AUSTIN (Nexstar) — A new law in Texas delays the requirement for physicians and pharmacists to check the prescription drug monitoring program to March 2020.
Pharmacies have been reporting controlled substance prescriptions they fill to the PMP database since 2017. However, industry experts have asked that the original September 2019 deadline for all pharmacists and physicians to check the system be pushed back, citing concerns that system integration wouldn’t be ready on time. There were worries that doctors would lose time having to jump from program to program in order to collect a patient’s records.
“Build in some flexibility into the timeline to allow for more system integration, I think there would be a benefit in that,” Walgreens senior manager of professional affairs Thompson George requested to the legislators in a hearing of the Interim Joint Committee on Prescribing & Dispensing Controlled Substances in 2018.
Rep. J.D. Sheffield, R-Gatesville, who is a physician, authored House Bill 3284, as a result of feedback lawmakers received from testimonies during the interim.
Dr. Debra Patt, who is vice president of Texas Oncology and chair of the Texas Medical Association’s Council on Legislation, says the Texas Legislature found a balance in addressing opioid misuse concerns.
“What we’d like to see is more integration with electronic health records to make this process more integrated and more seamless for physicians,” she said.
As a cancer specialist, she wants to ensure her patients, for example, have the appropriate medications they need, while knowing the full picture of what they’re using before she writes other prescriptions.
“Sometimes in cancer, some of the best things we can do for our patients is to palliate them,” she said. “So, my role as a doctor is not that of a police officer and that’s a challenge for me. My obligation is to patients.”
Though the deadline for checking the PMP was delayed, starting this September, the state must form an advisory committee made up of physicians from different practices and pharmacists. The committee is tasked with providing recommendations to the Texas State Board of Pharmacy about system weaknesses, best practices and workflow challenges.
“We’re going to have to see how this goes come March,” Patt said. “We’re going to have to see to what degree is the system integrated into health records and what is the feedback that we’re hearing from patients?”
Starting this month, PMP users will have access to an advanced tool called NarxCare. According to the Texas State Board of Pharmacy’s website, NarxCare “will aggregate and analyze prescription information from providers and pharmacies and present visual, interactive information, as well as advanced analytic insights, machine learning risk scores and more to help physicians, pharmacists and care teams to provide better patient safety and outcomes upfront.”
House Bill 2174, filed by Rep. John Zerwas, R-Richmond, limits opioid prescriptions to a 10-day supply for acute pain. It also requires continuing education for practitioners related to prescribing and dispensing opioids and mandates electronic prescribing starting in January 2020. House Bill 3285, also authored by Rep. Sheffield, expands telehealth services for the treatment of substance use disorders.
Opioid situation in Texas
According to the National Institute on Drug Abuse, “Texas continues to have one of the lowest rates of drug overdose deaths involving opioids.”
But there is still a rising trend in opioid-involved deaths, specifically tied to synthetic opioids, such as fentanyl or heroin. Numbers from the agency show deaths that involved fentanyl tripled over the last decade – 118 in 2007 to 348 in 2017. In that same time frame, heroin-related overdose deaths more than doubled, from 214 in 2007 to 569 in 2017.
Dr. Patt points to an increase in neonatal abstinence syndrome in Texas, too. It’s caused by opioid use during pregnancy. A 2018 presentation by the director of the Texas Targeted Opioid Response Project shows Texas Medicaid newborns diagnosed with neonatal abstinence syndrome in 2011 was 1,150 and increased to more than 1,300 in 2015.
“We know that opioid abuse and dependence leads to decreased productivity in work and increased disability,” Patt said. “There are many ways it hurts Texas in addition to the deaths.”
Efforts to raise awareness
Joseph Gorordo, vice president of business development at Recovery Unplugged in Austin, works with patients experiencing substance abuse. Recovery Unplugged provides music-focused addiction rehab. Patients have access to inpatient and outpatient treatment, group therapy and individual counseling.
However, Gorordo sees some challenges with the PMP.
“I think the whole deal with the PMP can be kind of a double-edged sword, because the idea is that people won’t be able to doctor shop and get different prescriptions from various doctors,” he said. “But that also cuts off their supply and very often, people with substance abuse issues are going to find a way to get what they need regardless.”
But even with those concerns, Gorordo sees the importance of getting the PMP mandate and integration implemented correctly. He hopes as this tracking system continues, state leaders and health experts can continue to educate the community on risks tied to opioid misuse, because there is often a small window of opportunity to help clients experiencing substance abuse.
“If help isn’t available to them in a timely manner, then they’re just going to continue doing what they do,” he said.
At Recovery Unplugged, third-year pharmacy students Lindsey Loera and Mandy Renfro shadow providers and therapists in group settings, as well as in one-on-one meetings. In their previous experiences, they’ve seen how helpful the data collected in the PMP can be.
“I’m excited that the PMP is going to be mandated,” Loera said. “I think there is a lot of positive that could come out of pharmacists and prescribers using it and it’s my hope that other pharmacists and providers share that same feeling.”
Both entered this field of study based on personal experiences with family members and share a goal to help other families touched by substance use disorders.
“I hope to go into this field because when I was born, I was exposed to a family member’s substance use disorder. I was very fortunate for that loved one to achieve sobriety and my life was completely changed for the positive. the reality is that there are a lot of Americans and Texans who don’t get that happy ending and I feel a calling to give back to this profession, to give other children or loved ones or friends that happy ending that I got”Lindsey Loera
“When I got older and I learned the full story about how that family member got help, then getting into pharmacy school and learning about different prescription medications that can be harmful to patients, that’s kind of when the opioid crisis really hit the headlines – it was when we got into school. I had this family member, this interest to learn more and once I started learning more and working with these patients, it’s extremely rewarding to help them because a lot of society does not want to help them. They would rather not, not give money or not support things that are going to help them.”Mandy Renfro
The Texas Department of State Health Services is increasing the number of regional and local public health staff trained in the use of naloxone, which can help reverse an opioid overdose. The department is also using funds from the Centers for Disease Control and Prevention to train health professionals so they can prescribe Buprenorphine, a medication used to help people with an opioid use disorder. Texas AIM is an initiative led by the department, Alliance for Innovation on Maternal Health and the Texas Hospital Association to help women with opioid use disorder during and after pregnancy.