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About The daily Astorian. (Astoria, Or.) 1961-current | View Entire Issue (Jan. 11, 2019)
A7 THE DAILY ASTORIAN • FRIDAY, JANuARY 11, 2019 Opiods: Auditors have found instances of Oregonians ‘doctor shopping’ Continued from Page A1 Oregon legislators in 2017 revised the state’s prescrip- tion reporting system to flag doctors who prescribe high volumes of opioids or pre- scribe conflicting drugs. ‘Doctor shopping’ State auditors examining the system found instances of Oregonians “doctor shop- ping.” Nearly 150 people were identified as each get- ting prescribed drugs from at least 30 different doctors. That led auditors to ques- tion how the state deals with those doctors identified as improperly prescribing opioids. “Questionable prescrib- ing habits seen within the data, even those that are egregious, cannot be ele- vated to any regulatory or enforcement entities to directly look into those situ- ations,” auditors said in their audit released in December. Auditors recommended that a state review committee get authority to require pre- scribers to justify practices deemed “concerning” and to collaborate with licensing boards and police. The state committee con- fidentially reviews pre- scriber, pharmacy and patient prescriptions, according to the Oregon Health Author- ity. It also developed criteria defining risky prescribing. When the committee spots a suspicious pattern, it typically writes to the doc- tor. A sample letter that state auditors reviewed said it was an “invitation to explore” the state’s resources and “review your prescribing practice.” The doctors don’t have to acknowledge the letter, or take any more training or education, auditors said. The information can’t be shared with medical licens- ing boards. Those licensing boards The Associated Press OxyContin is a powerful painkiller. can obtain the state’s infor- mation if they certify the information is needed for an investigation. According to the Ore- gon Health Authority, state licensing boards in the last three months of 2018 requested drug mon- itoring information 109 times. Department officials couldn’t recall a time when they denied a request for such information from the board and said the requests are increasing. Police can obtain the monitoring program’s data with a court order. By the time Oregon legis- lators established the state’s prescription drug monitoring program in 2009, Oregon was behind dozens of other states already operating sim- ilar programs. Rob Bovett, former Lin- coln County district attor- ney who at the time lobbied on behalf of law enforce- ment groups, helped lead the charge to create the monitor- ing program. The law was the result of “a lot of bargaining and compromise” between advo- cates and the ACLU of Ore- gon and the Oregon Medical Association, Bovett said. Police and prosecutors wanted to tackle prescrip- tion drug abuse at the source, Bovett said. “Oregon law enforcement doesn’t just want tools to go after people for drug abuse,” Bovett said. “They prefer that drug abuse drop because they’ve got plenty to keep them busy and we just, quite frankly, don’t have enough of them.” The Oregon District Attorneys Association plans to review the audit report at its board meeting today, according to the associa- tion’s executive director, Tim Colahan. Gary Schnabel, the exec- utive director of the state’s Board of Pharmacy from 1999 to 2014, said the board floated the idea of the state monitoring controlled sub- stance prescriptions for years before the legislation was passed. He got the idea while at a national conference and learned what other states were doing. “It was the very begin- nings of the opioid crisis, and it was a way to actually monitor opioid use,” Schna- bel said. The point was to identify people using more than a cer- tain amount — whatever pro- gram administrators thought was appropriate — and let doctors know. Pharmacists hoped that the program could prevent issues like doctor shopping Beer: Cary started Pilot House with Shelton in 2013 as North Coast Distilling Continued from Page A1 megabreweries have been for the last few years,” he said. “As that kind of set- tles out and we see where that goes, this is kind of a growing industry, and we have local people we can work with. “Would we have gone out and just bought dis- tilling equipment and found a distiller? Prob- ably not. But it was just kind of knowing Larry and Christina, and being able to trust them and work with them, is kind of what the main spark was.” Cary, a former bil- liards salesman, started Pilot House with Shelton in 2013 as North Coast Distilling in the Asto- ria Plumbing building on Duane Street. The dis- tillery has grown, win- ning national awards and becoming one of the first to release cocktails in a can. “My biggest obstacle the last couple of years has been keeping up with demand we’ve created,” Cary said. Since opening, Cary has also run into legal hur- dles, namely trademark disputes. North Coast Brewing Co., from Cali- fornia, threatened to sue over the similarity of the distillery’s original name, leading Cary to rename the company Pilot House Spirits. House Spirits Dis- tillery in Portland soon made a similar threat, leading to another name change to Pilot House Distilling. Cary said the craft dis- tilling industry has also been challenged by a dra- conian state tax system. Distillers pay up to 40 percent of tasting room bottle sales to the state. Gov. Kate Brown’s bud- get proposal calls for a 5 percent tax hike to raise another $21 million in revenue. “It makes it very hard for small distilleries to break out of that small mold and grow,” he said. The high taxes and administrative require- ments have made it dif- ficult to add employees, Cary said. Buoy Beer recently provided help to bottle spirits, along with mash from its brewhouse, to enable Cary to turn out more whiskey. Cary is excited about being able to keep up with demand and put out some new varieties of liquor and canned cock- tails, which now include a bloody mary, Mos- cow Mule and a gin and tonic. “The canned cocktails are crazy,” he said. “That was something I never thought in all my wild- est dreams would take off like they did. But I cannot keep up with that. We can- not do the bottled spirits at the same time.” The process of trans- ferring licenses has been delayed by the partial gov- ernment shutdown, but the two sides hope to com- plete the changeover by the summer. In the meantime, the brewers at Buoy will focus on making good beer, while Cary will have the freedom to focus on mak- ing good spirits, Kroening said. “Everybody’s focusing on what their passions are and what they’re great at,” he said. by having doctors intervene when they found a patient had multiple prescriptions for the same or conflicting drugs. But they didn’t want to share the database with police or investigators. “The only people who (would have) access to that data were the patient them- selves, or the patient’s phy- sician,” Schnabel said. “Nobody else would have access to it.” The state association rep- resenting doctors and the ACLU of Oregon resisted at first, Schnabel said. Privacy The ACLU of Oregon worried the program would invade patient privacy and could be susceptible to data breaches. Some health care providers also voiced privacy concerns, legislative records show. “They thought it was invasive,” Schnabel said of the Oregon Medical Asso- ciation. “They thought it might get physicians in trou- ble, thought it might be puni- tive against the physician for prescribing. They just didn’t trust it.” Courtni Dresser, director of government relations for the Oregon Medical Associ- ation, said the group never opposed the program. The monitoring system was cumbersome at first, said Dr. Amy Kerfoot, an Oregon Medical Association trustee who represents the associa- tion at the governor’s Opioid Epidemic Task Force. In recent years, the associ- ation urged reforms to make it easier for doctors to use the monitoring data, Dresser said. In 2017, state lawmak- ers created the special com- mittee to review prescrib- ing practices of controlled substances. The bill was sponsored by then-state Rep. Knute Bue- Culp is cleaning out the store, making repairs, tak- ing stock, securing wood with Hampton Lumber Mills and preparing to restart a franchise with Ace Hardware or independently. He isn’t worried about Home Depot. “If we don’t (make it), the construction company will just consume the store, and the construction com- pany will eat the inventory,” he said. “I have a plan B.” The expansive store includes ample shop space. Culp is taking inquiries through his building com- pany on what people are interested in renting as he Edward Stratton/The Daily Astorian Culp & Sons Builders Inc. are relocating their offices to the former Warrenton Builders Supply on Main Avenue, while reopening a hardware store and renting out commercial shop space. cleans and repairs the build- ing, remodeling spaces to suit. The relationship between the Culp and Walter families goes back as far as the open- ing of Warrenton Builders Supply, when Culp’s father, Jim, was a contractor and one of Walter’s first customers. “Because of that, I won three buckets of house stain,” Jim Culp said. The two families grew a of Economic Research that found opioid mis- use decreased in states that required health care provid- ers to check such a database. Dresser said requir- ing queries by law isn’t necessary. “There’s no need to man- date it because it will just be part of the workflow as the integration project contin- ues,” Dresser said. Oregon’s program, audi- tors said, was “intended to be used for determining the course of treatment for a patient and should be right- fully protected,” auditors wrote. “Yet it is also intended to help ensure appropriate use of prescription medications.” Improve care The ACLU of Oregon maintains that the monitoring program shouldn’t be used to punish or regulate doctors, but to help them improve medical care. In 2017, roughly 40 per- cent of prescribers were reg- istered with the program, according to the Oregon Health Authority. By late 2018, after state outreach efforts, 83 percent of pre- scribers were registered. Additionally, only retail pharmacies must submit pre- scription data to the state. That leaves out pharma- cies in long-term care facili- ties and residential treatment facilities, auditors said. There are 143 institutional pharmacies licensed in Ore- gon, according to the Board of Pharmacy. Of those, 56 are pharmacies in long-term care facilities. Those facilities often care for patients with chronic ill- nesses or disabilities, rather than patients with acute pain like a back injury. The Oregon Capital Bureau is a collaboration between EO Media Group, Pamplin Media Group and Salem Reporter. Property: Trend highlighted unpredictability of where the homeless may congregate Continued from Page A1 Business owners were concerned that some of the problem behaviors would resurface downtown. So far, though, that doesn’t appear to have happened, Heath said. The trend highlighted the unpredictability of where homeless people may con- gregate and what behaviors could follow. Right now, vacant storefronts are the hot spots. “I don’t think that any of the issues have been elimi- nated because, sometimes, the issues relocate to another spot. This usually mani- fests itself at a location that is vacant or doesn’t have a business currently using the property,” Randall said. “If there is no signage, such as the Property Watch signs, then those that want to hang out somewhere often see those locations as their best option.” In addition to the shifting locations, new faces can also appear. Schmidt differenti- ated between local homeless people and transients who pass through town. A different group has been hanging out at the small Store: Building includes ample shop space Continued from Page A1 hler, R-Bend, a surgeon, and supported by the medical association. The committee advises the Oregon Health Author- ity on interpreting prescrip- tion information and train- ing prescribers. State law requires committee mem- bers be licensed health care practitioners with at least five years’ experience prescribing controlled substances. The following year, Gov. Kate Brown asked the Legis- lature to mandate registration in the prescription program. Kerfoot testified in favor, as did other health care groups like the Oregon Pri- mary Care Association. “Requiring practitioners to register with the Prescrip- tion Drug Monitoring Pro- gram is another important step in the right direction,” Kerfoot told lawmakers in a letter. She said the program would be “a powerful tool to help providers rethink pre- scribing decisions that had been automatic in the past, but maybe should not have been for many patients.” In an interview, Kerfoot acknowledged that the med- ical association was con- cerned that doctors would become more liable for their prescribing decisions. “You never want to have a legislative body sending out what a physician is lia- ble for when they don’t yet have the background on the patient, the indications, the rationale behind it,” Kerfoot said. “They want prescribing to be safe, but prescribing is a tool that should be available to the people who need to use it — qualified physicians and pharmacists.” But that law created no consequence for not signing up and doesn’t require pre- scribers to access the data- base before prescribing a controlled substance. State auditors cited a study from the National Bureau symbiotic relationship, with Warrenton Builders Sup- ply taking messages for the Culp’s construction com- pany, which provided build- ing services and helped bring customers to the hardware store. The Culp surname still adorned a pegboard next to the cash register when Ken Culp first gained entry to the hardware store. Many have lamented the loss of local shops with knowledgeable staff because of competition from big- box retailers. Culp is hoping to lend his 48 years of con- struction experience to the hardware store, keeping a regular presence in the back office and providing advice to customers. Colin Murphey/The Daily Astorian A sign is posted in the window of a business in the downtown district. grassy area by Schmidt’s store in recent weeks. One night, after the store was closed, three different peo- ple knocked on the front door and asked an employee inside to let them in. For safety reasons, Schmidt advised againstit. “It just seems like it starts to close in after a while, and I don’t have any answers for them, honestly,” Schmidt said. The downtown associa- tion is sending a survey out to businesses this week in an attempt to measure the scope and severity of nag- ging concerns. Results from the survey may find their way into comments at pub- lic meetings. “We know it’s a prob- lem with many differ- ent aspects,” Heath said. “More to come at this point.” :ŽŝŶƚŚĞZDDŽĐĞŶƚŽƌƉƐ The Columbia River Maritime Museum is recruiting enthusiastic volunteers to lead gallery tours for adult & school visitors. Join our docent corps & experience the excitement that comes from inspiring visitors with enthusiasm & curiosity about the maritime traditions of the Columbia River & the PNW. Make new friends with people who have similar interests & become part of a great institution. Training: Tuesdays from January 29th - February 26th No prior experience is necessary—just enthusiasm for learning about what the maritime history of our region. Interested? Call the Volunteer Coordinator at 503-325-2323 or email volunteer@crmm.org. Space is limited to seven prospective docents per class.
