April 10, 2014

Compromise Deal: Doctors Would Check Drug Monitoring System Once a Year

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TX - Addicted Oklahoma bug closerDoctors would be required to check their patients’ drug histories only once a year before writing a narcotic prescription under a potential compromise reached Thursday at the state Capitol.

The latest measure is a far cry from the bill Gov. Mary Fallin first supported that would have required doctors to check the Prescription Monitoring Program database before writing any new or refill prescriptions for narcotics such as hydrocodone or oxycodone.

“We are confident the Legislature will continue working towards the governor’s goal of passing a meaningful, workable prescription drug monitoring program that serves as an effective tool in the fight against prescription drug abuse,” Fallin’s communications director, Alex Weintz, said.

The bill, SB 1820, is aimed at deterring “doctor shopping” by patients who fill multiple prescriptions written by different physicians, a practice helping fuel an epidemic that has Oklahomans dying in record numbers. Currently, doctors are not required to check the database.

Rep. Doug Cox, one of the negotiators, said of the compromise, “It’s pretty weak, but at least it’s a start.

“It will get doctors who haven’t been using (the PMP) at all to use it, and hopefully they will see what a wonderful tool it is and make a habit of checking it, particularly on patients they may not be familiar with,” said Cox, R-Grove.

A spokesman for the Oklahoma State Medical Association said the group’s leadership planned to review the proposed compromise over the weekend.

“We’re getting close,’’ spokesman Wes Glinsmann said.

But the bill already faces possible pitfalls in the Senate.

Sen. A.J. Griffin, who authored a Senate version of the bill requiring more frequent checks, said she would be disappointed if the House sent her a bill requiring only a yearly check.

“The window in which an individual can become addicted can be as short as six weeks,’’ said Griffin, R-Guthrie. “Checking once a year is not going to make a dent in this problem.”

An investigation by The Oklahoman and Oklahoma Watch determined that the lack of routine PMP checks is one factor contributing to a dramatic increase in drug overdose deaths in Oklahoma. A total of 534 Oklahomans died from overdoses of prescription drugs in 2012, and about half of those took medications prescribed to them by their physicians.

“I don’t believe once-a-year checks will save many lives,” Griffin said.

Legislative Resistance

The compromise on mandatory PMP checks is the latest in a series of legislative setbacks for advocates of tighter controls on prescription drug abuse.

Two bills designed to give enforcers more oversight of narcotic-dispensing practices at pain clinics and nursing homes have been withdrawn from consideration because of opposition from some lawmakers and medical professionals.

Under existing law, the Oklahoma Bureau of Narcotics and Dangerous Drugs has no oversight or enforcement authority over pain management clinics or nursing homes, which often dispense large quantities of controlled dangerous substances.

Instead, the bureau can only police the individual physicians and other medical professionals who work at those organizations. Oklahoma has been faulted by one national advocacy group for not having pain-clinic oversight legislation.

The two bills, HB 2907 by Rep. David Derby, R-Owasso, and SB 1243 by Sen. Rob Standridge, R-Norman, would have required pain clinics and nursing homes to register with the bureau and comply with narcotic oversight regulations.

HB 2907 had been approved by the House Public Health Committee and was awaiting a floor vote when it was withdrawn. SB 1243 had been approved 44-0 by the Senate and had gone to the House when it was pulled.

Narcotics bureau spokesman Mark Woodward said his agency originally requested the bills, but agreed to withdraw them after some legislators and medical groups raised objections.

“It was legislators and some of the associations that had some issues,” Woodward said. “They were (asking), is this an overreach of government and too much intrusion by government? We agreed not to fight it and agreed to pull those two bills at this point.”
Woodward said the bureau believes that most pain management clinics and nursing homes are prescribing and dispensing narcotics responsibly, and it was not opposed to killing the bills during this session.

“We don’t want to paint a picture that nursing homes or pain management clinics are a big part of the problem. I’d say they’re isolated problems,” Woodward said.

“That was a choice of the Bureau of Narcotics. Our agency requested those, and our agency also decided that we would not push it (and) that we could use the interim … to visit with some of these associations and legislators and see if we can find some common ground. We may pursue it again next year. We’ll see.”

Seeking Common Ground

Cox said the compromise on annual PMP checks was reached after discussions between himself, the governor’s office, the Oklahoma Osteopathic Association and the Oklahoma State Medical Association.

The medical associations also proposed moving oversight and administration of the PMP from the narcotics bureau to the state health department and transferring the bureau’s enforcement powers over problem doctors to the state’s medical licensing boards.

Cox opposed those changes.

“The licensure agencies are a board composed primarily of physicians,’’ Cox said. “They’re the ones who investigate physicians. Is it a conflict? I don’t know. I really didn’t feel comfortable compromising on that.”

The compromise measure now heads to the Senate. With both chambers adjourned for the week, the earliest Griffin said she could make a decision on whether to accept or reject the compromise language is next week.

Cox, a doctor, said he’s been disappointed with other members of his profession who are reluctant to use the PMP.

“You hear the argument that why should those of us practicing good medicine with good prescribing habits have to pay the price … for the bad doctors?” Cox said. “I don’t really have an answer for that other than, hey, that’s life in general.”

Cox also dismissed fears among some doctors that they potentially face massive fines should the bill pass. He said the narcotics agency long has had the ability to fine care providers, but rarely exercises that authority.

“The fears of physicians that the OBNDD are going to act like the Gestapo and use that as a revenue-raising tactic is really unfounded,’’ Cox said.

Cox, who at one point proposed quarterly PMP checks, is more sympathetic to doctors who say they are too busy to check the database. Cox said it only takes about 90 seconds to run a report using the database.

“Still, if you’re doing it 15 times a day … That doesn’t sound like a lot, but that’s a significant amount of time when you’re running a busy medical office,” Cox said.

“Doctors are like everyone else; they resent having the government tell them what to do.”

Opponents of frequent checks have also talked of the burden it would place on small-town doctors.

“When you have a physician who has a long-standing patient-physician relationship with somebody, somebody they’ve known for years and they know they don’t pose a threat, is it necessary to check on every prescription,’’ Glinsmann, the medical association spokesman asked.

Data from the medical examiner shows the highest rates of overdose deaths in 2012 occurred in non-urban counties, especially east and southeast Oklahoma. A list of all overdose deaths from the medical examiner from 2011 to 2013 shows numerous fatalities occurred in small and mid-size towns.

“Even a rural doctor that knows their patients by name and knows their family by name and sees them at the grocery, they still weigh them when they come in,’’ Griffin said. “It’s a standard of care so were making treatment decisions based on data and not assumptions. Assuming someone is not drug dependent when you give them a controlled dangerous substance can kill them.”