TMA Testimony by Sara Austin, MD
Senate Bill 316 by Sen. Juan Hinojosa/Rep. Larry Gonzalez
House Committee on Public Health
May 9, 2017
Chairman Price and members of the committee, I am Dr. Sara Austin. I am a practicing neurologist in Austin, and on behalf of the Texas Medical Association, I am testifying FOR the committee substitute and the substitute expected to come for Senate Bill 316.
Opioid abuse and the diversion of controlled substances constitute a real and vexing problem. While the problem is not as acute in Texas as it is in other states, this does not absolve us from taking steps to help deal with it. As TMA testified at the Sunset Advisory Commission hearings, physicians have an obligation to participate in the solution.
We have consistently taken the position that any legislation considered this session must include all prescribers and all dispensers and that the start dates for mandated use of the Prescription Monitoring Program (PMP) should be uniform for all. We are grateful that Representative Gonzalez has been willing to work with all of the prescriber and pharmacy groups. What he is proposing is both reasonable and helpful.
TMA and others worked for three sessions to improve PMP and make it a useful clinical tool by moving it from the Texas Department of Public Safety to the Texas State Board of Pharmacy. With the passage of Senate Bill 195 last session, this was accomplished. But the law only transferred PMP to the pharmacy board effective Sept. 1, 2016.
In the eight months the pharmacy board has had the program, it has chosen an experienced vendor and completely revamped the presentation of data into a far more useful and logical format. And we know this (from Texas Board of Pharmacy):
- Registered users increased from 27,202 in 2014 to 44,633 by the end of 2016. And this number continues to grow.
- The number of queries in 2014 was 867,879 … and last year, it was well over a million.
- At the same time, we know that opioid prescribing has been dropping consistently in Texas and across the country. By 2016, the Texas rate was down by nearly 17 percent over 2013.
All these data points are trending in the right direction.
We also appreciate that Senator Hinojosa and Representative Gonzalez have accepted our recommendations to:
- Require all prescriber boards to provide the Texas State Board of Pharmacy the name, license number, and email address of each licensee for the purpose of automatic registration, and
- Give the pharmacy board the explicit authority to push out notifications to prescribers and pharmacies when it detects instances of potential doctor-shopping.
And in the state pharmacy board sunset bill is a requirement that wholesalers provide the board same information they provide to the U.S. Drug Enforcement Administration so that, through comparison with PMP data, the board can get a clear picture of amounts of product delivered and product dispensed by specific areas of the state.
All these, taken together, harness the technology now available to identify critical data points — not available to the board in the past — that warrant closer looks.
As we move forward, we believe the interim presents a unique opportunity to study several critical aspects of this information. We recommend the following for your consideration:
- Study the number and effectiveness of push-out alerts to prescribers and pharmacists and the monitoring of such alerts by the licensing boards;
- Study the results and data related to geographic hot-spotting through the comparison of delivery and dispensing data;
- Assess the technological capabilities of the Board of Pharmacy vendor and system in terms of effectiveness in auto registration and scalability for inquiries;
- Study and recommend additional technical capabilities and support necessary for continuous improvement, accuracy, and security of PMP and its data;
- Study the capabilities and improvements to electronic health record systems that allow continuous contact with PMP for automatic polling and whether the state should mandate this capability; and
- Study and make recommendations about the reconciliation, accounting, and disposal of controlled substances at the conclusion of hospice/end-of-life care.
Members, I thank you for the opportunity to testify this morning. It is important work that you are doing, and we pledge our continuing cooperation.
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