Audit: State stuck trying to track 'questionable' drug prescriptions
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 released Dec. 11 results of his audit focusing on the Oregon Health Authority's use of the prescription system. State 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 different doctors to get multiple prescriptions.
Analyzing prescription data
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.
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.