Everybody Hurts: To get doctors to track prescription drugs, Oklahoma had to compromise
Oklahoma is now just one of a handful of states that requires physicians to – in many cases – check a patient’s prescription history before prescribing addictive drugs. How did Oklahoma enact this requirement when so many other states – including California – have tried and failed?
It’s instructive to look at what the new law does and what it does not do to understand the compromises state lawmakers made in order to pass the bill one year after facing deal-breaking opposition from powerful associations of health professionals. Here are five key areas that make the law less than it seems at first glance.
1. Time limit on checks. The law says that physicians or their administrative staff will have to check a patient’s history “if one hundred eighty (180) days have elapsed prior to the previous access and check.” Health professionals argued against more frequent checks and won, saying that forcing doctor’s offices to check more frequently would be a burden. A lot can happen in six months. Just ask anyone who has lost a loved one to addiction or an overdose.
2. Exclusion of stimulants. The law says that it applies to “opiates, synthetic opiates, semisynthetic opiates, benzodiazepine or carisoprodol.” This covers most painkillers, like Oxycodone and OxyContin, but it does not cover most stimulants, including: amphetamine, methylphenidate (Ritalin), lisdexamfetamine (Vyvanse), benzphetamine, chlorphentermine, clortermine, or phendimetrazine. Oklahoma lawmakers had worked to have a broader group of drugs included in the law but could not get past the objections of health professionals.
3. Exclusion of nursing homes and hospice care. The law says that the rules do not apply to “practitioners who prescribe the controlled substances … for hospice or end-of-life care, or … for a patient residing in a nursing facility”. This may make a lot of sense for people in extreme pain at the end of their lives. But nursing facility residents can live for many years with the right care.
4. Protection from lawsuits. The law says that if doctors don’t check the patient history database and something bad happens as a result – addiction, overdose, violence, etc. – the physician has no legal accountability. It says that physicians and their staff “shall not be liable to any person for any claim of damages as a result of accessing or failing to access the information in the central repository and no lawsuit may be predicated thereon.”
5. Protection from severe regulatory action. The agency that should be the most invested, most knowledgeable, and most interested in getting tough on the spread of addictive drugs beyond their medicinal purposes would be the State Bureau of Narcotics and Dangerous Drugs Control. But that agency is actually prohibited from doing anything based on whether the doctors uphold the law. Instead, the law hands over all regulatory authority to agencies that are run by the peers of the health professionals who are being monitored. It says that the “State Board of Podiatric Examiners, the State Board of Dentistry, the State Board of Medical Licensure and Supervision, the State Board of Examiners in Optometry, the State Board of Nursing, the State Board of Osteopathic Examiners and the State Board of Veterinary Medical Examiners shall have the sole responsibility for enforcement” and that “nothing in this section shall be construed so as to permit the Director of the State Bureau of Narcotics and Dangerous Drugs Control to assess administrative fines.”
In fact, the law even turns the tables on the state narcotics bureau. It says that the bureau has to provide a monthly list to all the health professional agencies of “the top twenty prescribers of controlled dangerous substances within their respective areas of jurisdiction.” What happens with that list? Well, that’s entirely up to the self-regulating agencies. “Licensing boards shall have exclusive jurisdiction to take action against a licensee,” the law says.
The law even addresses overdoses but says that information gathered about overdoses has to be kept secret and, once again, that the information cannot be used to sue any of the physicians involved. Given these limitations, it will be interesting to see whether the law has any impact on the prescription drug abuse problem in the state. We will keep our eyes on it and let you know.
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Everybody Hurts: Oklahoma navigates politics to require pain pill checks
[Photo by Kool Cats Photography via Flickr.]