FRANKFORT — Lawmakers tried to abate Kentucky's prescription drug abuse problem last year with House Bill 1, the so-called "pill mill bill." Now they're coming back for clean-up work.
During the 2013 General Assembly, lawmakers could narrow the focus of HB 1 and its administrative regulations to concentrate on adults with long-term prescriptions for frequently abused painkillers, such as hydrocodone and oxycodone.
Doctors, hospitals and patients have complained that HB 1 in its present form restricts too many drugs in too many clinical settings, needlessly complicating medical care in an effort to shut down storefront pain clinics that recklessly hand out prescriptions.
"We're gonna tweak it. It was a good bill that definitely had some unintended consequences," said Sen. Jimmy Higdon, R-Lebanon, who sits on an HB 1 oversight committee. "Once we got into this, six or seven months into it, we saw some of the rules were creating some personal hardships without really accomplishing what we were trying to do."
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For example: Under the current rules, Kentucky requires people with long-term prescriptions for controlled substances to submit to urine testing. The tests determine if patients take their medicine, rather than sell it, and if other, unprescribed drugs are in their systems.
In September, the Herald-Leader reported on complaints from patients charged hundreds of dollars for urine tests whose insurance companies denied coverage because the tests were not considered medically necessary. One retired couple in Lexington was billed $932 for urine tests necessary to get refills on insomnia and anti-anxiety medicines.
State regulators responded by negotiating with private insurers and Medicaid managers to force the health plans to cover urine tests.
However, the Kentucky Board of Medical Licensure, which wrote the regulations, is drafting a new set to cast a smaller net. The new rules would reduce the mandate for drug screening to pain medicine prescriptions of 90 days or more. Other drugs, such as those for insomnia, panic attacks and attention hyperactivity deficit disorder, would not necessarily require screening unless doctors thought that medical standards made it necessary. And tests would not have to involve urine if doctors believed another medium, such as hair, would be cheaper and as effective.
The Board of Medical Licensure is focusing on powerful painkillers, board director Michael Rodman told legislators at hearings last fall. Lawmakers are commending the board for striking a balance. The legislature's Administrative Regulation Review Subcommittee is scheduled to get a copy of the board's proposal on Monday.
"We're not here to make life any more difficult for those in need of pain treatment. But we've got a serious problem here that demands a public policy response," House Judiciary Chairman John Tilley, D-Hopkinsville, said at a hearing in December.
Nobody denies the problem. Drug-overdose deaths in Kentucky rose 296 percent from 2000 to 2010, largely in the poorer counties of Eastern Kentucky, according to a recent study at the University of Kentucky. Prescription drug abuse drove the increase. Of the 979 deaths in 2010, prescription drugs were involved in more than half, according to the study.
Under HB 1 as implemented, doctors generally cannot prescribe controlled substances until they complete patients' medical histories, conduct physical exams, check photo identifications and run names through the state's KASPER (Kentucky All Schedule Prescription Electronic Reporting) database. The proposed changes will leave much of that system in place, though the state will relax the rule on photo identifications if doctors can vouch for the identities of their patients.
The law also requires new pain management clinics to be owned by a licensed medical provider, and all clinics must employ a medical director in good standing with one of the state's professional licensure boards. State regulators say 10 of Kentucky's 44 known pain clinics closed following passage of HB 1, and prescriptions for several of the most-abused drugs are sharply decreasing.
The Kentucky Medical Association supports the new regulations proposed by the Board of Medical Licensure, said KMA lobbyist Cory Meadows.
"We do think these (revisions) are better, and we're encouraged by that," Meadows said. "We still feel there are some potential issues, but this is a better approach."
House Speaker Greg Stumbo, D-Prestonsburg, said he additionally favors "common sense" changes to the law itself, as compared to the regulations, if they protect legitimate medical care without lessening the pressure on unscrupulous doctors. For example, Stumbo said, the law should be amended to clarify that hospitals don't have to run a new background check on a patient every time they give another dose of a controlled substance during his stay.
Law-enforcement and drug-control groups say they're monitoring the proposed changes and talking to Gov. Steve Beshear and top lawmakers.
It's logical to focus on painkillers, but there are other controlled substances — such as Xanax, used to treat anxiety — that also are abused by addicts in Kentucky, said Karen Kelly, head of Operation UNITE, which investigates drug crimes and provides education and drug treatment. Lowering restrictions on all drugs other than painkillers would not be wise, Kelly said.
"Xanax does not have hydrocodone in it, but it is definitely abused and it is highly addictive," Kelly said. "We're keeping a close watch on this because we believe the intent of the bill is still very good, and it's saving lives."