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Ohio Senate bill targets ‘pill mills,’ painkiller abuse

Published: Mon, May 9, 2011 @ 12:00 a.m.

By Misti Crane

Columbus Dispatch


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.


1LtMacGowan(693 comments)posted 4 years, 6 months ago

This is absolute crap. I'm a patient at a pain clinic because of my military service related injuries. I had to jump through so many hoops, take so many stupid drug tests, pill counts, recalls, and red tape. It took almost 2 years before I was prescribed narcotic pain killers. TWO whole long agonizing years.

Its freaking easier just to buy them on the street than it is to go about it legitimately.

They terrify doctors into not prescribing narcotics so patients that legitimately need them are refused and suffer.

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2Lifesnadir(164 comments)posted 4 years, 6 months ago

I agree with LtMac.

There are many, many patients in legitimate pain. But other patients who abuse or sell their drugs makes it much harder for the rest of us who use our meds responsibly.

Problem 1: If the government requires doctors to be certified in pain management, how many docs will go get certified?

Problem 2: If all docs must be certified to prescribe, most of the certifed docs are in "Pain Management" clinics. That means patients will be re-directed to the clinics. Since these clinics are the "pill mills" that are, in part, prompting the legislation, HOW will forcing all patients to go to these clinics (certified docs) help?

Problem 3: Doctors and the Medical Board act "schizophrenic" - on the one hand, Ohio passed a Pain Law (ex. Representative Thomas) to ensure all patients experiencing pain are adequately treated. BUT too many Drs view "adequate" (or barely adequate) as "too much narcotics". Some patients do require long(er) term high doses but it does not mean overprescribing. Add the fear of the DEA, it's amazing that physicians are even sane about narcotics. The Medical Board needs to REQUIRE some CEUs on pain management AND work to dispel the myth that all patients are "drug seekers" or "drug users"!

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3Lifesnadir(164 comments)posted 4 years, 6 months ago

Problem 4: I don't mind having the Ohio Automated Rx Reporting System or any other automated way to detect "doctor shopping" or "doctor hopping". BUT, do Legislators realize how often that computer-software prohibits continuing care? A prescription is written on a pill-count basis, for example, 1 pill a day equals 30 pills a month. BUT, insurances including State Medicaid fail to realize many months have 31 days! BUT if your script reads 30 pills, by golly, you get 30 pills to be used for 31 days. Most docs do not write for 31 pills. IF you try to re-fill to get that 31st day, the computer will reject it. The pharmacist can count; they know patients are receiving less medication per calendar month, but pharmacists can do nothing to change the laws. The Legislators and Medical Board need to fix this oversight.

Problem 5: Since every doctor has a different idea of what meds can or should be used, a new physician to a case often tries to change everything. Example: Change morphine to an antidepressant. But, if a patient has previously shown allergies or another drug has been ineffective, patients should not have to bear suffering just because someone wants to change everything. What about a data-base where a Patient's history of known drug allergies--or drugs previously tried--must be consulted? AND if a person has been stable on their narcotic regime, leave that patient alone!

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4Lifesnadir(164 comments)posted 4 years, 6 months ago

Problem 6 (which relates to Problem 5): Patients have no choice when a doctor won't listen; If a doctor wants to switch me to Drug Abc, I must at "comply" (because the doc could refuse to continue seeing me) -- even if I know I've tried that drug before. Docs also don't listen when asked to prescribe a trial amount-- say, 15 days on a new narcotic. Yes, it would mean an extra appointment, but it would cut down on wasteful spending. If a script is filled for 4x a day, that's 120 pills. If a medication reaction or allergy occurs after 1 or 2 pills, that's a waste of 118-119 pills. Most patients know (or should know) to not flush unneeded pills down the toilet. So these situations cause patients to have meds they can't use, can't dispose of easily, and that if a patient is not very careful these extras could be taken/stolen (especially if you need Home Care workers in your house). So, there should be a database for "known drug allergies/failures" and doctors should be allowed to write a dual prescription on one pad: one for a "trial amount" with the balance to be filled IF the patient tolerates the trial number of days. The key to controlling the trial amount/balance is that if the patient tries to get a NEW narcotic med filled during that time (because they can't take the first drug), that should trigger the computer to tell the pharmacist to verify with the doctor that the first med has been cancelled. If the patient tried to get the balance of the first med (for illegal purposes), then they can't get the replacement.

The bottom line, the Legislature can't put decent and honest patients in the same category as people who are only getting drugs to sell them. Legitimate patients are so thankful to have even SOME pain control, that we ARE willing to work within the laws and guidelines. Just don't make legitimate patients 'jump through hoops" because many of us are just physically unable to "jump" due to severe pain.

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