TheTimesTribune.com, Corbin, KY

January 16, 2013

Expert believes medical community ‘overprescribing fuels drug epidemic’


The Times-Tribune

CORBIN — By Ronnie Ellis / CNHI News Service

Kentucky political leaders want to “tweak” legislation they passed last year to crack down on prescription painkiller abuse in response to physician complaints about burdensome regulations that impede legitimate pain treatment.

But Tuesday an expert on the epidemic of pain medication addiction said too many doctors prescribe the opium-based medications after being misled by pharmaceutical companies that such medication provides “compassionate care” and can be prescribed in ways to avoid addiction.

Andrew Kolodny, the president of Physicians for Responsible Opioid Prescribing and the chairman of the Department of Psychiatry at Maimonides Medical Center in New York, spoke at the Kentucky Prescription Drug Abuse Policy Forum sponsored by the National Governors’ Association.

Kolodny challenged the idea such medication can be widely used to treat pain effectively. Instead, he said, the worst drug epidemic in U.S. history “is fueled by the increase of medical prescribing of pain medication.”

Last year the General Assembly passed House Bill 1 to crack down on the for-profit “pain clinics” and “doctor shopping” by those who are addicted to painkillers. Overdose deaths from such medications now exceed traffic deaths in the state.

But many in the medical community complained often and loudly that the new law and its regulations are making it difficult for legitimate sufferers of traumatic and chronic pain to receive treatment.

Lawmakers and Gov. Steve Beshear have said the law needs to be “tweaked” to respond to those concerns, and Beshear again called for such changes Tuesday.

He briefly addressed the group of about 100 gathered for the policy forum and later told reporters he believes recently enacted regulations have dealt with most of the medical community’s concerns and the rest will be addressed in the current session.

“I think there are a few things left and I think we’ll take care of them,” Beshear said.

But Kolodny said many physicians were misled by marketing campaigns of big drug companies like Purdue Pharma, which introduced Oxycontin in 1996 and five years later was spending $30 million to market the drug.

Drug companies told doctors that addiction from such drugs was rare and they are safe and effective for chronic pain and can easily be discontinued. At about the same time, addiction rates and deaths from overdoses began rising dramatically.

Kolodny said some of the physician concerns are legitimate and there are legitimate uses for the drugs, especially for trauma, post-surgery pain and terminal and painful diseases like cancer. But he said the drugs really aren’t that effective for chronic pain.

He said data indicates injured workers treated with the medications “are far less likely to go back to work.” And, despite drug companies’ claims that patients can be incrementally taken off the drugs, most users suffer “months of insomnia, irritability and cravings” after they stop taking the drugs.

Kolodny said the proper response to rising rates of addiction is to educate the medical community on the dangers of the drugs relative to benefits to prevent new addictions; using prescription tracking systems like Kentucky’s KASPER program to link addicts to treatment, and to control supply of the drugs.

That means that medical boards and law enforcement work to reduce overprescribing, doctor shopping and black market availability.

Kolodny praised Kentucky for being a leader in taking on prescription pain medication abuse and said other states are looking to emulate some of the Kentucky reforms. He is aware of the backlash from Kentucky’s medical community and thinks some of those concerns are legitimate.

But he also thinks the medical community tends “to respond in a very defensive way” when policymakers try to address the problem, blaming “pill mill” clinics and bad actors rather than realizing they are contributing to the problem.

He said pain medication should be a last resort and non-opioid drugs are often as effective for chronic pain. Some chronic pain, especially in joints, is caused by obesity and physical therapy can also be effective.

Attorney General Jack Conway, who supported passage of the bill, and Tuesday called HB 1 “needed legislation,” but said he hears lots of complaints from physicians, some of whom are worried the KASPER monitoring provisions of the bill are being used to intimidate or spy on them.

“I want to assure the doctors and KMA (Kentucky Medical Association) there is not a snooping operation going on,” Conway said.

Instead, the Kentucky Medical Licensure Board looks for “gross deviations or disturbing trends” in prescribing patterns in an attempt to identify over prescribing or over use by patients who may be addicted or selling the drugs.

Like Beshear, Conway pointed to some of the successes engendered by HB 1 including shutting down 20 pain clinics and a drop in prescriptions for the drugs.

Karen Kelly, Director of Operation UNITE, a drug education, treatment and law enforcement program operating in 29 eastern Kentucky counties, emphasized the scope of the problem. She said at least half of the children in some counties in UNITE’s service area live with someone other than their parents, many of whom have died or been imprisoned because of drug addiction.

Kelly showed the group a short video of children in Rockcastle County schools who have lost their parents to addiction and told of an 8-year-old who had already lost her father to an overdose and then sat in her mother’s lap as she died from a drug overdose. The little girl had asked to call 911, but others attending the party had told her not to.

“I think HB 1 is a great start,” Kelly said. “But we need more treatment. We’ve got to stop creating new addicts.”

RONNIE ELLIS writes for CNHI News Service and is based in Frankfort. Reach him at rellis@cnhi.com. Follow CNHI News Service stories on Twitter at www.twitter.com/cnhifrankfort.