Pill-mill bill passes; attorney general won't get drug-monitoring system but narcotic-prescribing doctors will have to use it

House Speaker Greg Stumbo, center, walks
with House budget committee chair Rick
Rand and House Majority Floor Leader
Rocky Adkins. (Courier-Journal photo).

Legislators have sent Gov. Steve Beshear a bill to curb prescription drug abuse and crack down on rogue pain clinics, ending the special session of the General Assembly.

The final version left the state's prescription drug-monitoring system under the control of the Cabinet for Health and Family Services and the doctor-controlled Kentucky Board of Medical Licensure rather than move it to the attorney general's office, as the last version in the regular session would have. But in another significant change, it will require doctors and pharmacists who prescribe or dispense Schedule II and III drugs, such as oxycodone and morphine, to use the Kentucky All Schedule Prescription Electronic Reporting system. Only about 25 percent of Kentucky physicians now use KASPER.

Putting the drug-monitoring system in the hands of the attorney general was considered a linchpin of efforts to help law enforcement to proactively identify suspicious prescribers; law enforcement officers can access the database only if they have a case opened, and say they need the data to open cases. But the Kentucky Medical Association called giving law enforcement oversight of information with prescription-drug information a violation of personal privacy. "You are essentially legislating medical care," said Shawn Jones, president of the KMA.

Beshear, who repeatedly pressured legislators to pass a bill pertaining to the issue, issued a statement this evening expressing his delight. "Even though the prescription drug bill doesn't include every element we had hoped, it is an enormous bipartisan accomplishment, and it restores Kentucky as a leading state in innovative tactics in battling prescription drug abuse," he said. "The elements of the bill also help prevent Kentucky from becoming a source state for prescription pills.

House Speaker Greg Stumbo, who sponsored the bill, called its passage "a step forward" though he "would have preferred a stronger version." He told reporters that he did not feel this would be the last time lawmakers would be changing laws to fight the problem, and noted that Beshear could use his gubernatorial reorganization powers to change the administration of the system: "I think the governor, in the days ahead, will continue to take aggressive action on addressing this problem."

The measure will require pharmacists to submit information to KASPER within 24 hours of dispensing a narcotic and doctors must check the system before prescribing one to a new patient. They then would be required to check a KASPER report every three months during a patient's treatment.

As before, the measure will require most pain clinics be owned by at least one doctor; 33 of Kentucky's 77 pain clinics are owned by people with no medical background. Those who already own clinics and haven't had run-ins with the law will be "grandfathered" and be allowed to continue operating. "That really waters it down. A lot!!" Operation UNITE Director Karen Kelly said on Facebook.

Lawmakers also passed the transportation budget bill, which was the main reason why they were called in for a special session by Beshear. They reached an impasse last week when the Senate would not approve the budget, a move Beshear and Senate President David Williams blamed on each other.

There were suggestions that the road and drug issues, the only items that the legislature could consider under Beshear's call of the session, were related. "As the Senate receded on the amendment to put back $50 million of [road] money into Senate President David Williams' district, word went out that the House would compromise on the pill bill and let the Senate keep KASPER [where it is] as long as a funding change took place," Ryan Alessi reports for cn|2. "The Senate sprang into action amended the pill bill and leaders from the two chambers worked together to pass legislation before supper time."

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Fighting prescription drug abuse back on legislative agenda

As expected, finding a way to fight prescription drug abuse was back on the legislative agenda as lawmakers gathered for Day 1 of their special session. House Speaker Greg Stumbo introduced a bill today that will make it "mandatory for doctors to use the state's electronic reporting system for prescriptions, which would be moved from the Cabinet for Health and Family Services to the attorney general's office," report Jack Brammer and Beth Musgrave for the Lexington Herald-Leader.

Filed as House Bill 1, Stumbo said it "will correct damages caused by lobbyists for the Kentucky Medical Association in the final days of the regular session, when KMA inserted last-minute language that prevented mandatory use of this basic tool."

The bill also makes it possible for doctors who teach pain and addiction medicine at the University of Kentucky and University of Louisville to be appointed by the governor to the boards that license doctors and nurses. "The KMA's lobbyists can no longer argue that such experts do not exist or, if they do, that they should not be on the licensing boards," Stumbo said. "It is unfortunate that KMA lobbyists sought to obscure this provision."

The bill, slightly altered from House Bill 4 that did not pass before the end of the legislative session Thursday, is considered by experts to be the cornerstone of this legislative session. (Read more)

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Pill-mill bill does not pass as legislative session ends in failure; special session starts Monday

Though it's considered by experts as the most important bill needed this year, the Senate failed to pass a measure that would crack down on so-called pill mills before the end of the legislative session last night. Gov. Steve Beshear, above, called a special session that will begin Monday to give legislators more time to consider the bill, as well as approve funding for a $4.5 billion road-building plan — which was the main cause for the legislative gridlock.

Beshear wasn't happy, and blamed Senate President David Williams: "His rank partisanship, his obstructionist attitude, have caused numerous special sessions and cost the taxpayers millions of dollars of unnecessary expenses." The special session will cost more than $60,000 per day. "He's Senate president. I can't do a thing about that," Beshear said. "But what I can do is make sure that the people of this state know very loudly and clearly what damage he is causing to Kentucky."

Beshear even criticized Williams in his agenda for the special session, which included "legislation to enhance and expand tools and resources critical to Kentucky's continuing efforts to address the scourge of prescription drug abuse that plagues our citizens."

Negotiators on the prescription-drug measure, House Bill 4, came up with a compromise that pleased the Kentucky Medical Association, which opposes moving the state prescription-drug monitoring system to the attorney general's office from the Cabinet for Health and Family Services and the doctor-controlled Kentucky Board of Medical Licensure. The compromise would still make that move, and still limit ownership of pain clinics to physicians, but dropped a requirement that all physicians pay $50 to use the system.

Beshear railed against the impasse. "Sen. Williams willfully ignored the visible misery of our communities and allowed this essential bill to die," he said in a press release. "Why? Because of his road projects." Some lawmakers said another factor was House Democrats' refusal to override any of Beshear's budget vetoes, in spite of what Williams said was House Speaker Greg Stumbo's pledge to override. Stumbo denied making such a pledge.

On the road issue, "Williams wanted Beshear to sign the transportation projects list into law before the Senate voted on the bill authorizing the road construction money. Without the funding bill, those projects couldn't get started," reports Ryan Alessi of "Pure Politics" on cn|2, a cable-company news service. "Williams didn't want to give Beshear the ability to veto the project list and be able to unilaterally decide how to spend the $4 billion in federal and state road and bridge construction money."

According to Beshear, $288 million was allotted in the funding plan for Williams' district, $130 million of which would have been funded in the near future. But Williams "made some last-minute fine-print changes that moved an additional $155 million of those projects in his district ahead of those in other communities around the state." (Read more)

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Docs must stop over-prescribing pain pills, summit speakers say

When a statistic showed the number of opioid prescriptions increased from 76 million in 1991 to 219 million in 2011, Dr. Nora Volkow, director of the National Institute on Drug Abuse at the National Institutes of Health, asked the seminal questions: "Do we really have this number of people requiring these prescriptions? Have we increased four times in terms of chronic pain? That's clearly not the case."

Dr. Ileana Arias, principal deputy director of the Centers for Disease Control and Prevention, said "opioid overdose death rates have risen in lock step with sales," reports Laura Ungar for The Courier-Journal. "In 2010, enough prescription painkillers were prescribed to medicate every American adult around the clock for a month."

These were more troubling statistics discussed at the National Rx Drug Abuse Summit, held in Orlando, Fla., and organized by Eastern Kentucky's Operation UNITE. "This is an epidemic. And at CDC, we do not use the word epidemic very lightly," Arias said.

Volkow pointed out opioids are very addictive, since they raise dopamine levels in the brain, which are triggered when people do pleasurable activities, such as eating or sex. Heroin and the painkiller OxyContin are nearly identical in their chemical structure, she said. OxyContin blocks pain but increases dopamine. "You are decreasing pain, but you are activating a reward," she said.

Treatment is one solution, but "we don't have sufficient treatments. We are far behind other conditions," such as cancer or HIV, Volkow said.

More research is needed to "develop better pain medications that are as effective as opioids that are not addictive," she added. Doctors also need to be aware of over-prescribing, with Arias recounting a story in which she was prescribed two-weeks worth of Demerol after she had her wisdom teeth taken out — an excessive amount, in her view.

U.S. Rep. Harold "Hal" Rogers of Kentucky's 5th District said he wasn't surprised. "Time and again, we've heard that doctors have prescribed, say, two weeks of medication when only a few days are necessary," he said. "Then the rest go in a medicine cabinet for (others) to pilfer." (Read more)

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Troubling statistics discussed at prescription-drug summit

Staggering statistics were revealed this week at the Orlando-based National Rx Drug Abuse Summit, including one survey that found 2 million people age 12 and older started using prescription pain medicine for non-medical reasons in 2010. A troubling 11 percent of active-duty military personnel reported misusing pain medicine in the past month, Department of Defense research shows. And more than 15,000 people die each year because of pain killers, 1,000 of whom are Kentuckians, reports Laura Ungar of The Courier-Journal.

"Prescription-drug abuse is causing untold misery among our families," Gov. Steve Beshear said at the gathering, which was organized by Eastern Kentucky-based Operation UNITE. The problem is "wasting away the future of many people in the Commonwealth of Kentucky."

As he's done several times now, Beshear asked conference attendees to push legislators to pass House Bill 4, which should be voted on today in Frankfort. The bill would require pain clinics to be owned by doctors, require doctors to participate in the state's prescription-tracking system, and move the system to the attorney genera's office from the Cabinet for Health and Family Services.

Experts said prevention is key, which involves education youth, parents, as well as doctors and pharmacists. U.S. Surgeon General Dr. Regina Benjamin doctors "need to be more cognizant of the problem," Ungar reports, recounting an incident in which a patient stole one of her prescription pads by using her 4-year-old daughter to district Benjamin.

Gil Kerlikowske, known as the country's "drug czar," said general practitioners and family medicine doctors accounted for 27 percent of all prescribers of extended-release, long-acting opioids. Internal medicine physicians were the most common specialists to prescribe, accounting for almost 17 percent of prescriptions of pain pills.

One of the problems, Kerlikowske said, is prescription drug abuse is considered more acceptable than taking other kinds of drugs. Children "see their parents taking it. It's not heroin. It's not coke." (Read more)

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Beshear tells national audience legislature should pass pill-mill bill

Today, Gov. Steve Beshear again called on legislators to pass a bill Thursday that would crack down on so-called pill mills and thus curb prescription drug abuse. Speaking at the National Prescription Drug Abuse Summit in Orlando, Beshear asked for comprehensive collaboration to fight the problem, which kills more Americans than car accidents.

"No state or community is an island. It will take all of us — working across geographical and agency borders — to make headway against prescription drug abuse," he said.

The three-day summit is sponsored by Operation UNITE, which serves Kentucky's Fifth Congressional District, and features 100 leaders and experts, including Surgeon General Regina Benjamin, Office of National Drug Control Policy Director Gil Kerlikowske, Fifth District Rep. Hal Rogers, and Centers for Disease Control Principal Deputy Director Illeana Arias.

Beshear outlined what has already been implemented in Kentucky to combat the problem, including working with Ohio, Tennessee and West Virginia to identify those who exploit the system by crossing state borders and forming a panel of health professionals to develop criteria to identify suspicious drug-prescribing habits. But he also stressed the importance of passing House Bill 4, which would require pain clinics to be owned by doctors, require doctors to participate in the state's prescription-tracking system, and move the system to the attorney general's office from the Kentucky Board of Medical Licensure and the Cabinet for Health and Family Services.

The latter provision continues to draw opposition from the Kentucky Medical Association, which is lobbying hard to make changes to the bill, or perhaps kill it. Beshear has been touting the bill, considered the cornerstone of this year's General Assembly, since before it was filed. Al Cross, director of the University of Kentucky's Institute for Rural Journalism and Community Issues, said on KET's "Comment on Kentucky" Friday night that if the bill does not pass, the legislative session will be a failure. (Read more)

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Rx Drug Abuse Summit in Florida, organized by Ky. group, set to start as lobbying on 'pill-mill bill' continues to ramp up

By Tara Kaprowy
Kentucky Health News

As a bipartisan group of political leaders pushes the General Assembly to pass a bill Thursday that would crack down on "pill mills" that contribute to prescription drug abuse, Eastern Kentucky's Operation UNITE has organized a national summit in Florida.

The National Rx Drug Abuse Summit aims to "foster understanding and cooperation among those involved in the battle against the epidemic," reports Laura Ungar for The Courier-Journal.

The event starts tomorrow in Orlando and is expected to draw 700 people. "I think it's important because Kentucky's not an island ... This truly needs to be a national effort, standing up against the problem," Karen Kelly, president and CEO of Operation UNITE, which serves Eastern Kentucky's Fifth Congressional District, told Ungar.

Tuesday's agenda will include an address by Gov. Steve Beshear and Dr. Regina M. Benjamin, the U.S. surgeon general. About 1,000 Kentuckians died last year from prescription drug abuse, more than the number of people who died in car accidents.

But while Beshear, Attorney General Jack Conway and key legislators in both parties push to pass a bill that would crack down on the problem, the Kentucky Medical Association is pushing back.

An editorial Sunday in the Lexington Herald-Leader says the KMA "should support the effort to pass this bill and fight this killer." It said, "Drug abuse is not a problem society dumps at the door of physicians. It's one deeply entwined with how we deliver medical care and police the providers."

Today, 15 business lobbying groups issued a press release calling on the legislature to pass the bill, noting that it would "limit direct dispensing of narcotics at a physician’s office to no more than a 48-hour supply. This will help control the supply of narcotics and allow for better monitoring of prescription drug abuse." Dave Adkisson, president and CEO of the Kentucky Chamber of Commerce, said in the release, “Businesses large and small, rural and urban are all experiencing cost increases due to prescription drug abuse. Drug abuse is not only a social problem, it is a bottom-line business issue for Kentucky employers.”

Besides the Chamber, other groups joining in the release were the Kentucky Association of Manufacturers, Associated General Contractors, the Home Builders Association of Kentucky, Kentuckians for Better Transportation, the Kentucky Coal Association, Coal Operators and Associates, the Kentucky chapter of the National Federation of Independent Businesses and local chambers in Louisville, Lexington, Northern Kentucky, Southeast Kentucky, Christian County and Hardin County.

Meanwhile, the legal battle against prescription-pill abuse continues. Last week, a Christian County jury found three men guilty of mailing large amounts of oxycodone from Florida to Kentucky. Peter Nibert, 27, of Pasco County, Fla., is believed to have mailed more than 3,000 pills in 2010. Cary Alder, 24, and Scotty Highsmith, 26, both of Hopkinsville were sentenced 10 and 15 years respectively for their part in the scheme.

Kentucky Health News is a service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

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Pain-pill problem has spread to new areas from Appalachia

Sales of hydrocodone (the key ingredient of Vicodin, Norco and Lortab) and oxycodone (the main ingredient in OxyContin, Percocet and Percodan) skyrocketed in new parts of the country as the problem spread from its Appalachian roots in the last decade, an Associated Press analysis shows.

Oxycodone sales in Tennessee, New York and Florida were up by more than 499 percent from 2000 to 2010, the highest increases in the country, the study shows. When it came to hydrocodone, South Dakota had the highest increase, with 300 to 399 percent.

In Kentucky, oxycodone sales increased by 171 percent and hydrocodone sales increased 176 percent from 2000 to 2010. Kentucky's increase was not as high because the problem started in the eastern part of the state and in West Virginia, with coal miners needing relief from back and chronic pain, reports the AP's Chris Hawley. The problem also started in affluent suburbs, said Pete Jackson, president of Advocates for the Reform of Prescription Opioids. "Now it's spreading from those two poles," he said.

In 2010, pharmacies dispensed 69 tons of oxycodone and 42 tons of hydrocodone nationwide. "That's enough to give 40 5-milligram Percocets and 24 5-milligram Vicodins to every person in the country," Hawley reports.

As sales increase, so do overdose deaths and pharmacy robberies, Hawley reports. Opioid pain relievers, a category that includes oxycodone and hydrocodone, caused 14,800 overdose deaths in 2008 and numbers are rising, according to the Centers for Disease Control and Prevention.

Part of the increase in sales can be blamed on the fact that the U.S. population is aging, resulting in more pain issues. There is also more of a willingness by doctors to treat pain, said Gregory Bunt, medical director at New York's Daytop Village chain of drug treatment clinics. But they're also increasing because people are addicted. "We all recognized that these drugs can be just as dangerous and deadly as illicit substances when misused or abused," said Gil Kerlikowske, the U.S. drug czar.

The AP analysis used drug data collected four times a year by the Drug Enforcement Adminstration's Automation of Reports and Consolidated Orders System. "The DEA tracks shipments sent from distributors to pharmacies, hospitals, practitioners and teaching institutions and then compiles the data using three-digit ZIP codes," Hawley writes. "Every ZIP code starting with 100-, for example, is lumped together into one figure."

ZIP codes that include military bases or Veterans Affairs hospitals have had large increases because of treatment of injured soldiers. Some areas are affected because mail-order pharmacies have shipping centers there. Areas with large Indian reservations also had larger numbers.

The most sweeping trend, though, is how the pain pill epidemic has spread to areas previously untouched. In 2000, Florida's oxycodone sales were centered around West Palm Beach. By 2010, they were common in almost every part of the state. It has become commonplace in New York City and its suburbs. Staten Island alone saw a sales jump of 1,200 percent. And Tennessee had a five- to six-fold increase in that decade. "We've got a problem. We've got to get a handle on it," said Tommy Farmer, a counterdrug official with the Tennessee Bureau of Investigation. (Read more)

For a view of an interactive map that shows more Kentucky numbers, click here.

Rogers joins bill to link up states' prescription drug monitoring systems

Though a state bill aimed at quashing "pill mills" by proactively tracking drug prescriptions has so far failed to pass in the Kentucky General Assembly, Republican U.S. Rep. Hal Rogers of Eastern Kentucky's 5th District has joined a federal effort to allow state prescription drug tracking systems to share information. Though 48 states have such systems, there is no way for them to communicate with each other.

On Thursday, federal lawmakers introduced legislation "that would establish technical standards and security and encryption procedures to ease sharing information," James R. Carroll reports for The Courier-Journal.

"While my region of Southern and Eastern Kentucky became ground zero for the abuse of prescription drugs a decade ago, it is now wreaking havoc on communities small and large and cutting across socioeconomic and gender lines," Rogers said in a statement.

About 1,000 people in Kentucky died last year from prescription drug abuse, though the real number is suspected to be higher, due to under-reporting.

Missouri and New Hampshire are the only states that do not have, or don't have plans to set up, a drug-monitoring system that allows "doctors, pharmacists and law enforcement to share information that may identify abuse and misuse of pharmaceuticals," Carroll reports.

"It is high time we get these systems linked up to eliminate the interstate doctor-shopping which has been fueling the pill pipeline around our country," Rogers said.

The proposal would not create a new national database, but would also states to communicate with each other through data hubs already in place. The bill is expected to get the support of the White House administration, Carroll reports. (Read more)

Last week, Gov. Steve Beshear said Kentucky would sign an agreement to share and receive prescription drug dispensing data with at least 20 other states. "The blight of prescription drug abuse is tearing our families and communities apart, and we must use every tool available to attack this deadly scourge on our state," he said. "One of our key strategies is sharing information with surrounding states, so that we can not only cut off access to abusers, but also identify the problem prescribers." (Read more)

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Meds-for-meth, pain-pill bills each clear a second chamber; both probably headed to conference committee(s)

"State lawmakers gave new life Wednesday to two bills designed to tackle Kentucky's problems with methamphetamine labs and prescription drug abuse," John Cheves and Jack Brammer report for the Lexington Herald-Leader.

"On a 60-36 vote, the House approved Senate Bill 3, which would further limit the amount of cold medicines containing pseudoephedrine that consumers could buy without a prescription. Pseudoephedrine is a key ingredient used in making meth. Meanwhile, the Senate approved House Bill 4, which transfers from the state Cabinet for Health and Family Services to the attorney general's office an electronic monitoring system that keeps track of prescriptions for pain pills. The vote was 26-9. Both bills are likely to go to conference committees made up of representatives from both chambers, who will try to negotiate a compromise on differences in the House and Senate versions of the bills." (Read more)

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Senate panel OKs pill-mill bill with provision moving prescription-monitoring system to attorney general's office

Over the objections of the Kentucky Medical Association, a Senate committee today approved a bill that would "transfer oversight of the state’s prescription-monitoring system from the Cabinet for Health and Family Services to the attorney general’s office," Jack Brammer reports for the Lexington Herald-Leader.

House Bill 4, an effort to fight so-called "pill mills," passed the Senate Judiciary Committee 7-2 after Chairman Tom Jensen, R-London, said last week that he trusted the attorney general's office to handle the job, now in the hands of the Kentucky Board of Medical Licensure. The bill now goes to the Senate Rules Committee, which could send it to the floor or to another committee, a move that would probably kill it since this is the last week of the legislative session.

The bill would allow no more than 20 attorney-general employees to access the monitoring system. It would also require doctors to report pain-pill prescriptions within 24 hours starting July 1, 2013, and would "not charge health care providers a fee for using the system," Brammer reports. The committee also changed the bill to allows only physicians to own pain-management clinics. (Read more)

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Legislation to fight pill mills will need to strike balance between law enforcement and medicine, panelists on TV show make clear

By Tara Kaprowy
Kentucky Health News

The legislation meant to crack down on so-called "pill mills" will turn on striking a balance between thwarting prescription drug abuse and making sure doctors and patients don't feel their hands are tied, it became clear on statewide television Monday night.

On KET's "Kentucky Tonight," Attorney General Jack Conway argued strongly for the legislation, as did state Rep. John Tilley, D-Hopkinsville, chair of the House Judiciary Committee. Dr. Shawn Jones, president of the Kentucky Medical Association, said physicians are interested in fixing the problem but don't want legislation to be overly burdensome. State Sen. Tom Jensen, R-London, chair of the Senate Judiciary Committee, would not commit to either side, but did voice some concerns.

Conway said 90 Kentuckians a month die from prescription-pill overdoses, and Kentucky is the fourth most medicated state in the country. And he said the problem is expected to grow, with 80 percent of middle-schoolers saying they know someone who has used prescription pills for off-label purposes.

But Jones warned legislators should not over-reach. "When we write legislation and we try to mandate medical care, it's very difficult," he said. "We think primarily our role as physicians is to protect the right of the patient to relieve suffering. . . . We think we need to address this problem. How to do that is the big issue."

Right now, all prescriptions dispensed in Kentucky are tracked through the Kentucky All Schedule Prescription Electronic Reporting, a system known as KASPER. The Cabinet for Health and Family Services is charged with tracking disturbing trends that show up in the system and conveying those anomalies to the doctor-dominated board that licenses doctors. That is not happening, Conway said. "In my first four years in office, I've never gotten a referral from the Kentucky Board of Medical Licensure," he said, adding under the current system law enforcement has no way to "get at the data" unless they already have a case file opened.

House Bill 4 would put Conway's office in charge of tracking KASPER data and allow it to track data without opening a case. It would also require pain clinics to be owned by doctors or advanced registered nurse practitioners and require doctors to use KASPER when seeing new patients and periodically thereafter. Now, only about one in four physicians have KASPER accounts, Conway said. An alternative measure, Senate Bill 98, would not shift power to Conway's office, but would require that doctors be the owners of pain clinics.

Jones said requiring doctors to use KASPER is too heavy-handed, in part because the system does not instantly respond to doctors' requests. Conway acknowledged the system is old and "needs to be updated," but said Gov. Steve Beshear set aside $4.5 million in his proposed budget to do so.

Patient privacy is another consideration, since House Bill 4 would also allow county and commonwealth's attorneys, along with law enforcement, access to KASPER data, Jones said. Jensen pointed out another concern: "You don't want to have a chilling effect on physicians to prescribing medications on a patient. I hate to think we're doing something where doctors are going to say, 'I don't want to give someone pain meds because I might be monitored and I might get in trouble.'"

Bob Talley of Bowling Green, who called in to the show and said he has chronic pain, agreed with Jensen, saying he "certainly does not want the political process to make it harder for my doctor and harder for me to get legitimate treatment."

Though Jensen pointed out potential problems, he said he is "still in the mode where I'm learning" because he hasn't been involved in the process of sculpting what has been proposed. "I think this is a broad bill, it's a big bill that we need to look at cautiously," he said.

Tilley agreed "the devil is in the details," but said something needs to be passed before the impending end of the legislative session. "This is a scourge. People are dying," he said. "It's imperative we act this session."

Kentucky Health News is a service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

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Senate panel and House OK bills to tackle prescription-bill abuse

Two bills aimed at attacking the state's prescription drug abuse problem made headway yesterday, with a major difference between the House and Senate measures, reflecting possible turf battles between state agencies and doctors' desire to maintain as much control over regulation as they can.

Senate Bill 2 would keep the state drug monitoring system — known as the Kentucky All Schedule Prescription Electronic Reporting, or KASPER — the responsibility of the Cabinet for Health and Family Services. House Bill 4 would give it to the attorney general's office.

The Senate Judiciary Committee approved Senate Bill 2 on an 8-to-1 vote. House Bill 4 passed the full House 81 to 7. The bills' low numbers reflect their importance to legislative leaders in both chambers.

Lawmakers feel the issue will ultimately be taken up near the end of the session in a conference committee, whose members represent the House and Senate and come together to come to an agreement between the two chambers, reports Jack Brammer for the Lexington Herald-Leader.

SB 2 originally required that doctors use KASPER when dispensing narcotics and get a KASPER report before issuing a prescription. At the request of the Kentucky Medical Association, bill sponsor Sen. Jimmy Higdon, R-Lebanon, changed that stipulation, requiring the Kentucky Medical Licensure Board, made up mainly of doctors, to issue regulations on how doctors should use KASPER. Higdon said he made the change in order to get the bill out of committee, a move that angered Sen. Ray Jones, D-Pikeville, who accused the KMA of trying to "gut the bill." (Read more)

HB 4 would still require the use of KASPER, used by only less than a third of doctors, and "would bolster regulation on pain clinics and call on coroners to perform mandatory drug tests in cases of deaths with an unknown cause," reports Tom Loftus for The Courier-Journal. "It also would give commonwealth's and county attorneys access to the data in KASPER and would require that pain clinics be owned by a licensed physician or an advanced practice registered nurse." SB 2 would allow only doctors to own pain clinics, but Sen. Brandon Smith, R-Hazard, said clinics with non-physician owners should be grandfathered in if they have not have previous problems with the law.

As for whether the KASPER should stay in the cabinet or go to the attorney general, Sen. Tom Jensen, R-London, said he doesn't has one strong feeling over the other. "We have to make sure the enforcement is there, whoever is doing it. properly," he told Ryan Alessi on CN|2's "Pure Politics." 

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Conway pushes for all states to track prescription drugs

As Kentucky lawmakers consider legislation that would tackle suspect pain management clinics, the issue is making waves in Washington as well. On Thursday, Attorney General Jack Conway, right, told the U.S. Congress "that every state in the nation needs a prescription drug tracking system like Kentucky's and that the states must be able to share the information they collect," reports James R. Carroll for The Courier-Journal.

"This issue knows no party — it's an American tragedy," Conway said.

Conway was joined by Florida Attorney General Pam Bondi, who called prescription drug abuse "a national crisis." They were supported by Gil Kerlikowske, director of the White House's Office of National Drug Control Policy, who said tracking systems "need to be real-time, and they need to be interoperable across states."

There are two bills that have been proposed to address the issue, one that would "require those prescribing drugs to be informed about the potential risks of pharmaceutical misuse," Carroll reports. Rep. Hal Rogers, R-5th District, is one of the co-sponsors. Rogers is also co-sponsoring a bill that would require that oxycodone only be prescribed for severe pain. The bills have been in committees for months and have not been voted on.

Rep. Mary Bono Mack, R-Calif., said almost 30,000 Americans die each year from prescription drug overdoses. The scourge caused at least 1,000 deaths in Kentucky last year. "If 30,000 Americans died every year from food poisoning, Congress would take action," Mack said. "If 30,000 Americans died from pesticide exposure, Congress would take action. For that matter, if 30,00 dolphins died and washed up on our beaches every year, Congress would take action. So why are the victims of prescription drug abuse treated any differently?" (Read more)

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House Judiciary Committee approves two bills to curb synthetic, Rx drug abuse

Cracking down on drugs is one of the most pressing topics of the 2012 General Assembly, and lawmakers showed they were serious about it this afternoon. (Associated Press photo by Ed Reinke of House Judiciary Committee Chairman Rep. John Tilley, D-Hopkinsville)

In an effort to get a handle on prescription drug abuse — and so-called pill mills that supply the addictive medications — the House Judiciary Committee approved a bill that will place controls on pain management clinics, reports Jack Brammer of the Lexington Herald-Leader. House Bill 4 also puts the power to police the problem into the hands of the attorney general; cracks down on prescribers who have had trouble with the law for drug-related crime; requires that the clinics be owned by people who have a medical background; and will get a detailed look at how many deaths are occurring by having coroners report any death caused from the use of drugs or drug overdoses.

"We don't really know how bad (the problem) is," said House Speaker Greg Stumbo, the Prestonsburg Democrat who filed the bill. "I think it will astound us when we get the results in because I think it might double what we think the numbers are."

The committee also approved House Bill 482, which prohibits trafficking and possession of synthetic drugs that are sold as bath salts or incense in convenience stores and other places. The measure, sponsored by committee chairman John Tilley, D-Hopkinsville, was passed unanimously.

Both bills will now go to the full House for consideration. (Read more)

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Columnist likens pain docs to drug pushers and loan sharks

Doctors at some pain management clinics are the equivalent to modern-day drug pushers, writes Richmond business columnist Don McNay in a piece entitled, "Making money in businesses that are supposed to (and should) be illegal."

"People spend a few minutes and lots of money to get a 'physical'," he writes. "They skip insurance and pay the clinic with cash or a credit card. The 'medical staff' will then arrange for you to get a large order of the highly addictive pain medicines prescribed by the clinic doc. You can often get the prescription filled right at the clinic."

McNay points out such clinics are "perfectly legal" in Kentucky and owners do not have to have a medical background. (A bill in the legislature would change that.) "I'm not a lawyer, but would love to own a law firm," he writes. "I'd like to own a plumbing contracting firm but not be a licensed plumber. . . . None of those options are available to me. But owning a pain management clinic is."

He likens the clinics to payday lenders, which he likens to "legalized loan sharking." He also takes issue with the "Super PAC" concept, which allows corporations to make unlimited contributions to political campaigns. "With super PACs allowing corporations to give unlimited amounts to fund campaigns," he writes, "the big corporations control the political process."

McNay concludes, "As a society, it would seem logical that we would want drug pushing, loan sharking and corporate influence peddling to stop. At the very least, we could go back to making it against the law." (Read more)

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Board suspends license of doctor at raided Lexington pain clinic

DEA agent enters building housing clinic
(Herald-Leader photo by Charles Bertram)

Read more here: http://www.kentucky.com/2012/02/16/2071374/board-suspends-medical-license.html#storylink=cpy

The Kentucky Board of Medical Licensure imposed an emergency suspension yesterday on the license of the doctor at a Lexington pain clinic that was raided by the Drug Enforcement Administration on Wednesday.

Dr. Najam Azmat "had little formal training in pain management or primary care, yet he was paid $7,500 a week to write prescriptions for powerful narcotic painkillers" at Lexington Algiatry, a pain clinic on Alexandria Drive, the Lexington Herald-Leader reports, drawing on board documents. The board's order said, "Azmat organized his practice at the Lexington Algiatry Clinic to maximize fraud and abuse, and it appears to be intentional."

The board "acted on an investigation that's been going on for some time," President Preston Nunnelley told the Herald-Leader. Azmat referred the newspaper to his lawyer, Fox DeMoisey of Louisville, who said he could not respond because he had not seen the board's allegations or the DEA's search warrant. "He intends to defend the matter vigorously," DeMoisey told the paper.

Azmat told a board investigator that he was employed by Warren Gold of Tampa, Fla., who owns Lexington Algiatry, for $7,500 a week. Valarie Honeycutt Spears and Josh Kegley of the Herald-Leader report, "Gold provided him with an apartment in Lexington, and Azmat traveled between Lexington and Georgia, where his family lives, organizing his work schedule around his flight schedule, the documents said." (Read more)

UPDATE, Feb. 18: A representative of the clinic "filed to do business under a new name," Kegley reports.

His latest story has more background on Gold, left, who pleaded no contest in Tampa to operating a pain clinic without a license, which at the time (2010) was required only by a local ordinance. His probation ended Dec. 23. He does not have a medical license in Florida or Kentucky, Kegley reports.

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Broad front of officials, health-care leaders hold press conference to promote fighting Rx drug abuse

Representing a united front, policymakers from both sides of the political aisle, law enforcement, medical officials and other leaders stood by Gov. Steve Beshear Monday in support of attacking the state's prescription drug abuse problem head-on with legislation. (Courier-Journal photo by Tyler Bissmeyer)

"If ever there was a Kentucky issue, this is it," Beshear said.

Among others, Beshear was flanked by Attorney General Jack Conway, Dr. Preston Nunnelley, president of the state Board of Medical Licensure, and House Speaker Greg Stumbo, D-Prestonsburg, who last week introduced sweeping legislation that would require prescribers to use the Kentucky All Schedule Prescription Electronic Reporting system; shift KASPER responsibilities to Conway's office; and require that pain-management clinics be owned by licensed health practitioners.

A bill introduced by Sen. Jimmy Higdon, R-Lebanon, aims at making sure the 77 pain clinics in the state be owned by licensed practitioners; now, 33 of them don't. Higdon was also present at the rally Monday and feels "it doesn't matter who gets credit for the legislation — a strong bill needs to be passed," reports the C-J's Laura Ungar.

State Sen. Robert Stivers, R-Manchester, gave heartfelt testimony about people in his life who were battling prescription drug abuse, including a friend's nice and his cousin's daughter. He's also been approached by people in his district begging for help, including a man who stopped him while he was buying groceries. "He said, 'I buried my son in December because of prescription drug abuse. Y'all need to do something about that.'"

He called the issue "the worst problem this state has," adding, "It affects families, it affects business, it affects insurance, it affects productivity."

Stumbo said, "If your family has not been affected by this scourge, you should go home and get on your knees and pray to your God."

Each month, on average, more than 80 Kentuckians die from drug overdoses, more than from traffic accidents. Beshear said fighting the problem is one of his top priorities. "We want to make absolutely sure these bills get the attention they deserve in this session," he said. "... We won't solve (the pill problem), but we're gonna make an aggressive push toward radically reducing" it. (Read more)

To view KET's "Legislative Update" showing highlights of the press conference, click here.

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Stumbo bill aims to attack prescription abuse on all fronts

House Speaker Greg Stumbo filed a comprehensive bill Thursday aimed at attacking the state's prescription drug problem on all sides, namely taking the data already collected from the 11 million prescriptions dispensed in the state and putting them directly in the hands of the attorney general to zero in on pill pushers and dealers. (Illustration by Kentucky Health News)

The 50-page bill, filed by the Prestonsburg Democrat a day after a statewide summit that shed light on the extent of prescription pill abuse, would also require prescribers, including nurse practitioners, to use the state's prescription drug monitoring system known as KASPER and pay an annual fee of $100 to do so.

"This epidemic truly knows no bounds, and it's poised to get much worse if we do nothing," Stumbo said in a press release. "My approach will help us end the deadly flow of these drugs both now and however the battlefield may change in the future." Attorney General Jack Conway agreed something must be done. "I'm sick and tired of people coming up to me saying we've lost a generation to prescription pills," he said.

The main crux of the bill involves shifting the responsibility of KASPER to Conway's office from the Cabinet for Health and Family Services. To proactively track data, the Office of the Attorney General would be responsible for running trend reports from KASPER on a quarterly basis. If a prescriber is not using KASPER, that must be reported to the prescriber's licensing board. When a prescriber is prescribing a suspiciously high amount — thresholds will be developed by the Office of Attorney General and licensing boards — the Office of the Attorney General will report that finding to the prescriber's licensing board, which will deal with the issue promptly in turn.

The bill also aims at improving communication with law enforcement and medical licensing boards; if a complaint about suspect dispensing is received by the Office of the Attorney General or by a medical licensure board, for example, it must be relayed to the Kentucky State Police.

KSP Commissioner Rodney Brewer approves of Stumbo's proposal, particularly because the changes would mean KASPER could be used "as an investigative tool," he said. "It is a real step in the right direction regarding shutting down these fronts that are nothing more than pill mills."

The licensing boards, which would have pain and addiction specialists appointed to them, will be under the strict watch of Conway's office and will be compelled to cooperate "at all times" with its requests. Stumbo, left, has been critical of the state Board of Medical Licensure, which is authorized to analyze KASPER data to find problem prescribers, for failing to police its own profession.

As of now, just 32 percent of prescribers and just 26 percent of pharmacists have KASPER accounts, Dave Hopkins, KASPER program manager in the Office of Inspector General, said in January at a second statewide conference focused on prescription drug abuse. When prescribers have accounts, they are able to pull up reports online on what prescriptions a patient has taken in the past, numbers that can indicate whether patients are "doctor shopping" or abusing drugs.

The bill would require prescribers to use KASPER upon accepting a new patient and every three months with ongoing patients to see if there are suspicious patterns in their prescription history. Before writing a prescription, doctors and other providers must do a complete physical exam of the patient, write up a treatment plan and discuss the risks of the use of controlled substances.

The bill would also allow commonwealth's attorneys and county attorneys to gain access to KASPER. Medicaid would monitor prescribers in their program as well.

Though numbers were slightly lower in rural areas, more than 90 percent of pharmacists and more than 95 percent of prescribers that use KASPER feel it is effective, a study conducted by the Institute of Pharmaceutical Outcomes and Policy indicates. As for mandating its use, doctors seem open. "I would not have a problem with it if there was an easy way to do it, a little bit faster than what we have now," said Dr. Roger Humphries, chairman of the Department of Emergency Medicine at the University of Kentucky's College of Medicine.

The bill would also tackle the operation of pain management clinics themselves. Like a bill filed by Sen. Jimmy Higdon, R-Lebanon, Stumbo's proposal would require that pain management clinics be owned by licensed practitioners. As of now, of the 77 pain clinics in the state, 33 of them are owned by people who have no medical background.

The bill also cracks down on prescribers who have had trouble with the law for drug-related crime. As per the bill, practitioners who have had their license suspended or surrendered for drug violations will no longer be able to practice in Kentucky. Prescribers who have been convicted of a drug-related felony in Kentucky will have their license revoked for 5 years. A second felony will mean permanent revocation.

The bill would also prohibit pharmacies from accepting prescriptions for Schedule II or III controlled substances, like oxycodone and hydrocodone, for more than a 90-day supply. They also would no longer be able to ship more than 30-day supply of the drugs in one shipment. "Part of the problem is there is so much medication out there on the street," said Stumbo's spokesman Brian Wilkerson. "This prevents that."

Stumbo's bill additionally aims at getting a detailed look at how many deaths are occurring due to drugs or drug overdoses in Kentucky. To get accurate numbers, as per the bill's proposal, coroners would be required to report any death caused from the use of drugs or drug overdoes to the Division of Kentucky State Medical Examiners Office. That office will compile an annual report which includes all of the drugs which cause or contributed to the deaths, where they occurred and how the drugs were obtained.

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Shocking realities of prescription pill abuse drive another summit to get everyone in harness to fight it

By Tara Kaprowy
Kentucky Health News

Prescription drug abuse has become so prevalent in parts of Kentucky, people are buying Mason jars of clean urine at flea markets and under the table at tobacco stores so they can pass drug tests.

Kentuckians are pulling out their own teeth so they can go to the dentist to get a three-day prescription for hydrocodone, the most popular painkiller.

When they make arrests, law enforcement officers are finding stacks of food stamps that have been traded for pills.

Almost two-thirds of Kentuckians have used prescription drugs for non-prescription reasons, 30 percentage points higher than the rest of the country.

FBI intelligence analyst Anthony Carter detailed the problem.
(Photo by James Crisp for The Courier-Journal)

Those were just some of the sad, startling facts that surfaced Wednesday in Lexington during the Kentucky Prescription Drug Summit, the second comprehensive, statewide gathering on the subject in two weeks. The summit was sponsored by the two U.S. attorneys for Kentucky hosted by the University of Kentucky and brought together law enforcement, physicians and the pharmaceutical community to learn more about the problem and cooperate in fighting it.

"We're galvanizing our forces, all of our forces, in this fight," Gov. Steve Beshear told the packed crowd. "This is a corrosive evil and we have to stop it." He noted that drug overdoses kill more Kentuckians than traffic accidents, and other speakers said the overdose numbers are under-reported.

"I think a lot of our people have had enough," said Kerry Harvey, the chief federal prosecutor for Eastern Kentucky. That's where the problem is worst, but speakers made clear it is statewide.

The state has electronically tracked prescriptions since 2000, but Attorney General Jack Conway said only about 25 percent of doctors use the Kentucky All-Schedule Prescription Electronic Reporting system, and KASPER's data are "just sitting there and law enforcement are not able to access it" to proactively search for people getting an unusual amount of drugs.

Beshear recently appointed a panel of health-care providers to establish guidelines to identify over-prescribers through KASPER, and his budget proposal would put more money into the system and set up the state's first substance-abuse treatment program for Medicaid recipients.

House Speaker Greg Stumbo, D-Prestonsburg, is expected to file a bill that would require drug prescribers to use KASPER. That bill or another would also require pain clinics to be owned by doctors.

While Kentucky has many suspicious pain clinics, many of the pills have come from out of state, primarily Florida. Wifredo Ferrer, U.S attorney for Southern Florida, said the state is cracking down on pill mills, in which doctors were seeing as many as 500 patients and making between $2,000 and $6,000 in cash each day.

The speeches from officials were leavened with personal stories of drug abuse, death and near-death.

Marine Lance Cpl. Daniel Gross, 26, said he was 21 when his addiction started. He was introduced to pain pills shortly after a roadside bomb exploded beside his Humvee in Iraq in 2006. With his right foot shattered, his other one broken and his brain injured from the blast, he was prescribed Percocet and oxycodone. With prescriptions "overflowing" at Camp Lejeune, N.C., taking pills became commonplace. "If I ran out, I got them from someone else," Gross said.

Quickly he became an addict, a burden he carried with him after he was discharged two years later. "I pawned, stole, lied, cheated," he said. "Nothing else seemed to matter." After two stints in rehab, Gross was able to overcome his addiction. Now clean for 14 months, he won a standing ovation from the crowd.

Police and local prosecutors expressed their frustration over the problem, with State Police Major Anthony Terry likening the situation to "a dog chasing its tail." Floyd County Commonwealth's Attorney Brent Turner said, "We are not treading water. . . . We are drowning in a sea of pills, and if something is not done the whole region is going to be destroyed."

UK President Eli Capilouto told the crowd that the land-grant university needs to be a partner in solving such problems, and the extent of it had become clearer to him the day before, when he met with local extension agents: "This issue came to the forefront."

"This has to be a group effort" among public servants and health-care providers, said Dr. Lon Hays, chair of the UK Psychiatry Department. Too often, he said, providers use "the big gun" of a strong painkiller. "We need to exhaust other methods of pain control before we go to that method of pain control."

For more coverage, from The Courier-Journal or the Lexington Herald-Leader, click here or here.

Kentucky Health News is a service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

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