I_OpioidSubstance_2017A 10/23/2017 09:32:09 AM Committee Summary

09:33 AM -- Persons in Recovery from Opioid Use Disorders



09:33 AM -- Representative Pettersen called the meeting to order and reviewed the meeting agenda (Attachment A).



17Opioid1023AttachA.pdf



09:37 AM -- Marie Archambault, representing herself, spoke about her recovery experience. She discussed her first experience with heroin, living with addiction, methadone treatment, and the process by which she went through detoxification and recovery. She also spoke about losing and regaining custody of her child, as well as about people she knew who perished because of their addiction. Committee members asked Ms. Archambault about her recovery experience.



09:55 AM -- Blair Hubbard, representing herself, spoke about her recovery experience. She described her initial experience with prescription opioids as the result of a medical procedure, transitioning to heroin, health problems she experienced as a consequence of heroin use, and benefiting from medication-assisted treatment. She spoke about her recovery, including receiving a master's degree.















10:05 AM



Representative Singer asked Ms. Hubbard and Ms. Archambault to discuss what the committee could do to support recovery options. Ms. Hubbard spoke about safe injection sites and access to needle safety education and information for heroin users. Ms. Archambault said that she believes that everyone deserves treatment and that she supports any solution that provides treatment options.





10:08 AM -- Bill Discussion - Bill 2



Kristen Forrestal, representing the Office of Legislative Legal Services, gave a general overview of Bill 2 (Attachment B). The bill restricts the number of opioid pills that a health care practitioner, including physicians, physician assistants, advanced practice nurses, and dentists, may prescribe for an initial prescription to a 7-day supply and one refill for a 7-day supply, with certain exceptions. The bill clarifies that a health care practitioner may electronically prescribe opioids. Current law allows health care practitioners and other individuals to query the prescription drug monitoring program (PDMP). The bill requires health care practitioners to query the program except under specified circumstances, and requires the practitioner to indicate his or her specialty or practice area upon the query. Amendments 1, 2, 3, 4, and 5 were distributed (Attachments C, D, E, F, and G).



17Opioid1023AttachB.pdf 17Opioid1023AttachC.pdf



17Opioid1023AttachD.pdf 17Opioid1023AttachE.pdf



17Opioid1023AttachF.pdf 17Opioid1023AttachG.pdf



10:12 AM



Senator Priola explained that the language from amendment 1 mimics a law in North Carolina. He also presented two handouts (Attachments H and I). The members discussed the amendment.



17Opioid1023AttachH.pdf 17Opioid1023AttachI.pdf



10:26 AM



Representative Kennedy asked Ms. Forrestal and Senator Tate questions about the bill, including the mandate to use the PDMP.























10:29 AM



Dr. Rob Valuck, representing Colorado Consortium for Prescription Drug Abuse Prevention, responded to committee questions.





10:38 AM



Representative Pettersen explained amendment 2.





10:40 AM



Dr. Valuck and Ms. Forrestal explained amendment 3.





10:41 AM



Senator Priola explained amendment 4 and expressed his interest in including an appropriate sunset timeline for the bill.





10:43 AM



Ms. Forrestal explained amendment 5.



10:46 AM -- Dr. Donald Stader, representing Colorado Medical Society, testified in a neutral capacity. Senator Priola asked Dr. Stader about e-prescribing. Dr. Stader continued to answer committee questions. Dr. Stader also spoke on behalf of the Colorado Chapter of the American College of Emergency Physicians (Colorado ACEP) in favor of supervised injection facilities. Committee members asked Dr. Stader about the positive and negative aspects of supervised injection facilities.



11:21 AM -- Dr. Shannon Jantz, representing Colorado Academy of Family Physicians, testified in a neutral capacity. Representative Buck asked Dr. Jantz about doctors' willingness to use the PDMP. Representative Kennedy asked Dr. Jantz about prescriptions from multiple providers. Senator Priola asked Dr. Jantz about anecdotal experience with the proportion of primary care patients who receive opioid prescriptions.





































11:36 AM -- Dr. Laura Martin, representing Colorado Psychiatric Society and Colorado Society of Addiction Medicine, testified in a neutral capacity on Bill 2 and presented three handouts (Attachments J, K, and L). She discussed the value of including prescriptions for benzodiazepines in the PDMP. Representative Kennedy asked follow up questions.



17Opioid1023AttachJ.pdf 17Opioid1023AttachK.pdf



17Opioid1023AttachL.pdf



11:42 AM -- Dr. Tom Denberg, representing Pinnacol Assurance, testified in a neutral capacity on Bill 2.



11:50 AM -- Gina Moore, representing the Colorado Pharmacists Society, testified in a neutral capacity. Representative Pettersen asked Ms. Moore about benzodiazepine.



11:56 AM -- Heidi Schlossberg, representing herself, testified in a neutral capacity.



12:13 PM -- Dr. Judy Zerzan, representing the Colorado Department of Health Care Policy and Financing (HCPF) , testified in a neutral capacity.



12:19 PM -- Brad Young, representing Rx Plus Pharmacies, testified in a neutral capacity.



12:24 PM -- Cindy Sovine-Miller, representing herself, testified in a neutral capacity. She provided a handout to the committee (Attachment M) and spoke about the benefits of cannabis use for pain.



17Opioid1023AttachM.pdf



12:30 PM -- Jennifer Goodrum, representing Colorado Dental Association, testified in support of the bill as drafted and discussed the barriers dentists face with electronic prescribing.





12:35 PM



The committee recessed.





























01:35 PM -- Bill Discussion - Bill 1



The committee came back to order.



Representative Pettersen explained Bill 1 (Attachment N) and presented amendments 1 and 2 (Attachments O and P). The bill establishes in statute the Opioid and Other Substance Use Disorders Study Committee, consisting of five senators and five representatives from the General Assembly to:



17Opioid1023AttachN.pdf 17Opioid1023AttachO.pdf



17Opioid1023AttachP.pdf



- study data and statistics on the scope of the substance use disorder problem in Colorado;

- study current prevention, intervention, harm reduction, treatment, and recovery resources available to Coloradans, as well as public and private insurance coverage and other sources of support for treatment and recovery resources;

- review the availability of medication-assisted treatment and the ability of pharmacists to prescribe those medications;

- examine the measures that other states and counties use to address substance use disorders;

- identify the gaps in prevention, intervention, harm reduction, treatment, and recovery resources available to Coloradans and hurdles to accessing those resources; and

- identify possible legislative options to address gaps and hurdles to accessing prevention, intervention, harm reduction, treatment, and recovery resources.



The committee is authorized to meet up to 6 times in a calendar year and may report up to six legislative measures to the Legislative Council, which bills are exempt from bill limitations and introduction deadlines. The committee is repealed on July 1, 2023.



The bill directs the University of Colorado Hospital Authority to develop and implement continuing medical education activities to help prescribers of pain medication to safely and effectively manage patients with chronic pain, and when appropriate, prescribe opioids. It also specifies school-based health care centers may apply for grants from the school-based health center grant program to expand behavioral health services to include treatment for opioid and other substance use disorders. Finally, the bill directs HCPF, starting July 1, 2018, to award grants to organizations to operate a substance abuse screening, brief intervention, and referral program (SBIRT).



Ms. Forrestal explained the amendments. The committee members asked Ms. Forrestal questions about the bill and the amendments.





01:54 PM



Christy Chase, representing the Office of Legislative Legal Services, answered procedural questions.

















01:59 PM



Senator Lambert asked about the possible funding source. Ms. Forrestal discussed various funding options.



02:08 PM -- Dr. Laura Martin, representing the Colorado Psychiatric Society and the Colorado Society of Addiction Medicine, testified in a neutral capacity.



02:10 PM -- Gina Moore, representing the Colorado Pharmacists Society, testified in a neutral capacity and discussed the need for mandatory continuing medical education.



02:13 PM -- Elizabeth Pace and Bethany Pace Danley, Peer Assistance Services, testified in a neutral capacity. Ms. Danley discussed available funding for SBIRT training in rural areas in Colorado.



02:21 PM -- Dr. Qing Li, representing herself, testified in a neutral capacity and presented a handout (Attachment Q). Dr. Li answered committee questions.



17Opioid1023AttachQ.pdf



02:36 PM -- Bridget Beatty, representing the Colorado Association for School Based Health Care, testified in a neutral capacity.



02:45 PM -- Larisa Bolivar, representing the Cannabis Consumers Coalition, testified in a neutral capacity and presented a handout (Attachment R).





17Opioid1023AttachR.pdf





03:00 PM -- Bill Discussion - Bill 4



Christy Chase, representing the Office of Legislative Legal Services, explained Bill 4 (Attachment S). The bill modifies the Colorado Health Service Corps Program administered by the Primary Care Office in the Department of Public Health and Environment as follows:



17Opioid1023AttachS.pdf



- for purposes of determining areas in the state in which there is a shortage of health care professionals and behavioral health care providers to meet the needs of the community, allows the primary care office, under guidance adopted by the State Board of Health, to develop and administer state health professional shortage areas using state-specific methodologies;

















- allows behavioral health care providers, which include licensed and certified addiction counselors, licensed professional counselors, licensed clinical social workers, licensed marriage and family therapists, clinical psychologists, advanced practice nurses, and physicians certified or trained in addiction medicine, pain management, or psychiatry, and candidates for licensure as an addiction counselor, professional counselor, clinical social worker, marriage and family therapist, or psychologist, to participate in the loan repayment program on the condition of committing to provide behavioral health care services in health professional shortage areas for a specified period;

- directs the advisory council to prioritize loan repayment and scholarships for those behavioral health care providers, candidates for licensure, or addiction counselors who provide behavioral health care services in nonprofit or public employer settings but permits consideration of applicants practicing in a private setting that serves underserved populations;

- establishes a scholarship program to help defray the education and training costs associated with obtaining certification as an addiction counselor or with progressing to a higher level of certification;

- adds 2 members to the advisory council that reviews program applications, which members include a representative of an organization representing substance use disorder treatment providers and a licensed or certified addiction counselor who has experience in rural health, safety net clinics, or health equity;

- modifies program reporting requirements and requires annual reporting that coincides with required SMART Act reporting by the department; and

- requires the General Assembly to annually appropriate $2.5 million from the Marijuana Tax Cash Fund to the primary care office to provide loan repayment for behavioral health care providers and candidates for licensure participating in the Colorado Health Service Corps and to award scholarships to addiction counselors participating in the scholarship program.





03:04 PM -- Dr. Brad Sjostrom, representing the Colorado Providers Association, testified in support of Bill 4.



03:05 PM -- Mita Johnson, representing the Colorado Providers Association, testified in support of Bill 4.



03:08 PM -- Jennifer Miles, representing the Colorado Providers Association, testified in support of Bill 4. Ms. Miles answered committee questions.



03:19 PM -- Representative Pettersen permitted Dr. Sjostrom to testify in support of Bill 5 prior to leaving the witness table.



03:29 PM -- Gina Shimeall, representing herself, testified in a neutral capacity.



03:39 PM -- Dr. Reo Leslie, representing himself, testified in a neutral capacity and presented a handout (Attachment T).



17Opioid1023AttachT.pdf



03:43 PM -- Frank Cornelia, representing the Colorado Behavioral Health Council, testified in a neutral capacity.



















03:46 PM -- Bill Discussion - Bill 3



Christy Chase, representing the Office of Legislative Legal Services, explained Bill 3 to the committee (Attachment U). The bill:



17Opioid1023AttachU.pdf



- excludes supervised injection facilities from the laws regarding public nuisance;

- allows local public health agencies to establish clean syringe exchange programs without prior approval from their governing health boards and grants civil immunity to a person who provides a clean syringe in accordance with a clean syringe exchange program;

- specifies that hospitals may be used as clean syringe exchange sites;

- allows school districts and nonpublic schools to develop a policy by which schools are allowed to obtain a supply of opiate antagonists and school employees are trained to administer opiate antagonists to individuals at risk of experiencing a drug overdose; and

- increases the criminal penalties related to synthetic opioids.



04:13 PM -- Adeline Hodge, representing the Colorado Association of School Nurses, the Colorado Providers Association, and the Colorado Association of Local Public Health Officials, testified in a neutral capacity.



04:17 PM -- Maureen Cain, representing the Colorado State Public Defender's Office, testified in a neutral capacity.



04:30 PM -- Christie Donner, representing Colorado Criminal Justice Reform Coalition, testified in a neutral capacity.





04:35 PM



Dr. Valuck testified in support of Bill 5 and Bill 6. He expressed that there is a significant need for in patient treatment.



04:38 PM -- Lisa Raville, representing the Harm Reduction Action Center, testified in support of supervised injection facilities and presented a handout (Attachment V). Ms. Raville answered questions from committee members about concerns regarding supervised injection sites.



17Opioid1023AttachV.pdf



04:56 PM -- Heidi Schlossberg, representing herself, testified in a neutral capacity.





















04:57 PM -- Angela Bonaguidi, representing the Colorado Organization for the Treatment of Opioid Dependence, testified in a neutral capacity and distributed a handout (Attachment W).



17Opioid1023AttachW.pdf



04:59 PM -- Jamie Feld, representing Boulder County Public Health, testified in a neutral capacity. Ms. Feld responded to committee questions regarding naloxone in public schools.



05:10 PM -- Meghan Dollar, representing the Colorado Municipal League, testified in a neutral capacity and expressed concern regarding local control of proposed injection sites.



05:12 PM -- Frank Cornelia, representing the Colorado Behavioral Health Council, testified in a neutral capacity. Mr. Cornelia responded to questions from committee members regarding incentives for pursuing treatment and increasing inpatient programs in Colorado.



05:18 PM -- Michael Miller, representing Young People in Recovery, testified in a neutral capacity and expressed support for safe injections sites and other harm reduction measures.





05:23 PM -- Bill Discussion - Bill 5



Representative Pettersen explained Bill 5 (Attachment X). The bill adds residential and inpatient substance use disorder services to the Colorado medical assistance program. The benefit will not be effective until HCPF seeks and receives any federal authorization necessary to secure federal financial participation in the program.



17Opioid1023AttachX.pdf



Representative Pettersen described potential changes to the bill draft.



05:26 PM -- Gina Shimeall, representing herself, testified in a neutral capacity.





05:28 PM -- Bill Discussion - Bill 6



Brita Darling, representing the Office of Legislative Legal Services, summarized Bill 6 and distributed it to the committee (Attachment Y). The bill prohibits individual and group health benefit plans from requiring prior authorization for medication-assisted treatment. The bill requires all individual and group health benefit plans to include in the carrier's prescription drug benefit coverage a transdermal analgesic lidocaine patch for treatment of pain.



17Opioid1023AttachY.pdf















Additionally, all individual and group health benefit plans that cover physical therapy, acupuncture, or chiropractic services shall not subject those services to dollar limits, deductibles, copayments, or coinsurance provisions that are less favorable than those applicable to primary care services under the plan if the covered person has a diagnosis of chronic pain and has or has had a substance use disorder diagnosis.



The bill prohibits carriers from requiring a covered person to undergo step therapy using a prescription drug or drugs that include an opioid before covering a non-opioid prescription drug recommended by the covered person's provider.

The bill requires the Colorado Medical Assistance Program to authorize reimbursement for the brand-name version of intranasal naloxone hydrochloride, or Narcan, in addition to the generic version of the drug.

The bill prohibits the requirement that a recipient of medical assistance undergo a step-therapy protocol using a prescription drug containing an opioid prior to authorizing reimbursement for a non-opioid prescription drug recommended by the person's health care provider.

The bill prohibits prior authorization under the Colorado medical assistance program for medication-assisted treatment for substance use disorders.



Amendment 1 was distributed to the committee (Attachment Z). Representative Kennedy provided additional details about the bill. Committee members dialogued about the provisions of the bill.



17Opioid1023AttachZ.pdf



05:38 PM



Representative Kennedy responded to committee questions regarding drug pricing, and specific medication and dosages. Committee members continued to discuss the bill.





05:53 PM



Ms. Darling explained amendment 1 to the committee. Representative Pettersen commented on amendment 1.



05:55 PM -- Heidi Scholssberg, representing herself, testified in a neutral capacity.



05:56 PM -- Dr. Judy Zerzan, representing HCPF, testified in a neutral capacity and expressed concerns regarding prohibition of prior authorizations. Dr. Zerzan responded to committee questions regarding medication assisted treatment and prior authorizations.



06:09 PM -- Sara Orrange, representing the Colorado Association of Health Plans, testified in a neutral capacity and expressed concern regarding cost sharing provisions in the bill. Ms. Orrange responded to committee questions regarding cost sharing.





06:15 PM



The meeting adjourned.