In My Opinion | Fred Grimm

Fred Grimm: State slow to regulate pill mills, until the bodies start piling up

The assumption was that Florida fixed these perversities. That new legislation had banished strip-mall oxy peddlers. That we were done with pill mills.

Wayne Douthett knows better. “It’s been going on for three, four years. It’s still going on,” said Douthett, manager of Music Arts Enterprise on Davie Boulevard in Fort Lauderdale. Chasing oxy addicts away from the music store has become a part of his job description.

They line up early at the front entrance of Professional Pain Management Clinic, throngs of them in the mornings, waiting for the storefront clinic to open. “Especially Fridays,” Douthett said. Some Fridays, he said, so many show up that their cars fill the strip parking lot and they drive over to hijack spaces at his music store. He described them as people not apt to make his own customers feel comfortable. “I grew up in the Bronx,” said Douthett, 58. “My wife has been a Miami city cop for 25 years. I do music therapy at a drug rehab. I know what I’m seeing.”

But this Friday, there’s not so many over there. Maybe it’s the rain. Maybe it’s the protesters from STOPP — Stop The Organized Pill Pushers — in their red T-shirts and “Stop the Pill Mills” signs marching along the sidewalk outside the pain clinic keeping the junkies away.

Only about five patients waited at the entrance, with a demeanor that was a peculiar amalgamation of urgent nervousness and broken-down languor. Not threatening. Not unfriendly. But not folks you’d hire as a babysitter.

“I wouldn’t hire them to babysit my dog,” said a shop owner a few doors down.

She said it has long been obvious to the merchants renting space in this old plaza that Professional Pain Management was not some ordinary medical clinic.

Douthett said that it was as obvious as the armed guard they occasionally post at the doorway to manage their unruly patients.

On Friday, one of the patients wandered over to chat with the demonstrators, telling them that he was a Vietnam vet with a damaged gut and that the VA has refused to help him cope with his perpetual pain. He pulled up his black T-shirt to reveal a long scar down his belly. “I’m an addict,” he said.

There was no arguing that.

Back in 2009 and 2010 and 2011, these protests were commonplace, led by parents who had lost children to oxy overdoses. They blamed Florida’s proliferation of barely regulated pain clinics. By 2011, the 900 pill mills in Florida accounted for 89 percent of all the oxy sold in the nation, most of it peddled from walk-in, cash-only, no-insurance clinics that dispensed pills right from the premises. And most of those were in South Florida.

These retail opiate outlets attracted a bizarre influx of oxy tourism from states with more sensible regulations. So many overdose fatalities in Kentucky, Ohio, West Virginia and Tennessee were traced back to Broward and Palm Beach pain clinics that elected officials in those states begged Florida to crack down on its unfettered pill trade.

Meanwhile, we were racking up plenty of our own ODs. Florida suffered 1,185 oxycodone fatalities in 2009 and 1,516 in 2010. But the death toll fell back to 1,247 in 2011, after the Legislature was finally embarrassed into passing laws to rein in pill mills. With the new legislation, this stuff was supposed to be ending.

Not hardly. “We’ve just taken baby steps,” admitted state Sen. Mike Fasano of New Port Richey. Fasano said it had taken him and a few stubborn colleagues nearly a decade just to get legislation passed stopping these clinics from doubling as pharmacies and peddling their pills on site. And a new law passed in 2009 finally barred convicted felons from operating pain clinics.

But the great triumph was supposed to have been a statewide database that tracked opiate and other controlled-drug prescriptions. Doctors and pharmacists, with a few strokes on their computer, could check a patient’s history of prescription controlled drugs and tell whether the patient had been doctor-shopping: going from clinic to clinic and collecting multiple pain prescriptions. Doctor shopping had become the great engine supplying America’s booming oxy street trade.

Except the database law failed to make the checks mandatory. An investigation last fall by the Tampa Bay Times looked at 48 million prescriptions for controlled drugs since the database was initiated in September 2011.

Only 2 percent of the prescribing doctors and 1.7 percent of the pharmacists had bothered to check their oxy patients against the prescription database.

State law, in an outrageous capitulation to anti-regulatory ideologues, also bans the use of public money to fund the database. Fasano and some other supporters formed a private foundation to find the $500,000 a year needed to keep the system operating, but it has been a constant scrounge for adequate funding. Fasano promised that he would file a bill that would allow for public funding and make database checks mandatory for doctors and pharmacists. But he’s up against a governor and some influential legislators apt to resist more regulation. Fasano, frustrated, said he wasn’t sure that the opposition to reforms had to do with ideology or the powerful lobbying interests backing the pharmaceutical industry.

But Palm Beach State Attorney Dave Aronberg, the former special statewide prosecutor for drug trafficking, suggested Friday that counties could plug the loopholes in the state law with their own tough pill mill ordinances. Manatee and Sarasota counties have both cracked down on pain clinics.

“It’s worked well,” he said. And he wants Broward and Palm Beach counties to follow suit.

Even the tepid steps Florida has taken toward regulation has had some notable effects. Most of the oxy tourism seems to have shifted to the more permissive regulatory environment in Georgia.

And some operators have switched to weight-loss or anti-aging clinics, where they’ve revived their cash-only, no-insurance business plan, selling their very profitable pharmaceuticals, various hormones and steroids, right on the premises.

The osteopath listed as owner of Professional Pain Management, for example, also runs a weight-loss clinic in Davie based on an expensive regime of treatments derived from a hormone produced by pregnant women. The FDA has not approved the hormone, known as HCG, for weight loss. Two states outlaw such uses of HCG, but in wide-open Florida, clinics can sell this stuff with little worry about regulations or oversight.

Anti-aging clinics are similarly selling treatments based on human growth hormone, building profitable businesses appealing to vanity or to athletes looking for performance enhancing drugs. Again, these uses were never approved by the FDA. There’s little medical proof of either long-range safety or effectiveness, but at least the bodies aren’t piling up.

Not yet anyway. “We know that these opiates are deadly,” Aronberg said. “With the human growth hormones, we may not know for years.”

Read more Fred Grimm stories from the Miami Herald

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