News From Terre Haute, Indiana

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July 26, 2013

Indiana doctors may see new prescribing rules for painkillers

INDIANAPOLIS — A new law targeting “pill mills” may change the way doctors throughout Indiana treat patients with chronic pain by putting new protocols in place for prescribing opiod-based drugs.

The state’s Medical Licensing Board is considering an emergency set of rules, triggered by the new law, that calls for drug testing of pain-medication patients and more screening and monitoring of patients by doctors to detect drug addiction and abuse.  

If adopted, Indiana would be among the first in the nation to require doctors to follow certain protocols for prescribing and monitoring the opiod-based pain killers that experts say are both addictive and over-prescribed.

“This would be a sea change for providers who are used to writing out ‘scrips and just walking out the door,” said Dr. Amy LaHood, an Indianapolis family physician and a member the Prescription Drug Abuse Task Force, which supports the proposed new rules.

The board has until November to adopt the emergency rules, which would go into effect into December and likely form the basis of more permanent rules.

In April, the Indiana General Assembly passed a new law, dubbed the “pill mill bill”, that gives Indiana Attorney General Greg Zoeller new authority to crack down on what he’s called the thinly regulated pain-management clinics around the state.  

It gives the attorney general’s office more access to medical records maintained by pain clinics and requires every pain management clinic in Indiana be owned and operated by someone who holds a valid registration to prescribe controlled substances.

But the law goes much further, potentially impacting every doctor who prescribes addictive narcotics such as Oxycontin, Percocet, and Vicodin to patients with chronic pain.

The law mandates that the Medical Licensing Board adopt a set of emergency rules for how doctors prescribe morphine and opiod-based drugs and how they monitor those patients.

The board got a look at a draft of the proposed rules Wednesday and heard from task force members that called them “sweeping” in scope but critical to reducing the number of drug overdoses in Indiana from prescription painkillers.

Dr. Deborah McMahan, the Allen County Health Commissioner and task force chair, said the proposed rules will require doctors to take a “more thoughtful and intentional approach” to prescribing pain drugs.

“Doses [of pain drugs] are being escalated without any real thought,” McMahan told the board.

The proposed rules are aimed at curbing dependence on pain-killing drugs and their illegal sale to drug abusers. They would only apply, for example, when a doctor writes a prescription for more than 60 opiod-containing pills in a month or a morphine-equivalent dose of 15 milligrams a day for three months.  

The proposed rules would require doctors to do more screening of patients before prescribing the drugs, including the use of the state’s online database that tracks prescriptions for controlled substances.

It also requires patients undergo a urine or saliva drug-monitoring test before they get a prescription and additional drug tests while they’re on the pain killers, to determine the presence of other prescription or illicit drugs.

Other states have laws aimed at cracking down on the over-prescription of addictive painkillers, but Indiana would be among the first to have mandatory prescribing practices for physicians treating patients for chronic pain with controlled substances.

During the board hearing, LaHood said a similar drug-monitoring test is already in place at a family practice clinic in Indianapolis, run by St. Vincent Health, for patients prescribed pain-killing drugs. The test results showed about half of those screened either had an additional pain-killing drug in their system, or showed that they weren’t taking their prescribed pain medications at all.

McMahon and other task force members said the proposed rules intentionally exclude patients who are suffering from a terminal illness and receiving large doses of pain-killing medicine.

Some representatives of the state’s nursing home industry asked that adoption of the prescribing rules be delayed, to give them time to figure out how they’d  impact their patients. A representative from Indiana Academy of Family Physicians also asked for a delay, until March, to give doctors time to understand the new rules.

But Steve Huddleston, chairman of the Medical Licensing Board, indicated that a delay was unlikely.

“The legislature said this was an emergency,” Huddleston said. “I don’t see how we can duck that obligation.”

Maureen Hayden covers the Statehouse for the CNHI newspapers in Indiana. She can be reached at maureen.hayden@indianamediagroup.com

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