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Getting pills a pain even for legitimate patients

Susan Martin stopped at nearly every drugstore between her doctor's Tampa office and her North Pinellas home. But big chain stores and small independents all turned away her prescription for her debilitating back pain.

The next day, the former nurse called 26 different pharmacies before finding one that would sell her oxycodone, the drug now blamed for more overdose deaths in Florida than heroin and cocaine combined.

After years of watching the prescription drug abuse crisis escalate, law enforcement and medical authorities are seriously cracking down on oxycodone and other narcotics.

As a result, oxycodone is getting harder to find and more expensive to buy through legitimate channels. With demand still brisk, some local pharmacies reportedly are charging more than $6 for a pill that typically retails for about $1. Some say the price is also rising on the street, where "oxy" — one of the most widely abused prescription narcotics — can run around $15 per pill.

High-profile arrests and new laws have cut down on the once-familiar sight of out-of-state "patients'' lining up outside clinics. The U.S. Drug Enforcement Administration is scrutinizing manufacturers and distributors, who are then limiting supplies even to reputable pharmacies.

But there's no easy way to fight a drug war in which the line between pain patient and addict is often razor thin — and blurs if patients become addicted or start selling their medications.

• • •

Rumors are flying about oxycodone shortages in Florida. What's really happening, experts say, is that the drug's distribution is being limited by the combined force of new laws and tighter scrutiny.

The DEA is closely monitoring production and distribution patterns. In June, it suspended the controlled substances license of a Michigan-based supplier charged with distributing millions of oxycodone pills, mostly to pharmacies in Florida scheming to sell them to patients without credible prescriptions.

Such actions send a loud signal to drug wholesalers. One company, McKesson, said it is reviewing orders and setting thresholds to prevent drug diversion.

In Tampa, those effects are felt at Fletcher Medical Center Pharmacy, which gets a set monthly allocation of oxycodone from McKesson. Pharmacist Jim Martinez said he can't get more when supplies run out.

The drugstore has been inundated with new pain patients. Some are addicts who no longer can get supplies from pill mills shut down by recent legislation and law enforcement. Martinez said others appear to be legitimate patients, some finding that other pharmacies won't stock oxycodone because they fear robberies.

But his limits keep him from taking on new business.

"I am very, very leery of accepting any new patients," Martinez said. "That would mean that I may not be able to serve my longstanding patients."

Many pharmacies say they have seen demand intensify after a state law took effect in October that restricts pain clinics from dispensing more than a three-day supply of narcotics to cash-paying patients.

The law prompted many pain clinics to stop sales altogether, sending patients to pharmacies, said Paul Sloan, a Venice-based pain clinic owner and president of the Florida Society of Pain Management Providers.

"It's like when gasoline is in short supply during hurricanes. Gas stations start cranking the price up, because they have it and no one else does," said Sloan, noting that not all pharmacies are behaving unscrupulously.

More than 850 pain clinics are registered in Florida, according to state numbers. Some are soliciting new patients with splashy advertisements promising treatment for all types of pain.

• • •

The Dunedin Medicine Shoppe sells oxycodone to legitimate patients for about $1 for a 30-milligram pill. But the drugstore has some new rules.

Customers no longer can take their drug purchases into the restroom, because some oxycodone users were stealing pill crushers and snorting up before they even left the store.

Pharmacist and owner Steve Amato won't fill prescriptions for anyone who looks stoned. Ditto for those who are, as he calls it "working a triangle'' — living in one county, seeing a doctor in another, and bring the script to yet a third.

Each day, he hangs up the phone on dozens of callers seeking oxycodone because they don't sound legit to him. One indicator: asking for the light blue pills embossed with the letter "M" — the preferred variety on the street.

"It's crazy. It's driving us nuts," said Amato, who keeps a loaded handgun near the locked drawer where he stores the oxycodone bottles. "The doctors are still writing scripts, but now they are pushing all these, I hate to say the word, but all these druggies into legitimate pharmacies."

On a recent Friday afternoon, a stocky young adult walked in briskly. He had a tattoo on his neck and a smile on his face. He arrived around 5 p.m., just as the doctor's office that wrote him an oxycodone prescription would be closing and unavailable for Amato to call and check.

"I can't do it. I don't have 'em," Amato told the customer, who seemed to move very easily for a man in pain.

But even after three decades of experience, Amato constantly second-guesses himself. Earlier in the day, he filled an oxycodone prescription for a woman in her 50s who lives nearby and looked wholesome, with her blond hair in a ponytail.

She brought in a receipt from her last pharmacy, explaining she couldn't afford their inflated price of $2.50 per pill.

But when the woman returned to pick up her medication, she asked the cashier if she was receiving the "M" pills. Then she ran out to her car for cash.

"Some of those will be hitting the street," said Amato, sighing heavily when he heard the story. He suspected the customer would take some pills for herself, since she really did seem to be in pain, but then sell the rest.

"Are they selling it? Are they using it? Are they really in pain?" he said. "I can't be judging everybody."

• • •

At the Tampa Pain Clinic, Dr. David VanDercar's 600 patients almost all take narcotics, the pain treatment in which he specializes. Nearly half are on oxycodone.

He knows how quickly the line between treatment and addiction can fade.

In his waiting room, signs warn visitors they are under video surveillance. On a flat-screen monitor, staffers once caught a patient, supposedly in severe back pain, doing karate kicks when alone in an examining room.

The clinic runs a criminal background check on its prospective patients. Anyone suspected of selling their drugs is discharged — and those found to be abusing their medications are carefully evaluated and given support fighting the addiction.

"Most of the clinics don't do this," said Ashley VanDercar, the clinic's attorney and risk manager, and the doctor's daughter.

Dr. VanDercar says oxycodone is the best remedy for certain patients. Yet due to the difficulty filling prescriptions, he has had to switch many to other drugs.

But other painkillers can be sedating, a problem for patients trying to control their pain and still hold down jobs. Oxycodone, by contrast, has stimulating effects — which also can be the high making it so widely abused.

"My concern is that these patients who have significant, legitimate chronic pain be allowed to get the medication they need," Dr. VanDercar said.

His clinic recently came up with a creative solution: Work with a compounding pharmacist to infuse pills with a chemical that negates the effects of oxycodone if the pill is crushed and injected. And it's also laced with enough ginger to cause anyone who snorts it searing pain.

• • •

Are all these efforts having any impact on the street trade? Law enforcement officials say they haven't seen any dramatic slowdown in traffic.

In Hillsborough County, Maj. Donna Lusczynski of the sheriff's special investigations division dealing with prescription drug abuse is encouraged that smaller crowds are gathering in the pain clinic parking lots.

"They are keeping it a little more under control," she said. "It's not like the barbecue out back."

She said the price of an oxycodone pill on the street, once $8 to $10, depending on the quantity purchased, has risen to $10 to $15, as the drug gets harder to obtain. Still, users are willing to pay the freight, she said. Pinellas deputies say prices are holding steady at $15 per pill.

But officials say the true measure of success will be a future decline in overdose deaths.

Authorities say they understand the frustration of patients. Whenever a sought-after drug becomes harder to obtain, there are consequences. Prices can rise, and so may violent crimes.

Florida has seen a disproportionate share of the nation's more than 1,800 pharmacy robberies — typically committed to get narcotic painkillers — in the past three years. And each day, an average of seven people in Florida die from overdosing on these drugs.

All of which is little consolation for patients like Martin, who suffers the lingering effects of back injuries from her 22-year career as an emergency room nurse.

"I'm really aggravated," said Martin, who recently had to change to another painkiller that's easier to get. "Those of us that have legitimate reasons to be using the drugs — and are going about it the right way — are going through hell trying to get them."

Letitia Stein can be reached at lstein@sptimes.com or (813) 226-3322.

Getting pills a pain even for legitimate patients 02/11/11 [Last modified: Tuesday, February 15, 2011 3:59pm]

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