Kentucky Medicaid patients are prescribed narcotics more than any other drugs

bmusgrave@herald-leader.comOctober 9, 2012 

FRANKFORT — Narcotics were prescribed to adult Medicaid patients in Kentucky more than any other class of drug during the 2000s, according to a new study by the University of Kentucky.

In Eastern Kentucky, where abuse of pain pills has become an epidemic, Medicaid patients received double or triple the quantity of narcotics that patients got in most other Kentucky counties, the study found.

The analysis by UK's Center for Business and Economic Research examined Medicaid prescriptions from 2000 to 2010. In all, more than 3.8 million prescriptions for narcotics were written for Kentucky adults on Medicaid during that time, the study found.

The Medicaid program spent $212 million on pain medicine over those 11 years. The state paid about 30 percent of that, and the federal government picked up the rest.

Martin County led the state in narcotics prescriptions with 26,609 grams prescribed per 1,000 member-years of Medicaid. Shelby County had the lowest figure: 2,218 grams per 1,000 member-years of Medicaid.

Lawmakers, drug-control experts and members of Gov. Steve Beshear's administration said controversial legislation passed this year to crack down on unnecessary prescriptions of pain pills will probably result in a drop in narcotic prescriptions, not just in Medicaid but throughout Kentucky.

House Bill 1 requires doctors to check an online database for patients receiving controlled substances. It is called the Kentucky All Schedule Prescription Electronic Reporting, or KASPER.

Cabinet for Health and Family Services Secretary Audrey Tayse Haynes said changes included in the legislation, coupled with the state's decision to move more than 550,000 Medicaid patients to managed care last November, will go a long way toward rooting out over-prescribing of pain pills.

"We believe there is no 'one size fits all' to get at this problem," Haynes said.

The cabinet will examine its own internal numbers in coming weeks to look at whether there are problems in certain parts of Kentucky, Haynes said.

"We have an obligation to try to shine a light on some of these statistics, to try to dig deeper and figure out what we can do better," she said.

Van Ingram, director of the Governor's Office of Drug Control Policy, said the study's findings mesh with other trends, including huge increases over the past decade in deaths from narcotics overdoses, babies born addicted to drugs and people seeking drug treatment.

The numbers also mirror national data on prescriptions that drug-enforcement agents have seen at recent conferences, Ingram said. A similar study conducted by an insurance company in 2007 found that narcotics were the most-prescribed therapeutic class of drugs in Tennessee.

"I have heard that hydrocodone and (other narcotics) are more prescribed than any other medication," Ingram said. "It really is staggering."

The UK study showed that the number of narcotics prescriptions in the Medicaid program has declined slightly in recent years after peaking in 2005.

Part of that decline can be attributed to a policy that allows Medicaid to limit a patient to one provider or one pharmacy if the program detects that a patient has received multiple prescriptions for pain pills from multiple sources, officials said. The state's prescription monitoring program also became available electronically to doctors around the same time, Haynes said.

Michael Childress, author of the UK study, said part of the decrease can be attributed to a change in policy for Medicare, the federal health-insurance program primarily for people 65 or older. After 2006, Medicare began to pay for many prescriptions, which might have shifted the bill for some narcotics prescriptions from one government program to another.

"These people could have been getting the same medications, but they weren't paid for by Medicaid," he said.

Childress noted in his report that poor educational attainment, high unemployment and poverty also are found in counties with higher than average numbers of narcotic prescriptions.

"These are deep underlying issues that also have to be addressed," Childress said.

The rise in narcotic prescriptions is also a symptom of a deeper, cultural problem, Ingram said.

People have begun to accept that it's okay to take a pill for every ache and pain, Ingram said. That mentality is reinforced by pharmaceutical companies that encourage patients to ask their doctors for certain medications by name.

"We've set up these transactional relationships with our providers," Ingram said. "Every night we're bombarded with these commercials that tell us, 'If you have this problem, just take this pill.' That's a trend that we've got to, as a state, reverse. We're now seeing the result."

Beth Musgrave: (502) 875-3793. Twitter: @BGPolitics. Blog: Bluegrasspolitics.bloginky.com.

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