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

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.

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.

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

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

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

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

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.

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). 

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.

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.

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

Ms. Myers discussed prevention opportunities and the PDMP.

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.

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.

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.

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.

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.

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.

Senator Pettersen recessed the meeting.

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.

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.

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.

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.

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.

Committee questions and discussion with the panel followed.

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).

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

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

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.

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.

Senator Pettersen recessed the meeting.

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.

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.

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

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

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

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.

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

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

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

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.

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

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

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

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