NC Republican dislikes regulations. But in opioid fight, ‘It makes sense to me.’

Almost immediately after he was elected to the North Carolina General Assembly in 2010, Craig Horn got a call that changed his political career.

A worried father described how his teenage son had used synthetic marijuana and experienced hallucinations.

“I started calling the DEA,” said Horn, a Weddington Republican who represents western Union County. “They told me about meth and the resurgence of heroin. I learned about pill parties, which I didn’t even know existed.”

That’s how the retired food broker and businessman, who touts small government and less regulation, became one of the Legislature’s staunchest advocates for stricter state rules governing how doctors prescribe powerful painkillers.

He sponsored legislation in 2015 that required state health licensing agencies for nurses, dentists and others to follow policy set by the North Carolina Medical Board. The board urges extreme caution when prescribing Oxycontin, Percocet and other opioids widely blamed for a surge in drug overdose deaths.

Now, Horn said he will push for a bill that would force physicians to check a state-run drug database before prescribing medication. Used properly, he and other proponents said, the data can stop patients from inappropriately getting drugs from multiple doctors and help doctors avoid prescribing a fatal mix of medications.

States such as Tennessee and New York saw far fewer patients visit multiple prescribers to obtain the same drugs after making database checks mandatory.

“I don’t like the government forcing things on people, but this is one area where it seems like we should,” Horn said. “Maybe I am just dumb, but it makes sense to me. It doesn’t sound like a hard regulation.”

But his ideas have run into stiff resistance from some doctors and the North Carolina Medical Society, which encourages physicians to use the database, but has opposed attempts to make it mandatory.

North Carolina lawmakers passed a provision last year requiring that physicians register to use the database. Legislators, however, refused to include mandatory checks in the legislation after lobbying from the Medical Society, Horn said.

Stephen Keene, general counsel for the the North Carolina Medical Society, said there are still concerns about the computer system being time-consuming and cumbersome and a lack of information from neighboring states.

Other critics say little evidence supports new rules. They say most doctors prescribe drugs responsibly and are already overburdened with regulations.

“To ask somebody to do something 30 times a day is not a trivial matter,” Keene said. “We want to make sure the work flow issues are fully addressed. We need to make sure the system is as efficient and streamlined as it can be.”

Over prescribing

Healthcare providers in North Carolina write enough prescriptions for opioids to supply nearly every man, woman and child in the state, according to the federal Centers for Disease Control and Prevention.

Excessive prescribing started in the 1990s when doctors started offering opioids to relieve common problems such as back pain and arthritis. Pharmaceutical companies and aligned medical experts predicted the drugs — once reserved for cancer patients and the terminally ill — could be used with an extremely low risk of addiction.

Today, however, doctors are seen as a major reason for an epidemic of drug overdose deaths.

Fatal overdoses kill more than 1,000 people a year in North Carolina and almost half involve prescriptions written within 60 days of the victim’s death, according to a state report.

To curb deaths, the CDC recommends physicians use prescription drug databases. For each patient, pharmacists have entered information about prescriptions such as type of medicine, dosages, quantities and dates filled.

But a 2014 state report found that North Carolina’s drug database was used only about 6 percent of the time.

Patrick Burnside, a Charlotte emergency room physician, said there are misconceptions among doctors about how long it takes to use the database. Many complained the system was cumbersome and tricky to use when it was rolled out about 10 years ago.

Improvements have eliminated most of those issues, Burnside said.

A typical doctor’s appointment is scheduled to last 15 minutes, leaving little time for the database check. Burnside said doctors can check the database in as little as 20 to 30 seconds.

Critics warn greater regulation could leave patients with legitimate pain without needed medicine, but Burnside said there is no evidence so far that mandatory database checks cause patient harm.

Burnside, who supports mandatory checks, said evidence from other states suggest improved safety outcomes.

Unexpected turn

Horn is convinced requiring doctors to check the database before prescribing medication will save lives.

He acknowledges that he faces an uphill political fight, given that doctors carry significant clout with state lawmakers and their constituents.

The issue represents an unexpected twist in his political career.

Like most freshman legislators, Horn said, he came to the General Assembly facing a steep learning curve. Then, he said, he discovered no lawmaker was championing drug addiction as an urgent problem.

Now, Horn said, other politicians refer calls about drug issues to him. People sometimes ask him if a personal experience prompted him to propose legislation on prescribing.

“There is no story here,” Horn said. “I have four grown children and seven grandchildren. There has been no drug abuse in my family. I had no friends affected. I’m lucky. Odds are something will eventually go wrong.”

Horn said he can’t even go to a doctor’s visit without receiving some chiding for his views.

“My own doctor has acknowledged that I caused him a few headaches,” Horn said. “He also acknowledges that I’m going down the right path.”

This story was originally published November 23, 2016 at 5:11 PM with the headline "NC Republican dislikes regulations. But in opioid fight, ‘It makes sense to me.’."