Bill targets prescription drug abuse

The measure would revive and strengthen a defunct program that tracks the prescriptions of Medicaid patients who use controlled substances such as opioid painkillers, which lawmakers say are at the heart of a statewide addiction epidemic.

The program, which hasn’t operated since last July due to technical issues with the state’s Medicaid billing system, prevents “doctor shopping” – obtaining several prescriptions from different doctors – by requiring some Medicaid patients to receive controlled substance prescriptions from only one doctor at one pharmacy.

Proponents of the bill said prescription drug abuse often looms over military communities, where disabled and injured veterans can become dependent on painkillers.

Accidental prescription drug overdose deaths have tripled in large swaths of the state in a decade, according to an April report by the legislature’s Program Evaluation Division. Fatal overdoses are estimated to cost public and private insurers $72.5 billion a year nationally.

“This bill is absolutely necessary to keep us going in the right direction,” said primary sponsor Sen. Ben Clark, D-Hoke. “This is imperative that we move forward on this.”

The bill calls for state health officials to develop new guidelines for opioid prescribers and requires doctors to take continuing education classes on prescription opioid abuse.

But the legislation doesn’t address the pressure on doctors to appease drug-seeking patients – or risk losing their jobs – due to hospitals’ increasing emphasis on patient satisfaction surveys, said Dr. Sandra Brown, a physician who spoke at the committee meeting.

Brown opposes the provision requiring additional classes, saying the problem isn't caused by a lack of education on drug abuse.

“It comes from individual providers who know right from wrong, but who are under tremendous pressure to create satisfied patients,” she said. “The physician knows that he or she has absolutely no recourse, that the options are (to) start the supply chain or have an unhappy patient whose survey result may lead to a reduction in compensation or actual termination."

Bill co-sponsor Sen. Fletcher Hartsell Jr., R-Cabarrus, said he hopes to alter the bill’s language in the future to help ease the burden on prescribers.

“Hopefully, we’ll have the time to do it,” Hartsell said. “There is an extraordinarily perverse incentive for prescribers to face the kind of situation that Dr. Brown has indicated.”

The legislation would also streamline the database used to monitor these drugs, expanding access to the federal Drug Enforcement Administration and monitoring systems in neighboring states to better regulate opioid trafficking and doctor shopping across the state borders.

Upgrading the database would help law enforcement agencies, prescribers and pharmacies identify and prevent drug abuse, Clark said.

“You have a lot of data in a lot of different pockets,” he said. “When various systems become aligned, they will be able to communicate together and provide a complete picture of what is going on with regard to prescription drugs in the state.”

The bill’s next stop is the Senate Appropriations Committee.