Addiction to legal prescription drugs has become a major public health issue across the United States.
This problem has been especially hard on Kentuckians, particularly those in the poorer parts of the state.
This addiction is leading to increased incidents of crime, loss of employment opportunities and, sadly, many deaths, particularly of our younger citizens.
I was shocked recently to learn in a conversation with a state senator that there were more deaths from prescription overdoses last year than from motor vehicle fatalities on the highways across our state
It is quite understandable then why the Kentucky General Assembly felt compelled to address this problem by regulating pain management clinics with the so-called “pill mill bill."
Kentucky Medical Association physicians are in absolute support of any effort that would decrease prescription drug overuse. As physicians, we not only practice medicine, but we also live in the communities we serve, and we are often impacted personally by the effects of addiction to prescription drugs.
Patients and the general public need to have a clear understanding of what constitutes a “pill mill” versus a legitimate medical practice.
The so-called “pill mills” are clinics that generally do not take insurances, charge high fees (sometimes up to $250 per visit), and give out large quantities of controlled medication, mostly narcotics, that are frequently abused.
This is quite different from a legitimate medical practice, which accepts insurances, including Medicaid and Medicare, and provides treatment of chronic pain with the proper administration of narcotics under the guidelines recommended by the Kentucky Board of Medical Licensure and the Federal Drug Enforcement Agency.
We in the medical association became alarmed by one of the bills originating in the house and actively supported by the attorney general. This bill went overboard in treating all patients receiving these medications potentially as criminals, as opposed to innocent individuals seeking appropriate care for their conditions.
The most controversial aspect of this bill, which was actively opposed by the KMA, was the movement of the administration of the Kentucky All Schedule Prescription Electronic Reporting (KASPER) system from the Cabinet for Health & Family Services to the Office of the Attorney General.
The intent of this legislation was to have KASPER become a “law-enforcement tool” in the hands of the Attorney General and his staff. The KMA opposed this move because KASPER contains very private information, as I alluded to earlier.
If you as a patient purchased a drug that is a “controlled substance,” you are noted in the KASPER system by name and the drug you purchased. Everyone, beyond physicians and patients, should be concerned when such sensitive health information is handed over to a state agency or put in the hands of bureaucrats whose culture is to think naturally in terms of criminal intent, when the majority of patients are simply seeking medical care.
In the end, the KMA is pleased that, after extensive efforts to educate legislators about the potential harm of this legislation coming out of the House of Representatives, the Senate passed a bill that was much less onerous, though still concerning to us.
The effort to move the KASPER over to the attorney general’s office was shelved, as well as a tax on providers that was proposed in the house bill.
Nevertheless, the legislation will still have a decided impact in the individual patient-physician encounter in that it regulates what physicians must do before prescribing a controlled substance.
This is troubling because it not only places how we practice medicine in the hands of the law, but it also creates many time-consuming hassles for legitimate patients who might need a controlled medication for their particular physical or mental health condition.
Beginning later this year, Kentucky residents will note a decided change in this aspect of their medical care. It is going to be more of a pain to be treated for your pain or anxiety.
In the end, it is our position in the Kentucky Medical Association that these issues of concern, in terms of diversion, misuse and abuse of controlled medications by a few should not impact the care of the majority, who are legitimately seeking help.
It is our position that this is best addressed through regulations promulgated by the Kentucky Board of Medical Licensure as empowered by the governor and the State Legislature in the Medical Practice Act.
Editor’s note: Naren James, M.D., serves on the Board of Trustees for the Kentucky Medical Association .
