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Regulators debate how many pain scripts are too many

TAMPA — The tough restrictions in a new state law regulating pain clinics include a seemingly simple provision: Limit the number of prescriptions for powerful, controlled drugs a physician can write in one day.

But it's easier said than done.

Members of the state medical boards met Thursday in Tampa to devise a cap that left no one completely satisfied.

The proposal: Each physician working full time in a pain clinic could write a maximum of 150 prescriptions per day — three per patient, on average — for narcotics such as OxyContin and hydrocodone, and the antianxiety drug Xanax. Part-time doctors' totals would be limited by hours worked.

"There are going to be holes in this that people will find. They'll slither their way through," said Dr. Lisa Tucker, a Pensacola ob-gyn on the Board of Medicine, noting that state inspectors can't know a part-time doctor's hours. "If they lie, they lie."

The medical board objected to the caps before they became law. Their concerns include what happens when a physician meets the daily limit, then gets a last-minute visit from a sick patient.

But the general provision took effect this month with the new law, and it's the regulators' job to define it. So if people have problems with it, Board of Medicine attorney Ed Tellechea said they need to talk to legislators.

"I think it's completely unworkable. It makes no sense," he said. "There's a million loopholes in it."

Doctors say the new law and the boards' regulations impose burdens on their practices.

"Nothing that you are doing today is going to be easy for anyone who practices this specialty to implement," Dr. Carissa Stone, an anesthesiologist at Gulf-to-Bay Integrative Pain and Rehabilitation, told board members.

The sweeping law, aimed at addressing a drug abuse crisis that kills an average of seven Floridians a day, already has drawn a legal challenge. Pain doctors and a patient are objecting to a requirement that only a 72-hour supply of these controlled drugs can be dispensed to customers who pay in cash. They also have issues with the law's definitions and the training requirements to practice in pain clinics.

The training issue remains a lightning rod for the state medical boards, which have spent more than a year developing their pain clinic regulations. The Board of Medicine says pain practices should be limited to anesthesiologists, neurologists and neurosurgeons, psychiatrists, and those with specialized training in pain medicine or physical medicine/rehabilitation. Many physicians already in practice are grandfathered in.

But the Board of Osteopathic Medicine wants osteopaths to open their pain clinics to general internists, family physicians, orthopedists, gerontologists and those trained in hospice and palliative medicine.

The medical doctors have not decided how to address the discrepancy, which could make it harder to defend their rule.

Times researcher John Martin contributed to this story. Letitia Stein can be reached at or (813) 226-3322.

Regulators debate how many pain scripts are too many 10/14/10 [Last modified: Thursday, October 14, 2010 11:12pm]
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