What Kentucky Clinicians Should Know About Prescribing Opioids: A Legislative Update

Last year, 1,404 people died of drug overdoses in Kentucky, according to the Kentucky Office of Drug Control Policy.  Of those, roughly half  involved fentanyl, a powerful synthetic painkiller that we originally discussed in "The Word on the Street."   In response to this ongoing trend, Kentucky is one of a handful of states that have been at the forefront of PDMP improvement as well as increased opioid legislation.   Here, we discuss the enhancements to Kentucky's PDMP system, KASPER, as well as some of these important pieces of legislation.

The Kentucky All Schedule Prescription Electronic Reporting System, KASPER, tracks controlled substance prescriptions dispensed within the state of Kentucky and tracks all scheduled prescriptions for an individual over a specified time period, the prescriber and the dispenser.

What’s new? The Prescriber Report Card.  The Cabinet for Health and Family Services’ (CHFS) oversees KASPER and launched a tool in March of 2018, which allows healthcare providers to compare their prescribing patterns to their peers.  The Prescriber Report Card feature is the latest enhancement to the KASPER program. 

SUMMARY OF LEGISLATION:

Senate Bill 6 
Effective July 14, 2018, a pharmacist or a pharmacist's designee is required to inform persons verbally, in writing or by posted signage of methods for the sequestration or deactivation and disposal of unused, unwanted, or expired controlled substances anytime a controlled substance is dispensed; to permit a pharmacist or a pharmacist's designee to make available for purchase or distribute at no charge a nontoxic composition for the sequestration or deactivation and disposal of unused, unwanted, or expired controlled substances when a controlled substance is dispensed; require a practitioner who dispenses a controlled substance to inform all persons who receive a prescription about the importance of proper and safe disposal of unused, unwanted, or expired prescription drug and make available for purchase or distribute at no charge a nontoxic composition for the sequestration or deactivation and disposal of unused, unwanted, or expired controlled substances; encourage manufactures or distributors to enter into consignment-reimbursement contracts for inventory.

Find the bill here.

HB 333
This new law subjects trafficking and importation with intent to sell of fentanyl and fentanyl derivatives to much the same legal treatment as heroin.  HB 333 limits the prescription of Schedule II drugs to a three-day supply if they are intended to treat pain as an acute medical condition.   The limitation is subject to certain exceptions, such as if the practitioner believes that more than a three-day supply is medically necessary to treat the patient; the prescription is for chronic – as opposed to acute – pain; the prescription is for pain associated with a cancer diagnosis, hospice or end-of-life treatment; the drug is dispensed in an in-house setting; or the prescription is for pain following major surgery or trauma.  Claims of medical necessity must be adequately documented, but they will be presumed to be valid for purposes of pharmacy dispensing.

Amendments to the bill included: KRS 218A.010 to define "fentanyl," "carfentanil," and "fentanyl derivatives"; and KRS 218A.020 to expand the authority of the Office of Drug Control Policy to request the rescheduling of a substance; amend KRS 218A.050 to schedule fentanyl derivatives as Schedule I controlled substances; amend KRS 218A.1410 to include carfentanil, fentanyl, or fentanyl derivatives; amend KRS 218A.1412 to make trafficking in any amount of fentanyl, carfentanil, or fentanyl derivatives subject to elevated penalties; KRS 218A.142 to include carfentanil, fentanyl, or fentanyl derivatives; KRS 218A.205 to require state licensing boards to promulgate regulations limiting prescriptions for Schedule II controlled substances for acute pain to a three day supply, with certain exceptions; create a new section of KRS Chapter 218A to create a new offense of trafficking in a misrepresented controlled substance.

HFA3, Amendment KRS 218A.1412 to specify that a person who has a substance use disorder and traffics in less than two grams of heroin is guilty of a Class D felony; add additional exemptions to 72-hour limit on prescribing Schedule II controlled substances

Find the bill here.

HB 1
House Bill 1 (HB1) expanded the Kentucky All Schedule Prescription Electronic Reporting (KASPER) system, the state's prescription monitoring system, by requiring all prescription providers of controlled substances to register.   It requires pain management clinics to be owned by a licensed medical practitioner, and requires professional licensure boards to investigate prescribing complaints immediately.   The legislation allows for better coordination between health regulators and law enforcement to address problems of abuse.   Finally, elements of HB1 have helped prevent Kentucky from becoming a source state for prescription pills.

Find the bill Here.

Opioid related legislation:
Kentucky has become the first state in the United States to require that pregnant women be tested for the Hepatitis C virus.  An increase in HepC in Kentucky was referenced as the driving force behind the legislation. The increase is believed to be a direct result of the opioid epidemic and needle sharing as Hepatitis C is transmitted through the blood.

The General Assembly passed the mandatory testing law during the 2018 session, and Gov. Matt Bevin signed it.

Additional Resources:

Kentucky Office of Drug Policy Control: The Heroin Epidemic
Kentucky Office of Drug Policy: Addiction Treatment and Resources
Kentucky Board of Pharmacy: Controlled Substance FAQ
Kentucky Pharmacy Board: Controlled Substance Questions

AffirmHealth State by State Resource Guide 

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