As law enforcement agencies across the Tampa Bay area crack down on prescription drug abuse, state officials are hammering out the details of a long-delayed prescription drug monitoring program.
But during the long delay, the prescription drug trade in Florida has flourished.
Known as a drug dispensing haven for out-of-state buyers and traffickers, Florida leads the nation in prescriptions for oxycodone, the most popular painkiller on the street. Forty percent more oxycodone is prescribed in Florida than the second-leading state, California, which has twice the population.
And while South Florida leads the state in such prescriptions by a landslide, the Tampa Bay area is second on the U.S. Drug Enforcement's list of hot spots. Broward, Palm Beach and Miami-Dade counties are the top three, while Pinellas is fourth and Hillsborough fifth.
"We've done a lot to increase the manpower here and show we're not going to put up with this in Pinellas," said sheriff's Capt. Robert Alfonso, who oversaw a recent 10-month investigation that resulted in over 25 arrests and identified almost 50 other suspects.
But as long as the state struggles with lax medical regulations, slow legislation and an antiquated prescription system, local law enforcement agencies say there's only so much they can do.
Legitimate doctors who write painkiller prescriptions in good faith become prey to fraudulent patient claims, or doctor shopping. And too many pain management clinics operate without any oversight from the state's drug and health agencies.
"Right now the pain clinics are completely unregulated," said Glenn Kirkland, chief assistant to state Rep. John Legg, who has been working on legislation to limit physician dispensing.
"It is a difficult issue to tackle because it's so out of control. We're talking billions of dollars and lots and lots of pills. This is very much an organized crime."
And it's no coincidence that it feeds off of Florida.
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In the 1990s, Kentucky realized it had a serious problem.
The abuse of oxycodone, dubbed "hillbilly heroin," had exploded. In 1999, the state enacted an electronic prescription drug monitoring program which eventually cut off all doctor shopping in the state and became a model for others.
Today, 38 states have similar prescription drug monitoring programs. Florida is the largest that doesn't. Of the nation's top 100 doctors who dispense oxycodone, 92 are in Florida, according to the DEA. Two are in Tampa, and one is in South Pasadena.
A Broward County grand jury report presented last year noted that out-of-state drug traffickers are making frequent trips to Florida's pain clinics. Investigators were noticing Kentucky or Alabama license plates in the parking lots, and lines of people wrapped around certain clinics, known as pill mills.
But targeting pill mills is much trickier than targeting individuals, said Alfonso, the Pinellas sheriff's captain.
"We have to jump through some hoops in how we pursue the clinics," he said. "With doctors, it's a little more delicate. You don't want to go in and damage someone's professional career."
Regulation loopholes in clinic oversight seem to hold no one responsible for supplying too many pills to too many people.
The Florida Department of Health regulates doctors, but not clinic owners who are not doctors. A pain clinic that is not physician-owned needs only a doctor's name and license number to dispense medication, but the Board of Medicine won't necessarily hold a doctor responsible if the independently run clinic is a pill mill. And the Agency for Health Care Administration oversees only clinics that accept insurance.
Pill mills take only cash.
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It took seven years, a Broward County grand jury report, several antidrug groups and the support of the state's Office of Drug Control, but now Florida finally appears poised to catch up with the rest of the country.
Gov. Charlie Crist last year signed into law legislation (SB 462) championed by state Sen. Mike Fasano, R-New Port Richey, to implement an electronic prescription drug monitoring program that will prevent people from getting multiple painkiller prescriptions filled within a certain time. But it likely won't be active until next year, and then take months for all pharmacies and clinics to get on board.
Now, people in Florida can get prescriptions filled at multiple pharmacies without those pharmacies tracking the visits. The new database will track prescriptions and sales of pharmaceuticals. Doctors and pharmacists will be able to review a patient's history before writing or filling a prescription.
Critics have raised privacy concerns and the expense of implementing the plan. Still, it's expected to be in place by December.
In the meantime, Rep. Legg is working to push a bill that would effectively limit a physician's controlled substance dispensing to a 72-hour supply. This would effectively eliminate system-abusing pain clinics, which make money from volume dispensing, Kirkland said. The bill would not limit a doctor's ability to prescribe controlled substances because it applies only to dispensing.
"No one is coming from Kentucky to get a 72-hour supply," Kirkland said.
Until more state regulations are in place, law enforcement agencies, drug counselors and activists are doing what they can to curb the problem themselves.
The Pinellas Sheriff's Office has more than doubled its task force that investigates prescription drug crimes. Both Pinellas and Hillsborough have designated special days when people dispose of expired or unused medications in hopes of bringing awareness to the problem.
Drug courts that have seen a huge influx of painkiller-related offenses have designed special therapy programs for addicts. And a new Pinellas chapter of the national Narcotic Overdose Prevention & Education task force hopes to begin its first visits to county schools this year.
Laurie Serra, who helped create the Pinellas chapter, is encouraged by the state's attention to the problem over the past year. But like others, she couldn't understand what took so long.
"Why were 38 other states able to pass it before us?" Serra said. "Why has it gotten to this point in our state?"
Her frustration with the lag is understandable. Her 28-year-old stepson, Matthew, died from an prescription drug overdose a year and a half ago.
Reach Emily Nipps at firstname.lastname@example.org or (727) 893-8452.