May 21, 2014

Prospects Uncertain for Prescription-Monitoring Bill

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TX - Addicted Oklahoma bug closerGov. Mary Fallin’s office and key lawmakers battled Wednesday to prevent the death of a bill intended to crack down of prescription drug abuse, but its prospects appeared shaky as the 2014 session neared its end.

Rep. Doug Cox, R-Grove, said late in the day he had secured the support of only six committee members to advance the measure, which would require doctors to check an online database before writing narcotic prescriptions.

Cox, the bill’s House author, needed the support of nine of the House Public Safety Committee’s 17 members to keep the bill alive. He had until mid-day Thursday to win over three more lawmakers, and the prospects appeared dicey.

“I would say it’s on life support,” said Cox, a physician who spends weekends working in a hospital emergency department. “I am not overly optimistic. It’s like I say to the family of that patient in the OR (operating room), ‘You hope and pray for the best, but mentally prepare for the worst.’”

“I’m very disheartened right now,” said Mental Health Commissioner Terri White, who spent much of the day trying to persuade committee members to support the bill. But she said she held out hope that more lawmakers might get on board.

Art Rosseau, chairman of the Oklahoma State Medical Association’s Council on State Legislation, said late Wednesday that he, too, did not see much potential for a last-minute breakthrough.

“At this point, I would find it very hard to say that the physicians were willing to compromise any more than what we already have,” Rosseau said. “It’s very difficult for physicians to accept the concept of a mandate, and not for selfish reasons.”

Defeat of the bill would be a major legislative setback for Fallin and her legislative allies, who made mandatory prescription checks the cornerstone of their campaign to reduce the number of fatal drug overdoses in Oklahoma.

Last year, 788 Oklahomans died from overdoses, and 593 of those deaths involved at least one prescription drug, according to a preliminary tally by the Oklahoma Bureau of Narcotics and Dangerous Drugs.

The 2013 death toll is certain to rise as the Office of the Chief Medical Examiner files additional reports over the next few months, the narcotics bureau said.

Oklahoma, like most states, already has an online Prescription Monitoring Program. Pharmacies are required to log every new controlled dangerous substance prescriptions within five minutes of filing it.

But doctors are not required to check the PMP registry to make sure their patients aren’t obtaining prescriptions from other physicians, and many doctors don’t bother to check.

Oklahoma pharmacies filled 9.6 million controlled dangerous substance prescriptions last year. Physicians and other prescribers checked the database 1.5 million times. That’s roughly one check for every six prescriptions filled.

Cox’s measure, SB 1820, would require them to check the PMP every time they write or refill a prescription for Schedule II or Schedule III controlled substances. That includes all of the highly-addictive opiate painkillers such as oxycodone and hydrocodone as well as many non-narcotics such as hormone supplements.

The measure has been resisted by a coalition of doctors and other medical professionals. They contend that mandatory checks would place an unnecessary burden on overworked physicians or their staff members, who would be authorized to do the checks.

Cox said the two sides had battled to a standstill over the frequency of the checks and the list of drugs they would cover.

The governor’s office was insisting that doctors must check the online database every time they wrote or refilled a prescription for Schedule II or Schedule III drugs. The doctors were willing to check the PMP registry no more than once every six months for each patient, and they wanted to limit the list of Schedule III drugs to those containing hydrocodone or codeine.

“Being caught in the middle, I would say it’s a little bit of stubbornness on both sides,” Cox said. “Everyone wants to hold out for a perfect bill, and I don’t know too many perfect bills that I’ve seen passed in the 10 years I’ve been here.”

Supporters of the bill were racing to beat a looming deadline for legislative approval.

House and Senate leaders are hoping to adjourn the 2014 session on Friday. To get the PMP bill passed, Cox said he would need to garner the nine committee signatures he needs by mid-day Thursday. The full Senate would need to approve the bill by the end of Thursday, followed by the full House on Friday.

As recently as Tuesday night, Cox thought the legislation was dead, only to see its prospects revive somewhat on Wednesday.

“I do not expect to get enough signatures,” Cox said late Tuesday. At that point, he had won the support of only four conference committee members. “I was unable to get the doctors to give and unable to get the governor to give.”

Cox, who works weekends as an emergency room doctor in Grove, said he was disappointed that some committee members hadn’t attended a session in which he demonstrated he could check a patient’s prescribing history in about 30 seconds.

Cox said he was disappointed that some committee members hadn’t attended a session in which he demonstrated he could check a patient’s prescribing history in about 30 seconds.

“I’m afraid that it’s pretty much over for this session,” he said.

Then, on Wednesday, the governor’s office, which earlier this week publicly urged passage of bill, weighed in again.

Fallin’s chief of staff Denise Northrup, legislative liaison Craig Perry and two cabinet secretaries, Mental Health Commissioner White and Health Commissioner Terry Cline, roamed the Capitol hallways buttonholing committee members.

They were accompanied by Gail Box, whose son, Austin Box, a University of Oklahoma football linebacker, died of a prescription drug overdose in May 2011.

Box said her son received medication for a back injury, saw them as a way to help him through his daily life with pain and had friends who helped him obtain the drugs. She was frustrated by lawmakers’ inability to pass out of conference committee the bill she considers the best available solution.

“I do think if we monitored our prescription drugs more carefully and if we didn’t have so many prescriptions out there, yes, it could have made a difference,’’ Box said. “To me it is just simple logic. I mean I don’t look at it any other way than this is an opportunity to save lives. I find it disappointing. To me it’s just logical.”

By midday Wednesday, Cox had rounded up a fifth signature. Then one of Tuesday’s supporters dropped out. On Wednesday afternoon, he picked up two more, bringing the tally back to five. Later in the day, he got a sixth lawmaker to sign.

“No, it’s not over yet,” Cox said around noon. “The governor’s people … are up there working as we speak trying to convince people to sign on. Austin Box’s mom is up there. She’s very persuasive if the members will agree to visit with her.”

Cox said he was frustrated that opponents of the bill were still claiming that mandatory PMP checks would require doctors to spend hours online.

“I’m just trying to dispel untruths that are being told,” he said. “If there’s one thing that aggravates me, it’s using untruths to kill a bill. One of my colleagues was told that using the PMP takes six hours. I don’t know where they’re getting this kind of stuff.”

Health Commissioner Cline said he, too, was disturbed by the amount of misinformation he heard about the bill from committee members, including suggestions that Fallin was unwilling to negotiate any more on the measure.

Cline pointed out that Fallin and the medical associations already had compromised on several provisions in the legislation, only to hear that some of those issues remained a concern.

“Some of it feels like a stall tactic so the bill doesn’t get passed this year,’’ Cline said. “I think it’s a strategy that’s being employed. The end result of that is two years from now there will be over a thousand more lives lost to prescription drugs.”

“The Legislature has the power to stop that,” Cline said. “It’s unsettling that the medical associations have opposed a bill that would put a tool in the hands of physicians to make informed clinical decisions for their patients. What we’re hearing from those medical associations is they don’t want to do it even though they’re being told it could save lives.”
Rosseau, the medical association’s legislative liaison, said doctors remained concerned that as written, the bill would make it illegal to provide painkillers or other controlled substances to an ailing patient if for some reason the doctor was unable to access the PMP.

“Imagine going into your dentist with an abscessed tooth,” Rosseau said. “If his Internet is down or if the website is down, he could not prescribe you that medication without him breaking the law.”

Cox said that in his opinion, the bill’s prospects had been undermined by an unwillingness on both sides to make final compromises.

If the bill doesn’t pass this session, Cox said he already was making plans for a measure for next year that would exempt some non-narcotic drugs, such as hormone supplements from checks, but add some of the abuse-prone Schedule IV drugs, such as alprazolam, or Xanax, an anti-anxiety drug.

Oklahoman staff reporter Rick Green contributed to this report.

Warren Vieth can be reached at wvieth@oklahomawatch.org