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Oklahoma Watch: Oklahoma pharmacies fill nearly 10 million prescriptions for narcotic painkillers

Oklahoma Watch is a nonprofit, nonpartisan journalism service that produces in-depth and investigative content on important public-policy issues facing the state.
BY WARREN VIETH, Oklahoma Watch Modified: February 8, 2014 at 10:28 pm •  Published: February 9, 2014
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In some clinics, for example, one staff person might be running PMP checks for several doctors but entering only one registration number for each check. Also, one PMP check might apply to several prescriptions being written at the same time by a single doctor.

Bureau officials said about 74 percent of Oklahoma prescribers who wrote more than 10 controlled substance prescriptions logged into the PMP system at some point last year.

Fallin's office is working with lawmakers, law enforcement authorities, health officials and medical practitioners to devise a collaborative strategy acceptable to all sides. It is likely to include new restrictions on prescribing practices, tougher penalties for offenders and more public and professional outreach campaigns.

“We're all in this together,” Weaver said. “We're not going to arrest our way out of this problem. We've got to have our physicians involved. They've got to police themselves.”

The latest overdose data show that Oklahomans are being killed by prescription drugs at a rate of nearly two people per day.

The drug overdose fatality count climbed 80 percent over the past decade. Deaths caused by hydrocodone and oxycodone more than quadrupled over the 10-year period.

“This is something that's affecting normal Oklahomans,” Weaver said. “Schoolteachers. Police officers. People who are out there functioning in their day-to-day business.”

The danger of rising heroin use made headlines last week when actor Philip Seymour Hoffman died of an apparent overdose. Authorities said they found heroin and prescription drugs at his residence. Hoffman told an interviewer he had resumed a history of drug abuse last year by taking prescription painkillers, then progressing to heroin.

Hal Vorse, a physician who treats habitual drug users and teaches new doctors about addiction at the University of Oklahoma Health Sciences Center, said he's seen the phenomenon in his own practice.

“We're seeing a big surge in heroin, and 85 percent of those people started on prescription opiates,” said Vorse. “The cost of their addiction got so high that they switched to heroin because it's cheaper.”

Vorse said the price on the street for OxyContin has risen to $1 to $1.50 per milligram. Addicts typically use 200 to 300 milligrams per day, he said. “They find out they can get an equivalent dose of heroin for a third of what it costs for Oxys,” Vorse said.

“It's just like Prohibition in the '20s. People who couldn't get good whiskey bought moonshine. The problem with heroin is there's no quality control. You don't know what you're getting.”

Getting more doctors to participate in the Prescription Monitoring Program is a central element of the state's prescription drug-abuse offensive.

The PMP is an online database designed to flag patients who seek multiple prescriptions for painkillers and other narcotic drugs from more than one physician.

Oklahoma's system is considered one of the most advanced in the nation, officials say. All pharmacists are required to enter data for every controlled drug prescription within five minutes of filling it. No other state has a “real-time” reporting requirement like that.

But doctors and other health practitioners are not required to check the database before prescribing controlled dangerous substances, and some don't bother to do so (the only exception is methadone).

Although pharmacists are required to log controlled substance prescriptions into the system, current law does not require them to review a patient's prescribing history before filling the order. Bureau officials said checking a patient's history requires a different computer login process than entering prescription data.

If they do review a patient's history and see evidence of multiple concurrent prescriptions, pharmacists have the authority to refuse to fill a prescription, alert the prescribing physician or contact state authorities, bureau officials said.