SALEM, Ore. (AP) - Standing behind a photograph of her nephew, a state official on Tuesday described his drug overdose as she released an audit that found holes in a prescription drug monitoring program aimed at fighting the opioid epidemic.

Alex Eliot died four years ago at age 29 in Mount Airy, Maryland, after taking a combination of drugs that included opioids, said Debra Royal, chief of staff to Secretary of State Dennis Richardson.

“There are far too many families in Oregon and across this country who understand exactly what I’m talking about,” Royal said. “Guilt, loneliness, sorrow replace the space where the loved one used to be.”

Because Oregon has some of the highest opioid-abuse rates in the nation, averaging one overdose death every three days, Richardson ordered an audit of the state’s prescription drug monitoring program, or PDMP.

The rate of prescriptions for opioids is 13 percent higher than the national average, said audit manager Jamie Ralls. The state has the highest rate in the nation of those 65 and older who are hospitalized for opioid-related issues. The audit noted that Oregon is one of only nine states that do not require prescribers or pharmacies to use the PDMP.

The audit’s 12 recommendations include requiring a caregiver to check a patient’s history in the PDMP database before prescribing controlled substances. Another would require pharmacists to do the same.

The audit identified 148 people who received controlled-substance prescriptions from 30 or more different prescribers. One person amassed 290 prescriptions for opioids, primarily Hydrocodone, from 232 prescribers, 218 of whom were dentists. They were filled by 75 pharmacies.

The audit calls for the Oregon Health Authority to work with the Legislature to expand statutes to allow the PDMP to conduct and share analyses on prescription data. State laws limit the agency’s ability to examine practitioners’ activities and do not allow analyses focused on patients.

“If there’s political will to get the statutes changed, it could really fast-track,” said Audits Division Director Kip Memmott.

House Republican leader Carl Wilson said in the coming days his caucus will propose legislation based on the recommendations.

Health Authority Deputy Director Kris Kautz agreed with the recommendations. He noted that while deaths and overdoses from illicit opioids are rising, prescription opioid-related deaths have been steadily decreasing in Oregon for several years, and credited the monitoring program.

At a news conference in the state Capitol, Royal remembered her nephew as “smart, and talented, he was handsome and funny. He was our family’s go-to guy when you ever had a problem with your plumbing. Alex was also an addict.”

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