Rep. Rick West Studies Controlled Substances’ Regulation

From Oklahoma House Communications & Public Affairs

The last gift Mark and Shana McKenzie got to buy for their daughter Hannah was a headstone for her grave.

“As our only child, she was our only world” Mark McKenzie said. “Everything we did revolved around Hannah.”

McKenzie addressed a group of lawmakers and representatives from multiple state agencies and boards assembled for an interim study held before the House Alcohol, Tobacco and Controlled Substances Committee on Monday.

Rep. Rick West, R-Heavener, requested the study to help determine potential regulatory updates for the dispensing of controlled substances in Oklahoma after hearing the McKenzie’s story.

The couple lives in Pocola, a small town in West’s House district. Their daughter Hannah died July 23, 2017, of a methadone overdose. The drug, they said, came from a Roland, Oklahoma, pain management clinic.

“When I heard their story, I knew I had to do something as a lawmaker…”

“When I heard their story, I knew I had to do something as a lawmaker to increase transparency and better regulation of these pain management clinics,” West said. “I’m not against people in pain getting what they need from medical doctors, but we must have better legislative oversight in place to protect people like this man’s daughter.”

Mark McKenzie described the Sunday morning when the Pocola police chief and assistant chief showed up at his door and asked to come inside.

“I knew something bad must have happened,” McKenzie said. “They came into our house and notified us that Hannah had passed away. After falling to the floor in shock – you never expect to hear that about your child – we had asked how did she pass away.”

He said police first told him his daughter died of an alcohol overdose. It was months later when he learned she actually died from three times the fatal limit of methadone.

“We had never heard of Methandone…”

“We had never heard of Methadone before,” McKenzie said.

To his knowledge, his daughter had never been prescribed methadone and had no money to pay for the drug. She received the drug from a person who had gotten a take-home supply from the Roland clinic. That person was later charged in her death.

Methadone is a Schedule II controlled drug used to treat opioid addiction or for pain management. The drug, however, can cause serious or life-threatening problems for users. Everyone involved in Monday’s study agreed the drug needs better regulation. At the bare minimum it should be put on the Prescription Monitoring Program (PMP), which links data between prescribers and dispensers to help stop the overprescribing of opiates.

Fentanyl

While the PMP has helped with prescription opiates, participants at Monday’s study said an unintended consequence may be that people addicted to painkillers are now turning to illegal street drugs such as heroine or methamphetamines. Particularly concerning is an increase in the number of deaths due to overdosing on fentanyl, which is made stronger by drug cartels from places such as China or Mexico.

Pat Hall, a lobbyist for the Oklahoma State Medical Association. said from 2015 to 2020, Oklahoma saw a decrease of 39% in the prescribing of opioid pills after stricter regulations were passed by the Legislature. The Legislature, however, can’t control the illegal trade, and it’s growing, he said.

But while the spotlight has been on reducing addiction to opioids, drugs such as methadone or Suboxone have largely gone unregulated. This fact was acknowledged by the drug enforcement agent, the deputy first assistant for the state’s Attorney General, the public information officer for the Oklahoma Bureau of Narcotics and Dangerous Drugs, and the directors of the Oklahoma State Board of Pharmacy and the Oklahoma Medical Board who were present at Monday’s study.

Methadone, Suboxone on the PMP

One easy fix, most agreed, would be to include methadone and Suboxone on the PMP. The only kink in that plan is a federal regulation that requires a patient’s permission to have their name included in that system.

McKenzie said this is astounding to him. He has to visit a doctor and prove his identity to get a drug to treat a sore throat, he said. But his daughter was able to access a lethal drug that has almost no oversight in the dispensing of it, he said.

McKenzie said after his daughter’s death, he began his own investigation of the dispensing of methadone from the Roland clinic. He was told to show up about 4:15 a.m. when the line starts forming for those waiting to be dispensed the Schedule II narcotic. He said he took video of about 75 people lined up who can pay only with cash. Each person walked in one door of the clinic and out the back door within about five minutes, he said. Some of the people leaving carried black boxes.

This was the type of box found in the home where his daughter was discovered dead. The person administered the take-home doses of the drug had failed a urinalysis 47 times over the 10 years he was receiving methadone, according to Lou Randall, an agent with the attorney general’s office, who investigated Hannah McKenzie’s death. Randall said she’s since investigated many other similar cases and has learned much about the lack of regulations of methadone clinics.

She said she’s learned of people trading or selling bottles of urine in the parking lot of clinics to offset their urinalysis. People lined up also can purchase or trade for almost any other drug they want, she said.

“That’s just routine everyday behavior for them,” Randall said in a meeting earlier this summer in preparation for Monday’s study. “It’s sad that there is no regulation.”
Marty Hendrick, executive director of the Oklahoma State Board of Pharmacy, said its true that there seems to be very little regulation of drugs such as methadone or Suboxone. He said there needs to be an entity that looks at both federal and state regulations.

Should 51 percent of medical clinics be operated by doctors instead of out-of-state-corporations?

Hall said one thing he would like to see included in future legislation would be for 51% of all medical clinics to be operated by doctors, not out-of-state corporations who sometimes put profit over patient care, he said.

Lyle Kelsey, executive director of the Oklahoma Medical Board, said the sad part is there’s a lot of Hannah’s out there, a lot of other young men and women caught in this mess, and it needs to stop. He said it’s astounding there’s so little regulation of methadone clinics, but stressed it will take a combined effort from medical professionals, law enforcement and the attorney general’s office to help control them.

That’s why West said he held Monday’s study. Legislation already exists that could place these pain management clinics on the PMP, but other groups, such as medical doctors, osteopaths, veterinarians, ophthalmologists and pharmacists will have to agree on language, and there’s always unintended consequences to consider.

In the meantime, Mark McKenzie said he will keep fighting to see better regulations in place. He can no longer save his daughter, but he said he’ll do everything in his power to make sure the same thing doesn’t happen to someone else’s child.

Randall said it was heartbreaking to stand in the McKenzie’s living room and see pictures of Hannah, their only daughter.

Preventing This

“To think that with just a little bit of regulation this could have been prevented,” she said.

Mark McKenzie told study participants one final irony Monday.

He and his wife have a small French bulldog named Indi who recently has suffered paralysis. His veterinarian told him methadone would be the best thing to treat the dog, but he can’t get a prescription for it.

Rick West represents District 3 in the Oklahoma House of Representatives. His district includes part of LeFlore County.