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I_OpioidSubstance_2019A 09/06/2019 09:34:11 AM Committee Summary

PUBLIC
STAFF SUMMARY OF MEETING
INTERIM COMMITTEE  OPIOID AND OTHER SUBSTANCE USE DISORDERS
Date 09/06/2019
Attendance
Buck X
Buentello X
Herod X
Moreno X
Priola *
Tate X
Wilson X
Winter *
Kennedy X
Pettersen X
X = Present, E = Excused, A = Absent, * = Present after roll call
Time 09:34:11 AM to 02:41:18 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 Committee Discussion Only
Committee Bill Draft Requests Committee Discussion and Voting on Bill Draft Requests
Public Comment and Feedback on Bill Draft Requests Committee Discussion Only
Panel: Families Affected by Substance Use Disorder Committee Discussion Only
High Risk Population’s Access to Substance Use Disorder Services Committee Discussion Only

Call to Order - Committee Discussion Only


09:34:19 AM  

Senator Pettersen called the meeting order.  An agenda was distributed (Attachment A).



Committee Bill Draft Requests - Committee Discussion and Voting on Bill Draft Requests


09:35:14 AM  

Yelana Love, Office of Legislative Legal Services, explained the process for drafting interim committee bills and responded to questions. The committee discussed the rule related to the three day timeline for providing information about bills to the drafters.

09:43:19 AM  

Senator Pettersen discussed her expectations for the bill drafts.

09:44:42 AM  

Senator Kennedy discussed the process for discussing bill drafts. Committee discussion followed.

09:48:01 AM  

Dr. Rob Valuck, Colorado Consortium for Prescription Drug Abuse Prevention (Consortium), discussed the process committee members and stakeholders used to decide on the policies to be included in the bills.

09:52:53 AM  

Representative Kennedy discussed the following policy ideas related to the prevention bill:

  • increase access to other pain management methods, including both other medications and nonpharmaceutical solutions;
  • limit ability to prescribe opioids as the first option for pain treatment;
  • continue seven-day prescribing limit and requirement that prescribers check the Prescription Drug Monitoring Program (PDMP);
  • implement prescribing limits on benzodiazepines;
  • increase competition for PDMP software;
  • address ongoing continuing medical education (CME) competence-based standards;
  • explore community based prevention programs and a grant program to provide training for Screening, Brief Intervention and Referral to Treatment programs;
  • utilize evidence-based prevention programs and establish funding to help expand programs;
  • explore safe disposal options, including implementing a study to evaluate locating a drug incinerator in the state; and
  • expand drug drop box program.
09:59:27 AM  

Committee discussion followed about extending funding for grant writing assistance.

10:01:13 AM  

Jose Esquibel, Consortium, discussed provider education. Committee discussion followed about requiring CME to include a competence-based training regarding opioid prescribing.  Discussion followed about best practices for the CME requirements.

10:14:27 AM  

Representative Kennedy commented on including CME in the prevention bill.



10:25:03 AM
Motion Move to draft a bill on substance use disorder prevention and education to include provider education, payment reform, safe disposal, and other issues discussed,
Moved Kennedy
Seconded
Buck
Buentello
Herod
Moreno
Priola
Tate
Wilson
Winter
Kennedy
Pettersen
YES: 0   NO: 0   EXC: 0   ABS:  0   FINAL ACTION:  Pass Without Objection
10:25:04 AM  

Committee members discussed the possibility of drafting a bill concerning CME only.  Senator Pettersen assigned Representative Kennedy as the contact for the prevention bill.

10:25:06 AM  

The committee discussed topics to be included in the bill related to harm reduction, including extending the immunity from liability to individuals who administer expired naloxone and adding permissive language to statute to allow syringes to be sold at pharmacies.

10:27:31 AM  

Dr. Valuck commented on the issue of pharmacies selling syringes. Committee discussion followed.

10:30:20 AM  

The committee discussed increasing access to needle exchanges by allowing hospitals to operate needle exchange programs without the approval of the county board of health followed.

10:34:53 AM  

Mr. Esquibel responded to questions about needle exchanges. Committee discussion followed about the approval process required by law for needle exchanges. Currently, a county board of health must approve the establishment of a needle exchange located within its jurisdiction.

10:38:53 AM  

Committee discussion followed.

10:40:17 AM  

The committee members discussed funding for syringe exchange programs, best practices for harm reduction programs, and HIV and Hepatitis C testing. Committee discussion followed.

10:44:46 AM  

The committee discussed requiring insurers to reimburse hospitals that issue take-home naloxone kits and discrimination by insurance companies against individuals who fill a naloxone prescription.

10:52:48 AM  

Jamie Feld, Consortium, discussed the displacement of residents who live in or near a housing unit where methamphetamine contamination exists and the difficulty with being required to move.  She discussed an assessment tool used to determine the relative risk of coming into contact with the residue.  Committee discussion followed.

10:55:54 AM  

Mr. Esquibel commented on the issue of removing individuals from homes in close proximity to a home or room contaminated with methamphetamine residue.



11:00:38 AM
Motion Move to draft a bill on harm reduction based on ideas the committee discussed.
Moved Kennedy
Seconded
Buck
Buentello
Herod
Moreno
Priola
Tate
Wilson
Winter
Kennedy
Pettersen
YES: 0   NO: 0   EXC: 0   ABS:  0   FINAL ACTION:  Pass Without Objection
11:00:39 AM  

Senator Pettersen assigned Representative Kennedy as the contact person for the bill.

11:03:55 AM  

The committee discussed criminal justice reform and requiring jails to provide at least one opioid agonist or partial opioid agonist to inmates who are being treated for addiction while incarcerated.

11:13:58 AM  

Dr. Valuck discussed federal regulations around Methadone clinics and other medication-assisted treatment (MAT) requirements.

11:17:27 AM  

Committee members discussed expanding the Law Enforcement Assisted Diversion program by expanding funding, sealing criminal records, and providing continuity of care for individuals leaving jail or prisons.



11:18:47 AM
Motion Move to draft a bill on criminal justice containing ideas the committee discussed.
Moved Kennedy
Seconded
Buck
Buentello
Herod
Moreno
Priola
Tate
Wilson
Winter
Kennedy
Pettersen
YES: 0   NO: 0   EXC: 0   ABS:  0   FINAL ACTION:  Pass Without Objection
11:18:48 AM  

Senator Pettersen assigned Representative Herod as the contact person for the criminal justice bill.

11:19:17 AM  

The committee discussed the issues to be included in the treatment bill.  Senator Pettersen discussed adequate insurance coverage for substance use disorders, co-occurring mental health issues, and updating the community needs funding.

11:26:18 AM  

Ms. Feld discussed issues related to funding received under Senate Bill 16-202, concerning increasing access to effective substance use disorder services through designated regional managed service organizations.

11:29:58 AM  

Ms. Feld discussed issues related to the licensing of certified addiction counselors and the need for more qualified counselors. Committee discussion and comments followed.



11:39:20 AM
Motion Move to draft a bill on substance use disorder treatment to include all items the committee discussed.
Moved Kennedy
Seconded
Buck
Buentello
Herod
Moreno
Priola
Tate
Wilson
Winter
Kennedy
Pettersen
YES: 0   NO: 0   EXC: 0   ABS:  0   FINAL ACTION:  Pass Without Objection
11:39:21 AM  

Senator Pettersen will be the contact person for the treatment bill.

11:39:49 AM  
The committee discussed the provisions that should be included in the recovery bill: conduct an analysis on best practices; assess the standard of care across the state and recovery services, resources, and access; build capacity by providing sustained funding for support services, case management, housing, wrap-around services, and training for peer recovery coaches; establish tax incentives for employers for hiring people in recovery; create a payment structure to provide child care to parents and caregivers in treatment; certify recover support providers; and clarify that housing vouchers for individuals in recovery are for recovery placements; and increase funding for recovery housing voucher program.


11:53:23 AM
Motion Move to draft a substance use disorder recover bill to include the provisions the committee discussed.
Moved Kennedy
Seconded
Buck
Buentello
Herod
Moreno
Priola
Tate
Wilson
Winter
Kennedy
Pettersen
YES: 0   NO: 0   EXC: 0   ABS:  0   FINAL ACTION:  Pass Without Objection
11:54:11 AM  

Senator Pettersen will be the contact person for the recovery bill.  Senator Pettersen discussed the process for bill drafting and stakeholder input.  She discussed the committee's desire to draft a letter to the Governor requesting support for the committee's bills. She also discussed continuing the authority of the committee to meet in non-election years.  She also suggested that the committee draft a letter to the federal government about federal policies regarding SUD.



Public Comment and Feedback on Bill Draft Requests - Committee Discussion Only


11:58:57 AM  

Tonya Wheeler, Advocates for Recovery Colorado, told the committee that she would like statute to establish a definition for "recovery community organization." She discussed the role of recovery communities.

12:04:55 PM  

Sonny Lawrence, representing himself, discussed his idea about a bill addressing concerns of the chronic pain community.

12:11:10 PM  

Committee discussion followed about issues related to treating chronic pain and the ways the committee could include the issues impacting chronic pain patients, such as access to pain medications and provider education.

12:17:29 PM  
The committee discussed the process going forward for stakeholder engagement and bill drafting.
12:18:37 PM  

Representative Wilson distributed a handout (Attachment B).

12:19:38 PM  

Senator Pettersen recessed the meeting.



Panel: Families Affected by Substance Use Disorder - Committee Discussion Only


01:06:12 PM  

Senator Pettersen reconvened the meeting.

01:07:11 PM  

Jade Woodard, Illuminate Colorado, presented on families affected by SUD.  She referred to a PowerPoint during her presentation ( https://leg.colorado.gov/sites/default/files/images/committees/2017/isc_illuminate_9.6.19.pdf ). She spoke about the issues parents who are in recovery face when caring for their families. She spoke about the recommendations Illuminate has to support families in recovery, including: access to transitional housing for families; peer recovery supports; and consistency in the definition of medical necessity.  She discussed revising the Children' Code definition of child abuse to exclude the positive testing of a controlled substance as an indication of child abuse.  She also suggested creating home visitation and navigation supports.  Ms. Woodard discussed concerns related to drug testing of newborns as a determinate for subsequent child abuse.

01:22:12 PM  

Dr. Kathryn Wells, Kempe Center for Prevention and Treatment of Child Abuse and Neglect, presented on the issue of drug affected babies. She discussed the legacy of the Kempe Center. She discussed expanding local capacity for identifying needs, treatment, prevention, and integration.

01:31:52 PM  

Dan Makelky, Colorado Counties, Inc., discussed the ways counties help parents struggling with SUD and the importance of a supportive network in creating an environment for recovery and sobriety. He also discussed the activities and treatment options county departments of human services provide to youth in the youth corrections system.  He recommended using evidence based SUD treatment models for adolescents. He stated that about 60 percent of families in the child welfare system are impacted by SUD.

01:42:04 PM  

Ruby Richards, Douglas County Department of Human Services, spoke about the reasons why the child welfare system does not initially track SUD issues in a family.  Committee discussion followed about how data related to substance abuse would be useful to inform policy decisions and help identify the kind of services the state should offer to this population. Concerns about stigmatizing families by identifying a SUD followed. Committee discussion continued.

01:51:39 PM  

Mr. Makelky spoke about the need for increased services for families struggling with SUD. The committee discussed using data to inform county departments of human services about how to build capacity for services.

01:55:16 PM  

Dr. Wells discussed issues related to foster kids who are receiving services and who lose services when they move in and out of the system. The committee discussed issues related to paying for care and creating a system that provides a continuum of care.  The committee discussed the idea of creating a child welfare regional accountable entity (RAE) to provide children in the child welfare system a continuum of care.



High Risk Population’s Access to Substance Use Disorder Services - Committee Discussion Only


02:00:48 PM  

Julie Reiskin, Colorado Cross-Disability Coalition (CCDC), presented on the barriers persons with disabilities experience when trying to access treatment for SUD.  Ms. Reiskin referred to a PowerPoint during her presentation (https://leg.colorado.gov/sites/default/files/images/committees/2017/sud_treatment_barriers_legislative.fin__0.pdf ).

02:03:14 PM  

Kate Nicolson, CCDC, spoke about her professional experience with the Americans With Disabilities Act (ADA).

02:04:54 PM  

Ms. Reiskin explained that in order to address the needs of persons with disabilities, SUD treatment providers must provide effective communication including American Sign Language; provide or allow personal assistance; and modify policies, practices, or procedures unless it causes a fundamental alteration to the policy, practice, or procedure. She explained that many of the services needed do not cost money but require awareness, cultural competency, and training.

02:10:49 PM  

Ms. Nicolson discussed ways to change attitudes around treating persons with disabilities.  Ms. Reiskin suggested that treatment providers could allow a patient's caregiver to provided services in the treatment facility at no cost to the facility.

02:12:43 PM  

Ms. Nicholson told the committee that individuals with disabilities are facing extreme barriers to receiving SUD treatment.  She suggested that some barriers are related to the demonization of opioids, conflating addiction and dependence, and treating all use as misuse.

02:13:45 PM  

Ms. Nicholson discussed the difference between addiction and dependency. She stated that persons who depend on opioids for pain control cannot find a caregiver who is willing to provide care.

02:15:28 PM  

Ms. Reiskin discussed stigmatizing specific populations when they seek care and the lack of attention to their real needs.

02:19:16 PM  

Ms. Nicolson explained that some state policies limit care to individuals with disabilities, including prescribing limits and policies that negatively impact access to medication. She also told the committee that people with disabilities who have pain, a substance use disorder, or are in recovery are being abandoned in care. She also stated that some providers refuse to treat this population.  She discussed the negative impact of tapering policies on chronic pain patients. 

02:24:39 PM  

Ms. Nicolson discussed issues related to doctors and pharmacists flagging of patients and non-transparent use of medical information She stated that the appropriate response, even to identified drug-seeking behavior, is never dismissal from care.

02:30:49 PM  

The committee discussed the problems related to stigma related to substance use.

02:31:56 PM  

Ms. Reiskin discussed solutions for addressing the stigma persons with disabilities encounter when seeking care, including: assure state oversight is not making things worse; protect providers that treat complex patients especially those who responsibly prescribe opioids and medication-assisted treatment; provide disability cultural competency training for SUD providers and medical providers; check with disability advocates when advancing any policies related to SUD to assure no inadvertent harm; and require Medicaid and state regulated insurance to have exceptions to morphine milligram equivalents limits.

02:36:39 PM  

Committee discussion followed.  Committee members made closing comments.


02:41:18 PM   The committee adjourned.






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