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I_OpioidSubstance_2017A 07/10/2017 Committee Summary




Date: 07/10/2017
Time: 09:09 AM to 04:36 PM
Place: RM 271
This Meeting was called to order by
Representative Pettersen
This Report was prepared by
Anne Wallace
X = Present, E = Excused, A = Absent, * = Present after roll call
Bills Addressed: Action Taken:
Opening Remarks

Overview of Committee Charge and Deadlines

Origins and Scope of the Problem: United States

Scope of the Problem: Colorado

The Colorado Response: Coalitions and Task Forces

State Agency Perspectives

Committee Discussion Regarding Task Force

Public Comment
Witness Testimony and/or Committee Discussion Only

Witness Testimony and/or Committee Discussion Only

Witness Testimony and/or Committee Discussion Only

Witness Testimony and/or Committee Discussion Only

Witness Testimony and/or Committee Discussion Only

Witness Testimony and/or Committee Discussion Only

Witness Testimony and/or Committee Discussion Only

Witness Testimony and/or Committee Discussion Only

09:09 AM -- Opening Remarks

Representative Pettersen called the meeting to order and an agenda was distributed to committee members (Attachment A). Representative Pettersen and Senator Lambert commented on the purpose of the committee and their expectations during the interim.


09:14 AM -- Overview of Committee Charge and Deadlines

Bill Zepernick, Legislative Council Staff, provided an overview of the charge of the committee. Brita Darling, Office of Legislative Legal Services, explained the bill request process and went over important deadlines for the committee. Ms. Darling responded to a question regarding committee meeting dates.

09:19 AM -- Origins and Scope of the Problem: United States

Dr. Robert Valuck, Colorado Consortium for Prescription Drug Abuse Prevention (consortium), presented an overview of the substance use problem in the United States and distributed a handout to the committee (Attachment B). Dr. Valuck defined important terms related to substance use and misuse for the committee. He provided statistics on common substance use disorders in the U.S., including alcohol, tobacco, cannabis, stimulants, and opioid use disorders.


09:37 AM

Dr. Valuck responded to a question regarding negative consequences for various substance use. He provided statistics on misuse of substances and overdose deaths in the U.S., and explained the increase in overdose deaths over time. Dr. Valuck responded to questions regarding the production of heroin and synthetic opioids outside of the U.S.

09:54 AM

Dr. Valuck discussed different examples of opioid misuse. He responded to a question regrading treatment of an opioid use disorders. He provided statistics on the cost of substance use disorders on the U.S. economy, including health care costs, criminal justice costs, and lost productivity. Dr. Valuck explained the cost-benefit ratio for evidence-based substance use disorder treatments, and described the treatment gap for substance use disorders in the U.S.

10:08 AM

Dr. Valuck gave an overview of the use of substances throughout history, including the recent history of opioid use in the U.S. He responded to a question regarding genetic predisposition to substance use disorders, and lawsuits against pharmaceutical companies for false advertising concerning the use and safety of opioid medicines.

10:23 AM

Dr. Valuck explained the process for obtaining prescription opioids and gave statistics on U.S. opioid use compared to other countries. He explained that non-medical opioid use and heroin use are linked. Dr. Valuck gave examples of risk factors for substance misuse, including biology and genetics, environment, and brain mechanism. He responded to a questions about the role of gender and substance misuse.

10:35 AM

Dr. Valuck concluded his presentation and responded to questions regarding patient dependence on opioid addiction treatments and the cost of medication to treat opioid addiction.

10:43 AM -- Scope of the Problem: Colorado

Tamara Keeney and Teresa Manocchio, Colorado Health Institute, presented to the committee and distributed handouts (Attachments C and D). Ms. Keeney provided data on the increase of overdose death rates in Colorado from 2002 to 2014, and noted that opioid overdose deaths are the main driver in the overall increase in overdose deaths. Ms. Keeney described demographics on overdose deaths in Colorado. Ms. Keeney described data on self-reported drug misuse and statistics related to emergency department visits for drug-related health issues.

17Opioid0710AttachC.pdf17Opioid0710AttachC.pdf 17Opioid0710AttachD.pdf17Opioid0710AttachD.pdf

10:55 AM

Ms. Manocchio provided statistics related to treatment admissions by drug in Colorado. She noted that that there is a shortage of residential treatment services in Colorado, especially in rural areas. Ms. Manocchio described some barriers to medication-assisted treatment in Colorado, including stigma, lack of insurance, insufficient staff knowledge, and lack of counseling and other secondary staff. She noted that Colorado counties with no medication-assisted treatment locations may also have high overdose deaths. She concluded by discussing the cost effectiveness of treatment for substance use disorders.

11:03 AM

Ms. Manocchio and Ms. Keeney responded to questions regarding youth alcohol and marijuana use, non-opioid overdose deaths, and lack of substance use treatment resources.

11:16 AM

Lindsey Myers, Colorado Department of Public Health and Environment (CDPHE), presented to the committee and distributed a handout (Attachment E). Ms. Myers provided demographic statistics related to drug overdose deaths and opioid-related hospitalizations.


11:23 AM

Ms. Myers described the Colorado Prescription Drug Monitoring Program (PDMP) to the committee. She explained that the PDMP is managed by the Department of Regulatory Agencies (DORA) to keep track of certain drugs that have been prescribed, and the program has been enhanced by recent legislation. Ms. Myers provided data on the number and type of prescriptions issued annually in Colorado. She also provided information on patient demographics and prescription by payment type. Ms. Myers summarized a report on heroin use in Colorado, including overdose deaths, hospitalization and emergency department visits, naloxone administrations, and neonatal abstinence syndrome.

11:34 AM

Ms. Myers gave an overview on Colorado law enforcement data related to heroin, including seizures of heroin, and the price and purity of heroin. She discussed the results of a survey for heroin and opioid users in treatment. Ms. Myers provided additional data on substance use in Colorado to the committee, including binge drinking. Ms. Myers responded to a question from the committee regarding hepatitis and other infectious diseases.

11:46 AM

Cristen Bates and Rebecca Helfand, Colorado Department of Human Services (DHS), presented to the committee and provided a handout (Attachment F). Ms. Helfand provided data on state treatment admissions for opioids and all substances abuse, and explained the demographics of Coloradans in treatment. She noted that some patients also use secondary or tertiary substances when seeking treatment for opioid use.


11:52 AM

Ms. Bates discussed the number of DHS facilities in Colorado that provide opioid use disorder treatment. She described how physicians are licensed to provide medication-assisted treatment, and noted the difficulties that primary care providers have offering this treatment.

12:01 PM

The committee recessed.

01:22 PM -- The Colorado Response: Coalitions and Task Forces

Representative Pettersen called the meeting back to order. Jose Esquibel, Office of the Attorney General and the Substance Abuse Trend and Response Task Force (task force), presented to the committee and distributed handouts (Attachments G, H, I, J, and K). Mr. Esquibel described his previous professional experience with substance abuse. He explained the origins of the legislatively mandated task force and described the membership. Mr. Esquibel went over the charge of the task force, which includes monitoring substance abuse data, identifing best practices, and preparing an annual report and recommendations for legislators.

17Opioid0710AttachG.pdf17Opioid0710AttachG.pdf 17Opioid0710AttachH.pdf17Opioid0710AttachH.pdf

17Opioid0710AttachI.pdf17Opioid0710AttachI.pdf 17Opioid0710AttachJ.pdf17Opioid0710AttachJ.pdf


01:34 PM

Mr. Esquibel discussed various committees of the task force, including the Substance Exposed Newborn Committee, the Hospital Learning Collaborative, and Epidemiologist and Outcomes Work Group. He reviewed three policy recommendations that the task force made to the legislature in 2016. Mr. Esquibel explained the task force priorities for 2016, which included supporting the expansion of medication-assisted treatment, increasing access to naloxone, and monitoring underage use of marijuana.

01:45 PM

Mr. Esquibel discussed an initiative of the task force to obtain naloxone kits. He reviewed 2017 task force priorities, including addressing the impact of substance abuse on children, medication-assisted treatment expansion, funding AmeriCorps volunteers in the local community, initiating the Recovery Ready Colorado program, and gathering updated data and trends on substance use. He noted that the task force is set to repeal in July 2018. Mr. Esquibel responded to questions from the committee regarding substance use and suicide, and success rates for treatment programs.

02:03 PM

Mr. Esquibel continued to respond to questions regarding measurements of success for the task force and the price of naloxone and other addiction treatments.

02:13 PM

Dr. Robert Valuck, Colorado Consortium for Prescription Drug Abuse Prevention (consortium), presented to the committee and distributed a handout (Attachment L). He described the origin of the consortium, and summarized Governor Hickenlooper's strategic plan to reduce prescription drug abuse. Dr. Valuck explained the mission and objectives of the consortium, which include reducing overdose death, reducing emergency department visits and hospital stays related to substance abuse, increasing treatment admissions, and reducing non-medical use of opioids. Dr. Valuck highlighted the progress of certain work groups of the consortium, including the public awareness work group, safe disposal work group, the provider education work group, the heroin response work group, and the affected families work groups.


02:27 PM

Dr. Valuck responded to a question regarding limiting opioid quantities when prescribing, and physician retraining, and how Colorado compares to other states in regards to addressing opioid abuse.

02:42 PM

Dr. Valuck discussed efforts to obtain federal money to support local communities in combating opioid use, and gave examples of recent grants that the consortium has been involved with.

02:47 PM

Lisa Raville, Harm Reduction Action Center, presented to the committee and distributed a handout (Attachment M). She explained the recent shift from use of prescription pills to use of heroin. Ms. Raville described the Syringe Access Program in Colorado and the effort to reduce injection-related diseases, and explained legislation related to decriminalizing syringes. Ms. Raville described other services offered at the Harm Reduction Action Center, including health education programs and advocacy. She provided data regarding participation in the Syringe Access Program in Colorado.


02:55 PM

Ms. Raville discussed reasons why people overdose on opioids, including change in quality of opioid, tolerance, mixing substances, and using opioids by themselves. She explained the signs of an overdose and how overdoses are reversed, including through the use of naloxone. Ms. Raville described the training to administer naloxone, and explained who can administer naloxone and which pharmacies stock naloxone.

03:03 PM

Ms. Raville responded to questions regarding the Good Samaritan Law, reasons for the lack of access to treatment, and controlled injection sites to avoid public overdoses.

03:12 PM -- State Agency Perspectives

Lindsey Myers, CDPHE, presented to the committee and distributed a handout (Attachment N). She gave an overview of the CDPHE's multi-disciplinary approach to substance use. Ms. Myers described projects related to prescription drug abuse including funding from the Bureau of Justice Assistance to assist the consortium, a Centers for Disease Control grant for the PDMP, and the Medication Take Back Program. She summarized current CDPHE joint initiatives with other state agencies, county health departments, and providers and hospitals.


03:24 PM

Ms. Myers discussed funding for provider education and an alcohol epidemiology grant. She went over efforts related to marijuana, and the Communities that Care program.

03:30 PM

Mark Condojani, Colorado Department of Human Services, presented to the committee and referred to a previous handout (Attachment F). Mr. Condojani gave an overview of the substance use disorder services in Colorado, including treatment types, special organizations, and stakeholders. He summarized the medication-assisted treatment process, and explained how treatment facilities are licensed in Colorado. Mr. Condojani reviewed ongoing and planned DHS initiatives related to substance abuse treatment and recovery in Colorado.

03:44 PM

Mr. Condojani responded to questions regarding residential treatment programs and detox centers. He discussed residential and outpatient treatment options for treatment and medical detox. Committee members commented on the role of the mental health institutes and the criminal justice system in opioid and substance use treatment.

03:58 PM

Mr. Condojani discussed DHS family services and homeless services. He highlighted day-of-release services and other initiatives including stigma reduction, work with Native American tribes, and outreach.

04:01 PM

Ronne Hines, Department of Regulatory Agencies (DORA), began her presentation and provide a handout (Attachment O) and pamphlets to the committee. She described the role of DORA in preventing prescription drug abuse, including administering the PDMP, partnering with the consortium, and implementing a policy for prescribing and dispensing opioids. Ms. Hines explained various updates and enhancements to the PDMP.


04:15 PM -- Committee Discussion Regarding Task Force

Representative Pettersen explained that the committee may appoint a task force to research and report on particular topics. She noted that the committee is not yet prepared to create a task force, but will keep interested persons and stakeholders informed.

04:16 PM -- Public Comment

Representative Pettersen opened the meeting for public testimony.

04:17 PM --
Jessica LeRoux, representing herself, testified regarding the dangers of benzodiazepine withdrawal. Discussion with the committee ensued.

04:20 PM --
Cindy Sovine-Miller, representing herself, distributed two handouts to the committee (Attachments P and Q) and testified regarding the safety of medical marijuana compared to other pain medications. Ms. Sovine-Miller responded to questions from the committee.

17Opioid0710AttachP.pdf17Opioid0710AttachP.pdf 17Opioid0710AttachQ.pdf17Opioid0710AttachQ.pdf

Senator Aguilar commented on ideas for legislation, including limiting prescriptions for new patients, renewing the Attorney General's Task Force, integrating the PDMP into electronic health records, tracking additional drugs in the PDMP, removing pain as a patient 'vital sign', adjusting prescription formulations, and controlling the cost of generic prescriptions.

04:31 PM --
Dale Terasaki, representing himself, testified regarding the effectiveness of safe injection sites to prevent overdoses.

04:32 PM --
Denise Vincioni, representing the Denver Recovery Group, testified regarding the substance use disorder recovery workforce shortage.

04:34 PM

Representative Pettersen reminded the committee that the next meeting is scheduled for August 1, 2017, and requested feedback on the draft agenda for the next meeting.

04:36 PM

Representative Pettersen adjourned the meeting.

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