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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.”
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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
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Training: Tuesdays from January 29th - February 26th
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Space is limited to seven prospective docents per class.
