HAZARD — "Be strong, and please be safe," Danielle Sandlin told a gathering of about 375 medical professionals and others at a symposium on prescription drug abuse and clinic safety Saturday.
How to be safe is the question on many doctors' minds.
"There are patients I know that are very bad," said Dr. Cesar Agtarap, who works at Mercy Clinic in Jackson and attended the symposium. "I don't know if I'm out of line reporting these patients."
The symposium was planned after the death of Dr. Dennis Sandlin, Danielle Sandlin's father. A patient at Sandlin's Cornettsville clinic has been charged with shooting the doctor after he denied the patient a painkiller prescription without a urine test.
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Presenters encouraged doctors to use a "three strikes" written contract to stop aggressive patients. Doctors also were urged to screen patients with urine tests and photo identification and to tell patients up front that they should expect random drug tests. Knowing drug tests are expected and having to provide a photo ID often discourage people from lying to get a prescription to use illegally.
People who want pills to sell or abuse need to know they can't bully doctors into helping them, presenters said. Simply posting signs that inform new patients they won't get a prescription on their first visit can stop some abusers.
Operation UNITE, an Eastern Kentucky drug abuse task force that sponsored the symposium, is arranging an advisory council of medical providers to help create doctor protocols for addressing aggressive patients and managing patients' pain.
"It's the first time we've reached out to doctors in that way," said UNITE Director Karen Engle.
Doctors presenting at the symposium said attitudes about pain management and drug addiction need to change.
Sharon Walsh, director of the University of Kentucky's Center on Drug and Alcohol Research, showed Florida newspaper advertisements for "caring and confidential treatment" of pain with pictures of pretty women and headlines announcing discounted pain medication and on-site pill dispensing. Florida, which has had no prescription monitoring system, has been identified as a major source of pills brought into Kentucky for illegal sale and abuse.
"You need to refer patients to good treatment," Walsh said.
What used to be a subculture is now part of the culture, said Lt. Gov. Daniel Mongiardo, a Hazard physician.
"I don't know any family, including my own, that has not been affected by this," Mongiardo said. "But we're still treating it as a subculture."
Medical professionals said that in addition to more resources, they need more information from and communication with law enforcement. Operation UNITE officials have said they are interested in exploring a way to share state court records with medical providers.
Danielle Sandlin said she was shocked to find out that only about a third of medical providers use KASPER, the state's prescription-monitoring program. She said she hopes the symposium will encourage more providers to use KASPER so they can identify high-risk patients and not contribute to the problem of addiction.
Time and awareness of the system are the main obstacles to increasing KASPER usage, presenters said.
Dr. Lynn Webster, a Utah pain management and addiction specialist, said that a national prescription-monitoring system would be valuable but that many Utah doctors didn't use the state's system because of time constraints and ethical questions.
A national system has been partially funded by Congress, but Rep. Hal Rogers, R-Somerset, who spoke Saturday, said he opposes federal funding because a national system would not allow law enforcement access to the data. Police constitute about 2.3 percent of KASPER's use. They must have an active investigation open and can't "go fishing," said KASPER administrator Dave Hopkins.
Successful state-to-state prescription-data sharing is just starting, Hopkins said. He pointed to a recent successful test to integrate Ohio's monitoring program with Kentucky's.
While he can use KASPER to find out about patients' prescriptions, Dr. Agtarap said there's no system for him to report information about patients who become aggressive or violate some part of his patient contract. He said the information could help other doctors.
Agtarap said he worries about kicking out patients who slip up and sell or misuse their prescribed medications: "They just go through a revolving door to another pain clinic."
But he worries that if he keeps treating those patients, he could be at risk for prosecution: "Some of these patients are really pain patients."