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Critics say Ky. prescription-drug law has negatives

Kentucky Gov. Steve Beshear recently touted the success of a new law that cracks down on prescription-drug abuse. But critics of the law complain those claims are overblown and the law's negative effects are being ignored.

Gregory Hood is governor of the Kentucky chapter of the American College of Physicians. He told the Courier-Journal, Louisville, Ky., that the law has prompted some practices to require eight-page written agreements with patients. He also said the number of administrative tasks and follow-up visits required by the law prevent doctors from treating other patients.

But not all physicians agree with that assessment.

Robert Hughes, a family practice physician in Murray, said, "If this little extra administrative work that we have to do saves lives and cuts down on a huge problem in the commonwealth, then I think it is worth it."

House Bill 1 requires doctors to comply with a series of medical standards before prescribing controlled substances. It also beefs up regulations on pain management clinics and mandates use of the state's drug tracking system, known as KASPER.

Beshear released figures last month as proof of the new law's success, but a Courier-Journal review of the figures paints a more nuanced picture of the law's effectiveness.For example, the Kentucky Board of Medical Licensure disciplined 33 physicians in the prior six months for violating professional prescription standards. But the newspaper found that 16 of the cases were resolved before the law took effect on July 20, and 13 others involved investigations or actions that were well under way before the law's implementation.

Beshear replied in a statement that the law has accelerated the Kentucky Board of Medical Licensure's ability to take disciplinary actions, even in cases that began months ago.

The administration also reported that 18 of the 44 known pain management clinics in Kentucky have closed or discontinued pain management services, including 10 after House Bill 1 took effect. But state records are unclear if all the clinics were suspected of illegal prescribing.

In one case, Will Singleton, the owner of Central Kentucky Bariatric and Pain Management in Georgetown and Grant County Wellness Center in Dry Ridge, has closed his Kentucky clinics and opened a new location just across the Ohio River in Jeffersonville, Ind.

Local leaders and residents there say they have seen out-of-state vehicles from Eastern Kentucky and Ohio flocking to the facility.

Jill Midkiff, spokeswoman for the Cabinet for Health and Family Services, noted that, "Prior to HB 1, these facilities didn't report to anyone, which made our job of finding them a challenge."

And the administration's analysis credited the law for a 7.5 percent drop in hydrocodone prescriptions, a 6.4 percent decline in oxycodone, a 9 percent decrease in alprazolam and a 38 percent drop in oxymorphone.

But oxymorphone was subject to a shortage that affected its availability. And critics of the law say that at least some of the other declines are due to doctors denying prescriptions to legitimate patients because the new law is so burdensome.

Beshear called that "anecdotal conjecture" from opponents who are trying to scare patients.

Beshear said the medical industry had ample opportunity to address Kentucky's drug problem before the law was enacted. Instead, doctors failed to use KASPER, prescriptions skyrocketed and people died.

"We need a meaningful law to not only curb the madness of addiction, but also to provide better education and understanding among patients and physicians alike of how to avoid abuse," the governor said. The law "is a critical first step, and although we might tweak it to make it more effective, we will not abandon it."
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