As a drug epidemic rages in Oregon, the state has implemented only a few recommendations by the Secretary of State to curb opioid misuse.

That is the overarching finding of an audit released Wednesday by the Secretary of State’s Office of the Prescription Drug Monitoring Program. It reviewed changes the state has made since the Audits Division of the Secretary of State’s Office first audited program in December 2018. The program tracks prescriptions of controlled substances, including painkillers, stimulants and tranquilizers. 

When the 2018 audit was released, Oregon had the highest rate of seniors hospitalized for opioid overdoses, abuse and dependence. It had the sixth-highest percentage of teenage drug users.

Top prescribers by county:

  • Health authority data show that Multnomah County providers have the highest per capita rate of opioid prescriptions.
  • Prescribers in Clackamas and Lane counties follow.
  • Marion and Jackson counties are third.
  • Linn, Douglas, Deschutes and Josephine counties are fourth. 
  • The other counties have the lowest per capita rates statewide. 

Today, Oregon has the highest rate of misuse of prescription opioids in the country as the state continues to grapple with a drug crisis, the Secretary of State’s Office said in a statement.

“Although Oregon is dispensing fewer opioid prescriptions, it is still prescribing at a higher rate than the national average,” auditors wrote???. “Additionally, there has been a steady increase in prescription stimulants.”

A practice of excessive prescribing of opioids dates to the 1995 federal approval of OxyContin and aggressive marketing by Purdue Pharma. In the more than two decades since, hundreds of thousands of people have struggled with addiction, and many have died. Deaths from overdoses and poisoning jumped from about 600 in 2018 to 700 in 2019 and 900 in 2020, Oregon Health Authority data show. 

While prescription opioids have contributed to the epidemic, the state is also grappling with a flood of fake fentanyl pills that are easily accessible on the streets.

In the 2000s, amid an opioid epidemic fueled by overprescriptions, various states created databases to track prescriptions. Fifty states now have one. Oregon launched its program in 2011. Pharmacies have to file information about prescriptions of controlled substances. Prescribers are supposed to register so state officials can identify excessive prescribers. Prescribers also search the database to identify patients who “doctor shopped” to obtain more prescriptions than they need.

But Oregon providers are not required to check the database when they prescribe controlled substances, the latest audit said. This is something auditors recommended in 2018 and is common in other states.

The audit identified patients with opioid prescriptions from “excessive numbers of prescribers” and “dangerous prescription drug combinations,” which includes mixing opioids such as OxyContin with sedatives, like Xanax.

It also said that state laws prevent the database from being shared with health licensing boards and law enforcement to monitor and address questionable prescription activity, another area of concern. 

“Questionable prescribing habits seen within the data, even those that are egregious, cannot be elevated to any regulatory or enforcement entities to directly look into those situations,” the 2018 audit said.

Other recommendations that have not been implemented:

  • Develop a way for officials involved with Medicaid to query the database to allow them to monitor patient prescriptions for controlled substances statute
  • Ask the Legislature to adopt a change in statute ensuring that prescribers register with the program as required and that pharmacies submit corrected data. 
  • Ensure providers justify questionable prescribing practices and share potential signs of abuse, misuse or diversion of controlled substances with licensing boards and law enforcement. The health authority said it is “actively using appropriate channels” to recommend legislative changes.
  • Expand the list of professional and state entities that can access the database. The health authority said it is “actively” involved in making this legislative change.
  • Require prescribers to check the database before prescribing a controlled substance and require pharmacies to do the same before filling a prescription and periodically while the patient is on these medications. OHA staff said it is in the process of recommending that the Legislature make this change.

Three other recommendations were only partially implemented, including expanding information that the database collects.

The audit said Oregon Health Authority staff and Legislators have made some changes since the 2018 audit, but the current analysis said more needs to be done.

“Our follow-up work indicates Oregon could do more to promote and enhance the use of (the database) as a tool to help combat drug epidemics,” the audit said. 

Oregon Capital Chronicle

Oregon Capital Chronicle is part of States Newsroom, a network of news bureaus supported by grants and a coalition of donors as a 501c(3) public charity. Oregon Capital Chronicle maintains editorial independence. Contact Editor Lynne Terry for questions: Follow Oregon Capital Chronicle on Facebook and Twitter.

Lynne Terry has more than 30 years of journalism experience, including a recent stint as editor of The Lund Report, a highly regarded health news site. She reported on health and food safety in her 18 years at The Oregonian, was a senior producer at Oregon Public Broadcasting and Paris correspondent for National Public Radio for nine years. She has won state, regional and national awards, including a National Headliner Award for a long-term care facility story and a top award from the National Association of Health Care Journalists for an investigation into government failures to protect the public from repeated salmonella outbreaks. She loves to cook and entertain, speaks French and is learning Portuguese.