From The Paducah (KY) Sun, Aug. 13, 2005:

Paducahan acclaims drug abuse law
The physician played a role in getting the national law passed for states to share data on patients going doctor to doctor.

By Joe Walker jwalker@paducahsun.com--270.575.8656

After years of legislative battles, Paducah physician Laxmaiah Manchikanti is celebrating passage of a law he fostered to prevent prescription drug abuse by patients going from doctor to doctor and state to state.

President Bush signed the bill Thursday night. It failed in two previous sessions of Congress with mixed support from medical groups and stiff opposition by some lawmakers, Manchikanti said.

"We made over 1,200 legislative visits, some multiple times, including the White House, DEA (Drug Enforcement Administration), and Department for Health and Human Services," he said. "We put in thousands of hours. It's not easy to get a bill passed, especially from a small-town guy like me, but we did it."

The bill, co-sponsored by Rep. Ed Whitfield, R-Hopkinsville, authorizes $60 million over fiscal years 2006 through 2010 for a federal grant program to help create or expand state programs to monitor the abuse of controlled substances, such as the pain relievers Oxycontin, Percocet and Percodan.

Whitfield said the law will help doctors, pharmacists and police detect, prevent and treat prescription drug abuse.

"Addicts and dealers will no longer be able to thwart state programs by simply crossing into another state," he said. "With prescription drug abuse skyrocketing, a national approach is desperately needed to turn the tide against this devastating addiction."

Kentucky and 19 other states have prescription drug monitoring programs. But information is not shared among those states, so doctors aren't aware of prescriptions a patient was given in another state.

Rather than setting up a national database, the law requires states to set up their own monitoring systems and share with one another, said Manchikanti, medical director of the Pain Management Center of Paducah.

"We get information beforehand to provide proper care," he said, "and if there is a question of drug abuse and diversion, we can stop it."

Studies show that 6 percent of Kentucky patients get prescriptions from physicians in other states and 14 percent from other doctors within the state. Manchikanti said he has seen many patients on drugs prescribed from the multistate area around Paducah.

Whitfield's legislation has been endorsed by the American Society of Interventional Pain Physicians, the American Medical Association, the American Osteopathic Association, the American Society of Anesthesiologists and many other groups.

The bill also sets tough penalties. People who abuse the system will be fined $250,000 and face possible prison sentences.

While taking a patient's medical history recently, Paducah doctor Laxmaiah Manchikanti noticed something disturbing. His patient was on seven different types of narcotic medication — a potentially deadly cocktail.

Although both Kentucky and Illinois have electronic drug monitoring programs that should reveal such combinations, the programs don't share information with each other. A doctor in one state has no way of knowing what a doctor in another state has prescribed unless the patient mentions it.

"Patients can kill themselves by overdosing themselves," Manchikanti said. "They think they just want more relief, a little more high, something."

All that may be about to change, and it's largely because of Dr. Manchikanti, according to both the American Society of Interventional Pain Physicians and the office of U.S. Rep. Ed Whitfield, R-Hopkinsville.

The House of Representatives unanimously passed the measure on Wednesday to help prevent prescription drug abuse. It has its roots in Manchikanti's worries.

It is expected to be passed by the Senate today or Friday, and then go to President Bush to be signed into law. The White House has expressed support.

Whitfield introduced and backed the legislation.

"We have taken a large step forward today to curbing this destructive habit," he said in a news release Wednesday.

The bill authorizes spending $60 million from fiscal year 2006 to 2010 to create a federal grant program housed at the U.S. Department of Health and Human Services to help establish or improve state-run prescription drug monitoring programs. Twenty states, including Kentucky , have such programs.

"It improves patient care, definitely," Manchikanti said.

The measure is intended to prevent "doctor shopping" — a practice in which patients receive prescriptions, such as painkillers, from multiple doctors to treat the same illness. It also helps prevent patients from accidentally mixing medications that could be harmful in combination, Manchikanti said.

Manchikanti is the medical director of the Pain Management Center of Paducah. He founded the American Society of Interventional Pain Physicians in 1998, and quickly began talking with colleagues about the need for a national monitoring program. He was concerned because only half of his patients come from Kentucky , where he could monitor what prescriptions they were taking.

"The rest of mine are from other states, but I really don't know what is going on with all the rest of my patients," he said.

A few years ago, he brought his concerns to Whitfield.

"In a city like Paducah where the city sits on a border, it became apparent that the Kentucky system was easily thwarted by people crossing the river," Whitfield press secretary Jeff Miles said. "Doctors, including Dr. Manchikanti, began discussing the problem with Congressman Whitfield."

Manchikanti has worked with Whitfield through three congressional sessions to win approval for the bill, including testifying before Congress. Last year, a version passed the House but did not get through the Senate.

This version is more promising because instead of creating a single national database, it ensures that existing databases communicate details of a patient's prescriptions. Databases will be created in states that have none, and the whole system should be implemented by January 2007, Manchikanti said.

This bill also ensures nearly instantaneous access to patients' prescription information by the pharmacists filling the prescriptions. It allows law enforcement officers to check the information only if they have a reason to believe someone is committing a crime. People who abuse the system will be fined $250,000 and face possible prison sentences.

The bill is H.R. 1132.