Ohio Academy of Family Physicians President Don Mack, MD, and Executive Vice President Ann Spicer met with Steven W. Schierholt, executive director of the State of Ohio Board of Pharmacy (SOBP), on May 23. A. J. Groeber, executive director of the State Medical Board of Ohio (SMBO), joined the meeting by phone.
During the meeting, Dr. Mack reviewed each and every one of the 41 comments received from OAFP members regarding the Ohio Automated Rx Reporting System (OARRS) and emails received by members alleging missing OARRS checks. Comments were categorized under the following themes: management issues/system dysfunction; threats/physician frustration; physician burnout; actions taken are not reducing overdose deaths (reduction of which is the stated goal of OARRS compliance checks); delayed prescription fills by patients; confusing rules about controlled vs. non controlled medications; identification hospice/cancer patients; patients with no report; and suggestions for added features.
Future rounds of emails from the SMBO will provide a direct link to additional information about alleged missed checks. Information provided will include patient name, date of prescription, patient’s date of birth, and medication. No longer will prescribers have to call the SMBO, which in turn has to call the SOBP, to request information for the prescriber.
We spent substantial time discussing the importance of tone—that a collaborative approach is much more conducive to achieving desired outcomes than is a strategy using accusations and threats of punishment based on data that may or may not be correct. The SOBP seemed more receptive to that argument than the SMBO. We repeatedly made the point that streamlining and simplifying processes is extremely important for busy physicians. OARRS should be a tool to help physicians not a practice burden.
OARRS knows they have a problem with specific identification of hospice/cancer patients and they are working on that.
We also learned that the SOBP is working to institute red flag alerts in OARRS that would identify patients who have overdosed in the past and/or who had participated in drug court. They could not give us an estimate as to when that feature would be available.
While OARRS checks are increasing and opioid prescriptions are down substantially, overdose deaths continue to rise. The Kasich administration is wedded to the idea that reduced opioid scripts will eventually result in fewer patients with addiction and fewer overdose deaths. They base their belief on the fact that OARRS records indicate the majority of those patients who have overdosed have received a controlled substance script in the past. A May 8 review in the Annuals of Internal Medicine found there is insufficient evidence available for examining the correlation between prescription drug monitoring programs and non-fatal overdoses.
Clearly, the directives for all the new regulations, compliance checks, and aggressive action on controlled substance prescribing are coming directly from the governor’s office as a response to Ohio’s opioid epidemic. Both directors listened attentively to what we had to say, but operate at the pleasure of the governor.
Please continue to let the OAFP know what you are experiencing in your practice so we can continue to work for system improvements.