There was predictable controversy about House Bill 1 in 2012, otherwise known as the pill mill bill.
That bill was an attempt to stem the epidemic of prescription pain pill abuse in Kentucky. The nickname arose from the term for storefront pain clinics where licensed physicians prescribed pain killers freely, often without any examination.
There wasn't much public defense of the clinics, but the medical community complained about the legislation's plan to fully implement KASPER, the Kentucky All Schedule Prescription Electronic Reporting System. KASPER was designed to catch doctor-shopping, the practice of going to multiple doctors to get prescriptions for marketable pain pills. KASPER allows a physician to check whether a patient has other recent prescriptions for pain medications. The pill mill bill made physician participation mandatory, requiring those who prescribe certain pain medications to register with KASPER, check prescription histories before prescribing pain medication, and enter prescriptions they write.
As it turns out, it wasn't the end of the world for medical practices, but KASPER participation has ended a lot of doctor-shopping. That and other provisions of the legislation also sounded the death knell for many pill mills in Kentucky, according to an evaluation made public last week of the impact of HB 1 by the Institute for Pharmaceutical Outcomes & Policy in the College of Pharmacy at the University of Kentucky.
Some of the findings:
■ Patients' doctor-shopping have declined 52 percent.
■ 24 pill mills have closed.
■ Prescriber registration in KASPER has grown 262 percent.
■ Annual KASPER queries by prescribers have grown 650 percent.
■ Between July 2012 and this March, the Kentucky Board of Medical Licensure took 196 disciplinary actions related to pain-pill prescribing against 142 physicians.
Predictions that doctors would simply stop prescribing these drugs for legitimate patients have not come true. The study notes that, although some physicians have opted out, the number of registered prescribers has increased each year.
No one is declaring victory over drug abuse in Kentucky. But this evaluation confirms that serious legislation can produce measurable progress.
This year, legislation to address the heroin epidemic in Kentucky included a provision allowing communities to establish needle exchanges, which provide clean needles to users for free and without threat of arrest. Shared dirty needles, spread serious and costly diseases, including hepatitis C and the AIDS virus. Kentucky's rate of hepatitis C is seven times the national average. The exchanges also provide free testing for some diseases and information about drug treatment options. Studies have shown that needle-exchange clients are more likely to seek treatment.
Despite objections that the exchanges signal approval of drug abuse, that provisions was included in the law. Some legislators are again assailing the exchanges, pledging to limit or exclude them in the next session.
Legislators and the new governor should stay the evidence-based course they've set out, as they did in 2012. The war against drug abuse and its devastating consequences is a long, complex and hard one that won't be won with histrionics and scare tactics.