I_OpioidSubstance_2017A 08/01/2017 09:00 AM Committee Summary

09:36 AM -- Call to Order & Opening Remarks



Representative Pettersen made opening remarks and explained the committee's business for the day.





09:38 AM -- Providers' Perspectives On Opioid Medications



Dr. Don Stader and Dr. Katie Lozano, representing the Colorado Medical Society, began their presentation and provided other informational material to the committee (Attachment A). Their presentation focused on the history of opioid prescribing and the origins of the opioid epidemic in the U.S., the rising rate of overdose deaths, and local physicians' response and outreach efforts, including the creation of the Colorado Consortium for Prescription Drug Abuse. They also described implementing pain management strategies, where their core objectives are to maintain and expand ongoing physician outreach, continuing medical education, training on pain management and addiction treatment; to ensure sustained treatment and support for addicted patients and support for both caregivers and first responders; and to provide optimal practice support to physicians evaluating and treating patients with pain conditions. In addition, they emphasized the importance of increased use of the prescription drug monitoring program (PDMP). The witnesses responded to committee member questions.



17Opioid0801AttachA.pdf











10:31 AM



Dr. Shannon Jantz, representing the Colorado Academy of Family Physicians, spoke about the opioid epidemic from the standpoint of family physicians. She focused on interactions with patients in urgent/emergent care compared to a clinical setting, explained the differing challenges of providing care in rural and urban settings, and described the differences between treating chronic and acute pain.





10:41 AM



Dr. Greg Ingalls, representing the Colorado Dental Association, spoke about the issue of opioid medication use in the dental practice setting. He described methods for limiting opioid prescriptions in the dental practice setting and discussed partial fill prescriptions and the PDMP. Dr. Ingalls responded to committee member questions.





11:02 AM -- Role of Pharmacists in Dispensing Opioid Medications



Dr. Jeff Lalama, representing the Colorado Pharmacists Society, presented a handout (Attachment B) and spoke about dispensing opioid prescriptions. He encouraged increasing the use of e-prescribing, integrating the PDMP with electronic health record software systems, limiting the days supplied for opioid prescriptions for the treatment of acute pain, and increasing public awareness of drug take-back programs. Dr. Lalama responded to questions regarding monitoring of pharmacy technicians, warning labels on opioids, and partial fill prescriptions.



17Opioid0801AttachB.pdf



11:32 AM



Ky Davis, representing RX Plus Pharmacies, presented a handout to the committee (Attachment C) and described current initiatives to reduce opioid misuse in rural areas and to increase naloxone and suboxone training and use in rural pharmacies. Mr. Davis responded to committee questions.



17Opioid0801AttachC.pdf









































11:48 AM



Nikki Price and Lynn Stover, representing the Colorado Retail Chain Pharmacies, presented a handout to the committee (Attachment D). They discussed the role of chain pharmacies in preventing prescription drug diversion and abuse. They explained that chain pharmacies support a collaborative approach to curb abuse while preserving patient access to medically necessary pain medications. Many chain pharmacies have implemented zero-tolerance policies, loss prevention and internal security systems, and strict employment policies to ensure that prescription drugs are accounted for from distribution centers to the point of dispensing. They also encouraged the use of e-prescribing and limiting initial fills of controlled substance prescriptions.



17Opioid0801AttachD.pdf



12:04 PM



The panelists responded to committee questions.





12:13 PM -- Chronic Pain & Pain Management



Dr. Joshua Blum, representing the Colorado Pain Society, presented a handout (Attachment E) on chronic pain and the biopsychosocial model of pain. He explained the "fear avoidance model" in which a person experiences an injury, and it either leads to a pain experience resulting in no fear, confrontation and recovery, or it leads to the pain catastrophizing, pain-related fear, avoidance, and often disuse, depression, and disability. He spoke about negative psychosocial variables and protective factors that play a role in the development of substance use disorders related to pain, as well as about the challenges of addressing chronic pain treatment in the clinical setting. Dr. Blum responded to committee questions.



17Opioid0801AttachE.pdf



12:37 PM



Dr. Alan Bielsky, representing the Colorado Society of Anesthesiology, presented a handout (Attachment F) and spoke about the role of anesthesiologists in treating chronic pain and opioid alternatives. He described multimodal analgesic therapy that includes opioids, adjunctive pain medicines, and non-medical therapy such as physical therapy and massage.



17Opioid0801AttachF.pdf



12:50 PM



The committee recessed.















01:41 PM -- Current Options for Addiction Treatment



Mike Butler and Amy Lowe, representing Arapahoe House, presented a handout (Attachment G) and discussed the treatment options and challenges at Arapahoe House. Arapahoe House focused on outpatient, residential, and medication-assisted treatments that provide deep therapeutic and life-changing impact. They have observed a significant increase in treatment needs related to opioid admissions, as well as workforce shortages for care workers.



17Opioid0801AttachG.pdf



02:10 PM



Frank Cornelia, representing the Colorado Behavioral Health Care Council (CBHC), presented a packet of handouts (Attachment H) to the committee. He discussed the CBHC's work and the work of its member organizations, including the regional managed service organizations (MSOs) that are contracted with the Office of Behavioral Health to provide substance use disorder treatment services for patients throughout Colorado..



17Opioid0801AttachH.pdf



02:25 PM



Daniel Darting, representing Signal Behavioral Health Network, discussed addiction services provided by managed service organizations. He discussed Senate Bill 16-202 and the needs assessment required by the bill.





02:31 PM



Lorez Meinhold, representing the Keystone Policy Center, discussed the needs assessment performed pursuant to SB16-202, focusing especially on the continuum of care. In order to determine how to effectively allocate funding for substance use disorder services in Colorado, the Keystone Policy Center conducted a needs assessment. Ms. Meinhold explained that stakeholders across the state reported a need for funding that is flexible at the regional and community levels, sustainable, and focused on the development of a continuum of care.





02:40 PM



Mr. Darting and Ms. Meinhold responded to committee member questions.





























02:48 PM



Brad Sjostrom, representing Colorado Association of Addiction Counselors and Colorado Providers Association, discussed access to treatment including cost, limited numbers of providers and treatment locations, stigma, and individual readiness.





03:00 PM



Angela Bonaguidi began her segment of the presentation and discussed her work with Colorado Organization for the Treatment of Opioid Dependence (COTOD) and narcotic treatment organizations and described the use of medication-assisted treatments (MAT). She highlighted the effectiveness of MAT when used for different lengths of time and described the different types of medications used. Ms. Bonaguidi described maintenance treatment for persons with opioid use disorders using MAT and stated her objection to the idea that MAT is replacing one addiction with another. She discussed the clinical aspects of MAT, including how it is prescribed by physicians and providers, dispensed by regulated facilities, and used by patients. She discussed reimbursement rates for MAT and gaps in treatment under Medicaid and Medicare. She discussed recommendations, including increased reimbursement rates, workforce support, modernization of the central registry of MAT care in the Office of Behavioral Health, and preventing patients from being detoxed from MAT treatment when moving into a higher level of care. Ms. Bonaguidi responded to questions from the committee.





03:12 PM



Dr. Laura Martin, representing the Center for Dependency, Addiction, and Rehabilitation (CeDAR) and the Colorado Society of Addiction Medicine (COSAM) began her presentation to the committee (Attachment I). She discussed opioid agonist therapy. She explained CeDAR's multidisciplinary approach to treatment, including addiction medicine, addiction psychiatry, nursing, counseling, psychology, spirituality, nutrition, fitness, recovery support, and family services. CeDAR supports medication-assisted therapies, including the use of methadone, buprenorphine, and naltrexone. She also discussed challenges to addiction treatment, including the lack of providers and clinical support, spotty insurance coverage for treatment, lack of health system support, co-occurring behavioral and medical health conditions, episodic treatment models, and lack of housing options.



17Opioid0801AttachI.pdf



03:35 PM



The panelists responded to committee questions.































03:57 PM -- Recovery Support



Rourke Weaver, representing Red Rock Recovery Center, Michael Miller, representing Young People in Recovery, and Tonya Wheeler, representing Advocates for Recovery Colorado, spoke about their recovery experiences and provided two handouts to the committee (Attachments J and K). They explained the importance of using non-stigmatized language for people in recovery, highlighted the lack of recovery services and support, and described the experiences of people who have been both successful in their recovery and who have faced ongoing challenges. They also emphasized the importance of meaningful and gainful employment in the recovery process. The panelists answered committee questions.



17Opioid0801AttachJ.pdf 17Opioid0801AttachK.pdf



04:38 PM -- Discussion of Task Force



Dr. Rob Valuck, representing the Colorado Consortium for Prescription Drug Abuse Prevention, and Jose Esquibel, representing the Attorney General's Office discussed the Task Force's planned activities. The prospective topics the Task Force will focus on are prevention and early intervention, and treatment and recovery. Committee members also suggested a focus on hard reduction, payment reform (PDMP, partial fill), development of new technologies to reduce addictiveness, benzodiazepine use disorder, law enforcement.





04:45 PM



Dr. Valuck explained that prevention and early intervention will include discussions of the PDMP, harm reduction, pain treatment, the role of providers and pharmacists, and successful programs in other states.





04:50 PM



Dr. Valuck explained that treatment and recovery will include workforce discussion, payment-related issues, access to types of treatment, interaction with criminal justice system, transition from treatment, treatment providers and training, rural healthcare, and successful programs in other states.











































04:53 PM -- Public Comment



04:54 PM -- Dr. Steven Wright, representing himself, testified regarding his experience as a pain physician and discussed educating providers on the use of Screening, Brief Intervention, and Referral to Treatment (SBIRT).



05:02 PM -- Mary Russell, representing herself, discussed the challenges she has faced in trying to get treatment for her son and distributed three handouts (Attachment L, M, and N).



17Opioid0801AttachL.pdf 17Opioid0801AttachM.pdf



17Opioid0801AttachN.pdf



05:07 PM



The meeting adjourned.