Speeches & Floor Statements
Posted on February 27, 2018
Like many doctors, John Hopkins surgeon Marty Makary was taught to prescribe opioids for patients during medical school and “gave out opioids like candy. My colleagues and I were unaware that about one in 16 patients become chronic users.”
After seeing his own father recover from gallbladder surgery with a single ibuprofen tablet, Dr. Makary realized the extent of which the medical community had been overprescribing opioid painkillers.
Data and technology can help identify these intentional or unintentional actions so their behaviors can be improved.
For example, Dr. Makary said, “My colleagues at Johns Hopkins and I have used data to identify the average number of opioids a doctor prescribes after a routine C-section… The range of doctors’ prescribing patterns is stunning. Some doctors average three to 10 opioid tablets after C-section, while other doctors still average 30 or 60 tablets.”
As we’ve examined this crisis over the last five months, we’ve learned that strong local communities are key to finding solutions and Washington’s role is to support those efforts.
When we look at what the federal government can do, sharing more data and utilizing new technologies may be the most helpful thing that we do.
Data can paint a more complete picture of the opioid crisis:
- revealing which communities are seeing a spike in prescriptions – such as a West Virginia town of 3,191 people that saw 20.8 million painkillers shipped to its two pharmacies for over a decade;
- helping doctors avoid prescribing opioids to someone recovering from addiction – we’ve suggested that in Jessie’s Law, which the Senate passed last year, we can make it easier for doctors to be alerted to a patient’s opioid abuse history; and
- recording the last time someone who overdosed had filled a prescription – by checking health records and the Prescription Drug Monitoring System, Tennessee has found that less than 50 percent of people who died from an overdose in 2017 had filled a prescription in the prior 60 days, suggesting that more people dying from an overdose are buying heroin or fentanyl illegally.
Quality data gives everyone the ability to make informed decisions about how best to address the opioid crisis.
For state and local governments, it means having Prescription Drug Monitoring Programs, or PDMPs, that are easy to use.
PDMPs are databases that nearly every state uses to track controlled substance prescriptions so state officials can see what is happening at the community level and doctors and pharmacists can check a patient’s history with controlled substances before writing or filling a prescription.
- For Tennessee, this has proved to be an invaluable tool. Between 2015-2017, the number of prescriptions written for opioids has decreased by 14 percent in Tennessee. The Tennessee Department of Health attributes those decreases to doctors and pharmacists using the PDMP more.
- However, in our state of 6.6 million people, there were still 7.6 million opioid prescriptions written in 2016.
- And for individual doctors, nurses, and patients, data can mean helping prevent more people from sliding down the slope of addiction.
- For example, if a patient wants their doctors to know about a past opioid addiction, that should be clearly marked in their electronic health record. We need electronic health records that doctors are able to use and patients are able to access for this to be successful.
- Additionally, integrating the data from PDMPs into electronic health record systems – so that providers don’t have to log into different systems to see all of a patient’s records – will make it easier for doctors to have better information and reduce the time they spend looking at screens instead of seeing the patient.
- As we consider new legislation, I want to hear specific suggestions about how the federal government can help states and local communities take full advantage of the amazing potential that technology has to offer in solving the opioid crisis.
- Is the federal government preventing states from using their PDMPs in ways they think would best help their communities?
- How can the federal government encourage states to share more data?
- For example, someone may visit a doctor in Obion County who writes them a prescription for 30 Oxycodone and then they could cross into Missouri to visit another doctor who writes another prescription for 30 more.
- If states aren’t sharing data, there’s no way anyone can track this “doctor shopping” to prevent it.
- It is not as easy as it ought to be for states to share this information. We want to make sure states are encouraged to share data but not mandate exactly how to do so.
- While we do not want to mandate burdensome rules for doctors to follow, how can we encourage doctors to prescribe medications, especially controlled substances, electronically whenever possible?
- If a patient has a procedure done at Vanderbilt, but lives in Jackson, his doctor may write a prescription for more opioids than he needs, to prevent the patient from needing to come back to Nashville for a refill.
- If the doctor electronically prescribes that prescription it makes sure there is a digital record of the prescription that can be logged in the PDMP so states have a complete picture of who is prescribing what medication for which patient.
- In the private sector, health care companies like clearinghouses, hospitals, and insurance companies have a lot of data – and these businesses use that data to their advantage, to make improvements to their business.
- I would like to hear about how the federal government can start using all the data it collects to identify and prevent overprescribing before it leads to addiction and overdose.
- For example, BlueCross BlueShield can take claims data to see who is prescribing opioids and who is using opioids and try to prevent doctors from overprescribing and patients from filling too many prescriptions.
Privacy – Why It is Important
New technology and more data can be very useful tools, but we also have to consider everyone’s privacy – and there is a lot at stake.
We have heard stories about grandparents who filled a prescription for Naloxone – an opioid overdose reversal medication – to keep in the house in case their grandchild overdoses, but is then unable to qualify for life insurance because their record shows they filled a prescription for an overdose drug.
Addiction can impact every aspect of a person’s life, from their ability to find a job and housing and keep custody of their child, so we need to ensure that whatever action we take, people’s privacy is protected.