Just days after new legislation has taken effect to combat prescription drug abuse, four pain clinics in Kentucky say they will close, Gov. Steve Beshear announced today. "The word is out. Kentucky is deadly serious about stopping this scourge of prescription drug abuse and now we have some of the strongest tools in the country to make that happen," the governor said, adding that nine other pain-management clinics have not applied for licenses and will be investigated.
The law puts more restrictions on pain clinics to prevent so-called "pill mills" from setting up shop in the state. To be licensed, pain clinics must be owned by a licensed medical practitioner, and the law requires licensing boards to investigate complaints immediately.
It also requires doctors who prescribe controlled substances to refer to the state's drug-monitoring system known as KASPER before they write a prescription so they can see if a patient appears to be doctor shopping. The licensing boards have been charged to set up standards to increase oversight and spell out how doctors should be using KASPER (Kentucky All Schedule Prescription Electronic Reporting).
Though changes are still possible, the licensing boards issued those regulations last week, which were more expansive than originally required in the new law. The boards indicated they wanted KASPER to track all Schedule II and III drugs and 15 more Schedule IV drugs. The statute originally only required tracking of Schedule II and Schedule III drugs that contain hydrocodone.
Cracking down on actual pill mill owners, drug abusers and dealers had been difficult up until now since law enforcement couldn't see the data in KASPER without already having a case file opened. In his first four years in office, Attorney General Jack Conway said repeatedly he never got a referral from the Kentucky Board of Medical Licensure saying an investigation should be conducted. Now when a complaint about prescription drug abuse is lodged with any investigative agency — the attorney general's office, Kentucky State Police, any of the licensing boards or the Cabinet for Health and Family Services — it must be shared with the other agencies within three days. However, the six licensing boards (medical licensure, nursing, dentistry, pharmacy, podiatry and optometry) don't have to share among each other. "This alleviates concerns that the professional organizations would be forced to report information to other boards that have no jurisdiction over the complaint," Beshear said.
Some critics have said the legislation interferes with the care doctors provide for their patients and threatens confidentiality. To that end, Beshear said people who legitimately need prescription drugs "have nothing to fear. You'll get your medicine." For doctors who are concerned they won't be able to prescribe as they wish, Beshear said provisions have been built into the law to prevent that from happening.
"But if you're doctor-shopping, buying extra pills for recreational use, or prescribing pills for cash, you'd better change your vocation or change your location, because we're coming after you," he said.
As for arguments that checking with KASPER to see if a patient has a questionable prescription history will be too time consuming for providers, "nine times out of 10, it will take as much time as measuring a patient's blood pressure or recording their insurance information," said Mary Begley, CHFS inspector general. CHFS reports 90 percent of KASPER reports are completed within 15 to 30 seconds.
A prescriber or pharmacist can also choose delegates — like a nurse or an aid — to run reports on their behalf, said CHFS spokeswoman Jill Midkiff.
The licensing boards have allowed a grace period until Oct. 1 to allow practitioners to time to learn how the new policies will work, according to Beshear's press release.