At an interim committee meeting Tuesday, state legislators moved a step closer to introducing a new package of bills and gave updates on the rough framework of bills they hope to bring in the 2019 legislative session. The committee will vote on the bills to introduce at its Oct. 3 meeting. At a session in late August, the members voted to draft measures under the broad umbrellas of treatment, recovery, harm reduction, prevention and criminal justice.
Committee chair Rep. Brittany Pettersen acknowledged the bill drafts are far from finalized, and the legislators will meet with stakeholder groups in several sessions before Oct. 3 to hash out gaps in each bill.
Rep. Chris Kennedy said the bill draft for addressing substance abuse treatment has three main components. One prong would implement a comprehensive capacity-tracking system, based on a recommendation from Mental Health Colorado, to keep track of what treatment programs have availability to take new patients. He said the role different organizations and departments will play, such as Mental Health Colorado and the Office of Behavioral Health, is still in discussion.
“Even when people are ready to seek services, they don’t always know where to go,” Kennedy said. “Sometimes they go to places where the see a big ‘no vacancy’ sign, figuratively speaking of course.”
Another component based on a recommendation from Mental Health Colorado would create a care coordination entity that would centralize an initial step in getting substance abuse treatment. A potential patient would call the existing mental health crisis number and receive an assessment to determine the types of treatment they need.
Kennedy said the bill’s third component aims to close funding gaps such as those around medically managed substance withdrawal or detox. He said an 1115 waiver currently pending from the Center for Medicare and Medicaid Services, which would allow Colorado to include some substance abuse treatment services in its Medicaid program, should bring in money from increased state investment in expanded services Medicaid could provide under the waiver.
“But that is still potentially a couple of years away,” he said. “These waiver processes take a long time.” The treatment bill asks for $5 million for the Office of Behavioral Health to abuse as a grant program to build capacity and infrastructure for state-funded treatment in the meantime.
Sen. Kevin Priola detailed the bill draft for addressing harm reduction, a term that generally encompasses reducing negative consequences associated with drug abuse, such as overdose reversing agents and syringe exchange programs. The bill includes an authorization for schools to keep supplies of overdose antagonists, and would also allow hospitals to be used as syringe exchange sites. Sen. Dominick Moreno expressed concern over deciding whether the bill should extend the time period for a previously introduced provision limiting opioid prescription supplies to seven days, saying more data study should be done first to assess how such a limit affects patients.
Another element prohibits pharmacists from dispensing controlled substances unless an electronic prescription was sent. Priola said the element would go into effect Jan. 1, 2020, the same date Walmart will begin allowing only electronic prescriptions for controlled substances.
“We have the largest retailer in the world saying their stated policy is…to go this route,” he said in response to doubts Pettersen expressed that the provision belongs in the harm reduction bill. The aim of “e-prescriptions” is to reduce mistakes in prescriptions and reduce fraudulent practices such as doctor-shopping and forged prescriptions. “I see it completely as harm reduction.” He added the provision for e-prescriptions would create a consistent standard for what major corporations seem to be doing anyway.
Rep. Jonathan Singer outlined key elements in a drafted bill for substance abuse prevention, such as required training on substance abuse for licensed prescribers when they renew their licenses and expanding programs for safe disposal of drugs and medical devices.
Pettersen said her part in the bill for substance abuse recovery has involved examining bills brought in past sessions to determine what areas of recovery need more attention, such as oversight on best practices for sober living facilities and other transitional housing. Standards are currently malleable and change as more information comes to light about substance abuse, she said.
“Some of these pieces, we put small band-aids on the problem, and we don’t actually get people the spectrum of care that they need,” she said.
In the vein of Pettersen’s acknowledgment that the bill drafts still need much work until they represent a package of legislative proposals that everyone on the committee can support, Rep. Perry Buck asked about the possibility of splitting some elements off into separate bills. Her disagreement with some elements may make it difficult for her to support an entire bill, she said.
Singer said he believes the interim committee setting is the best environment for working through disagreements.
“I think the best possible way to have this discussion is in interim committee, outside the heat of a legislative session where we can really roll up our sleeves,” he said.
— Julia Cardi