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Florida Board of Medicine discusses flaw in prescription drug database

ORLANDO — The prescription drug database intended to crack down on Florida's pain pill crisis has another gaping loophole, state officials conceded Friday: Doctors don't have to check it.

The law that created Florida's Prescription Drug Monitoring Program, which is expected to start later this year, has already been criticized for giving pharmacists 15 days to enter data into the system, plenty of time for abusers to buy lots of drugs and disappear.

Friday, members of the state Board of Medicine discussed the fact that the law doesn't require doctors — not even those working in pain clinics — to check the database before writing prescriptions for the kind of potent drugs blamed for killing nearly 2,500 Floridians last year.

Enlisting physicians to participate will be critical to the database's success, the governor's chief drug controller told the state board that regulates medical doctors, which is meeting this weekend in Orlando.

But it won't be an easy sell.

Only about one in three Kentucky doctors has signed up for that state's drug monitoring program, which is considered a gold standard nationally, said Bruce Grant, director of the Florida Governor's Office of Drug Control. He said even fewer — roughly one in five — actually use it.

"If it isn't utilized, then it doesn't accomplish anything," Grant said. "It doesn't reduce prescription drug abuse. It doesn't reduce the crime. It doesn't reduce the addiction."

Florida lawmakers created the monitoring program in response to the current crisis in prescription drug abuse. Lax regulations have turned the state into a tourist destination for drug seekers from all over the nation, including Kentucky.

Last year, 681 people in the Tampa Bay area fatally overdosed on prescription drugs. About 90 percent of those deaths were ruled accidents; most of the rest were suicides.

When the Florida database comes online in December, pharmacists and doctors who dispense drugs will be required to report within 15 days information on anyone who has a prescription filled for drugs classified as Schedule II through IV, which includes substances like oxycodone, amphetamines, Vicodin and Xanax.

Doctors will then be able to see if the patient asking for pain pills recently got a month's worth down the street. But they aren't required to look; participation is strictly voluntary.

"A physician has really no way to know if someone is doctor shopping or not," said Fred Bearison, a Valrico physician and chairman of a committee of state physicians working on new pain clinic rules. "Most well-intentioned doctors probably would use it. It's the pill mill doctors that don't want to check it."

In developing the proposed pain clinic regulations, Bearison said the boards regulating physicians would like to require pain clinic doctors to review the database. But current law — as is the case in most states with monitoring laws — won't allow them to.

On Friday, the Florida Board of Medicine agreed to ask the Legislature to require such a check just for these doctors.

"I absolutely think it's an issue," said Dr. Rafael Miguel, a pain medicine specialist affiliated with the University of South Florida, who feels strongly that doctors should have to check the list. But he said medical associations objected when the law was being crafted.

"As many of these laws are, there's a lot of negotiations. Many doctors are overwhelmed" by the many regulations they already must follow, he said.

"However, a pain physician should realize … this is part of his practice and part of his responsibility."

Miguel is vice president of the Florida Society of Interventional Pain Physicians, which has discussed requiring members to check the list.

State Sen. Mike Fasano, R-New Port Richey, who sponsored the bill, said Florida's law looks like others around the country.

Of the 30 or so states that have operating drug monitoring programs, only three — Nevada, Utah and Delaware — have some sort of mandate in the law, according to the National Alliance for Model State Drug Laws.

"The Florida approach is not unusual, but we've seen interest recently in several states in making it mandatory for prescribers to check," said Sherry Green, chief executive officer of the organization.

Fasano said although there is no mandate for doctors to check the database, he's confident most will.

"Certainly I would hope that every physician that wants to put their patient's safety and health first would check it," he said. "I think it's going to be a good program. If we find out that doctors need to be compelled, then we will pass legislation to compel them."

Yet for all its imperfections, Florida's monitoring program is eagerly anticipated by doctors, law enforcement officials and others eager to stem the tide of prescription drug abuse.

It should help to speed up police investigations, said Grant, the governor's drug controller. Instead of running from pharmacy to pharmacy, officials can check the database to see if a patient has been receiving — or a doctor prescribing — excessive drugs. (For patient privacy reasons, Florida police and investigators can get permission to use the database only when they have an active case.)

Miguel, who's been in practice since 1984, said there's already a sense that because Florida is starting to clamp down, the prescription drug problem will migrate.

He said authorities in Georgia, which does not have a prescription drug monitoring program, already have seen pain clinic operators who used to be in Florida move north. He's giving a talk to doctors in Georgia on Sunday about the issue.

Miguel said he's optimistic that, with time, Florida's program will be strengthened.

"I think we'll keep fine-tuning it," he said. "We have to get a grip on this."

Letitia Stein can be reached at lstein@sptimes.com; Kameel Stanley at kstanley@sptimes.com.

Florida Board of Medicine discusses flaw in prescription drug database 08/06/10 [Last modified: Friday, August 6, 2010 11:59pm]
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