Drug users in Florida are dying of pill overdoses at a rate of seven per day as measures aimed at curbing crooked pain clinics are held up in a thicket of delays and setbacks.
After the Legislature last year passed the toughest restrictions yet for pain clinics, here's what was supposed to happened: The state boards of medicine and osteopathic medicine were to hammer out tough new rules for clinics, complete with penalties.
Those rules, combined with a prescription drug monitoring program that would come online Dec. 1, 2010, would staunch the flow of oxycodone painkillers and other powerful drugs from storefront clinics to junkies and multistate drug traffickers.
Here's what actually happened: In a special session on Nov. 16, lawmakers overrode a veto and revived a bill that effectively quashed state agencies' ability to make rules.
Although the state Board of Osteopathic Medicine, which oversees doctors with osteopathic degrees, finalized rules before the veto override, the move shelved pain clinic standards of another medical panel, the Board of Medicine, nine days before they were to take effect.
Now, standards for physicians with doctor of medicine degrees have to wait for the Legislature's approval during the next regular session.
Adding to the uncertainty, Gov. Rick Scott's first executive order, signed the day of his inauguration, "freezes all new regulations" and creates an accountability office to review rules before they're enacted, possibly requiring pain clinic rules to jump another hurdle.
"I hope and expect that the new governor's office, when they say they want the most favorable climate in the world for business, that they're talking about legitimate businesses," said Palm Beach County State Attorney Michael McAuliffe. "These aren't legitimate businesses, and that's the heart of the matter. They haven't been regulated, and they've mushroomed in our communities.
"It is a little frustrating from my position as state attorney, because it looked like we were poised to make some progress," McAuliffe added. "And whether this was a pause or a pushback, I'm not sure."
A spokeswoman for the governor said she was gathering information about the executive order's impact on pain clinic regulation.
As the Florida Department of Health remains powerless to go after medical doctors who are breaking the new standards, a prescription-tracking system that would serve as a powerful weapon against doctor-shoppers and corrupt physicians has yet to materialize.
A law passed in 2008 said Florida's prescription drug monitoring program would grind into gear by last month, but an Ohio company's repeated protests over a contract to run the program have postponed the database at least until spring.
With these measures pending, lawmakers no longer can turn to the state office that led anti-pain clinic efforts and helped focus the Legislature's attention on pain clinics. Scott eliminated the Florida Office of Drug Control before he was sworn in.
"They played a key role, really, in hitting the streets, or the hallways, I should say, and going from office to office, meeting with people and answering questions," said Greg Giordano, chief legislative assistant to state Sen. Mike Fasano, R-New Port Richey, who sponsored last year's pain-clinic bill. "I think the loss of that office, I think it will have an impact on the legislation that the senator's going to work on in the future."
Taken as a whole, the setbacks and obstacles are preventing Florida from carrying out what its own lawmakers have branded a critical duty: stamping out prescription drug-dealing and abuse.
Although frustrated by holdups, Dave Aronberg, newly appointed by Attorney General Pam Bondi to head her office's anti-pain clinic initiative, said the state still is making progress.
"I try to focus on the positive, and I do think there's reason for optimism in 2011," said Aronberg, a former state senator who last year mounted an unsuccessful bid for attorney general. "Once the rules are in place, we're going to aggressively enforce the rules."
Until that happens, and until the prescription monitoring program is up and running, the body count in Florida will continue to rise, said state officials and investigators.
A Florida Department of Law Enforcement report published in December showed deaths caused by oxycodone in the first six months of 2010 were up 25.5 percent compared with the same period in 2009.
At least 1,200 pain clinics were operating statewide, and at least 122 clinics were doing business in Palm Beach County, state records show.
Palm Beach County Sheriff's Office Capt. Karl Durr, who heads a county task force assembled to target prescription drug traffickers, said his detectives were watching pain clinics react to existing rules.
"We're not seeing a change in the amount of pills in the street. It's still out there. These people are morphing their businesses to try to get around regulation," Durr said. "We're not seeing the problem going away. We're still here at ground zero."