Monday, August 6, 2012

Kentucky's HB 1: Immediate Impact

Four "pain management clinics" in Kentucky have already folded up shop.  More than 9,000 providers have registered for PDMP access since April (115% increase since HB 1 passed).   And the law went into effect just a few days ago. 

That didn't take long...

Congratulations to Kentucky, which has clearly grown tired of serving as one of our nation's best examples of how NOT to stem the tide of prescription drug abuse.  HB 1 is working and that's not just great news for Kentucky - that's great news for all states looking for legislative and regulatory templates for how to deal with this crisis. 

Last week, I posted about the new Texas PDMP.  I was disappointed to learn that physicians in Texas object to any requirement that the database be consulted prior to writing a script for a controlled substance.  Such a requirement was referred to as an "unfunded mandate." 

In Kentucky, 90% of all KASPER (Kentucky's PDMP) reports are completed within 15 to 30 seconds.  That's 15 to 30 seconds to understand the types and amounts of controlled substances a patient might already be receiving prior to a new doctor writing additional prescriptions.  This is easy, fast, and clearly in the best interests of patient safety. 

HB 1 requires providers in Kentucky to run a KASPER report before prescribing a controlled substance.  Other states should do the same. 

On Twitter @PRIUM1


  1. In Kentucky, 90% of all KASPER (Kentucky's PDMP) reports are completed within 15 to 30 seconds.

    Where does your data come from? It is certainly not the case in our facility.

    Additionally, the 225 to 450 hours a year that your numbers would constitute at our facility are absolutely unfunded.

  2. The 90% data point is directly from the Cabinet for Health and Family Services in KY which oversees the KASPER database and has been quoted in several articles regarding the new regulations (here's one:

    Regarding the "unfunded" mandate: I wasn't suggesting that the 225 to 450 hours a year incurred by your practice wasn't unfunded - I was suggesting that it's a worthy investment in patient safety.

  3. One of our chief concerns as a society should be the reduction of aggregate health care cost as a percentage of GDP. The only way for that to happen is for the supply curve to expand faster than the demand curve. HB 1 only increases the demand for healthcare and if it has any affect on supply it is to decrease it. Therefore, it is entirely reasonable and rational to expect health care costs in Kentucky to go up as a result of the implementation of HB1. I pray that HB1 will do some good to curtail the drug abuse in Kentucky even to a modest extent; but the root cause of such abuse is not the ease with which drugs can be obtained (they will always be easy for an addict to obtain) but rather is more likely to be extreme levels of poverty.

  4. The closing of four clinics is not a success. There are certainly other ways that could have been accomplished. It is not reasonable to paint this as a win for Kentuckians when it really is not. There are many serious issues with this bill that have been ignored. The last thing I would like to see are other states using this as a template for anything.

    The Kentucky Medical Association and medical professionals in general have legitimate concerns regarding this legislation which have been repeatedly ignored. Their complaints largely surround the impact it will have on doctors (substantive administrative changes, threat of criminal liability for simple administrative mistakes) and the timely treatment they provide to their patients. No one, however, has actually considered the impact this will have on patients personally.

    There are many aspects of this amended law that are dangerous, ineffectual of their stated goals, and largely misguided. This law goes well beyond just hurting doctors, who have their own legitimate concerns about this has a direct impact on patients as well. Tens of thousands of innocent patients who suffer from an illness that may have absolutely nothing to do with pain medicine are directly impacted by this law...effectively putting us in the middle of a "war on drugs" that play no part in our lives.

    Further, the privacy implications of allowing our private medical data to be shared with state police and the attorney general goes well beyond what many people would consider reasonable, or even Constitutional, yet out governor has publicly stated he believes it is within his right to do so.

    All patients who take controlled substances are now required to submit to mandatory random drug tests and pill counting. While most patients take their medications responsibly and have no reason to fear a drug test, it is still a violation of dignity and a "guilty until proven innocent" mentality that has been adopted by our legislators by forcing this stipulation upon us.

    Patients are also required to see their doctors twice as often. The invariable result of this will be that patients can expect to see their insurance premiums raised significantly when it is time for them to renew, possibly double in rate since the patient is now costing the insurance company twice as much.

    While this law *is* well-meaning, it goes way too far...toward the doctors who are now criminally liable for just doing their jobs, and to patients as stated above. This should give us all pause. If the government requires this much direct control over us to win this "war on drugs," they are failing. They're targeting the wrong people. And this is not a solution.

    Please visit Facebook and search for "Opposition to Kentucky House Bill 1" and help us have this law amended to meet its goals and protect doctors and patients.

  5. I appreciate Mr. White's comments and, in the interest of ensuring that this blog remains the forum for healthy discussion I intend it to be, I'm happy to publish his post above.

    Personally, however, I remain unconvinced that measures short of those outlined in HB 1 will be sufficient to prevent the epidemic of prescription drug abuse in Kentucky - or anywhere else.