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Fla. takes first step to thwart pill mills

TALLAHASSEE -- Florida lawmakers on Thursday approved a plan to monitor the prescription drugs sold by doctors and pharmacists throughout the state, hoping to shed South Florida's reputation as the fountainhead of black-market painkillers flooding the eastern United States.

By a vote of 103 to 10, the House of Representatives agreed to create a statewide database to track drug purchases and curb "doctor shopping" by addicts and potential drug peddlers seeking pills from multiple physicians. Last week, the Senate also approved the bill, which Gov. Charlie Crist is expected to sign into law.

Florida is one of only 12 states without such a law -- making the state a magnet for pill dealers from elsewhere who come to Florida's pain clinics to buy pills undetected, narcotics investigators say.

Backers of the bill say the database will allow doctors to track the prescription history of patients and flag those getting pills from other doctors. In some instances, law enforcement investigators will be able to obtain prescription records.

In a two-part series in March, The Miami Herald explored how a growing cottage industry of storefront pain clinics has exploited lax regulations to feed an illegal pill pipeline stretching through Appalachia and the Northeast. Investigators say the number of pain clinics in South Florida has ballooned from an estimated 60 to 150 in the past year -- with at least 89 in Broward County alone.

DUBIOUS DISTINCTION

"I'm ashamed that my county has the unenviable distinction of being the pill mill capital of the United States. We have a chance to change that, " said Rep. Ari Porth, D-Coral Springs.

During Thursday's 90-minute debate, lawmakers also denounced the clinics for trying to lure patients with blaring advertisements, discount coupons and the promise of narcotics sold on-site.

"Come to Broward County. Have some fun. Buy some pills, " scoffed Rep. Evan Jenne, D-Dania Beach.

Health advocacy groups battled for seven years to win approval for a prescription monitoring program, but the proposal was repeatedly shot down in the Legislature over patient-privacy concerns. The issue didn't gain traction among lawmakers until the prescription drug problem grew into a crisis.

In recent years, South Florida pain clinics have become a chief supplier of illegal painkillers around the country -- with Broward at the heart of it. In the last half of 2008, the nation's top 50 doctors dispensing oxycodone -- an addictive and potentially dangerous narcotic -- all practiced in Florida, with 33 of those doctors working in Broward, according to the DEA.

The proliferation of pain clinics has fueled a rapid rise in overdose deaths, health officials say. Florida deaths from prescription drugs now outnumber deaths from illegal drugs such as cocaine and heroin. The number of deaths in the state blamed on oxycodone doubled between 2005 and 2007, to more than 700, state records show.

BEYOND FLORIDA

South Florida pills are also responsible for deaths in other states.

Kentucky's lieutenant governor, Daniel Mongiardo, said he began lobbying Florida officials to pass the prescription-monitoring bill after receiving complaints from doctors in Kentucky emergency rooms who were routinely treating overdose victims with pills prescribed by Florida doctors.

Kentucky created one of the nation's first prescription monitoring programs several years ago, greatly reducing "doctor shopping" in that state, said Mongiardo, who is also a surgeon. But that pushed the black market to Florida and other states without monitoring programs.

"It really made a huge difference in this state. Hopefully, we'll see the same thing there, " Mongiardo said.

Supporters say the monitoring program -- which begins operating in December 2010 -- will not just prevent illegal pill sales, it will help doctors identify potential addicts and get them treatment.

"It's also trying to get people the help that they need, " said Joel Kaufman, executive director of Broward's Commission on Substance Abuse. "This will really be an important tool in our strategy to address this pretty significant problem."

OUT OF REACH

The new legislation has its limitations. For example, the bill does not require pain clinics to adhere to licensing rules requiring criminal background checks for owners and employees -- rules that apply to most other health clinics. The Miami Herald has identified six South Florida pain clinic owners or doctors with felony records.

"We ought to consider attacking the problem where it really happens, at the pain clinics, " said Rep. Ellyn Bogdanoff, R-Fort Lauderdale, who offered and later withdrew a proposal to limit the number of pills doctors could sell directly to patients.

The new legislation does require pain clinics to register with the state, and it mandates annual inspections by the Department of Health. It also gives the Board of Medicine the authority to draft new rules governing how the clinics operate.

"This bill may not be a perfect bill but it's a great bill taking us in the right direction, " said Rep. Marcelo Llorente, R-Miami, who sponsored the House bill along with Kelly Skidmore, D-Boca Raton, and Kurt Kelly, R-Ocala. "Let's end the practice of doctor shopping."

The monitoring program, expected to cost more than $4 million, will not be paid for by state tax dollars. Officials plan to seek federal grant money.

PRIVACY CONCERNS

Lawmakers, including several from South Florida, continued to raise privacy concerns, worried the state was gathering sensitive data about its residents.

"We are spending money and we are creating a database to track our citizens and their activities, " said Rep. Carlos Lopez-Cantera, R-Miami, who voted against the measure. "And I just don't believe in that."

The manager of one Gulf Coast clinic already has vowed to file a lawsuit challenging the prescription-monitoring program, arguing that it violates the privacy guarantees of the Florida Constitution.

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