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State: Pain med abuse ‘epidemic’

Senate bill would regulate clinics as overdoses increase

– Legislators are wrestling this session with how to regulate prescription drug abuse at pain clinics around the state as a local case alleging several deaths and reckless practices unfolds.

Both the Allen County and Huntington County coroners’ offices report a trend of growing prescription drug overdoses, usually involving highly addictive narcotics.

And Indiana Attorney General Greg Zoeller has targeted the abuse with a statewide task force, annual drug summit and by aggressively filing complaints against a number of doctors in Indiana.

“We need to address when and how long you give narcotics. Doctors owe it to their patients to not get them addicted,” Huntington County Coroner Philip Zahm said. “I think it’s time for our legislators to step in and establish some guidelines.”

The use of oxycodone, sold under the brand name OxyContin and as an ingredient in Percocet and Percodan, was up 712 percent from 1997 to 2006.

And a doctor from Indiana University’s department of emergency medicine testified recently that in 2010 there was enough hydrocodone prescribed to patients in Indiana to medicate every U.S. adult.

“It’s at epidemic proportions,” Zoeller said. “That means it’s out of control. In looking at other states, we recognized a few glaring problems, mostly that it’s underregulated.”

Sen. Ron Grooms, R-Jeffersonville, is a pharmacist who has seen the problem grow over the years.

He describes pill mills where Hoosiers line up, grab a beeper and wait to pay cash for a prescription.

Zoeller said the case of Fort Wayne pain doctor William Hedrick is different, instead being a large, sophisticated enterprise billing federal and state health care programs for millions. Hedrick is the founder and president of Centers for Pain Relief in northeast Indiana.

He currently faces discipline from the state’s medical licensing board stemming from a complaint filed against him last month by Zoeller, who alleges some of his patients have died from multiple drug toxicities.

No criminal charges have been filed, but last week several of his offices were raided by state and federal law enforcement agencies.

Hedrick’s license is temporarily suspended pending a formal disciplinary hearing this month. Members of the medical licensing board rejected a proposed settlement in January that would have resulted in a two-year suspension of his medical license and a four-year probation period during which he couldn’t write prescriptions for controlled substances.

Dr. Bharat H. Barai voted against the settlement partly because there is pending legislation to try to bring pain clinics under control and he wanted to know if the board could learn something from the Hedrick case to prevent future bad outcomes.

Michael Burris, chief investigator for the Allen County Coroner’s Office, thinks prosecution of Hedrick is getting the medical industry’s attention.

“I would be almost willing to bet that the other pain doctors have stepped back and decided to review their practices,” he said.

The Senate Health and Provider Services Committee will weigh in on the issue Feb. 13 when it hears a bill by Grooms.

“There is some really bad stuff going on out there,” said Sen. Patricia Miller, R-Indianapolis, chairman of the panel. “We have people prescribing who are incorrectly motivated.”

Senate Bill 246 was filed originally with the intent of the state certifying controlled drug clinics. But Grooms said discussions have refined the legislation.

For instance, the medical board prefers focusing on physician actions over the licensing of facilities. One way to do that is require doctors to own any clinic. In some cases, it has been a nurse or outside business entity.

Grooms said the bill also will require the Indiana Medical Licensing Board to establish rules and standards for these clinics; gives Zoeller’s office on-site inspection authority; and reinforces INSPECT, the state’s prescription drug monitoring program.

INSPECT collects and retains in its database every controlled substance dispensed on an outpatient basis by all licensed pharmacies in Indiana. More than 1,700 pharmacies report 12 million prescription records annually, and there is a 96 percent compliance rate.

But it isn’t a real-time system like what legislators put in place to track cold medicine used to make methamphetamine.

For instance, pharmacists are only required to update the system within seven days, which means it is difficult to catch someone doctor shopping for more medicine. It also doesn’t stop the dispensing of a drug in questionable circumstances, and physicians aren’t required to look at reports on a patient before prescribing a controlled substance.

Grooms said some of that will be addressed in his bill. And there is separate legislation in the House focused solely on INSPECT.

Rep. Dennis Zent, R-Angola, said it is good practice for a doctor to look at the system, but he would not support mandating that.

“I’m not for more regulation,” the longtime dentist said.

INSPECT does send unsolicited emails to doctors if a patient is possibly shopping for drugs and engaged in illegal activity. The patients must have seen 10 prescribers in 60 days to trigger the notice. About 30 reports are sent weekly.

“I think being more proactive with INSPECT would help,” Burris said. “As a doctor, I would cover myself by documenting that the prescription history was checked, but not everyone does.”

Zoeller said Grooms’ bill is a good first step.

“There are more regulatory efforts to come,” he said. “And we need more training for prescribing doctors – an education component. Some doctors are intentionally doing this, and others need more exposure to education.”