LEXINGTON, Ky. – They can be bought on the street or obtained through a doctor's prescription. How ever people get them, prescription pain killers can lead to a life of addiction. But for the past ten years, the state has offered a tool meant to curb the abuse. In the second of our three-part series, reporter Brenna Angel examines what Kentucky's prescription monitoring program is doing right, and what it needs to do better.
When psychiatrist Dr. Jennie Hahn gets a new patient at the community mental health agency she works for in northern Kentucky, she gets on her computer and logs on to a state-run program called the Kentucky All Schedule Prescription Electronic Reporting system, or KASPER for short.
"A lot of people joke around in my office and they call me the Queen of KASPER," Hahn laughs. "You know I use it every day."
KASPER is a prescription monitoring program. Physicians, dentists, and nurse practitioners can use it to see what medications their patients have been prescribed, and where that medication was dispensed in Kentucky.
The controlled substances Hahn typically prescribes are Clonazepam, Valium, and Xanax. She runs KASPER reports on her patients once or twice a year, more frequently if they are also taking pain medication. Every so often, Hahn sees a red flag.
"So if something looks suspicious, I'll call the pharmacy and make sure the information is correct. If everything's correct, then I have to confront the patient and say 'Hey why did you get two different medications from two different doctors, including me? You're not supposed to be doing that.'"
KASPER is a useful tool to help spot drug addicts who may be "doctor shopping" to get their fix. Although the system has been around for more than a decade, only 31 percent of prescribers licensed by the DEA in Kentucky actually have a KASPER account. Stephanie Hold, Assistant Director of the Division of Audits and Investigations in the Cabinet for Health and Family Services, says getting to a user rate of 100 percent isn't realistic.
"Even though you have a DEA license, you might not ever prescribe a controlled substance, or very rarely for a pediatrician. So we don't quite know what the percentage should be, but we all agree it should be more."
KASPER can also be used to identify problems with doctors who over-prescribe medication, so called drug-dealers in white coats. A staff of four investigators who are also licensed pharmacists reviews KASPER reports.
"We get various complaints from different sources. We operate a hotline in our office, and we have callers that call in and they'll say that there is a bad prescriber that they feel like there is a prescriber who is prescribing too much, or we receive calls from our pharmacists, people in our community," Hold says.
But a hotline isn't enough to stop to pill mills - self-proclaimed clinics or wellness centers often set up in old store fronts and strip malls. Van Ingram, head of the Kentucky Office of Drug Control Policy. He says there needs to be a more proactive approach to reviewing the KASPER data.
"Let's not wait til someone dies or files a formal complaint. If we can identify these folks early on, we can save lives."
Ingram is working with a KASPER advisory council that was appointed by the governor in November. The group is looking at possible guidelines that could make it easier to identify someone has prescribed too much of a controlled substance.
State lawmakers are also discussing ways to improve KASPER. A bill filed this legislative session would require pain management clinics to be licensed and to be owned by a physician or hospital. Ingram believes that would take entrepreneurship out of medicine.
"We've got about 33 clinics here in Kentucky, out of 77, about 33 of them are non-medically owned, owned by entrepreneurs," Ingram says.
KASPER works, but it is underutilized and doesn't have enough investigators. The system has caught the attention of Governor Steve Beshear, who wants to budget $4 million to expand KASPER and another $8 million for substance abuse treatment programs.