Buried within the more than 800 pages of Gov. Rick Scott's budget and legislative proposals is a call to repeal the prescription drug monitoring program. That's a bad idea — the database is a vital tool in our quest to get a handle on Florida's dangerous pill problem.
The database does not rely on state funding, and it already has sufficient money to run for at least one year. Responding to criticism, Scott says he intends to work with Attorney General Pam Bondi to address "pill mills," pain clinics that indiscriminately prescribe large quantities of pain medication while requiring only minimal documentation.
Not all pain clinics are pill mills. But many are. Florida is viewed as the pill mill capital of the South mainly because Florida is one of the few states without a controlled substance database. In most states, physicians and pharmacists are able to instantly determine whether a patient is attempting to doctor shop.
Doctor shopping, a third-degree felony punishable by up to five years in prison and a $5,000 fine per occurrence, occurs when a patient goes to a practitioner attempting to obtain a prescription for a controlled substance such as oxycodone or Xanax and withholds the fact that they have obtained a similar controlled substance from a different practitioner within the past 30 days.
Without a controlled substance database, a doctor shopper can visit numerous clinics, obtaining identical medication from each physician, and then fill those medications at various pharmacies. Currently, it is almost impossible to catch doctor shoppers unless they become sloppy, for example, using their insurance or the same pharmacy to fill prescriptions from different doctors.
Florida, in particular, has a large number of pill mills due to the high demand for pain medication. Much of this demand arises from doctor shoppers, who typically sell most of their medication on the street, contributing to daily overdoses.
Typically, doctor shoppers have legitimate pain (for example, failed back surgery) and initially obtain pain medication for their own use. At some point they learn that they can illegally sell their medication and make $10 to $30 a pill. Doctor shoppers are often disabled and hard up for money, and start seeing multiple doctors so they can get enough medication to sell on the street while still having medication for their own use.
Bondi has recently unveiled her plan to combat Florida's pill mills. One suggested provision imposes a mandatory six-month suspension and $10,000 fine whenever a physician at a pain clinic violates the "standard of care." Unfortunately, such a proposal will not have the desired effect, especially without a controlled substance database.
A physician can follow the standard of care and still end up unknowingly treating a doctor shopper for several years; this can occur even though the physician has practiced good medicine and followed all of the rules put forth by the department of medicine. For example, the Tampa Pain Clinic, which carefully scrutinizes prospective patients before even allowing them to schedule a consultation, has discharged several hundred patients over the past six years as a result of doctor-shopping and/or drug abuse.
Simply put, the legislation enacting the prescription drug database must be allowed to take effect. If useful tools such as the database are discarded and replaced with regulations like those proposed by Bondi, Florida will continue to struggle with its attempt to get a handle on our pill problem.
State funds are not needed for the database, so it isn't a budgetary issue. The governor also mentioned privacy concerns, which can be viewed as ironic given that in Florida you cannot buy over-the-counter Sudafed without providing your driver's license and being logged into a statewide database.
The real kicker is that in 2003, before Florida's pill problem began in earnest, a proposal for a prescription drug monitoring program was rejected by Florida legislators, mainly based on privacy concerns. Had that bill passed, we likely wouldn't be in the spot we are in today.
Ashley VanDercar is a local lawyer who works as in-house counsel and risk manager for the Tampa Pain Clinic.