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president of the Texas Pain Society (TPS) and member of the Texas Medi- cal Association’s Interspecialty Soci- ety Committee. But he also has patients with le-

gitimate needs and wants to be able to prescribe safely. Some of his patients travel from Oklahoma or Louisiana to see him because they don’t have ac- cess to specialty care in their areas. Even when PAT is up and running,

Dr. Schade must play detective. He hunts through the system’s unwieldy spreadsheets because PAT doesn’t alert him when patients get similar prescriptions from multiple doctors. Almost three years after the sys-

tem’s launch, he prints out patients’ prescription histories and stores them separately because PAT cannot connect with his electronic medical records. And to prescribe in the first place, physicians and other prescrib- ers must get a state controlled sub- stances registration (CSR) certificate

— another process that fails to run smoothly — in addition to their fed- eral prescribing license from the Drug Enforcement Administration (DEA). Dr. Schade says physicians should

be vigilant, and if someone is suspect- ed of doctor-shopping or stealing his prescriptive identity, “Tell me. I want to know.”

But physicians also must be able

to practice medicine efficiently and effectively, he says. And for doctors to more readily and widely make use of PAT, the system needs a makeover.

“Texas is far behind the curve. Other states are already doing these things.” Texas has come a long way in the

fight against prescription drug abuse and misuse, ranking 44th in the na- tion for prescription opioid overdose deaths per year. (See “Texas Tackles Prescription Drug Abuse,” below.) But the state still has a ways to go,

ranking 12th for nonmedical use of prescription opioids. That’s the gist of a pair of Senate

and House committee reports that recommend improvements to PAT as one of several strategies to fight diver- sion. (See “Fixing PAT,” page 40.) The reports, likely to spur legislation, are the result of the Senate Health and Human Services and House Public Health committees’ interim charges to find ways to better tackle the problem, particularly among high-risk popula- tions like pregnant women.

MOVING PAT TO THE BOARD OF PHARMACY As an important first step, the com- mittees agree that transferring the operation and oversight of PAT from the Texas Department of Public Safe-

ty (DPS) to the Texas State Board of Pharmacy (TSBP) would enhance the program’s usefulness. “PAT has the potential to be a

very effective tool in the state’s fight against prescription drug abuse, but is currently not reaching its full poten- tial,” the Senate panel wrote. “DPS is responsible for the monumental tasks of combating crime and terrorism, assisting with statewide emergency management, and ensuring public safety. The agency does not have the bandwidth to focus their attention on prescription monitoring, and the online program has not progressed in terms of usability or interactive fea- tures since its creation in 2012.” The House committee report notes

also that TMA-backed House Bill 1803 from the 2013 legislative session linked renewal of physicians’ CSR per- mits to their medical license renewal; and Senate Bill 1643 authorized path- ways for doctors to access prescrip- tion information through a health information exchange and electronic medical records. “None of these legislative initiatives

from 2013 have been implemented by DPS,” House members wrote. Senate Bill 195, introduced this

year by Sen. Charles Schwertner, MD (R-Georgetown), would shift PAT



To weed out so-called “pill mills,” lawmakers require all pain man- agement clinics to

register with the Texas Medical Board.

The Texas Department of Insurance Division of Workers’ Compensa- tion adopts a closed

formulary that requires prior authorization for certain pain drugs.

38 TEXAS MEDICINE March 2015 2011

The legislature creates criminal penalties for doctor shopping and increases penalties for illicit distribution of prescription drugs.


The Department of Public Safety makes the state’s prescription monitoring program,

Prescription Access in Texas, available online for easier access.

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