County governments don't have the right to ban pain-management clinics, according to a state attorney general's opinion.
Because such local ordinances infringe on the state's right to regulate medical practices, counties cannot ban legal medical practices within their lines, Assistant Attorney General James Herrick wrote in an opinion issued Thursday. The opinion was written in response to Johnson County officials seeking advice on a local grass-roots petition to ban clinics that prescribe high amounts of addictive painkillers.
The issue could end up in court if counties decide to enact such bans anyway.
Johnson County's fiscal court sought the attorney general's opinion before passing a ban, but several other counties, particularly in Eastern Kentucky, already have sought to fight prescription-drug abuse by calling high-volume pain-management clinics a public nuisance.
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Local elected officials said they were disappointed, despite admitting that enforcing the bans was difficult or impossible. They want to send a message to businesses that see an opportunity in Eastern Kentucky's high rates of addiction and overdose.
"With the opinion, now it's kind of like all the work we did was for naught," said Kacey Smith, who works for the Owsley County Drug Awareness Council.
The council has met with the county fiscal court and Booneville City Council about adopting a pain-clinic ordinance similar to the ones in Knott and other counties. Both entities supported the move, but the proponents decided to wait for the attorney general's opinion.
She is not sure of the next step. The board will discuss the issue at its next meeting. One board member has suggested talking to legislators about requiring pain clinics to show a need before opening in a county.
The attorney general's opinion said only the state and federal governments have the authority to regulate medical practices.
"I am ashamed of our state legislature's lack of backbone and not having the courage to pass the legislation desperately needed to help solve the problem," Johnson County Judge-Executive Tucker Daniel said.
At least three state Senate bills proposing the regulation of pain clinics died in committee during the last General Assembly.
"That's shameful, in my opinion," Daniel said.
He lauded efforts by state Sen. Ray Jones, D-Pikeville, who proposed one of the bills.
"It's a desperately needed legislation," Jones said Monday. "I don't see that we scrutinize the dispensing of these medications enough. There's too much devastation to our region to have physicians indiscriminately prescribing narcotics."
Most medical-care providers are legitimate, "but it only takes one or two in a community to flood the market," he said.
The Kentucky Board of Medical Licensure regulates individual providers and doctors but not facilities. Physicians are responsible for telling the board their specialties, such as radiology, family practice or pain management, and there are no laws requiring that they have particular training in those areas, Jones noted.
The board may sanction a doctor after a complaint has been filed. It has published an opinion on the proper way to prescribe narcotics but has not provided a definition of what constitutes a pain-management clinic.
The attorney general's opinion didn't surprise Knott Judge-Executive Randy Thompson.
Local officials questioned the enforceability of the ordinance, he said, but adopted it to send a strong message that pill mills were not welcome in the county.
Still, he said he was disappointed with the finding.
Despite the opinion, Thompson said, he would favor trying to enforce the ordinance, defending it in court if necessary. There are no facilities in Knott County now that would be considered pain-management clinics under the local ordinance.
"I'm not backing down," he said.
He said state lawmakers had not done enough.
"It comes back on us at the local level to try to do something about the problem," Thompson said.