2023 Legislative Update: SB 559 (PDMP)

Call to Action: Legislative Alert — OVMA Opposes SB 559

The PDMP bill is scheduled for a hearing this coming Monday, March 6, at 1:00 pm.

The Senate Committee on Health Care will hold a public hearing on Senate Bill 559, which adds veterinarians and veterinary facilities to Oregon’s Prescription Drug Monitoring Program. This could require veterinarians to check an online database prior to dispensing Schedule II, III and IV drugs. The OVMA strongly opposes this bill due to the negative impact it will have on veterinary practices, and the limited value it has towards mitigating the opioid crisis.

Time is of the essence, and we need you to send a message to the Senate Health Committee, Senate Leadership, and your personal House and Senate member, preferably before the hearing on Monday, March 6, at 1:00 pm.

Senate Health Care Committee:

Senate Leadership:

Find the Oregon legislator in your district:

Background

The OVMA is working hard to stop Senate Bill 559 and House Bill 2642 from moving forward. While we believe both bills are well-intentioned and support public policy efforts to address the State’s concerns about the opioid crisis, adding veterinarians to Oregon’s Prescription Drug Monitoring Program is problematic. Including veterinarians in the PDMP doesn’t benefit animals, would not benefit or enhance the program, and could harm your patients and damage the profession.

Senate Bill 559 would bring veterinarians and veterinary clinics into the State’s PDMP. As a result:

  • The facility would be required to enter into the PDMP all Schedule II, III and IV drugs and other drugs of interest (i.e., gabapentin, pseudoephedrine) dispensed by the practice. (Drugs administered to your patients are not recorded).
  • All veterinary licensees would be assessed a $35.00 fee to fund oversight of the PDMP by the Oregon Health Authority. This fee would be added to the renewal of your veterinary license and processed through the Oregon Veterinary Medical Examining Board.

House Bill 2642 would mandate that all prescribers/dispensers query the system before dispensing an initial prescription and for all refills of Schedule II, III and IV medications. This would include veterinarians, if SB 559 were approved by the legislature. As a result:

  • The dispensing veterinarian would be required to access the PDMP to check a client’s history of obtaining Schedule II, III and IV drugs and other drugs of interest for their animal.
  • Before any query of the PDMP, you would be required to inform your client that you must look them up in the system.
  • This access would also display your client’s personal prescription history for controlled substances and other drugs of interest. In Alaska, where veterinarians are required to query their state’s PDMP system, some of the drugs on display are: Adderall, post-partum depression medications, sex hormones, anabolic steroids such as testosterone, Xanax, sleep aids like Ambien, etc.
  • Because veterinarians regularly treat animals owned by employees of the facility, you would also be required to follow the same steps as noted above.

The Issue
The PDMP is a tool—enacted in all 50 states—to help physicians and pharmacists provide human patients better care in managing their prescriptions and to reduce the misuse and abuse of controlled substances. Currently, veterinarians in Oregon are exempt from the PDMP, as are veterinarians in 33 other states. In addition, 10 states that one time included veterinarians in their PDMPs repealed their participation for many of the same reasons noted below.

SB 559 was introduced on behalf of Oregon’s Secretary of State, who is following up on a predecessor’s recommendation to include veterinarians in the PDMP. Former Secretary of State Dennis Richardson’s recommendation came after his agency conducted an audit of the opioids crisis in 2018 and indicated that the State of Oregon was failing to adequately address this issue.

OVMA’s Concerns about the Legislation
We have seven concerns with the proposed legislation:

1. HIPAA privacy concerns about querying the PDMP and accessing information

  • The Oregon Medical Association, the ACLU, and the OVMA have raised concerns about HIPAA privacy issues with inclusion of veterinarians in Oregon’s PDMP and opposed similar prior legislation. Finding a workaround may be problematic.
  • Patients in human medicine are your clients in veterinary medicine—and not your patients. You should not have access (intentionally or unintentionally) to view your client’s—or one of your team members’—personal prescription history.

2. Challenges with inputting the required data into the PDMP

  • Veterinary facilities lack the standardized software used in human healthcare facilities, and data captured by veterinary PIMS is not automatically portable into the PDMP’s format. As a result, you would have to enter data—the same information included in your veterinary dispensing record requirement under OVMEB—into a “new” system, all of which would be onerous and labor intensive, require training, and add to the cost of providing veterinary care. All at a time when the veterinary profession is experiencing a significant staffing shortage.

3. Challenges with querying your clients

  • Animals are not uniquely identifiable by a common identifier such as a social security number. Thus, they would be coded under your client’s PDMP database information.
  • This leads us to ask: Whose information should you record and enter into the database? Whose information should you query, if that is required? Animals are often brought in by different family members or friends. Sometimes it is the owner of a boarding kennel. And there can be multiple owners, too—as can be the case for dogs, cats and horses. It also is common for an animal to be taken to different veterinary clinics.

4. Concerns for your patients and the profession

  • While there are many issues with both bills, a primary concern, first and foremost, is for the animal patient. Will veterinary facilities (that are already overburdened, overwhelmed, and understaffed to the crisis point) opt to dispense less-effective but non-reportable pain medications to avoid the challenges this requirement would present?
  • Will clients put off or delay bringing their animals to you because for an examination and/or treatment because they are offended by the intrusion of privacy?

5. Uncertainty about the validity and usefulness of the veterinary information collected by the PDMP

  • A major difference in Oregon’s PDMP compared to most other states is that prescribers/dispensers are mandated to record dosages of dispensed scheduled drugs and other drugs of interest. But dosing and timing for animals is significantly different than it is for humans.
  • Mixing human and animal information in the PDMP detracts from the integrity and value of that information. For instance, veterinarians are not trained to recognize and understand the personal medication needs of their clients. Conversely, physicians do not have the training and experience about the vast dosage ranges for cats, dogs, pocket pets, horse, and farm animals.
  • Any query of this information can lead to inappropriate and incorrect assessments about the data and the human patient. In addition, it is unclear what you are even supposed to do with this information.

6. Vast differences between dispensing in veterinary medicine and human medicine

  • While veterinarians regularly dispense controlled drugs for patient care, the amount is minute compared to the schedule drugs prescribed for and dispensed in the human medical profession.
  • Data from a national prescription drug audit in 2017 showed that opioid prescriptions written by veterinarians and dispensed in retail pharmacy settings in the U.S. accounted for 0.34% of all opioid analgesic prescriptions dispensed in the country.

7. The most common drugs involved in opioid overdose deaths are not from the drugs most commonly used in veterinary medicine

  • According to the Center for Disease Control, the most common drugs involved in the prescription opioid overdose deaths include: Methadone, Oxycodone (such as OxyContin) and Hydrocodone (such as Vicodin). And an increasing number of overdoses are now associated with Heroin and illicitly manufactured Fentanyl.
  • Some of the most commonly purchased opioids by veterinary clinics (2014-2018) are Buprenorphine, Butorphanol, Hydromorphone, and Tramadol. Gabapentin is a drug of interest that also is used in veterinary medicine. Also, Phenobarbital is not a narcotic but is a schedule drug and would have to be recorded into the PDMP as well.

 

Updated: 2023-03-02 08:00:00

Author: Oregon Veterinary Medical Association