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Study Finds Decreasing Number of Pill Mills and Drug Overdose Deaths in Florida

After years of notoriety for a rapid increase in prescription opioid abuse and overdose deaths, Florida is now a “success story,” demonstrating that state government action can reverse such trends, according to a study presented at PAINWeek.

Overdose deaths in Florida related to prescription drugs grew by 84.2% from 2003 to 2009, with oxycodone leading the increase by 264.6%, according to the poster (108). It was estimated that 732 “pill mills”—pain clinics that inappropriately prescribe and dispense a high volume of opioids—existed in Florida in 2009.

Decisive steps were put into effect in 2010 to fight the rampant abuse: Pain clinics were required to register with the state; Schedule II or III substances could be prescribed but no longer dispensed from offices; a prescription drug monitoring program and mandatory dispenser reporting was put into effect; and pill mills were raided and their assets seized.

Since these actions were put into place, there have been positive “interim” results in Florida, according to Joseph V. Pergolizzi Jr., MD, the lead study author. From 2010 to 2013, all 98 high-volume oxycodone-dispensing clinics were shut down, 250 pill mills closed and peak prescription drug overdose deaths decreased from 2,722 in 2010 to 2,116 in 2012.

“The study is important because it shows that Florida, by putting certain types of processes in place, was able to have an impact and reduce the negative societal burdens that are related to opioid prescribing,” said Dr. Pergolizzi, adjunct assistant professor in the Department of Medicine at Johns Hopkins School of Medicine, in Baltimore, and a Pain Medicine News editorial board member.

Theodore Cicero, PhD, professor of psychiatry at Washington University School of Medicine, in St. Louis, Mo., who was not involved in the study, said Florida’s crackdown had an enormous effect, but there was a confounding factor.

“Around the country, it seems like prescription opioid abuse is leveling off a bit and maybe decreasing somewhat, so … it could be that phenomenon we’re seeing, but it also could be the state legislation. I would agree with the abstract [of the poster] that although there may be some national pressures or trends in the prescription opiate problem in a downward direction, Florida’s lax policy was really contributing to a lot of the diversion of medications from medically appropriate channels into illegal ones. I think the new policy is reasonable; I think the abstract captures that pretty well,” Dr. Cicero said. “The big concern I have with all of these studies, and the prescription monitoring programs that almost every state has adopted now, is whether legitimate patients are in some way being deprived of medications. … The worry is that we’re going to make it so difficult for some legitimate patients to get pain medication that we will cut into the appropriate therapeutic use of these drugs.”

Dr. Pergolizzi, who is also a senior partner in Naples Anesthesia and Pain Associates of Southwest Florida, responded by saying, “When you look at a balance between potential increased administrative effort you have to put in, and the results that we see in this preliminary data, it’s worth it. I think the realized reverse value proposition is in favor of the potential incremental increase in administrative burden.”

When asked whether it will be harder for legitimate pain patients to get the prescription drugs they need, Dr. Pergolizzi said, “We don’t know. I tend to think not if the patient’s going to a pain specialist. There may be some hesitancy by primary care doctors that may have led them to potentially underprescribe or avoid prescribing an opioid.”

Dr. Pergolizzi added that the data are encouraging because it shows a multifaceted approach. “Patients, doctors, legislators and managed care or payors of insurance should all get on board if we’re really going to address this societal negativity related to opioid prescribing,” he said.

Source: www.painmedicinenews.com