Kentucky lawmakers have passed several health-related bills to deal with the opioid epidemic, and could pass several more

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. – The 2017 General Assembly has passed several bills meant to put more "tools in the toolbox" as the state works to combat its growing opioid epidemic.

And several more are in the pipeline to pass when lawmakers come back March 29 and 30. Those two days are provided to reconsider any bills Gov. Matt Bevin vetoes, but legislation in the pipeline can also get initial passage. It would be subject to a veto without the opportunity for an override.

Opioid-related bills that have passed:

House Bill 314, sponsored by Rep. Danny Bentley, R-Russell, would require hospitals to report positive drug tests to the Cabinet for Health and Family Services,, including results from newborn babies if the provider thinks they have been exposed to drugs. This data would be entered into the KASPER (Kentucky All Schedule Prescription Electronic Reporting) database and would give federal prosecutors, medical professionals and pharmacists access to the system.

The bill would also require hospitals and emergency departments to report all drugs with a high potential for abuse that are dispensed to patients during their stay, exempting Schedule III and IV drugs if they are dispensed for a maximum of 48 hours and not dispensed by a hospital's emergency department. The bill also requires the reporting of all positive drug tests conducted in an ER. This bill has passed both houses and been delivered to the governor.

HB 158, sponsored by Rep. Kim Moser, R-Taylor Mill, brings state controlled-substance listings into compliance with federal policy. This bill has been delivered to the governor.

Senate Bill 32, sponsored by Sen. Danny Carroll, R-Paducah, would require the Administrative Office of the Courts to forward drug-conviction data to the health cabinet for inclusion in KASPER. This bill has been delivered to the governor.

Likely to pass: 

HB 333, sponsored by Moser, would limit painkiller prescriptions such as oxycodone and morphine to a three-day supply if prescribed for acute pain, with exceptions for the terminally ill and some other circumstances.

The bill would also increase jail time for those who deal in the synthetic opioid pain killer fentanyl or any derivative of it, as well as carfentanil, which is used as an elephant tranquilizer. It would make it a felony to bring any amount of fentanyl, fentanyl derivative, or carfentanil into the state for sale or distribution. And it would create a felony offense for those who misrepresent a controlled substance including fentanyl, fentanyl derivatives or carfentanil as a legitimate prescription drug.

Also, HB 333 would ease penalties for those found guilty of selling less than two grams of heroin and excludes cannabidoiol, or CBD, products from the definition of marijuana under state law if the products are approved as a prescription medication by the U.S. Food and Drug Administration. This bill passed the House and a Senate committee and is in the Senate Judiciary Committee with two readings.

HB 305, sponsored by Moser, is meant to improve treatment options and costs associated with involuntary treatment for alcohol and drug addiction under Casey's Law.

The bill would allow a judge to order a person to undergo treatment for up to a year with the option of an additional year, and limit the costs that could be incurred by a family member or friend who asks the court to order involuntary treatment for a loved one, among other provisions. This bill unanimously passed the House, passed a Senate committee and is now on the Senate floor.

HB 308, sponsored by Rep. Addia Wuchner, R-Florence, would require Kentucky health insurers to have at least two abuse-deterrent opioid painkillers in their formulary and prohibit the substitution or dispensing of an equivalent drug product without documentation from the prescribing provider.

Abuse-deterrent opioid analgesic drugs cannot be crushed, snorted, or injected by drug abusers as readily as other opioids can. This bill passed the House and a Senate committee and has had one reading in the Senate. Bills need three readings on separate days before they can get a floor vote.

HB 145, sponsored by Rep. James Tipton, R-Taylorsville, would require age-appropriate physical and health education instruction about prescription-opioid abuse prevention and the connection between abuse and addiction to other drugs. This bill unanimously passed the House, passed a Senate committee and is on the Senate floor with two readings.

HB 454, Rep. Johnathan Shell, R-Lancaster, would require the Kentucky Department of Education and others to develop an age-appropriate drug awareness and prevention program and would require local school boards to ensure that students receive annual instruction in drug awareness and prevention, starting next academic year. The bill passed the House and a Senate committee, and resides in the Senate Education Committee with two readings.

At National Prescription Drug Abuse Summit, Beshear cites Kentucky's successes

Gov. Steve Beshear told attendees at the 2014 National Prescription Drug Abuse Summit in Atlanta on Wednesday about the progress Kentucky has made in the last two years in its battle to combat abuse of prescription drugs.

"Prescription drug abuse was wasting away the future of Kentucky... and collectively, as a state, we decided it was past time to take aggressive action," Beshear said.

Two years ago, Beshear attended the summit  and described a plan; what Kentucky was going to do about prescription drug abuse. Since then, not only has Kentucky implemented an aggressive, strategic plan, it has data showing significant progress.

The plan included increased monitoring of prescriptions, tighter regulations for painkillers, closing pain clinics that did not meet tougher requirements, collecting and disposing of leftover drugs and educating prescribers and the public about the dangerous, addictive nature of these drugs.

The state also set up an electronic prescription drug monitoring system, called KASPER and increased coordination among health regulators and law enforcement both inside Kentucky and with other states.

As for the progress, the evidence is in the numbers. From August 2012 to July 2013, Kentucky saw an 8.5 percent drop in the prescription of controlled substances, Beshear reported, adding that there must have been " a lot of unnecessary prescribing going on."

He also noted the closure of 36 pain clinics that did not meet the new requirements: "They packed up and left, essentially in the dark of the night."

Beshear reported the third area of improvement as less reported abuse of prescription drugs by teen-agers, based on every-other-year surveys of Kentucky 10th graders by Kentucky Incentives for Prevention.

In 2008, 19.3 percent of 10th graders said they had used prescription drugs for non-medical purposes at some point in their lives. In 2012, that number had dropped to 10.4 percent. In 2008, 14.1 percent said they had illegally used prescription drugs in the last month; in 2012, that number dropped to 7.6 percent.

Getting rid of old, unused drugs, whose presence in medicine cabinets can lead to abuse and theft, has also been a strategy of success in Kentucky, Beshear said. He said 172 permanent drop-off sites have been established, with at least one site in 110 of Kentucky's 120 counties.

Beshear also stressed the importance of educating both prescribers and the public. Kentucky's medical community has access to a free, on-line education program and students in Kentucky participate in Keep Kentucky Kids Safe program which has reached 40,000 students so far.

The governor said increased availability of substance abuse treatment is important, and mentioned his expansion of Medicaid under federal health reform. "Access to treatment is at an all-time high in Kentucky, thanks to expanded Medicaid programs and the Affordable Care Act," he said. "There are many addicts who want to get clean, and we’re helping them." For a copy of the speech, click here.

More than $32 million from settlements with drug makers will finance expanded substance-abuse treatment in Kentucky

By Melissa Patrick and Al Cross
Kentucky Health News

Kentucky will receive more than $32 million as a result of lawsuit settlements with two pharmaceutical companies, and top state officials have allocated the money to expand access to substance-abuse treatment, especially for the young, the officials announced at a Frankfort press conference Monday.

"The only way to curb substance abuse was to start finding a way to work with the children, to help these young men and women when this disease first begins," said Jane Beshear, co-chairman of Recovery Kentucky, a residential treatment program for substance abusers that would get some of the money under an executive order from her husband, Gov. Steve Beshear.

From left: Conway, the Beshears, House Speaker Greg Stumbo

"We must increase access to treatment if we are going to stop this cycle of addiction" that runs in families, said Attorney General Jack Conway, who sued GlaxoSmithKline and Merck Sharp and Dohme Corp., alleging that they failed to disclose heart-attack risks posed by their drugs: Glaxo's arthritis pain drug Vioxx, which was withdrawn from the market in 2004; and Merck's diabtes drug Avandia, which the U.S. Food and Drug Administration found in 2007 carried inadequate warnings.

Conway said the settlement money "will be allocated to help create a new treatment center for adults, for treatment scholarships and for a grant program to create more treatment beds for our juveniles and adolescents." He said a study by the University of Kentucky reported that the state has only 10 percent of the beds needed for substance-abuse treatment.

The governor said national estimates indicate that as many as one in eight Kentucky high-school students in meet the criteria for a substance abuse disorder, but most youth ending up in juvenile justice detention facilities or in the state child welfare system. neither of which is a long-term solution. He said the current system is "fragmented, hard to access and inconsistent."

Beshear issued an executive order allocating the money, citing as authority a state law on such settlements. However, that law says the legislature has the sole power to appropriate money, so the General Assembly may have more to say about it. Beshear  said Senate President Robert Stivers had planned to attend the press conference but dropped out because of concern that the order usurped legislative authority. Stivers alluded to that a few hours later on KET's "Kentucky Tonight," questioning the allocation of money by executive order.

Stivers is a Republican; Beshear and Conway are Democrats. So is Stivers' House counterpart, Speaker Greg Stumbo, who spoke at the press conference and called the use of the settlement money "truly a remarkable turn in public policy in our state." Conway said the settlements required that the money go to drug treatment.

Under the order, $19 million of the money will go for additional juvenile and adolescent treatment, including new centers and additional beds in existing facilities. A committee crested by Beshear and headed by Conway will take applications and decide where the money goes. The committee is to include Jane Beshear, appointees of Stivers and Stumbo, and several state officials.

More specific allocations include $6 million for improvements in KASPER, the Kentucky All Schedule Prescription Electronic Reporting system, which is designed to track all controlled-substance prescriptions in the state; $2.52 million in scholarships for non-correctional referrals for people who seek treatment at Recovery Kentucky centers; $1.25 million to the state Department of Education, to develop a school based substance abuse screening and assessment tool and a database to evaluate the outcomes of juvenile treatment; a total of $1 million to The Chrysalis House in Lexington and the Independence House in Corbin, which provide substance-abuse treatment for pregnant women; $560,000 over two years to create 14 recovery homes for people who have completed treatment and are transitioning out of residential substance abuse facilities; and $500,000 to complete construction on a Recovery Kentucky treatment center facility in Boyd County.

National magazine looks at drug companies' efforts to stop anti-methamphetamine bills, especially in Kentucky

In a strong piece of investigative reporting for Mother Jones magazine, largely about Kentucky, freelancer Jonah Engle delves into the history of how making methamphetamine became a simple task via over-the-counter cold medications, and how drug makers have warded off most state laws intended to make the decongestant pseudoephedrine more difficult to purchase. (Photo by Stacy Kranitz: Cleaning up a meth lab found on school property in London.)

Engle's well-rounded story examines the issue from the viewpoints of politics, law enforcement, drug users and the effects of their habits on their children, while looking at how small-town life -- especially in Kentucky, where meth-related cleanup and law enforcement cost the state $30 million in 2009 -- has been hit hard by the drug. When a bill in 2011 to require a prescription for pseudoephedrine, a Washington-based group representing the makers and distributors of over-the-counter medicines and dietary supplements, reportedly spent more than $303,000 in three weeks, with most of the money spent on "robocalls," or automated telephone messages. The bill failed, but in 2012 the legislature passed a law with a tighter limit on the amount of pseudoephedrine anyone can buy in a month, after a strong radio advertising campaign by the Consumer Healthcare Products Association. The drug is kept behind counters so purchases can be tracked but does not require a prescription.

Engle tells a tragic story of meth in many states, ever since 2007, when the process called "shake-and-bake" or "one-pot" method, became commonplace. "The number of clandestine meth sites discovered by police has increased 63 percent nationwide," Engel writes. "As law enforcement agencies scramble to clean up and dispose of toxic labs, prosecute cooks, and find foster homes for their children, they are waging two battles: one against destitute, strung-out addicts, the other against some of the world's wealthiest and most politically connected drug manufacturers. In the past several years, lawmakers in 25 states have sought to make pseudoephedrine—the one irreplaceable ingredient in a shake-and-bake lab—a prescription drug. In all but two—Oregon and Mississippi—they have failed as the industry has deployed all-star lobbying teams and campaign-trail tactics such as robocalls and advertising blitzes."

In Oregon, the number of meth labs found by police dropped 96 percent since the bill was passed, while in Mississippi the number dropped 74 percent, Engle writes. "Children are no longer being pulled from homes with meth labs, and police officers have been freed up to pursue leads instead of cleaning up labs and chasing smurfers. In 2008, Oregon experienced the largest drop in violent-crime rates in the country. By 2009, property crime rates fell to their lowest in 43 years. That year, overall crime in Oregon reached a 40-year low. The state's Criminal Justice Commission credited the pseudoephedrine prescription bill, along with declining meth use, as key factors."

"Everywhere else, industry has prevailed," Engle reports. "Many states have very limited laws on what lobbyists must report, and they don't monitor spending on robocalls or ads. But news reports and my interviews with legislators in Southeastern and Midwestern states where meth labs are most concentrated—and where CHPA had the biggest fight on its hands—show that the pharmaceutical industry deployed a mix of robocalls, print and radio ads, as well as a Facebook page and a website, stopmethnotmeds.com. These states include Alabama, Kansas, Missouri, North Carolina, Oklahoma, and Tennessee." (Read more)

House panel approves bill easing rules of 2012's pill-mill bill

They could call it the pill they're taking to fix the pill-mill bill.

A state House committee approved a bill Tuesday that would tweak last year's legislation aimed at cracking down on prescription drug abuse through doctor shopping and "pill mills" where painkiller prescriptions are easily available for a fee.

House Speaker Greg Stumbo told the House Judiciary Committee that House Bill 217 would fix “unintended consequences” of 2012's House Bill 1 while still requiring that health-care providers use the Kentucky All Schedule Prescription Electronic Reporting system to track painkiller prescriptions.

The bill "would exempt hospitals and long-term care facilities from HB 1’s per-unit patient dosing restrictions and ensure that physicians decide when physicals are needed," the Kentucky Press News Service reported. "It would limit restricted access to narcotic pain medication for surgery patients, end-of-life patients, cancer patients and a few other categories of patients who may need increased pain management, Stumbo said." (Read more)

Board of Medical Licensure to amend pill-mill regulations to address concerns of doctors and some patients

The Kentucky Board of Medical Licensure wants to change some of the more controversial requirements for urine screenings and digital monitoring in the state’s new prescription-drug regulations under the law aimed at fighting doctor shopping and "pill mills" that dispense painkillers indiscriminately.

Mike Wynn of The Courier-Journal reports that Dr. Preston Nunnelley, the board’s president, told state lawmakers Wednesday that the board plans to submit amendments to the regulations by Nov. 1 to address the concerns of doctors that the new law is proving too burdensome, and because patients are being charged for urine tests that insurance companies are refusing to cover. Nunnelley said the amendments would provide more flexibility on when patients must receive those screenings. He said "chronic pain patients would not face regular screenings unless they are considered high risk for abuse or diversion," Wynn reports. "The amendments are also likely to exempt certain patients, such as children, from checks through the Kentucky All Schedule Prescription Electronic Reporting system, or KASPER, he said."

Nunnelley called the changes “tune-ups." “This is a new experience for the board of licensure,” he testified. “This is the first time we’ve done anything on this scale and obviously we didn’t do it perfect.” Or perfectly. (Read more)

Governor lauds HB 1 for closing 10 of the state's worst pain clinics, reducing the number of controlled-substance prescriptions

Gov. Steve Beshear gave credit this week to House Bill 1 for reducing the number of prescriptions written for frequently abused controlled substances and for closing the doors on 10 of the state's worst pain-management clinics. He also said the bill had promoted investigations into what he called "suspicious prescribing practices." Beshear, in a prepared statement, said: "We knew that this bill would have an immediate impact on thwarting the abuse and diversion of prescription drugs in our state, and the statistics over the last few months are already showing progress."

The governor also noted that Kentucky All Schedule Prescription Electronic Reporting (KASPER) accounts have increased from 7,911 in April to 21,542 in October. Account users are physicians, dentists, optometrists, advances practice nurses and podiatrists who then use those accounts to check on the drug records of patients daily. Beshear, responding to frequent criticism that the reporting of KASPER results is time-consuming, remarked that "the vast majority of those requests are processed in less than 15 seconds."
 
John Cheves of the Lexington Herald-Leader also reported that state regulators said this week that "they're working with private insurance companies and Medicaid managers to make sure health insurance plans help cover the cost of urine tests required under HB 1." Cheves had written earlier about consumer complaints that the costs of those tests, now required by the bill, were being borne by the patient. The
Kentucky Department of Insurance is communicating with insurers to guarantee that urine tests under HB 1 are classified as a medically necessary expense, Insurance Commissioner Sharon Clark told Cheves. The Kentucky Cabinet for Health and Family Services is doing the same for Medicaid clients.
(Read more)

Covington police chief: New prescription-drug law has unintended consequence of encouraging pain pill addicts to use heroin, commit crimes

Black tar heroin

Kentucky's new prescription drug law may be having its desired effect of taking prescription painkillers off the streets, but could be forcing those very same addicts into using heroin. That's the view of Covington Police Chief Spike Jones, who took his case to the state Senate Judiciary Committee last week to complain about increased crime in his area and to ask for some money for help.

The drug law passed in April 2012, designated House Bill 1, requires Kentucky doctors to complete patients' medical histories, conduct physicals, check photo identifications and run names through the state's KASPER (Kentucky All Schedule Prescription Electronic Reporting) database before prescribing a controlled substance for pain relief. It has required a vast network of oversight of doctors and patients by government and licensing entities. This has reportedly caused some doctors to stop writing those prescriptions completely.

Tiffany Wilson of Cincinnati's WKRC-TV reports that Chief Jones reports more prostitution, theft, car thefts and car break-ins in his northern Kentucky region. He asked the state legislature for money to research how deep the problem is and to discuss the need for more treatment facilities. 

Jones pointed to the recent closure of the pain management clinic of Dr. Gary Shearer in Florence as adding to the problem. Shearer's license was suspended following the death of 15 patients from prescription-drug overdoses. These patients, Jones told Wilson, are exactly the ones at risk for taking the next step and turning to heroin. He added that heroin dealers will often give potential customers the first hit for free, "and from that point, there's no returning to prescription pills." (Read more)

Licensing board needs to step up its game against pain-pill docs, Stumbo says

If the Kentucky Board of Medical Licensure doesn't increase its oversight on doctors who prescribe excessive amounts of pain pills, House Speaker Greg Stumbo said Tuesday he'll find an agency that will. "If the medical licensure board refuses to do its job, then we will try to find some entity in the enforcement community that wishes to do that," said Stumbo, D-Prestonsburg, right.

In 2003, the licensing board asked to be able to analyze data from the Kentucky All Schedule Prescription Electronic Reporting registry — known more commonly as KASPER — so it could identify over-prescribing doctors. That same year, the legislature passed a law "that would allow the Cabinet for Health and Family Services, which maintains KASPER, to provide geographical data about prescriptions for controlled substances. The licensing board could use that data to determine whether doctors were overprescribing controlled substances in areas that had high prescription rates," the Lexington Herald-Leader's Beth Musgrave reports.

But the board had not used the data, Stumbo said.

Lloyd Vest II, the licensing board's general counsel, said the data was not used because it was not specific enough. The cabinet informed the board it did not have the legal right to analyze the data in depth, he added.

Stumbo informed Vest the board is the only agency that had the legal authority to study the information.

Bill Schmidt, the board's executive director, said the board, which does not receive any government funding, does not have the staff to deal with the data analysis Stumbo is asking for. "The board had five investigators to police nearly 10,000 doctors," Musgrave reports. Stumbo said the understaffing issue could be solved by raising licensing fees and assessment prices on doctors.

Board members said they will return to committee in December with suggestions for how the state can better police doctors' prescription practices.

Data show drug overdoses is the leading cause of death for some age groups in Kentucky. Federal statistics show 6.5 percent of Kentuckians have abused prescription drugs. (Read more)