Oklahoma Watch and The Oklahoman are collaborating on a series of stories about the state’s prescription-drug abuse problem.
Oklahoma physicians are being “selfish and short-sighted” by opposing legislation that would require doctors to check an online database each time they write a prescription for narcotic painkillers and other controlled dangerous substances, health leaders say.
A coalition of nine physician groups announced on Thursday that they had reached an impasse over legislation that would require them to check the state’s prescription drug monitoring program when writing prescriptions for some of the most abused drugs in Oklahoma.
That announcement prompted a fierce response from Terry Cline, the state’s health commissioner, and Terri White, the state’s mental health and substance abuse commissioner, who denounced the physician groups for digging in their heels.
“The fact that any medical association would oppose prescription monitoring and mandatory checks of commonly abused medications quite frankly makes no sense, and amounts to actively opposing policies that are proven to save lives,” White and Cline said in a joint news release.
“This is a problem that the governor and multiple state agencies have committed themselves to solving. We are baffled that any professional medical association would resist a measure that clearly improves health care.”
Senate Bill 1820 is intended to address a prescription drug overdose crisis that claimed the lives of 534 Oklahomans in 2012. At least half of the people who died took drugs they were prescribed by their own doctors, according to Oklahoma State Department of Health Department data.
The bill, backed by Gov. Mary Fallin’s office, would require doctors, physician assistants, advanced practice nurses and other prescribers to check the state’s prescription drug registry before writing new or refill prescriptions for Schedule II and Schedule III controlled dangerous substances. That would include prescriptions for some of the most abused and most prescribed drugs in the state.
According to data provided by the Health Department, Oklahoma ranks in the top five nationally for per capita sales of hydrocodone and morphine, and No. 2 in the nation for the sale of Demerol and fentanyl. All are powerful painkillers.
White said with the high rate of prescription drug abuse and overdose deaths in Oklahoma, it’s puzzling why the legislation to mandate prescription checks has become such a contentious issue.
“The bottom line is that we are trying to save lives and do what is right for health care in our state,” White said. “This is something that benefits the people of Oklahoma and we should not be concerned that a physician, or their staff, may be required to take a few extra minutes to check an online database.”
That “few extra minutes” is one of the issues at the heart of the debate among state leaders and medical professionals.
Leaders among medical associations have argued in recent weeks that mandatory checks each time a prescriber writes a Schedule II or Schedule III prescription would be too time-consuming and largely unnecessary for most of the patients they see.
The physicians’ groups have instead proposed that the legislation require checking Schedule II drugs and products containing hydrocodone or codeine.
Dr. Michael Ogle, president-elect of the Oklahoma Osteopathic Association, said that as an emergency room physician, he regularly uses the state’s prescription drug registry and thinks it’s its a good program, but this proposed legislation goes too far.
“It’s a complicated problem, and we’re trying to throw a blanket over the whole problem and make one big swoop to stop prescription drugs,” Ogle said. “We don’t need to stop all of them — we need to stop the abuse. They’re trying to legislate my behavior as a physician when I’m educated to know what to do about patients.”
Ogle said if a patient that a doctor has seen for 20 years comes in, complaining of migraine headaches, a doctor would know whether to trust that patient and shouldn’t have to waste the patient’s time making an unnecessary check.
“Is it really what he should be doing with his time?” Ogle said. “He should be talking about her cholesterol, her heart disease, her overeating, her diabetes.”
Advocates of Prescription Monitoring Program checks note that two academic studies have shown that doctors who rely on their intuition sometimes misjudge their patients. After comparing their own judgments to the results of PMP checks, some doctors said they were surprised to learn that patients they trusted turned out to be doctor-shopping for multiple prescriptions.
Meanwhile, Cline, the state secretary of health, said it only takes about 90 seconds for medical professionals to check the state’s prescription drug registry. Under the proposed legislation, the physician’s staff could perform the check for the doctors, a proposal that was added to address concerns that doctors did not have time to complete the checks.
“Surely hundreds of lives would be worth a minute or two per patient,” Cline said. “Why would lobbyists claiming to represent the interests of physicians refuse the use of a clinical tool that is proven to work and save lives?
“The medical associations, hospital association and their lobbyists are paid to reflect the values of their individual physicians and members, and frankly, this reflects very poorly on those individuals, both personally and professionally.”
Oklahoma Watch reporter Warren Vieth contributed to this story.