I_OpioidSubstance_2019A 09/24/2019 09:37:08 AM Committee Summary

Representative Kennedy called the meeting to order and an agenda was distributed (Attachment A).

Representative Kennedy introduced the prevention bill (Attachment B). Kirsten Forestal, Office of Legislative Legal Services (OLLS) bill drafter, gave a quick overview of the bill. Representative Kennedy noted subcategories of the prevention bill, including community prevention efforts, safe disposal, and mandatory coverage provisions. Ms. Forestal delved into the specifics of the bill. The bill gets rid of several repeal dates. Section 13 of the bill continues an annual appropriation to the Colorado Department of Public Health and Environment (CDPHE). Section 14 appropriates money to the Department of Health Care Policy and Financing (HCPF). Section 15 appropriates money to the Office of Behavioral Health (OBH) in the Department of Human Services.

Ms. Forestal noted some outstanding issues that need to be resolved with the bill.

Representative Herod noted that each bill out of this committee should have diversity language included. Ms. Forestal was asked to include the language by Representative Kennedy.

Senator Petterson noted that the ongoing funding for grants is building off of previous year's work.

Steve Silvern, representing himself, discussed the morality of punishing law abiding chronic pain sufferers. Carrie Carlson, representing herself, shared her husband's story with chronic pain management and palliative care. Representative Kennedy asked the panel about the 2018 hospice and palliative care bill and noted that there are currently exemptions for chronic pain patients for the seven day limit on opioid prescriptions.

Dr. Don Stader, representing the Colorado Medical Society, noted opposition to regulatory language in the bill about benzodiazepines. Dr. Stader is concerned that this added physician task may get in the way of patients' access to benzodiazepines. Dr. Stader noted that there is a lack of evidence suggesting that there needs to be a query each time when prescribing benzodiazepines. Dr. Jonathan Clapp, representing the Colorado Medical Society, noted that pain psychology is very important and should be added to other therapies listed in the bill.

Representative Herod asked Dr. Stader and Dr. Clapp if this bill would add any undue burdens. Representative Kennedy asked about benzodiazepines. Dr. Stader noted there are risks associated with benzodiazepines and that it is a co-existing epidemic with the opioid epidemic.

Representative Buck asked about the work the Colorado Medical Association is doing to address training and education. Dr. Stader discussed Colorado Cures, a program for creating and implementing guidelines.

Dr. Lisa Pearson, representing herself, suggested including the nursing board and other boards in addition to the Medical Board that have an interest in the issue. Nita Walter, representing herself, discussed accessing care in rural Colorado and managing chronic pain. Kathy Oatis, representing the Occupational Therapy Association of Colorado, suggested adding occupational therapists and noted that occupational therapy cannot bill Medicaid so they are requesting a state waiver. Dr. Pearson noted that there is stigma associated with chronic pain and that there may need to be education for providers.

Representative Kennedy asked Dr. Pearson about stigma and if there are any policies allowing for this to occur. Dr. Pearson noted that there is a lot of work required to fill an opioid prescription.

Representative Buck asked the committee to make exceptions for chronic pain patients expressly in bill language.

Tracy Anselmo, representing herself, voiced concerns about a university lead collaboration. Ms. Anselmo noted that this may be better suited by expanding existing collaboration. Lawrence Hullinghurst, representing the Acupuncture Society of Colorado, discussed keeping acupuncture in the language in the bill. Jason Hoffer, Colorado Association of Health Plans, noted general concern regarding the insurance commissioner promulgating rules and with Section 2 of the bill.

Lauren Snyder, representing Mental Health Colorado, supports section 11 of the bill that may require providers to query regarding prescriptions other than opioids such as benzodiazepines.

Yelana Love, OLLS, discussed the harm reduction bill summary (Attachment C). Ms. Love discussed hospital reimbursement for opioid antagonist kits, extension of civil and criminal immunity for persons who use an expired opioid antagonist in a good faith effort, and the removal of the requirement that entities need local health board approval for syringe exchange programs.

Dr. Stader, representing the Colorado Medical Society, spoke in support of hospital reimbursement for opioid antagonist or naloxone kits. Dr. Stader suggested adding language about discrimination for those who fill an opioid prescription. Katie Wolf, representing Colorado Pharmacist Society, suggested using the language of 'non-prescription' syringes in the bill and to add good samaritan language for pharmacists. Rica Rodriguez, representing herself, discussed adding funding for syringe access programs.

Senator Moreno asked about the cost of syringes . Ms. Woldf said she would follow up with the committee. Senator Moreno also asked about the efficacy of expired naloxone kits. Dr. Stader provided rational for why it would maintain efficacy. Dr. Rob Valuck, Colorado Consortium for Prescription Drug Abuse Prevention (Colorado Consortium), cited a growing body of evidence about the remaining efficacy of naloxone in expired kits.

Steve Silvern, representing himself, shared the story of Martin Schneider and the need for balance with prescribing opioids to ensure chronic pain patients still have access.

Shelby Ross, OLLS, spoke about the criminal justice bill summary (Attachment D). Ms. Ross discussed requiring the Department of Corrections (DOC), the Department of Human Services (DHS) facilities, and local jails to make available at least one agonist and one antagonist, and continuity of care for inmates who leave those facilities. Ms. Ross also discussed setting up safe stations to allow people to turn over controlled substances and an appropriation to OBH for criminal justice diversion programs. Representative Herod asked that diversity language be added to the bill.

Senator Moreno asked about the definition of safe station. The Senator wants to ensure its all inclusive.

Dr. Pearson, representing herself, discussed including medically assisted treatment (MAT) providers in the OBH system to be able to match people better.

Valerie Schlect, representing herself, suggested referring to opioid antagonists instead of narcan in the bill.

Brita Darling, OLLS, discussed the treatment bill (Attachment E). Ms. Darling discussed the sections of the bill including funding for student loan forgiveness and scholarships, pharmacy reimbursement, and state child care treatment study. Ms. Darling noted some outstanding issues with the bill that need to be addressed.

Katie Wolf, representing herself, noted the work she is doing with HCPF. Snyder, representing Mental Health Colorado, expressed support for several sections of the bill. Dr. Pearson, representing herself, discussed MAT providers who are neither primary care or behavioral health and that those providers are left out in the bill.

Dr. Valuck answered committee questions.

Senator Moreno asked a question about recovery residences. Ms. Feld responded.

Chair Kennedy asked Ms. Snyder if she was monitoring the mental health parity bill from last session. Ms. Snyder noted that they are monitoring the bill and that there appears to be some confusion around the MAT portion of the bill.

Yelana Love, OLLS, discussed the recovery bill (Attachment F). Ms. Love discussed sections of the bill including the continuation of the Opioid and Other Substance Use Disorders Committee, increased funding for the housing voucher program, requiring the center to conduct a comprehensive study of Colorado substance use disorder, and ongoing research on prenatal substance exposure.

Jordan Smith, discussed prenatal substance exposure and its relationship to recovery. Representative Buck asked if there was any state laws related to substance exposed children. Representative Herod responded and noted that direct harm can be referred to child welfare.

Representative Herod noted that she believed there are other ways to detect substance use exposure in newborns, in answer to Senator Moreno's question.

Lauren Snyder, representing Mental Health Colorado, discussed concern with recovery language in the bill. Jose Esquibel, Colorado Consortium, noted some issues with the housing voucher portion of the bill.

Jeannie Pekarek, representing herself, thanked the committee for the work they have done and discussed her chronic pain management,  alternative therapies, and accountability of providers to care for pain sufferers. Megan Broschat, representing herself, discussed financial barriers to treatment and the difficulty for pain sufferers to receive proper treatment. Ms. Broschat suggested setting aside funding in one of the bills for provider education. Michelle Figurelli, representing herself, discussed stigma of chronic pain from her own experience as a registered nurse.

Representative Kennedy recessed the committee.

Tracy Ritter, representing herself, discussed her role in advocating for substance use disorder for Aurora and Aurora Mental Health in her current position.

Reprsentative Kennedy made closing remarks and adjourned the committee.