OLYMPIA — The well-dressed, middle-aged woman came to the emergency room complaining of shoulder pain. She didn’t look like a drug addict. But when the patient’s history of taking a narcotic painkiller popped up on Dr. Nathan Schlicher’s computer at St. Joseph Medical Center in Tacoma, he started asking more questions.
The patient admitted that her regular doctor had pulled her prescription after she tested positive for cocaine. Schlicher told the woman he could not give her a new script.
“Doctor-shopping” is what Schlicher’s patient tried that day. It’s helping to fuel an opioid addiction explosion and a related rise in heroin addiction.
State Rep. Strom Peterson, D-Edmonds, this year filed legislation seeking to curtail doctor-shopping by requiring all doctors to check the state’s five-year-old statewide Prescription Monitoring Program, a database that tracks all prescriptions, before they prescribe opioids and other highly addictive drugs.
The House approved an amended version of House Bill 2730 in February and the Senate passed it late Thursday. It will now go to Gov. Jay Inslee for signing.
About 600 people in the state die each year from either prescription opioids or heroin, according to the Department of Health.
“Opioids” is a term for natural or synthetic drugs drawn from or mimicking the opium poppy, including heroin and prescription painkillers such as oxycodone and hydrocodone.
But as efforts such as the prescription monitoring system have squeezed the supply of prescription painkillers, more people have turned to heroin, leading to a spike in heroin overdoses.
More people in Washington died of overdoses than from car crashes in 2012.
“Now we’re facing the worst man-made epidemic in modern medical history,” said Dr. Gary Franklin, medical director at the Department of Labor &Industries, which has made extensive use of the state’s system. “The more the better for prescription monitoring,” he said.
But the medical lobby pushed back against the mandate in the original Peterson bill. Doctors like Schlicher say the software is so cumbersome that it deters doctors from using it and wastes precious time with patients.
“The solution is to fix the software, not to add one more administrative burden that’s going to push providers out of the practice,” Schlicher said in an interview with InvestigateWest.
Doctors say they have a better way. Schlicher helped to develop a special system for emergency departments that allows doctors to bypass the state’s clunky online program altogether. Instead, patients’ prescription history from the Prescription Monitoring Program’s database is automatically pushed out to emergency rooms when patients walk in.
The amended version of Peterson’s bill would encourage other facilities to develop “push” systems similar to the one used in emergency rooms.
Physicians complain that the state’s existing system is inconvenient, requiring doctors to remember their password and log-in when they want to check a patient’s records, for example.
The legislation would allow health care facilities and doctor groups of at least five medical professionals to register for the monitoring program as a group. Then the facility can bring the state-gathered information into the practice’s own electronic health records. In practices that opt in, what had been a process of three minutes or more can become a one-click solution.
“If everything goes the way I hope it does eventually, as we move to this push system, it’s no longer a question of if you want to access it. It will be delivered to you,” Schlicher said.
Individual and small group providers would still be stuck logging directly into the state’s system. But proponents of this approach say it targets facilities and large provider groups, such as orthopedic departments, which prescribe a lot of narcotics.
The Department of Health, which has run the prescription monitoring program since it began in late 2011, acknowledges that the difficulty of accessing the system deters some doctors from using it. Only one-third of the state’s licensed prescribers have registered for an account.
“Our idea is, if you make this seamless and easy for them to access, you shouldn’t have to mandate that they use it,” said the health department’s Chris Baumgartner, who oversees the program.
Peterson, the state representative, lost a young cousin to a heroin overdose about a year ago and serves on a legislative work group on opioid issues. He said the state might have to mandate use of the monitoring program in the future if some doctors still refuse to participate. But he hopes that the majority will sign up voluntarily as the system becomes easier to use.
Washington is one of 29 states that does mandate use of the monitoring program in some circumstances, such as in conjunction with worker’s compensation claims and methadone treatment, according to the National Alliance for Model State Drug Laws.
This story is part of InvestigateWest’s Statehouse News Project, a crowdfunded effort to provide independent reporting on the Legislature. Please support the project with a tax-deductible donation at invw.org.
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