Prescription Drug Abuse

Dear Friends and Colleagues:

Attached an article from today’s Sun Sentinel highlighting the rampant use of prescription painkillers in Florida.
In the absence of any statewide prescription drug tracking system doctors and pharmacists often have to rely on their best judgment to fill or refill narcotics.
The article states that –“as of June, 32 states had adopted prescription-tracking programs to curb problems such as those in Florida, the most populous state without such a law.”
Furthermore the article correctly reports that – “despite the known dangers, Florida lacks a system for tracking prescription drugs. That, according to law enforcement officials, makes it a haven for addicts and "pill mills," where doctors churn out prescriptions without thoroughly examining patients.”
The Florida Medical Association in cooperation with the State Attorneys Office has released a comprehensive guide for physicians on how to diagnose, manage and treat patients with acute and chronic pain.
I want to EMPHASIZE that the MAJORITY of physician are prescribing narcotic pain medications in a responsible and professional manner!!!!
Nevertheless,we need to continue taking a proactive stand against unethical and unscrupulous “physicians”, who churn out prescriptions for their own financial gain. Those so-called “Pain Management “clinics are sprouting like mushrooms all over the State often owned and operated by doctors, who have little or no special training in pain management. Contrary to common belief these “doctors” are not being duped by patients to write prescriptions or trying to help patient suffering from pain. These “doctors” abuse their prescribing privileges to issue THOUSANDS or highly addictive opioids for ANYONE who pays. These “doctors” are driven by profits and not by the motivation to help patients. We need to protect our profession and point out those drug dealers in white coats and at the same time support legislation creating a statewide prescription pain medication-monitoring program.

Bernd Wollschlaeger,MD,FAAFP

Alarm in South Florida over prescription drug trade


Deaths skyrocket as dealers and addicts flock to S. Florida.

By Vanessa Blum
South Florida Sun-Sentinel

December 3, 2006


Out-of-state drug dealers and addicts are traveling long distances to visit Florida pain clinics, targeting the state because its lax oversight of prescription drugs makes scoring pills easier.

The unwanted tourism alarms state officials who have watched deaths from prescription pain medication skyrocket in recent years. In 2005, such prescription drugs as hydrocodone, methadone and oxycodone contributed to more overdose deaths than all other narcotics combined, according to Florida medical examiners.

Despite the known dangers, Florida lacks a system for tracking prescription drugs. That, according to law enforcement officials, makes it a haven for addicts and "pill mills," where doctors churn out prescriptions without thoroughly examining patients.

The problem was noted in a national drug threat assessment released Nov. 15 by the U.S.Department of Justice. The report outlined the "drug run" phenomenon in South Florida, saying residents of states with prescription monitoring "have in some cases turned to traveling to nearby states ... to illegally obtain pharmaceuticals."

That was the case for more than two dozen people from Kentucky who drove 1,000 miles each way to see doctors in Palm Beach County and Fort Lauderdale. They came by the van-load throughout 2005 and early 2006, returning with doses of OxyContin, Endocet, Percocet, Methadose -- drugs that were more difficult to get at home, according to federal prosecutors.

Eight people involved in the trips pleaded guilty to drug-trafficking charges in Palm Beach federal court, and several more are being tried in Kentucky state courts for alleged drug-related crimes.

The Fort Lauderdale medical office that supplied some of their prescriptions also is being investigated.

Drugs prescribed by Florida doctors caused the deaths of five people in Kentucky, according to prosecutors. One man died from a fatal overdose during the 18-hour drive home.

"We've seen people coming from all over the Southeast United States," said Rick Zenuch, an agent with the Florida Department of Law Enforcement who monitors drug-related trends. "The fact is, illicit drug traffickers don't see state lines as any boundary."

As of June, 32 states had adopted prescription-tracking programs to curb problems such as those in Florida, the most populous state without such a law.

While each system follows slightly different rules, their primary goal is to identify forged prescriptions and to expose so-called doctor shoppers who visit multiple physicians and pharmacies seeking drugs.

The programs generally require doctors to submit information on prescriptions to a centralized database. When an order is filled, the pharmacist also sends an electronic record.

If a doctor or pharmacist were to notice anything amiss in a patient's file, they could contact law enforcement or state health officers.

Kentucky's system is a model for other jurisdictions. Its effectiveness drove illicit drug seekers to surrounding states like Indiana, Ohio, Virginia and West Virginia. Each, in turn, created tracking programs, said Danna Droz, a former administrator of Kentucky's system.

In 2004, Florida's Legislature seemed poised to jump on the bandwagon. OxyContin manufacturer Purdue Pharma agreed to pay the state $2 million to cover start-up costs. But key legislators blocked a vote on the proposal citing its annual $2.8 million price tag and patient privacy considerations.

Dr. Rafael Miguel, a professor of pain medicine at the University of South Florida, called the inaction "infuriating and depressing."

"You have to provide Florida doctors with tools so they can safely prescribe these medications and know they're in the right hands," Miguel said. "Right now doctors are being made unwilling and unknowing participants in the drug trade."

A similar proposal languished and died this year as the legislature focused on other issues. Drug enforcers like Bill Janes, director of the Florida Office of Drug Control, vow to continue their push. Janes said working with lawmakers to pass a prescription-tracking program is his top priority for the new legislative session.

Soon legislators may have no choice. Under a federal law passed in 2006, states that do not implement prescription-tracking within three years will take a backseat for federal funding of drug-related programs.

A prescription tracking system is not a cure-all, Janes said, but could help prevent doctors and pharmacists from unwittingly aiding addicts and drug dealers. Moreover, if criminal activity were suspected, police could get evidence much more quickly.

"It would be a first step," Janes said. "Certainly the opportunity to obtain illegal drugs is much higher if you don't have this."

Maureen Barrett of Fort Lauderdale will support those efforts. She lost her son to a painkiller overdose in 2002 and thinks prescription monitoring might have saved his life.

Drew Parkinson, a student at Florida Atlantic University, received prescriptions for 1,455 pills in 57 days. He died at 25, two days after picking up his final doses.

"Somewhere along the line, a red flag should have come up so they wouldn't have kept giving him the pills," Barrett said.

Privacy concerns cited by opponents are overblown, she added.

"If you go to CVS or Walgreens they have a complete list of all the medicine you've gotten," Barrett said. "We have laws in place to make sure that information is not disseminated."

Dr. Robert Yezierski, director of University of Florida's Comprehensive Center for Pain Research, isn't convinced. He said prescription-tracking is "a good idea in theory," but people who want to abuse the system will find a way.

"What we don't want to do is deny treatment to people who legitimately need pain medication," Yezierski said.

Pain relievers such as methadone and oxycodone -- both chemically altered opioids similar to heroin -- are among the most commonly abused prescription drugs. According to a report published by the Florida Department of Law Enforcement, methadone caused 620 Florida deaths in 2005 -- either alone or in combination with other drugs. The report listed oxycodone as the cause of 340 fatal overdoses.

Used at recommended doses, oxycodone is a powerful treatment for pain and is often prescribed to cancer patients. The drug also is highly addictive and dangerous when taken in large quantities or mixed with alcohol.

Oxycodone tablets sell on the street for about $1 per milligram -- almost 10 times what they cost at a pharmacy.

The Kentucky group frequented clinics in Broward and Palm Beach counties. Some pills went to feed their own addictions, prosecutors and law enforcement say. Others they sold on the street or to friends and neighbors in their small towns near Lexington.

Kentucky law enforcement alerted the Drug Enforcement Administration after a number of overdoses were linked to Florida prescriptions. The individuals charged in federal court range in age from 21 to 64 and face sentences of about four to nine years.

So far, no physicians have been charged in the connection with the case.

In May, federal agents raided the offices of a Fort Lauderdale pain clinic where some Kentucky travelers received prescriptions.

Kentucky grandmother Jewel Padgett, 64, was among those prescribed pills by physicians at the AMMA Pain Care Center in Fort Lauderdale, according to her attorney.

She pleaded guilty to four felonies connected to her Florida trips, including conspiracy to distribute controlled substances and traveling across state lines to promote drug trafficking.

Government lawyers contend Padgett organized and paid for many of the trips from Kentucky in exchange for a portion of the others' pills, earning roughly $30,000.

Padgett's son said his mother went to Florida because she couldn't find a doctor in Kentucky willing to treat neck and back pain caused by a 1998 car accident.

"They wouldn't give her medication she needed," said Don Padgett. "They're scared up here. They got them so restricted."

Fort Lauderdale attorney Theresa Van Vliet, who represents AMMA, said her client supports prescription monitoring and hired a Tallahassee lobbyist earlier this year to push the measure.

"They think it's a good thing," Van Vliet said of her clients. "Pain management is a very new medical field and it is one that clearly can be manipulated."

Van Vliet declined to discuss the Kentucky cases, citing medical privacy laws.

She said AMMA physicians are told to verify medical reports before prescribing pain medication and discouraged from treating out-of-state patients. "It's not foolproof," Van Vliet said, "but nothing is foolproof."

Vanessa Blum can be reached at vbblum@sun-sentinel.com or 954-356-4605.