State prescription drug databases like KASPER cut back doctor shopping and drug abuse, new study shows

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Research from the University of North Carolina indicates drug databases like the Kentucky All Schedule Prescription Electronic Reporting system do reduce doctor shopping and change prescribing behavior.

Another article showed state drug databases "facilitate a relative decrease over time in prescription drug misuse, despite state differences in program administration," reports Maggie Clark for Stateline, the freshly revised news service of The Pew Center on the States.

A 2010 evaluation of KASPER showed 90 percent of doctors who used the system found it effective in preventing drug abuse and doctor shopping. A new Kentucky law "mandates that all physicians and pharmacists who prescribe schedule II and III drugs, such as oxycodone and hydrocodone, check the patient's prescription records before writing or filling a prescription," Clark reports. Dispensers must also register prescriptions in the state database without 24 hours of writing or filling the prescription.

Clark points out the legislation change sparked a debate about "how to balance patient privacy and law enforcements needs in fighting a serious criminal and public health problem." Attorney General Jack Conway, who wanted KASPER put into his office's hands, lost that fight as part of the legislative compromise. It will remain the responsibility of the Cabinet for Health and Family Services and, by extension, the doctor-run Kentucky Board of Medical Licensure.

Privacy issues have likewise surfaced in Vermont. "The discussion really is about what kind of access the police will have to electronic personal health information," said Allen Gilbert, executive director of the Vermont Civil Liberties Union. (Read more)

Major newspapers publish reflections, reactions and details (including videos) on new law that will fight 'pill mills'

Reflections on the new law to fight "pill mills" are in both of Kentucky's major metropolitan newspapers today.

The Courier-Journal, which rightly takes partial credit for focusing attention on the issue, has a story by Laura Ungar that summarizes what the bill will do and not do. In the Lexington Herald-Leader, Kentucky Medical Association President Shawn Jones has an opinion piece defending his organization's lobbying against key parts of the bill.

"Unfortunately, in a desire to pass something, many did not consider the details of proposed legislation, and many of the details were extremely troublesome," writes Jones, right. "Most troubling were the proposed infringements on patient privacy through access to the state's Kentucky All Scheduled Prescription Electronic Reporting, or KASPER, system, which contains what is essentially a log of all of the controlled substances an individual has bought. A controlled substance is not just what many people have characterized as 'pain medicine.' It also includes prescriptions for medicines for anxiety, depression or attention deficit disorder." (Read more)

Jones is among the people featured in videos posted with The Courier-Journal's story. Others include Dr. Greg Cooper of Cynthiana; attorney Fox DeMoisey, who represents physicians accused of malpractice; and Dr. Patrick Murphy, a pain-management physician, talking about the various responsibilities of doctors in his field.

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."

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)

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)

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)

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.

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.

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)

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.

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." 

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)

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.

Lawmakers hear testimony about state's pill mill problem, discuss whether to put all prescription-drug issues into one bill

With a raid on a pain clinic in Paintsville making headlines yesterday morning, state legislators heard from community leaders and officials telling them to pass legislation to curb the proliferation of pill mills.

Lois Windhorst, best known as a leader of Mothers Against Drunk Driving, told the Senate Judiciary Committee about a family member she lost to prescription-drug abuse. "It just progressively got worse," she said. "She carried a big bag of pills with her wherever she went."

On the legislative agenda is Senate Bill 42, which "would require licenses for pain management clinics and doctors to own them," notes Greg Hall of The Courier-Journal. There are 77 pain clinics in the state, 33 of which are owned by people who have no medical background.

No vote was taken on the bill. Its sponsor, Sen. Jimmy Higdon, R-Lebanon, said he will revise it based on yesterday's testimony.

Sen. Ray Jones, D-Pikeville, argued for a more all-inclusive bill, which would include the premise of Higdon's bill; ban cash payment at clinics, as proposed in House Bill 251; and require doctors and pharmacists to use the state's electronic drug monitoring system known as KASPER, a bill that Attorney General Jack Conway and others are expected to push once it is filed.

Jones "also said filling prescriptions from out of state should be required to check with registries in those states to guard against duplicate prescriptions," Hall reports.

Committee Chairman Tom Jensen, R-London, said there is much support to deal with the issue of prescription-drug abuse in this legislative session. Nearly 1,000 Kentuckians die each year due to prescription drug overdoses. (Read more)

Florida-to-Appalachia 'pill pipeline' appears to be shriveling

Attorneys general from Florida and Kentucky say the prescription pill pipeline between the two states is beginning to close, reports Bill Estep of the Lexington Herald-Leader. They credit new programs and rules in Florida, but Kentucky AG Jack Conway says more work is needed "to attack the epidemic of prescription drug abuse in Kentucky." The pipeline has also supplied Ohio, West Virginia, Virginia and Tennessee.

Florida became the epicenter of the prescription drug trade to the Appalachian states because of lax regulation of pain clinics and tracking prescription drugs, Estep reports. People from the region traveled to Florida, stocked up on drugs, then returned home to sell them. In 2010, a police raid uncovered 1,400 files in a Florida doctor's office, and most were on Eastern Kentuckians. Police estimated that 60 percent of pills illegally sold in Kentucky were prescribed in Florida.

Florida officials have increased monitoring of prescription pills, boosted enforcement, required pain clinics to register with the state, started a prescription monitoring system and barred many clinics from dispensing pills. The results have been significant, Florida AG Pam Bondi said at a substance-abuse conference in Lexington. In 2010, 98 of the top 100 oxycodone prescribers were in Florida; only 11 are now. Registered pain clinics in the state have dropped from 943 to 579. (Read more)

Expect action against pill mills, Beshear says in State of Commonwealth address; House GOP leader promises it

Gov. Steve Beshear received only two standing ovations during his State of the Commonwealth address last night, when he mentioned Kentucky soldiers and when he talked about fighting prescription drug abuse. (Photo by John Flavell, The Associated Press)

UPDATE, Jan. 6: House Republican Leader Jeff Hoover said at the state Chamber of Commerce dinner last night, "We will do something this session about this terrible plague," which is "crippling our society."

Beshear called the problem one "of the largest threats to productivity and health in our communities" and referred to the Kentucky Health Issues Poll, which showed 32 percent of Kentuckians have either a family member or friend who has battled prescription drug abuse. A report from the Kentucky Department of Public Health showed more Kentuckians die from prescription drug overdoses than from car accidents.

"Think about that: Our medicine cabinets are deadlier than our highways," Beshear said. As such, legislators should expect "to consider a wide-ranging package of legislation designed to strengthen KASPER, including making participation mandatory, and cracking down on pill pushers in white coats and on pill mills in Kentucky." Kentucky All-Schedule Prescription Electronic Reporting is the state's prescription drug monitoring system.

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 required that a physician in such a clinic own part of it.

To view the entirety of Beshear's address, click here.

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)

Nearly 1 in 3 Kentuckians say they know a friend or relative who has struggled with prescription-pill abuse, poll finds

Almost one in three Kentuckians say they have a friend or relative that has had problems stemming from prescription drug abuse, the Kentucky Health Issues Poll has found.

In Eastern Kentucky, 43.2 percent of respondents said "yes" when asked if a family member or friend had had problems because they had abused pain pills. In the Lexington area, it was 39.4 percent. Western Kentucky had the lowest number at 19.7 percent. Statewide, it was 31.9 percent.

"Although other studies have shown that Kentucky has among the highest levels of prescription-drug abuse in the nation, the latest survey helps illustrate how pervasive the issue has become in the state," reports Bill Estep of the Lexington Herald-Leader.

The survey, which polled 1,614 people, found that people ages 18 to 29 were more likely to have a friend or relative who had had a problem with pill abuse — 43.8 percent compared to 29.7 percent of people ages 46 to 64.

"Other findings include that 54.5 percent of those polled in Kentucky said they'd been prescribed a pain reliever such as OxyContin, Vicodin or Percocet in the past five years," Estep reports. "The rate in Appalachia was the lowest in the state, at 46.4 percent. That might reflect that there are fewer medical providers in that part of the state, and that fewer people have insurance."

The survey also asked respondents if they had ever used a prescription drug that was not prescribed to them. In that case, just 5.5 percent said yes, but nearly twice as many 18-to-29-year-olds answered yes. "These findings underscore the impact misuse of prescription pain medications is having in Kentucky and the importance of work by prescribers and policymakers to assure that these drugs aren't used inappropriately," said Susan Zepeda, chief executive officer of the Foundation for a Healthy Kentucky, which helped fund the survey.

The poll was also funded by The Health Foundation of Greater Cincinnati. It was conducted Sept. 27 to Oct. 27 by the Institute for Policy Research at the University of Cincinnati. A random sample of adults across Kentucky were interviewed, including 1,313 landline interviews and 308 cell-phone interviews. For more from the Foundation for a Healthy Kentucky, click here. (Read more)

'Pill mills' proliferating in Ky.; legislators plan countermeasures

Suspected "pill mills" that feed Kentucky's "epidemic of prescription-drug abuse" have proliferated in the last two years, and "not just in Eastern Kentucky, where the problem was once most prominent," the Lexington Herald-Leader reported yesterday. "Faced with a growing problem, calls are mounting for increased regulation of pain clinics" with proposed laws for the 2012 General Assembly, said the story by Josh Kegley, Valarie Honeycutt Spears and Bill Estep.

PRESCRIPTIONS FOR CONTROLLED SUBSTANCES
PER PERSON BY COUNTY 3RD QUARTER 2011

Pain-pill cases have become the most prevalent type of drug case for state police in Central Kentucky, outpacing cocaine and marijuana, Lt. Todd Dalton, assistant commander of the state police drug-enforcement unit for the eastern half of the state, told the newspaper. Dalton "said that when Florida authorities started discussing legislation aimed at curbing pill mills, clinic owners started looking to move into Kentucky." (Read more)