By Misti Crane
State leaders are close to enacting a law that aims to eliminate Ohio’s “pill mills” and cut into its growing painkiller-addiction problem.
Doctors’ groups are behind the move and say there’s no denying that regulators need more muscle to get rid of the bad actors. But they’re also mindful of concerns that patients with legitimate pain could suffer if physicians become too nervous to prescribe narcotics.
The legislation, which is now in the Senate, calls for licensing by the Ohio State Board of Pharmacy and increased rules and oversight for free-standing pain-management clinics — those in which more than half the patients receive narcotics.
The proposed law also calls for development of a drug take-back program to help ensure that unused painkillers don’t land in addicts’ hands.
At the urging of Gov. John Kasich, the State Medical Board of Ohio already has reconfigured its priorities, moving inappropriate prescribing to the top of the list. It has begun drafting rules that detail how the law will be carried out.
Among other things, proposed rules would require doctors to be board-certified in pain management and have an affiliation with a local hospital, said Kimberly Anderson, the board’s assistant executive director of investigations, compliance and enforcement.
The board also wants pain-clinic doctors to make use of the Ohio Automated Rx Reporting System, which tracks prescriptions statewide and can help identify patients who are shopping around for narcotics.
Increased oversight inevitably has raised concerns among doctors, especially those who have fought for better pain management and remember the days when physicians were reluctant to prescribe strong painkillers to anyone but the sickest cancer patients.
More than a decade has passed since doctors were told they should take pain more seriously and consider it a “fifth vital sign.”
“I think there really was a crisis of inadequate pain management; now, there’s a crisis of drug abuse and diversion,” said Dr. Robert Taylor, medical director for the Center for Palliative Care at Ohio State University Medical Center.
“The challenge is always to sort of figure out what’s the right balance.”
He and others, including Ohio doctors’ groups, say lawmakers and regulators appear to be intent on trying to find that balance.
“They don’t strike me as getting involved in witch hunts or anything like that,” Taylor said.
What remains to be seen is how physicians react, given the increased attention on painkiller prescribing.
“When there’s a lot of publicity and a lot of things going on like this, everyone is paranoid that they’re going to be scrutinized if they have too many patients that are problems,” said Jon Wills, executive director of the Ohio Osteopathic Association.
Ann Spicer, executive vice president of the Ohio Academy of Family Physicians, and Jeff Smith, director of government relations at the Ohio State Medical Association, share Wills’ concerns and said they’ll watch closely as the Medical Board finalizes the rules after the law is passed.
The prescription-drug problem is “giving all of medicine a black eye,” Smith said.
Among their other concerns is the apparent inability of the state’s automated reporting system to keep up with increased demand.
Richard Whitehouse, executive director of the State Medical Board, said he’s eager to have more authority to go after rogue doctors, but he wants to assure others that the board will remain fair.
“Nothing about anything that we’re doing is meant to dissuade good physicians,” he said.
Under the current law, the board can’t go after clinics, only individual doctors, and that posed many problems, he said.
When they did put a bad doctor out of business, “a new doc comes in the next day,” Whitehouse said.
The law change won’t be a cure-all, experts say. Eliminating pill mills gets rid of a big part of the problem, but it doesn’t mean that addicts and drug dealers won’t keep shopping around for pills from legitimate sources in Ohio and from pill mills outside the state.