House panel approves bill easing rules of 2012's pill-mill bill

They could call it the pill they're taking to fix the pill-mill bill.

A state House committee approved a bill Tuesday that would tweak last year's legislation aimed at cracking down on prescription drug abuse through doctor shopping and "pill mills" where painkiller prescriptions are easily available for a fee.

House Speaker Greg Stumbo told the House Judiciary Committee that House Bill 217 would fix “unintended consequences” of 2012's House Bill 1 while still requiring that health-care providers use the Kentucky All Schedule Prescription Electronic Reporting system to track painkiller prescriptions.

The bill "would exempt hospitals and long-term care facilities from HB 1’s per-unit patient dosing restrictions and ensure that physicians decide when physicals are needed," the Kentucky Press News Service reported. "It would limit restricted access to narcotic pain medication for surgery patients, end-of-life patients, cancer patients and a few other categories of patients who may need increased pain management, Stumbo said." (Read more)

Board of Medical Licensure to amend pill-mill regulations to address concerns of doctors and some patients

The Kentucky Board of Medical Licensure wants to change some of the more controversial requirements for urine screenings and digital monitoring in the state’s new prescription-drug regulations under the law aimed at fighting doctor shopping and "pill mills" that dispense painkillers indiscriminately.

Mike Wynn of The Courier-Journal reports that Dr. Preston Nunnelley, the board’s president, told state lawmakers Wednesday that the board plans to submit amendments to the regulations by Nov. 1 to address the concerns of doctors that the new law is proving too burdensome, and because patients are being charged for urine tests that insurance companies are refusing to cover. Nunnelley said the amendments would provide more flexibility on when patients must receive those screenings. He said "chronic pain patients would not face regular screenings unless they are considered high risk for abuse or diversion," Wynn reports. "The amendments are also likely to exempt certain patients, such as children, from checks through the Kentucky All Schedule Prescription Electronic Reporting system, or KASPER, he said."

Nunnelley called the changes “tune-ups." “This is a new experience for the board of licensure,” he testified. “This is the first time we’ve done anything on this scale and obviously we didn’t do it perfect.” Or perfectly. (Read more)

Governor lauds HB 1 for closing 10 of the state's worst pain clinics, reducing the number of controlled-substance prescriptions

Gov. Steve Beshear gave credit this week to House Bill 1 for reducing the number of prescriptions written for frequently abused controlled substances and for closing the doors on 10 of the state's worst pain-management clinics. He also said the bill had promoted investigations into what he called "suspicious prescribing practices." Beshear, in a prepared statement, said: "We knew that this bill would have an immediate impact on thwarting the abuse and diversion of prescription drugs in our state, and the statistics over the last few months are already showing progress."

The governor also noted that Kentucky All Schedule Prescription Electronic Reporting (KASPER) accounts have increased from 7,911 in April to 21,542 in October. Account users are physicians, dentists, optometrists, advances practice nurses and podiatrists who then use those accounts to check on the drug records of patients daily. Beshear, responding to frequent criticism that the reporting of KASPER results is time-consuming, remarked that "the vast majority of those requests are processed in less than 15 seconds."
 
John Cheves of the Lexington Herald-Leader also reported that state regulators said this week that "they're working with private insurance companies and Medicaid managers to make sure health insurance plans help cover the cost of urine tests required under HB 1." Cheves had written earlier about consumer complaints that the costs of those tests, now required by the bill, were being borne by the patient. The
Kentucky Department of Insurance is communicating with insurers to guarantee that urine tests under HB 1 are classified as a medically necessary expense, Insurance Commissioner Sharon Clark told Cheves. The Kentucky Cabinet for Health and Family Services is doing the same for Medicaid clients.
(Read more)

Covington police chief: New prescription-drug law has unintended consequence of encouraging pain pill addicts to use heroin, commit crimes

Black tar heroin

Kentucky's new prescription drug law may be having its desired effect of taking prescription painkillers off the streets, but could be forcing those very same addicts into using heroin. That's the view of Covington Police Chief Spike Jones, who took his case to the state Senate Judiciary Committee last week to complain about increased crime in his area and to ask for some money for help.

The drug law passed in April 2012, designated House Bill 1, requires Kentucky doctors to complete patients' medical histories, conduct physicals, check photo identifications and run names through the state's KASPER (Kentucky All Schedule Prescription Electronic Reporting) database before prescribing a controlled substance for pain relief. It has required a vast network of oversight of doctors and patients by government and licensing entities. This has reportedly caused some doctors to stop writing those prescriptions completely.

Tiffany Wilson of Cincinnati's WKRC-TV reports that Chief Jones reports more prostitution, theft, car thefts and car break-ins in his northern Kentucky region. He asked the state legislature for money to research how deep the problem is and to discuss the need for more treatment facilities. 

Jones pointed to the recent closure of the pain management clinic of Dr. Gary Shearer in Florence as adding to the problem. Shearer's license was suspended following the death of 15 patients from prescription-drug overdoses. These patients, Jones told Wilson, are exactly the ones at risk for taking the next step and turning to heroin. He added that heroin dealers will often give potential customers the first hit for free, "and from that point, there's no returning to prescription pills." (Read more)

Licensing board needs to step up its game against pain-pill docs, Stumbo says

If the Kentucky Board of Medical Licensure doesn't increase its oversight on doctors who prescribe excessive amounts of pain pills, House Speaker Greg Stumbo said Tuesday he'll find an agency that will. "If the medical licensure board refuses to do its job, then we will try to find some entity in the enforcement community that wishes to do that," said Stumbo, D-Prestonsburg, right.

In 2003, the licensing board asked to be able to analyze data from the Kentucky All Schedule Prescription Electronic Reporting registry — known more commonly as KASPER — so it could identify over-prescribing doctors. That same year, the legislature passed a law "that would allow the Cabinet for Health and Family Services, which maintains KASPER, to provide geographical data about prescriptions for controlled substances. The licensing board could use that data to determine whether doctors were overprescribing controlled substances in areas that had high prescription rates," the Lexington Herald-Leader's Beth Musgrave reports.

But the board had not used the data, Stumbo said.

Lloyd Vest II, the licensing board's general counsel, said the data was not used because it was not specific enough. The cabinet informed the board it did not have the legal right to analyze the data in depth, he added.

Stumbo informed Vest the board is the only agency that had the legal authority to study the information.

Bill Schmidt, the board's executive director, said the board, which does not receive any government funding, does not have the staff to deal with the data analysis Stumbo is asking for. "The board had five investigators to police nearly 10,000 doctors," Musgrave reports. Stumbo said the understaffing issue could be solved by raising licensing fees and assessment prices on doctors.

Board members said they will return to committee in December with suggestions for how the state can better police doctors' prescription practices.

Data show drug overdoses is the leading cause of death for some age groups in Kentucky. Federal statistics show 6.5 percent of Kentuckians have abused prescription drugs. (Read more)