Since the implementation this summer of House Bill 1 (HB1), the state's landmark prescription drug abuse bill, 10 pain management clinics have closed, prescriptions for some of the most-abused controlled substances are dropping, and a record number of investigations are under way into suspicious prescribing practices, Governor Steve Beshear announced today.
"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," said Gov. Beshear. "But we will not rest. Too many families and communities have been shattered by prescription drug abuse. We will not let up on these doctor shoppers and greed-driven practitioners who continue to supply these poisons to addicted Kentuckians."
HB1, sponsored by House Speaker Greg Stumbo, passed in a special legislative session this spring. The bill included multiple elements to prevent the abuse and diversion of prescription drugs and to enhance law enforcement's tools to investigate illegal prescribing practices. The law went into effect July 20.
"In the three short months since House Bill 1 took effect, the headlines have been clear: The pill mills are closing up shop. They need to know we're not going to rest until they are all gone," said Speaker Stumbo. "I want to thank Governor Beshear, my colleagues in the General Assembly, law enforcement and many in the medical community who got on board to make this law possible. I'm sorry that some doctors have led their patients to believe that this legislation somehow makes it more difficult for them to prescribe needed medicine. Nothing could be further from truth. Protecting patients is at the heart of this law."
"Every law requires change, and transitions are sometimes hard," said Senate Majority Leader Robert Stivers. "But we have already seen great benefits to Kentucky's families and communities due to the passage of HB1."
"The abuse of prescription drugs is an epidemic in our state and we have to have strong, enforceable and practical laws and regulations to protect patients," said Dr. Preston Nunnelley, President of the Kentucky Board of Medical Licensure (KBML). "We are cooperating with law enforcement and are aggressively pursuing investigations against physicians who are prescribing inappropriately or negligently. I have no doubt that HB1 is saving lives."
"House Bill 1 has solidified our longstanding relationship with other front-line agencies and provided us with a unified front as we combat one of the most serious threats facing our state," said Attorney General Conway. "The agreement our office drafted and entered into with other agencies requires the sharing of this information and helps provide law enforcement with the ability to use its resources to target the most egregious cases of illegal or inappropriate prescribing. The dramatic increase in shared information and increased enforcement by the KBML is good news for families across the Commonwealth touched by prescription drug abuse."
HB1 Impact: Fewer "Pill Mills'
The new law mandates that all new pain management clinics must be owned by a licensed medical provider, and all pain management clinics must employ a medical director in good standing with one of the professional licensure boards.
The Office of Inspector General identified 44 facilities as pain management clinics in 2012. Eighteen of them have closed or have discontinued providing pain management services -- including 10 that shut down since HB1's implementation.
"Not all pain management clinics are "pill mills', prescribing large volumes of pills to patients with little medical oversight. But the fact that nearly a dozen clinics voluntarily closed down before we could check their patient records and prescribing practices signals to us that they couldn't take the heat," said Secretary Audrey Tayse Haynes, of the Cabinet for Health and Family Services.
The Office of Inspector General is currently processing 11 applications for licensure as pain management facilities under the new law. That process includes on-site surveys and evaluation of records and practices.
"House Bill 1 has proven effective at shutting down pill mills -- those who profit from pain. As co-chairman of the implementation task force for this law, I am working with all stakeholders to make sure that its mission is upheld," said Rep. John Tilley.
HB1 Impact: More KASPER reports, registered users
HB1 expanded the Kentucky All Schedule Prescription Electronic Reporting (KASPER) system, the state's prescription monitoring system, by requiring all prescription providers of controlled substances to register. Regulations promulgated by the various medical professional licensure boards mandate that licensees use the KASPER system before prescribing controlled substances.
When the law passed in April, KASPER had 7,911 registered accounts. On Oct. 1, KASPER had 21,542 registered users -- nearly triple its accounts from just six months earlier. Users include physicians, dentists, optometrists, advanced practice registered nurses, and podiatrists.
A year ago, KASPER provided an average of 2,888 reports daily. Now, providers request an average of 18,149 reports each day. The vast majority of those reports -- 93 percent -- are processed in less than fifteen seconds.
"Providers are learning that requesting a KASPER report takes less time than measuring a patient's blood pressure, and the practice is becoming routine instead of a special task," said Mary Begley, CHFS Inspector General. "These reports are providing crucial information that can flag a problem user, or may also warn a provider of otherwise unforeseen complications from drug interactions."
HB1 Impact: Fewer Controlled Substances Dispensed
KASPER recorded 219 million doses of hydrocodone dispensed in Kentucky in 2011. That's enough for 51 doses for every man, woman and child in Kentucky. However, records since HB1 implementation indicate that the prescriptions are declining for certain controlled substances.
In August 2011, doctors prescribed 20.9 million doses of hydrocodone. A year later, hydrocodone prescriptions in August dropped to19.3 million doses -- a 7.5 percent reduction. In that same time period, oxycodone prescriptions dropped 6.4 percent; alprazolam (Xanax) prescription doses fell by 9 percent; and oxymorphone (Opana) prescriptions dropped 38 percent.
"No one could argue that 219 million doses of hydrocodone dispensed a year in a state our size is appropriate," said Van Ingram, executive director of the Kentucky Office of Drug Control Policy. "What we are beginning to see is the impact of medical providers reviewing KASPER reports and making changes in patient treatment. This not only puts the brakes on doctor shoppers, it also improves patient care."
A 2010 CHFS poll of KASPER users noted that 94 percent of medical providers said that the program is an effective tool in tracking an individual's prescription history, and nearly 94 percent reported satisfaction with the tool. Nearly nine in 10 KASPER users reported denying a prescription for a controlled substance to a patient based on information provided by a KASPER report.
HB1 Impact: More Investigations, License Suspensions of Medical Providers
HB1 requires that when a complaint about prescription abuse is lodged with any of several investigative agencies -- the Attorney General, Kentucky State Police (KSP), CHFS, or any of the professional licensure boards -- that complaint must be shared with the remaining agencies. The Memorandum of Agreement entered into by these agencies facilitates the distribution and use of the information for administrative and law enforcement purposes.
KBML disciplined 18 physicians for prescribing violations in 2011. But in just the last six months, KBML has taken disciplinary action against 33 physicians for prescribing violations. Those actions include nine emergency orders of license suspension and one emergency license restriction. Another 15 physicians agreed to indefinite restriction of their prescribing authority, and five more surrendered their licenses rather than have them revoked.
"The immediate cross-agency investigation of a prescribing complaint has accelerated our ability to review practices and take action against providers who are prescribing inappropriately," said Dr. Nunnelley. "The Board considers violations involving prescribing of controlled substances to be very serious and is committed to carrying out the intent of HB1."