KY Pill Bill

Today the doctors in the office had our yearly meeting with the regional medical director of my group. He explained what he understood about the newly passed KY law for prescribing controlled substances. Here are some details on the law:

Every patient prescribed controlled substances such as hydrocodone (a common synthetic codeine that is given for moderate pain and an ingredient in many cough medications) must have something called a KASPER query done on them. This involves obtaining information on the patient regarding prescribing of narcotics by other physicians from a website. This typically takes ten to fifteen minutes to do. We must discuss the risks and benefits of using a controlled substance including tolerance and drug dependence and get written consent for giving the patient that drug. 

I can only imagine what that written consent is going to look like. Some estimates suggest that it will be a seven page document. The timeline for implementation of these new rules is July 12. This may not sound like that big a deal, so let me give a couple of circumstances that are not uncommon to me. A patient presents to my office with a persistent moderate viral respiratory infection who I have known for fifteen years. She doesn't like to take any type of narcotic or other addictive substance but hasn't slept for three nights due to the coughing. It's late afternoon and she is my last patient of the day, I'm already behind and need to be at a meeting on the other side of town in fifteen minutes. She's allergic to codeine. Guess who's probably not going to get her cough medication? Or my neighbor who is also my patient, sprains her ankle on the weekend. She doesn't need to be seen immediately but she would like some pain medication in order to sleep tonight and I'll see her in the morning. With this bill in place, I cannot relieve her pain. I've been in practice for more than 25 years. It is my job to know my patients. I know who has a tendency to overuse their pain meds. I wasn't born yesterday and can spot a drug-seeker at ten feet. However, because Kentucky allowed "Pill Mills" to run rampant in our fair state, my patients and thousands of other Kentucky citizens will be held hostage to this new state law HB1. Here's a link to one legal firm's interpretation of the bill. I suppose the good news is that I can always prescribe oxycodone, since it is hydrocodone that is targeted in the bill. (What?!?!!?)

So now in addition to the insurance company, the lawyer, the employer, and the federal government in my examining room, please welcome the state of KY. It's getting mighty crowded in there, so much so that many days it's really hard to hear the patient. And that's unfortunate since that's the only way I can treat her.