Florida pill mill legislation prompts pain experts to weigh in
The legislation, which received bipartisan support in the Florida Legislature, is aimed at reining in prescription narcotics dispensed through pain management clinics. The clinics have been a source of controversy in recent years, as people have flocked to the Sunshine State to take advantage of the so called pill mills.
One of the issues has been the lack of a tracking system to prevent patients from obtaining multiple prescriptions. The Prescription Drug Monitoring Program, passed during the 2009 Florida legislative session, is an effort to begin collecting specified dispensed controlled prescription drug medication information to encourage safer controlled substance prescription use and reduce drug abuse and diversion. It allows health care practitioners to view all their patients' dispensed prescription history that is 15 days or later.
There's also the fact that the pain clinics dispense the pills on-site rather than forcing patients to go to pharmacies. "It's amazing this is even allowed to happen," said Dr. Steven D. Feinberg, the medical director of the Feinberg Medical Group and chief medical officer for American Pain Solutions.
Feinberg says that while there are high-quality physicians who appropriately dispense medications from their offices, the downside is too strong. "I think it is too seductive for financial gain and should be stopped," he said. "We all like to make money and support our families, but we're talking about people's lives. In my role I see a lot of patients on a variety of medications dispensed by their doctors that are unnecessary and potentially damaging."
There is also the issue of quality control. Lazarovic says there's no effective way to get the context of what additional medications a patient might be taking.
"Obviously you ask, but the patient may not disclose," Lazarovic said. "On the other hand, if they are going through the normal pattern, of filling at a network pharmacy, and that prescription is for an opioid and that patient is already on two others, that will be flagged for action by the payer's pharmacy benefit manager."
There's also additional expense to the workers' comp system when injured workers get medications dispensed directly through physicians' offices. Lazarovic says it typically costs more than it would at network pharmacies that have negotiated prices.
The experts are perplexed as to why Florida in particular has become a hotbed of pill mills, although Lazarovic suspects the state's oversight of the situation has been more lax than other states. "Most of the physicians in [the pill mills] are not doctors with specialty expertise and training in pain management," he said. "So they're basically profit centers for the clinics that hire physicians for maintaining volume and generating revenue from drug sales."
The legislation, which was expected to be signed by the governor, seeks to crack down on the pill mills in the following ways:
- Create administrative and criminal penalties for physicians who over prescribe narcotics and violate standards of care.
- Protect the Florida Prescription Drug Monitoring Program by requiring data to be submitted within seven rather than 15 days and require the Prescription Drug Monitoring Program manager and support staff with access to the database to undergo criminal background checks.
- Target dispensing of particular narcotics through a physician dispensing ban, with specific exceptions.
- Require practitioners who prescribe controlled substances to register with the state Department of Health and comply with specific standards of care.
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June 2, 2011
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