I_OpioidSubstance_2018A 08/22/2018 09:41:55 AM Committee Summary

Representative Pettersen called the meeting to order and reviewed the meeting agenda [Attachment A].

Dr. Rob Valuck, Colorado Consortium for Prescription Drug Abuse Prevention, presented on a statewide survey commissioned by the Public Awareness work group [Attachment B].  Dr. Valuck referred to a PowerPoint throughout his discussion [Attachment C].  He stated that the statewide survey focused on gaining a better understanding of Coloradans' knowledge of behaviors regarding opioids. He told the committee that the survey evaluated prescription medication use, prescription medication storage and disposal, opioid misuse prevention, and public policy support.  

Dr. Valuck continued his presentation and responded to questions.  He explained the dangers of combining opioids and anxiety medication.  Committee discussion followed.

Dr. Valuck discussed the survey findings related to safe storage and disposal of opioids, substance misuse prevention, and public policy issues.  Dr. Valuck responded to questions about the Prescription Drug Monitoring Program (PDMP).  

Dana Malick, PhRMA, discussed the steps pharmaceutical manufacturers are taking to participate in a solution to the opioid crisis.  Ms. Malick referred to a PowerPoint throughout her presentation [Attachment D].  She discussed PhRMA's public policy strategies to combat the opioid crisis, including ensuring patients with legitimate medical needs have access to appropriate pain treatment options and ensuring patients vulnerable to abuse or addiction receive appropriate treatment.  She discussed the seven-day prescribing limit for opioids, mandatory prescriber training, and access to a range of options to treat drug addiction.

Ms. Malick continued her presentation and responded to questions.  Committee members discussed drug pricing and the low cost of opioids, drug abuse deterrents, alternative pain management medications, certified additiction counselors, and access to addiction treatment.

Committee questions and discussion continued.  The committee discussed prescriber training and continuing education for prescribers, collaborative solutions for treatment and recovery funding, and PhRMA's position on basing pain management on a fact-based standard rather than on the fifth vital sign standard.

Gina Moore, Colorado Pharmacist Society (CPS), presented on CPS's proposals to further address opioid misuse in Colorado and provided handout to the committee [Attachment E] .  She discussed CPS's current sunrise application for pharmacy technician registration and the role some pharmacy technicians have in diverting controlled substances.

Ms. Moore continued her presentation and discussed e-prescribing as a tool to reduce prescription forgeries.  Committee discussion followed about pharmacy technicians.  

Dr. Don Stader, Colorado Medical Society (CMS), discussed CMS's recommendations to address the opioid crisis.  He told the committee that CMS would like to increase access to care and decrease the use of opioids.  He discussed the barriers that keep patients from selecting alternatives to opioids for the treatment of pain.  He discussed ensuring that insurance coverage works for opioid addicted patients, increasing the health care workforce, and issues around e-prescribing.  Dr. Stader discussed issues facing practitioners when providing patients with information about drugs being prescribed.  Committee discussion about drug pricing followed.  

Dr. Stader responded to questions and discussed the use of both prescription and illicit opioids, treating opioid use disorders more effectively, and the cost of opioids compared to other pain treatments.  Committee discussion and questions continued.  

Discussion continued about patients who are mislabeled as opioid seekers, e-prescribing issues, issues around the use of the PDMP, and continuing education on opioid prescribing and treatment.

Kacy Crawford, Colorado Department Public Health and Environment and Peter Rumbach, University of Colorado - The Evaluation Center, presented on alcohol abuse and binge drinking. They referred to a PowerPoint presentation throughout their discussion [Attachment F].

Mr. Rumbach discussed the definition of excessive drinking, standard drink sizes, alcohol use by high school students, and the number of deaths related to heavy drinking and binge drinking.  He also discussed injuries, violence, and risky sexual behaviors related to drinking.  Mr. Rumbach spoke about the long term risks of cancer, high blood pressure, learning and memory disorders, and mental health disorders related to drinking alcohol.

Ms. Crawford discussed effective policies to reduce excessive drinking.  She discussed limiting alcohol outlet density, strengthening liability laws, alcohol tax increases, and the economic cost of excessive drinking.  Ms. Crawford responded to questions.

Ms. Crawford told the committee that communities with stronger alcohol policies have less adult alcohol-related impaired driving, alcohol-related motor vehicle crash deaths among youth and adults, adult binge drinking, youth drinking, youth binge drinking, alcohol-related homicides and suicides, and alcoholic cirrhosis and mortality rates.  Committee discussion and questions followed. Committee comments followed.

Representative Pettersen commented on the committee's afternoon agenda and adjourned the meeting.

Chief Rick Brandt, Substance Abuse Trend and Response Task Force, discussed the efforts of law enforcement in addressing the sale and use of heroin.  He spoke about the seizure rate of heroin by police officers, the number of overdose deaths from heroin, and the use of Narcan by first responders.  Chief Brandt spoke about Law Enforcement Assisted Diversion (L.E.A.D.) and the co-responder model.  Chief Brandt responded to questions.

Committee members dialogued with Chief Brandt about the L.E.A.D. program and the co-responder model.

Christian Mohr, Colorado Bureau of Investigation, spoke about the history of law enforcement drug task forces.  

Dan May, District Attorney 4th Judicial, spoke about the number of heroin distribution and possession cases prosecuted in the 4th Judicial District.  He pointed out that law enforcement task forces are an effective way to set enforcement and treatment policies across local jurisdictions.  He discussed funding needs for task forces.  He discussed the benefits to funding treatment programs for individuals with substance use disorders, and suggested that law enforcement establish a referral system for these individuals, which would include a referral to a county department of health for treatment.  

Jose Esquibel, Colorado Office of the Attorney General (AG), told the committee about the AG's Summit.  He discussed concerns about work force capacity of law enforcement, opioid response teams, targeting drug trafficking, coordinating with the US Drug Enforcement Administration (DEA), enforcement actions against DEA registrants' operations that are outside of the law, and tracking overdose deaths. Committee questions followed.  

DA May responded to questions about the use of marijuana and whether marijuana use increases the likelihood of using other drugs.  Committee discussion followed about substance use in Native American communities.  Discussion followed about the best use of state funds to address adverse social issues related to drug use.  

DA May discussed the 4th Judicial District drug court and diversion efforts.  He expressed concern that state law could affect the success of drug courts.

Dr. Sarah Rowan, Denver Public Health, discussed infectious diseases related to drug use.  She provided background information about Hepatitis C and HIV.

Dr. Rowan discussed the effects of untreated Hepatitis C.  She spoke about HIV diagnosis related to drug use.  She also discussed the incidents of Hepatitis A and B cases in Colorado and bacterial infections effecting intravenous drug users.  She discussed prevention strategies, barriers within the Medicaid system for treating Hepatitis C, and partnerships to address the disease.

Nancy Steinfurth, Liver Health Connection (LHC), described the work of the LHC.  Ms. Steinfurth referred to a PowerPoint during her presentation [Attachment G].  She discussed the US Health and Human Services perspective that the opioid crisis is part of a syndemic.  She presented recommendations for public policy which partners infectious diseases testing and treatment with substance use treatment.

Lisa Pearson, Colorado Association of Nurse Anesthetists, presented on pain management and rural health perspectives and provided a PowerPoint presentation [Attachment H].  She discussed discrimination directed toward nurse anesthetists by insurance companies' that are reluctant to contract directly with these providers and the difficulty nurse anesthetists have getting credential to practice in hospitals and surgical clinics.  She discussed Medicaid reimbursement rates.

Ms. Pearson continued her presentation.  She recommended solutions to her concerns related to the ability of nurse anesthetists to receive insurance and Medicaid reimbursements and to prescribe medical marijuana.

Steve Silvern, Pain Education Project, told the committee that the Centers for Disease Control data shows the rate of overdose deaths has increased since the number of opioid prescriptions have gone down.   He asked that the legislature pass a bill to eliminate the the limits on opioid prescribing.

Linda Hughes, representing herself, testified regarding her son's experience with addiction.  She responded to committee questions.

Melanie Dreiling, Boulder County Jail, testified regarding substance use disorder treatment in jail and for pregnant women.

Scot Williams, Boulder County Sheriff's Office, testified regarding the work of the Boulder County Task Force.  He responded to committee questions.  

Qing Li, representing herself, testified regarding prenatal screening and distributed a handout [Attachment I].  

Yelena Love, Office of Legislative Legal Services, discussed the need for one point of contact for each bill idea and distributed a handout [Attachment J].  She noted that the drafters require sufficient information to draft bills by Monday and described how fiscal notes are created for the bill drafts.

Committee discussion ensued regarding topic areas.

Representative Pettersen made announcements regarding the committee's schedule.