It's not really surprising that the road toward implementing House Bill 1, the pill-mill bill, has been very, very rocky.
The law, enacted in the spring by the General Assembly, aims to get certain prescription medicines out of the hands of people who abuse or sell them while assuring patients who do need them can get them.
There were immediate successes. Some pain clinics simply left the state when the stricter requirements became law. The Kentucky All Schedule Prescription Electronic Reporting program, or KASPER, is finally on track to fulfill its promise of making sure patients aren't getting prescriptions from several doctors, because the law requires all doctors to register with the system and use it before prescribing certain abused drugs. Use of KASPER had been voluntary.
But the law went beyond these measures, with provisions aimed at preventing legitimate physicians from mistakenly prescribing drugs to patients who would abuse or sell them.
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And that's where things have gotten sticky, as state government has begun to tread in the private, protected territory of the physician-patient relationship. Many doctors also believe it gives the government a hand in deciding what's medically appropriate for patients.
Most recently, reporter John Cheves outlined the cost of urine drug screens that a physician, citing the regulations, had ordered for two retired patients to continue receiving medications they had long needed. The cost of the testing, over $1,000 for both patients, was not likely to be covered by insurance.
It's tempting to say that everything would have been better if Gov. Steve Beshear hadn't approved the early implementation of the pill-mill bill under emergency regulations.
But if there's ever been a situation that can legitimately be called an emergency, it is prescription drug abuse.
It accounts for more deaths in Kentucky than auto accidents; one in five of our teenagers admit to using prescription drugs non-medically; crime to feed drug dependency is rampant. Attorney General Jack Conway said recently that law enforcement officers in Eastern Kentucky estimate that 80 percent of crime in their region arises from prescription painkiller abuse.
So, where does this leave us?
Kentucky state government must stay firm on its commitment to reduce the volume of prescription drugs that get into the hands of people who abuse or peddle them. In the decades this problem has been developing, the medical community did not step up to police its own to address this public health crisis, leaving that job by default to government.
That said, in a poor and unhealthy state like Kentucky, dictating intrusive and costly procedures could end in locking people who need care out of the medical system, and distracting doctors from their essential work.
The Kentucky Board of Medical Licensure, charged with writing the permanent regulations, is working with representatives of the medical community to identify and address problems. Some of the fixes will require legislative action in the next session.
It is delicate and hard work finding the balance between achieving the public good and protecting private rights and professional judgement. But it must be done.
Getting this right is important.