Opioid epidemic keeps shadowing Ky. policy, as Senate removes opioids from list of drugs physician assistants could prescribe

By Melissa Patrick
Kentucky Health News

A House bill to let physician assistants prescribe some highly regulated drugs is moving through the Senate, but without application to some highly addictive drugs like oxycodone and hydrocodone, showing how the opioid epidemic continues to influence state health policy.

As amended by a Senate committee March 3, House Bill 135, sponsored by Rep. Steve Sheldon, R- Bowling Green, would allow physician assistants “modified prescriptive authority” for controlled substances in federal Schedules III, IV, and V after the PAs have practiced for a year.

The Senate Licensing, Occupations and Administrative Regulations Committee removed Schedule II drugs, which include a long list of narcotics used for pain management as well as several psycho-stimulants that are used to treat attention deficit hyperactivity disorder, or ADHD — a condition for which Kentucky has the highest rate in the nation.

Sen. Chris McDaniel, R-Taylor Mill, told the committee that he would not have voted for the bill if the Schedule II drugs had not been removed. He warned, “Know if we come back for Schedule II next year, I will oppose it as vigorously as possible.”

McDaniel acknowledged that only a few PAs would likely abuse their Schedule II prescriptive authority, but said that isn’t worth the risk because it was only a small percentage of physicians that not so long ago flooded the state with pain pills.

“The damage that they did was monstrous and we’re still working to overcome it,” McDaniel said. “The fact is, one step toward where we were, for me, is a step too many.”

Majority Floor Leader Damon Thayer said likewise: “I thought the bill that came flying out of the House was a bridge too far, and going to Schedule II is not going to fly in the Senate right now, and I hope you don’t come back and try it again next year; it won’t be received very well by this body.”

Andrew Rutherford, vice-president of the Kentucky Academy of Physician Assistants, told the committee that the PAs would keep seeing Schedule II authority.

“Our ultimate goal is always to provide the best patient care we can to our patients, that includes allowing us to practice to our full scope of practice,” he said.

Rutherford told the committee that Kentucky is losing its PAs to other states because it does not allow them to practice at their full scope of care. Kentucky is the only state in the nation that does not allow PAs to prescribe any controlled substances.

The bill passed the House 91-1 on Feb. 6, with Rep. Lynn Bechler, R-Marion, voting against it. This was the fourth time the legislation had been filed, and the first time it’s gained any traction.

Sen. Michael Nemes, R-Shepherdsville, noted that the Kentucky Medical Association, which has opposed this bill in the past, isn’t necessarily for the bill but is “not fighting it.”

Asked about its stance on the bill, the KMA told Kentucky Health News in an e-mail that it “continues to have concerns regarding the expansion of prescriptive authority for controlled substances among non-physician groups. KMA did work, however, with the Kentucky Academy of Physician Assistants on House Bill 135 with two objectives in mind – promoting public safety and preserving the ‘physician-led team model.’ KMA will monitor the progress of this bill and urge that principles such as these be included as the legislative process continues.”

Adam Haley, government-affairs coordinator for KAPA, told Kentucky Health News that PAs were still working with lawmakers to try to carve out the Schedule II drugs that are used to treat ADHD.

“We obviously heard loud and clear from our members of Senate leadership in committee that there are strong reservations about some of the opioids in Schedule II, and while we believe the gold standard of care does include full Schedule II authority, we’re sensitive to those concerns and are working with those legislators on addressing the issue of some of the psycho-stimulants in Schedule II and whether or not those can be broken out separately,” Haley said.

Sheldon, the bill’s prime sponsor, noted that 49 states allow full prescriptive authority for PAs and Kentucky would become the sixth state to place restrictions on Schedule II if this bill were to become law.

The KAPA’s Rutherford said, “Changing this legislation will allow Kentucky to be more attractive for PA practice and will hopefully keep many of those PAs from going to practice in neighboring states. This would allow for more providers in Kentucky, which we all know is much needed.”

The bill includes several restrictions on how PAs can prescribe drugs, and new continuing-education requirements, including a number of required hours related to controlled substances. It also leads to a more accurate account of who actually prescribes drugs; now, all scheduled drugs prescribed by a PA are attributed to the supervising physician.

Under the regulation, PAs would still have to work under the supervision of a physician who would be allowed to limit which controlled substances they can prescribe.

Sen. Paul Hornback, R-Shelbyville, said he supported the bill as a way to increase access to care in rural Kentucky and that he hoped the House bill to expand the scope of practice for nurse practitioners would also pass.

Nurse practitioners have been able to prescribe Schedule II drugs, the highest level of painkillers, since 2006, under the supervision of a physician. HB 286, a bipartisan bill sponsored by Rep. Russell Webber, R-Shepherdsville, would allow them to do that without a supervising physician after four years, if their license is in good standing. The General Assembly approved similar authority in 2014 for non-scheduled drugs. This bill is posted in the House Licensing, Occupations and Administrative Regulation Committee.

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