May 23, 2014

Bill Aimed at Lowering Prescription Drug-Abuse Deaths Fails to Pass

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TX - Addicted Oklahoma bug closerDespite an intensive last minute push by supporters, including Gov. Mary Fallin, who lobbied lawmakers in person and by telephone, a bill intended to crack down on prescription drug abuse failed to win legislative approval Friday.

Backers of the measure, which would have required doctors to check an online database before writing narcotic prescriptions, needed the support of nine of the House Public Safety Committee’s 17 members to keep the bill alive. They never got more than six, killing the measure’s chance for passage this year.

“I am disappointed the House Public Safety Committee would not even let their colleagues in the Legislature get to vote on a prescription drug monitoring bill,” Fallin said late Friday, after it became clear the legislation was doomed. “Requiring doctors to check an online database before writing prescriptions for narcotics is the best, most reliable way of cracking down on prescription drug abuse. It is a policy we know has been successfully used to save lives and lower addiction rates in other states, and an area where Oklahoma continues to lag behind.”

Fallin said she would continue to push for similar measures in the next legislative session, but that she considered the issue too important to wait a year before taking action.

“I accept that legislative change comes slowly at the Capitol. What I cannot accept is to stand idly by while another 500 husbands, wives, sons and daughters lose their lives to preventable drug overdoses. I plan on using every tool at the state’s disposal to fight this scourge and to help save lives,” Fallin said.

In coming weeks, she said her administration will work closely with Oklahoma law enforcement agencies, health and mental health officials, and health care providers to develop rules, policies and a statewide plan of action to curb prescription drug abuse and deaths.

“Over 500 Oklahomans die each year of prescription drug overdoses and tens of thousands of men and women suffer from addiction issues,” Fallin said. “Prescription drug abuse continues to be the state’s fastest growing and most prevalent drug problem.”

A coalition of doctors and other medical professionals resisted the mandatory checks,  saying they were burdensome.

Dr. Art Rousseau, chairman of the Oklahoma State Medical Association legislative council, said even after lengthy conversations between lawmakers and doctors’ groups, the bill still had too many problems.

“I think that the Oklahoma State Medical Association as well as the Oklahoma Osteopathic Association certainly made as many compromises that we felt we could before it would start hurting patients,” Rousseau said.

Mandating doctors to check the database would increase fears among physicians about prescribing narcotics, even when patients have a clear medical need, he said.

“I think that will hurt the patient that is a law-abiding individual who is just trying to get the care they need,” Rousseau said.

“What’s so sad about this is the medical associations and the governor were on the same page,” he said. “We’re on the same side, and there was no need for this to end up in being a word-slinging, mud-slinging campaign.”

The medical associations and physicians have begun conversations about what next year’s legislative cycle will bring in the way of prescription drug bills.

Rep. Brian Renegar, D-McAlester, was among those who declined to sign the bill out of committee. He characterized the bill as government overreach and said physicians shouldn’t be forced into “regulatory medicine.” He said he also objected to some of the drugs that would fall under the legislation’s purview, such as hormones.

“This PMP bill is supposed to be the bill to save people’s lives, and I haven’t read too many deaths that have been attributed to estrogen or testosterone,” Renegar said.

The measure’s defeat is considered a major 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. While Fallin did sign a handful of other bills into law aimed at curbing the rising number of overdose deaths, her advisers said without the PMP checks, “we don’t move the needle” on a problem they describe as a crisis.

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.

“There was a great deal of misinformation used by those opposing this legislation. That is unfortunate, because the facts don’t lie,” said Mental Health Commissioner Terri White, who spent much of the last three days at the Capitol trying to pressure committee members to support the bill. She was joined by Health Commissioner Terry Cline, some of Fallin’s top staff and Fallin herself, who in addition to making phone calls, visited with lawmakers on the Capitol’s fourth floor on Thursday.

Alex Weintz, Fallin’s spokesman, said the governor’s message to lawmakers was that the bill was important and would save lives.

Oklahoma ranks in the top five nationally for per-capita sales of hydrocodone and morphine, and second for the sale of Demerol and fentanyl; and, is among the top 10 nationally for the purchase of all prescription painkillers, White said.

“That, in part, is why 81 percent of all unintentional poisoning deaths in our state involve at least one prescription drug,” White said. “We must do something about this.”

“This is an issue that is far too important to ignore,” White said. “We owe this to the families who grieve for their loved-ones, and for the people of Oklahoma who will shoulder the burden if we do not act.”

Among the drug-abuse prevention measures that did pass is one aimed at improving communication between the medical examiner’s office and the state narcotics agency on tracking prescription drug overdose deaths. Another gives the Oklahoma Medical Board the power to issue subpoenas in board investigations, including complaints about prescription drug abuse. The new law makes it simpler and faster to issue subpoenaes and wade through evidence before deciding whether there is clear and convincing evidence to pursue a formal complaint.

Another new law will allow the Oklahoma Osteopathic Board to hire an investigator certified to access law enforcement records. Citing liability concerns, some police departments have been reluctant in the past to share police reports with the board, which handles licensure matters, not criminal prosecutions. The new law will aid the agency in getting records and reports related to overdose deaths and investigating cases of overprescribing, said Deborah Bruce, the board’s executive director.

Rep. Doug Cox, R-Grove, the bill’s House author, said he was frustrated by the committee’s failure to act this session, but said it could set the stage for an even better bill next year.

“What I have learned from this is that governor is passionate about addressing this issue, but also the physicians want to address the issues, too,” said Cox, an emergency room doctor. “It’s just there was a little space separating the sides on how to do it.”

Oklahoma already has a Prescription Monitoring Program that requires pharmacies to log every new controlled dangerous substance prescription within five minutes of filling it.

But doctors are not required to check the registry to make sure their patients aren’t obtaining prescriptions from other physicians, a practice known as doctor shopping. And many doctors don’t bother to voluntarily check the registry.

The bill supported by Fallin, SB 1820, would have required doctors to check the registry every time they write or refill a prescription for Schedule II and 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.

Cox said he planned to introduce legislation next year that would require physicians to more frequently check the database while narrowing the number of drugs they would be required to check.

“If we could do those two things…we will make great strides,” Cox said. “It’s just unfortunate we couldn’t do anything this year, but the problem isn’t going away, so it’s never too late.”