Hal Vorse, a physician who treats habitual drug users and teaches new doctors about addiction at the University of Oklahoma Health Sciences Center, said he’s seen the phenomenon in his own practice.
“We’re seeing a big surge in heroin, and 85 percent of those people started on prescription opiates,” said Vorse. “The cost of their addiction got so high that they switched to heroin because it’s cheaper.”
Vorse said the price on the street for OxyContin has risen to $1 to $1.50 per milligram. Addicts typically use 200 to 300 milligrams per day, he said. “They find out they can get an equivalent dose of heroin for a third of what it costs for Oxys,” Vorse said.
“It’s just like Prohibition in the ‘20s. People who couldn’t get good whiskey bought moonshine. The problem with heroin is there’s no quality control. You don’t know what you’re getting.”
Getting more doctors to participate in the Prescription Monitoring Program is a central element of the state’s prescription drug-abuse offensive.
The PMP is an online database designed to flag patients who seek multiple prescriptions for painkillers and other narcotic drugs from more than one physician.
Oklahoma’s system is considered one of the most advanced in the nation, officials say. All pharmacists are required to enter data for every controlled drug prescription within five minutes of filling it. No other state has a “real-time” reporting requirement like that.
But doctors and other health practitioners are not required to check the database before prescribing controlled dangerous substances, and some don’t bother to do so. (The only exception is methadone.)
Although pharmacists are required to log controlled substance prescriptions into the system, current law does not require them to review a patient’s prescribing history before filling the order. Bureau officials said checking a patient’s history requires a different computer log-in process than entering prescription data.
If they do review a patient’s history and see evidence of multiple concurrent prescriptions, pharmacists have the authority to refuse to fill a prescription, alert the prescribing physician or contact state authorities, bureau officials said.
Drug enforcers say it is difficult to compare Oklahoma’s PMP data with prescribing rates in other states because few states collect as much data as Oklahoma does.
The PMP data does not cover all narcotics administered in the state. Hospitals are exempt, as are some Indian Health Service and Defense Department facilities. Prescriptions dispensed at Veterans Administration facilities have been reported to the PMP system for only a few months.
Oklahoma’s doctors have resisted proposals to require them to use the system each time they write a prescription for a controlled substance.
Two years ago, the Oklahoma State Medical Association sent a letter to lawmakers saying that mandatory PMP checks for every narcotics prescription “will require additional staff time and resources in physicians’ offices and result in higher costs and longer waits for patients.” It urged them to reject the proposal.
But the medical group says it is willing to consider a less comprehensive mandate, one that requires occasional checks and lets office staffers handle the job instead of the requiring doctors to do it.
“We are meeting with the governor’s staff and all of the stakeholders involved with that,” said Ken King, executive director of the medical association. “We want to make sure that any solution is a true solution, and not something that tries to make the physician the policeman in this process.”
State Medical Association President Robert McCaffree, a pulmonary disease physician, said Oklahoma doctors continue to hear a mixed message about the use of prescription painkillers.
“We’re often told as physicians that pain is undertreated,” McCaffree said.
“But we also have this issue that there are prescription drug abuses. The physicians are caught in the middle. How do we best be the advocates for our patients but also be responsible to society?”
State officials said they will look at several options for new legislation to increase physician use of the PMP. At one extreme, physicians could be required to check the database every time they write a new prescription for frequently abused controlled substances.
But a more incremental approach appears likely, Mullins and others said. Physicians might be required to check the database every six months, or once a year, for frequent patients, or before writing a prescription for new patients.
Vorse said his staff checks the PMP every time he writes a prescription for a controlled dangerous substance, even with patients he has been treating for years.
At a reporter’s request, he demonstrated what is involved in a PMP check. It took him about 90 seconds to log onto the system with a laptop computer and review the reporter’s prescription history.
“Just last week I picked up a relapse in one of my patients who had started getting narcotics from another doctor,” he said. “If I hadn’t done a PMP, I never would have picked it up.”
Warren Vieth can be reached at wvieth@oklahomawatch.org
