Last year, we argued that the legislature had missed an opportunity by punting on a bill that would have required doctors to check the state’s prescription monitoring program (PMP) before writing a prescription for some of the most dangerous drugs, to make sure patients were not “doctor-shopping” or showing signs of addiction. This year, legislators righted that wrong, and a bill requiring doctors to check the PMP, although on a narrower range of substances and on a looser schedule, was signed into law by Governor Fallin on March 31.
HB 1948, sponsored by Rep. Doug Cox in the House and Sen. A.J. Griffin in the Senate, requires doctors to check the PMP before writing a prescription for opiates (such as oxycodone and Lortab), benzodiazepines (such as Xanax and Valium), and carisoprodol (Soma) the first time they see a patient and every 180 days thereafter. Prescribers must note the check in the patient’s chart. Providers writing such prescriptions for hospice and end-of-life care are exempt, as are nursing homes.
This new requirement will be enforced by various professional boards, and the bill specifically prohibits the Oklahoma Bureau of Narcotics (OBN) from assessing fines related to the PMP mandate. However, it does require OBN to issue monthly lists of the top 20 prescribers of the drugs to the directors of state medical professional boards, which may then investigate whether those prescribers are operating recklessly, and take appropriate action if they are.
Unfortunately, it’s not clear where this leaves the patients. The bill makes no mention of what a doctors’s action ought to be if the PMP reveals a patient is doctor-shopping, or in any way misusing prescription medication. An estimated 100,000 Oklahomans abuse prescription drugs, and law enforcement leaders have said that prescription drug abuse isn’t a problem we can arrest our way out of; addicts need treatment, not prison sentences. While increased use of Narcan (naloxone) by law enforcement can – and indeed has – saved the lives of Oklahomans who have overdosed on opiates, it’s not a substitute for addiction treatment.
According to the Oklahoman Department of Mental Health and Substances Abuse Services, physician evaluation can determine how serious a patient’s abuse or misuse of prescription drugs is. Many patients require only outpatient treatment. The Department also has resources to help providers determine a course of treatment, should they find that a patient is misusing prescription drugs.
Unfortunately, for patients in need of more intensive, inpatient treatment, the situation is hairier. Such treatment is typically expensive with private health insurance, but it may at least be available on a somewhat timely basis. However, for patients requiring publicly-funded residential inpatient therapy, resources are much more restricted, with few providers and long waiting lists. And uninsured patients likely don’t have any access to this care.
The most powerful option to help these patients is for Oklahoma to accept federal funds for expanded health coverage. We wouldn’t be in this situation if Oklahoma had accepted federal funds to expand health coverage to low-income residents. The increased federal match would save Oklahoma taxpayers an estimated $340 million over the next decade, the 150,000 Oklahomans currently in the coverage crater would have access to the health care they need – including substance abuse treatment.
The PMP bill was the first bill Gov. Fallin signed this session, and it has been broadly hailed as a strong step forward in Oklahoma’s struggle with prescription drug abuse. But just like cancer and diabetes, simply screening for prescription drug abuse isn’t enough. Oklahomans need treatment, too.