A bill that would require doctors to check their patients’ drug histories before writing narcotic prescriptions was derailed Tuesday by a House committee chairman, but sponsors expressed hope they could keep the issue alive.
The bill, requested by Gov. Mary Fallin, was designed to address a key contributor to Oklahoma’s prescription drug overdose crisis by deterring “doctor shopping” by patients who fill multiple prescriptions written by different physicians.
Rep. David Derby, chairman of the House Public Health Committee, would not let the bill be heard Tuesday during his panel’s last scheduled meeting before a deadline for committee approval.
Derby said he was concerned about several elements of the bill, including a provision that could allow the Bureau of Narcotics and Dangerous Drugs to fine physicians $2,000 for failing to check the online Prescription Monitoring Program.
“If you’re an emergency room physician and you see a hundred people and you prescribe a hundred different scripts of hydrocodone and you forget to check 10 of those hundred, that’s a $20,000 fine,” said Derby, R-Owasso. “You get into that situation where it could be an abuse of power.”
Sponsors of the PMP measure characterized Derby’s opposition as a temporary setback, not a fatal blow. They said they had already identified another bill that could serve as a vehicle for some or all of its provisions.
"The governor's office is working closely with both the medical community and legislators on this issue,” said Alex Weintz, Fallin’s communications director. “We expect to have a legislative vehicle this session to introduce a workable prescription drug monitoring program that the majority of doctors and lawmakers can support.
“The importance of sensibly monitoring prescription drugs cannot be overstated,” Weintz added. “Over 80 percent of drug-related deaths are caused by prescription drugs, and studies suggest that as many as one in eight Oklahomans are abusing prescription pain killers.”
Rep. Doug Cox, R-Grove and House author of the prescription monitoring legislation, said he was working with Senate author A.J. Griffin, R-Guthrie, to address prescription monitoring in a different bill that Griffin is sponsoring in the Senate.
Cox said the governor’s office and the bill’s legislative supporters were close to an agreement with physician groups on compromise language when Derby chose to bottle up the bill in his committee.
“Once we get support from the physician group, which is a powerful lobby out here, it should be easy to pass,” said Cox, an emergency room physician.
Griffin was more cautious, saying she felt confident legislation would be enacted “to be sure that we move in the direction of improving the state’s response to prescription drug abuse.”
“We should be able to come up with some kind of compromise,” she said.
As written, the Griffin-Cox bill would require doctors to check the Prescription Monitoring Program database before writing new or refill prescriptions for narcotics such as hydrocodone and oxycodone.
Last year, Oklahoma pharmacies filled 9.7 million prescriptions — ¬¬or nearly 600 million doses — for controlled dangerous substances. Prescribers logged into the PMP database 1.2 million times, suggesting that many do not use the system routinely.
An investigation by Oklahoma Watch and The Oklahoman determined that the lack of routine PMP checks is one factor contributing to a dramatic increase in drug overdose deaths in Oklahoma. At total of 534 Oklahomans died from overdoses of prescription drugs in 2012, and about half of those took medications prescribed to them by their own physicians.
Wes Glinsmann, director of legislative affairs at the Oklahoma State Medical Association, said the association would probably not support a bill that required doctors to check the PMP system during every patient visit.
However, he said the association continues to negotiate with the governor’s office and lawmakers on an appropriate course of action to combat doctor shopping and the state’s prescription-drug epidemic.
“A lot of it depends on what kind of patient you’re dealing with,” Glinsmann said. “If it’s a first-time patient, I think that could make some sense. We know there are doctor shoppers out there, but if you're a physician in a rural community, and you've been treating the same person for 30 years, and you know they're not a threat, does it makes sense to take time out of the practice and away from other patients for someone who doesn't pose a risk?”
Glinsmann said under current Oklahoma law, a physician’s staff member cannot check the monitoring system, only someone with prescribing authority. The association would welcome a change to that part of the law, he said.
Under current law, physicians are not required to use the database.
Professional groups such as the Oklahoma State Medical Association and Oklahoma Osteopathic Association have fended off previous proposals to require mandatory PMP checks. The groups argued that they would take too much time and impose an unnecessary burden on prescribers who know their patients well.
A compromise still being negotiated by both sides would require occasional PMP checks, perhaps once every six months or once a year, for existing patients who are receiving controlled dangerous substances.
Cox said he was not opposed to scaling back the frequency of PMP checks.
“Being a primary care doctor in a small town, I tend to agree,” Cox said. “Particularly when you know your patients and you see them in the post office and the restaurant and the grocery store, and you know Aunt Mary has a bad knee, and you’ve seen her for 10 years, and you’re not too worried about her diverting stuff.”
Still, Cox said he was distressed by the reluctance of medical groups to embrace mandatory PMP checks.
“It frustrates me that doctors are so resistant, because we’re talking about what’s best for the patient and what’s best for our state,” he said. “But doctors are like everyone else. They’re a little bit resistant to change. They don’t like government telling them what they have to do.”
Even Derby, a forensic chemist, said he was not opposed to reconsidering PMP check legislation if all sides can come to agreement on its provisions.
“There are still two PMP bills out there to deal with this issue, so by far, the fat lady has not sung yet,” Derby said.
Meanwhile, Derby’s committee voted Tuesday to take steps to improve information sharing about prescription overdose deaths.
One provision, sponsored by Cox, would direct the Office of the Chief Medical Examiner to notify the narcotics bureau when prescription drug overdoses occur. The medical examiner’s office already sends copies of its death reports to the bureau, but it typically takes two to three months before it completes them.
Another provision, proposed by Derby, would direct the narcotics bureau to provide the Legislature with summary PMP data so it could determine how many narcotic prescriptions are written by different categories of providers, such as medical doctors, osteopaths, physician assistants and advanced practice nurses.
Both provisions were attached to another bill that was approved by the committee.
Warren Vieth can be reached at firstname.lastname@example.org