Legislature(2015 - 2016)BELTZ 105 (TSBldg)
04/01/2015 01:30 PM Senate JUDICIARY
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SB 23-IMMUNITY FOR PROVIDING OPIOID OD DRUG 1:33:23 PM CHAIR MCGUIRE announced the consideration of SB 23. "An Act relating to immunity for prescribing, providing, or administering opioid overdose drugs." 1:33:38 PM DR. PAULA COLESCOTT, MD, Addiction Specialist, Providence Breakthrough, testifying via teleconference, spoke about unintentional drug overdoses from prescription opiates and heroin. [Due to a poor connection, the testimony was indiscernible. The sponsor noted that Dr. Colescott supported the legislation.] 1:35:46 PM SENATOR JOHNNY ELLIS, Alaska State Legislature, sponsor of SB 23, said he and former Senator Dyson talked about the growing problem of opioid addiction for over a decade. It has reached epidemic proportions in the state and the problem is growing. Fatal drug overdoses have increased more than six-fold in the past three decades and now claim the lives of over 36,000 Americans every year. According to the Anchorage Police Department, heroin-related overdoses are claiming more young lives than traffic fatalities. The 2014 Alaska State Troopers' Drug Report identified an increase in heroin abuse and the continued use of other opiates as significant concerns for law enforcement. He reported that the abuse and overdose epidemic was largely driven by addiction to prescription opioids such as OxyContin, Oxycodone, and Vicodin. Because these drugs have grown more expensive over time, abusers and addicts have sought cheaper alternatives, such as black tar heroin which is imported to Alaska by the Mexican drug cartel. SENATOR ELLIS said that heroin abuse crosses all economic levels and has left no community untouched. This trend is troubling because prescription opioids are popular among young Alaskans. According to 2011 data from the Centers for Disease Control and the Prevention Youth Risk Behavior Survey, 15.8 percent of Alaska students reported having used prescription drugs without a prescription. These drugs are more popular among high school students than alcohol, tobacco, and marijuana. Fortunately, opioid overdose is reversible through the timely administration of the medication Naloxone, but that medication is often not available when needed. Friends and family members are often the ones who are best situated to save the life of a person who has overdosed, but medical professionals are wary of prescribing Naloxone and lay persons are wary of administering it due to potential civil liability. SB 23 removes the civil liability from doctors and trained bystanders. He expressed hope that Alaska would be the 29th state to provide this protection. The bill has attracted bipartisan support along with the Alaska State Medical Association, the Alaska Police Department Employees Association, the Alaska Mental Health Trust Authority, the Alaska Mental Health Board and Advisory Board on Alcoholism and Drug Abuse, the Narcotic Treatment Center, and countless families and addicts. He noted that during a previous committee hearing, Rick Svobodny testified that the Department of Law (DOL) and the Administration support the legislation. CHAIR MCGUIRE stated her intention to become a co-sponsor. 1:43:58 PM SENATOR COGHILL moved to adopt the proposed committee substitute for SB 23, labeled 29-LS0058\E, as the working document. SENATOR COSTELLO objected for discussion purposes. 1:44:37 PM MATTHEW MOSER, Staff, Senator Johnny Ellis, described the changes in version E. Bill sections 1 and 2 change the definition of "opioid overdose program" so that it is not limited to state, federal or municipally funded programs. Sec. 09.65.340(a)(1)(A) authorizes health care providers to prescribe an opioid overdose drug directly or to a person who is in a position to administer an opioid overdose drug to a person at risk of experiencing an opioid overdose. Sec. 09.65.340(a)(1)(B) authorizes an employee or volunteer of an opioid overdose program, or other person in a position to administer the opioid overdose drug, to receive a supply, possess, and supply opioid overdose drugs to persons at risk of experiencing an opioid overdose. SENATOR COSTELLO removed her objection and version E was before the committee. CHAIR MCGUIRE asked if the Alaska State Troopers and local police would be authorized to carry the opioid overdose drug in their care kits. MR. MOSER replied it's already a common part of the EMT tool kit and he suspects this would allow troopers to carry it. SENATOR COGHILL asked how broad the interpretation will be for "at risk" in this context. SENATOR ELLIS replied it's a good question, but it doesn't matter because there are no negative side effects if a person is administered Naloxone when they're not in jeopardy of heroin or opioid overdose. SENATOR COGHILL asked what it takes to be trained to administer the overdose drug. MR. MOSER explained that the drug may be administered as a nasal spray or by injection that is similar to an EpiPen, which is commonly used for allergic reactions. The lay person would also be made aware of the symptoms of an overdose. SENATOR ELLIS added that the prescription EpiPen with Naloxone has the injection instructions are on the pen. That is basically when the training would occur. He said that for years he and former Senator Dyson pointed out to their colleagues the gross underfunding of the Methadone clinics in Fairbanks and Anchorage. Those programs are still underfunded and the waiting lists are even longer in light of the current epidemic. He said he's heard from some parents who are taking desperate measures to help their teenage daughter or son at home because they can't get them into a treatment program. SENATOR COGHILL asked what the procedure is for getting a prescription. MR. MOSER replied it would be available through a prescription from a doctor or an opioid overdose reversal program. He offered to follow up with information from a program in Massachusetts that reported about 2,000 overdose reversals. 1:55:10 PM CHAIR MCGUIRE referenced the presentation the committee heard [on 2/4/15 about medication assisted treatment (MAT), specifically Vivitrol, to treat opioid addictions. It blocks the effects of opioids and removes the pleasure index.] MR. MOSER replied it sounds like a promising tool to address the addiction itself as opposed to Naltrexone that treats an overdose. SENATOR ELLIS added that his staff member Amory LeLake is the expert and she would follow up with specifics. CHAIR MCGUIRE said she understands that the group that delivered the MAT presentation is looking at a million dollar grant for the treatment of opioid addiction. SENATOR ELLIS agreed that Vivitrol holds promise for the future. He noted that a doctor in the MatSu Valley is currently prescribing Vivitrol within his practice. CHAIR MCGUIRE said she found it particularly interesting that someone with an opioid addiction could receive an injection of Vivitrol when they leave prison and they would be protected from the craving for 30 days. They wouldn't be looking for their drug dealer immediately. SENATOR ELLIS agreed that without treatment in prison or the community the addict would be looking for their dealer right away. 1:58:41 PM KATE BURKHART, Executive Director, Advisory Board on Alcohol and Drug Abuse and Alaska Mental Health Board, stated support for SB 23 on behalf of the boards. She said the bill speaks directly to the concerns raised by physicians engaged in medication assisted treatment to help people recover from opioid addiction. These physicians asked if it was within their professional ethics to prescribe this medication when it could be viewed as promoting illicit drug use. SB 23 provides the guidance these physicians were looking for. Prescribing this drug is within the scope of practice to take care of their patients. It will save lives. 2:03:07 PM KARA NELSON, Director, Haven House, Executive Committee, Juneau Reentry Coalition, and Member, Juneau Recovery Community, testified in support of SB 23. She described her personal history with drug addiction and overdose. She related how important the drug Naloxone is. She pointed out that addiction does not discriminate. She testified how important one saved life is. She said the bill will keep people from worrying about going to jail for trying to save a life. It is not a criminal issue. She described her work with Haven House. She stressed that Narcan is very important to recovery and so is community support. Vivitrol is a good product but it has to be surrounded with recovery-oriented systems of care, she said. 2:18:27 PM CHAIR MCGUIRE thanked Ms. Nelson for coming forward. SENATOR COGHILL referenced page 3, lines 2-3, and noted that an opioid overdose drug may be prescribed directly or by standing order or protocol to a person at risk. He asked if "protocol to a person at risk" includes an addict who says he/she is trying to recover and needs to have the drug available in case of relapse. MR. MOSER said that's his understanding. The standing order of protocol can also relate to a pharmacist who has authority from a physician to prescribe the drug. He suggested that Ms. Burkhardt might be able to supplement the answer. 2:20:26 PM MS. BURKHARDT said her reading of prescription by standing order or protocol would allow the medical director of a treatment program to have a standing order that all patients that are receiving treatment for opioid addiction could receive the prescription. It would also allow a physician to prescribe the drug individually. SENATOR COGHILL expressed satisfaction with the explanation. SENATOR COSTELLO interpreted the language on page 2, line 13, to mean that a person who received education and training in the administration of the drug would not be civilly liable, but an untrained person who had no training doesn't have that protection. MR. MOSER agreed that proper education and training is a required component of administering the drug. MS. BURKHARDT added that the training that's anticipated is very similar to the patient education a person receives for other prescription medications. She noted that the EpiPen for allergic reactions was referenced earlier. SENATOR COSTELLO said she was envisioning a bystander administering the drug. MR. MOSER offered his belief that the civil liability is extended to both the physician and someone who has received training to administer the drug. He noted that other states have removed the civil liability altogether. He said it speaks to the safety of the drug that it's been available in Italy without a prescription since the 1990s. CHAIR MCGUIRE described the bill as a first step. 2:26:19 PM SENATOR COGHILL motioned to report the CS for SB 23(JUD) from committee with individual recommendations and attached zero fiscal note. 2:26:51 PM CHAIR MCGUIRE announced that without objection, CSSB 23(JUD) is reported from the Senate Judiciary Standing Committee.