Governor Shumlin asked the Senate Judiciary Committee in DC for help broadening the ability for non-physician medical professionals to prescribe medication for opiate addiction.He testified that while physician assistants and nurse practitioners can prescribe addictive narcotics for pain, they are not allowed - under the Drug Abuse Treatment Act - to prescribe medications to break addictions to painkillers and heroin. The committee - the Ranking Member of which is Senator Leahy - seemed open to the idea.Wednesday's hearing covered a range of issues related to heroin and prescription drug abuse. GovernorShumlin also asked for more federal dollars for building treatment centers, providing rescue kits with the opiate antidote Narcan and monitoring prescription drugs that are dispensed.
Governor Shumlin and Senator Sears Stress Progress on Marijuana Legalization
Senator Dick Sears - Chair of the Senate Judiciary Committee - spent a busy weekend getting a new approach to the legalization of marijuana drafted: a proposal of amendment to S.241. On Tuesday Sears and Governor Shumlin held a press conference to tout the direction of the Sears proposal. According to both the bill made real progress toward meeting the Governor's five points of concern as outlined in his State of the State Address earlier this month.
- Marijuana and other drugs must stay out of the hands of underage kids.
- Any tax must be low enough to undercut the black market and illegal drug dealers.
- Revenue from legalization must be used to expand addiction prevention programs.
- Law enforcement's response to impaired drivers must be strengthened.
- The sale of edibles must be prohibited at first.
We have been particularly interested in the third of these five points: the destination of any revenue generated by this act. Here is how Senator Sears' proposal addresses that question:
- 25 percent to prevention of substance abuse
- 25 percent to the treatment of substance abuse
- 25 percent to law enforcement for combatting the drug trade and drugged driving
- 25 percent to the general fund with the purposes of this act in mind
The key piece of the legislation is the removal of existing civil penalties for possession of one ounce or less of marijuana by a person 21 years of age or older. Cultivation and sale of marijuana will require a license. Ten more law enforcement officers will be trained as drug recognition experts. Twenty-five new State Troopers will be added over the next three years. The tax question - its nature and level - will be taken up by the Senate Finance Committee. Senator Sears allowed as he had not yet decided whether he would vote for the final version, saying that it would depend on what the proposal looked like when it came to the floor of the Senate.
Focus on Prescription Opioids
This week the Senate Health and Welfare Committee focused on the abuse of prescription opioids. Two bills - S.201 introduced by Senator Nitka and S.243 introduced by Senators Sirotkin and Ashe - were the starting point for a wide-ranging discussion. That discussion was dominated by two issues: first was the question of limiting the size and availability of prescriptions. There was no agreement as to what the exact limits might be. There was some concern about unintended consequences. It was suggested, for instance, that a low limit would increase doctor visits. The expansion of the scope Vermont Prescription Monitoring System was also discussed. The second issue was the disposal of excess prescription drugs. Some progress has been made. There are twenty-three locations for disposal, a mail-in system and drop boxes appearing at pharmacies around the state. Committee Chair Claire Ayer was curious what the eventual destination of the disposed drugs might be. So are we. More testimony and discussion to follow.
Budget Adjustment
The summary report of the House Appropriations Committee focuses on many of issues of concern to us:
"The FY 2016 Budget Adjustment continues to reflect a multiyear process to bring spending and revenues toward long-term sustainability. Slower economic growth, a January reduction in the General Fund (GF) revenue forecast, and growing service demands create a difficult budget environment. FY 2015 saw over $40 million in GF revenue downgrades. The FY 2016 Budget Adjustment addresses the additional January GF downgrade of $4.7 million. The Budget Adjustment represents an all funds increase of $91.8m of which $70m is Medicaid related. The GF increase is $12.3m and the State Health Care Resource is $12m. It relies on $23 million in one-time resources. The FY 2016 Budget Adjustment addresses cost pressures related to the Opiate Epidemic:
- Funds growing juvenile caseload in the Department for Children and Families (DCF)
- Funds child protection package at DCF to address caseload pressures and child and worker safety
- Meets DCF funding needs, including: a cost per case increase in subsidized adoptions; increases in substitute care caseload; and an increase in foster parent respite care costs
- Funds an increase in foster parent transportation costs
- Adds funds for Licensed Alcohol and Drug Abuse Counselors (LADC)
- Funds additional need in Syringe Exchange Program in the Department of Health
Other Health Care Investments:
- Provides initial funding for 53rd week in Medicaid program with the expectation that remaining funding needs will be addressed in FY 2017
- Funds caseload and utilization increases in Medicaid
- Reallocates funding to areas where the need for emergency housing remains high, recognizing that statewide use of emergency housing is down by 25%
- Funds caseload and utilization pressures in DVHA
- Adds $490K to fully staff the VT Psychiatric Care Hospital in Berlin by including hiring incentives
- Adds funds for Applied Behavioral Analysis (ABA) (per the DVHA request)"
Tobacco Policy Fumes
A controversial policy regarding no smoking in residential treatment facilities was instituted as of the first of the year. It is unclear what the impact may be, but there is some initial impression - due to some rare empty beds - that it might be making some clients reluctant. The policy is being loosely enforced at the moment and the Senate Health and Welfare Committee planned to review it at the end of the week. More to follow.
