Summary.
House Bill-1 passed in 2012 was a landmark legialstive effort to deal with Kentucky’s exploding epidemic of substance abuse. It clearly was effective in acheiving some of its goals, but it seems to have had less effect in some parts of the state and may have done as much as it can. We have improved our ability to collect data about prescription of controlled substances, but we have lagged in taking advaitage of what we have learned. We need to keep trying to do other things. Not all will work as well as hoped for either, but doing nothing is a non-starter.
Press conference(s).
In July, Governor Steve Beshear, Attorney General Jack Conway, Senate President Robert Stivers and House Speaker Greg Stumbo presided over a press conference to provide an update on House Bill 1, the comprehensive prescription drug abuse legislation passed in 2012. Details presented included that the number of overdose deaths were down, the numbers of prescriptions for commonly abused drugs had dropped, and that 20 pain clinics had been shut down since HB-1 took effect. Recall that prescriptions for controlled drugs dispensed in Kentucky must be reported to the Kentucky All Schedule Prescription Electronic Reporting (KASPER) database. The number of prescribers enrolled in the KASPER program increased from 75,45 to more than 24,000 with a tripling of queries to the KASPER database for reports on their patients from 811,000 to 2.7 million. Over a ten-month period, the number of doses of hydrocodone dispensed dropped 9.5% from 198 million to 179 million doses. The number of doses of oxycodone dropped 10.5% from 72 million to 64 million does. Some of the other improvements were not so impressive. Overdose fatalities over the previous year dropped, but only from 1023 to 1004. The number of physicians disciplined for prescribing violations by the the Kentucky Board of Medical Licensure rose from 53 to only 64. Some bad news was that the number of overdose deaths attributed to heroin rose from 22 to 143, a forerunner of worse to come.
There is no doubt that HB-1, enacted in July 2012, has had an impact in the right directions, but some of the observed effects were relatively modest and some of the major impacts were probably one-time benefits. Most of the immediate impact of the bill was either predictable or the result of picking the low-hanging fruit. The 20 or so “pain clinics” that were shut down were obvious pseudo-medical pill-mills in disguise. Enrollment in KASPER by prescribers became mandatory with the new law which also required prescribers to make at least some inquiries about their patients before prescribing selected high-risk drugs. A stunning number of out-of-state licensed prescribers all of a sudden discovered it was too risky to use Kentucky as the drugstore of choice for their prescriptions to abusing co-conspirators. These changes to the prescriber population alone would be expected to decrease the overall volume of controlled substances entering the system. The distressing observation remained that use and diversion of controlled prescription drugs remains huge and pervasive.
Oops— Start over!
Even though I had heard last week’s press conference live, I was a few paragraphs into the document summarized above before I realized I was erroneously reading a press release from July 25, 2013 that I had just downloaded from the Internet! The players from last week’s press conference were the same, but the occasion was the release of a study commissioned by the Cabinet for Health and Family Services and prepared by a unit of the University of Kentucky’s College of Pharmacy. The report compared two year’s prescribing of controlled substances before HB-1 to that of the following full year ending July 2013. The July 27, 2015 press conference therefore had a longer follow-up to draw upon but the results were not all that different and not always better than those of two years before. Continue reading “Is HB-1 Working To Decrease Prescription Drug Abuse And Diversion?”