New audit says Oregon regulators failed to enact majority of recommendations aimed to stem opioid misuse

By LYNNE TERRY/Oregon Capital Chronicle

SALEM — As a deadly drug epidemic continues to rage in Oregon, state officials have only made a few changes recommended by the Secretary of State’s Office nearly four years ago to curb opioid misuse.

That was the overarching finding of an audit released Wednesday of the state’s Prescription Drug Monitoring Program, which tracks prescriptions of controlled substances, including painkillers, stimulants and tranquilizers.

The report reviewed changes the state has made since the Audits Division of the Secretary of State’s Office first audited the program in December 2018.

Over that time, the drug epidemic has worsened, and today poses a major threat to adolescents. Secretary of State Shemia Fagan said during an online news conference that her mother became addicted and ended up homeless. Addiction, for her, is deeply personal, she said.

“These are people’s parents and kids and uncles and brothers and siblings and friends,” Fagan said. “Five Oregonians die a week from opioid related overdoses.”

When the 2018 audit was released, Oregon had the highest rate of seniors hospitalized for opioid overdoses, abuse and dependence. It had the sixth-highest percentage of teenage drug users.

Today, Oregon has the highest rate of misuse of prescription opioids in the country, the Secretary of State’s Office said in a statement.

“Although Oregon is dispensing fewer opioid prescriptions, it is still prescribing at a higher rate than the national average,” auditors wrote. “Additionally, there has been a steady increase in prescription stimulants.”

A practice of excessive prescribing of opioids dates to the 1995 federal approval of OxyContin and aggressive marketing by Purdue Pharma. In the more than two decades since, thousands of people have died across the country. Deaths in Oregon from overdoses and poisoning jumped from about 600 in 2018 to 700 in 2019 and 900 in 2020, Oregon Health Authority data show.

While prescription opioids have contributed to the epidemic, the state is also grappling with a flood of fake fentanyl pills that are easily accessible on the streets.

In the 2000s, amid an opioid epidemic fueled by overprescriptions, various states created databases to track them as a way of limiting excessive prescribing of opioids. Fifty states now have a monitoring program but many have tighter rules than Oregon and they don’t have a drug problem as severe as Oregon, said Kip Mennott, the Secretary of State’s audit director. Tightening the program’s requirements will help stem the problem but it’s not the only answer, he said.

“This is not the entire drug epidemic – this is one part of it,” Mennott said.

Program’s requirements

The program requires pharmacies to file information about prescriptions of controlled substances. Prescribers are supposed to register so state officials can identify excessive prescribers. Prescribers also search the database to identify patients who “doctor shopped” to obtain more prescriptions than they need.

But Oregon providers are not required to check the database when they prescribe controlled substances, the latest audit said. This is something auditors recommended in 2018 and is common in other states.

The audit identified patients with opioid prescriptions from “excessive numbers of prescribers” and “dangerous prescription drug combinations,” which includes mixing opioids such as OxyContin with sedatives, like Xanax.

It also said that state laws prevent the database from being shared with health licensing boards and law enforcement to monitor and address questionable prescription activity, another area of concern.

“Questionable prescribing habits seen within the data, even those that are egregious, cannot be elevated to any regulatory or enforcement entities to directly look into those situations,” the 2018 audit said.

Memmott, whose youngest brother has struggled with a lifelong drug addiction, said many of the changes needed are up to the Legislature. But he said the Oregon Health Authority has not taken an aggressive role in pursuing those changes.

“They feel like they’re limited, and they have other legislative priorities as well,” Memmott said.

As a result, the Secretary of State’s Office is taking “a more active role” in lobbying lawmakers, including presenting the audit to the Legislature, Fagan said. She called on state lawmakers to pass the remaining changes recommended by the audit.

“We have to take full advantage of it,” Fagan said, referring to the program.

The health authority said in a statement that it values the state’s prescription monitoring program, noting it has reduced overprescribing.

“The agency is pleased with the performance of the (program) in ensuring appropriate use of prescription drugs, and helping people work with their health care providers and pharmacists to determine what medications are best for them,” the statement said.

But the agency will not play a major role in pursuing legislative changes.

“OHA appreciates that the Secretary of State auditors identified additional areas of improvement. However, many of the recommendations fall outside of the scope of OHA and require additional legislative changes,” the statement said. “The agency looks forward to working with the Oregon Legislature as potential statutory changes are considered in future sessions. The Legislature established the (the program) as a means for improving provider collaboration and patient outcomes, but the program is not a law enforcement, regulatory or insurance tool.”

The audit said five recommendations have not been implemented and three others

• Develop a way for officials involved with Medicaid to query the database to allow them to monitor patient prescriptions for controlled substances statute
• Ask the Legislature to adopt a change in statute ensuring that prescribers register with the program as required and that pharmacies submit corrected data.
• Ensure providers justify questionable prescribing practices and share potential signs of abuse, misuse or diversion of controlled substances with licensing boards and law enforcement. The health authority said it is “actively using appropriate channels” to recommend legislative changes.
• Expand the list of professional and state entities that can access the database. The health authority said it is “actively” involved in making this legislative change.
• Require prescribers to check the database before prescribing a controlled substance and require pharmacies to do the same before filling a prescription and periodically while the patient is on these medications. OHA staff said it is in the process of recommending that the Legislature make this change.

The three recommendations that have been partially implemented include expanding information that the database collects.

“We need more transparency,” Mennott said.

Top prescribers by county:

• Health authority data show that Multnomah County providers have the highest per capita rate of opioid prescriptions.
• Prescribers in Clackamas and Lane counties follow.
• Marion and Jackson counties are third.
• Linn, Douglas, Deschutes and Josephine counties are fourth.
• The other counties have the lowest per capita rates statewide.

• Oregon Capital Chronicle is a nonprofit Salem-based news service that focuses its reporting on Oregon state government, politics and policy.