Witness Testimony
Mr. James W. Holsinger Jr, MD, PhD
Secretary
Kentucky Cabinet for Health and Family Services
275 E. Main Street
Frankfort, KY, 40601
Prescription Drug Monitoring: Strategies to Promote Treatment and Deter Prescription Drug Abuse
Subcommittee on Health
March 4, 2004
1:00 PM
Chairman Bilirakis, members of the Committee, thank you for allowing me the
opportunity to come and testify this afternoon. I also want to thank and
recognize Congressman Hal Rogers, who we affectionately refer to as the Dean of
the Kentucky delegation, for all of his hard work to reduce the abuse of
prescription drugs. I also want to thank Congressman Ed Whitfield who is
passionate about wanting to work towards reducing the abuse of prescription
drugs in the Commonwealth and beyond.
KASPER is the acronym for the Kentucky All Schedule Prescription Electronic
Reporting program. This system automated the processing of data to support the
tracking and sharing of information in accordance with existing statutes
governing controlled substance prescriptions.
KASPER was enacted into law during the 1998 legislative session following the
recommendation of a task force chaired by Dr. Rice Leach, Commissioner for
Public Health for the Commonwealth, and made up of representatives of many
groups in the state with a stake in controlled substance diversion issues. Even
today KASPER is considered a public health initiative.
In addition to authorizing KASPER, the 1998 legislation made other changes to
the controlled substance act including permission for the cabinet to share
prescription information with providers and law enforcement agencies under
specific circumstances, the mandatory use of security prescription blanks for
all controlled substance prescriptions, and the theft of a security prescription
blank became a felony offense.
KASPER did not add any authority the state did not already have to monitor
scheduled drug prescriptions. KASPER's purpose, like that of any tool, is to
increase productivity of individuals with the task of administering the
controlled substance act.
A comprehensive program like KASPER, in conjunction with Kentucky's other
controlled substance statutes, is necessary because the diversion of controlled
substances is at epidemic levels. Since persons involved in drug diversion cover
large geographic areas to obtain drugs the agencies charged with controlling the
problem needed a tool that would add value to their investigative efforts.
The two main goals of the statutes that created KASPER are: to be a source of
information for physicians and pharmacists and to be an investigative tool for
law enforcement. KASPER is the tool that enables this information to be
collected, analyzed, and shared rapidly.
KASPER allows the state to capture dispensing information on schedules C-II,
III, IV, and V drugs electronically in a relational database.
Data gets into the relational database as dispensers transmit prescription
data to our data collection agent by modem, diskette or tape. The data
collection agent then verifies, compiles and sends the data to the Drug
Enforcement and Professional Practices Branch in the Department for Public
Health to be loaded onto the secure KASPER server.
Very high security procedures protect access to the data with only Branch
personnel having access to information within the KASPER database. Report
requesting by authorized individuals also undergoes a high level of scrutiny.
Release of data to anyone not authorized by Kentucky statute is a class D
felony.
Kentucky's KASPER statute allows a report to be obtained by a grand jury
subpoena, by a prescriber for medical treatment, by a pharmacist for
pharmaceutical treatment, by law enforcement officers with a bona-fide
investigation, by professional licensing boards investigating a licensee, by
Medicaid programs for a recipient and by a court order from a judge of competent
jurisdiction.
As a result of KASPER, state reporting productivity has increased 30 fold*
and investigation productivity has improved 5 fold** in 5 years.
Many of the clinicians in the state were skeptical when KASPER was initiated.
They felt the scrutiny implied by a monitoring program would interfere with
their practice. In actuality they have found that by utilizing the program to
monitor their patients chronically utilizing controlled substances they have
documentation to prove they are treating these patients judiciously.
Even the Kentucky Board of Medical Licensure has included the use of KASPER
reports in its standards of practice guidelines for chronic pain management.
Prior to the ready availability of KASPER reports, law enforcement personnel
would receive a complaint, then use a "spiral out" approach visiting
pharmacies to determine if the suspect had purchased controlled substances at
that location. When they found a number of records they would then visit the
physicians involved to get statements. In a highly populated area this could
involve a large number or pharmacies. In rural areas this could involve going to
several counties.
The information available from KASPER has drastically improved the
investigative routine for law enforcement officers. They receive a complaint,
request a KASPER report and know immediately where the prescriptions were filled
and the doctor that wrote the prescription.
The results generated by the KASPER data have been so well received the state
legislature saw fit to make funding available to enhance the program. In an
effort to address the biggest complaint with KASPER, which was a four hour
report turn around time, the enhanced system will be web based allowing
requestors to receive a majority of their reports within 15 minutes with the
ultimate goal of becoming a real-time program. These and other additional
enhancements are also being studied as funding for these projects becomes
available. I want to thank the Chairman and Committee members for allowing me to
come and testify.
CONCLUSION
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