The Spillover

Pain prescription routes to and from Florida infect Kentucky with abusers

By KATIE BRANDENBURG - The Independent

Several years ago when investigating a case, Roy Ison, of FIVCO area drug enforcement, got on a discounted flight from Tri-State airport to Fort Lauderdale, Fla.

When Ison boarded the plane, he found six he knew to be drug dealers among his traveling companions.

The flight was frequented by those hoping to get prescriptions for pain medications in Florida and bring them back to Kentucky to sell, Ison said. It cost about $38 one way and $68 round trip.

He said a law passed by the Florida legislature will help make similar situations rarer.

Law enforcement and drug control officials in Kentucky say a Florida law signed in June will help shut down a pipeline of prescription medication from Florida to Kentucky. The bill creates a prescription drug registry system similar to one in Kentucky and gives the Florida Medical Board power to inspect pain management clinics that thrive in Florida’s southern counties.

Ison said abuse of prescription drugs began to be a large problem about eight years ago.

“It is THE problem in the region,” Ison said. “There’s no other problem.”

Boyd County Sheriff Terry Keelin said three years ago about 900 people in the area traveled down to Florida to get pain medication, and the number making the trip has only gone up since then.

According to the Office of Drug Control Policy, Kentucky led the nation in non-medical use of prescription drugs last year.

Methadone, a pain medication also used to treat withdrawal symptoms, was a factor in 16 percent of Northern Kentucky deaths in 2006. That number increased to 43.2 percent in 2007 and settled at about 21.2 percent in 2008, according to reports from the State Medical Examiner.

In comparison cocaine was a factor in 15 percent of deaths in 2006, 6.2 percent in 2007 and 9.5 percent in 2008.

Keelin said the problem with abuse of prescription medication began with people using the Internet to order medication and having it shipped to the state or to neighboring states.

“Then Florida, of course, opened up like a bottomless pit,” Keelin said.

The Internet problem still exists, but it became less attractive after pain management clinics made it easy to get prescription in Florida, he said. People drive down to Florida, get fake Florida IDs, and get prescriptions using them.

Lewis County Sheriff Bill Lewis said his county deals with the same problem. He said the majority of people his officers arrest for trafficking prescriptions got them from Florida.

He said prescription drug trafficking also leads to other crimes such as theft of either medications or of other items which can be sold to buy the drugs.

“They’re sucking on society,” Lewis said. “They’re parasites.”

Keelin said pain management clinics in Florida try to attract the business of people in Kentucky, referring to a letter sent to a Boyd County resident from a clinic called Executive Pain in West Palm Beach, Fla.

“There are no procedures done here; we treat pain through the use of medication,” according to the letter. “There is an on-site dispensary also for your convenience to fill your medication which has very competitive prices.”

Sen. Mike Fasano, R-New Port Richey, said the recently passed legislation has been in the works for about seven years, since former Gov. Jeb Bush originally called for a prescription monitoring program.

The bill was narrowed in scope and backed by the support of medical and pharmacy groups this time around, he said.

Pain management clinics specializing in treatment through pain medications such as oxycontin are most abundant in Broward and Miami-Dade counties in the southeastern tip of the state, Fasano said.

“Florida is looked at as the pill mill of the U.S.,” he said.

The system, which will be set up by December 2010, will require dispensers of schedule II through schedule IV drugs to submit information to an electronic monitoring system. Dispensers can be either pharmacies or clinics that have an on-site dispensary. They must report to the system within 15 days of dispensing the prescription.

Fifteen days is a minimum, and as people get more familiar with the system that wait period should decrease, Fasano said.

He said the new law will help to prevent people from doctor shopping, visiting multiple doctors to get multiple prescriptions.

“I guess I’m hoping that we’re not only going to save Florida lives, but we’re going to save lives in Kentucky as well,” he said.

The bill states that in 2007 an average of nine Floridians died each day from prescription drugs.

Despite the purported benefits, some Florida representatives didn’t support the bill when it came up for a vote

Rep. Bill Proctor, R-St. Augustine, said he voted against the bill because it didn’t have enough protection for people’s private information. He’s not against the idea of a registry but its potential for leaks.

Proctor referred to a situation in Virginia in April where a hacker breached the state’s prescription monitoring Web site at the risk of millions of records. As of June, the system was still not restored.

Fasano said the system will only be accessible to doctors, pharmacists and police when they are working on an open investigation.

William H. Janes, director of the Florida Office of Drug Control, said that, while setting up a monitoring system is an important step in the fight against prescription drug abuse, regulating the pain clinics at the center of the problem is also key.

In addition to establishing the prescription monitoring system, the bill also calls for the Florida Board of Medicine to set up a list or guidelines for clinics that primarily prescribe pain medication. Those clinics will have to register with the board and pass an inspection.

“Once the Board of Medicine promulgates rules to inspect these pain clinics, many will just go out of business,” Fasano said.

Janes said the Department of Health is working on setting those rules up, and he expects them to be in place before the December 2010 deadline. The Florida departments of Drug Control and Health will meet in September to review possible plans for the system and estimates of how much it will cost.

Eulinda Smith, a spokeswoman for the Florida Department of Health, said there isn’t a clear picture yet of what the new system will look like. It was signed into law recently and doesn’t have to be in place for about a year and a half.

“It’s still in the grassroots stages,” she said.

But despite the newness of the program, Ison said he’s seeing a small but visible impact from the bill’s passage.

“You’re talking about a number of years before you see a drastic effect,” he said.

Ison said drug dealers and pain clinics alike have heard about the bill and are changing behavior because of it. He’s seen trafficking from Florida slow and said the bill has scared people out of going.

“It’s already had an effect,” Ison said.

He said the most significant effect of the bill will be upon the management of the pain clinics.

Circuit Judge George W. Davis III said the area’s drug problem used to come from a pipeline for illicit drugs such as heroine and crack cocaine from Columbus and Huntington. As prescription drugs became more accessible the pipeline was replaced by one moving those medications from Florida.

Those drugs are easier to get and have less of a social stigma than heroine or cocaine, Davis said.

“They created in this area thousands and thousands of new addicts,” he said.

Davis said he’s hopeful the new legislation will help shut down the Florida pipeline, but that won’t solve the problem as a whole.

He said he thinks illicit drugs will start to come back into the system—this time with a much larger number of potential addicts.

Davis said the only effective way of dealing with the problem is money spent on law enforcement and treatment.

Van Ingram, acting executive director of Kentucky’s Office of Drug Control Policy, said he worries the problem will only move to another state, specifically Georgia, which doesn’t have a prescription monitoring program.

Georgia is one of several states considering PMP legislation, according to the Office of Diversion Control Web site. PMPs were operational in 32 states as of 2008.

Ingram said his office has been working to form a group people from many different fields including medicine, pharmacy and insurance to come up with strategies to help with Kentucky’s prescription abuse problem.

“So many of us own a piece of this problem, “ he said.

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