FL Legislature improves pain pill oversight, but bills still lacking

April 14, 2013 

Florida, and Manatee County in particular, have made impressive gains in the struggle to corral prescription drug abuse. At the height of epidemic, the easy access to highly addictive pain killers and other narcotic medications exacted a severe toll on the health and welfare of Floridians.

While the number of deaths linked to oxycodone, methadone and hydrocodone has dropped dramatically, thousands of people are still dying each year. The state cannot afford to rest on past success.

Companion bills in the House and Senate improve state oversight over controlled substances but miss the opportunity for tighter regulations. The upper chamber's version, SB 1192, contains a provision that amounts to a poison pill for Manatee County and other jurisdictions. House Bill 831 strengthens use of the state's Prescription Drug Monitoring Program but not as much as originally intended.

A home rule intrusion

Last year, Manatee County adopted an ordinance governing so-called pill mills and physicians -- far stricter than state law. The ordinance bans dispensers from requiring cash-only sales; limits pain clinic hours and governs ownership.

Most significantly, it requires doctors to check the electronic monitoring system before prescribing controlled substances and retain a printout, which law enforcement could inspect.

SB 1192 preempts all local oversight of pain management clinics, eliminating home rule over this societal scourge. Why would the state enable drug abuse by voiding regulations vastly stronger than Florida law?

Soon after Manatee County adopted that ordinance, the number of pain clinics dropped as did the supply of illegally obtained medications. Other counties enjoyed similar success with tighter rules. The state should not scuttle local oversight.

As originally filed, the House legislation included a reasonable and just provision that required doctors and pharmacists to check the drug tracking system. But it was stricken after physicians complained that would be too burdensome on busy doctors. Who's too busy to possibly save a life?

Doctor shopping by addicts and dealers intent on acquiring multiple prescriptions quickly could be prevented by requiring checks of the drug database, established in September 2011. But the House bill omits doctors' mandatory use of the system.

A startling admission

Rep. Cary Pigman graphically illustrated the deep flaw in a voluntary system. The Avon Park Republican -- an emergency room doctor -- wrote a pain medication prescription last weekend but soon heard from a pharmacist who checked the electronic monitoring system. The patient had filled a 100-pill prescription the previous Friday.

"I didn't take that 15 seconds I should have," Pigman recounted in an Associated Press report. "We physicians ... often need a kick in the pants."

So do House lawmakers who watered down Rep. Mike Fasano's bill in favor of shirking doctors who don't want to be bothered with 15- to 30-second tasks.

The New Port Richey Republican accepted defeat of the physician requirement but hopes the House embraces a Senate proposal that requires doctors to check the tracking system for new patients. His bill passed the Health and Human Services Committee and now heads to the House floor.

But HB 831 does contain two positive developments. Prescriptions must be entered into the drug database within two days instead of the current seven days. And the measure allows private sources to fund the system, removing the restriction against pharmaceutical companies from contributing money. That was a bone of contention in the debate before the program was finalized.

System packed with data

The Prescription Drug Monitoring Program now contains more than 56 million records, an invaluable instrument to prevent drug addicts and dealers from doctor shopping. When the Senate and House combine the two bills into one, we'd prefer a requirement that physicians check the database.

Outside of that, every doctor should accept this simple task as part of their practice -- if for no other reason than the part of the Hippocratic Oath about never doing harm to anyone.

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