October 30, 2013

Doctors to see new restrictions on painkiller prescriptions

Licensing board calls for drug testing, more screening.

By Maureen Hayden CNHI Statehouse Bureau

---- — INDIANAPOLIS — Indiana is joining a growing number of states adopting tighter controls on how doctors are prescribing some of the most commonly used narcotic painkillers, in an effort to curb what public health officials call an epidemic of prescription drug abuse.

Late last week, the Indiana Medical Licensing Board adopted a set of emergency rules that call for drug testing of pain-medication patients, more screening and monitoring of patients by doctors to detect drug addiction and abuse, and a mandatory “treatment agreement” between doctors and patients that’s focused on improving health and not just alleviating pain.

The new rules — which serve as the basis for permanent rules to come — were adopted the same week that the federal Food and Drug Administration recommended tougher restrictions for the most widely abused prescription drugs that contain the narcotic hydrocodone, such a Vicodin, Lortab and their generic equivalents. The FDA restrictions, if passed, would reduce the number of refills patients could get before going back to see their doctor and would require patients to take a prescription to a pharmacy, rather than have their doctor call it in.

“These are big first steps, but we still have a long way to go controlling access to some very dangerous drugs,” said Republican state Sen. Ron Grooms, a retired Jeffersonville pharmacist who sponsored the legislation that lead to the new state rules.

Grooms and members of a statewide drug abuse prevention task force that helped craft the new restrictions expect pushback from patients and doctors who’ve grown accustomed to relatively easy access to the commonly prescribed medications used to treat pain from arthritis, injuries, dental extractions and other problems.

But it’s grief they’re willing to take, given the explosion of people dependent on painkillers and the rise in overdose deaths.

“We knew if we didn’t get ahold of this problem now, it was going to be one of those things that we’d never get ahold of,” said Dr. Deborah McMahan, the Allen County Health Commissioner and chair of a statewide task force of medical and legal experts who helped craft the new prescribing rules.

In 2012, the Centers for Disease Control and Prevention called prescription drug abuse the fastest-growing drug problem in the U.S. From 1999 to 2009, the number of deaths nationwide from opioid painkillers such as hydrocodone and oxycodone nearly quadrupled — causing more deaths than cocaine and heroin combined. A recent study by Trust for America’s Health found Indiana has the 17th highest drug overdose mortality rate in the country.

Drugs containing hydrocodone represent a major share of the drug overdoses and some public health experts believe tightening the rules governing how opioid-based painkillers are prescribed will curb their abuse.

The painkillers being targeted by the new restrictions are widely prescribed. In 2011, the federal government estimated there were 131 million prescriptions written for hydrocodone-containing drugs.

“You’ve got to believe those numbers are even higher now,” said Grooms.

Grooms sponsored what’s known as the “pill mill” that gives Indiana Attorney General Greg Zoeller new authority to crack down on pain-management clinics around the state. It gives the attorney general’s office more access to medical records maintained by pain clinics and requires every pain management clinic in Indiana be owned and operated by someone who holds a valid registration to prescribe controlled substances.

But the law also called for the state Medical Licensing Board to put new protocols in place for prescribing opioid-based drugs. Dr. Amy LaHood, an Indianapolis family physician who helped write the rules said they were needed to target doctors “used to writing out ‘scrips and just walking out the door.”

The new rules are aimed at curbing dependence on pain-killing drugs and their illegal sale to drug abusers. The new rules require doctors to do more screening of patients before prescribing the drugs, including the use of the state’s online database that tracks prescriptions for controlled substances.

They also requires patients undergo a urine or saliva drug-monitoring test before they get a prescription. And they require doctors and patients who are prescribed painkillers to sign a mandatory “treatment agreement” that compels doctors to disclose information about the potential for addiction.

The new rules reflect the increasing attention that states are paying to the problem of overprescribed painkillers. In Alabama, the legislature passed a series of laws last year aimed at curbing access to narcotic painkillers, including making “doctor shopping” to get multiple painkiller prescriptions a Class A misdemeanor punishable by up to a year in jail.

The Washington state legislature has set dosage limits for doctors who prescribe pain medicines. Patients prescribed higher dosage amounts are required to get a second opinion from a pain specialist.

Also in 2012, Kentucky passed laws requiring the licensing of pain clinics and gave law enforcement officials greater access to the state’s prescription drug monitoring database.