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Florida DOs welcome, wary of constraints under new ‘pill mill’ law

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A number of osteopathic physicians are concerned about the unintended consequences of legislative efforts to rein in pill mills. (Photo by Jennifer Durban/Flickr)

In late February, federal and local law enforcement agents raided more than a dozen pain clinics in southern Florida, arresting 22 people, including five physicians. Seven other physicians voluntarily surrendered their federal licenses to prescribe controlled substances. The culmination of a two-year investigation led by the U.S. Drug Enforcement Administration, the sweep was the first in a series that has resulted in more than 350 arrests.

During the sting, known as Operation Pill Nation, narcotics agents pretending to be patients made hundreds of purchases from 60 physicians at 40 clinics in Florida. The arrested physicians have been charged with prescribing and dispensing oxycodone hydrochloride, a Schedule II drug, and other controlled substances without legitimate medical justification. The DEA estimates that 86% of oxycodone is prescribed in Florida.

“Prescription drug abuse is our country’s fastest-growing drug problem, and pill mills such as those in Florida are fueling much of that growth,” DEA Administrator Michele M. Leonhart said in a statement after the initial raids. “Rogue doctors who run these operations violate their professional oaths and are, in fact, drug dealers. Florida today is ‘ground zero’ in the fight against pill mills.”

While Florida is considered the epicenter of prescription drug trafficking and addiction, the problem is nationwide. In April, the Obama administration released an action plan aimed at “cracking down on drug diversion and protecting delivery of effective pain management.” One of the plan’s goals is to require that physicians undergo specific training prior to obtaining DEA registration to prescribe Schedule II and Schedule III opioids.

Buttressing the federal crackdown, Florida Gov. Rick Scott signed the state’s latest “pill mill bill” on June 3. The new law tightens the reporting requirements for the state’s prescription drug-monitoring database, increases penalties for overprescribing oxycodone and other controlled substances, and bans most physicians who prescribe narcotics from dispensing them. The law also requires that physicians write prescriptions for controlled substances on new counterfeit-proof pads that are available only from specific state-approved vendors.

Federal proposals, Florida’s pill mill legislation, similar recently passed laws in Washington and Ohio, and several related bills in other states are drawing mixed reviews from DOs. Although concerned about the role of pill mills in prescription drug abuse, a number of osteopathic physicians express concern about the unintended consequences of new laws, the loss of physicians’ prescribing autonomy, and patients’ diminished access to needed medication. The most aggressive of the proposed measures being considered by the U.S. Congress and state legislatures would limit the prescription of controlled substances to certain medical specialties and subspecialties.

Requirements, penalties

Florida’s William H. Stager, DO, describes his state’s new drug legislation as “very controversial” because of the “additional hoops physicians must jump through” to care for patients and the steep penalties that will be imposed on physicians who do not comply. While the law’s requirement that every patient be evaluated for pain be given a physical examination is sound medical practice, the paperwork created by the legislation is excessive, says Dr. Stager, who practices family medicine and neuromusculoskeletal medicine in West Palm Beach, Fla.

Dr. Mendez

Although concerned about its unintended consequences, Michelle R. Mendez, DO, believes that Florida’s new pill mill law will alleviate the state’s prescription drug-abuse crisis. Like Jonathon R. Kirsch, DO (top), and William Blazey, DO, Dr. Mendez is a former AOA health policy fellow. (Photo by Patrick Sinco)

Among other requirements, Florida’s law mandates that DEA-registered physicians do the following when treating patients for chronic nonmalignant pain:

  • Document the nature and intensity of the pain, current and past treatments for pain, underlying or coexisting diseases or conditions, the effect of the pain on physical and psychological function, previous diagnostic studies, and any history of alcohol and substance abuse.
  • Document a plan for assessing the patient’s risk of aberrant drug-related behavior, then follow through on the plan, which may include patient drug testing.
  • Discuss the risks and benefits of controlled substances with the patient or the patient’s caregiver.
  • Require the patient to sign a written agreement that outlines the patient’s responsibilities.
  • Monitor patient compliance.

Physicians who violate the law will be suspended from practicing medicine for at least six months and will have to pay a fine of at least $10,000 per violation.

Family physician Michelle R. Mendez, DO, of Jacksonville, Fla., welcomes the tighter requirements. “An estimated seven people die every day in Florida from prescription drug abuse,” she says. Previously, Florida physicians with DEA registration were allowed to dispense narcotic medication as they saw fit, notes Dr. Mendez, a former AOA health policy fellow who wrote her thesis on pill mills. As a result, drug dealers would join forces with unethical physicians to prescribe and dispense pain medications at storefront clinics that often did not even perform physical examinations.

“I’m glad that the law restricts physicians’ dispensing authority, ” Dr. Mendez says. Allowing only licensed pharmacies, hospitals, nursing homes and limited other entities to dispense these medications will make it much more difficult for pill mills to operate in Florida, she explains.

46 Responses

  1. robert migliorino,d.o. on Sept. 2, 2011, 1:16 p.m.

    Excellent!Finally it is put in writing.Over 40 years I have seen too many physicians prescribing indiscriminately so that they can buy their next Mercedes or Rolex.Many are new but,many are not. They live in fear that some admin bean counter will note decreased production numbers.No,I am not rich & never had lines extending out of the office.But then,most never had mine position that I retired from…Medical Director in the Federal Dept of Justice.My guests were serving a “vacation” of 25 years to Life for their indiscretions.They had lived the good life for a few years but ,are paying for it now.The Florida law is reflecting what should have been in place years ago.Unfortunately,the situation is universal.Many states are 25 years behind the times.While working as a contract locums,I nearly was fired because I refused to write for Controlled Substances w/o a State CSR.The Admin & B/C Med Director blithely told me that their locums had been doing this for the past 3 years!Ignorance of the law is no excuse.In other cases ,I was ordered to write for seniors & others so that they would be quiet & sleep better.In fact,soporfics were prescribed for months or years on end.The threat always was,”if you don’t give it,they’ll go to someone else who will”.I could rant on,but the law simply puts into black & white what should have been done for decades.

  2. robert migliorino,d.o. on Sept. 2, 2011, 1:30 p.m.

    Another point,word gets around swiftly that one writes and/or dispenses indiscrimately.Sooner or later,anumber of “new” patients will be State Police and/or DEA undercover agents. One won’t know it until at 3 AM comes a knock on the door during a roundup.At trial,the Admin or ancillary will sit in the courtroom….in the gallery as an observer.

  3. robert migliorino,d.o. on Sept. 2, 2011, 1:36 p.m.

    Limiting prescribing to a few specialties is a joke.They can write for more than is being done now.BC/BE has nothing to do with it,the question is ethics & morals.It is no different than giving B12 injections & charging for them because the red color & injection make a person “feel good”.

  4. Bruce D. Latham,DO on Sept. 2, 2011, 3:11 p.m.

    Over the last 4 years I have witnessed the death of several young mothers and children as a result of over dose from diverted narcotics. I work with over 100 narcotic dependent patients now who are trying to reach sobriety. It is interesting to see the changes that come as these people leave their life of drugs and again become gainfully employed and develop stable relationships. Most are more than willing to give me the names of those who supplied them their drugs. One individual was making $12,000 per month on her sales of Oxycontin in just 2 days, thats more than I make as a physician in a month. I recently discovered another clinic was prescribing #720 Methadone per month to one patient. The pharmacist was told that the clinic had been treating heroin addicts for years but calling it “pain management”. When I called DEA, I got the response, “What do you want us to do.” I had discovered over 50 dealers in our area, and turned over the names, cell phone numbers and dates of delivery to law enforcement. When I finally asked to have a meeting with the agents I was informed that they were going after the “Big Fish”. Unfortunately, when I discharge a patient for selling, buying, or abnormal drug screen, they call the Board of Medicine on me because now they are forced to go back on the streets to get their drugs, and I get investigated. I guess one benefit to caring for most of the law enforcement personnel in my region, and being a former prison doctor, I can usually call their probation officers, report their cocaine use, and they are pulled back in for violating their parole. I would welcome the legislation and would love to work with government in taking care of diversion while preserving the individual doctors right to provide adequate pain relief in legitimate cases.

  5. Pedro Sanchez DO on Sept. 2, 2011, 3:52 p.m.

    I too have cried along with patients and friends whose children I knew and are now gone due to this greed and obsession with intoxication. Manuel Noriega once commented “Americans make up four percent of the people on earth but consume sixty-five percent of the drugs” I don’t know if his figures were correct, but the point stuck. But now consider my 78 year old little lady from rural florida with spinal compression fractures and severe DJD of hips, knees, and shoulders?NSAIDs too risky,not a good surgical candidate, PT tried with little success. The nearest pain specialist or physiatrist is 38 miles away. Let’s not forget her and 300 like her that trust and rely on me. The DEA issued us certificate to use our expertise for the benefit of our patients. The osteopathic oath is very clear in showing us a shinning path! Practice assuming each patient were your family ,but don’t let the times strip us of who we are and the privileges we have earned!

  6. robert migliorino,d.o. on Sept. 2, 2011, 4 p.m.

    Dr.Latham’s note is unfortunately true.Similarly,30 or 90 day addiction programs are woefully ineffective.It is true most go after the Big Guy as dealers are small fry.A lot has to do with the outrageous number of frivolous suits on the docket,mostly from inmates of all levels,for which action you can thank the Supreme Court.Many states have also drug enforcement as a side line,although they are starting to recognize the huge increase in incidents.If DEA ,in my day,answered as Dr.Latham described;the FBI would be on them so fast one’s head would spin.Re enforcement,look too at who is running the show now.Could they be the same generation who were at Woodstock & hung on every word from Chip Munk & Wavy Gravy or watched Cheech & Chong in a haze of smoke?Similarly,one bashes education & teachers as a cause,yet if you asked a third grader to multiply 7 x 4,he would take 30 minutes & still give the wrong answer.Yet,if you asked the same person to calculate the cost/kg of 2.37 kg of weed times cost of 23.74 kg of rock,he would have the correct answer in 60 seconds or less.Many are into it for the quick buck,auto,shoes etc.If Medicine boards Investigate you,as described,and you are innocent,then you should report that to the IG,AG or Internal Affairs.Time to play hardball.Unfortunately,there are too many huggers around & its always the monolithic state vs the pooor ,downtrodden masses yearning to be free.

  7. Scott on Sept. 3, 2011, 6:48 a.m.

    It is not just Florida with this problem. Here in
    Delaware most pain management Dr’s only want
    to do procedures because of the reimbursement.
    Prescription refills fall back into the laps of FP/IM.
    The local DEA are constantly looking at your records
    to catch you in a mistake. As always the few bad apple
    patients have made us all leary of prescribing
    appropriate medications.

  8. joe white, d.o on Sept. 4, 2011, 7:43 a.m.

    As a monolithic hugger who has been investigated by the New Jersey State Board as a consequence of my own questions to the DEA about questionable patients. I am pleased to see something done by such a feckless soul as Govenor Scott to curb rogue pain control in Florida. Local dealers have confessed to me they bought the oxycodone quite cheaply from persons in FL.
    What is sad is to see so many doctors prescribing benzodiazepines and drugs that act identically, e.g., soma, to patients on opiates. No one is looking seriously at the body of data reffered to as “rational polypharmacy”, whereby prescribers can mix adjuvants with opiates that stabilize nerves and prevent ephatic nerve transmission.

  9. robert migliorino,d.o. on Sept. 4, 2011, 8:22 a.m.

    To Scott & Dr.White,as you see,the problem is universal.But,I also see several sides to the story as previously described.BTW,I am a native NJian who got out due to outrageous taxes,greedy hospital admins,etc.One other area not mentioned is the realm of the Dentist.No one questions their fee schedules,their prescribing practices,or what they do.If you think Blue Cross Bldgs are upscale or lavish;take a look at Delta Dental’s office bldgs around the country.At least,in Dr.White’ case,NJ now has a Governor compared to priors.If the Board investigated you then ,perhaps a letter or call to his office might stir the pot.Some years ago,in NJ at the Shore,an MD had lines streaming out of his door.It took some time,but he was arrested by State Troopers & his license revoked.After several years his license was reinstated but CSR/DEA was not. So…no more lines…after a few weeks he was not seen,police found him in a closed garage, sealed auto with motor running.i know this because his office was 3 miles south of mine & I passed it daily.

  10. Mo on Sept. 5, 2011, 7:35 a.m.

    While all of the comments are well thought, the bottom line to this travesty is the DOH and BOM.
    Many warning’s were give to all physician’s in Florida, after the “dispensing” qualification became available for $100.00. This qualification, was a nice idea for both office income and patient convenience, it went very south. And, had the DOH and BOM disciplined their peers appropriately, I do not think we would be where we are today. Peer review in the State of Florida has failed.

  11. robert migliorino,d.o. on Sept. 5, 2011, 7:52 a.m.

    Mo,that may very well be true. However,if Fla is like most states,their staff is limited.But,if indeed they only deal out a slap on the wrist,then I can see where you’re coming from.Perhaps hospital insurances can become involved,as they currently are in determining staff composition & requirements.

  12. Mo on Sept. 5, 2011, 9:30 a.m.

    Robert – it is true. I have attended many full board BOM meetings, and have witnessed first hand the “dispensing” cases. Also, trended the data of cases brought to the BOM and dismissed. Astounding. In addition the BOM attorney states – “if we didn’t think it was a problem before, we can’t now”.
    The DOH and BOM is the ONLY agency that can stop this travesty. Our police officers can not arrest the doc’s because they do not enforce Administrative Code. Only our “appointed” representatives can. Now with the Statute change, our officers can do more, other than arrest our kids for possesion, and knock on doors notifying parents of their child’s “accidental” OD. Where is the DOH and BOM in all of that? Reactive, and not proactive.
    Again, only physicians can stop this. Physician organizations are the stongest political group there is. it is up to you to save the citizens of Florida, as this is a State problem – 98 of top 100 physcians are in Florida. It is also up to the physicians to uphold the Hippocratic Oath, and the DOH to uphold their mission of protecting the public health safety of it’s citizens. There is no other answer. Administrative Code vs. Statute. Technically speaking, we should need such a strong Statute if Florida physician peer review, disciplining and/or revocation occured.

  13. Mo on Sept. 5, 2011, 9:36 a.m.

    TO ALL:

    Bottom line:

    “Can’t have a pill mill without a physician”.

    Regardless of ownership, “standards of practice”, imposed limitations, or any other attempt to end this travesty….

    It is up to Florida physicians to end this gross daily mortality.

  14. cathy on Sept. 11, 2011, 11:36 a.m.

    In 2000 I was taking percocets for pain not very high dose of a pain killer but it was treating my pain well. My Dr says to me he was going to fix me, my problem witch is rare 21 known cases 2 wks latter he shot corterzone in my back and was my 1st day early to pain management sayin to him somethings wrong! He took 1 loook at my back and said no more shots for you and prescribed me take 3 diluadid 8mg 4x a day 360 a month with morphean lollipops 4 brake through. Even though I had on my record I was in recovery for cocain and I reminded him of that fact as well with him stating Im not going to give you no cocain! Ok so being in an extraordinary amount of pain I take what prescribed and fastly become addicted. Within 6 months I was shotting it with track marks ev ery were drs still prescribed. Today I go to the Methadone clinic and even though they say its more adictive its monitored with nurses and drs erveryday and I am no longer having to do ileal thinkgs to get a fix.. Class 2 drugs my point is should be i;llegal, they are more addictive then any coke Ive even done in my past.Even when taking as directed u still get addicted

  15. robert migliorino,d.o. on Sept. 13, 2011, 9:02 a.m.

    Sounds like the “pain clinic” was a “pill mill’.You also need to use spell check.Another area of addiction is phenobarb used in seizure disorders. i had a patient who was on it for 25 years ,seizure free.Referred him to Neurologist who weaned him off it. Weaning took 20 months.

  16. Margaret Dunn on Sept. 28, 2011, 11:24 a.m.

    I am visting my sister in Palm Coast, I have been here for 1 month and had planned on staying for another 2 months but I must go home (New Jersey) because the prescription that my Phila. doctor wrote for percorcet can not be filled because it was not written on tamper proof paper which is not a law in Phila. but it is a law in New Jersey and when I take my prescription to CVS in New Jersey where I live they fill it. If Florida still wants tourist to come here they should fix the law so when your not from Florida you can still get the medicine you need. New Jersey does they let you go to the doctor you perfer not only the ones in the STATE OF NEW JERSEY. If there was a problem with something on the script the pharmacist should be able to call doctor from that state. I told the pharmacist that I get my perscription filled at CVS in New Jersey every month from the same doctor can she just look it up and she told me nothing matters because it not written on tamper paper and I should maybe go to Georgia to fill it. I don’t think that was funny that was a insult to me. I am here visting family. I AM NOT A DRUG DEALER OR ADDICTIVE TO MEDICINE but this is unfair to anyone from another State because we don’t know the law changes. So for now on I am able to visit my family for 1 month because I can’t get the medicine I need. SHAME ON YOU FLORIDA

  17. robert migliorino,d.o. on Sept. 28, 2011, 3:47 p.m.

    Mrs. Dunn:There are hundreds of Florida physicians who can write a new prescription for you.If you have the finances for an extended stay plus travel,then you have the finances for a new prescription.By the way, I am a NATIVE New Jerseyan,so just to set the record straight I am not a rube from a town named “Resume Speed”.When I was in practice,I am now retired,patients in other states such as Florida would write or call for refills.I would refuse & tell them to see a local physician.I know that this cost me patients but,I would rather be legal than accommodating.Another thing,Snowbirds upon returning “Up North” would talk about how poor treatment was & how excessive fees were during their hiatus in the South.Yet,my colleagues in the South would tell me that these same people would state the exact same thing to their physicians there regarding treatment & fees “Up North”.I also found this to be true while practising in a Clinic in NW Indiana run by two large & well known steel companies.Retirees outside the local area would get prescriptions from the clinic physicians to tide them over for 6 or 7 months until they returned North.So don’t give me the old song & dance about being unable to get your meds.You simply were looking for the cheap way & now that method is gone. This applies not only to Controlled Substances but,meds requiring follow up as well which are non narcotic.

  18. robert migliorino,d.o. on Sept. 28, 2011, 3:56 p.m.

    I also noted the old standard line,”I am not a drug dealer or addicted”.That line is used by many. You are probably physically and /or psychologically dependent on the Percocets. Remember too that there are 49 other states besides New Jersey.

  19. robert migliorino,d.o. on Oct. 2, 2011, 8:07 a.m.

    See also article in /28/2011 issue of JAMA about this worsening problem in Florida

  20. robert migliorino,d.o. on Oct. 2, 2011, 8:08 a.m.

    that is september

  21. Joe M on Nov. 4, 2011, 11:56 p.m.

    I was investigated by the FL DOH and BOM. Anyone who is investigated will be punished
    as much as they can muster. I was given an Emergency Suspension Order 15 months after
    I left pain management. I was in for 2 days a week for 16 weeks.
    I decreased doses on all patients who entered, and if they would not take reductions, I discharged them. I discontinued many opiods and balanced their overall medication intake.
    The FL statues say you will not be judged by chronicity or amount of medications but by
    the results of treatment – but you can forget any of that being considered.
    They have another statute which is a legal presumption that says anything they say that is
    excessive levels is considered outside your regular practice [like on the street], and any high doses [their call on the amount] are never in the interest of the patient regardless of
    the physicians intent.
    The presumption is put into every complaint they can get by with. Next year they have plans to follow that by recommending criminal prosecution for every board discipline containing that statute. The doctor will be charged with drug dealing as if he was on the street dealing.
    Do a google search for Bernard Cassidy, a Florida attorney who directly accused the FL DOH of corruption and wrongdoing on an ongoing basis.
    All this clamping down sounds good but the real problem is no education of the doctors about pain management. I mean no practical education of what is best practice and why it is so.
    I would hesitate to go to Florida to practice because they show no mercy and if you are caught up in the system on a pain related matter you will get the maximum. I was recommended a fine of 47000 and fees of 7000. 4 years of monitored probation, a medical records course and a controlled substance prescribing course which they recommend for several thousand dollars each.
    Come on down to Florida and enjoy the sun as a visitor but don’t jump into practice without long consideration.

  22. Mike on Dec. 30, 2011, 12:12 p.m.

    To everyone who seems to believe this is the way curtail our nations drug problem. You are all full of it and rightly so. If you are sick you have all kinds of access to the world of medications. Yesterday I visited my primary care physician where I informed him that I has having terrible head aches. His response was basically “don’t look at me, you have to go to a pain specialist now”. I can’t write you any prescription for pani meds due to the new law. I knew the new law would scare the ligitimate doctors into hiding. DEA is good for that, but then what do you expect from an agency that was created in the back unlite halls of the whitehouse. I will end up going to a pain management center but meanwhile what’s next? Doctors no longer want the responsibility of managing their patients pain. It’s become a legal and monetary nightmare for them.

  23. e roberts on Feb. 3, 2012, 11:40 p.m.

    to suggest that a pain doctor buys a mercedes or a rolex by over prescribing class ii narcotics is stupid, doctors get paid for prescribing ten oxycod or 100, because they get paid for the patients visit only.s. . i did have a back operation 4 ears ago, but not from either of those doctor the only doctors who i have dealth with, that i question their ethics is a told me i needed to replace both hips, but i went to another one who said he would not replace by hips for a million dollars. he said my pain was radiated from my back, sinal stenosis from birth. th one who wanted to replave my hips required a 900.00 mri the second said you only need an xray to diagnose hip problems. i also had a neck peration abd a titanium plate abd removal of a vertafre and replaced with a cadava vertabreay for that disagnosis. that was ten years ago and i still have my hips. there are more bad doctors than good ones, bad meaning the ones who get sued over and over, but doctors and/or the medical boards don’t take their license and th good ones won’t testify against them. doctors only can clean up the mess. every doctor i ever got pain medicine frm never gave me to many pills and they reluctantly gave me any, it was MRI, EPEDURALS, BURNING NERVES, BEFORE I GOT PILLS. I HAVE NEVER BEEN ADDICTED TO ALCOHOL AND NEVER SMOKED ANY MARIJUANA CIGARETS.

  24. Ben on Feb. 12, 2012, 12:39 a.m.

    I have three chronic spine and bone disorders. I live in pain 24clinic hours a day. I have also had cancer twice, with it possible to come back at anytime. I go to a pain clinic and have to be prescribed pain medicine just to make it thru the day, and 4-5 hours of uninterrupted sleep. I have had these conditions for over six years and have been thru many surgeries only to have it increase the pain that was already there. It is sad that people and doctors abuse the medications. I take my medication as prescribed to dull the pain. It is now more expensive and harder to find due to people from out of state coming to my state to get prescriptions to sell, abuse or whatever they are doing with them. I have a MRI,CAT,and a PET scans done every year with new tumors, severed nerve in spine or outher painful abnormalities showing up. It has made it harder on me to find my medication’s and I do not take oxycontin. The doctors should not prescribe anything without proof of a medical condition that causes ligament ironic pain.

  25. Free American on Feb. 15, 2012, 11:13 p.m.

    I read a quote recently that said “you are not addicted if the medicine is for a justified cause” Just as a heart patient needs their medication and the diabetes patients needs insulin, a person in chronic pain needs pain medication. Why can’t we be rational? If a person has been responsible in taking their medication, why punish them? If they stayed consistent with their doseage, and have a “true” history of justified pain – WHAT IS THE PROBLEM? Seriously, this has all gotten so far out of control. I really do understand why something had to be done… BUT again, we are punishing the people who actually do need it. And, to the person who thinks that saying “I am not addicted” is a crap line, just ask a person with another chronic illness if they are addicted to their medicine and they will say “no, but I do need it”. What is the difference? A need…. is a need! Try walking a day in the lives of someone with chronic pain. Well, heck, I will give you a week in mine. (without the medication of course… so that you can true effect) I haven’t had a problem with my medication, Thank God, but I do pitty all out there who are fighting for something that should be a given. If there is a medication out there that stops the effects of whatever you are going through, then, so be the Free America – Gosh Darn… Why don’t they just let you have it! Trust me, after walking that week in my shoes, you would understand.

  26. John on Feb. 17, 2012, 8:51 p.m.

    Having arthritis for 30 years and taking regulated pain medication the new laws raised my Dr. visits 73%. I have no history of abuse and my physician is outstanding. I agree the mills needed to be shut down however there are thousands of legitimate patients who see their family Dr. now once a month to obtain medications to function daily. Our Dr.s are under extreme pressure and they have been virtually stripped of their ability to practice their profession with out fear of government intrusion. Shame on us all for letting criminals and reprobates impact services so desperately needed by so many in true need. Where do we go from here?

  27. DJW on Feb. 25, 2012, 7:19 p.m.

    In 1989 I was diagnosed with HIV (17yo). In 1994 I was considered AIDS. I have been in and out of the hospitals in Miami for numerous opportunistic infections. I’ve had cancer cut out, stroke, blood vessel rupture in my brain (right occipital lobe) so I have lost some vision. Im on my last HIV medication cocktail because I have taken everything and become resistant…I even remember when AZT was the first and new thing; it made me sooo sick. My vascular system is shutting down. Right carotid artery is closed. The list of other ailments goes on…ect..ect…ect

    I have been put on painkillers throughout the years and have always stopped them until the next catastrophic problem came my way. The nuropathy in my feet and legs have really kick in within the last few months even spreading to my hands and wrists. I was on Lortab (vicoden) 10mg, 2 tabs every 4 to 6 hours. Doctor initially wanted to put me on Oxycontin but I asked for Lortab because I know about Oxycontin and problems you can have on it. Now because of Rick Scott and the other GOP religious right (wanna be) do gooders put this new law in place in Florida my doctor completely cut me off of Lortab cold turkey two days ago. He put me on Tramadol and Neruotin. Made me feel like I was a junky because I cried in his office. He said and I quote, ” My hands are tied because of the new laws” and “If I write you a prescription for Lortab you have to be within 6 months of death”. This last quote was BS to me. My labs show my t-cells above 200 so Im not at 6months to live. I may have 7 months to live if I stop my HIV meds today. I recently worked with a Nurologist who tried me on Lyrica, Tegretol, Depakote, and Neurotin and many other seizure meds—they all made me so sick. These medicines will make you insane, nauseous and dependent. I had an awful time going on, then going off was harder.

    This is horrible that patients who need medicines are getting squeezed. I am disability and still work a part time job. I dont want to lose my job…If I do I cant cover rent and food with just disability. I never drank or did drugs…been with my doctor for 15 years…he knows my history. What is going on??? THe lawmakers are saying it wont effect the needy — but they are lying.

    DO’s out there — show some mercy to the people with chronic pain.

  28. DJW on Feb. 25, 2012, 7:56 p.m.

    Also…forgot to mention that when my primary care doctor of 15 years referred me to a Neurologist he was able to wash his hand of me and my chronic pain. It is now legally another doctors responsibility, my neurologist. Since my neurologist wasn’t able to help me with the seizure medicines he pushed me back to my primary care doc. My primary care doctor can now refuse to treat me for pain because he can say its my Neurologist So now im out in limbo with my pain issues. It’s what the doctors do to get rid of you. The DO’s out there like you when your just coming in to get your 3 month lab results and all they have to do is give you numbers. But when it gets rough for you and there is a little more paperwork to do they want nothing to do with you.

    Suggestions to DO’s … Stop taking 10 patients an hour and give yourself time to comprehensively give your patients care. And, yes, this does include the paperwork and reporting that goes with it. Its part of your job like it or not. Things change in every profession and we still have to do are job just the same, especially when your dealing with patients who come to you for help in their lowest moments.

  29. robert migliorino,d.o. on Feb. 27, 2012, 8:14 p.m.

    DJW,stop whining. First of all,the religious right has nothing to do with this.Re your suggestion about D.O.’s not seeing 10/hour,better to chastise the admins who specify PRODUCTION in the contracts.Perhaps seeing a dentist for your pain would be better,no one regulates their charges & you can get controlled drugs OR Mexican pharmacies sell them OTC.BTW,there are hundreds of clinics & agencies that treat HIV & its associated conditions at absolutely NO charge for labs & meds throughout the country.After all,the squeaking wheel did get the most grease.

  30. pat on March 17, 2012, 8:31 p.m.

    I live in Florida and have been taking morphine, by injection for several years. I am obviously physically dependent at this point. I should add I have a brain tumor and failed every medication, narcotic and nonnarcotic before taking the morphine. I went from two years in bed, being fed and bathed by my husband to becoming human again. I have had no side effects, have never had an increase in dosage and my qualify of life has improved immeasurably. Now my primary care doctor says he can’t write narcotic scripts anymore. Well, sorry I didn’t die like everyone expected but it seems my demise will be certainly hastened by the abrupt cessation of this med. What about all the really sick people in Florida?? Where do we go and who is brave enough to take care of us. It sickens me and frankly I wish I had died rather than having to go through this. I hope you catch all the drug abusers but you’ll have to step over the bodies of the real sick people to get to them.

  31. Kathy on March 18, 2012, 3:37 p.m.

    I am a Delaware resident and also have lived with chronic pain for almost ten years now, spinal fusion, herniated discs, ruptured discs and now carpel tunnell syndrome, and what has happened in Florida is now happening in Delaware and I am just here to say that what the DEA is doing to people have legitamate pain issues just is not fair I started out ten years ago with physical therapy, tens unit and after those treatments didnt help me I was then prescribed 10mg percocet after ten years I now take 30mg oxycodone 4x daily, in my opinion the Dr’s did go through the correct measures in order to evaluate my pain and prescribe accordingly, now after being on the oxycodone for approx. 4 yrs, the Dr’s are scared to death and are taking the medications that truley helped me to function and maintain a “Quality of life” and prescribing morphine which all I want to do is sleep all the time, how am I supposed to go to work, and be available to my family if I am tired all the time and in pain? what the government is doing is taking our freedom of choice away, the freedom to recieve the medical treatment that we as americans deserve!!!!!

  32. Robert on March 22, 2012, 4:04 a.m.

    Same issue. Chronic pain for 7 years. Was on Oxycontinn and switched myself to Morphine as I am disabled and cannot afford Oxycontin when in the Donut Hole. I had a nice Doctor who was origonally in Pain Management but got out and became an Internist. Up until Dec 2011 she prescribed my meds and would give me 3 scripts (90 days)as I was considered stable. In Dec she gave me a letter that the entire practice (10 Doctors) would no longer treat Chronic Pain patients. The practice had done this before but she still treated me because I never had any “The dog ate my script” excuses. Now I go to a pain clinic and pay $40 a month copay, had to fill out 15 pages of paperwork, get my picture taken and am seen by a Nurse Practioner for 10 min and pick up my script. I hope that my new Doctor does not get raided or become (“Dr. Feelscared” By Maria Szalavitz Feb 2002). I cant beleive my regular Doctor dropped Chronic patients and did not help them out until they could find the right doctor. I feel like I am going to a pill mill. I asked my regular Doc to carry me for a couple of months until I could find a better Clinic and she refused. Isn’t that unethical? She is the one who started me on the drugs and she is also qualified to get people off of pain killers. I just dont get it. The Doctors should stand up and fight. I know the patients would be happy to be wittnesses for the effort. Scott and Bondi have taken this way to far and the DEA is going against thier own philosophy that a good Doctor should have nothing to fear. Check out some of the articles about Pam Bondi firing 2 attorneys for doing to good of a job in an investigation involving foreclosures where she has friends working at the companies being invstigated. Huff Post 10.12.2011. Florida is creepy and I have lived here since 1966.

  33. John on April 18, 2012, 4:57 p.m.

    So where do we go from here, real patients with thick files on the only course of treatment we can afford or is effective. I just want enough relief to continue working and contribute to my family and community. The fact I take 3 10/mg Lortabs for 10 years is hardly consequential in the big picture when considering the value of a mans life. I have never played games, been arrested or had any negative consequences associated with my pain management. There is no other viable solution or medication I can take. What now? We all need a miracle, either a cure or super drug that criminals wont kill for. I have about 8 years left and I would very much enjoy the ability to help my family and continue working.Thoughts?

  34. robert migliorino,d.o. on April 20, 2012, 6:38 p.m.

    John,sorry to say that there is NO panacea.I am surprised that your 3 Lortabs/day did not appear on company drug testing,or doesn’t your company do drug testing?Your description of your saintly life is impressive but,others numbering in the thousands or more have proclaimed the same innocence.True,a miracle is indicated but, none are forthcoming at this time.

  35. William Faber DO on June 1, 2012, 3:36 p.m.

    Pain pills do not cure pain. At best they give temporary relief. Osteopathic Medicine was discovered nearly 150 years ago by A.T. Still MD because of the need to give patients relief. It is well documented that he did so very often without drugs and surgery. He named his science and methods Osteopathic Medicine. The art and science of Osteopathic Medicine is practiced today giving those in pain, illnesses and disability relief without drugs and surgery. I recently completed a book along with Jason Haxton M.A. and other osteopathic physicians decribing the principles of Dr Still and how they were used successfully over 100 years ago and how they are used today to give needed relief to those suffering and not finding relief. That is how I came into Osteopathic Medicine. I suffered 24/7 pain and disability @ 18 years of age. I went the allopathic route with hospitalization, multiple medicines, physical therapy and back braces and was advised for a spinal fusion. At that point I entered the osteopathic world. The rest is detailed in the book along with many other actual cases histories of those suffering and finding no relief in pills and surgery. The road out is described in the “OSTEOPATHIC MEDICINE ADVANTAGE: How Medical Miracles are Made.” It is available on Amazon and Kindle in seconds.

  36. Susan Gleason on April 3, 2013, 4:11 p.m.

    The new pill law, though beneficial for some is crippling for others. And of course the now “pain management doctors” are doing a booming business. I truly resent the fact that the state government can control my health, not my primary physician. What next?? Limiting the amount of wine served in church, oops does this harm or set the younger generation on the path to alcohol addiction. My having to go to two separate doctors, primary and pain management, is not exactly easy. But this law also is making the statement that your primary doctor cannot be trusted, only Big Brother. Get rid of this before we lose our good doctors.

  37. Eusebia on April 30, 2013, 11:18 a.m.

    I don’t drop many responses, but i did some searching and wound up here The DO | Florida DOs welcome, wary of constraints under new ‘pill mill’ law. And I actually do have 2 questions for you if it’s allright.
    Could it be simply me or does it look as if like some of these
    comments look like written by brain dead people?
    :-P And, if you are posting on additional social sites, I’d like to follow anything new you have to post. Could you list of all of your community sites like your twitter feed, Facebook page or linkedin profile?

  38. MJP on July 8, 2013, 8:31 p.m.

    Everyone will get used to it. It’s been like this in Jersey for years. It’s a good thing when you think about it! Everyone who has chronic pain should see a pain specialist, sometimes there are other avenues to explore other than just meds, and if you need them the pain specialist will give them to you as long as you’re not shady! It’s all good peeps!

  39. Priscilla on Dec. 2, 2013, 3:47 p.m.

    A good, no, GREAT DO kept me going for a decade, but following a badly botched epidural, it was Pain Management for me. I’ve been in pain since 1975. I can never have the life I would like, but I can have some quality of life of ai take the proper amount of pain medication . Thanks to government pressure, I have had an awful te getting my prescriptions filled ( they are prescribed by an anesthesiologist who is now a pain managemt specialist.

    I have been to over fifty drugstores…and have been treated shabbily by many.
    The mom and pop store that had filled my Rx’s the past few months, is telling me that they are being pressured by the DEA to not fill my scrips. Because of my zip code?! There is no state or federal law that specifies (I am in Floridida)how close one must live to the drugstore to get an Rx filled.

    I am at the end of my wits. What would you do if you were me? If your mother needed pain medicine in order to function?

    The problem for patients inFlorida is terrible. I should not have an intrusive government agency between me, my doctor, the pharmacy, and my quality of life.

    The last time I went without my medicine for ten days, I sobbed myself to sleep clutching a loaded 38 cal. Revolver to my chest…the pain was out of this world. People should not have to suffer to the degree that suicide seems like an option when they have a valid, much needed Rx in hand.

    I tried every conservative treaent over a twenty year period before I ever took a pain pill. So don’t suggest to me that my character is weak or that addiction is involved here. Have some empathy if you can. Pain does not discriminate among persons. It can happen to anyone. You could be next.

  40. hector p on Dec. 26, 2013, 6:19 a.m.

    Bruce D. Latham,DO Robert migliorino,d.o

    u both are poster-child i didn’t take long to find u two Dr. who care only about them self and to hell with there patients. Latham u should go into being a prosecutor to put more minority in prison your description and outlook already has us tag as user addicts etc. The fact that Florida did not have tight law for pain management Dr not the patients fault that falls on the idiotic politician. there was a loophole the size of Texas and people took advantage of it. but let get this straight the % of patient who abuse the med are small between 5% to 10% , not the other way around but listening to ur opinion hell 90 out of 100 people coming to u for help with pain are liar and criminals. very sad indeed u are more of the problem u and the DEA who lost the war on st drugs a long time ago now target Dr. and patients bully Dr. so bad Dr. are afraid of their own shadows, in America land of the free the law enforcement entity decided who need legal prescriptions drug and who doesn’t with dr. like u who has ur head so far up there asses us real patient who thru no fault of our own are going to go on suffering until death give us the relief. our govt is out of control.
    Dr. like yourself should be barred from practice or just quit all together ur patient are better served going to the street and getting some weed making Brownies or just get a bag of heroin and use very carefully because with this witch hunt that going on the millions of USA CITIZENS OF THIS SUPPOSE FREE COUNTRY!!!!?????? are getting shafted, mistreated ostracized but more important are not getting treated for their condition and all we have to look forward TO IS A Miserable LIFE OF PURE HELL PAIN 24 HR A DAY 365 DAY OF THE YR SLEEPLESS NIGHT, ANXIETY, MADNESS, DEPRESSION , HELPLESSNESS AND ABOUT ALL FEEL BETRAYED BY THE SAME DR who TOOK A OATH TO PUT THE PATIENT 1ST ABOVE ALL ELSE, WITH U AND UR PARTNER IN CRIME Robert migliorino,d.o + DEA THE PEOPLE WHO SUFFER IN SILENCE AND OUT LOUD DON’T STAND A CHANCE ON LIVING A DESCENT PRODUCTIVE LIFE AND WILL BECOME FODDER FOR THIS EVER GROWING PRISON NATION.
    we have let our govt create until we as American grow a pair and start reminding all official that they work for us not the other way around and if they keep on this track we kick them there families and especially the Dr in league with them to the curb. So we can prove to all of them that we the people have the power to make changes and especially make sure that Dr. like u TWO never practices another day in this lifetime. But unfortunately we are scared of our own govt / who use the Gestapo tactives from Hitler day to keeps us inline. One day in the future we be so much in pain and feel so abused that we no longer fear death when that happens then we can rise as one and throw the bums (DEA) Politicization and make sure u two never see another patient so u wont label him a addict or criminal because no one would step foot into ur office u both are a joke and poor excuse of a Dr. i will from this moment until, I pass away pray every day for both of u to get , develop, fall break anyway have major chronic pain like me every min every day every second no letup and ur pain never dips under a 9 on the scale so u can get feel get treated the way u treat people now i know there a god who make sure those who injure there brother receive injury onto himself well that my rant

    Bruce D. Latham,DO
    Most are more than willing to give me the names of those who supplied them their drugs. You’re a Snitch on top of everything else huh plus being a horrible Dr.30 or 90 day addiction programs are woefully ineffective.
    30 or 90 day addiction programs Because they are woefully underfunded and under staffed something about WAR ON DRUGS AND PRISON MORE IMPORTANT LARGE $$$$$$ FOR FRIENDS OF THOSE IN POWER??? HUH

    Robert migliorino,d.o

    o just to set the record straight I am not a rube from a town named “Resume Speed”. When I was in practice i am now retired


  41. r. migliorino,d.o. on Jan. 2, 2014, 2:39 p.m.

    guess that you haven’t taken your medication recently!

  42. P.Murphy DO construction of hard knocks on April 16, 2014, 7:10 p.m.

    I could wrote a essay of being a victim of the anti narcotic freaks. Aka my primary for over 20 years who ignored my words of chest pains and other descriptions that could be tied to you guessed it myocardio infarction. Screw spell check. He was nice enough to say heartburn and prescribe the purple pill. Even after prep for torn bicep rotator etc… showed high bp abnormal EKG he let me be in Jan 13 I had the stent in a 95% clogg the 100% right coronary been clogged to long the collaterelles will have to do. Oh I wo not even mention my spine the torn hip the return shoulder the hernia repair there’s more but my primary the vice on the Virginia medical board has only prescribed a narcotic 2 times in 20 years roughly. Oh 5 mm 3mm etc kidney stones he is anti narcotic and is on the board we are so screwed. A doc that who he made sure in his words won’t practice again figured out my heart and prescribed nitrous which saved my life. I took his kids on cubs out and boy scout camp outs with his wife who died recently five months ago.I think just making me feel good she died cause he is such a blank blank blank.

  43. LETDRUGADDICTSDIE on July 4, 2014, 11:31 a.m.

    I don’t care how many young Mothers died from prescription drugs or children of lousy parents that didn’t bring them up right who die from same. THEY SHOULD DIE. THEY are the ones who have made me lose my hope of having another child and even being able to walk and play with the one I have.

    I HATE ALL OF THEM. Sick scum that play with drugs people like me NEED TO LIVE, for their own selfish benefit or pleasure. They don’t need rehab, they need PRISON. We don’t need to lose our pain relief by making it hard to obtain narcotics. We don’t need to be punished THEY DO!!! MAKE THEM GET 10 YEARS IN PRISON FOR NARCOTIC ABUSE and allow Narcotics to not be so hard to get.


  44. DR Michael DO on Aug. 20, 2014, 3:20 p.m.

    Declare War on everything. That is the answer by supposedly educated peoples. Why not declare Peace first as the good Lord intended. These substances were made by God as a gift for alleviating suffering but as usual mankind goes and messes it up. Genesis states He created herb for the service of mankind Just becase there is bad in the world it does not change our inalienable right of free will. To relieve one’s pain is not only a right but a bodies natural function and when the bodies natural opiods and other chemicals are not sufficient we trust a natural substance to help. Dr Still was a God faring man but today’s DO has abandoned the techniques and methods of our profession. I think mankind is very confused and afraid of the liberty a sound mind is given so he attacks that which he is afraid. So kindness and peace and understanding are part of what heals my friends. Like the NRA do we need an NOA to protect our right to use the opiod that is a part of our natural makeup.Moderation works. We are healers but have lost our way in a world full of violence. How many DO’s practice OMM? That is a shame on you because stimulating the bodies endogeous opiod system helps so many diseases. Dr Still knew there was so much more to learn and condensed this knowldge in a short lifetme. We must learn how to truly care for each other instead of the fear that continues to permeate the practce of Osteopathy and medicine in general. So much to learn and so little time! The damage done can continue or true healing can begin it is the age old problem that plagues us. I can go on about why the cost of medicine is so high and all the Real Ill’s I see in our society because of intolerance, greed, corruption. Believe me this will only get worse no high horse can cure that mankind can create. It has already been created for us. Heroin use and death continuse to soar so when will we truly get it right. We are America the Land of the free lets not confuse Liberty with lack of reason. Oh and I have no healthcare or work after more than 25 years of education. That is the American dream. Because I cared at 40 to go fulfill a lifelong dream in medicine, an Army medic a public school teacher after Viet Nam, college professor and now healer a good one but not one rferral to have OMM done which I know has saved the few by my hand from the surgeon’s blade. Perspective is a funny thing one sees something entirely different from another when looking at the very same thing. Why? God bless us and open our minds but most of all our hearts. Thank you Dr. Still the learning continues.Get it right!

  45. k.D on Oct. 17, 2014, 3:04 a.m.

    I can understand why and what the law inforcment is doing what they are doing,but in the same understanding.They also need to realize that some average normal people like me with copd lung desease,Four rubtered dise in my back,deteriating joint and bone deseace,pad desseace,gaut,autheridous,….Well I could go on,but my point is, I only get $400 a month and now have to drive 65 miles from where I live to a pain clinic just to get my meds…Well hopefully theirs just a hand ful of use that will have to go threw this.If so its worth it I guess…

  46. AtoZ on Nov. 8, 2014, 12:36 p.m.

    Let’s work more on the diploma mills too.

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