Legislation requiring doctors to use a state-run drug-monitoring system before prescribing a controlled substance represents the “start of a journey” to address the opioid epidemic in Michigan.
The two bills are part of a broader legislative push emanating from the work of a task force that urged action on the growing problem of opioid and prescription drug abuse, which has contributed to a rising death rate from overdoses.
“This is indeed a journey … and I can’t tell you how long it’s going to last,” Sen. Mike Shirkey said as the Senate Health Policy Committee began reviewing the two bills in mid-April.
A Republican from Jackson who chairs the committee, Shirkey hopes to see movement on the bills by the time the Legislature goes on summer recess. The legislation offers a state response to the opioid problem, he said. A broader fix requires the involvement of the private sector and grassroots community organizations in the state as well, said Shirkey, who expects the bills to change from their present version.
“These bills are not the end of what we will see. Nor are these bills the end-all or solution to our problems,” he said. “Ultimately, this is a community-level culture issue. It is not a statutory issue, but we can do some things to enable those efforts to take root and make a difference.”
A task force appointed by Gov. Rick Snyder to examine the rising rate of drug overdoses recommended requiring doctors to use the recently upgraded Michigan Automated Prescription System, or MAPS, which the legislation addresses. Another bill coming from the task force’s work would require Medicaid to pay for treating opioid addiction.
The October 2015 report from the Michigan Prescription Drug and Opioid Abuse Task Force concluded that prescription drug abuse “has reached epidemic proportions.”
“The increased availability of prescription drugs, coupled with general misperceptions regarding the safety of physician-prescribed medications, has led to exponential growth of drug users and drug abusers,” according to the report.
Deaths in Michigan from overdoses of prescription drugs have tripled from 1999 and the problem is particularly serious among young adults and teens, according to the task force. The report noted that people abusing prescription drugs will at times transition to illegal drugs such as heroin.
Requiring doctors to use MAPS, which the state updated in April to make it quicker and much more user-friendly, can “decrease the number of opioid-related overdose deaths, eliminate doctor shopping, and limit the number of excessive pills for misuse,” said Sen. Tonya Schuitmaker, a Republican from Lawton in Van Buren County and lead sponsor of the two bills.
Doctor shopping happens when a person visits multiple physicians to obtain prescriptions. MAPS allows doctors to see patients’ prescription histories for controlled substances before issuing prescriptions.
“The epidemic in our state is multi-faceted,” Schuitmaker said. “This legislation is a key part to ending addiction where it often begins: in the doctor’s office.”
In introducing the legislation to the Senate Health Policy Committee, Schuitmaker cited statistics that show 44 overdose deaths occur daily in the U.S., and Michigan ranks 10th in prescribing rates for controlled substances and 18th in overdoses.
“These statistics are too alarming and we need to do something about it. These bills are a first step,” she said.
From 2011 to 2015, drug-related deaths in Michigan grew 21 percent to 15.7 per 100,000 people, according to the annual America’s Health Rankings report from the United Health Foundation.
Schuitmaker’s proposed bills would require doctors to use MAPS when they prescribe a controlled substance, beginning in 2020. Physicians who decline to use MAPS would have to go through training within 180 days of a first violation. For a second violation, physicians could face license suspension or revocation.
IMPROVED EFFICIENCY
At the end of the state’s 2016 fiscal year last September, about 36 percent of the licensed prescribers for controlled substances in Michigan were registered MAPS users, although that number is probably inflated because some physicians have multiple registrations, said Kim Gaedeke, director of the state’s Bureau of Professional Licensing.
When prescribing a controlled substance, licensed prescribers use MAPS only 14 percent of the time, according to a report issued in March by the Bureau of Professional Licensing that examined opioid overprescribing.
In states that have mandated physician use of monitoring systems such as MAPS, 80 percent to 90 percent of licensed prescribers use it, Gaedeke said. In states that lack a mandate, the rate hovers at 20 percent to 30 percent, she said.
“For us, it would be ideal to get 100 percent, but that’s just not realistic,” said Gaedeke, noting that some of the 63,000 licensed prescribers in Michigan never actually prescribe a controlled substance.
“Our goal would be to be like the other states that have mandated use,” she said.
One complaint about MAPS has been the five to 10 minutes it took physicians to run a query on a patient. Upgrades the state made to the system in early April reduced wait times to a few seconds, Gaedeke said. Others within a practice, a nurse or administrator, may also run a query on behalf of the doctor, she said.
The Michigan State Medical Society represents more than 15,000 physicians and is “extremely supportive of the updated MAPS system, seeing it as a crucial first step in giving physicians the tools they need to do their part in reducing drug diversion,” Director of Marketing and Communications Kevin McFatridge wrote in an email to MiBiz.
However, he stopped short of backing the legislation. The Medical Society first wants to see MAPS synced with patient electronic health records so their information is uploaded automatically.
“Until that has been implemented, MSMS won’t be fully supportive” of the bills, McFatridge said.
TWEAKS SUGGESTED
The state Department of Licensing and Regulatory Affairs plans to integrate MAPS with electronic health records. The agency secured a federal grant to pay for five vendors of electronic health records operating in Michigan to integrate with MAPS.
Directly linking MAPS to the electronic health records would eliminate the need for prescribers to log in to two systems. That direct connection would let physicians see the MAPS data in their own systems “and avoid the cumbersome task of logging out of one system and then logging into the state’s system,” according to the Bureau of Professional Licensing report from March.
The integration will cost an estimated $5 million over three years, according to the bureau.
In an initial hearing late last month on Schuitmaker’s bills, health care advocates asked lawmakers for other changes as well.
The Michigan Health & Hospital Association wants the legislation to distinguish between controlled substances prescribed to patients who are hospitalized.
“The delivery of such a prescription drug is for immediate use by lawful order of a prescriber, and the hospital is monitoring both the use the drugs and the patient in an inpatient setting,” MHA wrote in testimony to lawmakers.
Meanwhile, the Epilepsy Foundation of Michigan also asked lawmakers to exempt from the monitoring program such non-opioid, non-narcotic controlled drugs that are used to treat epilepsy patients. Requiring a query for those drugs could cause delays in access to medication, the foundation argued.
