Auditors hope opioid findings will light fire under Oregon legislators

SALEM — Oregon is collecting valuable information about opioid prescribers and their patients but state law hamstrings using the system to confront drug abuse, state auditors said Tuesday.

Oregon, like all other states, collects information on prescriptions for controlled substances like Oxycodone and Percocet.

But Oregon’s program has little teeth, auditors found.

Auditors blamed state lawmakers, saying that constraints they put in place on the program, created nearly a decade ago, limit the program’s “efficiency, effectiveness and impact.”

Misuse or abuse of prescription drugs can lead to abuse of illicit drugs like heroin and fentanyl, the audit report said.

Secretary of State Dennis Richardson Tuesday released results of his audit, focusing on the Oregon Health Authority’s use of the prescription system.

His auditors noted that more seniors are hospitalized for opioid abuse, overdoses and dependence in Oregon than in any other state.

Oregon ranks sixth for teen drug use and is the worst in the country for treatment and recovery support for teens.

While deaths due to prescription opioids have declined 45 percent since a peak in 2006, about one Oregonian dies from an opioid overdose every three days, auditors said. Some research suggests that deaths from prescription opioids are underreported by 20 to 35 percent.

In March, Gov. Kate Brown declared addiction a public health crisis.

In the face of such problems, prescription monitoring could provide Oregon a wealth of information about how opioids are prescribed and dispensed and more tools to prevent abuse.

It can help the state catch patterns like doctors who overprescribe, pharmacists who dispense “excessive quantities” of opioids and problems like “doctor shopping,” where a patient goes to several doctors to get multiple prescriptions.

But in Oregon, even if the state finds “egregious” examples of questionable prescribing habits, the information can’t be shared with regulatory or enforcement agencies that could investigate, auditors said.

The existing database still has value, said Audit Manager Jamie Ralls.

“We were able to get the data, and it was a wealth of information,” Ralls said.

The state could collect more information like doctors’ specialty and how patients pay for their prescriptions.

The problem is that the information just sits on the shelf, said State Rep. Cedric Hayden, R-Roseburg.

Oregon is one of nine states that don’t make prescribers or pharmacies use drug monitoring databases to check patient histories before prescribing certain drugs.

And although prescribers are required to register with the monitoring program, only about 77 percent of prescribers have done so, auditors found. There are no repercussions in state rules for prescribers who don’t register, auditors said.

This year, a new state committee reviewed prescribers’ histories for high-volume prescribers and other warning signs.

That group identified 160 medical professionals in Oregon with suspicious prescribing patterns and reached out to them with letters suggesting more training or education. The professionals had no obligation to take the advice or to even respond, auditors said.

And the committee that detects suspicious patterns can’t share its findings with state health licensing boards.

Police also have limited access to the information, available only with a warrant as part of a drug investigation.

The state’s licensed pharmacists and prescribers fund the prescription database through annual fees totaling about $800,000 per year.

State auditors found red flags in the state’s database.

Reviewing three years of information, auditors found 148 people who each received controlled substance prescriptions from 30 or more providers and filled their prescriptions at 15 or more pharmacies.

In comparison, auditors said, the average patient in Oregon gets prescriptions from two providers and two pharmacies.

Auditors recommended changing state law to allow the drug monitoring program to analyze data on prescriber, pharmacy and patient practices, and to share those results with licensing boards and police.

The state could also give the state committee that reviews prescriptions more authority, and require prescribers to check the program’s database to review a patient’s prescription history.

State Rep. Carl Wilson of Grants Pass, the House Republican leader, said his caucus would propose legislation to follow the audit’s recommendations.

“The findings from today’s audit are clear and disturbing: Oregon has an opioid crisis, and not nearly enough is being done to protect individual Oregonians and their families from this epidemic of suffering,” Wilson said.  “It is unacceptable that this tragedy had been compounded by ineffective, duplicative, and even nonexistent regulation and protection. Oregonians throughout the state have been affected, and too many have paid with their lives.”

Nicole Krishnaswami, executive director of the Oregon Medical Board, which regulates physicians, said the program allows providers to see a patient’s drug history, and that has helped them make more thoughtful decisions about care.

She hadn’t reviewed Tuesday’s audit, but said that if the Legislature were to change policies, that protecting patient privacy is important.

“We’d always want to be sure that data is being used in a way that’s respectful of the patient information contained in there,” Krishnaswami said.

Hayden, the representative from Roseburg and a dentist, said only about 70 percent of dentists licensed by the state have registered with the program, according to information he received from the state’s dental board last week.

Many doctors, dentists and nurse practitioners are pressed for time and hesitant to add one more item to their to-do list.

“Providers aren’t known for loving to add things to their plate,” Hayden said.

Hayden thinks that the program could be improved to be more interactive and give medical providers more feedback.

Privacy concerns are an issue, too, so improvements would have to safeguard patient information, Hayden said.

Other states with more robust programs have helped providers make the database a seamless part of their medical practice while controlling who accesses the system, Ralls said.

Under the program, about 93 percent of top prescribers of controlled substances are registered, said Pat Allen, director of the Oregon Health Authority Director. His agency manages the prescription database.

 “Oregon has seen a steady decline in prescription opioid-related deaths and opioid prescribing in recent years, thanks to the (program) and other initiatives aimed at reducing opioid overdose and death,” Allen said in a statement.

That said, the agency agreed with the auditors’ recommendations and is working to resolve some of the issues identified in the audit. Some changes would require law changes.

Audits Director Kip Memmott said that he didn’t think making the audit’s recommended changes would cost the state more money.

And while other groups, like a gubernatorial task force on opioid abuse, are working on similar issues, his office thought that an audit could spur action by legislators.

“If there’s some political will to get the statute changed, then I think it could really it fast track, which is why we did this audit,” Memmott said. “We know there are some other groups working on this with great intent, but we just wanted to, for lack of a better term, you know, light the fire on it a little bit and see if we could move this from our office a little bit differently.”

Prior efforts to expand the program haven’t passed the Legislature, Ralls said.

Addressing weaknesses in the monitoring program is just one step the state can take to prevent opioid abuse and the harms that result.

“This epidemic is not a one-solution kind of issue, as we all know,” Memmott said. “The prescription drug monitoring program is a key tool in the kit the state has to battle this.”

Reporter Claire Withycombe: [email protected] or 971-304-4148. Withycombe is a reporter for the East Oregonian working for the Oregon Capital Bureau, a collaboration of EO Media Group, Pamplin Media Group, and Salem Reporter.