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I_OpioidSubstance_2019A 07/09/2019 09:38:17 AM Committee Summary

PUBLIC
STAFF SUMMARY OF MEETING
INTERIM COMMITTEE  OPIOID AND OTHER SUBSTANCE USE DISORDERS
Date 07/09/2019
Attendance
Buck X
Buentello X
Herod X
Moreno X
Priola X
Tate E
Wilson X
Winter X
Kennedy X
Pettersen X
X = Present, E = Excused, A = Absent, * = Present after roll call
Time 09:38:17 AM to 05:09:01 PM
Place Old State Library
This Meeting was called to order by Senator Pettersen
This Report was prepared by Elizabeth Haskell
Hearing Items Action Taken
Call to Order and Committee Introductions Committee Discussion Only
Committee Charge and Timelines Committee Discussion Only
Overview of Past Opioid Committee Legislation Committee Discussion Only
Update on State Agency Substance Use Disorder Programs Committee Discussion Only
Update on the Substance Abuse Trend and Response Task Force Committee Discussion Only
Consortium Survey and Results Committee Discussion Only
Provider Education and Prescribing Practices Committee Discussion Only
Alternatives to Opioids and Barriers to Access Committee Discussion Only
Statewide Substance Use Disorder Prevention Committee Discussion Only
Community-based Substance Use Disorder Prevention Committee Discussion Only
Public Testimony on Prevention and Education Committee Discussion Only
Committee Policy Discussion on Prevention and Education Committee Discussion Only
Public Testimony Committee Discussion Only

Call to Order and Committee Introductions - Committee Discussion Only


09:38:20 AM  

Senator Petterson called the meeting to order and reviewed the agenda (Attachment A).  She discussed the committee's goals for the interim and the subject matter for each of the committee's five bills. She explained that the committee will focus on one topic area and one bill at each meeting.  She discussed the meeting dates and the bill request deadlines.

09:43:42 AM  

Representative Kennedy commented on the stakeholder survey conducted by the Consortium for Prescription Drug Abuse Prevention. He invited interested parties to sign up for the committee mailing list. He also indicated that the committee will be considering issues related to the use and misuse of other drugs and alcohol.



Committee Charge and Timelines - Committee Discussion Only


09:46:13 AM  

Anne Wallace, Legislative Council Staff, reviewed the committee charge memorandum (Attachment B).

09:48:42 AM  
Yelana Love, Office of Legislative Legal
Services, reviewed the bill drafting deadlines.



Overview of Past Opioid Committee Legislation - Committee Discussion Only


09:54:11 AM  
Dr. Robert Valuck, Colorado Consortium for Prescription Drug Abuse Prevention (Consortium), discussed the legislation passed in the previous three legislative sessions addressing the prevention, treatment, harm reduction, and recovery of substance use disorders (SUD).  He provided a packet of handouts to the committee and referred to a power point during his presentation (Attachment C).  He discussed the Naloxone awareness campaign being released in August and responded to questions.  Dr. Valuck discussed the Consortium's role in studying prescribing disparities.
10:05:18 AM  

Dr. Valuck continued to discuss drug use and misuse policies and programs established through legislation. Committee questions and discussion about the legislation followed.

10:23:32 AM  

Dr. Valuck continued discussing the legislation passed in the previous three years. Committee members commented on funding for the legislation.

10:32:26 AM  

Committee members discussed the importance of providing medication-assisted treatment to individuals involved in the criminal justice system. Dr. Valuck discussed electronic prescribing.

10:40:56 AM  

Dr. Valuck discussed the overdose death rate.  He told the committee that the average length of time between an individual's first use of an opioid and a subsequent overdose death is ten years. Committee discussion followed.



Update on State Agency Substance Use Disorder Programs - Committee Discussion Only


10:49:00 AM  

Cristen Bates, Office of Behavioral Health (OBH), Department of Human Services (DHS), and Lindsey Myers, Colorado Department of Public Health and Environment (CDPHE), discussed state agency policy and program efforts to address the opioid epidemic and the gaps in intervention and prevention efforts.  Ms. Bates discussed the substance use care continuum.  Ms. Bates and Ms. Myers referred to a power point during their presentation (Attachment D). 

10:53:31 AM  
Ms. Myers discussed substance abuse prevention strategies.
10:54:46 AM  
Ms. Bates discussed the role of DHS in prevention, treatment, harm reduction, and recovery of SUD.
11:01:38 AM  
Ms. Myers discussed CDPHE's role in prevention, treatment, and harm reduction of drug and alcohol misuse.  Ms. Myers responded to questions about safe disposal of opioids.
11:08:13 AM  
Ms. Bates responded to questions about the efforts of the Department of Health Care Policy and Financing (HCPF) and the Consortium around prevention, treatment, harm reduction, and recovery of opioid misuse.  She discussed the role of the Attorney General's Substance Abuse Trends Task Force; department data tracking; community engagement and alignment; and the state lawsuit against pharmaceutical companies and the management of any settlement funds. She discussed the role of the Department of Regulatory Agencies (DORA), the Department of Local Affairs, and the Judicial Department in supporting the education, prevention, and treatment of substance use disorders (SUD).
11:13:05 AM  

Ms. Bates continued to discuss federally funded OBH programs designed to increase prevention outreach.  She told the committee that the federal State Opioid Response Grant is $15,000,000 per year through September 2020.  She spoke about resources for treatment and responded to questions.

11:21:53 AM  

Ms. Myers discussed CDPHE's effort to identify and target population disparities using multiple data sources, such as, death, hospitalization, emergency department, Prescription Drug Monitoring Program (PDMP), EMS, and population health surveys.  She discussed funding distributed by CDPHE to community grantees who work on coalition building, strengthening educational, economic, and societal policies, community or societal norms, and improving access to mental health and substance abuse services.  Ms. Myers discussed the Medication Take Back Program; the loan repayment program for behavioral health providers; CDPHE's efforts to prevent, track, and mitigate HepC and HIV outbreaks; and efforts to create and execute response plans to address emerging issues, such as Fentanyl, Naloxone standing orders, and Opioid Antagonist Bulk Order Fund.

11:28:15 AM  

Ms. Bates discussed ways to expand prevention and treatment opportunities.  Committee members commented on the disparities of treatment options within communities of color.

11:35:36 AM  

Ms. Myers discussed prevention opportunities and the PDMP.

11:47:41 AM  

Ms. Bates discussed the 1115 demonstration waiver for a residential substance use benefit under Medicaid being considered by HCPF; current OBH subsidy for the cost of residential treatment for those under 300 percent of the Federal Poverty Level, including Medicaid beneficiaries; and OBH's work with managed service organizations (MSOs) to prepare for the update by identifying areas of need and priority for funding.

11:49:35 AM  

Ms. Bates discussed policy gaps, including challenges tracking funding data and connecting the investment to outcomes. She discussed the disparity in treatment and overdose prevention expansion efforts among minority populations.  Ms. Bates commented of the need for insurance parity enforcement and coverage.

11:53:25 AM  

Ms. Myers discussed PDMP policy gaps, including the integration of the PDMP into provider workflow; sustainability issues related to grant-funded work; local prevention and harm reduction efforts; shifts in data related to prescriptions for stimulants; and provider education related to benzodiazepines.  Ms. Myers responded to committee questions.



Update on the Substance Abuse Trend and Response Task Force - Committee Discussion Only


12:00:05 PM  

Jose Esquibel, Colorado Consortium for Prescription Drug Abuse Prevention, provided a packet of handouts to the committee (Attachment E). He discussed the duties of the Substance Abuse Trend and Response Task Force (task force) located in the Attorney General's office; Substance Exposed Newborns Steering Committee activities; and gaps identified by the task force, including recovery support.  He discussed the expansion of the Medicaid Special Connections program and responded to questions.



Consortium Survey and Results - Committee Discussion Only


12:12:40 PM  

Dr. Valuck presented on the Consortium's Stakeholder Policy Feedback Survey (Attachment C).  He told the committee that the Consortium received survey responses from 220 individuals and agencies.  He discussed commonly mentioned respondent requests including payment reform, insurance coverage issues, and expanding the focus of the Opioid and Other Substance Use Disorders Study Committee beyond opioids to include stimulants, benzodiazepines, alcohol, and other drugs.  He discussed examples of the comments and ideas provided by survey respondents.  Committee discussion followed.

12:28:33 PM  

Committee discussion with Dr. Valuck continued.  He discussed harm reduction and treatment issues identified in the survey.  He discussed the Consortium specific policy recommendations for prevention, harm reduction, and recovery.

12:41:34 PM  

Senator Pettersen recessed the meeting.



Provider Education and Prescribing Practices - Committee Discussion Only


01:12:38 PM  
Senator Pettersen reconvened the meeting.
01:12:39 PM  

Ronne Hines, Colorado Department of Regulatory Agencies, discussed the provision established in Senate Bill 19-228 that requires medical professionals to complete continuing education on the safe prescribing of opioids prior to license renewal and distributed a handout (Attachment F).  She discussed the timeline associated with rule promulgation and responded to questions.

01:14:45 PM  

Dr. Valuck discussed best practices for providing pain management and treatment and made recommendations about the development of competency standards for health care providers offering pain management treatment.

01:18:38 PM  

Dr. Debra Parsons, Colorado Medical Society, spoke about physician prescribing rates for opioids, the recent decline in opioid prescriptions, and the increased number of PDMP queries.  She discussed the new continuing education requirement for medical provider licensure renewal. She discussed the Colorado CURE Initiative, which focuses on developing guidelines targeted towards limiting opioid use; using alternatives to opioids for the treatment of pain; implementing harm reduction strategies; and improving the treatment and referral of patients with Opioid Use Disorder.  Dr. Parsons responded to questions. Committee discussion followed about the role of pharmaceutical companies in the high rate of prescribing opioids.

01:29:57 PM  

Dr. Jonathan Clapp, Colorado Pain Society, discussed the number of deaths related to opioid use and distributed a handout to the committee (Attachment G).  He explained that access to opioids and insurance coverage for opioids make it easier for physicians to prescribe opioids for pain than other types of more costly treatments.  He told the committee that insurance companies often require doctors to use opioids to treat pain before trying safer alternatives to opioids.  Dr. Clapp discussed the practice of requiring preauthorization for alternative pain treatments and responded to questions.



Alternatives to Opioids and Barriers to Access - Committee Discussion Only

01:47:16 PM  
Paul Mintken, American Physical Therapy Association – Colorado Chapter, provided a handout to the committee and referred to a power point during his presentation (Attachment H).  He discussed the advantages of physical therapy (PT) for the prevention of pain.  He discussed the reduction in opioid use by patients who receive PT. He discussed reimbursement rates for PT from both Medicaid and private insurance companies.
01:57:09 PM  
Bailey LeBoeuf Johnson, Occupational Therapy Association
of Colorado, provided a handout to the committee (Attachment I).  She
gave an overview of the therapies provided by occupation therapist.  She
explained that occupational therapy services can treat pain and addiction.
She spoke about the barriers individuals face when trying to access occupational
therapy services, including cost, lack of awareness of the role of an occupational
therapist, and Medicaid restrictions. She explained that Medicaid does
not cover occupational therapy services that are billed under a psychosocial
diagnosis.
02:06:05 PM  
Amanda Massey, Executive Director, Colorado Association of Health Plans, discussed the recent efforts of insurance carriers and health care providers to expand services for SUD prevention and treatment.  She suggested that more evidence-based treatments for pain management needs to be identified.  Ms. Massey responded to questions.
02:13:31 PM  

Dr. Tuesday Wasserman, Acupuncture Association of Colorado, provided a handout to the committee (Attachment J).  She discussed the benefits of acupuncture to control pain and the cost savings associated with using acupuncture in multimodel care. She told the committee that the lack of insurance coverage for acupuncture services limits access to services for patients seeking care.

02:17:52 PM  
Dr. Shad Sutton, Colorado Chiropractic Association, provided
a handout to the committee (Attachment K).  He provided an overview
of the history of chiropractic care. He discussed the barriers for chiropractic
care as an alternative treatment, including lack of coverage under Medicaid,
and insurance equality.
02:25:37 PM  

Committee questions and discussion with the panel followed.



Statewide Substance Use Disorder Prevention - Committee Discussion Only


02:36:42 PM  
Jeff Jenson, University of Denver, discussed progress and gaps in prevention practice, policy, and science.  He referred to a power point during his presentation (Attachment L).  He discussed the history of drug prevention strategies, such as "Scared Straight" and "Just Say No."  He pointed out that these programs were not effective in decreasing drug use or delinquency.  Mr. Jenson discussed effective prevention programs that focus on interventions that reduce risk factors and increase protective factors.  He suggested that universal prevention for all young people is the most effective way to reduce substance use.
02:50:15 PM  
Mr. Jenson continued to discuss successful prevention programs and responded to questions.
02:58:23 PM  

Jenny Corvalan-Wood, DHS, spoke about the Colorado's Statewide Strategic Plan for Primary Prevention of Substance Abuse: 2019-2024 (https://www.colorado.gov/pacific/cdhs/article/statewide-strategic-plan-primary-prevention-substance-use).

02:59:07 PM  

Ali Maffey, CDPHE, discussed the strategic prevention plan. She spoke about prevention programs offered in middle schools, such as the Communities that Care program.

03:04:12 PM  

Ms. Corvalan-Wood spoke about strengthening Colorado's prevention workforce and strategies for increasing access to funding  prevention programs.

03:09:20 PM  

Ms. Corvalan-Wood pointed out that the statewide strategic plan builds on decades of collaboration between OBH, CDPHE, and other statewide prevention funders and demonstrates a commitment by Colorado’s prevention funders to align funding streams, strengthen the prevention workforce, and promote evidence-based prevention statewide.  Committee discussion about funding gaps.

03:21:27 PM  

J. Douglas Coatsworth, Colorado State University Prevention Research Center, discussed applying prevention science to impact public health and create effective prevention infrastructures. He spoke about the structure and goals of the University Prevention Science Collaborative. He discussed building an effective prevention infrastructure in Colorado. The panel responded to questions.

03:21:28 PM  

Senator Pettersen recessed the meeting.



Community-based Substance Use Disorder Prevention - Committee Discussion Only


03:35:53 PM  
Senator Petterson reconvened the meeting.
03:35:54 PM  

Marion Rorke, Colorado Association of Local Public Health Officials, discussed local efforts related to substance use prevention, including Communities that Care and telehealth services.  She discussed local public health agencies' goals of supporting youth substance use prevention efforts.

03:38:38 PM  

Mae Thompson, Rise Above Colorado, spoke about the efforts of Rise Above Colorado to help youth gain skills and relationships to impact teens' perceptions and attitudes about the risks of substance abuse and to help youth make empowered, healthy choices.

03:42:02 PM  

Rain Green, Rise Above Colorado, discussed her participation with the group and helping other teens make good choices about substance use and misuse.

03:44:06 PM  
Vrishank Bikkumalla, Rise Above Colorado, discussed his work with this group, including developing a vaping website and let other teens know that not all teens are using drugs and alcohol.  Mr. Bikkumalla responded to questions.  Ms. Thompson responded to questions.



Public Testimony on Prevention and Education - Committee Discussion Only


03:51:20 PM  

Sonny Lawrence, representing himself, discussed the use of pain classes as an alternative to opioids.

03:57:08 PM  

Trina Faatz, representing herself, discussed her efforts to prevent substance use by being a resource to children in schools.

04:02:18 PM  

Danielle Felder, Colorado Alliance of Boys and Girls Clubs, discussed the use of after-school programs as a prevention tool for substance use.  She responded to questions and discussed evidence-informed prevention programs used by Boys and Girls Clubs.

04:08:50 PM  

Cheryl Johnson, Colorado Coalition of Massage Therapists and Society for Oncology Massage, spoke about the use of massage to treat pain.

04:11:57 PM  

Laura Embleton, Association of Bodywork and Massage Professionals, discussed the value of massage therapy as a alternative treatment for pain.

04:11:58 PM  

Roni Lawrence, representing herself, discussed her experience as a middle school student and her perspective of the drug culture in schools.



Committee Policy Discussion on Prevention and Education - Committee Discussion Only


04:19:48 PM  

Representative Kennedy discussed areas of interest for legislation, including payment reform, prescribing practices, PDMP integration, provider education, safe disposal of drugs, and local prevention efforts.  Senator Pettersen discussed issues related to the PDMP, screening tools, program and grant funding, and prescribing for children.

04:31:02 PM  
Representative Kennedy and Senator Pettersen discussed which members of the committee will take the lead on each of the committee's bills.  Senator Pettersen reviewed the subject areas for the bills: prevention, treatment, harm reduction, criminal justice, and recovery.  Representatives Kennedy and Buentello and Senators Priola and Winter will work together on the prevention bill.



Public Testimony - Committee Discussion Only


04:40:52 PM  

Megan Broschat, representing herself, testified about her experience as a chronic pain patient.

04:50:26 PM  

Sonny Lawrence, representing himself, testified about his experience as a chronic pain patient.

04:57:20 PM  

Jeannie Pekarek, representing herself, spoke about the fentanyl crisis and her experience as chronic pain patient.

04:57:21 PM  

Roni Lawrence, representing herself, discussed her experience as the daughter of a chronic pain patient.


05:09:01 PM   The committee adjourned.