Unintended Consequences

Not long ago I wrote about the upcoming and now in place regulations concerning implementation of the new Drug law passes last session. It will require doctors to submit all prescriptions for certain drugs to KASPAR, the state's prescription monitoring system, before giving them to the patient. At the time I thought that was a reasonable thing to do to combat the rampant epidemic of illegal prescription medicines and methamphetamine. As I said, the devil is in the details because it has now come to light that the doctors will be required to order a urine test for all long term prescriptions defined as one lasting longer than 3 months. What this does is takes the under $10 cost per month for many prescriptions and drives the cost up an additional $70 to $150 per month making the drugs unaffordable to most people. The state is negotiating with Medicare and Medicaid to cover the cost of the drugs but many insurance companies are kicking on the grounds that the test is not medically necessary which is a difficult argument to refute. Just at a time when we are trying to hold down medical costs comes this burden that will drive the cost of these prescriptions up more than inflation ever could. It is just ridiculous.

While talking with one of our legislators I found out that the Kentucky Medical Association was asked to help with the writing of the law but refused on the grounds that they did not want anything at all and did not think it could pass. A serious error in judgment on the part of KMA and now they are wanting in to offer their help in amending the law.

In my opinion, the requirement for drug testing will do little over and above what just submitting prescription orders through KASPAR will do. What it will do is place excessive burden on those most unable to bear the burden. If the costs of the testing is borne by Medicare and Medicaid it will be a budget buster and, if insurance companies cover it, it will have the effect of driving insurance costs up.

After talking with another person who is a medical professional I discovered another aspect of the law that may be disturbing. She suggested that many people who seek prescriptions for scheduled drugs are already illicitly using some other drug and that the test will reveal them and prevent them from obtaining the prescription from the doctor. I didn't think too much of it until she said, “including marijuana” and that got my attention. I was surprised that they would be testing for a substance other than prescription medicines and it had not occurred to me that something like marijuana could prevent someone from obtaining a prescription for a medically necessary drug.

I have heard all along that the General Assembly will take up amending the drug bill when they next meet and they should. But the idea that people who smoke marijuana could be denied prescriptions could very well be a blow up of major proportions.

What will be done about the miscreants that the drug tests reveal? Will they be turned over to the police? Will they be jailed? Of one thing I am certain. There will be a great hue and cry from a lot of people who smoke marijuana and there are quite a few more of them than one would imagine. It has become such a ubiquitous drug and one that is perceived to be acceptable to use that many people will not even think about it before becoming a victim of the new regulations. But that is not the most that will happen by far.

The underground use of marijuana has become much like alcohol was during prohibition. It may be illegal but it is widely accepted and considered relatively harmless. Just as making alcohol illegal during prohibition was so we can expect the use of marijuana to be. Up until now there has been a sort of unspoken truce between users and law enforcement where if one will be discreet then law enforcement will not see every infraction that occurs. Will this drug testing force the had of law enforcement to arrest and jail pot users? Will doctors be drafted into being part of the law enforcement community? What would we do with our jails, already overcrowded, if we started locking up pot smokers? Already Kentucky leads the nation in percentage of population incarcerated and the United States leads the world in that category also. There has been a low grade persistence to decriminalize the use of marijuana and several states have medical marijuana laws which are often flouted to enable the general use of the drug for recreational purposes. If the underground economy is forced out into the open the pressure may become too much for our legislators to resist.

The testing requirement may serve some minimal purpose but the cost to those least able to bear it is too much. If the state wants to assume the costs of testing then by all means it should proceed. However, in my mind the whole idea comes close to prior restraint. Rather than decriminalize marijuana I predict the General Assemble will rethink the necessity of testing prior to receiving a prescription.