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Audit: Oregon doctors still don’t have to check opioid history

Oregon has the highest reported rate of prescription pain killer abuse of any state
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Oregon has failed to make key changes intended to reduce improper opioid prescriptions, the Secretary of State’s office said Wednesday in a follow-up report to a 2018 audit that identified a host of problems with the state’s use of a database tracking prescriptions of addictive medications.

Only four of auditors’ 12 recommendations have been fully implemented, according to the report. The Oregon Health Authority, which oversees the state’s drug monitoring program, told auditors most of the changes required legislative action.

Governor Kate Brown’s 2019 to 2021 state budget said the health authority supported the recommendations and would await further guidance from the Legislature.

“Our follow-up work indicates Oregon could do more to promote and enhance the use of [the prescription drug database] as a tool to help combat drug epidemics,” the office said. “However, Legislative changes are needed to fully implement outstanding recommendations.”

The opioid epidemic was initially fueled by prescription painkillers, originally billed as safe, yet found to be highly addictive. That has led to today’s heroin and fentanyl epidemic.

Secretary of State Shemia Fagan drew a straight line from the problems it wants fixed to the opioid epidemic that, according to the health authority, kills five Oregonians a week.

“These are not statistics; these are not just numbers,” Fagan said at a news briefing Wednesday. “These are people.”

As awareness grew about opioid abuse, government agencies cracked down on pain pill prescriptions and took the companies making and selling them to court. Nationally and in Oregon, opioid prescriptions have fallen. Unintentional prescription drug overdoses in the state have fallen in the past six years, even as overdoses from other opioids, such as heroin and fentanyl, have climbed dramatically.

But Oregon is an outlier nationally, with the highest reported rate of prescription pain killer abuse of any state, according to the most recent federal recent data.

One component of the multi-pronged effort nationally to cut down on inappropriate opioid prescriptions has been the Prescription Drug Monitoring Program, a database that is meant to track every prescription of medicines that can be abused.

But that system only works if everyone who prescribes the medicines uses the database. Oregon is one of fewer than 10 states that does not require all prescribers to check the database for suspicious activity, such as doctor shopping, before writing a prescription, according to the 2018 audit. Since late 2021, providers have had to check the database before prescribing drugs to Medicaid patients.

That was one of a dozen shortcomings the Secretary of State identified in its 2018 audit of the program. Since then, the state has acted on some of the original audit’s recommendations, including putting together “report cards” analyzing prescription trends among prescribers and clinics and helping clinics become more familiar with the prescription drug database.

But the state has not taken the bulk of the most important actions, including mandating that all prescribers actually use the database, pursuing changes in the law that would force prescribers to register with the drug monitoring program and penalizing pharmacies that input incorrect information.

Most of the outstanding changes require legislative action, the auditors said the health authority told them.

The health authority “is actively using appropriate channels to recommend legislative changes,” auditors wrote of the recommendation that all prescribers be required to use the database.