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Saturday, February 2, 2019

House health panel's new chair starts fast, with bills to ban school tobacco use, study medical marijuana and spur drug treatment

By Melissa Patrick
Kentucky Health News

State Rep. Kim Moser plans a busy first meeting as chair of the House Health and Family Services Committee on Thursday, Feb. 7. She says she has the votes to approve bills to make schools tobacco-free, urge medical-marijuana research, and make it easier to get treatment for addiction.

"Those are all issues that we continue to talk about and have taken a while to get passed, and those are my priorities for the first meeting," the Northern Kentucky Republican said in an interview with Kentucky Health News.

Rep. Kim Moser, new chair of the House
Health and Family Services Committee
The measures are:
  • House Bill 11, which would ban the use of tobacco products, including electronic cigarettes, on Kentucky school property;
  • House Concurrent Resolution 5, which calls on Congress to expedite research on medical marijuana;
  • HB 121, to keep insurance companies from requiring "prior authorization," which delays medication-assisted treatments for addiction.
Moser, who is starting only her second two-year term in the House, said that she loves "helping to solve problems" and that it's time for Kentucky to address these three issues.

Moser, of Taylor Mill, is the primary sponsor of the tobacco-free-schools and prior-authorization bills and a co-sponsor of the marijuana-research bill filed by Rep. Danny Bentley, R-Russell.

Tobacco-free schools

The tobacco-free-schools bill would bar the use of tobacco and e-cigarettes on all school-owned properties, including all school events on school property. Sen. Ralph Alvarado, R-Winchester, has filed a companion bill, Senate Bill 27.

Similar bills have been filed in past legislative sessions, but have gained little or no traction. The Senate passed one in 2017, but it died in the House. Two bills were introduced last year, but were not called up in either of the legislature's education committees.

Moser said now could be the time for a ban to pass, because tobacco companies are on board with it and because one has passed the Senate.

"It's pretty difficult to argue that we need to prevent addiction to nicotine in children and that we need to set a good example for kids," she said. "And that's really the purpose."

She said the bill also has the support of Kentucky School Boards Association, the Kentucky Association of School Superintendents, 87 percent of Kentucky adults in a statewide poll, and the lobbying support of the Coalition for a Smoke-Free Tomorrow, about 180 groups across the state.

"I think folks just realize that when we spend $2 billion a year nearly on tobacco-related illnesses in Kentucky – $600 million of which comes from Medicaid – that's problematic," Moser said. "We are always looking for additional revenue and I think preventing illness is a perfect way to get more revenue for our state."

In the most recent survey of Kentucky high-school students, they smoked cigarettes and e-cigarettes at about the same rate, 14 percent, but health officials say the e-cig rate is likely higher because Juul sales have surged since then. At a Jan. 22 rally, health advocates said passing a statewide tobacco-free school bill would stop nearly one in three Kentucky students from smoking.

Districts in green do not include electronic cigarettes in their tobacco-free policies.
Fewer than half of Kentucky school districts have enacted such policies. As of November, 74 of the 173 districts had adopted 100 percent tobacco-free policies, covering 740 schools and 58 percent of the state's students. Federal law only prohibits smoking inside schools that receive federal funding.

Medical marijuana research

The resolution asking federal officials to expedite research on medical marijuana would require Congress to move the drug from Schedule I, a list of drugs with no medicinal use, to Schedule II.

Moser said universities can't do research on the drug's medicinal qualities as long as it's illegal under federal law because it puts all of their federal funding at risk. "I would like to think that we could encourage Congress to lift marijuana from a Schedule I at least to allow research."

For some legislators, the bill is a way to make some progress on an issue that they hear a lot about but are not ready to embrace. Five House lawmakers have signed on to sponsor HB 136 to legalize medical marijuana, which they are hopeful will pass this year, and some legislators favor legalizing recreational pot.

Asked if she thought the medical-pot bill would pass, Moser said: "I don't get the sense that folks have all of their questions answered in terms of medical marijuana. The science is not indicating that it's as useful as anecdotally noted. You hear a lot of anecdotal stories and not a lot of science."

Thirty-three states and the District of Columbia have legalized marijuana in some form for medicinal use. Another 10 have legalized recreational marijuana. Moser attributed that wave to voter-approved ballot initiatives and a strong lobbying effort by "Big Marijuana," which she says has done "a really good job of normalizing the use of marijuana."

She said Kentucky should take a good look at what is going on in other states, noting that California is looking at lowering its tax on its recreational marijuana because it makes legal pot uncompetitive with the black market.

Moser said marijuana needs to go through the U.S. Food and Drug Administration's rigorous testing process, as has been the case with other drugs that have been derived from the plant. For example, Epidiolex, or cannabidiol, which is comprised of an active ingredient in marijuana was approved by the FDA in 2018.

"It's not as harmless as you think," Moser said. "So I think it's imperative that Kentucky, since we haven't legalized anything yet, either medicinal or recreational, that we have a real opportunity to slow down and do things right."

Medication-assisted treatment

To treat drug addiction, experts generally favor medication-assisted treatment, using drugs such as buprenorphine (branded as Suboxone or Subutex) and Vivitrol. The drugs are prescribed by doctors, but insurance companies have a five- to 10-day waiting period for approval of the treatment.

That is a real problem, said Moser, whose main job between 2014 and 2018 was Northern Kentucky director of the state Office of Drug Control Policy. She said her bill that would get people straight into therapy keeps them from cycling in and out of jail or emergency rooms, and prevents overdose deaths.

"When someone is ready for treatment, they need to be able to get it right away because we know that if they don't . . . that they will relapse, overdose, and we've seen death," she said. "I think if a physician prescribes something, they generally speaking know what they are doing and we should allow them to make those decisions."

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