Florida steps back on drug monitoring

Hollywood bombshell Anna Nicole Smith's 2007 death in a South Florida hotel room ignited a frenzy of headlines. The four-poster bed she died in at the Hard Rock Hotel. The tub of crushed ice to break her fever. The row of amber pill canisters on the night table.

The coroner's verdict: An accidental overdose of some of her nine prescription drugs killed the former Playboy Playmate.

Not long after, authorities declared legal narcotics were killing three times as many people as street drugs in Florida. Those events combined to give the Sunshine State an embarrassing new nickname: Pill Mill Capital of the Nation.

Legislators started to pay more attention to the crisis. But it wasn't until 2009, after seven deadly years of political stalemate, that lawmakers approved creating a database to thwart drug-seekers who go from doctor to doctor, and pharmacy to pharmacy, filling multiple prescriptions for powerful narcotics.

The database still doesn't exist.

Florida's Prescription Drug Monitoring Program is the subject of a battle that pits Republicans against Republicans, politicians against major campaign contributors and at least one legislator against his own vote.

As Gov. Rick Scott and opponents work to kill the program, an unlikely coalition of pain clinic doctors, police officers and grieving mothers are united in distress. Politicians from New York to Kentucky are begging the state to stop the drug pipeline that sends deadly narcotics across their borders. Even the nation's drug czar recently implored Florida to enact the monitoring system.

John Eadie, director of the PMP (Prescription Monitoring Program) Center of Excellence at Brandeis University, attends the annual meetings of the 34 states that have monitoring programs.

"Florida is always discussed," he said. "No one can comprehend why you're not moving rapidly forward with a prescription monitoring program.

"Given the deaths, given the threat to safety, it makes no sense."

But the prescription drug trade marches on. In 2009, Florida distributed more than a half-billion pills of the widely abused drug oxycodone — nearly twice as much as the No. 2 state, Pennsylvania. And every day, an average of seven people die in Florida from prescription drugs, just like Anna Nicole Smith.

• • •

To understand the strange and tangled history of Florida's drug monitoring efforts, a good starting point is 2001 — when state medical examiners reported a dangerous spike in overdose deaths from prescription narcotics.

At a statewide conference on drug control, Gov. Jeb Bush proposed a monitoring system to track drug prescriptions.

Florida's attorney general, concerned about Purdue Pharma's marketing of the painkiller OxyContin as a pick-me-up for arthritic seniors, launched an investigation into the drugmaker. One brochure, seized upon by politicians, showed seniors happily dancing.

In 2002, the state dropped its investigation after Purdue agreed to give Florida $2 million to start a drug monitoring database.

But first, the state would need a law to create it.

New Port Richey Republican Sen. Mike Fasano signed up to advance an issue important to the governor. But it became a personal crusade.

"How could I accept that something that would save lives was defeated year after year?" he asked.

His opponents included many of Tallahassee's most powerful special interest groups: The doctors' lobby opposed government intrusion into medical practices. Influential Cuban-Americans saw the database as a communist-style Big Brother tactic. Conservatives and liberals alike worried about the privacy and security of patient data in the new Internet age.

The tracking system stood to rein in a business that was profitable for drugmakers, distributors, pharmacies and doctors who dispensed pills from their clinics. And these drugs were hailed as a boon for patients suffering pain that other therapies couldn't touch.

In contrast, supporters of the bill, at least in the early years, were mostly a small cadre of grieving parents, worried law enforcement officials and health care professionals. By 2005, the Florida Medical Association decided to support the system.

Reputable pain clinic owners also came on board as they recognized that the database would help to weed out drug-seekers, so legitimate patients could get the drugs they needed.

But it wasn't until early 2007 when Smith's death in Florida made international headlines that the tide began to turn in favor of the database. As the death toll rose, images of pain clinic parking lots overrun with eager pill shoppers became media fixtures.

Bruce Grant, former director of the Florida Office of Drug Control, called the media attention a "V-8 moment" for the Legislature. "Suddenly people in the House were saying, 'I shoulda had a prescription drug monitoring program!' "

In April 2009, the Legislature overwhelmingly approved a monitoring system.

Fasano's legislative aide, watching the action in the House, texted him two words: "It passed!"

Fasano's reply: "Finally."

• • •

But nothing was final.

A month later, 13 members of the House sent a letter to Gov. Charlie Crist asking him for a veto. A Virginia man had hacked into that state's monitoring system, although no patient data got out. Still, the legislators wrote, the Florida system "would be susceptible to cyber terrorists and criminals who would use such information against the citizens of Florida."

Crist signed the program into law, but it would be some time before it could take effect.

Lawmakers insisted the system's $500,000 annual cost be raised through private donations and grants, not state tax dollars.

And to appease special interests, they left gaping loopholes: Doctors would not be required to check it. Pharmacists would have 15 days to enter data, leaving time for shoppers to fill many prescriptions.

Last summer, the state Department of Health took bids from companies seeking to run the database. But a losing company, Optimum Technology, filed a court protest, saying the scoring process was unfair.

When officials agreed to start the bid process over, it seemed unlikely the database would open for business by the deadline set in law: Dec. 1, 2010.

So the Office of Drug Control hatched a plan. Prescription drug abuse had reached emergency levels, the office declared, and the law permitted an emergency one-year contract to get the monitoring program started.

But the Health Department didn't help. Neither did Crist.

"Once again, the prescription drug monitoring program got kicked down the road," said Grant, who led the drug control office.

• • •

"It can't be. It just can't be." That was Fasano's reaction when his aide sent him Gov. Rick Scott's 800-page budget proposal last month. One sentence was underlined and starred with a black marker: "Section 899.055, F.S. is hereby repealed."

It was the monitoring program. Scott planned to kill it.

The governor cited concerns about privacy and cost — although $1.2 million in private donations and grants already had been raised, and no states with monitoring programs have reported privacy issues.

Pain clinic owners and law enforcement officials furiously protested. Parents who had lost children to prescription drugs picketed in South Florida.

Then Scott complained that the foundation that had raised $464,194 for the program misspent on legal fees and travel.

"It was a cheap swipe that was untrue," said Rene Bruer, vice chairman of the Prescription Drug Monitoring Program Foundation.

Foundation chairman David Bowen was "blindsided" by Scott's stance, said Claude Shipley, former chief of staff in the Office of Drug Control. Equally baffling: Scott's political snub. Bowen's Automated Health Care Solutions had been an early supporter of Scott, giving at least $1.5 million to his campaign and a roster of Republican causes.

"We just have a disagreement on this issue," said Bowen, unwilling to discuss the matter further. "We're supporters of the governor. We believe in him."

Scott's plan: "We are putting a big focus on making sure that the people who are violating our law with regard to prescription drugs are put into jail," he said. "We've proposed some additional penalties and things like that."

• • •

The governor's call for repeal sounded a clarion. Longtime critics dusted off talking points that the 34 states with monitoring systems call nonissues. Only now, many critics of the system had advanced to powerful leader­ship positions.

One was House Speaker Dean Cannon, who was among the "Gang of 13" seeking Crist's veto. In late February, Rep. Rob Schenck, R-Spring Hill and chairman of the House Health and Human Services Committee, scheduled a meeting to talk about why monitoring programs don't work.

Yet in 2009, he had voted for it. "I intended to vote against it before, but I left the floor and somebody pushed my (voting) buttons without telling me," he said recently.

At the meeting, staffers handed out a six-year-old U.S. Centers for Disease Control and Prevention study that showed overdose death rates did not differ markedly between states with drug monitoring programs and those without.

But the study's author issued a statement to set the record straight. Researcher Leonard Paulozzi highlighted a more recent study showing that states with databases had "slower rates of abuse/misuse over time."

Monitoring programs "are a promising mechanism for addressing the epidemic of prescription drug abuse," Paulozzi wrote to Florida legislators.

Yet, this conclusion was not mentioned in the meeting, nor were supporters of the system allowed to speak. Schenck told them there was no time for them in the 140-minute session.

Schenck has introduced two bills: one to repeal the monitoring program, the other to prohibit doctors from dispensing controlled substances. Instead, pharmacists would do the dispensing after deciding — how is not made clear — that the patient isn't doing anything fraudulent.

Pharmacists would have to give law enforcement the names of patients trying to fill prescriptions that they deem illegitimate. And although the state refused to fund the database, this program would get $1.5 million in tax money the first year.

Schenck says he thinks a database would violate privacy, though he hadn't heard of such a problem in any other state. "That hasn't happened yet but it could in the future," he said.

• • •

As for the fate of the monitoring law in the current session, it appears as unpredictable as it has been for the past decade.

The doctors' lobby, not surprisingly, opposes Schenck's plan to strip doctors of dispensing authority. It supports the 2009 law, but a higher priority looks to be the battle over how the state will pay doctors to treat the poor and the elderly.

Senate President Mike Hari­dopolos supports the database and hopes to win over the governor.

"If not," he said, "we'll have the votes to override a veto."

Last week, a Tallahassee judge ruled the monitoring program's bid process was fair, clearing the way for the system to start. "Hopefully this ruling will end needless delays to the implementation of Florida's database," declared state Attorney General Pam Bondi.

Reaction from state Health Department officials — whose ultimate boss is the governor — was far less enthusiastic. A spokeswoman said the agency was reviewing its options.

Wednesday, OxyContin maker Purdue Pharma renewed its long-expired proposal to contribute funds for the program, but Scott rejected the money.

The first of what could be many votes on the repeal came Thursday. The House Health and Human Services Committee moved 12-5 to repeal the Prescription Drug Monitoring Program, despite the tearful pleas of a mother.

Linda Bartz, vice mayor of Port St. Lucie, spoke about her adult daughter's struggle with addiction, and how she filled prescriptions for the same drugs from multiple doctors. That wouldn't be so easy if Florida had an electronic database, Bartz said.

She reminded the legislators of the seven people a day who die of prescription drug abuse.

"I will tell you as I look at your faces, I'm one of the lucky ones," Bartz said, her voice breaking with emotion.

"My daughter is not one of the seven.

"Yet."

Times staff writer Alex Leary, Times/Herald staff writer Marc Caputo and researchers John Martin and Caryn Baird contributed to this report. Contact Meg Laughlin at mlaughlin@sptimes.com.

Florida steps back on drug monitoring 03/11/11 [Last modified: Saturday, March 12, 2011 8:33pm]

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