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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.



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.



Provider Education and Prescribing Practices - Committee Discussion Only


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



Community-based Substance Use Disorder Prevention - Committee Discussion Only


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



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.


05:09:01 PM   The committee adjourned.