“It’s actually three bills in one,” says Larry Dixon, Executive Director of the Alabama Board of Medical Examiners. In total, the three bills will tighten the definitions, regulations and oversight of physicians prescribing pain medications.
“I think the bill is a good start,” says Ty Thomas, MD, with Alabama Pain Physicians. “Most of the meat of this bill will come from the Board of Medical Examiners where the rules will be established. I actually welcome this, because if this bill is to accomplish its goals, it needs more meat.”
Dixon says: “we need this Act to combat prescription drug diversion, which law enforcement is fighting across the country.”
Pill Mills, where unscrupulous physicians write large quantities of narcotic prescriptions that then are sold on the streets, are a major source of drug diversion. The other source is addicted individuals who visit legitimate physicians and hospitals to dupe them out of prescriptions and then sell them. “It’s the number-one drug problem in America, according to the DEA,” Dixon says.
Dixon says a milligram of Oxycontin, a narcotic pain reliever, sells for one dollar on the street. “So if you get a prescription for 60mg pills at 120 at a time, you can see how much you get for selling these on the street,” he says.
Besides pain relievers, sellers also seek out depressants and sedatives, like Ambien and Xanax, along with stimulants, like Adderall and Ritalin. “It’s typical to see someone go into these pain clinics and get a prescription for all three,” Dixon says.
That level of revenue sparked the interest of drug cartels, which set up seemingly legitimate pain clinics in Florida. The state reacted with legislation. “Florida came through with far-reaching, effective regulations,” Dixon says.
So the clinics moved north. Numerous states have since had to enact laws to address prescription drug diversion, including Oklahoma, Kansas, and Georgia. “Florida was the hardest-hitting legislation,” Dixon says. “It was just so obviously drug cartels for them.”
Now it’s Alabama’s turn. One of the changes in the Act will help physicians spot individuals looking to score prescriptions. “The Act expands the use of the state prescription data monitoring program to allow access by two additional employees in the practice besides the physician,” Dixon says.
That would mean the physician walks in the exam room armed with the new patient’s prescription history. “This will cut down on patients fooling physicians,” Dixon says. “These people see eight or ten docs claiming false ailments or using false records, and often in different cities. Then they take some for themselves and sell the rest. It’s called doc shopping.”
Medicaid will also gain access to the state’s prescription data monitoring database. That allows Medicaid to spot abusive benefactors. “We envision it being programmed to kick out top prescribers, and these pill-mill guys will stick out like a sore thumb,” Dixon says.
“Alabama has done a good thing with this legislation,” Thomas says. “First and foremost, it’s important to get something out there that defines some regulations. Also with this law, the Board can see who is calling themselves pain physicians and practicing pain management.”
“Some physicians are either being fooled by drug diversion or cashing in on it,” Dixon says, citing one physician who got caught after prescribing 8.8 million pills. “Under the new law, we won’t be spending six months getting that kind of guy’s controlled substance certificate away from him in a due process hearing while the next day, the pill mill hire someone new to take his place.”
That’s why the Act will require pain management clinics to appoint a medical director. “But the law clearly differentiates pain clinics from other practices. And it will be up to the Board of Medical Examiners to define what a pain clinic is under this law,” Dixon says.
To be eligible to be a medical director requires a complete residency in specialties that have to deal with pain, such as anesthesiology, among other educational requirements. They must also register with the Board of Medical Examiners.
“You have to jump through some hoops, with annual educational and training requirements and registering with the state. The registration lets us keep track of pain physicians,” Dixon says.
“We know every rule can be got around if the risk is worth it,” he says. “We just want to narrow the field of people these clinics can get to write scripts.”
The additional powers granted to the Board of Medical Examiners worries some. “We’ve talked with other physicians, and they don’t like giving the Board additional powers,” Thomas says. “But as pain physicians, we see this on the front line, and we want to clean up our specialty. We do not want these folks out there.”
Legitimate practices need not worry about the Board’s new authority, Dixon says. “Due process is not suspended by this law. It still has to take place within 120 days of being shut down,” he says. “If you’re following the law, it isn’t going to happen to you. You don’t have to worry.”