Key provisions in fighting opioid abuse were signed into law Wednesday by Gov. Bruce Rauner, but the bill is less stringent than an earlier version written in March.
Doctors and other prescribers, or their designees, will now have to check the state Prescription Monitoring Program the first time they write an opioid prescription for someone, as well as keep a record of their action.
The Prescription Monitoring Program, or PMP, keeps track of prescriptions for opioids and other addictive drugs when they are filled.
The main idea behind checking the PMP is that prescribers would catch “doctor shoppers” who are trying to fraudulently obtain multiple prescriptions for controlled substances. Doctor shoppers are considered people who see three or more prescribers and fill prescriptions at three or more pharmacies.
Using the program “has been proven to significantly decrease opioid over-prescribing, and it has also been associated with a major reduction in doctor-shopping,” Dr. Sarah Pointer, the clinical director for the PMP, said at the bill-signing ceremony at the Comprehensive Behavioral Health Center in East St. Louis. There were more than 37,000 doctor shoppers in 2017, she added.
According to Dr. Eldon Trame, a Belleville physician and past president of the Illinois State Medical Society, opioid prescriptions are down 10 percent in the past four years, and PMP use is up more than 40 percent.
There were 5.8 million prescriptions for Schedule II opioids and about 1.15 million PMP checks by prescribers in 2014, according to previous reporting. Meaning, if all of the checks were for Schedule II opioids, they would have been checked about 20 percent of the time.
Al Frederic, a board member at Comprehensive, said he thought the law was particularly important for the area. Dr. Katie Wright, another board member, also thought the legislation was important.
“We need this,” she said.
“The simple fact is, it’s been very easy for patients ... to get access to medications that are addictive,” Rauner said, “and there has not been a proper way, a good way, to monitor that and prevent overprescription and prescription abuse.”
The law, which takes effect Jan. 1, also requires the PMP to link with electronic health records by 2021. Integrating the records systems should save time during visits to the doctor because PMP information would appear on the same screen as other health information.
As of September, 14 hospitals had linked their record systems with the PMP, according to the governor’s Opioid Action Plan. The process is funded through a grant from the Department of Justice, and the PMP has enough money to link about two-thirds of the 300 records systems in Illinois, according to previous reporting. The current grant ends in 2018, but Illinois has not received the grant every year.
“We can take strong action with or without more federal funding,” Rauner said, but he did not say whether the state would devote money to the effort. “This (law) is only one step.”
The law also requires prescribers with a controlled substance license to register with the PMP by 2018. Previously, the Illinois Department of Financial and Professional Regulation was supposed to make accounts for prescribers when they renewed their controlled substance licenses.
A renewal deadline for physicians passed in July, but, Pointer said, the department did not sign everyone up because the measure wasn’t being enforced.
“(Signups) would be a question for DHS since they oversee the PMP,” Terry Horstman, of IDFPR, wrote in an email Tuesday. IDFPR was unable to provide information on how many signed up.
DHS could not be immediately reached for comment.
Key provisions of the bill
The PMP measures were written by state Rep. Cynthia Soto, D-Chicago. They are similar to ones written earlier in the year by state Sen. Melinda Bush, D-Grayslake, but include key differences:
▪ First, prescribers will have to check the PMP only when they prescribe Schedule II drugs, the most dangerous ones legally available. Schedule II opioids made up nearly 90 percent of all opioids prescribed in Illinois from 2008 through 2016, according to data provided by the PMP. Schedules III, IV and V drugs include anti-anxiety drugs and Tramadol, a popular Schedule IV opioid. They will not have to be checked.
▪ Second, the law watered down a safety check measure when patients are flagged as doctor shoppers by the PMP.
In Soto’s version, when doctor shoppers show up on the PMP, an alert is to be sent to the pharmacy, but no one needs to act on it.
In Bush’s bill, prescribers were initially to be prohibited from writing a prescription for a PMP-monitored drug unless they documented that they had seen the doctor-shopping alert. In addition, pharmacists were not to be allowed to fill prescriptions for flagged patients until receiving the acknowledgment from prescribers. In an amendment she filed in May, Bush adopted the approach that ended up in Soto’s version.
▪ Third, the law also stipulates conditions when prescribers don’t have to access the PMP, including in emergencies, palliative care settings, cancer treatment or when prescriptions are for a maximum of seven days. Bush initially required all controlled substances be checked but later adopted exceptions for oncology and hospice-care settings.
Despite these changes, Bush was happy with the bill.
“Requiring doctors to check a patient’s prescription history before prescribing opioids is a simple way to ensure doctors aren’t over-prescribing and patients aren’t doctor shopping,” Bush said in a statement. “This common-sense change has the potential to prevent overdoses, save thousands of lives and advance the shared goal of ending the opioid epidemic.”
Soto could not be reached for comment.