A measure aimed at battling Kentucky's crippling prescription-drug abuse problem would bring new controls on pain clinics and beef up the attorney general's power to police overprescribing by health care providers.
The bill also would require regulators to investigate potential improper prescribing quickly, and to set up a way to strip prescribing authority from providers faster in certain cases.
House Speaker Greg Stumbo, D-Prestonsburg, filed the bill Thursday. Stumbo said the state must do more to fight rising abuse of prescription drugs.
"We're seeing hundreds of Kentuckians lose their lives every year to this disease and thousands of others caught in the death spiral of addiction," Stumbo said. "We cannot afford to wait another year to act."
One goal of Stumbo's bill is to crack down on what police call "pill mills" — offices where unscrupulous doctors give people prescriptions for powerful painkillers with cursory or no real examinations.
Those operations typically take cash only. Dozens of such facilities in Kentucky are owned by businesspeople, not medical professionals, police say.
Authorities argue that is a problem because some clinic owners push the doctors to write prescriptions improperly to make more money.
Stumbo's bill would require pain clinics to be owned by licensed health care practitioners.
Brent Turner, commonwealth's attorney in Floyd County, said shady pain clinics contribute to the tide of pills on the street.
"Anything that would limit the clinics like that would help because it's going to reduce the number of pills going out there," Turner said of Stumbo's bill.
There are other measures pending to address the issue of alleged pill mills. Senate Bill 42 would set up licensing and other controls, and House Bill 251 would ban cash-only pain clinics.
Gov. Steve Beshear and Attorney General Jack Conway back Stumbo's bill, though Beshear said Thursday it was a starting point that might pull in ideas from other lawmakers.
"I am confident we're going to end up with a very aggressive, strong measure that will make a dent in prescription drug abuse in Kentucky," Beshear said.
Several pieces of the measure deal with the state's prescription-monitoring system, known by the acronym KASPER. The bill would move the system to Conway's office, allow the office to sift through reports on what drugs people get in order to spot improper prescribing or drug-seeking, give county prosecutors and commonwealth's attorneys access to KASPER, and let the attorney general's office seek federal money to upgrade the system so users could get reports more quickly.
The bill also would require that anyone with authority to write drug prescriptions check a KASPER report — showing what drugs a person had gotten — before giving a new patient a prescription, and to check such reports on regular patients periodically.
That would include nurse practitioners.
Doctors, dentists and others may use KASPER to see whether patients are getting prescriptions from multiple sources, but Conway said this week that only 25 percent of doctors use it.
Providers have said they don't have time to get KASPER reports. Stumbo, however, said the inconvenience is not an excuse.
"I say the same thing to them that I say to people who have to stop at red lights. It's a safety precaution," Stumbo said. "You've got to take the time."
The attorney general's office would get other new duties under the bill, including authority to set thresholds on the amount of certain drugs that would be considered proper to prescribe.
If a provider went over the threshold, Conway's office could notify state police and the board that regulates providers.
The bill also would give the attorney general's office oversight over how licensing boards investigated complaints.
On other fronts, the bill would require boards that license people with prescribing authority, such as doctors, dentists and nurses, to move more quickly in investigating complaints of potential improper prescribing.
The boards also would have to set up a way to stop a provider from prescribing if that review — which would take place before a full-scale hearing — showed that letting the person continue to issue drug orders probably would endanger patients or the public.
In addition, the bill would increase penalties for health care providers convicted of drug offenses, allow pharmacies to keep taking prescriptions for a 90-day supply of drugs but bar them from shipping more than a 30-day supply at one time, and require coroners to order an autopsy if drug use was suspected in a death.
Overdose deaths have risen steadily during the past decade, to an estimated 82 a month, or nearly 1,000 a year.
However, police say the number is actually higher because coroners don't order autopsies in every case to see whether drugs played a role in the death.
Health care providers might balk at parts of the bill. Representatives of the Kentucky Medical Association and Kentucky Board of Medical Licensure said Thursday that they hadn't seen the measure and couldn't comment on it.