Coventry changes course, will pay for addiction-treatment drug

Reversing its decision, likely after it was pressured to do so, a Medicaid managed-care organization will continue to pay for a drug used to treat drug addiction.

Coventry Cares said it "decided to change course after talking to representatives of a chain of addition treatment clinics that threatened last week to sue Coventry," reports Beth Musgrave for the Lexington Herald-Leader.

Last week, the Cabinet for Health and Family Services sent Coventry a letter expressing its displeasure about the MCO's move, saying it would be a contractual violation. The drug in question is Suboxone, an expensive treatment option for addicts dependent on taking opioids such as Oxycontin and Vicodin. Coventry had said it was aligning its coverage in keeping with Medicaid policy, moving to only cover the full price of the drug for pregnant or recently pregnant women and youth under 21.

After the MCO discussed the issue with SelfRefind, the chain of addiction treatment clinics in question, "Coventry understands their concerns," said Coventry spokesman Eyles. "As a result, we will continue covering Suboxone and similar medicines for all Coventry members while we work through the cabinet's process to determine whether these drugs should be covered for certain categories of Medicaid recipients or everyone." (Read more)

Medicaid managed-care firm Coventry plans to stop paying for expensive drug that curtails addiction

Coventry Cares, one of the four firms that manage patient care for the state Medicaid program, has once again hit the headlines, this time for its plans to stop paying for medicine that helps addicts keep their opioid addiction at bay. State officials quickly condemned the move Thursday and called it a contract violation, reports Beth Musgrave of the Lexington Herald-Leader.

Coventry decided to stop paying for buprenorphine, more commonly known as Suboxone, which helps curtain cravings for drugs such as Oxycontin and Vicodin. A 30-day supply of the drug can cost more than $450, Musgrave reports.

"They will be at risk for relapsing and going back to using illegal opioids," Dr. Michelle Lofwall, an addiction specialist and assistant professor at the University of Kentucky, told Musgrave. "Whenever you are using illegal opioids, there is a risk of overdose and death."

Coventry said it will no longer offer the coverage because only pregnant women, women who recently gave birth and those under the age of 21 are eligible for addiction treatment in Kentucky's Medicaid program. "What we've done is align our coverage with the cabinet's Medicaid policy," said Matt Eyles, a Coventry spokesman.

However, the state Cabinet for Health and Family Services said the decision violates the contract and "cannot take this unilateral action without the cabinet's approval," said Jill Midkiff, a cabinet spokeswoman. 

A company that operates addiction treatment centers across the state was planning to file suit over the move Friday, but, after learning of the cabinet's reaction, "We are going to give them the chance to work this out," Anna Whites, an attorney who represents SelfRefind.

Coventry already caused controversy this week when it informed Baptist Health System wants to renegotiate its contract. The move comes just a week after Coventry and Appalachian Regional Healthcare came to a temporary agreement after Coventry threatened to terminate its contract and ARH sued Coventry. The company has also told King's Daughters Medical Center in Ashland it will terminate its contract after May 26. (Read more)

Meds-for-meth bill drew record lobbying expenses, not even including radio and newspaper ad campaigns

Makers of over-the-counter drugs spent more than any lobbying interest ever had during a single Kentucky legislative session in their effort to defeat a bill requiring prescriptions for the key ingredient in methamphetamine, Bill Estep reports for the Lexington Herald-Leader.

"The Consumer Healthcare Products Association spent $457,053 on lobbying activities in the first three months of this year's legislative session, according to reports filed with the state Legislative Ethics Commission," Estep writes. "The group's lobbying effort was so dominant that it spent more than the next five groups combined in that period, January through March, according to spending reports."

And the figure doesn't even included hundreds of thousands of dollars that the trade group spent on radio and newspaper campaigns, because the lobby-reporting requirements do not apply to messages aimed only at the general public. The group did report spending on "a phone-bank operation to put people in contact with legislators to voice concerns about legislation to require a prescription for medicine containing pseudoephedrine, which is now available over the counter," Estep writes.

Read more here: http://www.kentucky.com/2012/04/30/2170495/makers-of-cold-medicines-set-new.html#storylink=cpy

The efforts, dating back to 2010, were partly successful. The legislature passed a bill "that will require a doctor's prescription for pseudoephedrine, but only after someone has bought 24 grams of the medicine a year," Estep notes. "A 48-count box of the generic medicine with 30-milligram pills contains 1.44 grams of pseudoephedrine. The bill excludes limits on gel caps and liquid pseudoephedrine." (Read more)

The lobbying effort wasn't only about Kentucky. The makers of Sudafed and other pseudoephedrine preparations are trying to stave off similar efforts in other states, and viewed Kentucky as a sort of firewall after seeing prescription-only laws pass in Oregon and Mississippi.

Read more here: http://www.kentucky.com/2012/04/30/2170495/makers-of-cold-medicines-set-new.html#storylink=cpy

Read more here: http://www.kentucky.com/2012/04/30/2170495/makers-of-cold-medicines-set-new.html#storylink=cpy

Beshear OKs prescription bill, telling pill mills, 'Get out of this state'

Saying it couldn't get to his desk quickly enough, Gov. Steve Beshear signed a bill aimed at curbing prescription drug abuse in celebration today, warning so-called pill mills to "Get out of this state, because we're coming after you."

House Bill 1 requires 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 and requires pain clinics to be owned by at least one physician. Clinics already in operation that have not had trouble with the law but are not owned by doctors will be grandfathered in under the law.

Though there was a strong push for it by law enforcement, the bill will not move KASPER over to the attorney general's office but will stay under the control of the Cabinet for Health and Family Services and the doctor-controlled Kentucky Board of Medical Licensure.

House Speaker Greg Stumbo, who sponsored the bill, called the legislation "a major step forward in the ongoing battle to put the brakes on prescription drug abuse."

Though KASPER will not move to  Attorney General Jack Conway's office, as Conway wanted, he endorsed the effort. "It helps keep entrepreneurs out of the pill mill business and requires doctors, with reasonable exceptions, to use the KASPER system," he said. "I encourage those who are fearful of increased oversight to end the hyperbole and begin a constructive process with the legislature and executive branch to implement this bill." (Read more)

1 in 4 grandparents keep meds where kids can reach them

A new poll shows nearly one in four grandparents say they store prescription medicines in places that can be accessed by children. Unintentional poisonings cause more visits to the emergency room for young children — one every 10 minutes — than car accidents, to say nothing of the threat of theft, a factor in the prescription-drug epidemic that is killing more Kentuckians than such accidents.

The most common type of prescriptions that are accidentally ingested are opioids, the poll found. The most common type of over-the-counter medicine ingested is acetaminophen, the active ingredient in Tylenol, reports research-reporting service Newswise.

The poll found that 23 percent of grandparents and 5 percent of parents store prescription meds in easy-to-access places. Eighteen percent of grandparents and 8 percent of parents said they store over-the-counter medicine in easily accessible spots.

"Emergency room visits for accidental poisonings among young children have become much more frequent in the last decade," said Matthew Davis, director of the C.S. Mott Children's Hospital National Poll on Children's Health. "We hope the results of this poll are a reminder to parents, grandparents and all those who care for young children: check around your homes to make sure that medicines are safely stored out of reach." (Read more)

Though the numbers are on the rise, on the whole, American children are safer than they ever were, according to the Centers for Disease Control and Prevention. The rate of death from unintentional injuries dropped 29 percent from 2000 to 2009. Deaths dropped from 12,400 in 2000 to about 9,100 in 2009.

Poisoning death rates rose dramatically, however‚ going up 91 percent in youths aged 15 to 19, "a byproduct of the rising prescription-drug abuse among teens who either obtain the pills illegally or swipe them from medicine cabinets of their parents or others," reports Timothy Martin for The Wall Street Journal. (Read more)

Doctors' lobby still working for changes in 'pill mill' legislation

By Al Cross
Kentucky Health News

The Kentucky Medical Association, historically one of the most powerful lobbying interests at the General Assembly, has mounted a last-ditch attempt to change or perhaps kill the bill that would crack down on "pill mills" that contribute to prescription drug abuse.

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 general's office from the Kentucky Board of Medical Licensure, which is made up almost entirely of doctors and has done little to curb the growing problem.

The tracking system remains the central concern for the KMA, which issued a "call to action" for physicians to contact legislators and argue that it "could infringe on privacy and lead to excessive oversight of legitimate medical practices," reports Mike Wynn of The Courier-Journal. "Other critics have said the bill could make doctors reluctant to provide pain medication for legitimate patients."

KMA President Shawn Jones told Wynn, “We would like to see something come out of this session. We would just like to make sure that it is something that addresses both the needs of law enforcement and at the same time is not overreaching in its imposition on our ability to practice medicine in a professional way.”

The KMA’s call notes that the system "tracks medications such as Xanax, Valium and Klonopin and was placed under the cabinet’s responsibility partly for patient privacy and protection," Wynn notes. Jones told him, “The access to that data really should be limited to government agencies that are charged with public health, and not law enforcement.”

Moving the tracking system to the attorney general's office is "pretty much a cornerstone of this legislation," Senate Majority Floor Leader Robert Stivers, R-Manchester, left, told Ryan Alessi Friday night on cn|2's "Pure Politics" program. He said the medical licensure board "hasn't done a whole lot" about prescription drug abuse, and indicated that part of the bill would stand.

However, Stivers said he and other supporters of the bill might drop the bill's 30-day limit on the length of painkiller prescriptions because of concerns that it would raise costs to patients. Those concerns helped delay the bill on the 59th day of the legislature's 60-day session. House Speaker Greg Stumbo "has said the issue could be resolved with a simple fix in the bill’s language," Wynn notes.

Stivers and Stumbo were among a group of bipartisan political leaders, led by Gov. Steve Beshear, who issued a statement Friday calling on the General Assembly to pass the bill Thursday, when it is scheduled to reconvene. The legislature is in recess, pending possible vetoes of other legislation by Beshear.

KMA "also takes issue with a $50 fee that the attorney general would be able to charge doctors to fund the program," Wynn reports. "Jones said the amount will only continue to climb in coming years to address a societal problem that doctors did not create. Proponents contend that the fee is nominal and is capped by statute except for inflation adjustments." (Read more)

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.

In bipartisan way, political leaders push passage of 'pill mill' bill

A bipartisan group of political leaders issued a call today "to pass a bill that will help the state battle one of its most significant threats – prescription drug abuse," a press release from Gov. Steve Beshear's office said. Beshear, Attorney General Jack Conway, House Speaker Greg Stumbo, Senate Republican Floor Leader Robert Stivers, Sen. Jimmy Higdon, R-Lebanon, and House Judiciary Committee Chairman John Tilley, D-Hopkinsville, said the legislature should pass House Bill 4 when it returns to Frankfort for its final day April 12.

"Since the beginning of 2012, more than 400 Kentuckians have been hospitalized because of prescription drug overdoses – a statistic that the leaders say underscores the crucial need to pass this bill in this legislative session," the release said. "Kentucky has the nation’s sixth-highest rate of prescription drug overdose deaths, at nearly 18 deaths per 100,000."

Conway said in the release, “I'm hopeful everyone, including the medical community, can get on board with House Bill 4 to ensure that we don't lose another generation in Kentucky to prescription drug abuse.” The bill would move the Kentucky All Schedule Prescription Electronic Reporting (KASPER) system to Conway's office from the Kentucky Board of Medical Licensure, which is controlled by doctors and has done little to rein in "pill mills" that churn out prescriptions for painkillers.

"Law enforcement members warn that Ohio, Tennessee, West Virginia and Florida have passed legislation similar to HB 4 to address pill mills, and failing to pass similar legislation could create a diversion effect in which Kentucky could become a source state for prescription painkillers," the release said.

Stumbo, who preceded Conway as attorney general, said in the release, “Given the true epidemic we are seeing, we cannot afford to wait another year to try to pass this again.” In October, Stumbo, Beshear and Conway "announced creation of an advisory board of physicians, dentists, nurses, and pharmacists to work with KASPER officials and law enforcement professionals to create guidelines for generally accepted prescribing practices among different medical disciplines," the release said. "These criteria will be used as a guide for when a prescriber or dispenser’s KASPER reports may be flagged for unusual prescribing activity."

The bill would require all prescription providers to register and use KASPER, require pain management clinics to be owned by a licensed medical practitioner, make medical licensure boards investigate prescribing complaints within four months. 

Need for painkillers and social support, shortage of treatment programs, feeds prescription drug abuse in Appalachian Ky.

By Ivy Brashear
Kentucky Health News

Taking opioids is still the best way to treat patients with pain, but the drugs are addictive because they do more than just alleviate physical suffering — they cause patients to feel good too. That's causing big problems in Kentucky, the state with the highest rate of opioid use and overdose.

In Perry County, for example, prescription medicines are the drugs of choice, second only to marijuana, and users may get more of them from relatives than from doctors. And their drug use appears to be part of a social support system.

Those were the findings of three separate studies presented at the second annual Appalachian Health Summit in Lexington last week.

Prescription-drug abuse is "an epidemic" that "seems to have started in rural Appalachia," Jennifer Havens, an associate professor in the University of Kentucky Department of Behavioral Science, said in presenting a study showing how disease spreads through the region.

Havens’ study of Hazard and Perry County found that prescription drug abuse in the county is second to marijuana use, and that painkiller abuse among high school seniors is at the same rate as in adults.

Though it’s not clear why prescription drug abuse is so rampant in the region, Havens speculated that lack of availability of other “hard” drugs, like heroin and cocaine, has led Appalachian drug users to turn to prescription medicine to get high. There are few drug-treatment options for users in the region, and many hospitals aren’t “financially viable” to care for drug abusers, she said.

An earlier study in which Havens was involved revealed that rural adults use more “alternate” methods to take drugs, including snorting and injecting. The study compared drug users in Perry County to those in Louisville and found that more than 40 percent of adults in the Hazard area were injecting prescription drugs to get high, and youth there were 25 percent more likely than those in Louisville to abuse such drugs.

The study found high rates of sharing drug-taking instruments, which increases risk for diseases such as hepatitis and HIV, Havens said. Almost 90 percent of participants said they shared snorting straws, and almost 1 in 3 said they shared syringes. No cases of HIV were found among the participants, but almost 43.7 percent of the 500 interviewed had hepatitis-C, and 11.5 percent had herpes-2.

Eighty percent were lifetime users, and about half first abused Oxycontin through injection. Havens said 28 percent of users had overdosed, and 58 percent had witnessed an overdose.

The study also found that a person’s likelihood of continuing drug use correlated with higher levels of social support, which Havens said contradicts long-held assumptions that drug users continue to abuse prescription pills because of low social support.

“Most people in the study depended on people also using drugs for social support,” Havens said. “As you can imagine, that’s not a good idea.”

No good alternative to prescribing painkillers

Despite widespread opioid abuse in Appalachia, such drugs are “still the best pain therapy,” UK physiology professor Karin Westlund High reported.

The purpose of her study was to determine what effect a high-fat and alcohol diet would have on “visceral pain” in the pancreas, and then what effect opioid gene therapy would have on the organ.

There are clusters of Appalachian counties at high risk for pancreatitis, which can lead to pancreatic cancer. Severe abdominal pain is associated with both, and morphine is typically used to treat it. However, High said, patients usually develop a tolerance to the drug over time.

She and other researchers used rats to test an opioid gene therapy involving herpes simplex-1, which 90 percent of Americans already have, to see if it would reduce pancreatitis pain without building tolerance in the rats. After 10 weeks of treatment, there was no tolerance present and the therapy seemed to be reversing damaged sections of the pancreas caused by the disease.

While opioids are effective in alleviating pain, "There are lots of different kinds of pain, but most opioids act as if they treat the same pain,” said Michelle Lofwall, a UK psychiatry and behavioral science assistant professor. Lofwall set out to discover how pain affects prescription drug abuse, since that is the main reason such drugs are prescribed or first used.

Her study participants, who were all drug users, placed one arm in a cooler of ice to elicit pain, and then were asked about pain levels. The test was repeated after a dose of painkiller.  Researchers were attempting to give the drug to treat patients’ pain only, and not to have the patient feel a high when the drug was in their system, but that failed.

“Unfortunately, in my patients I wanted to say, ‘Yes, let’s treat your pain and you won’t feel any good effects’,” Lofwall said. “I wasn’t able to say that to them.” She said they are now trying to help doctors better prescribe pain medication so that habits aren’t formed.

One of the biggest habit-forming painkillers is Oxycontin, which was introduced in 1996 but wasn’t abused on a large scale until doctors had to start documenting pain in 1999, Lofwall said. Sales of, treatment for, and death from prescription drug abuse have increased since then. She noted that Kentucky has the highest rates of opioid use and overdose.

The makers of Oxycontin have reformulated the drug to make it harder to crush, mix with water and snort, but a new drug has risen to take its place: Opana. Lofwall said researchers have been trying to study Opana use, but can’t get a study supply because it is in such high demand. She said she has seen more of a rise in heroin use by her patients because even heroin is easier to get than Opana.

Though legislators are grappling to curb the proliferation of "pill mills" in the state, Lofwall said "doctor shopping" may not be the problem it's been billed to be. According to the National Household Survey on Drug Use and Health, 56 percent of users get their supply from a relative, of whom 85 percent have a prescription from one doctor. The drug abuser may get the drug from the relative as a gift, by paying for it or by stealing it.

Asked about the Kentucky All Schedule Prescription Electronic Reporting system, which allows doctors to search a database for “doctor shoppers” before prescribing pain pills, Lofwall said KASPER is limited because it only covers Kentucky, but “I think the state’s ready to make it better.”

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.

Legislature passes bill on personal-care homes but stalls on one to regulate pill mills as doctors lobby hard

By Al Cross
Kentucky Health News

The effort to quash "pill mills" that feed one of Kentucky's worst problems, prescription drug abuse, stalled on the next-to-last day of the General Assembly's session and faces cloudy prospects on April 12, when the legislature returns to conclude its business. But the legislature gave final passage to a bill aimed at limiting the admission of mental patients to personal-care homes.

The snag in the pill-mill bill stems from the Kentucky Medical Association's opposition to moving the state's electronic prescription-tracking system to the attorney general's office from the Kentucky Board of Medical Licensure, which is controlled by doctors and has been found to go easy on them, compared to other states. The bill includes several other measures, including a requirement that pain clinics must be owned by doctors.

After Sen. Carroll Gibson, R-Leitchfield, failed in a parliamentary maneuver to make the bill more difficult to pass, and Senate President Pro Tem Katie Stine, R-Southgate, ruled that his motion had lost on a voice vote, Majority Floor Leader Robert Stivers, R-Manchester, "said it might be better to consider the bill April 12, but Sen. Ray Jones, D-Pikeville, said delaying a vote on it would give its opponents more time to try to kill it," report John Cheves and Jack Brammer of the Lexington Herald-Leader. "Stivers called for party caucuses to meet to discuss the issue. After the caucus meetings, the Senate adjourned and Stivers said lawmakers would work on the bill for possible consideration April 12."

The session's final day is scheduled to give the legislature a chance to override any vetoes by Gov. Steve Beshear, so a bill passed then could be killed by a veto. That might seem unlikely, since Beshear has been among those pushing for stronger action against pill mills. However, if he were unhappy with a bill the legislature sent him, he could veto it and call a special legislative session to pass one more to his liking. That possibility, and his power to set the agenda of a special session, could make him a player in the negotiations between now and April 12.

The bill’s sponsor, House Speaker Greg Stumbo, D-Prestonsburg, downplayed the problem. He blamed it on "confusion over a provision that limits the amount of drugs that may be supplied to a patient at any one time," Mike Wynn of The Courier-Journal reports. "Some lawmakers feared that limits on prescriptions would cause more patient co-pays, but a simple fix to the bill’s language could allay those concerns, Stumbo said."

Also on Friday, the legislature sent Beshear a bill that would "require potential residents at personal-care homes to be screened for brain injuries by medical professionals," the Herald-Leader reports. "Personal care homes provide long-term care for people who do not need full-time nursing care but need some assistance."

Senate Bill 115 "stems from the death last year of Larry Lee, a brain-injured resident who disappeared from a personal care home and was found dead four weeks later on the banks of the Licking River, not far from the Falmouth Nursing Home in Pendleton County," the Herald-Leader notes. "There are about 2,500 to 3,000 people in 82 free-standing personal care homes across Kentucky," and many are mentally disabled or mentally ill. Kentucky Protection and Advocacy, a watchdog state agency, released a report last week saying that said placement of the mentally ill in personal-care homes violates federal disability laws. (Read more)

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.

'Meds for meth' bill is about to become law despite heavy lobbying campaign by pharmaceutical companies

The bill to limit purchases of a popular cold medicine used to make methamphetamine passed the General Assembly today and Gov. Steve Beshear said he would sign it.

The Senate voted 29-8 to approve changes the House made in Senate Bill 3, sponsored by Senate Majority Floor Leader Robert Stivers, R-Manchester, left. The bill would require a prescription to buy more than 7.2 grams of pseudoephedrine in a month and 24 grams in a year. "A generic box of pseudoephedrine with 48 pills, each with a 30-milligram dosage, contains 1.44 grams of the medicine," Jack Brammer of the Lexington Herald-Leader reports. ""Gel caps and liquid pseudoephedrine would be excluded from the limits in SB 3 because making meth from those forms is considered more difficult."

The bill’s sponsors had wanted lower limits, an initially a prescription for any amount, "but they compromised with opponents who worried about inconveniencing cold and allergy sufferers," Brammer notes. "The pharmaceutical industry has lobbied aggressively against the state requiring prescriptions for pseudoephedrine at any level," ranking first in reported lobbying expenses without even counting its extensive advertising campaign. The industry apparently viewed Kentucky as a sort of firewall, the absence of which could make passage of similar "meds for meth" bills in other states. Only Oregon and Mississippi now have such legislation.

Makers of Sudafed, similar cold medicines again lead in legislative lobbying expenses, and that doesn't count their radio ad campaign

The Consumer Healthcare Products Association, which is fighting legislation that would limit the amount of pseudoephedrine that could be bought without a prescription, remained the leading spender among lobbying interests at the General Assembly in February, the state Legislative Ethics Commission said in its monthly newsletter.

CHPA, which represents manufacturers and distributors of over-the-counter medicines, spent $192,985 on lobbying in February, and a total of $388,000 for the first two months of the session. Those amounts do not include an extensive radio advertising campaign, which from all indications has cost more than the spending that had to be reported.

Other health-care interests were among the top spenders in February. Ranking second through 11th were the Kentucky Hospital Association ($38,422, for a two-month total of $74,543); the Kentucky Chamber of Commerce ($30,056, two-month total $63,404); Altria (Philip Morris) Client Services ($28,129, two-month $50,434); the Kentucky Farm Bureau Federation ($24,805, total $38,655); AT&T ($24,199, total $47,432); the Kentucky Medical Association ($21,958, total $42,731); the Kentucky Education Association ($21,629, total $45,249); the Kentucky Retail Federation ($21,191, total $45,452), which also opposes the meds-for-meth bill; Kentuckians for the Commonwealth ($18,317, total $34,188) and the Kentucky Optometric Association ($18,227, total unavailable).

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)

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)

House panel OKs "meds for meth" bill; chair predicts passage

The bill to limit purchases of the cold medicine used to make methamphetamine cleared another legislative hurdle Monday, and the chairman of the committee that approved it predicted that it will become law despite a heavy lobbying effort by over-the-counter drug makers.

By a 10-4 vote, the House Judiciary Committee approved a version of Senate Bill 3 that differs slightly from the version passed by the Senate. Rep. John Tilley, a Hopkinsville Democrat and the committee’s chairman, predicted the revised SB 3 will pass on the House floor. "Tilley said Senate leaders have signed off on the changes the House committee made," Jack Brammer reports for the Lexington Herald-Leader. The House version clarifies "language regarding prescriptions" and would ban "criminals convicted of meth-related offenses from purchasing pseudoephedrine for a five-year period," Mike Wynn of The Courier-Journal reports.

The core of the bill would allow consumers without meth records to buy 7.2 grams of medicines with pseudoephedrine each month, approximately a two-week dose, and up to 24 grams per year, without a prescription. Another 7.5 grams a month or 90 grams a year could be available with a prescription. "Experts have testified that those amounts are adequate for most cold and allergy sufferers, and more than 90 percent of all purchasers use dosages that fall below the proposed thresholds," Wynn reports. "State law already limits purchases to 9 grams per month, with a yearly cap of 108 grams, and purchasers are required to present a photo ID and sign a log at the point of sale."

The bill would not apply to gelcaps, which are more difficult to use for meth, or liquids, which are used for children. (Read more)

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.

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

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

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

Senate committee narrowly passes meds-for-meth bill as advocates start their own radio advertising campaign

In the face of a strong lobbying effort by makers of over-the-counter cold medicines, a state Senate committee narrowly approved a bill today that would require a prescription for most products containing pseudoephedrine, a key ingredient used to make methamphetamine.

Senate Bill 50, approved 6-5 by the Judiciary Committee, is sponsored by Senate Majority Floor Leader Robert Stivers, R-Manchester, left, but he said he isn't sure of its chances in the full Senate, reports Jack Brammer of the Lexington Herald-Leader. A similar bill got out of committee last year but never came to a vote on the Senate floor because it lacked the votes to pass. This year's bill would not apply to gelcaps, which are more difficult to use in meth making.

The Kentucky State Police recorded about 1,200 meth labs last year, and former meth addict Melanda Adams, from Stivers' home Clay County, told the committee she believed the bill would "cut the burgeoning number of dangerous home-made meth labs in the state." The Consumer Healthcare Products Association, a non-profit that represents the over-the-counter medicine industry, argues that requiring a prescription would "create a hardship for legitimate consumers," reports Jessie Halladay of The Courier-Journal.

Only Oregon and Mississippi have passed such laws, so Kentucky has become a firewall for the drug makers' lobby, which has bought many radio commercials urging people to contact senators in opposition to the bill, contending it would "punish Kentucky families" and pushing an alternative measure that would bar people convicted of meth making from buying the medicines. Opponents of that bill say meth makers would continue to use surrogates to buy the medicines for them. Sen. Ray Jones, D-Pikeville, who voted for SB 50, called the radio ads "scare tactics." UPDATE: For more on the lawmakers' complaints about the ads, from cn|2 Politics, click here.

As of Feb. 3, the group had spent more than $82,000 running ads on Louisville, Lexington and Somerset radio stations owned by Clear Channel Communications Inc., the nation's largest radio operator, according to public-inspection files at those stations. In 2011, CHPA paid the Kentucky Association of Radio and Television more than $93,000 to run ads, according to public-inspection files from Cummulus Broadcasting, another major owner of stations in Kentucky.

UPDATE, Feb. 17: The drug makers have a 60-second ad from Pat Davis, who identifies herself as "a Kentucky resident for over 20 years" and the mother of six children who all "battle allergies." She is not identified as the wife of 4th District U.S. Rep. Geoff Davis, who is not seeking re-election. She testified against last year's bill. Here is the ad, via Page One Kentucky, a popular blog that has been critical of the legislation.

The drug makers' ads have been running uncontested for two months, but this week a group headed by Knox and Laurel County's Commonwealth's Attorney Jackie Steele, Real Facts About Meth, offered a counter-ad, describing the impact of meth on communities. The group does not appear to be well funded; its website solicits contributions.

Pain clinics in Texas skirting law by calling themselves 'wellness' or 'rehab' facilities

Calling themselves rehabilitation or wellness clinics is the latest way operators of pill mills are skirting the law in Texas, which requires pain management clinics to register and be inspected by the state medical board. The issue is one to consider as legislators look at ways to curb prescription pill abuse in Kentucky in the 2012 legislative session, which started today.

One doctor in Santa Fe, Tex., labeled his facility a "family practice" instead of a pain clinic. "But investigators said his office had no stethoscopes or blood pressure cuffs and only a single thermometer," reports Cindy Horswell of the Houston Chronicle. "His records indicated he dispensed hundreds of thousands of highly addictive pills to known drug abusers, the Texas Medical Board said before suspending the doctor's medical license in March."

In Kentucky, Sen. Jimmy Higdon, R-Lebanon, has pre-filed a bill that would require background checks for people planning to open pain clinics, prohibit convicted felons from running them, and require that a physician in such a clinic own part of it. (Read more)

Johnson County focus of C-J series on docs, prescription abuse

The second day of The Courier-Journal's investigation into prescription drug abuse and the role of doctors looks at Johnson County, ranked 11th in the state for drug overdose deaths despite its small population of 24,000. It ranks second in such deaths per capita, right behind adjoining Floyd County, as shown on this C-J map of death rates by county. (Click on map for larger version.)

In Paintsville, Johnson's county seat, three doctors have been convicted in the past 10 years of prescribing narcotics illegally. The epidemic prompted the county Fiscal Court to try to pass an ordinance that would have outlawed clinics that were "dealing largely in cash; drawing significant numbers of patients from other counties; generating at least half of their revenue from prescribing narcotics; dispensing disproportionate amount of prescriptions, compared with other medical services; and not being affiliated with a nearby hospital," R.G. Dunlop reports. Attorney General Jack Conway's office ruled the county did not have the authority to pass such a ban.

Dunlop relays the stories of the Paintsville doctors with shocking prescribing practices and also speaks to the mayor, who called the problem "an epidemic." "What we end up doing is arresting all these 'victims' ... and the doctors who create the problem continue to practice." The C-J site also includes this video of Dunlop and photographer Scott Utterback's encounter with Aaron Cantrell, a co-owner of a clinic that is pictured today and will be the focus of more coverage tomorrow. (Read more)

Independent pharmacists say managed care costs them money

Because two of the three new Medicaid managed-care companies have slashed the dispensing fee they will pay them, independent pharmacists are in danger of going out of business all over the state, pharmacists told the interim joint Health and Welfare Committee yesterday.

But one managed-care firm said that's the cost of saving money for the taxpayers, the reason the state implemented managed care statewide. "We recognize ... there's a big change here for everyone," said Barb Witte, CEO of CoventryCares. "All health care providers are going to have to tighten their belts."

Under the traditional Medicaid system, "pharmacists were paid a 'dispensing fee' per prescription of $4.50 to $5 plus reimbursement for their actual cost of the drug based on an industry formula called the 'maximum allowable cost,'" reports Deborah Yetter of The Courier-Journal.

But the dispensing fee of CoventryCares is only $1 to $1.50. WellCare increased its fee to $3 from $1.50, but cut reimbursement for cost, making the increase only worth about 80 cents. Kentucky Spirit is still paying $4.50 to $5.

Because the maximum allowable cost fluctuates on a monthly basis, pharmacists don't know their return until they file a claim. Often, "pharmacists find they are being paid less than it cost them to buy the drug from a wholesaler," Yetter reports.

"How long will I be able to stay in business losing money?" asked Mayfield pharmacist Sam Willett. "Not very long."

Rep. Tom Burch, D-Louisville, told the MCOs and pharmacists to come to an agreement. "There must be a way to work this out," he said. (Read more)

McCracken County to consider banning new kind of synthetic pot

In response to several teenagers overdosing on it, officials in McCracken County are considering banning chemicals that are being sold as synthetic marijuana.

"Death is a realistic side effect when using this stuff," said Jamey Locke, emergency director for Mercy Regional Hospital.

Between July 10 and Aug. 21, 17 people — 13 of them teenagers — were taken to hospitals by ambulance after having smoked synthetic marijuana. "In almost every case they ended up in ICU," McCracken County Sheriff Jon Hayden said.

An ordinance will be introduced Nov. 14 at a Fiscal Court meeting. It would outlaw the sale or possession of the new synthetic marijuana. Although Kentucky has previously banned certain types of synthetic marijuana, "It appears manufacturers have changed the chemical composition to meet that requirement," The Associated Press reports. (Read more)