22 Days into Implementing KY's "Emergency" Narcotic Regulations

(This is the second of my blog series on KY's "Pill Mill Bill". Please access the first blog post here)
At some point in the discussion of the perfect storm created by Kentucky's new narcotic-prescribing bill someone asked "How can regulations that aren't going to be enforced until October be considered emergent?" I have no clue what the answer to that is but I can give an update into my office's attempt at implementing the regs. Let me start by describing it as chaotic, confusing, time-consuming, and utterly frustrating.

We have patients calling from other doctors' offices who want to switch their care because those physicians have thrown their hands up in frustration and are simply refusing to prescribe any controlled substances. We are not accepting any new patients on controlled substances until the dust settles. I spoke with an ER doctor a couple of days ago who told me it is taking 15 more minutes per patient who needs a controlled substance prescription. I was unable to find any statistics on how many patients leave an ER needing a narcotic or other scheduled medication, but given that it is an acute care environment, one could assume at least 25%. Emergency Departments are already over-crowded, so imagine the issue with increasing the waiting time due to these ill-conceived, burdensome regulations added to a law already over-reaching in its original form, now with many more medications than originally intended.

I try to explain the regulations to patients, including the need to have urine drug testing because of their Ambien (a sleep aid of mild abuse potential) or testosterone prescriptions. Their expressions and questions are of disbelief and frustration.

• Question: Will my insurance pay for the drug tests?  Answer: I have no clue. 
• Question: Why am I being treated like a drug abuser? Answer: Call your governor. 
• Question: Am I going to have to be seen every three months? Answer: As long as I have to run a KASPER report on you every three months--yes.
• Question: Will my insurance pay for those visits? Answer: I have no clue.
• Question: Who thought this up? Answer: I'm not sure but I'd recommend asking Governor Beshear that one too.
• Question: I've heard some doctors are just not prescribing controlled substances. Are you going to do that too? Answer: No, uh, let me qualify that. I don't think so.

Despite Governor Beshear's reassuring words "For doctors who worry their ability to prescribe will be compromised, you have nothing to fear", it is taking my associates and me an average of twenty minutes per patient to explain the regulations, have patients sign informed consent papers, obtain drug tests, and run KASPERS. We only have fifteen minutes slots for patients so this is, of course, making us run behind all day long. And we are about average in the number of patients we have who take a controlled substance. The bill in its original form, covering only Schedule II meds (drugs like Oxycontin, morphine, amphetamines) and Schedule IIIs with hydrocodone would only have been an inconvenience during flu season with cough meds. But with the medications added in the emergency regulations, it's a nightmare).

So far I have run maybe fifty KASPER reports. How many have had any surprises on them? ZERO. Let me repeat that number--ZERO. Not one of my patients have had any controlled substances that they have obtained in this state over the last year that I didn't know about. Let me repeat that number--not one. When I asked the ER doctor what he thought of the law, he said, "This is a waste of time. None of the KASPERs we are running have anything of significance on them. The people that come in here who are drug-seekers we know about and we don't get KASPER reports on them because we don't give them controlled substances. Everyone else have clean reports. And the people from out-of-town we can't get a report on anyway." Then he said, "Oh here's your patient's KASPER. It has one entry." I guessed, "The 20 Valiums I gave her last February?" His response? "Yep. That's it. A real abuser, this one." She's 75 years old and her family begged me to prescribe something to help when she is completely overwrought with caring for her demented, terminally-ill husband. So far she's taken two of them. Yep, a real abuser there!