Competing programs hamper Kentucky's prescription drug abuse fight

Kentucky drug task force Detective Joel Cunigan put on a hazardous materials suit to check if the chemical he found under a trailer was anhydrous ammonia in London, Kentucky, on January, 22, 2008. The toxic chemical can cause permanent damage if inhaled. (J.B. Forbes/St. Louis Post-Dispatch/MCT)
Kentucky drug task force Detective Joel Cunigan put on a hazardous materials suit to check if the chemical he found under a trailer was anhydrous ammonia in London, Kentucky, on January, 22, 2008. The toxic chemical can cause permanent damage if inhaled. (J.B. Forbes/St. Louis Post-Dispatch/MCT) J. B. Forbes / St. Louis Post-Dispatch / MCT

WASHINGTON -- Kentucky lawmakers are at the center of a political feud over how to best derail the so-called "pain-pill pipeline" from Florida to the Bluegrass State, a multi-state trafficking scheme that has contributed heavily to the state's crippling prescription drug addiction epidemic.

Competing national prescription drug-tracking programs -- one supported by and named for Rep. Hal Rogers, a veteran lawmaker who sits on the powerful House Appropriations Committee, and another called the National All Schedules Prescription Electronic Reporting program, or NASPER, backed by Reps. Ben Chandler and Ed Whitfield -- have complicated matters.

Since 2002, the Somerset Republican's eponymous Hal Rogers Prescription Monitoring Program, a grant managed by the Department of Justice, has received $48 million to help 47 states and territories set up and improve guidelines for tracking prescription medication and encourage those states to share information nationally.

In the meantime, the much newer NASPER program has received less than one-fourth of the $48 million it needs through appropriations. The program, managed by the Department of Health and Human Services, is greatly preferred by law enforcement and pain management specialists. Chandler and Whitfield support it because of its uniform tracking guidelines and its requirement to share information.

"I requested $10 million to fund in 2010 in appropriations. It has been blocked because the committee is funding a competing program, the Hal Rogers Prescription Drug Monitoring Program," said Chandler, a Versailles Democrat. "We think the NASPER program, because it provides a uniform national system, is the way to go. Congressman Rogers feels otherwise."

NASPER is largely modeled on the similarly named Kentucky All Schedule Prescription Electronic Reporting system, or KASPER, used by physicians and pharmacists to determine whether someone is going to multiple doctors to try to get drugs and by police to investigate people who divert legal pills to the black market.

Last week, Kentucky law enforcement agents arrested more than 300 people and are pursuing 200 more in one of the largest drug busts in the state's history. It was an unprecedented attack on traffickers who bring pills from out of state to feed the region's debilitating drug problem. According to law enforcement, people getting their drugs from out of state to avoid being identified by the KASPER program.

In part, the backroom battles over funding the competing programs boil down to philosophical differences.

Rogers' program offers states a greater degree of autonomy in sharing information and prescription data with other states. It's currently developing a system for states to exchange prescription information with each other. The Justice Department, which sponsors the Rogers grant program, believes the size and cost of a national database like NASPER may be prohibitive.

Critics accuse Rogers of blocking NASPER funding to ensure that the program named for him has no competition.

Rogers "has personally blocked the funding of NASPER because his fear is if this program gets funded his funding will stop," said David Kloth, a member of the Association of Interventional Pain Medicine, which originally pushed for NASPER's passage. "Here's a perfect example of one legislator worried about his legacy rather than what's best for everyone."

Still, law enforcement worries that the lack of a national tracking system will continue to hamper efforts to halt interstate trafficking. Currently, monitoring systems vary from state to state, are not linked and have different rules. Some states have no system.

"That is the chief reason we're in the mess we're in in Florida," said Dave Keller, a retired FBI agent and director of the Kentucky section of the Appalachia High Intensity Drug Trafficking Area, which includes 66 counties in Kentucky -- including more than 15 in Rogers' district -- Tennessee and West Virginia.

People seeking to divert pharmaceuticals will look for inconsistencies in various state programs, said Thomas Loving, director of the Bowling Green-Warren County Drug Task Force and former president of the Kentucky Narcotic Officers' Association.

Warren County is near the Tennessee line. People can drive 25 miles into Tennessee, where police access to prescription drug tracking is more limited than in Kentucky, to get prescriptions from multiple doctors in a tactic known as "doctor shopping." Kentucky police can't track that.

"If every state had a prescription-monitoring program up and running, that would be a great plus, but there would still be inconsistencies," Loving said. "One national system would be better ... as long as it has law enforcement access."

Meanwhile, Florida state lawmakers are consulting their Kentucky counterparts in their own efforts to stop out-of-state prescription drug seekers from frequenting the Sunshine state's cash clinics, where in the words of one lawmaker, getting pain pills is as "easy as picking up a Big Mac at a fast-food drive-through."

However, the proposed Florida program isn't equipped to share data nationally -- a requirement of NASPER and something strongly advocated by law enforcement, physicians and pharmacists.

A law passed by the Florida General Assembly in July requires that a prescription monitoring system be created by Dec. 1, 2010. But despite the new law, there will be no prescription monitoring system in Florida without federal grants or private funding, said Florida Department of Health spokeswoman Eulinda Smith.

Smith said Florida will apply for grants for the system through the Hal Rogers program.

"We will not be able to apply for NASPER funding until there is legislation allowing for our data to be shared with other states," Smith said.

Still, Whitfield and other lawmakers are encouraged by the Obama administration's support for the NASPER program.

"President Obama had NASPER in his budget this time and we know there's support," said Whitfield, a Hopkinsville Republican. "I'm quite confident that NASPER will be funded and will be increased every year."