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Florida: Strict curbs on physicians bring “pill mill” operations under control

Florida has been especially troubled with prescription abuse for the last decade. I-75, the freeway that runs north-south through the state, has been known as the “Oxy Express” due to the alarming number of overdoses that are recorded in emergency rooms along the way.

A 2011 report by National Public Radio noted that the state had more of these pill mills than McDonald restaurants. The situation seemed out of control.

But in 2014, Florida’s Attorney General, Pam Bondi, campaigned on a claim that all of Florida’s pill mills were gone. And according to the Florida Department of Health, Bondi’s claim is not far off.

Mara Burger, press secretary for the department, asserted that the state has seen a sharp decrease in pain clinics and prescription drug abuse, “In 2010, Florida held 90 of the top 100 national oxy purchasers in the country. Today, Florida holds the last spot of the top 100 purchasers and has seen its purchases decrease by 99.82 percent since 2010,” said Burger. “Florida has 324 pain management clinics today, as opposed to 921 in 2009.”

The reasons for the decrease, Burger noted, are newly imposed regulations on physicians and collaboration with law enforcement agencies.

“After July 1, 2011, physicians were no longer authorized to dispense controlled substances except in very limited circumstances, and by January 1, 2012, all physicians, osteopathic physicians, podiatric physicians, and dentists who prescribe controlled substances for the treatment of chronic non-malignant pain had to register their profile and comply with the new standards of practice.”

These changes were implemented under the initiative that passed in 2011, HB 7095. But Burger said that’s not all that happened to help reduce opiate abuse and prevent doctors from engaging in unprofessional prescribing practices. Burger points out that the Prescription Drug Monitoring Program (PDMP) was also implemented during this time.

“It’s a useful tool to help support sound clinical prescribing, dispensing, and use of controlled substances,” stated Burger.

The database maintains information that helps expose the patients, facilities, or doctors that are participating in illegal activities, such as improper prescribing and prescription fraud.

“Evidence continues to validate Florida’s PDMP as effective in improving clinical decision making, reducing multiple provider episodes, preventing diversion of controlled substances, and assisting in other efforts to curb the prescription drug abuse epidemic.”

The difficulty of reprimanding a doctor for improper prescribing practices can vary, according to Burger, but “cases that present an immediate threat to public safety are given priority.” However, she says, all cases are investigated promptly.

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According to the National Institute on Drug Abuse, 52 million people in the U.S. over the age of 12 have abused prescription drugs sometime in their lives. The U.S. has 5 percent of the world’s population, yet consumes 75% of the world’s prescription drugs. Every year, approximately 6 million Americans will abuse prescription painkillers.

At the center of the prescription painkiller epidemic in the U.S. are “pill mills” – establishments infamously known for arbitrarily dispensing Schedule II narcotics, such as Oxycodone, to people who often haven’t been properly examined. The licensed professionals operating these establishments have been known to dole out thousands of prescriptions for opiate painkillers.

Arkansas and Connecticut are two states that are currently dealing with an epidemic of dubious prescribing practices.

In Connecticut, a nurse practitioner wrote out more prescriptions for Exalgo—a highly addictive opioid—than any other Medicare provider in the nation. She was also the seventh highest prescriber in the country for Oxycontin. Three other physicians have been suspended recently in the state for improper prescribing practices.

Yet, the nurse practitioner was allowed to continue to indiscriminately prescribe lethal medications to thousands of patients for several more years, according to the report, despite the fact that few NPs prescribe Schedule II drugs.

Neither the Department of Health nor the state medical board track the prescription database. Instead, the database is only examined when there is a complaint.

The DEA launched an operation just last summer aimed at raiding “pill mill” establishments across the U.S. The operation, dubbed “Operation Pilluted,” has primarily focused on southern states and has resulted in nearly 300 arrests, including dozens of doctors and pharmacists.

Just two suspensions have been issued to the more than 40 accused doctors and pharmacists thus far as a result of the DEA’s operation, according to a recent AP report. The accused commonly argue that their discretion is protected by state law.

The state of Arkansas has seen the most law enforcement activity, with approximately half of the operation’s 300 arrests occurring there. Arkansas is a leading distributor in controlled substances – with hundreds of millions of oxycodone, hydrocodone, and Xanax pills disseminated annually. “Pill mills,” which front as medical clinics or pharmacies, are the center-point of mass distribution of these drugs.