Richardson audit: Oregon lags in curbing opioid abuse

(Update: Adding AP summary of findings)

SALEM, Ore. (AP) – With Oregon having some of the highest opioid-abuse rates in the nation, a state audit found many holes in a prescription drug monitoring program that’s supposed to combat the epidemic.

The audit, released Tuesday by the secretary of state’s office, noted that Oregon is one of only nine states that do not require prescribers or pharmacies to use the prescription drug monitoring program, or PDMP.

Among recommendations of the audit is to require a caregiver to check a patient’s history on the PDMP database before prescribing controlled substances. Another is for pharmacists to do the same before issuing a medication.

The audit identified 148 people who received controlled substance prescriptions from 30 or more different prescribers. One person had 290 opioid prescriptions filled by 75 pharmacies.

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Secretary of state news release:

Secretary of State Dennis Richardson released an audit Tuesday of Oregon’s response to the opioid crisis through the Oregon Health Authority’s Prescription Drug Monitoring Program. He said the audit found that Oregon lags behind other states in implementing many best practices, and it recommends much-needed solutions.

In Oregon, 4,270 people were recently prescribed a dangerous combination of three drugs (opioids, benzos, and muscle relaxants) in the same month, which can be lethal if taken together. One Oregonian received a 1,545 days’ supply of zolpidem (which can be used as a date rape drug) from five separate prescribers in a single year.

Shockingly, Richardson said, 148 Oregonians received controlled substance prescriptions from 30 or more separate prescribers and filled their prescriptions at 15 or more pharmacies within a three-year time frame.

The full findings of this audit are outlined in the Secretary of State’s report entitled: “Constraints on Oregon’s Prescription Drug Monitoring Program Limit the State’s Ability to Help Address Opioid Misuse and Abuse.”

On average, every three days, an Oregonian dies due to prescription opioids. While opioids can be helpful in addressing pain with appropriate medical oversight, they are highly addictive. Dependence on prescription opioids can occur in less than a week, and taking a low dose prescription of an opioid for more than three months raises the risk of addiction 15-fold.

When it comes to providing access to treatment and recovery support for those with substance use disorders, Oregon ranks last for adults and second-to-last for adolescents, Richardson said.

The audit said Oregon has made some progress in dispensing fewer opioid prescriptions over recent years, but our state still prescribes opioids at a rate of 13 percent more than the national average, and the U.S. prescribes more than other comparable countries.

The opioid crisis has a significant personal and financial cost. Oregon has the highest rate in the nation of seniors hospitalized for opioid-related issues such as overdose, abuse, and dependence. The median cost for each hospitalization due to opioids is $13,000.

In 2016, almost 500 pregnancies were complicated by maternal opioid use and 280 infants were born with Neonatal Abstinence Syndrome. From 2015 to 2017, 314 more children entered foster care due to a parent’s drug abuse. The state also has the sixth-highest percentage of teenage drug users. Many people who are severely addicted also find themselves incarcerated at some point.

“Many opioid deaths are preventable, but OHA is trying to fight this crisis with one hand tied behind its back,” Richardson said. “Oregon should learn from the experiences of other states and follow the best practices being successfully implemented across the nation. This audit identifies solutions to save lives and money.”

An important tool found in all 50 states to help combat the opioid crisis is a PDMP. PDMPs collect information on opioid and other controlled substance prescriptions directly from certain pharmacies to provide healthcare professionals with a patient’s prescription history. PDMPs also allow tracking of physician prescribing practices to help state authorities create informed guidelines and address other efforts to improve addiction prevention and treatment.

Oregon laws prevent the use of a number of best practice methods of the PDMP that many other states have incorporated into their programs. Compared to other states, Oregon’s PDMP collects less information. It is used less effectively. It does not allow key players reasonable access to information.

Oregon Lags Behind Neighboring States in Implementing Best Practices

Using PDMP data, auditors found numerous instances of apparent doctor shopping for opioids, dangerous drug combinations, and prescriptions for excessive amounts of drugs. Currently, OHA cannot share this data with health licensing boards or law enforcement. The program is also prohibited from collecting some important information, such as Schedule V medications and method of payment, which could be useful in preventing prescription drug abuse.

“The Prescription Drug Monitoring Program is a critical tool that needs significant upgrades in order to most effectively fight the opioid crisis,” said Audits Director Kip Memmott. “This audit maps out a way to better address opioid and other substance abuse issues.”

Auditors made 12 recommendations to OHA. These include ensuring all key prescribers are required to register and to use the PDMP, sharing data with the state’s Medicaid program, providing guidance on integrating use of the PDMP database, identifying and proposing drugs of concern, ensuring prescription information is complete, working with the legislature to expand laws to allow for more data analyses and sharing, more information to be collected, and require prescribers to use the PDMP database.

Read the full audit on the Secretary of State website.

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News release from the Oregon Health Authority:

OHA responds to audit on Prescription Drug Monitoring Program

SALEM, Ore. – Oregon Health Authority (OHA) Director Patrick Allen issued the following statement today, following the release of the Oregon Secretary of State’s audit on the Prescription Drug Monitoring Program:

“We want to thank the Secretary of State’s audit team for their recommendations on how to improve the Prescription Drug Monitoring Program, one of Oregon’s key strategies to protect patient safety in health care. The PDMP tracks prescriptions of controlled substances such as oxycodone to help clinicians make safe prescribing decisions and detect problems.

“Oregon has seen a steady decline in prescription opioid-related deaths and opioid prescribing in recent years, thanks to the PDMP and other initiatives aimed at reducing opioid overdose and death. About 93 percent of Oregon’s top prescribers of controlled substances are registered, and queries on the PDMP have quadrupled since 2012.

“We agree with the auditors’ recommendations and many align with work already ongoing at OHA. Other recommendations require legislative action, and we look forward to advising the Legislature on these policy ideas.”

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Salem, Ore. – Today, Secretary of State Dennis Richardson released an audit on the opioid crisis in Oregon. Senate Republican Leader Jackie Winters (R-Salem) has released the following statement:

“I am pleased to see that Secretary Richardson and his audits team have looked into this issue that has huge impacts on families and communities across Oregon. We must do more to address the issues of opioid abuse and addiction. I sincerely hope the Legislature will strongly consider some of the recommendations outlined in this audit.”

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Salem, Ore. – House Republican Leader Representative Carl Wilson, (R-Grants Pass) reacted today to the Prescription Drug Monitoring Program audit by the office of the Secretary of State.

Leader Wilson’s statement on the audit:

” 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. 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.

In the coming days, House Republicans will be putting forth legislation based on the recommendations of the Secretary of State. I urge my Democratic colleagues to join with us in this critical work to better protect our friends and neighbors.”