Florida continues to see a rapid rise in fatal overdoses caused by prescription-drug abuse -- a trend fueled by a cottage industry of cash-only pain clinics -- while deaths from illegal drugs wane, according to a report from the state's medical examiners released Tuesday.
Nearly 1,000 deaths were caused in 2008 by the potent painkiller oxycodone -- a 33 percent increase from 2007, the report says. Four years ago, only 340 deaths statewide were attributed to oxycodone, the most popular drug in the black-market pill trade supplied by pain clinics.
Conversely, deaths from cocaine overdoses declined by 23 percent, to 648 in 2008.
Overall, prescription drugs accounted for 75 percent of the drugs found in overdose victims last year, the report says.
"The magnitude and severity of prescription drug abuse calls for strong, coordinated action, " said Bill Janes, the director of the state's Office of Drug Control, in a written statement.
Florida took a step in that direction when the Legislature passed a law creating a statewide database to monitor prescription sales and increasing oversight of pain clinics, which operate with little scrutiny.
The prescription database is designed to detect addicts and drug dealers buying pills from multiple doctors -- often by faking ailments or medical records -- a practice known as "doctor shopping."
"It's almost impossible to monitor different people shopping doctors, " said Dr. Joshua Perper, Broward County's medical examiner. "A person can get hundreds or thousands of pills."
This can also lead to dangerous drug combinations. Perper said the most common overdoses involve mixing several drugs, with oxycodone and anti-anxiety drugs such as Xanax and Valium among the most common combinations.
Though the new prescription monitoring law takes effect Wednesday, the database is not expected to begin operating until late next year.
Broward has become the nation's capital of illegal prescription drug trafficking, police say, with nearly 100 storefront pain clinics feeding a black market in pain pills stretching through Kentucky, Ohio, Tennessee, West Virginia and Massachusetts. Florida leads the nation in oxycodone sales -- largely because of these clinics -- according to U.S. Drug Enforcement Administration data.
In 2008, Perper's office detected oxycodone in 171 Broward County overdose deaths -- more than twice the number found in 2005.
The highest number of oxycodone overdoses were reported in Pinellas and Pasco counties, where the drug was detected in 308 deaths last year.
The medical examiner in that district, Dr. Jon Thogmartin, attributes the unusually high number to advanced detection techniques employed by his lab.
"Prescription drugs have really begun, to a significant degree, to replace illicit drugs, " Thogmartin said.
Thogmartin said many victims overdose on pills prescribed to them by licensed doctors.
To health advocates, this shows that doctors practicing as pain-management specialists need more training and more oversight from the state medical board.
"It's unacceptable to open up a practice and call yourself a pain management physician and start writing prescriptions, " said Dr. Laura Brown, a Bradenton physician on the board of the American Society of Interventional Pain Physicians. "That's not pain management."