Months after sharp criticism from lawmakers over how it tracks prescription drugs, the Kentucky Medical Licensure Board says it has taken steps to improve the system and crack down on over-prescribing doctors.
But there’s lots of work ahead, chiefly getting more doctors familiar with the system and making it easier for physicians to spot so-called doctor shoppers, officials and lawmakers say.
Officials with the licensure board testified before the legislature’s Program Review and Investigations Committee Thursday.
They said the board had met with the state Cabinet for Health and Family Services, which oversees the Kentucky All Schedule Prescription Electronic Reporting system that tracks controlled substance prescriptions in the state, to discuss ways to improve spotting prescription trends.
The cabinet releases quarterly reports showing how doctors are prescribing and patients are using commonly abused medications, such as hydrocodone and oxycodone, across the state.
“If we see a bump in an area, then we’re asking for the top 10 prescribers in that area and looking at them to see whether to open an investigation or not,” said KMLB President Dr. Preston Nunnelley.
“… In doing that, and we haven’t been doing it very long, we’ve already opened five investigations just based on the trend reports and how we use those.”
Since 2006, Nunnelley said, KMLB has launched 167 investigations on Kentucky doctors with suspicious prescribing patterns and taken action on 132 of those. Only three medical licenses have been revoked in that span, he said.
The board also modified its license application, adding questions that ask physicians if they work for a pain clinic and prescribe chronic pain medication, Nunnelley said.
In August, state House Speaker Greg Stumbo blasted the board for not policing doctors who over prescribe pain killers and other abused medications. After a Program Review and Investigations Committee meeting that month, he said in a statement,
“If KMLB will not take action, the legislature will find an agency that will.”
The board seems to have gotten the message. Stumbo, D-Prestonsburg, said KMLB appears committed to a more pro-active, aggressive approach to investigating prescription abuses in Kentucky.
“In light of testimony today, you would have to be blind not to recognize that progress is being made,” he said in a statement Thursday. “That doesn’t mean we are where we need to be, but we are moving in the right direction.”
Key lawmakers on the program oversight committee agreed.
“(Stumbo) said just what needed to be said,” Sen. Jimmy Higdon, R-Lebanon and co-chair of the committee, said of Stumbo’s comments at the August meeting. “And of course you saw they had an attitude adjustment, and they were back today and recommitted to doing what they’re supposed to do.
“A lot of good things came out of that meeting.”
Rep. Fitz Steele, D-Hazard and co-chair of the committee, said the board’s changes are only a starting point.
“We still have a long way to go, and it’s a work in progress,” Steele said after Thursday’s meeting.
Still, participation among DEA-licensed prescribers in the KASPER system remains low across Kentucky. Of 16,450 licensed prescribers, only 5,180 – or 31 percent – have KASPER accounts, according to figures provided by the Cabinet for Health and Family Services.
Nunnelley said the board is reaching out to health professionals through newsletters and seminars in an effort to get more doctors comfortable with the system.
“We’re trying to educate them on how important this really is, how much of a problem prescription drug abuse is for Kentucky,” Nunnelley said after the meeting.
But education may not be enough. Lawmakers say KASPER-related legislation will likely be introduced in the next General Assembly session, including possibly making participation in the program mandatory for prescribers.
“Making KASPER mandatory is one of the ideas being considered by House Speaker Stumbo for those doctors who prescribe scheduled drugs, but no formal legislation has yet been filed on our side,” Brian Wilkerson, Stumbo’s spokesman, said in an email. He noted that Stumbo would have some sort of proposal dealing with prescription drug abuse ready for the upcoming session.
Higdon, who’s already pre-filed a bill that would strengthen oversight of pain clinics, said he expects to see legislation that would make KASPER participation mandatory among prescribers.
“Right now it’s voluntary, but I think you’ll see that it becomes mandatory,” he said after the meeting.
Higdon also mentioned possibly mandating pharmacists immediately posting sales of controlled substance prescriptions to KASPER (they currently have five days to do so).
Dr. Mary Helen Davis, chairwoman of the KASPER Advisory Council appointed by Gov. Steve Beshear in October to help agencies identify prescription abuses, said she wouldn’t want to see KASPER made mandatory because some physicians rarely,
if ever, prescribe painkillers or anti-anxiety medication.
She also pointed out that KASPER usage among prescribers has increased since the monitoring system was established in 2003.
Instead, she said other measures should be considered, like including patients’ KASPER reports in medical files so doctors can keep track of prescription histories. A doctor can look at a patient’s KASPER report now, but he or she would face criminal charges for sharing that information.
“There are some things that are confusing about KASPER and what to do,” Davis said by phone Thursday. “Once you’ve got the report, you can’t share the report, so there are some of those things that have been in discussion about changing (KASPER).”
Nunnelley mentioned that possible change during Thursday’s meeting.
While the council will look at ways to improve the monitoring of suspicious prescription patterns, Davis said the recommendations wouldn’t be prohibitive for those who need medication or pain relief.
And while over prescription doesn’t affect Franklin County, prescription drug abuse does. A Shelby County man was killed here in 2010 after a suspected pill deal went awry, and a group of locals was charged as an organized crime syndicate for allegedly traveling to Florida and getting pills from pain clinics to sell here.
There are also many who’ve been charged with possession or trafficking prescription medication.