May 15, 2014

Doctors, Fallin’s Office Face Off Over Prescription Checks

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Oklahoma’s doctors declared a deadlock Thursday in negotiations over a legislative proposal that would require them to check an online database before writing narcotic prescriptions.

A coalition of nine physician groups said it had reached an impasse with state officials over how often doctors would be required to use the database, and how many drugs would be subject to the checks.

“We’ve made a lot of progress in our negotiations,” said Art Rosseau, chairman of the Oklahoma State Medical Association’s Council on State Legislation in a prepared statement. “But unfortunately there are still a couple of big issues on which we simply cannot agree at this point.”

The medical groups have been wrangling for weeks with Gov. Mary Fallin’s office and key lawmakers over a bill that would require doctors to check their patients’ drug-taking histories on the state’s Prescription Monitoring Program.

The measure, SB 1820, is intended to address a prescription drug overdose crisis that claimed the lives of 534 Oklahomans in 2012. Officials say at least half of the casualties took drugs they were prescribed by their own doctors.

The bill would require doctors, physician assistants, advanced practice nurses and other prescribers to check the PMP registry before writing new or refill prescriptions for Schedule II and Schedule III controlled dangerous substances.

Those categories include most of the commonly abused opiate painkillers such as morphine, oxycodone and hydrocodone. But they also include many non-opiate drugs, such as testosterone supplements.

Mandatory PMP checks have been resisted by physicians and some lawmakers, who contend they would impose a time-consuming administrative burden on already overburdened doctors and their staffs.

In announcing the deadlock, the medical associations said they would not endorse the legislation unless it is scaled back to include only Schedule II narcotics and Schedule III drugs containing hydrocodone or codeine.

They also oppose mandatory checks with every prescription refill. Instead, they want to limit the checks to the initial prescription, followed by annual follow-up checks for chronic-pain patients.

“We know we have a prescription drug abuse problem in our state and we absolutely want to be part of the solution,” said Gabe Pitman, vice president of the Oklahoma Osteopathic Association. “But let’s do it in a way that identifies the doctor shoppers and other bad actors without placing an unnecessary burden on law-abiding citizens with legitimate medical needs.”

Members of Fallin’s staff defended her stance on the issue.

“We have worked closely with the doctors on trying to find a bill that will be workable for the crisis in Oklahoma,” Steve Mullins, general counsel to Fallin, said Thursday. “We believe our bill is using proven methods that have been proven effective in other states and we would welcome their support as we go forward and are open to any ideas they might have.”

Mullins said several Oklahoma physician groups have consistently opposed having to check the database on prescription refills. The delay in service the doctors’ groups complained about amounts to one to three minutes per patient, Mullins said.

Without, the mandatory checks, the cornerstone of Fallin’s initiative to cut prescription drug abuse, ‘’we don’t move the needle’’ on the problem, Mullins said.

Fallin spokesman Alex Weintz noted that many public and private care providers in Oklahoma are fully supportive of mandatory checks for every prescription and believe it’s good public policy.

“Prescription drug abuse has reached a crisis level,” Weintz said. “People are dying from the overuse of these drugs. That’s why this is such a priority for the governor.”

Sen. AJ Griffin, who authored a Senate version of the bill requiring more frequent checks, said she did not agree with the doctors’ claim that checking the PMP with every Schedule II and Schedule III prescription was too time-consuming.

If many months pass between required checks, “that’s plenty of time for someone to develop an addiction and plenty of time for someone to accidentally overdose,” Griffin said. “It would not be a best practice when it comes to preventing addiction.”

Griffin said she plans to meet with some of Fallin’s staff Monday to discuss the legislation and pointed out that the bill is one of the governor’s priorities this session. Griffin said that in shaping the bill, lawmakers have heeded some of the medical community’s other requests, including moving oversight of monitoring prescription drug use from law enforcement to the medical boards; allowing a doctor’s staff members to run PMP checks; and exempting veterinarians from the bill’s requirements.

“All of the other requests they’ve made have been allowed,” Griffin said, “so I really want to hear the justification for how (using infrequent checks) is really going to solve this problem we have in the state.”

Dr. Charles Shaw, an Oklahoma City addiction specialist, said checking the prescription drug monitoring program does not take much time and is necessary to ensure patients are not abusing the drugs that doctors prescribe.

“That’s what it is for,” Shaw said. “That’s what I use it for. There’s not a week that goes by that I don’t question patients because of it.”

If Oklahoma begins requiring mandatory PMP checks, it will be the fifth state to do so. Kentucky, Tennessee, New York and Ohio now require doctors to check their online prescription registries.

In all four cases, the number of narcotic prescriptions written declined significantly after the checks became mandatory, and preliminary data indicates Kentucky’s overdose death rate is now falling.

Oklahoma lawmakers are running out of time to address the issue this year. The 2014 legislative session is scheduled to end no later than May 30, which leaves only two weeks for the impasse to be resolved and final House and Senate votes to occur.

Even if the governor’s office prevails, the PMP legislation would not require doctors to check the registry before writing prescriptions for all controlled dangerous substances. Scores of controlled drugs are classified as Schedule IV and Schedule V medications and would not be subject to the checks.

They include the popular anti-anxiety drug alprazolam (Xanax), which contributed to 128 Oklahoma overdose deaths in 2012.