act                                                              
within minutes  and can last up  to 30-60 minutes.   She described                                                              
it  as a very  rapid  acting agent,  at an  acceptable dose,  that                                                              
would  hopefully restore  the ability  of that  person to  breathe                                                              
until  emergency help  arrives.   She explained  that usually  two                                                              
doses  are in  the nasal  or injectable  kit, and  the GoodRx  app                                                              
offers  approximate over-the-counter  retail  prices, as  follows:                                                              
the  nasal product  is  $136;  and Evzio  (naloxone  hydrochloride                                                              
injection) similar  to an  EpiPen is $757,  which would  vary with                                                              
Medicaid or insurance.                                                                                                          
3:13:57 PM                                                                                                                    
DR. COLESCOTT, in  response to a previous question,  answered that                                                              
the agents that  immediately reverse opiate  intoxication, failure                                                              
to  breathe, or  an  individual turning  blue,  not breathing  not                                                              
responsive,  are agents  that have  been used  over four years  in                                                              
the emergency  room (ER)  setting.   Narcan is routinely  injected                                                              
in the ER,  and this is an agent  that you don't need  to give IV,                                                              
but  "you can  actually  have the  person  ...  injected into  the                                                              
nasal passage"  and it  will be absorbed  and, she reiterated,  it                                                              
begins  to  have  an  onset  within a  few  minutes  that  can  be                                                              
lifesaving for  these people.   Obviously, she said,  the response                                                              
could be a  bit more rapid if  you inject Evzio, but  more pricey.                                                              
She  remarked  that  she  is unaware  of  any  other  good  opiate                                                              
reversal agents used  routinely in the ER.  Again,  the importance                                                              
of this bill is that these are situations in which emergent ...                                                                 
3:15:17 PM                                                                                                                    
[Technical difficulties]                                                                                                        
3:15:39 PM                                                                                                                    
DR.  COLESCOTT  explained  that  both  the  nasal  and  injectable                                                              
application  would   have  an  immediate  effect   that  could  be                                                              
lifesaving.    In  the  event  a  person  is  not  breathing,  the                                                              
[immediate   goal]  is   to   restore  respirations   to   prevent                                                              
undesirable  neurologic  outcomes   within  10-15  minutes.    She                                                              
emphasized that  in order to avoid  anoxic brain injury  or injury                                                              
to the  brain due to lack  of oxygen it  has to be onsite,  has to                                                              
be immediately available to people at risk for overdosing.                                                                      
3:16:43 PM                                                                                                                    
CHAIR  LEDOUX asked  whose insurance  company a  family member  or                                                              
friend would submit  the naloxone insurance claim,  and noted that                                                              
they  would  not  necessarily  have   a  prescription.    Usually,                                                              
without a prescription  the insurance companies won't  pay for it.                                                              
She stressed  that her question  is not a  reason to not  pass the                                                              
bill, but  the discussion has  been around significant  amounts of                                                              
money.  She asked  whether there is a way the  insurance companies                                                              
will pay for it.                                                                                                                
DR.  COLESCOTT responded  that  within  her circumstances  in  the                                                              
methadone  clinic, it  would  be dispensed  to  "probably all  the                                                              
people  on  methadone"  through the  medical  director's  standing                                                              
order.  The clients  she sees for Buprenorphine,  for instance, or                                                              
anyone  that failed  to  progress through  the  program and  stops                                                              
Buprenorphine,  would be  given  a prescription  because they  put                                                              
themselves at  risk of  resuming heroin and  overdosing.   In that                                                              
setting, she  would personally  write the  prescription or  in the                                                              
clinics,  dealing with  large numbers  of people,  it would  be by                                                              
standing order from the medical director, she explained.                                                                        
3:18:24 PM                                                                                                                    
CHAIR  LEDOUX  put  forth  Representative  Keller's  concern  that                                                              
there  not  be confusion  between  methadone  and naloxone.    She                                                              
opined that methadone is not a narcotic reversal medication.                                                                    
DR. COLESCOTT agreed,  and explained that methadone  is an opioid,                                                              
a  synthetic  opioid,  first synthesized  in  Germany,  and  after                                                              
World War II  the United States received the  rights to methadone.                                                              
Two  biochemists in  New  York then  theorized  that  in giving  a                                                              
heroin addict  the correct dose of  an opiate lasting all  day, it                                                              
would somehow  stabilize the brain,  stop cravings,  they wouldn't                                                              
inject,  and they  would feel  normal.   She  explained that  from                                                              
that  research  the  federal  government   stepped  in  and  began                                                              
developing federally  run methadone  clinics for opioid  dependent                                                              
people.   These drugs would never  be given [under this  bill] and                                                              
are only  prescribed by a physician  or practitioner with  the DEA                                                              
schedule   permit.     She   further  explained   that   methadone                                                              
stimulates  receptors as an  opiate, is  very long acting,  treats                                                              
pain, and can  be used to stabilize  the brain in people  that are                                                              
shooting up  heroin 4-6  times a  day.  If  there is something  on                                                              
the  receptor   that  has   caused  over   stimulation,   such  as                                                              
methadone, oxycodone,  hydrocodone, or  morphine, and  that person                                                              
is  not  breathing,  naloxone  will   knock  the  opiate  off  the                                                              
receptor and restore breathing immediately.                                                                                     
3:21:02 PM                                                                                                                    
REPRESENTATIVE  CLAMAN  opined   that  before  naloxone  could  be                                                              
dispensed, the  state would have  a particular drug  identified by                                                              
the Board of Pharmacy.   He said, to the extent  there was another                                                              
drug meeting  the definition, people  would still need to  rely on                                                              
the  regulations   being  issued  by   Board  of  Pharmacy.     He                                                              
continued,  "Rather  than  saying,  'Oh  look, this  is  what  the                                                              
statute  says ...  the  statute' ...  you still  are  left in  the                                                              
DR.  COLESCOTT  replied "Yes,  that  is  my understanding."    She                                                              
replied to Chair  LeDoux that she did not have  further testimony,                                                              
and  that  [the  bill]  would be  something  that  could  be  very                                                              
helpful to people that are trapped in this process.                                                                             
3:22:12 PM                                                                                                                    
REPRESENTATIVE  GRUENBERG pointed  out  that the  language at  the                                                              
beginning  of the  bill deals  with pharmacists  and the  training                                                              
program for  them; however,  pharmacists are  not the  only health                                                              
care professionals  who can prescribe these drugs.   He pointed to                                                              
the  health care  providers listed  on  page 4,  lines 19-21,  and                                                              
also page  5, lines  14-16, [text  provided previously]  and noted                                                              
that  pharmacists  are  only  one profession  and  they  are  well                                                              
covered at the beginning  of the bill.  He further  noted that the                                                              
other  professions  do not  appear  to  be similarly  covered  and                                                              
asked whether  the bill should  contain similar language  covering                                                              
the  other  professionals  so  they  do not  get  in  trouble  and                                                              
REPRESENTATIVE  GRUENBERG  further asked  whether  the sponsor  is                                                              
careful  and  sure  these  other people  will  not  be  criminally                                                              
liable, and should the bill give civil liability.                                                                               
3:24:12 PM                                                                                                                    
CHAIR LEDOUX  pointed out  that those are  questions for  the bill                                                              
sponsor or Legislative Legal and Research Services.                                                                             
DR. COLESCOTT commented  that Representative Gruenberg  is correct                                                              
and  that maybe  it  could be  broadly  worded  to include  health                                                              
providers/pharmacists.    In  response  to  the  notion  of  civil                                                              
liability, she said,  she recently attended the  annual conference                                                              
of the  American Society  of Addiction  Medicine (ASAM)  and there                                                              
was  great  discussion  regarding  this issue.    The  overarching                                                              
opinion  was  that for  physicians  to  ...  or when  a  physician                                                              
prescribes  something   in  the   ordinary  practice  that   is  a                                                              
legitimate  reason for  dispensing a  drug there  is no  increased                                                              
civil  liability  at  all.   She  stressed  that  for  prescribing                                                              
something  lifesaving  there  would  not be  any  increased  civil                                                              
liability, but  there's been enough  concern that in  this setting                                                              
people have  wanted to be  exempt from this.   She opined  that it                                                              
should obviously be included in this.                                                                                           
3:25:57 PM                                                                                                                    
REPRESENTATIVE GRUENBERG  stated he would like a  "real expert" to                                                              
determine whether  there are other types of health  care providers                                                              
not  listed  in  the  bill, such  as  a  dentist,  naturopath,  or                                                              
whoever, and further stated that he wants to be certain that                                                                    
anyone who legitimately does this should be covered.                                                                            
[CHAIR LEDOUX closed invited testimony and opened public                                                                        
testimony to allow Representative Lynn Gattis to testify.]                                                                      
3:26:54 PM                                                                                                                    
REPRESENTATIVE    LYNN   GATTIS,    Alaska   State    Legislature,                                                              
paraphrased written testimony as follows: [original punctuation                                                                 
     For  the record  my  name is  Lynn  Gattis, I  represent                                                                   
     district 7,  the greater Wasilla  area. I want  to thank                                                                   
     Senator Ellis  for his tremendous work on  this bill and                                                                   
     for reaching across the aisle to work with me on it.                                                                       
     I  strongly  support SB23  for  the simple  reason  that                                                                   
     it's literally a life-saver.                                                                                               
     -    Across  Alaska,  and certainly  the  Matsu,  heroin                                                                   
     abuse   is   having   a   deadly   impact   on   Alaskan                                                                   
     -    Too many  people are getting  caught in  a terrible                                                                   
     addiction, and too many people are dying.                                                                                  
     -    There is  one last line of protection  we can offer                                                                   
     addicts, families, and friends - Narcan.                                                                                   
     -    SB23 gives  addicts and loved ones  the opportunity                                                                   
     to have  lifesaving  medication with  them if the  worst                                                                   
     does occur.                                                                                                                
     -    We  need to  stop treating  addiction as  something                                                                   
     we  hide under  the  rug.  Let me  be  clear  - I  don't                                                                   
     condone any  drug use or  substance abuse. I  also don't                                                                   
     think we  can stand by and  do nothing while  people are                                                                   
     -    What  Senate  Bill  23  does is  give  mothers  and                                                                   
     grandparents,  even  addicts  themselves,  a  chance  to                                                                   
     save their loved ones.                                                                                                     
     -    This bill  would allow pharmacies to  offer Narcan,                                                                   
     and  a mom or  grandma to  go and  purchase it over  the                                                                   
     counter - just like you would Sudafed today.                                                                               
     -    To finish  my comments Madam  Chair, to me  this is                                                                   
     a life-saving  bill. We  have a  medicine that can  save                                                                   
     lives  and  has  no  adverse  impacts,  no  high  to  be                                                                   
     -    Even  if we save  just one life  - this bill  would                                                                   
     do its job. So let's allow Alaska that opportunity.                                                                        
     Thank you  for your time  Madam Chair and I'm  available                                                                   
     for any questions.                                                                                                         
3:30:14 PM                                                                                                                    
TERRIA WALTERS, offered testimony, as follows:                                                                                  
     My name  is Terria Walters, and  I am a person  in long-                                                                   
     term  recovery from  heroin and  meth, and  I am also  a                                                                   
     recovery advocate  and started a program ...  a ministry                                                                   
     called  (indisc.) Ministries  where I  help addicts  and                                                                   
     inmates  transition   back  into  the   community  after                                                                   
     I  wanted to  share a  little  bit about  how I  support                                                                   
     this  bill ...  or  why I  support this  bill.   Um  ...                                                                   
     while I was  in my addiction I watched many  many people                                                                   
     that  I  cared about  ...  um,  overdose.   And  as  Dr.                                                                   
     Colescott  stated that most  ... the  solution a  lot of                                                                   
     the  time   was  to  take   that  individual   that  was                                                                   
     overdosing  and put  them in  a cold bath  ... um,  with                                                                   
     ice  in it to  ... to  get them revived,  lips would  be                                                                   
     turning  blue.    And  of course  all  of  us  that  was                                                                   
     watching this  happen would  be freaking out  because we                                                                   
     didn't know  what to do ...  um, other than ...  um, put                                                                   
     down ...  immerse them  into ... um,  a bathtub  ... um,                                                                   
     with ice  and cold water.  Um  ... I um ... I  have also                                                                   
     OD'd, but thanks  to the grace of God I ...  um, did not                                                                   
     die.   Um ...  and a ...  eventually I  came out  of ...                                                                   
     um, the overdoses.   And my addiction started  with pain                                                                   
     pills.    Um  ... and  then  a  ...  overprescribing  of                                                                   
     methadone  by  my pain  management  doctor where  I  was                                                                   
     taking  ...  um,  a ...  seven  10  milligram  methadone                                                                   
     pills  a  ...   three  times  a  day  ...   a  with  210                                                                   
     milligrams   of    methadone   for   pain    management.                                                                   
     Eventually  I ended  up getting  off of  that that.   Um                                                                   
     ...  once I  got clean  and sober  ... um,  in 2000  ...                                                                   
     April  2,  2005   is  my  clean  date  and   I  will  be                                                                   
     celebrating  11 years clean  and sober  on April  2nd of                                                                   
     this year.                                                                                                                 
CHAIR LEDOUX congratulated Ms. Walters.                                                                                         
3:32:07 PM                                                                                                                    
MS. WALTERS continued her testimony, as follows:                                                                                
     Um  ...thank you  so much.    Um ...  I ...  um want  to                                                                   
     share that I  also ... the reason why I support  this is                                                                   
     because  I  have had  loss  of  my  friends and  an  ex-                                                                   
     boyfriend that  overdosed four years  ago and died.   Um                                                                   
     ... I  think that this a  ... this um ...  medication is                                                                   
     essential to ...  um, the ... you know ...  a ... people                                                                   
     eventually  getting their  ...  you know  ... not  ODing                                                                   
     and then ... a ... being unable to be pulled out it.                                                                       
     Um ...  I don't know  ... if some of  you know who  I am                                                                   
     and some  of you don't.  Um  ... but I am also  a mother                                                                   
     of an addict  that was murdered on June  22, 2015, it'll                                                                   
     be seven  months here pretty  soon where I ...  or eight                                                                   
     months  here pretty  soon where  I've had  to deal  with                                                                   
     ... um, the  murder of my son by somebody  that was also                                                                   
     a  heroin  addict that  went  to  great lengths  to  ...                                                                   
     support his drug addiction.                                                                                                
     Um ...  while we have lack  of a ... treatment  services                                                                   
     in this  state, including  medical detox  ... um,  a lot                                                                   
     of individuals  continue  to use drugs  because ...  um,                                                                   
     and some  of them  really don't want  to because  I know                                                                   
     I've been  there and I deal  them ... a ... a  ... daily                                                                   
     on  the  ...  um,  through  private  message  and  phone                                                                   
     calls.    Parents   of  addicts  trying  to   get  their                                                                   
     children  help but  unfortunately they  continue to  use                                                                   
     ...  they're turned  away from  hospitals.   Ultimately,                                                                   
     ... um,  if they get  a strong batch  and ... do  a dose                                                                   
     that ...  the same  amount that  they get from  somebody                                                                   
     else ... sometimes  that ... that heroin would  be a lot                                                                   
     stronger   than  the   batch  that   they  did   before.                                                                   
     Ultimately,  possibly,   leading  to  ...  um,   a  drug                                                                   
     Um  ... sorry,  I'm trying  ... this ...  um, this  bill                                                                   
     ... um, is  essential to ... to be passed  to stop this.                                                                   
     While  we push for  recovery services  that include  ...                                                                   
     um,  eventual abstinence  from  all  substances ...  all                                                                   
     substances including  suboxone and methadone,  which are                                                                   
     both  narcotics.   I'm  not  a  fan of  the  maintenance                                                                   
     program but I'll  only ... tapering.  I'm more  of a fan                                                                   
     of medical  detox coupled  with an Evzio  shot.   Um ...                                                                   
     as  a  person  of long-term  recovery,  I  support  this                                                                   
     bill.   Um ... I'm not sure  if you guys are  well aware                                                                   
     of the  Evzio shots,  but it  is also  a blocker and  it                                                                   
     does  not ...  um, it's  not a  narcotic like  methadone                                                                   
     and suboxone.                                                                                                              
     Um  ... basically  because  of  my own  experiences  and                                                                   
     what I  deal with on  a daily basis,  and then  the loss                                                                   
     of  my  own child,  and  friends  that have  lost  their                                                                   
     children to overdoses,  I think that this is  ... um, as                                                                   
     a  person  that  lives this  lifestyle  ...  lives  this                                                                   
     lifestyle  and  also deals  with  it in  the  community.                                                                   
     This medication  would save lives  and ... um,  not hurt                                                                   
     their  family  members where  they  are having  to  bury                                                                   
     their children, or their husbands, or their wives.                                                                         
CHAIR LEDOUX thanked Ms. Walters and related that her testimony                                                                 
is quite compelling.                                                                                                            
3:35:33 PM                                                                                                                    
CHAIR LEDOUX closed public testimony and opened invited                                                                         
3:35:44 PM                                                                                                                    
KARA NELSON, Director, Haven House Juneau, offered testimony, as                                                                
the follows:                                                                                                                    
     My name  is Kara Nelson and  I am the director  of Haven                                                                   
     House  Juneau.   Well, thank  you very much.   This  ...                                                                   
     it's  an honor  to be  here.   I've followed  SB 23  for                                                                   
     quite some  time, and  have come a  long ways since  our                                                                   
     early  testimonies, I  think.   Um  ... and  as you  can                                                                   
     see, thank  you for  allowing Terria to  go ...  she had                                                                   
     to  go to  work, but  she is  such a  powerful voice  in                                                                   
     this ...  um, cause of  recovery and long-term  recovery                                                                   
     as well as every life matters.                                                                                             
     So,  I've testified  prior about  my own  story ...  um,                                                                   
     overdosing three  times myself.  Today I am  a person of                                                                   
     long-term recovery  and what that  means for me  is that                                                                   
     I have not  taken a drink or a drug since  June 1, 2011.                                                                   
     Ironically,  that's also  the  day I  was released  from                                                                   
     Lemon  Creek Correctional Center.   And  so it's  my ...                                                                   
     by  the grace  of God,  after  20 plus  years of  active                                                                   
     addiction,  and  several  overdoses,  I  am  here  today                                                                   
     serving my community.                                                                                                      
     Um  ...  you know,  this  has  been  a long  process  of                                                                   
     watching our  legislative ... kind of this  new era that                                                                   
     is  coming towards  us  with  criminal justice  and  the                                                                   
     recovery  movement coming  together.   And that's how  I                                                                   
     see it because  most of the people I work  with, as well                                                                   
     as  myself ...  you know  we were  incarcerated for  our                                                                   
     substance  abuse  and mental  health  disorders  without                                                                   
     the  proper  supports  around  that.   Every  life  does                                                                   
3:37:17 PM                                                                                                                    
MS. NELSON continued her testimony, as follows:                                                                                 
     On 12/10/15, we  had our very first relapse  in our home                                                                   
     as well  as overdose.   When I got  the call about  2:00                                                                   
     a.m.,  I was in  Anchorage with  several women who  were                                                                   
     striving  to be  the best  that  they could  ever be  in                                                                   
     their life.   They were very confident, who  were moving                                                                   
     forward  and this  is  a disease.    And without  having                                                                   
     those  supports there,  this woman  overdosed, was  gone                                                                   
     literally  about one-half  hour,  overdosed, her  friend                                                                   
     had  the sense  to call  the  police.   They came,  they                                                                   
     revived  her by  Narcan, and  then of course  had to  do                                                                   
     that  several  times afterwards.    What we  know  about                                                                   
     (indisc.) on Narcan  is ... I wish I would  have brought                                                                   
     with me,  but Evzio ... um,  shot.  I actually  have one                                                                   
     at my  house -it's a very  simple ... I've  seen several                                                                   
     people utilize  the nasal spray  as well as  the EpiPen.                                                                   
     It's just  a little  box, stick it  on your thigh,  five                                                                   
     seconds,  administer  the drug.   Um  ...  I've been  to                                                                   
     several different  ... I mean,  since then I've  been to                                                                   
     several  different  ...  um,   national  ...  you  know,                                                                   
     rallies and  different things, really  highlighting that                                                                   
     right  now  we're  still  treating   it,  because  we're                                                                   
     having  these different  conversations about  ... and  I                                                                   
     know this  isn't necessary  on this bill.   But,  in the                                                                   
     different  conversations  surrounding  this  bill,  what                                                                   
     I've  seen is  ... you  know,  kind of  like people  are                                                                   
     still treating  it as  a moral issue  and not a  medical                                                                   
     issue.  And  so, to come in here and hear  the different                                                                   
     dialogue  from last  year is very  rewarding, it's  very                                                                   
     hopeful, and very  ... um, I just want to  say thank you                                                                   
     to  every person  that  has  been involved.    Obviously                                                                   
     Johnny  Ellis  is one  of  our  personal heroes  in  the                                                                   
     recovery community  because we know that this  works and                                                                   
     our  lives do  matter.   If I  hadn't come  back out  of                                                                   
     those overdoses,  if this woman  hadn't been  revived by                                                                   
     Narcan,  she  wouldn't  have   been  with  her  daughter                                                                   
     yesterday,  as  she  was still  striving  for  long-term                                                                   
     recovery.   You know,  this is not  a choice that  we're                                                                   
     making.   We want  to continue ...  people want  to have                                                                   
     help and sometimes  those helps are not available.   So,                                                                   
     I am  in support of  SB 23, I'm  in support of  naloxone                                                                   
     and Narcan.   I  also know, and  my colleague said  this                                                                   
     last  time, I'm  going to say  it again,  the only  side                                                                   
     effects of Narcan is life.  And it's that simple.                                                                          
CHAIR LEDOUX related that Ms. Nelson's testimony was compelling.                                                                
3:39:57 PM                                                                                                                    
REPRESENTATIVE  GRUENBERG  asked Ms.  Nelson  to  explain how  the                                                              
medication is simple to administer.                                                                                             
MS. NELSON  explained that  one way to  administer Narcan  is with                                                              
an EpiPen,  which is in  a little box,  the bottom is  pulled off,                                                              
place it  on the thigh, click  it, count 5-4-3-2-1,  administered.                                                              
At  that point,  she said,  some of  the education  would be  that                                                              
people  will then  go  back into  an overdose  after  a period  of                                                              
time,  again 5-4-3-2-1,  although by  then the  hope is that  they                                                              
would be at a medical facility.                                                                                                 
REPRESENTATIVE   CLAMAN  noted  he   had  to  leave   for  another                                                              
appointment  and expressed  that  he strongly  supports this  bill                                                              
and would sign "do pass."                                                                                                       
3:41:27 PM                                                                                                                    
MICHELE  MORGAN, said  she is  representing herself  and said  she                                                              
runs  the Juneau  Sports  Association  where  people out  of  high                                                              
school and  play softball  with "us  older people," and  families.                                                              
She expressed that  last year four of their softball  players died                                                              
and no one talked  about why they died.  Their  parents would have                                                              
loved to testify  but they are too  broken and cannot  speak.  Ms.                                                              
Morgan offered testimony, as follows:                                                                                           
     When our first  softball player died, his  name is Ryan.                                                                   
     He  was 24  years  old, he  was with  a  party of  about                                                                   
     seven  people, they'd  just played  in the  championship                                                                   
     game of softball  and they were partying afterwards.   A                                                                   
     friend  that  was  there  called  Ryan's  dad  and  said                                                                   
     "Ryan's  not  doing well,"  and  the dad  asked,  "Well,                                                                   
     what  are you  guys doing?"   He said,  "Oh, we're  just                                                                   
     drinking  a  few  beers,  you  know  we  played  in  the                                                                   
     championship game.   The dad assumed ...  he said, "Just                                                                   
     watch  him  if he's  drank  too  much  call me,  I'm  in                                                                   
     Sitka, if he  gets worse we'll have someone  come over."                                                                   
     So they  called again,  and Ryan's  dad sent his  sister                                                                   
     over, and Ryan had overdosed, he was dead.                                                                                 
3:43:02 PM                                                                                                                    
MS. MORGAN  emphasized that  there were seven  people in  the room                                                              
and they  reached  out to get  help but  they were  using so  they                                                              
were high, and they  were afraid and didn't know what  to do.  She                                                              
stressed that if  naloxone had been in the hands  of our community                                                              
last year,  Ryan would be here,  and his mom and  sisters wouldn't                                                              
be broken.   She said her  main purpose in starting  Juneau's Stop                                                              
Heroin  Start Talking  purpose  was to  get  people talking  about                                                              
this  and to  save our  children.   She said  she appreciates  the                                                              
support the  program has received,  and she thanked  Senator Ellis                                                              
and  the bill's  co-sponsors  for  putting this  out  there.   She                                                              
referred  to   the  question  of   pricing,  and  said   that  the                                                              
Washington  Health  and  Social Services  purchases  Narcan  nasal                                                              
spray in bulk  and the cost is  $14 for two doses, which  it hands                                                              
out.   She said the  Juneau Police  Department (JPD)  advised that                                                              
200-400 people  in Juneau are  using heroin  every day, a  town of                                                              
36,000 people  runs out to  be 1 in  80 people doing  heroin every                                                              
3:44:15 PM                                                                                                                    
MS.  MORGAN  stated  that it  is  about  $9  a hit  of  heroin  in                                                              
Seattle, and  $100 in Juneau.   She remarked  that a  person doing                                                              
four  hits of  heroin  a day  in Juneau  will  burn through  their                                                              
family,  friends,  everyone,  and   could  become  a  criminal  to                                                              
support  their  habit.    People  from  all  over  the  state  are                                                              
reaching  out to  just talk  about  this issue,  and she  stressed                                                              
that if  "we can  get this  out there  for one  kid, I think  Ryan                                                              
would have been alive right now."                                                                                               
3:45:29 PM                                                                                                                    
CHAIR   LEDOUX  closed   invited  testimony   and  opened   public                                                              
3:46:07 PM                                                                                                                    
GARY MILLER, offered testimony, as follows:                                                                                     
     My  name is  Gary Miller,  I  live here  in Juneau,  I'm                                                                   
     here  representing myself.   On  May 17th  last year  my                                                                   
     daughter died  of a drug overdose with heroin.   We have                                                                   
     her ashes  interred out  at the  Shrine of St.  Therese.                                                                   
     I visit her  at night so I can cry in private.   I bring                                                                   
     her  a red rose  that was  her favorite  flower.   And I                                                                   
     tell her  how much I love her  and how much I  miss her.                                                                   
     This  bill will save  other parents  from going  through                                                                   
     the  grief that my  wife and  I live  with.  It'll  also                                                                   
     give  other  addicts  another opportunity  to  live,  so                                                                   
     please pass this bill.  Thanks.                                                                                            
CHAIR LEDOUX thanked Mr. Miller and offered him her condolences.                                                                
3:47:15 PM                                                                                                                    
KATHERINE BOTZ,  said that she  is representing herself,  that she                                                              
is 28-years old,  and that she sees her generation  suffering from                                                              
heroin overdoses  and dying from it.   She said she lost  a friend                                                              
last  September due  to a  heroin overdose,  and that  he was  not                                                              
only  a  friend, he  was  a  co-worker,  and almost  like  another                                                              
brother of  hers.   His family knew  me, my  family knew  him, and                                                              
they would  hang out quite a bit.   She then paraphrased  a letter                                                              
his mother wanted to share, as follows:                                                                                         
     After  Verner's  (indisc.)  death, one  of  his  friends                                                                   
     told me he  broke a rule - do not do alone,  always have                                                                   
     others  with you.   We  think  that he  may have  abused                                                                   
     with another person  and the reaction was to  put him in                                                                   
     his truck  and drive  him to Fred  Meyers and leave  him                                                                   
     there.   We will never  know.  I  think that my  comment                                                                   
     would  be,  to  give  these  users  a  fighting  chance.                                                                   
MS.  BOTZ  said that  as  a  28-year  old person,  she  is  seeing                                                              
friends  die, her  classmates  die, co-workers  die,  and of  this                                                              
generation, she does not want to be the last one standing.                                                                      
MS. BOTZ then said  that JPD has confiscated almost  $4 million of                                                              
drug money,  and Kodiak  confiscated approximately  $3 million  of                                                              
drug money.   She  said that  families and  friends are  wondering                                                              
where that money  is going, and how to help people  who are using,                                                              
help drug addicts, and facilities and health clinics as well.                                                                   
3:51:15 PM                                                                                                                    
TERRA BURNS,  Community United for  Safety and Protection  (CUSP),                                                              
said  she   represents  the  Community   United  for   Safety  and                                                              
Protection (CUSP).   She stated she is a lifelong  Alaskan and has                                                              
always had people  in her community that she cared  about and have                                                              
been narcotics  users.   Ms. Burns advised  that she  has received                                                              
harm reduction  training and  is trained  to administer  Narcan in                                                              
Canada, Oregon,  California, and New  York.  Within many  of those                                                              
states  Narcan is  freely given  out  by people  involved in  harm                                                              
reduction education  and, she said,  that commonly it  is included                                                              
in  shooting kits  if needed.    She stressed  that Alaska  should                                                              
have Narcan  available as it  saves lives as  she used it  once to                                                              
reverse  an  overdose.    She  noted she  has  also  been  in  the                                                              
position  of  attempting  to  resuscitate   when  Narcan  was  not                                                              
available.  Public  comments have been to not allow  Narcan due to                                                              
how  hard it  is on  the person  administering the  drug but,  she                                                              
emphasized, it  is much harder not  to have it.  As  an individual                                                              
and representative  of CUSP, she  strongly supports this  bill and                                                              
having this  lifesaving measure available  to Alaskans would  be a                                                              
new public treasure, she said.                                                                                                  
3:53:07 PM                                                                                                                    
MS. BURNS,  in response to  Representative Gruenberg,  advised she                                                              
had read the bill.                                                                                                              
REPRESENTATIVE  GRUENBERG   referred  to  [Sec.   09.65.340(a)(2),                                                              
[text  provided  previously], and  restated  that  each person  to                                                              
whom the  drug is prescribed or  provided must have  been educated                                                              
and  trained in  the proper  emergency use  and administration  of                                                              
the  drug  in  order  to receive  the  tort  immunity.    He  then                                                              
referred   to  a  previous   witness's  statement   in  that   its                                                              
application is  easy and similar to  a diabetic.  In  reference to                                                              
other states, he  asked whether the person administering  the drug                                                              
must receive special training.                                                                                                  
MS. BURNS  opined no, and advised  that she is most  familiar with                                                              
the State of  New York's policy  in that people can be  trained to                                                              
become peer  educators, carry Narcan  across state lines,  and can                                                              
also  hand Narcan  out to  people  "so, you  know, there's  always                                                              
somebody, you  know, telling you  how to do  it when they  give it                                                              
to you."   Also,  she advised  that the  instructions with  Narcan                                                              
are  quite clear  and that  she is  most familiar  with the  nasal                                                              
administration.  She  noted that even though she  had not received                                                              
training in five-seven  years, a couple of years ago  she read the                                                              
instructions and successfully administered Narcan.                                                                              
3:55:52 PM                                                                                                                    
REPRESENTATIVE  GRUENBERG referred  to [Sec.  5, AS  09.65.340(a)]                                                              
page 3, lines 18-23, which read:                                                                                                
               (a) Except as provided in (c) of this                                                                            
     section,  a  person  is not  liable  for  civil  damages                                                                   
     resulting  from an  act or  omission  in prescribing  or                                                                   
     providing an  opioid overdose drug  to a person  at risk                                                                   
     of  experiencing  an  opioid  overdose or  to  a  family                                                                   
     member,  friend,   caregiver,  or  other  person   in  a                                                                   
     position  to administer  an  opioid overdose  drug to  a                                                                   
     person at risk of experiencing an opioid overdose if                                                                       
REPRESENTATIVE  GRUENBERG offered concern  that if the  above-list                                                              
of people  must have "a bunch  of training," the  people available                                                              
to administer  the drug  may be  dissuaded from administering  it.                                                              
He  surmised that  the  people in  New York  are  not required  to                                                              
obtain training, rather they just administer the [Narcan].                                                                      
MS. BURNS  opined that the  nasal administration is  more commonly                                                              
used, the  least expensive option,  and is covered by  more health                                                              
insurance  companies.     She  reiterated   that  Narcan   is  not                                                              
difficult to use,  and she used the example of  a doctor providing                                                              
an EpiPen  and providing  an explanation  [of administration],  or                                                              
reading the instructions.                                                                                                       
3:57:16 PM                                                                                                                    
DONNA  BALDWIN,  advised  that   she  is  one  of  four  long-term                                                              
recovery  coaches  in Juneau,  and  in  response to  Chair  LeDoux                                                              
stated she  is testifying on  her own behalf.   She  stressed that                                                              
watching  the  process of  SB  23  in action,  because  it  didn't                                                              
happen for so many  years, is a miracle and that  the committee is                                                              
"awesome to  do this work  because it is  so needed."   She opined                                                              
that if a  person is "not living  in that, you don't  know that it                                                              
exists," she  said, and  is thankful her  children are  still with                                                              
her,  and that she  does not  want to  see any  more parents  tell                                                              
their story about  their lost children.  She pointed  out that the                                                              
Juneau  Police Department  (JPD) wants  to help  these people  and                                                              
believes  it really  is a  disease,  and that  our mistakes  don't                                                              
define who individuals  are but what is done to  make a difference                                                              
does.   She stressed that  while this is  a good beginning,  it is                                                              
by no  means the  end of the  problem.   She emphasized  that more                                                              
support and  recovery facilities  are needed because  every single                                                              
day treatment  is unavailable  for  people asking  for help.   She                                                              
added  that "we've  even brought  addicts  into our  own homes  to                                                              
detox because  there was nowhere to  bring them."  She  asked that                                                              
the legislature not stop here.                                                                                                  
4:01:30 PM                                                                                                                    
ANDREA ROBINSON, offered testimony, as follows:                                                                                 
     Hi,  I'm  Andrea  Robinson   from  the  Haven  House  in                                                                   
     Juneau, I'm also  in recovery.  Um ... I  have overdosed                                                                   
     three  times myself and  I'm very  grateful to be  here.                                                                   
     Um ...  but in November of  2014, on my  three-year olds                                                                   
     birthday,  my   brother  overdosed.    They   found  him                                                                   
     underneath  the parking garage,  right down there.   His                                                                   
     girlfriend  found him.   Um  ...  thankfully she  called                                                                   
     the  ambulance, he  got  the Narcan  shot,  ah ...  they                                                                   
     brought  him back.    They  had to  do it  several  more                                                                   
     times.  And  then they did it at the ER,  and thankfully                                                                   
     he got that  or else he wouldn't be here today.   Um ...                                                                   
     I'm grateful  for it, I  definitely think that  it could                                                                   
     save a  lot of lives.   Everybody  in our house,  I know                                                                   
     ... I  mean just living in  a sober house, I  think that                                                                   
     we  should have  that  available  just because  for  all                                                                   
     recovery addicts  there is no  telling if ... I  mean, I                                                                   
     could  relapse tomorrow and  if we  didn't have that  in                                                                   
     our  house ...  you know,  one of  us could  just ...  I                                                                   
     mean  we wouldn't  really know  what to  do except  call                                                                   
     911, and  who's to say they  would be there  right away.                                                                   
     Um ...  I think  it should be  available in all  places,                                                                   
     halfway  houses, everywhere.   Um  ... so  yeah, I  just                                                                   
     want  to thank  you guys for  this and  ... yeah,  thank                                                                   
4:03:19 PM                                                                                                                    
REPRESENTATIVE MILLETT  thanked Ms.  Robinson for being  brave and                                                              
sharing because  the legislature needs  to hear from  people going                                                              
through  this and have  experience  with it.   She emphasized  the                                                              
importance of  this issue  and that the  legislature is  not going                                                              
to give  up on anyone  going through any  type of addiction.   She                                                              
reiterated  that  the legislature  is  here, with  Senator  Johnny                                                              
Ellis's help,  to support her and  she again thanked  Ms. Robinson                                                              
for testifying as it is an emotional issue.                                                                                     
4:04:17 PM                                                                                                                    
CHAIR LEDOUX  closed public  testimony after  ascertaining  no one                                                              
further wished to testify.                                                                                                      
CHAIR LEDOUX emphasized  that this is an important  bill and asked                                                              
whether there were comments from the committee.                                                                                 
REPRESENTATIVE  GRUENBERG noted he  had offered several  questions                                                              
that had not yet been answered by the lawyers.                                                                                  
4:04:57 PM                                                                                                                    
MEGAN WALLACE,  Attorney, Legislative  Legal Counsel,  Legislative                                                              
Legal and Research  Services, Legislative Affairs  Services, asked                                                              
Representative   Gruenberg   to   please   repeat   the   specific                                                              
4:05:48 PM                                                                                                                    
REPRESENTATIVE  GRUENBERG referred  to  page 3,  lines 29-31,  and                                                              
page  4, lines  1-3,  [text  provided  previously] and  asked  for                                                              
clarification   that  under   the   bill  in   order  to   receive                                                              
immunization  from tort  liability, the  person administering  the                                                              
drug must have  been educated and trained in  the proper emergency                                                              
use and administration of the opioid overdose drug.                                                                             
[CHAIR LEDOUX passed the gavel to Representative Millett.]                                                                      
MS. WALLACE  answered that is correct.   She said  the prescribing                                                              
or providing  health care provider  would have to prescribe  it or                                                              
provide it to a person who has had that education and training.                                                                 
REPRESENTATIVE  GRUENBERG  referred to  the  definition of  health                                                              
care  provider,  and noted  that  the  chair  of the  House  State                                                              
Affairs  Standing   Committee  said  it  does  not   include,  for                                                              
example, a  paramedic or ambulance  driver.   He said he  has been                                                              
given  several definitions  of health  care  providers from  other                                                              
parts of the  code, for example, AS 09.55.560  lists approximately                                                              
20 different professions  under health care provider.   He pointed                                                              
out  that some  of whom  are probably  not  appropriate, but  some                                                              
probably are.   Also,  AS 21.07.250 goes  to the opposite  extreme                                                              
and paraphrased,  "Health  care provider  means a person  licensed                                                              
in this  state or another  state of the  United States  to provide                                                              
medical  care services,  whatever that  is defined  in here."   He                                                              
asked whether Ms. Wallace had a comment.                                                                                        
MS. WALLACE  explained that  the bill would  only apply  to health                                                              
care providers  as  defined in the  bill.   She further  explained                                                              
that defining  a health care provider  is a policy choice  and the                                                              
sponsor or committee can make that decision.                                                                                    
4:08:43 PM                                                                                                                    
REPRESENTATIVE  MILLETT announced,  for  the record,  that she  is                                                              
sitting as chair  of the House Judiciary Standing  Committee while                                                              
Representative LeDoux stepped out.                                                                                              
4:08:52 PM                                                                                                                    
REPRESENTATIVE   GRUENBERG  questioned   whether  the   bill  only                                                              
applies to immunity  from civil damages, and not  to immunity from                                                              
criminal  damages or damages  or actions  that may  be taken  by a                                                              
licensing board.                                                                                                                
MS. WALLCE  responded that is correct.   The bill only  applies to                                                              
civil immunity and  does not affect any criminal law  and does not                                                              
affect any  licensing or regulatory  action that a board  or other                                                              
committee could take, she said.                                                                                                 
[REPRESENTATIVE MILLETT passed the gavel back to Chair LeDoux.]                                                                 
4:09:35 PM                                                                                                                    
CHAIR LEDOUX announced  she had returned to the  committee and was                                                              
in possession of the gavel.                                                                                                     
REPRESENTATIVE  GRUENBERG  offered  that  he  does  not  know  the                                                              
interplay  between this  law and  federal law,  and asked  whether                                                              
someone immunized  under state law  could still face some  sort of                                                              
action under federal  law since the federal law is  so involved in                                                              
this area.                                                                                                                      
MS. WALLACE  commented that  she has not  looked deeply  into that                                                              
issue and  does not want  to misstate the  law, but did  note that                                                              
in  order for  a  federal  civil action  to  impose  damages on  a                                                              
health care provider  there would have to be some  sort of federal                                                              
jurisdiction  and normally  these  kinds of  civil damages  claims                                                              
are governed  by state  jurisdiction.  She  advised she  could not                                                              
think  of anything  that  would  allow  a federal  court  original                                                              
jurisdiction over a civil damages case relating to Alaska law.                                                                  
REPRESENTATIVE GRUENBERG  commented that  he was not trying  to be                                                              
difficult but rather to be certain "we do what we need to."                                                                     
4:10:54 PM                                                                                                                    
REPRESENTATIVE  LYNN offered  a scenario  of several  people  in a                                                              
home  where someone  experiences  an overdose,  and asked  whether                                                              
anyone in  that room  could give the  medication while  not having                                                              
had any  type of  training.  He  stressed that  he would  give the                                                              
medication even if he didn't have the training.                                                                                 
MS. EVANS  responded that the  House Health, Education  and Social                                                              
Services  Standing  Committee tried  to  expand how  the  training                                                              
could  be implemented,  and referred  to page  4, lines 1-3  [text                                                              
previously  provided].   She explained  that  the availability  of                                                              
Narcan over  the counter  is a law  in 41  other states,  plus the                                                              
District of  Columbia.  "There's  so much  out there about  how to                                                              
educate and  train the public on  how to administer  naloxone that                                                              
that's why  we put that information  in there and ...  so it would                                                              
be a quick  easy way to get  the training out there  and available                                                              
for all persons," she stated.                                                                                                   
4:12:54 PM                                                                                                                    
REPRESENTATIVE   LYNN  restated   his  question   and  asked   the                                                              
consequences  of  him  never  having  had  any  of  this  training                                                              
whatsoever, happens  to be at a  party, sees a  person overdosing,                                                              
and administers the medication.                                                                                                 
MS.  EVANS stated  that  "The correct  answer  would  be that  you                                                              
would  not  be  provided  civil  immunity the  way  this  bill  is                                                              
written."   She  offered that  she  didn't think  anyone would  go                                                              
after him.                                                                                                                      
REPRESENTATIVE  LYNN agreed that  probably no  one would  go after                                                              
him because a life  had been saved.  Nonetheless,  why require all                                                              
of  the training  when  it really  isn't needed  if  he gives  the                                                              
medication without training which, he reiterated, he would do.                                                                  
4:13:54 PM                                                                                                                    
MS.  WALLACE answered  that there  are some  civil immunities  for                                                              
rendering emergency  aid in  AS 09.65.090.   She explained  that a                                                              
person  rendering   emergency  aid   without  training   may  have                                                              
immunity under that section.                                                                                                    
MS. WALLACE, in  response to Representative Lynn,  advised that he                                                              
was correct that it is the Good Samaritan law.                                                                                  
MS.  EVANS offered  that  last session  the  Good Samaritan  House                                                              
Bill 369  passed, allowing  a good  samaritan to summon  emergency                                                              
responders  or  act  on  something  such as  SB  23,  without  any                                                              
negative legal consequences.                                                                                                    
4:14:52 PM                                                                                                                    
CHAIR LEDOUX  asked why  the bill  is written  so that  the person                                                              
administering [Narcan] has to have the education.                                                                               
CHAIR  LEDOUX then  announced that,  although  she had  originally                                                              
intended to pass  the bill out of committee today,  the bill would                                                              
be  held over.   She  thanked everyone  for  their testimony,  and                                                              
particularly thanked  Senator Ellis and  Ms. Evans for  their work                                                              
on the bill.                                                                                                                    

Document Name Date/Time Subjects
HJR 19 - Sponsor Statement.pdf HJUD 2/8/2016 1:00:00 PM
HJR 19
HJR 19 - Version W.pdf HJUD 2/8/2016 1:00:00 PM
HJR 19
SB 23 - Sponsor Statement.pdf HJUD 2/8/2016 1:00:00 PM
SB 23
SB 23 - Legal Memo RE DOC Liability.pdf HJUD 2/8/2016 1:00:00 PM
SB 23
SB 23 - Fiscal Note - DCCED-CBPL-01-22-16.pdf HJUD 2/8/2016 1:00:00 PM
SB 23
SB 23 - Fiscal Note - DOC-HRS-01-22-16.pdf HJUD 2/8/2016 1:00:00 PM
SB 23
SB 23 - Supporting Document - How to Administer Naloxone.pdf HJUD 2/8/2016 1:00:00 PM
SB 23
SB 23 - Supporting Document - NCSL Drug Overdose Immunity Laws.pdf HJUD 2/8/2016 1:00:00 PM
SB 23
SB 23 - Supporting Document - State Naloxone, Good Samaritan Legislation.pdf HJUD 2/8/2016 1:00:00 PM
SB 23
SB 23 - Supporting Document - Alaska Dispatch 11.14.15.pdf HJUD 2/8/2016 1:00:00 PM
SB 23
SB 23 - Supporting Document - Juneau Empire 11.07.15.pdf HJUD 2/8/2016 1:00:00 PM
SB 23
SB 23 - Supporting Document - Juneau Empire 11.17.15.pdf HJUD 2/8/2016 1:00:00 PM
SB 23
SB 23 - Supporting Document - Wall Street Journal 03.12.15.pdf HJUD 2/8/2016 1:00:00 PM
SB 23
SB 23 - Letter of Support - ABADA AMHB 03.17.15.pdf HJUD 2/8/2016 1:00:00 PM
HB 3
SB 23
SB 23 - Letter of Support - Alaska Mental Health Trust Authority 03.06.15.pdf HJUD 2/8/2016 1:00:00 PM
SB 23
SB 23 - Letter of Support - Alaska Nurse Practitioner Association.pdf HJUD 2/8/2016 1:00:00 PM
SB 23
SB 23 - Letter of Support - Alaska State Medical Association 03.16.15.pdf HJUD 2/8/2016 1:00:00 PM
SB 23
SB 23 - Letter of Support - APDEA 03.17.15.pdf HJUD 2/8/2016 1:00:00 PM
SB 23
SB 23 - Letter of Support - ASHNHA 02.02.16.pdf HJUD 2/8/2016 1:00:00 PM
SB 23
SB 23 - Letter of Support - Lisa Reynolds 03.16.15.pdf HJUD 2/8/2016 1:00:00 PM
SB 23
SB 23 - Letter of Support - Megan Ritter 01.25.16.pdf HJUD 2/8/2016 1:00:00 PM
SB 23
SB 23 - Letter of Support - Narcotic Drug Treatment Center 01.23.15.pdf HJUD 2/8/2016 1:00:00 PM
SB 23
SB 23 - Letter of Support - Alaska Pharmacists Association 02.05.16.pdf HJUD 2/8/2016 1:00:00 PM
SB 23