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The Pill-Mill Bill

Prescription drug abuse in Kentucky is a disturbing and growing problem. House Bill 1 (HB 1), which was passed during a special session of the Kentucky General Assembly this past April, seeks to deal with this problem.

“We have more deaths in Kentucky from prescriptive drug abuse than we do car accidents, so it’s a significant problem,” said Dr. Preston Nunnelley, president of the Kentucky Board of Medical Licensure, which was responsible for designing the regulations for HB 1. The work required awareness of different nuances.

“We were trying to develop a program that will decrease prescriptive drug abuse but not penalize patients who really require chronic pain medication,” Nunnelley said. “It’s a very narrow line. We wanted to make sure there were not too many unintended consequences.”

The so-called “Pill Mill Bill” was never intended to be obstructive to the practice of medicine but to attempt to thwart the rising use of prescription drugs in illegal commerce and with addiction issues. It includes a definition of pain management facilities and has an ownership requirement stating only physicians with an active license may own or have investment interest in a pain management facility. In addition, the physician-owner or physician-designee must be on site practicing medicine at least 50 percent of the time.

“The doctor just can’t set up the clinic and have somebody else run it and dispense the drugs,” Nunnelley said. “He has to be there.” The physician must also hold subspecialty certifications. Five recognized certifications in pain management are defined in the statute.

“We have pain clinics that are owned by people that aren’t physicians,” Nunnelley said. “They are different types of entrepreneurs that own pain management clinics. In many cases they are prescribing without evaluating the patient.” HB 1 will crack down on these types of clinics.

Physicians with a DEA will be required to register with KASPER (Kentucky All Schedule Prescription Electronic Reporting) through the Cabinet for Health and Family Services. Physicians must query the system when prescribing acute or chronic pain medication. There are exceptions to this rule as defined in the statute. KASPER can indicate if the patient has been “doctor shopping” and received medication from other doctors. It can also show if a doctor is a high utilizer of scheduled drugs. “That’s a red flag,” Nunnelley said. “We can use this information to investigate a physician. In many cases we find his utilization appropriate.”

Doctors who over prescribe without justification can lose their license. “In the past six months the Board of Licensure has taken the licenses of several physicians and in some cases restricted their ability to prescribe scheduled drugs,” Nunnelley said. “We’ve had several who retired early rather than go through [an investigation].”

However, most Kentucky physicians are astute about how much and how often they prescribe pain medication. “I think most of our physicians are trying their best to make sure they are complying with the law and to make sure that they’re taking good care of their patients with acute and chronic pain,” Nunnelley said.

Illegal prescribing, criminal activity, drug diversion (when patients sell their surplus medications) and interstate transportation are other concerns. The “Florida pipeline” has been squelched because that state has buckled down and is working hard to resolve the problem. However, people who are addicted to pain medication will do whatever they can to get their drugs. Treating addiction is essential.

“Our problem in Kentucky – and probably our problem nationwide – is we really don’t have enough facilities to treat the number of people that are addicted,” Nunnelley said. “We have to be able to help these people.”

HB 1 still needs some tweaking, Nunnelley said, but he HB 1 is a step in the right direction. “While what we’ve done is not perfect, we have the opportunity to modify the regulations to improve HB 1,” he said. “What we can’t change with regulation would be possible to change during the next legislative session.”

You can view HB 1 at http://www.kbml.ky.gov.

Tanya J. Tyler, Associate Editor

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