Refusing to Fight Florida Pill Mills

The Wall Street Journal describes some of the blowback Governor Scott is getting for proposing to repeal Florida’s planned prescription drug monitoring system. His spokesperson argues that this isn’t a legitimate function of government, but it’s too late in our history for that argument to make sense. Government has been licensing physicians and pharmacists and overseeing the development and approval of medications for over a century. It’s already deeply involved in all aspects of this problem and the question is not whether it “gets” involved, but how to make its involvement more effective.

The Sun-Sentinel reports that Florida accounts for almost ten times as many prescribed doses of oxycodone as the other 49 states combined! I almost can’t believe that number, but ARCOS data are usually pretty good (and with a finding like this, ARCOS could be overstating the situation in Florida dramatically and the contrast would still be startling).

Florida’s pill mills are increasing addiction and overdose deaths not just in Florida but throughout the Southeast. I don’t personally know the governor and his team, but the tone of their remarks suggests to me that the initial decision to scuttle the program was made casually in the early, hectic days of office and they were surprised by the response from health and law officials and politicians from both parties. But rather than take a breath and ponder their next move, they reflexively came out swinging and staked the new governor’s reputation on a bad policy that is a loser for his constituents.

In the macho world of politics, it’s hard to climb down in these situations…but Governor Scott, this isn’t about ego, this is life and death and no one is going to say “I told you so” if you change your mind. They are going to help you succeed in bringing this terrible public health and public safety problem to heel.

Author: Keith Humphreys

Keith Humphreys is the Esther Ting Memorial Professor of Psychiatry at Stanford University and an Honorary Professor of Psychiatry at Kings College London. His research, teaching and writing have focused on addictive disorders, self-help organizations (e.g., breast cancer support groups, Alcoholics Anonymous), evaluation research methods, and public policy related to health care, mental illness, veterans, drugs, crime and correctional systems. Professor Humphreys' over 300 scholarly articles, monographs and books have been cited over thirteen thousand times by scientific colleagues. He is a regular contributor to Washington Post and has also written for the New York Times, Wall Street Journal, Washington Monthly, San Francisco Chronicle, The Guardian (UK), The Telegraph (UK), Times Higher Education (UK), Crossbow (UK) and other media outlets.

12 thoughts on “Refusing to Fight Florida Pill Mills”

  1. Now if the governor had been prosecuted under the RICO law when he stole all of that money from Medicare and Medicaid, Florida wouldn’t have any problem would it? He would be a famous bankrupt and not the darling of the mentally challenged.

  2. FDA approval of oxycodone was probably the biggest misstep it has ever made. Its approval was premised on the theory that it could not be abused, obviously incorrect, but because this was the basis for the approval, the manufacturer felt free to market the tablets to primary care physicians with much less experience in identifying and coping with drug seekers. The DEA decided to step into the breach and basically terrorize physicians. So you had the regulatory agency failing to do its job and the enforcement agency vastly overreaching to fill the void left by the absent regulators. The fact that the manufacturer was subsequently held to have obtained its patent on the product by misrepresenting certaint things to PTO is just icing on the cake.

    In the meantime, although oxycodone is definitely a problem, so are meth labs. What makes the pill mills different is how bold they are — unlike meth labs, they aren’t hiding and they maintain a veneer of legality, creating havoc in many communities. Each and every one of them is being enabled by a licensed physician.

  3. Barbara, my wife lives with constant, chronic pain and without Oycodone she’d be mostly bedridden, condemned to a life of unrelieved pain and suffering. So I’d like to very politely invite you to jump in a lake.

    People with chronic pain live in constant fear that efforts to relieve their suffering, things like a trip to the emergency room for a an acute attack, will construed as “drug-seeking behavior” and will result in them being cut off from the one thing that makes their lives bearable.

  4. Chuchundra, with all due respect to you and your wife, the FDA should have required the manufacturer to offer more proof on the issue that is the main issue with oxycodone: abuse potential. The point is that it isn’t simply WHETHER Oxycodone was approved, it was the labelling and directions to physicians about its potential for abuse, and the manufacturers’ consistent efforts to downplay those with what turned out to be false claims. Most likely, Oxycodone would still have been approved but the marketing and utilization patterns would have been a lot different, doctors would have been more careful out of the starting gate and it would not have gained the kind of reputation and use profile that it did. In short, people like your wife are paying the price BECAUSE the FDA failed to do its job.

  5. To clarify, the main issues with “oxycodone” are with the slow release version marketed under the brand name OxyContin, which is dangerous because time release formulation has substantially higher levels of the active ingredient in each dose. This version was marketed as not being subject to the same abuse potential as other versions of oxycodone when its abuse potential is actually much higher as a result of the higher dose. Oxycodone has been around for a long time and is no more likely to be abused than Vicodin or Percocet.

  6. Barbara:

    You seem to be knowledgeable about some of these issues. I wonder if you happen to know anything about Exalgo, which is a newly approved, exorbitantly priced, extended release form of hydromorphone. A number of years ago, there was an XR hydromorphone on the market under the brand name of Palladone; it was taken off the market by Purdue fairly quickly after significant problems developed, including fatal interactions with alcohol. Exalgo sounds like a disaster waiting to happen. I bet you can get it at the pill mills in Florida, though.

  7. The “abuse potential” is in the biology, not the drug. Short of re-engineering the human nervous system, (Thankfully the drug warriors haven’t tried that… yet.) pretty much any drug that effectively treats severe chronic pain is going to be popular with some people who *don’t* experience it.

    The question boils down to this, IMO: Are you going to act affirmatively to harm the innocent, (Chronic pain sufferers, the doctors who treat them, and all the victims of the drug war induced high crime rates and militarized police.) or allow the ‘guilty’, (People who chose to use drugs for recreational purposes.) to harm themselves? Imagine a response to addiction which focused on minimizing the harm to non-users of drugs, rather than forcing users to comply with somebody else’s preferences. Could it be any more expensive? It would surely have less impact on our civil liberties.

  8. Brett, that’s true insofar as it goes but OxyContin had specific characteristics that made it more likely to be addictive and deadly, and thus create havoc as an abused product, than the normal version of Oxycodone with the same active ingredient, which has been on the market since 1916. Anyone who has had surgery has probably taken it in the first few days they are home from the hospital. It is not just a feature of human biology alone, but in its interaction with the specific properties of this formulation of the drug.

    Also, I would note that the whole concept of distinguishing innocent use rather falls apart if there is no or minimal regulatory overlay under which the specific use of a product is deemed to be “abuse” — you just have dangerous and non-dangerous.

  9. When an undercover agent reports pain as “1″ on a 1-10 scale, and the nurse writes “10″ and the agent gets a prescription for 140 oxycodone pills, that is not treating chronic pain patients…

    Assuming that the doctor is working off the nurse’s notes (as is normal), is there any reason to think this is abuse rather than a mistake? And a prescription for 140 pills–of what size? I’m not seeing anything that flags this as a problem on its face. (Chronic pain sufferes can easily 10 pills a day of the small 20mg size.) And OMG, they renewed a prescription (I’m assuming at the time it ran out) without doing a new medical exam; that’s extremely common (often doctors will renew prescriptions like asthma inhalers over the phone.)

    $150 cash for a visit is on the low side for a new patient–when we moved 6 months ago the initial pediatrician visits for the children were about that (yes, insurance paid less, but that’s the billing amount.)

  10. It seems to me that the comments to this article have devolved into a debate about controlling illicit drug supply and the so-called “war on drugs.” Where did the Florida PDMP go in all of that?

    PDMP’s are about: (1) Giving doctors and pharmacists an effective tool to ensure their patients are not doctor shopping or combining drugs that shouldn’t be combined (i.e., good patient care); and (2) putting a check on bad doctors that would otherwise prescribe whatever drug endlessly to whomever requested, just to make more money (i.e., drug dealers with a license).

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