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[UPDATE] Florida's War on Prescription Drugs

By: Governor's Press Office; Carol Gentry, Health News Florida; AP; Jim Saunders, The News Service of Florida
By: Governor's Press Office; Carol Gentry, Health News Florida; AP; Jim Saunders, The News Service of Florida

[UPDATE] Tallahassee, Florida - April 22, 2011 - Jim Saunders -

The Florida House overwhelmingly approved a plan Thursday to curb prescription-drug abuse, after offering a glimpse of how the “epidemic’’ is hitting their communities and families.

Reps. Rich Glorioso, R-Plant City, and Fred Costello, R-Ormond Beach, told the House that they have family members who have abused prescription drugs.

“I will tell you it’s devastating on everyone who comes in contact with it,’’ said Glorioso, who did not identify his family member but indicated the person was taking the painkiller Oxycontin.

In an emotional speech, the usually low-key Rep. John Legg, R-Port Richey, said prescription-drug abuse is “destroying our state.’’

“Once and for all, it is time that we kill this monster,’’ Legg said.

The House voted 116-1 to approve HB 7095, with only Rep. John Tobia, R-Melbourne, opposing it. The full Senate is ready to take up a bill (SB 818) that includes significant differences, and both chambers will have to agree on a final version.

Gov. Rick Scott and Attorney General Pam Bondi immediately issued statements praising the House. Florida in recent years has become a magnet for prescription drug abuse, with “pill mills” popping up across the state.

“Today we are one step closer to giving law enforcement and regulators the tools they need to combat pill mills and prescription drug abuse in Florida,’’ said Bondi, who has made the issue one of her top priorities.

The House bill would place new restrictions on clinics, doctors, pharmacies and drug wholesalers. But in some ways, its passage Thursday was a turnaround from the House leadership’s position early in the legislative session.

At that time, House leaders and Scott called for scrapping a planned prescription-drug database because of concerns that it could infringe on privacy rights. The database, which is aimed at better tracking sales of dangerous drugs, was approved in 2009 but was delayed by a bid dispute. It recently got the OK to start operating.

Senate President Mike Haridopolos, R-Merritt Island, opposed eliminating the database, and the issue also drew attention from officials as far away as Kentucky. That is because drug users and traffickers have traveled to Florida from other states to get supplies of painkillers.

The House bill will keep the database, though it also would ban drug manufacturers from contributing money to pay for the system. That worries some database supporters because lawmakers have refused to set aside state money for the system.

Drug-company Purdue Pharma recently offered to contribute $1 million to the database, an offer that would not be allowed under the House bill.

The bill also would take steps such as barring most doctors from dispensing two categories of controlled substances in their offices and clinics. That means patients would have to go to pharmacies to get the substances, curbing the ability of unscrupulous clinics to sell painkillers.

Another part of the bill sets up a new permitting process for pharmacies that want to sell the two categories of controlled substances. That process is designed to make sure shady clinics don’t create pharmacies to try to circumvent the ban on doctors dispensing dangerous drugs.

But pharmacies have raised concerns about that requirement, at least in part, because of a March 1, 2012, deadline for getting permits. They are concerned that would not leave enough time for the Department of Health to approve rules and issue permits.

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UPDATED By Candace Sweat 4-21 at 11:14

One by one, state representatives stood up during the designated debate that always comes before a vote is taken on a bill.

Only this time it really wasn't much of a debate, because the majority was in favor of the bill.

Ultimately House Bill 7095 passed 116 to 1.

"We don't want to be seen as the state of tourism because it's the easiest place to get pills. We need to shut that down and make sure the beaches and golf courses and environment are great places to come. That's the reason to visit Florida, not pills," said Representative Mark Pafford.

The measure, commonly known as the Pill Mill Bill, addresses the problem of prescription drug abuse in Florida, which happens to lead the nation in the number of pills prescribed by unethical doctors.

The U.S. Department of Justice, Drug Enforcement Agency says Florida's population accounts for less than 6 percent of that in the U.S.

Still, 90 percent of the methadone dispensed in America comes from Florida physicians.

From 2008-2009, of all pill mills that dispensed the most oxicotton, 49 out of 50 were found in Florida. In fact, everyday 7 Floridians die of prescription overdose.

Among other things, the bill would ban doctors from dispensing certain controlled substances in their offices or clinics, meaning patients would have to get the drugs at a pharmacy.
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Statement from Governor Rick Scott Supporting Pill Mill Vote

“I applaud Speaker Cannon, Chairman Schenck and the Florida House of Representatives for passing legislation critical to combating Florida’s prescription drug epidemic. I also commend the House for crafting a bill that is both tough on illegal distributors and fair to law-abiding industry professionals.

“I will continue to work the Senate and to ensure that this important bill becomes law. I am confident that legislation coupled with the efforts of the Drug Strikeforce will make Florida a leader in the fight against prescription drug abuse.”

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UPDATE 4-21-2011 at 4:30pm

TALLAHASSEE, Fla. (AP) -- A bill touted as getting tough on "pill mills" that supply drug dealers and addicts with illicit prescription painkillers has passed the Florida House.

The 106-1 roll call Thursday sends the measure to the Senate, where it's expected to meet resistance on grounds that it's still too weak.

The bill (HB 7095) would ban most doctors from dispensing controlled substances and limit pharmacies to dispensing 5,000
doses per month. It no longer has a provision that would have repealed the state's prescription tracking system scheduled to begin operating in August.

A House committee last week removed the repeal that had been proposed by Gov. Rick Scott. He had questioned the effectiveness of
the database and argued it would have infringed on patient privacy. Scott has since backed down.

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UPDATE 4-21-2011

Tallahassee, FL --

House Bill 7095 passed 116 to 1. The bill would lead the way to a major change in the growth management law that does away with some state oversight and returns the duty for managing growth to local government

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[UPDATE] THE CAPITAL, TALLAHASSEE, April 21, 2011 - Jim Saunders -

Amid a growing national debate about prescription-drug abuse, the Florida House is poised Thursday to approve a wide-ranging bill aimed at cleaning up the state’s notorious reputation.

“Florida faces a prescription-drug abuse epidemic like no other in history,’’ bill sponsor Rob Schenck, R-Spring Hill, said Wednesday as the full House began considering the measure.

The bill (HB 7095) would place new restrictions on clinics, doctors, pharmacies and drug wholesalers. Also, House leaders have dropped opposition to moving forward with a planned prescription-drug database that would help track sales of dangerous painkillers.

Among other things, the bill would bar doctors from dispensing two categories of controlled substances in their offices or clinics --- effectively meaning patients would have to get the drugs at pharmacies. The House, however, added an exception Wednesday to allow surgeons to dispense drugs for up to a week after some patients undergo surgery.

House leaders contend such a dispensing ban would eliminate many of the state’s problems with doctors in “pill mills” dishing out large amounts of pain pills.

Another part of the bill sets up a new permitting process for pharmacies that want to sell the two categories of controlled substances. Schenck said that process is designed to make sure unscrupulous clinics don’t create pharmacies to try to circumvent the ban on doctors dispensing dangerous drugs.

Facing objections from small pharmacies, the House moved back a deadline for getting the new permits from Jan. 1, 2012, to March 1, 2012.

But Sally West, director of government affairs for the Florida Retail Federation, which includes pharmacies, questioned whether that was still enough time for the Department of Health to put the permitting system in place. She said the department will have to write permitting rules and get them approved, a process that could take months.

“I think it’s problematic,’’ West said.

Also raising questions is part of the bill that would ban drug wholesalers from selling to a retail pharmacy more than 5,000 “unit doses” a month of oxycodone, hydrocodone or other types of often-abused drugs.
Schenck said the goal of the proposal is to restrict drug supplies. But West said some pharmacies legitimately dispense far more than 5,000 unit doses a month.

Also, a “unit dose” might mean a patient is required to take two or more pills at a time.
Rep. Rick Kriseman, D-St. Petersburg, questioned how wholesalers would even know how many pills they could sell to pharmacies.

“How do we get more clarity here?’’ Kriseman asked.

While the House is expected to approve Schenck’s bill Thursday, it still will have to reach agreement with the Senate on a final version. The full Senate is ready to take up a bill (SB 818) that is substantially different, including leaving out the proposals for new pharmacy permits and limits on unit doses.

Lawmakers, however, are under pressure to pass a prescription-drug bill this session. Shady clinics have popped up in many areas of Florida in recent years, drawing users and traffickers from other states such as Kentucky.

The Obama administration this week ramped up efforts to fight the problem nationally, describing prescription drug abuse as the “nation’s fastest-growing drug problem.’’ Among other things, it called for the creation of prescription-drug databases in every state.

[UPDATE] Miami, Florida - April 19, 2011 -

A new national strategy is being unveiled by the White House drug czar to combat the prescription drug abuse
epidemic and aims to reduce misuse of powerful painkillers like
oxycodone by 15 percent within five years.

The plan is being unveiled Tuesday in Washington by drug czar
Gil Kerlikowske.

It focuses on areas such as education for prescribing physicians
and the public, pushing for tracking databases in all 50 states,
better methods of throwing out unused or expired prescriptions, and
more intense training and focus by law enforcement on illegal pill
mill clinics.

Florida is the epicenter of the deadly rise in prescription
abuse. Doctors in the Sunshine State prescribe 85 percent of all
oxycodone in the U.S.

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[UPDATE] Tallahassee, Florida - April 15, 2011 -

Carol Gentry, Health News Florida

Gov. Rick Scott, whose mantra throughout his campaign and early months in office has been deregulation, on Thursday called on Congress to tighten federal restrictions on companies that make and sell addictive prescription drugs.

Scott offered two other surprises: He said a family member had a serious addiction and bragged about Florida's current crackdown on its pain-pill problem -- including the drug database he long opposed.

Scott mentioned his addicted relative in a question-and-answer session, without elaboration. He said the family member was “addicted his whole life – he never beat it.” He didn’t say what the addictive substance was.

Scott made his comments before a hearing on the “growing danger of prescription drug diversion,” held by the House Subcommittee on Commerce, Manufacturing, and Trade. His prepared remarks had not specifically mentioned tighter federal regulation of drug companies, instead calling for a coordinated effort all along the distribution chain.

After describing the severe problems that Florida has had with the over-prescribing of narcotics to addicts and drug dealers, Scott answered a question about what Washington could do to help states by replying: “regulating these manufacturers.”

“Why are they even able to sell these things?” Scott asked, rhetorically. “Should there be a much more limited use?”

It wasn’t a slip of the tongue, because a few minutes later Scott again called for federal regulation: “There ought to be restrictions on what these drugs can be used for, prescribed (for).”

Subcommittee Chairwoman Mary Bono Mack had asked Scott to appear along with Kentucky’s Gov. Steve Beshear.

Beshear and other Kentucky officials have been sharply critical of Scott’s earlier position opposing a prescription drug monitoring program. Scott had said such a database would be an invasion of privacy.

During his prepared remarks, Scott did mention his concerns, calling the breach of databases a “serious risk” to privacy, since most prescription drug users are law-abiding.

“So, while the database in Florida is brought online, I continue working with my legislative partners to find solutions that protect patient privacy,” Scott said.

Given the tension between the two states, Bono Mack said she had expected “sparks” between Beshear and Scott. Instead, all was harmony, as Scott did an about-face.

Without mentioning his earlier opposition, Scott said the drug database will now be rolled out after being held up by a “lawsuit,” an allusion to an appeal by the losing vendor. That case was resolved last week.

That cleared the way for the Department of Health to begin work, which Surgeon General Frank Farmer – a Scott appointee – authorized last Friday.

Scott said Florida will use lessons learned by early-adopter states like Kentucky in building a database that helps prevent “doctor-shopping” by addicts and dealers, while being as secure as possible from hackers.

Scott's change of position mirrored that of state House leaders, who on Tuesday unveiled an 86-page rewrite of an earlier bill that had called for repeal of the drug database and regulations on pain clinics adopted in previous years.

By accepting the database and other regulations, the House made it more likely that its own tweaks to the law will make it through the legislative session, set to end May 6. They would bar doctors from dispensing two categories of controlled substances in their offices and would set up a new permitting process for pharmacies.

In his prepared remarks, Scott called for a coordinated effort to stop the flood of pills all along the distribution chain. “Together, if we hold the manufacturers, wholesalers, doctors and pharmacies accountable, we can win this fight,” he said.

He praised Florida Attorney Gen. Pam Bondi's leadership on the issue, and she issued a release returning the favor. She also praised the Florida Legislature for bills pending there, which she said offer "the tools we need to stop pill mills."

Bondi also called for Congress to pass "The Pill Mill Crackdown Act of 2011," by Rep. Vern Buchanan, R-Bradenton.

Scott's call for tighter regulation did not specify which manufacturers or which drugs he meant.

But his comments came in answers to questions from Bono Mack about the dangers of OxyContin, which she said was the equivalent of “heroin.”

Bono Mack complimented Scott for his refusal to accept a $1 million grant from Purdue Pharma, maker of OxyContin, that would have supported development of the drug database.

Scott said the funding would come from other private sources.

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Tallahassee, Florida - April 14, 2011 -

Governor Rick Scott releases remarks for the United States House of Representatives Energy and Commerce Committee; Subcommittee on Commerce, Manufacturing and Trade; hearing on the growing danger of prescription drug diversion.
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Pictures are attached. Click on the "Photos" tab above."

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Chairman Bono Mack, Vice Chair Blackburn, Ranking Member Butterfield, and members of the subcommittee, I want to thank you for convening this important hearing on the perils of the illegal distribution of prescription drugs. This dangerous problem is destroying communities in my state and across the nation, so I thank you for your attention.

Last year, throughout my campaign, and in the months since I was sworn in as Florida’s Governor, I have heard firsthand the heart wrenching stories from family members and friends of those who have lost their livelihoods, and, tragically, their loved ones to prescription drug addiction. And, Chairman Bono Mack I know you have been personally touched by this epidemic.

Florida, like much of the nation, has a long history of criminal drug enterprises. The drugs have ruined lives and threatened the safety of our fellow citizens. Across the decades, the names of the drugs have changed, but the problem has remained.

Today, one of the most common names when it comes to the diversion of legal pharmaceuticals for illegal use is Oxycodone. If you consider some of the statistics from my state, the scope of our problem is made clear.

Consider these facts that come from an analysis of the U.S. Drug Enforcement Agency’s (DEA) data:

· 98 of the top 100 doctors dispensing Oxycodone nationally are in Florida – concentrated in the Miami, Tampa, and Orlando regions. (see Chart #1 attached)

· 126 million pills of Oxycodone are dispensed through Florida pharmacies – most of them are in or near the Tampa, Orlando, and Miami regions. (see Chart #2 attached)

By far, more Oxycodone is dispensed in the state of Florida than in the rest of the nation. (see Chart #3)

When confronted with these numbers, a serious problem is plain to see. However, the nature of our response to the problem is sometimes less clear.

The targets for law enforcement have often been the street dealers and addicts – essentially the bottom level of the distribution chain. In fact, one tool that focuses on end users is a database focused on the patient level. This month in Florida, my Department of Health began implementation of such a database.

As the database implementation moves forward, I must draw your attention to a serious risk that I believe databases like this pose to the privacy of individuals – most of whom are law-abiding individuals.

As you know, in 2009 the Associated Press reported a massive privacy breach when hackers broke into Virginia’s prescription-drug database. They obtained more than 8.2 million patient records and a total of nearly 36 million prescriptions.

So, while the database in Florida is brought online, I continue working with my legislative partners to find solutions that protect patient privacy.

More important than computer databases, though, is focusing the resources of my administration on a law enforcement solution that starts at the top of the distribution chain – instead of the bottom.

Every day, we see that pharmaceutical manufacturers and wholesalers turn a blind eye when massive amounts of narcotics stream into the same regions of Florida week after week. Meanwhile, unscrupulous doctors work with storefront pill mills masquerading as legitimate health clinics. Each of these levels (see Chart #4) provides an opportunity for law enforcement to intervene and stop the illegal flow of drugs into our communities.

Since my first days in office, I was told by law enforcement professionals at the state, county and local level that we needed a coordinated, law enforcement response to this criminal plague. Something that, according to law enforcement, had been lacking in Florida.

So, recently, I had the privilege of standing alongside representatives of Florida’s law enforcement community, some of the best professionals in the nation, to initiate an immediate law enforcement response to criminal drug trafficking in Florida.

This action, the creation of a Statewide Drug Strike Force, meant that from the highest offices of statewide law enforcement down to the street cops in our cities, we would open the channels of communication and ensure multiagency cooperation. The goal is clear: target the sources of these drugs before they hit the streets.

Until recently, the burden of enforcement has primarily fallen on local jurisdictions. However, our local sheriffs and police chiefs simply cannot continue to tackle this mounting issue alone. They need the assistance of a statewide coordinated effort that provides intelligence, analytical, and investigative support.

Today in Florida, local law enforcement strike teams are working to identify, investigate, and apprehend those in the medical and pharmaceutical distribution chains who are facilitating the abuse of prescription drugs. Commissioner Gerald Bailey of Florida’s Department of Law Enforcement serves as the statewide coordinator to support the work of local law enforcement, and local strike teams are co-led by Florida’s sheriffs and police chiefs.

In addition, I directed all of the state agencies in Florida that are under my purview to identify investigative resources, licensing and registration information, and analytical research that can be used by law enforcement.

Specifically, I have directed the Florida Department of Health and the Agency for Health Care Administration to provide regulatory and licensing personnel; the Department of Business and Professional Regulation Division of Alcoholic Beverages and Tobacco to provide sworn investigators. Plus, my colleagues on the Florida Cabinet have authorized the Florida Highway Patrol’s participation, and investigators from the Division of Insurance Fraud are supporting this effort. Attorney General Pam Bondi is working with prosecutors across our state to ensure these criminals are prosecuted to the fullest extent of the law. I am grateful to all of these professionals for their commitment to this important work.

Not only are these efforts focused on Florida, but we are also coordinating with other states to shutdown a national prescription drug pipeline that some have called the “Oxy Express.”

In these first days, I can report that a strike force in Central Florida has already assisted in an out-of-state case last week. Just the other day, I was disappointed to learn that a Deputy Sheriff in South Florida was the first drug trafficking arrest made since the initiation of the Strike Force. At this point it is too early to go into details on these cases, but I can tell you investigations are underway and we expect arrests to continue.

I believe these efforts are the crucial and necessary tools to turn off the supply of drugs into and out of Florida. But there is more for Florida to do.

With my partners in the Florida Legislature, we are moving legislation to limit how doctors dispense narcotics and making sure doctors divest from pharmacies. The role of doctors who have forsaken their commitment to people’s health in exchange for the quick buck of unethical and criminal dispensing cannot be overstated and absolutely must be put to an end.

We will also closely review the activities of wholesalers in Florida, and we will put in place tough penalties for those manufacturers and distributors who fail to help us turn off the illegal supply chain.

Let me conclude by telling you I believe we can fight this problem and, with the right strategy, I believe we can win. In my opinion, that strategy is centered on a law enforcement solution that focuses resources at the top of the distribution chain rather than the bottom.

I applaud this committee for taking a serious look at the issue and would ask you to also focus your energy at the sources of this problem. Together, if we hold the manufacturers, wholesalers, doctors and pharmacies accountable, we can win this fight.

Thank you.

Governor Rick Scott


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