I_OpioidSubstance_2018A 07/20/2018 09:42:22 AM Committee Summary

Representative Pettersen called the meeting to order and provided an overview of the agenda [Attachment A].

Representative Pettersen engaged the committee in discussion about the best practices for committee meetings. The committee discussed the topics they would like to hear about during the interim, including reviewing the successes of policies and programs addressing the opioid epidemic at both the state and federal levels and reviewing the science and evidence behind the opioid problem, rather than anecdotes.  The members discussed the work the committee accomplished last year.

Committee discussion continued about the areas of interest to committee members, including the use of medication-assisted treatment (MAT) in jails, addiction services, increased communication with other legislators about the effect the opioid crisis is having on their communities, e-prescribing issues, wraparound services for those in recovery, including sober living communities, and the efficacy of the seven day limit on opioid prescriptions.

Bill Zepernick, Legislative Council Staff, discussed the deadline for requesting bill drafts and provided a handout to the committee [Attachment B].

Yelana Love, Office of Legislative Legal Services, discussed the bill drafting process and responded to questions about the information she needs to draft committee bills.

Representative Pettersen discussed the appropriate use of terms associated with substance use disorders and individuals with substance use disorders.

Attorney General Cynthia Coffman discussed her role as the Chair of the Colorado Substance Abuse Trend and Response Task Force (task force).  She discussed the charge and structure of the task force and the work of the task force.  She spoke about the entities that the take force collaborates with to purchase Narcan for use by law enforcement.  She stated that her office is working with several other states to investigate the marketing of the opioids.  She spoke about the activities related to this investigation.

Committee members commented on the role of pharmaceutical companies in creating the opioid crisis and the role they could take in solving the problem.  AG Coffman responded to questions. Committee discussion ensued about the the use of warning labels on opioid prescriptions to notify patients of the addictive properties of opioids as well as instructions on safe disposal of unused opioids.  Committee members pointed out that there are patients who have chronic pain and need access to opioids.

Committee discussion about multi-state settlements with pharmaceutical companies and the distribution of the proceeds followed.

Committee discussion and questions continued about the role that pharmaceutical companies played in the opioid epidemic and the issues surrounding international drug smuggling.

The committee discussed the black market distribution of drugs and whether law enforcement agencies have the tools to combat this problem.  AG Coffman suggested that local law enforcement agencies do not have the resources to address illegal marijuana grows or other drug distribution issues.

Committee discussion ensued about possible legislation to address drug crimes, and substance use issues effecting Native American communities.

Jose Esquibel, Substance Abuse Trend and Response Task Force, told the committee that opioid and heroin overdoses continue to rise across the country.  He discussed a variety of publications that provided detailed information about the current status of the opioid epidemic (these documents are available on the committees website at: http://leg.colorado.gov/committees/opioid-and-other-substance-use-disorders-study-committee/2018-regular-session).  He suggested that Colorado is a national leader in its response to the epidemic.

Committee members commented on the cost to solve the epidemic. Mr. Esquibel responded to questions about educational efforts aimed at substance use prevention and mental health support, such as Communities That Care and Restoring Individuals Safely and Effectively (RISE).  Discussion about educating health care providers on safe opioid use and prescribing followed.

Dr. Rob Valuck, Colorado Consortium for Prescription Drug Abuse Prevention (CCPDAP), discussed the federal government's efforts to address the opioid crisis and referred to documents that he provided to the committee (these documents may be found on the committee's website at: http://leg.colorado.gov/committees/opioid-and-other-substance-use-disorders-study-committee/2018-regular-session ). He discussed Colorado's involvement with directing policy at the federal level.

Committee discussion and questions followed about research related to the medical use of marijuana, evidence based studies on the uses of medical marijuana, other pharmaceuticals that may be abused, alternatives to opioids, and international efforts to address substance abuse and misuse.

The committee discussed the genesis of the fifth vital sign and Medicaid and Medicare reimbursement rates for pain management services and drugs.

Linda Zittleman, University of Colorado, discussed the It MATTTERs Colorado program and provided a handout to the committee [Attachment C]. The program is a multi-faceted MAT intervention to build primary care practice capacity to treat opioid use disorders. She focused on the extent of the opioid epidemic in rural areas of the state. She discussed MAT provider training and pointed out that the program has provided training to 330 providers and 820 patients have benefited from the program thus far.  She discussed the team training program which focuses on training all of the employees in a medical practice to provide follow-up care to patients using MAT.

Ms. Zittleman discussed the need to reduce the stigma surrounding substance use disorders and increase awareness, knowledge, and utilization of MAT in rural primary care practices.  She discussed the public service announcements the program uses to support these efforts.

Ms. Zittleman responded to questions about the specifics of the program.  Committee discussion followed about the effects on consumers of advertising by drug companies.

Cristen Bates, Office of Behavioral Health (OBH), Department of Human Services, provided a handout to the committee [Attachment D].

Marc Condojani, OBH, presented on MAT expansion in Colorado.  He discussed MAT, opioid treatment programs (OTP), office-based opioid treatment, the specific medications used in MAT, the effectiveness of MAT, and the OBH's Wildly Important Goal of expanding MAT services to 50 percent of individuals with an opioid use disorder.

Cristen Bates, OBH, continued the presentation.  She discussed OBH's MAT expansion activities, contracts and funding for opioid treatment programs, training providers through the It MATTTERs program, the Lift the Label Campaign, and MAT in community settings, including county jails.  Discussion followed about strategies to expand MAT into more county jails.

Ms. Bates continued her presentation. She briefed the committee on OBH's efforts to expand the State Opioid Response Grant and a new federal grant.  Ms. Bates concluded her presentation.

Committee members discussed concerns about the amount of paperwork involved with becoming a MAT provider and resources available to providers to help them comply with the regulatory requirements.

Representative Pettersen recessed the meeting.

Representative Pettersen reconvened the meeting.

Dr. Rob Valuck, CCPDAP, provided a handout [ due to the size of the handout, it is on file in the Legislative Council Staff office] and discussed the CCPDAP's efforts to increase awareness of the medication take-back program, decrease the number of opioids prescribed in emergency rooms, and expand access to Naloxone in the community.  He told the committee that he was able to raise money to fund the CCPDAP after the state contributed $1M to the CCPDAP.  Dr. Valuck responded to questions.

Dr. Valuck discussed the CCPDAP partnership with AmeriCorps volunteers and other partners that support local communities that are implementing strategies to reduce the impact of opioid abuse.  Committee discussion followed about locking pill bottles and more options for better storage.

Daniel Darting, Signal Behavioral Health, presented a power point presentation on tracking the cost of substance use disorder treatment [Mr. Darting's power point presentation may be found in Attachment G].  He told the committee that Signal is a nonprofit managed services behavioral health agencies that provides treatment, recovery, and preventions through local provider networks.  He explained that managed service organizations have been able to expand access to treatment, recovery, and prevention of substance use disorders.  He discussed grants that have helped Signal provide care. He told the committee that the overall costs of substance use disorders is $442 billion annually, which includes criminal justice cost, avoidable health care costs, and other economic impacts, such as lost productivity.

Mr. Darting continued his presentation.  He discussed the social cost of substance use disorders, and stated that one third to two thirds of child welfare cases involved parents with a substance use disorder. 

He discussed outcomes of substance use disorder treatment or recovery services.  Mr. Darting responded to questions about the cost of care.

Camille Harding, OBH, provided an overview of the programs OBH funds and provided a handout [Attachment H].  She referred to the funding table included in the handout.  She discussed the issues surrounding data sharing across state government departments.

Ms. Harding dialogued with the committee about how to coordinate with the other state agencies to address the misuse and abuse of opioids.

Dana Smith, The Phoenix, discussed efforts of the Recovery Work Group of the CCPDAP and provided a handout [Attachment I]. She discussed the Angel Initiative.  This program allows individuals seeking help to overcome a substance disorder to request help at local police stations, emergency rooms, fire houses, and community centers.

Rourke Weaver, Recovery Work Group Group, CCPDAP, spoke about the charge of the work group.  He told the committee that the work group partnered with OBH to develop the Recovery Services Strategic Plan.  He discussed the goal of implementing standards for recovery residences and treatment facilities in Colorado. He stated that a current barrier to accessing recovery treatment is the lack of funding for programming for individuals in recovery. Ms. Smith and Mr. Weaver dialogued with the committee.

Tim Lopez, representing himself, discussed resources for grant writing assistance.

Dr. Laura Martin, representing herself, provided information on the prescribing of Buprenorphine. She told the committee she supports recovery work and discussed the barriers some individuals in recovery experience when looking for appropriate housing.  She suggested that sober living facilities do not allow people on MAT to live in the facility.

Duke Rumely, representing himself, spoke about his organization's efforts to create sober events for individuals who like to attend sporting events, but who want to enjoy the event without being surrounded by fans who are drinking and using other substances.

Dr. Qing Li, representing herself, clarified questions that the committee had during previous sections of the meeting.  She discussed the new concept of legal epidemiology and federal funding to support research.

Daniel Fuchs, Oxford House Recovery, told the committee about the recovery services Oxford House offers.  He spoke about the peer to peer programs, the 45 Oxford House Recovery homes in Colorado, and the plans to open a home for women and children.  He told the committee that Oxford House does allow individuals who are on MAT to live in their homes.

Lisa Pearson, representing herself, suggested that insurance companies need to expand coverage to medications and treatments to address pain that are less likely to be abused, such as radiofrequency ablation.

Dr. Mary Weber, University of Colorado - College of Nursing, presented on Senate Bill 17-074 and provided a handout to the committee [Attachemnt E].  She told the committee that the purpose of the bill is to increase access to MAT in Routt and Pueblo counties and expand the number of nurse practitioners and physician assistances who are trained and licensed to provide MAT.  Dr. Weber discussed the results of the pilot program at the two sites in Pueblo County and one site in Routt County.  She discussed the wraparound services provided at the three pilot sites, the efforts to provide recovery services, and community outreach efforts.

Ms. Weber discussed the barriers to care individuals with substance use disorders experience when seeking services and recommendations to reduce these barriers. She explained that providing MAT is complicated for providers.

Dr. Weber discussed the barriers individuals with substance use disorders experience when seeking services and recommendations to reduce these barriers. Dr. Weber concluded her presentation.

Greg Fabisiak, Colorado Department of Public Health and Environment (CDPHE), presented on the Colorado Household Medication Take-Back Program and provided a handout [Attachment F].  He discussed the growth in the number of sites that participate in the program each month and the pounds of prescription medication collected per month.  He discussed the disposal of collected medications and the contract CDPHE maintains with a DEA-registered reverse distributor for disposal.  He discussed the efforts CDPHE has taken to increase the number of take- back sites and to promote those sites.