Lessons learned from one state’s drug crackdown initiatives

Florida’s prescription drug monitoring program (PDMP) and pill mill laws have led to statistically significant decreases in opioid prescriptions, opioid volume and morphine milligram equivalent per transaction, according to a new study in JAMA Internal Medicine.

After the implementation of Florida’s stringent laws and PDMP:

• Oxycodone purchases by Florida doctors decreased 97%, according to the U.S. Centers for Disease Control and Prevention (CDC) and only 13 of the top 100 oxycodone-dispensing prescribers remained in Florida, according to the U.S. Drug Enforcement Administration (DEA). In 2013, that number dropped to zero, according to the CDC.

• Opioid overdose fatalities also plummeted. Between 2010 and 2012, Florida recorded a 26.1% decrease in opioid analgesic overdose deaths, according to CDC. The Florida Department of Health said that from 2010 to 2013, oxycodone overdose deaths fell from 1,516 to 534-a 65% decrease.

These statistics illustrate the dramatic impact Florida’s PDMP and tougher laws have had on rogue pill mills, opioid abuse and overdose deaths, says Kent Runyon, executive director of Novus Medical Detox Center.

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“Other states would be wise to follow Florida’s example, since pain clinics will set up shop wherever there are lax laws and weak regulatory oversight,” Runyon says. “Everyone involved in direct patient care or in any way affiliated with medical care is impacted by persons suffering from addiction and abuse of prescription medications. This behavior increases the cost of care and counteracts any efforts put toward wellness.”

This system tracks prescription medication orders and therefore can lead to the identification of persons who are doctor shopping or by other means are filling prescriptions at a rate that suggests some form of abuse or illegal activity, according to Runyon.

NEXT: Information sharing among states

The programs, which indicate details such as when and where patients have controlled medications filled, could help prevent patients from getting controlled medications from multiple physicians-but current programs could also benefit from modernization, because while they already exist in most U.S. states, the level of information sharing among states is minimal.

“That gap is what allows those struggling with addiction to visit neighboring states and retain access to their drug of choice with no repercussions,” he says.

There are three things to remember, he says:

• There are ways to mitigate the risk of individual prescription medication abuse.

• Sadly, a takeaway is that there are practitioners who are driven by money and not patient care.

• People will go to great lengths to gain access to prescription medications. 

“When the pill mills were shutting down in Florida they began opening in Georgia where they did not have as laws as strong,” Runyon says. “The programs are not necessarily mandated or enforced in all states; and there are indications that some patients attempt to circumvent these programs by filling prescriptions out of state.”

Related:AMCP fights back: Abuse-deterrent opioid coverage mandate

An Express Scripts analysis found that “residents from seven neighboring states filled opiate prescriptions in Missouri as much as four times more often than residents in Missouri filled opioid prescriptions out of state.”

“While many physicians and pharmacists are cautious about issuing prescriptions that can lead to dependency or dangerous interactions, the current system has too many loopholes, which is why so many patients are able to access dangerous combinations of prescription drugs,” he says.

The bottom line is that systems must communicate, Runyon says.

“We cannot ever underestimate the desperate acts that will be taken to gain access to certain prescription medications,” he says. “We need to insure that while we are making it more difficult for people to get access to these prescription drugs that we also continue to make it easier for them to get the help that they need. But while many states are now pushing for databases that allow law enforcement agencies to track drug-related overdoses, deaths, hospital admissions and crimes, the true key to stemming the rise of prescription drug abuse is not by treating addicted individuals as criminals, but by understanding that they were once contributing members of society who now need help getting their lives back.”