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)

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.

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)

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

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

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

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

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

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

Columnist likens pain docs to drug pushers and loan sharks

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

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

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

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

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

Foundation funded by drug companies calls pill abuse overblown

Almost 15,000 Americans die a year from prescription pain medication, a statistic that has the Centers for Disease Control and Prevention calling the problem "an epidemic." But while the issue has been substantiated by troubling facts — in Kentucky, more people die from prescription drug overdoses than car accidents — the American Pain Foundation says it's overblown. (Photo by Darren McCollester/Getty Images)

ProPublica found that "The foundation collected nearly 90 percent of its $5 million in funding last year from the drug and medical-device industry," Charles Ornstein and Tracy Weber report for the nonprofit, independent investigative news service. "Some of the foundation's board members have extensive financial ties to drug makers ... and the group has lobbied against federal and state proposals to limited opioid use. Painkiller sales have increased fourfold since 1999, but the foundation argues that pain remains widely undertreated."

The problem is not the drugs, but doctors who prescribe them too easily, contends Will Rowe, the foundation's chief executive. "I'm convinced with every shred of my body that our interest is improving the lives of people affected by pain," he said, "and we want to do that the best way we can."

Last year, $8.5 billion in narcotic painkillers were sold in the United States, IMS Health found. The CDC reported enough drugs were prescribed last year to "medicate every American adult around the clock for a month." OxyContin alone accounted for $3.1 billion in sales in 2010, up from $752 million in 2006. Last summer, the Institute of Medicine found 116 million American adults suffer from chronic pain.

The American Pain Foundation's website lists several publications for patients, policymakers and journalists. "Each depicts the benefits of opioids, and each is underwritten by the makers of those drugs," Ornstein and Weber report. Dr. Lewis Nelson, chairman of the federal Food and Drug Administration's Drug Safety and Risk Management Advisory Committee, said the funding behind these guides, by its very nature, slants them. "If you're taking drug-company money and you're working as an advocacy group for patients, I think by definition you're biased," he said. "I take everything they say with a grain of salt." (Read more)