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