Study finds legislative crackdown on pill mills worked, but some providers are still prescribing lots of drugs

By Al Cross

Kentucky Health News

The 2012 legislation to crack down on abuse of painkillers in Kentucky had an immediate and significant effect, according to a study by researchers at the University of Kentucky.

"Doctor shopping," defined as a patient receiving multiple prescriptions from at least four prescribers and at least four pharmacies in a three-month period, declined by 52 percent, according to the researchers' analysis of 2009-2013 data from the Kentucky All Schedule Prescription Electronic Reporting system, which tracks prescriptions for controlled substances.

Interviews with prescribers, pharmacists and law-enforcement officials found that they "believed KASPER to be more effective at reducing doctor shopping than reducing the abuse and diversion of prescription drugs," study report says. "This perception may be a direct result of the impact of mandatory registration and greater use of KASPER by these professionals."

Use of the KASPER system increased greatly, with 322 percent more pharmacists and 262 percent more prescribers using it, and making 650 percent more queries to see patients' prescription history, said UK's Institute for Pharmaceutical Outcomes and Policy.

The number of prescribers of controlled substances (CS) declined 14 percent. "A minority of prescribers indicated they no longer prescribe CS, or prescribe fewer CS, as a result of the HB1 mandate and its burden on their practices," the report says. However, "multiple analyses in this

comprehensive evaluation argue against a blanket chilling effect" of the legislation, 2012 House Bill 1.

At the other end of the spectrum, some doctors still seem to be prescribing too many drugs. "High-volume prescribers contribute significantly to the overall prescribing of CS in Kentucky and the Cabinet for Health and Family Services should continue to identify and investigate top prescribers for appropriate prescribing practices," the researchers wrote.

At a press conference held to announce the study, Gov. Steve Beshear said the Kentucky Board of Medical Licensure, which filed no CS actions against health-care providers in 2011, has since filed 196 actions against 192 providers.

"What has happened is a cultural shift among the Board of Medical Licensure," which is now working with law enforcement, said Attorney General Jack Conway, who battled with the board and the Kentucky Medical Association, the physicians' lobby, during debate over the legislation.

Conway is the Democratic nominee to succeed Beshear, also a Democrat. Senate President Robert Stivers, a Republican, credited Beshear with encouraging the board to be more active.

The legislation also targeted "pill mills" where painkillers were easy to get. Conway said, "We've shuttered just about every one of the state's non-compliant clinics."

Officials have said the legislation led to a rise in heroin use and overdoses, but the study says the causes are more complicated: "Alterations in the heroin market were underway prior to HB1 and this policy change should not be characterized as the sole contributor to the rise in heroin abuse in Kentucky."