Doctors would be required to check up on most patients before prescribing opioid painkillers under a legislative proposal that will get a warm reception at a Capitol rally on Tuesday. From there, it may face a tougher reception from physicians who view it as overkill and a crimp on their ever-shrinking amount of time to treat patients.
But national research suggests that requiring physicians to check state registries of patients’ drug histories can help curb the painkiller epidemic by identifying patients who are abusing opioids and “shopping” among doctors for prescriptions.
“Mandate is a word I take very seriously. However, this is a unique issue,” said Rep. Dave Baker R-Willmar, who lost a son to an overdose and has co-authored a bill supporting the requirement. He is scheduled to join with advocates in briefings and at a rally Tuesday for Opioid Awareness Day on the Hill.
Deaths related to misuse and overuse of opioids — legal pills such as oxycodone as well as illicit heroin — have increased sixfold since 2000 in Minnesota.
Most states have responded to the rise in opioid deaths with prescription monitoring databases so that doctors can check on their patients’ drug histories before prescribing opioids. Minnesota’s version launched in 2010, but uptake has been modest.
Only half of the state’s prescribing doctors have created an account so they can access the data.
As of July they will be required to create an account, but current law doesn’t require them to use it.
Opioid prescriptions decline
The number of oxycodone and hydrocodone prescriptions dropped in Minnesota from 2015 to 2016, according to the Drug Trends report published by Carol Falkowski, a former state substance abuse policy executive.
Voluntary prescription monitoring by some doctors probably played a role, but Falkowski said all doctors need to use it or addicts will eventually get around it.
“People who doctor-shop are not amateurs,” she said.
Studies published in 2017 support requiring doctors to use the databases. Researchers with the U.S. Substance Abuse and Mental Health Services Administration analyzed survey data and reported last month that drug abusers took fewer opioids per year in states with stronger monitoring programs.
They also found that reduced use of prescription opioids was not offset by an increase in heroin users. This was a concern for policymakers because they don’t want restrictive prescribing policies to simply drive addicts to street drugs.
A report this month from the National Bureau of Economic Research found that prescription databases curbed opioid use only in states where doctors were required to use them.
And in December, researchers at Brandeis University reported that doctor-shopping declined in Kentucky and Tennessee after the states began requiring doctors to check their prescription databases.
“There’s good evidence, and it’s accumulating, that the strong mandated-use laws have a definite impact,” said Peter Kreiner, a senior researcher at Brandeis, which provides training on prescription monitoring systems.
Wisconsin is mandating, as of April, that doctors check the state’s database before prescribing opioids.
Doctors cite trade-offs
Legislation proposed in Minnesota by Baker and DFL Sen. Chris Eaton — who also lost a child to an opioid overdose — would excuse Minnesota doctors from checking the database only in medical emergencies or if their patients were dying or being treated for cancer pain.
Such an approach could come with trade-offs in the patient-doctor relationship, which is why the Minnesota Medical Association supports using the database but not requiring that doctors check it.
“It’s not practical to require checking the PMP for every opioid prescription,” said Dr. David Agerter, the association’s president, who noted that some studies on mandatory use haven’t been conclusive.
Agerter said Minnesota doctors have taken other steps to reduce opioid abuse, such as educating patients on alternatives for pain relief and supporting the development of online lectures on pain management alternatives for medical students at the University of Minnesota.
On the other hand, Dr. Chris Johnson said he believes that doctors should be required to check the databases before prescribing opioids to their patients because their excessive prescribing habits fueled the rise in addictions in the first place.
Johnson, who directs a state opioid prescribing task force, cited a December 2015 study in Boston that found that 90 percent of patients treated in emergency rooms for overdoses received new opioid prescriptions within two months.
“[Doctors] have forfeited their [right] to tell the rest of society to just ‘back off’ and ‘let us handle it,’ ” Johnson said. “We have greatly damaged our own credibility in this matter.”
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