Princess Health and Kentucky is cracking down on Suboxone, a heroin substitute that has become a big part of the illegal trade in painkillers.Princessiccia

Princess Health and Kentucky is cracking down on Suboxone, a heroin substitute that has become a big part of the illegal trade in painkillers.Princessiccia

doctor shopping doctors drug abuse drugs health insurance health reform insurance coverage narcotics obamacare pain clinics physicians pill mills state government

Gusty 09:40 Add Comment

A drug that was supposed to help people get off heroin has "created a new cash-for-pills market and a street trade" that state officials are trying to stop, Mary Meehan reports for the Lexington Herald-Leader.

The drug is buprenorphine, the active ingredient in the brand-name drugs Suboxone and Subutex, which became more popular in 2012, when the state cracked down on "pill mills" that were freely handing out prescriptions for painkillers. "A lot of the pill mills morphed into facilities that dispense these prescriptions," Dr. John Langefeld, medical director for the state's Medicaid program, told Meehan.

Also, Meehan writes, the Patient Protection and Affordable Care Act required insurance plans to cover treatment for substance abuse, and "as more Medicaid patients and others got health-insurance coverage, more people obtained prescriptions for buprenorphine, Langefeld said. . . . According to a state report, one user obtained prescriptions from nine doctors."

Read more here: http://www.kentucky.com/2015/06/20/3910362_the-drug-that-was-supposed-to.html?rh=1#storylink=cpy

Read more here: http://www.kentucky.com/2015/06/20/3910362_the-drug-that-was-supposed-to.html?rh=1#storylink=cpy

Lexington Herald-Leader chart by Chris Ware from state data

Use of the drug in Kentucky "has increased 241 percent since 2012," Meehan reports. "And 80 percent of the prescriptions for it were being written by 20 percent of the state's 470 certified prescribers, said Dr. Allen Brenzel, medical director of the state's Department of Behavioral Health. . . . Since 2011, 10 doctors have been sanctioned by the Kentucky Board of Medical Licensure because of problems prescribing Suboxone."

Suboxone is supposed to be taken in conjunction with therapy and drug testing. "a patient receives a controlled dose of a legal drug as the dose is tapered by a physician for a safe and effective withdrawal," Meehan notes. However, "doctors started to see Suboxone patients on a cash basis, asking for as much as $300 for an office visit that included a prescription for the maximum allowable amount of Suboxone. Patients often received no therapy or drug testing. Some patients were on the maximum dose indefinitely, Brenzel said." Some doctors prescribed the drug with other painkillers, creating an illegal market.

To prevent such abuse by unscrupulous doctors, the medical-licensure board has issued regulations that require "more physician education and the requirement that the drug be prescribed only for medically supervised withdrawal and not be given to pregnant women," Meehan writes. "Patients should also be closely monitored and drug tested. If those rules are not followed, a doctor can face sanctions or restrictions to his medical license."

Suboxone was in the national news recently because the accused killer in the Charleston, S.C., shootings was arrested for illegal possession of it four months ago at a South Carolina shopping mall, the Herald-Leader notes.

Read more here: http://www.kentucky.com/2015/06/20/3910362_the-drug-that-was-supposed-to.html?rh=1#storylink=cpy

Read more here: http://www.kentucky.com/2015/06/20/3910362_the-drug-that-was-supposed-to.html?rh=1#storylink=cpy

Princess Health and Paducah Sun looks at two local doctors who write many prescriptions for painkillers; such local data are easily available.Princessiccia

Princess Health and Paducah Sun looks at two local doctors who write many prescriptions for painkillers; such local data are easily available.Princessiccia

doctors drug abuse narcotics pain pain clinics pain management physicians pill mills prescription drug abuse

Gusty 11:52 Add Comment

The Paducah Sun has used some easily available information about two local doctors to shine a local light on their heavy prescribing of opioids.

The story by Laurel Black begins, "As narcotic painkiller abuse has drawn more public attention, two Paducah physicians � who have been ranked high among prescribers of such drugs � have found themselves defending their practices."

The story cites The Courier-Journal's analysis of 2012 Medicare data that showed Dr. Yogesh Malla of Paducah was "the No. 3 prescriber of narcotic painkillers in the commonwealth. A USA Today article listed Dr. Riley Love, also of Paducah, as 20th in the nation. Both reports used information the news organization ProPublica obtained under the Freedom of Information Act."

The Sun offers a quick retort from the medical director of the pain-management center where Malla practices, paraphrasung him as saying "the reports omit or minimize important factors, such as the specialty of the physicians and the morphine equivalence of the drugs they prescribe."

Dr. Laxmaiah Manchikanti also said in his written statement that his group emphasizes drugs with lower abuse potential and that more than 92 percent of patients at such centers "are already on long-term opioids; consequently, the best we can do (at these centers) is reduce the dosage."

Manchikani is CEO of the American Society of Interventional Pain Physicians, a lobbying group that advocates monitoring of painlkiller prescriptions, and a leading contributor to a wde range of political causes. The Sun doesn't note the latter point, but focuses on the issues of painkiller abuse, a major problem in Kentucky.

"With more than 1,000 deaths per year, Kentucky in 2013 had the third-highest drug overdose mortality rate in the United States, according to the Trust for America's Health," Black notes.

As for the other doctor, the Sun reports, "ProPublica's data on Love, who practices at the Lourdes Pain Management Center, reports that 59 percent of his 1,141 patients filled one or more prescriptions for a Schedule 2 drug and 51 percent filled for a Schedule 3 drug. Both figures are above the average of 45 percent and 41 percent, respectively, for his specialty in Kentucky.

"A spokeswoman for Love said Lourdes center represents the only location in the region where Medicaid patients receive inpatient pain consultations," the Sun reports, quoting her: "The patients we see are often very sick, and the treatments and medications we provide are the last resort comfort measures so the patients can spend quality time with family" as they near death.

The story is behind the Sun's paywall.

Princess Health and Princess Health andNew rule allows Medicare to drop doctors for irresponsible prescribing.Princessiccia

Princess Health and Princess Health andNew rule allows Medicare to drop doctors for irresponsible prescribing.Princessiccia

doctor shopping doctors Medicare physicians pill mills prescription drug abuse prescription drugs

Gusty 17:28 Add Comment

Medicare physicians who prescribe drugs in abusive ways can now be expelled by the federal government, Charles Ornstein reports for ProPublica.

This increased oversight of Medicare Part D prescribers could help decrease the availability of prescription drugs to abusers in Kentucky. More than 1,000 Kentuckians die each year from prescription drug overdoses, and the state has the third-highest overdose death rate in the nation.

Opoids, which are often found in pain medicine, are the most commonly abused prescription drugs, according to the National Institute on Drug Abuse. Hydrocodone, an opoid, is the most commonly prescribed controlled substance in Kentucky, according to the Kentucky All Schedule Prescription Electronic Reporting (KASPER) system, and is also the most prescribed drug in Part D program, according to ProPublica's Prescriber Checkup, a tool that compares physicians' prescribing patterns among specialties and states.

The Centers for Medicare and Medicaid Services proposed the new rule after ProPublica documented "how Medicare's failure to oversee Part D effectively had enabled doctors to prescribe inappropriate or risky medications, had led to the waste of billions of dollars on needlessly expensive drugs and had exposed the program to rampant fraud," Ornstein writes.

Part D covers 37.5 million seniors and disabled patients, and one in every four prescriptions in the U.S. is paid for by Medicare, costing taxpayers $62 billion in 2012, and experts have complained that Medicare is more interested in providing drugs to patients than in targeting problem prescribers, Ornstein notes. The U.S. Department of Health and Human Services' inspector general has called for tighter controls.

The new rule allows Medicare to drop doctors "if it finds their prescribing abusive, a threat to public safety or in violation of Medicare rules," or if their Drug Enforcement Administration registration certificates are suspended or revoked, Ornstein writes. Problem providers will be identified by prescribing data, disciplinary actions, malpractice lawsuits and other information.

Opponents of the rule have called its definition of "abusive" prescribing too vague. Some worry that patients will lose access to necessary medication if their doctor is removed from the program, Ornstein writes. Medicare officials said they intend to expel providers only in "very limited and exceptional circumstances," saying "It will become clear to honest and legitimate prescribers . . . that our focus is restricted to cases of improper prescribing that are so egregious that the physician or practitioner's removal from the Medicare program is needed to protect Medicare beneficiaries."

The new rule also allows the Medicare center to "compel health care providers to enroll in Medicare to order medications for patients covered by its drug program, known as Part D," Ornstein writes. Now, doctors not enrolled in Medicare can prescribe for Part D patients; they will have to enroll or opt out of the program by June 1, 2015.

The doctors most affected by this will be dentists and Department of Veterans Affairs physicians who provide services not covered by Medicare but have patients who fill prescriptions covered by the program, Ornstein notes. Most health providers are already enrolled. (Read more)

Princess Health and Princess Health andMore treatment needed to deal with painkiller abuse, expert witness tells Senate caucus; McConnell says jail helps, too.Princessiccia

Princess Health and Princess Health andMore treatment needed to deal with painkiller abuse, expert witness tells Senate caucus; McConnell says jail helps, too.Princessiccia

pain pain clinics pill mills prescription drug abuse prescription drugs

Gusty 13:00 Add Comment

Addiction to prescription painkillers, and increased addiction to heroin by people originally hooked on prescription medicine, is "a public health disaster of catastrophic proportions" that "was caused by the medical community," the chief medical officer of a New York drug-treatment program said at a U.S. Senate hearing Wednesday.

"The medical community, including dentists, must prescribe more cautiously," Dr. Andrew Kolodny of Phoenix House told the U.S. Senate Caucus on International Narcotics Control. In areas where abuse is rampant, "Treatment capacity does not come close to meeting demand," he said. "If we don't rapidly expand access to treatment, the outlook is grim." He also called for better education of physicians about the risks of prescribing painkillers.

Senate Republican Leader Mitch McConnell of Kentucky attended the first several minutes of the hearing and read a statement calling for the problem to be attacked by a combination of treatment and incarceration, with the use of multi-agency partnerships. He also said, "It's clear that the increase in heroin addiction is tied to our fight against prescription drug abuse."

Part of that fight included requiring Kentucky doctors to participate in the state's prescription-drug monitoring program, which Kolodny said made the state one of only three with such a requirement. The others are New York and Tennessee.

Officials have said that when Kentucky cracked down on disreputable "pill mill" pain clinics, making prescriptions harder to get, addicts turned to heroin. "Heroin is just a symbol for the prescription-drug problem," Joseph Rannazzisi, deputy assistant administrator of the Drug Enforcement Administration, told the senators.

Rannazzisi said the largely successful effort against pill mills in Florida has driven them to Georgia and Tennessee. He said Tennessee has 300 pain clinics. "They're moving north and west," he said. "Regulatory boards in the states need to take control."

Sen. Dianne Feinstein of California, the Democratic co-chair of the caucus, said the testimony made prescription-painkiller and heroin abuse seem worse than the drug problems she dealt with as mayor of San Francisco in the 1980s. "Nothing like today," she said. "I am really struck."

Princess Health and Legislature sends fix of last year's pill-mill bill to Beshear.Princessiccia

Princess Health and Legislature sends fix of last year's pill-mill bill to Beshear.Princessiccia

doctor shopping doctors drug abuse General Assembly legislation legislature physicians pill mills prescription drug abuse prescription drugs state government

Gusty 18:06 Add Comment

"After more than a year of debate, a bill that would revamp Kentucky�s prescription-drug law to more strictly focus on pill abuse and ease requirements on patients is heading to the governor�s desk," Mike Wynn reports for The Courier-Journal. On a 36-0 vote, the Senate sent House Bill 217 to Gov. Steve Beshear, who said he will sign it tomorrow.

The chief lobbyist for the Kentucky Medical Association said the physicians' group did not get all the changes it requested in last year's law but is satisfied with the bill. It "would exempt hospitals and long-term care facilities from many of the requirements that doctors must follow before prescribing drugs," Wynn writes. "It also creates a 14-day exemption for surgery patients and gives doctors more discretion in examining patients before a prescription is given." (Read more)

Princess Health and House sends Senate pill-mill and Medicaid managed-care fixes.Princessiccia

Princess Health and House sends Senate pill-mill and Medicaid managed-care fixes.Princessiccia

doctor shopping legislation legislature managed care Medicaid pain management pill mills prescription drug abuse prescription drugs state government; General Assembly

Gusty 10:38 Add Comment

The state House yesterday approved without dissent two bills aimed at improving Kentucky's health care.

House Bill 217 addresses some "unintended consequences" of last year's "pill mill bill" by easing some of the bills regualtions. The bill also tightens restricitions on prescription drugs, reports Ryan Alessi of cn|2.

The other measure, House Bill 5, deals with payment problems of the Medicaid managed care system. Itl would apply the prompt-payment laws to managed-care organizations and would move Medicaid late-payment complaints and disputes to the insurance department; those are now handled by the Cabinet for Health and Family Services, which administers Medicaid.

Both bills are expected to see action in the Senate.

Princess Health and House panel approves bill easing rules of 2012's pill-mill bill.Princessiccia

Princess Health and House panel approves bill easing rules of 2012's pill-mill bill.Princessiccia

doctor shopping drug abuse drugs General Assembly KASPER legislation legislature pain clinics pill mills prescription drug abuse prescription drugs state government

Gusty 13:04 Add Comment

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)

Princess Health and Beshear calls for action to improve state's health, but says only that 'It's time for us to begin looking seriously' at a smoking ban.Princessiccia

Princess Health and Beshear calls for action to improve state's health, but says only that 'It's time for us to begin looking seriously' at a smoking ban.Princessiccia

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Gusty 20:57 Add Comment

By Al Cross
Kentucky Health News

His priorities were education and tax reform, but Gov. Steve Beshear mentioned several health issues in his State of the Commonwealth speech tonight to a joint session of the General Assembly.

Beshear called for action to correct the state's "fundamental weaknesses," including "a population whose health ranks among the worst in the nation." Near the end of his speech, he said, "We need to continue improving the health of our people," but after about a minute of discussing tobacco and smoking he stopped short of endorsing a statewide ban on smoking in the workplace. (KET photo)

"It's time for us to begin looking seriously at doing this on a statewide level," he said to some applause, after noting that nearly half of Kentuckians live in jurisdictions where smoking is legally restricted, that the state has the highest or next-to-highest smoking rate overall and among teens and pregnant women, and that "Our smoking-related mortality rate is the worst in the nation. . . . Our addiction hurts productivity, jacks up health care costs and kills our people."

Beshear called for improving prenatal care and newborn screening, and for minor improvements in last year's bill to fight prescription drug abuse. He said the bill has caused a precipitous drop in abuse of prescription painkillers. "Kentucky at one time had the sixth highest rate in the nation, but . . . we improved 24 spots," he said. "Nearly half of the state's known pain management clinics have closed rather than submit to new rules that protect patients." He said use of the Kentucky All Schedule Prescription Electronic Reporting system "has increased nearly seven-fold . . . and prescriptions for some of the most abused drugs have dropped up to 14 percent from a year ago."

However, the problem of babies becoming addicted to drugs in their addicted mothers' wombs has skyrocketed in the last decade or so, Beshear said: "In 2000, reports showed 29 babies in Kentucky born addicted to drugs. But in 2011, there were 730 babies � more than 25 times as many. And that figure is thought to be under-reported." He did not say how he wants to improve screening.

Beshear did not mention perhaps the biggest health policy question facing the commonwealth, whether to use federal subsidies to expand the Medicaid program to people in households earning up to 138 percent of the federal poverty threshold. Now the program covers people in households earning up to 70 percent of the poverty line. The federal government would pay all the cost of the additional enrollees through 2016, when the state would start picking up part of the tab, up to 20 percent in 2020.

Some Republicans say the state can't afford the expansion, while some Democrats say it would be a good long-term investment in the state's health and economy. Beshear has said he wants to do it if the commonwealth can afford it, and expects to get cost estimates around the end of March -- about the time the legislature must adjourn.

For a PDF of the speech text, click here. For an audio recording, go here. For video from KET, here.

Princess Health and With crackdown on pill abuse, will legitimate patients be able to get the prescriptions they need?.Princessiccia

Princess Health and With crackdown on pill abuse, will legitimate patients be able to get the prescriptions they need?.Princessiccia

pain clinics pain management pill mills prescription drug abuse prescription drugs

Gusty 11:23 Add Comment

The crackdown on prescription-pill abuse has some patients worried they won't be able to get the medicine they need because doctors are fearful of over-prescribing. "It's a huge concern in a nation where chronic pain afflicts 116 million American adults and is associated with up to $635 billion in health care costs," reports Laura Ungar in an ongoing series for The Courier-Journal.

"Pain patients feel ashamed or weak that they have to take these medications ... (and) shy away from being treated," said Dr. James Murphy, a pain specialist in Louisville. 

But there is little evidence that pain patients who really need medicine are unable to find treatment. Ungar reports: "It may take longer for them to find a doctor, experts said, and they may be subjected to urine tests and pill counts to ensure they're not abusing their medicines. But most eventually are able to get the medication they need."

"I don't see any decrease in the amount of opioid prescribing in any jurisdiction," Dr. Nathaniel Katz, president and chief executive officer of the Masschusetts-based consulting firm Analgesic Solutions, told Ungar. "So it's difficult to justify a position that legitimate opioid prescribing is being chilled."

Some worry that making physicians use the state's prescription drug monitoring system � commonly known as KASPER � for new patients could create that chilling effect. A survey of controlled-substance prescribers made to use KASPER found about half didn't change their prescribing habits and about 13 percent said they actually prescribed more opioids. But 35 percent, or 190 prescribers, said they had decreased the amount of controlled substance they subscribed because of "media coverage of abuse, increased law enforcement activity related to prescription-drug abuse and fear of investigations by law enforcement or the medical board," Ungar reports.

Some are concerned that "if more doctors make that choice, desperate pain patients may feel forced to seek relief at unscrupulous pain clinics," Ungar reports. (Read more)

Princess Health and Couple shares 'horrible journey' of prescription drug abuse.Princessiccia

Princess Health and Couple shares 'horrible journey' of prescription drug abuse.Princessiccia

health journalism newspapers pain management pill mills prescription drug abuse prescription drugs

Gusty 08:20 Add Comment

Recovering pill addict Stacy Pennington
of Ashland is due to give birth next month.
(Courier-Journal photo by Matt Stone)

Stacy and James Pennington had to lose everything, including their children and home, before they were able to face their prescription drug abuse problem. Now in recovery at The Healing Place in Louisville, they spoke to The Courier-Journal's Laura Ungar of their downward spiral.

"It had gotten to the point where my prescription drugs were my everything. As long as I had them, I was OK," said James, 40, of Ashland. "Before, we had everything we could want. In the end, we were just feeding an addiction. We had lost everything."

Stacy Pennington said she took her first painkillers in 2002 after she cut her finger on a glass candle jar and needed two surgeries. "A year later, she was diagnosed with cervical cancer, then severe endometriosis, and she required several more surgeries," Ungar reports. "Each of her 14 operations brought another prescription for pain pills."

James Pennington took prescription drugs for the first time at age 14 after he dislocated his shoulder. After he broke his shoulder in a motorcycle accident when he was 25, he got a 30-day supply for Percocet and, later, was prescribed more of the drug after a knee injury. "Pain medications became my drug of choice from there on out," he said.

Soon, he was traveling to "pill mills" in Florida to fuel his addiction, pills he sold and shared with his wife. When Stacy gave birth to their daughter, she was heavily addicted and eventually lost custody of her. James' older daughter was also taken from the home. 

Before Stacy Pennington checked in to The Healing Place, she had sold her engagement ring, the Penningtons sold their home before they lost it, and they were spending $100 to $500 a day to feed their addiction. Now, Stacy is expecting another child and the couple is fighting for their sobriety. "It's a horrible journey. I had to absolutely lose everything. But I see that as a blessing," said James Pennington. "I'm so glad I'm on the other side today." (Read more)

Princess Health and Improvements to Rx monitoring systems worth the expense, study finds; using systems influence doctors' prescribing decisions.Princessiccia

Princess Health and Improvements to Rx monitoring systems worth the expense, study finds; using systems influence doctors' prescribing decisions.Princessiccia

pain clinics pain management pill mills prescription drug abuse state government

Gusty 07:22 Add Comment

A plan for an ideal prescription drug monitoring system was published today in the New England Journal of Medicine, with its authors concluding spending more money to improve systems is worth the expense.

To improve databases, the paper's authors recommended "standardization of the type of information submitted to the databases, and a move toward the use of bar-coded prescription paper to more quickly log entries, or a robust e-prescribing system that would eliminate paper and the resulting prescription fraud and 'doctor shopping' that contributes to illicit use of these controlled substances," reports research-reporting service Newswise. (Read more)

Forty-three states, including Kentucky, now have databases to monitor prescriptions for pain relievers and another five states have passed laws to create them, reports Mary Wisniewski for Reuters. Part of the reason for the push is prescription drug abuse is an increasingly big problem, with more people dying from prescription drug overdoses each year than cocaine and heroin combined. Kentucky is a hot spot, with nearly 1,000 people dying from prescription drug overdoses in 2010.

On July 12, a new law will take effect in Kentucky that will make it mandatory for a physician to consult the state drug-monitoring system before writing a prescription for certain drugs for a new patient. Doing so can influence how a doctor chooses to prescribe. A study by the emergency department of the University of Toledo's College of Medicine found "doctors or pharmacists who reviewed state prescription data changed how they managed cases 41 percent of the time," Wisniewski reports

The study found 61 percent of prescribed either no opioid medicine, or less than originally planned, while 39 percent decided to prescribe more. (Read more)

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

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

doctor shopping doctors legislation legislature pain clinics physicians pill mills prescription drug abuse prescription drugs state government; General Assembly

Gusty 12:11 Add Comment

Photo by iStockphoto

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)

Princess Health and Beshear OKs prescription bill, telling pill mills, 'Get out of this state'.Princessiccia

Princess Health and Beshear OKs prescription bill, telling pill mills, 'Get out of this state'.Princessiccia

doctor shopping doctors drugs legislation legislature physicians pill mills prescription drug abuse prescription drugs

Gusty 15:37 Add Comment

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)

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

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

attorney general doctor shopping doctors General Assembly legislation legislature pain clinics pain management physicians pill mills state government

Gusty 16:25 Add Comment

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."

Princess Health and Fighting prescription drug abuse back on legislative agenda.Princessiccia

Princess Health and Fighting prescription drug abuse back on legislative agenda.Princessiccia

legislation legislature pain clinics pain management pill mills state government; General Assembly

Gusty 19:31 Add Comment

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)

Princess Health and Pill-mill bill does not pass as legislative session ends in failure; special session starts Monday.Princessiccia

Princess Health and Pill-mill bill does not pass as legislative session ends in failure; special session starts Monday.Princessiccia

attorney general doctor shopping doctors General Assembly legislation legislature lobbying pain clinics pill mills state government

Gusty 12:18 Add Comment

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)

Princess Health and Docs must stop over-prescribing pain pills, summit speakers say.Princessiccia

Princess Health and Docs must stop over-prescribing pain pills, summit speakers say.Princessiccia

pill mills prescription drug abuse prescription drugs

Gusty 14:31 Add Comment

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

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

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

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

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

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

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

Princess Health and Troubling statistics discussed at prescription-drug summit.Princessiccia

Princess Health and Troubling statistics discussed at prescription-drug summit.Princessiccia

pill mills prescription drug abuse prescription drugs state government; General Assembly

Gusty 14:29 Add Comment

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

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

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

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

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

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

Princess Health and Beshear tells national audience legislature should pass pill-mill bill.Princessiccia

Princess Health and Beshear tells national audience legislature should pass pill-mill bill.Princessiccia

attorney general General Assembly legislation legislature pain clinics pill mills prescription drug abuse prescription drugs state government

Gusty 15:07 Add Comment

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)

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

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

pain clinics pill mills prescription drug abuse state government; General Assembly

Gusty 13:39 Add Comment

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.