Hawaii lawmakers weigh painkiller abuse with legitimate need

There’s no question that Americans are using too many prescription painkillers, according to state Sen. Josh Green, D-Kona, Ka‘u.

“We (the United States) account for 3 percent of the world’s population, and we use 80 percent of the world’s narcotics. That’s a problem,” he said Thursday.

But finding ways for government to address the overuse and overprescription of narcotics must be tempered by concern for patients who have a legitimate need for the drugs.

“The issue cuts both ways. We need adequate pain medication for our community. However, there’s been significant excesses as far as prescriptions and the amount of medication getting out into the community. … There’s a tension right now. When the feds see too many pills going into one region, they kind of put the brakes on and contact the pharmacies.”

The senator, who works as an emergency room physician and serves as chairman of the Hawaii Senate Committee on Health, said he believes one answer is to find ways to make Hawaii health care providers more accountable for the prescriptions they write, and he has made finding workable laws to address that issue a priority for the next legislative session. Recently, he said, he convened a work group of 16 health leaders from across the state to research and discuss how best to cut down on narcotic abuse.

“My group is going to put out recommendations such as a mandatory drug registry, where doctors must check to see if any other doctors have already prescribed a drug for a patient,” he said. “That’ll likely be a top recommendation.”

Another possibility could include random drug screenings for chronic pain patients to ensure that they are taking the correct doses and the right medications.

“Each physician already has the latitude to set down office standards. This is done particularly by people who run pain management practices. One method is drug testing for those who are prescribed narcotics. Another is having a drug contract with their patient to monitor that they are taking the correct medications,” Green said. “We’re looking at adopting national best practices.”

Ultimately, he said, efforts to limit abuse of pain drugs is important to prevent misuse, and especially overdoses, which recently overtook car accidents as the state’s No. 1 cause of death by injury.

“There have been a few physicians that have had a pattern of an extremely high prescribing rate,” he said. “I’ve asked the public safety department and (the Regulated Industries Complaints Office) to be more proactive on checking on these outliers. A few bad players are causing a problem … and end up casting negative light over others. We’re trying to keep out of that.”

Dr. Richard Lee-Ching, president of the East Hawaii Independent Physician Association, said Thursday that while he agrees more must be done to oversee and prosecute doctors who run so-called “pill mills,” any legislation that creates more work for physicians will likely be unpopular among them.

“The solution they’re saying is, ‘Let’s dump more stuff on the physicians.’ We’re not gonna get paid any more, and (doctors) are going to have to be the cop on the beat. What you’re going to have is a lot of doctors saying it’s not worth the trouble,” he said.

The doctors who are aren’t breaking the law will be the ones who bear the brunt of laws requiring things like a prescription registry, he said, while those who are creating the problem won’t be affected.

“It just doesn’t reach the doctors who are Dr. Feelgood. They’re going to do what they want, because a lot of their customers are just paying cash. We’ve heard stories about massive overprescribing, and the government knows who they are, but instead of going after them, what they’re doing is creating policy that is hurting the hell out of physicians,” Lee-Ching said.

Email Colin M. Stewart at cstewart@hawaiitribune-herald.com.