A new, improved pill mill bill

The misguided attempt by gov. Rick Scott and some legislators to dismantle Florida's program for monitoring high-powered narcotics has created a window of opportunity.

In 2009, the Republican-led Legislature passed a law that created the Prescription Drug Monitoring Program. The program calls for the implementation of a secure database for tracking narcotics and other drugs as they are dispensed.

The legislation resulted in some important regulations to stem the spread of so-called pill mills that dispense enormous volumes of painkillers and sedatives. But the purchase of a system for creating and managing the database was slowed by a dispute over the state's bidding process.

Then, after Scott took office, he proposed eliminating the database, citing privacy issues and potential long-term costs.

The legislation approved two years ago contained a long list of provisions intended to protect the privacy of patients prescribed drugs such as OxyContin, a painkiller, and Xanax, a sedative. Those are among the drugs that have been prescribed and dispensed in huge volumes, and have been linked to a rising number of deaths — in the thousands — in Florida.

The 2009 law clearly calls for the use of private funds to create the database. A private foundation raised $500,000 and, recently, Purdue Pharma offered $1 million to fund the program two years. Yet Scott maintained his opposition, saying the program might someday require state funds.

To which state Sen. Mike Fasano, the original sponsor of the bill, effectively replied recently: So what?

Broad base of support

Fasano, a republican from Pasco County, recently introduced a new proposal — Senate Bill 818 — that not only would maintain the Prescription Drug Monitoring Program but strengthen its provisions.

For instance, SB 818 would provide stricter penalties — including felony criminal charges — for narcotics dispensers who repeatedly fail to put the required information into the monitoring system. This provision would improve the 2009 legislation and is warranted; ditto for a requirement for dispensers to consult the database before selling the drugs in question.

Fasano's bill would erase the current prohibition against public funding of the system; the senator, whose work on this legislation has been exemplary, said he would consider negotiating over the funding provision, but not the entire program, with the governor or the House.

Senate president Mike Haridopolos has, to his credit, stood firmly behind the program, known by its acronym, PDMP. Sen. Mike Bennett, a republican whose district includes our region, has publicly declared his support as well.

The PDMP has broad-based support from sheriffs, pain-management experts, drug-treatment providers, public and private hospitals and others.

Attorney general Pam Bondi has spoken out strongly in favor of maintaining and improving the program. "It's such a horrible, horrible problem in our state. We have become the destination for drug dealers," Bondi recently told the Senate. "We've got to have a comprehensive strategy."

She's right — and a comprehensive strategy requires a statewide database and monitoring program.

Beyond the state level, U.S. rep. Vern Buchanan, a republican who represents Southwest Florida, recently said he will introduce federal legislation to help reduce the number of pill mills. In a guest column published in the Herald-Tribune, Buchanan also stated: "I support a state drug database approved by the Florida Legislature that would allow us to track these narcotics and identify abusive practices."

Diversionary tactic

In the state House, rep. Robert Schenck, the republican chairman of a key health committee, has attempted a diversionary tactic. Under the guise of getting tough, Schenck's bill would prohibit all doctors from dispensing painkillers. Worse, the bill would deregulate pain clinics and repeal the database mandate.

That response is flawed. It doesn't recognize that the 2009 law restricted the ability of many doctors to dispense painkillers and ignores findings presented to the Senate.

For example, only about 16 percent of oxycodone prescribed in Florida is dispensed by physicians; the rest is dispensed by pharmacies and hospitals, and would not be adequately monitored without the database.

Certainly a small but significant percentage of doctors have unethically — and sometimes illegally — dispensed painkillers and other potentially addictive or dangerous drugs. Some of them have been caught and prosecuted; the remainder would find it more difficult to evade detection, however, if they were required, under the threat of penalty, to report their actions.

The lack of a database would also hinder efforts by concerned physicians and law enforcement agencies to prevent patients — including those truly in need of pain medicines or tranquilizers, as well as black-market dealers — from going from one doctor to another to obtain repeated, high-volume prescriptions. It would also make it harder to determine whether drug buyers are being directed to pharmacies willing to provide pills in inexplicable amounts.

Painkillers and sedatives are invaluable to patients who need them; their access should not be unnecessarily impeded. But the need to maintain the PDMP, implement the database and provide stricter penalties for noncompliance is clear. These drugs have been cited as the cause of at least 2,500 deaths annually in Florida and our region — especially its young people — have been particularly vulnerable to misuse and abuse. What's more, Florida has become a destination for out-of-state traffickers.

Opponents of the PDMP needlessly reopened this political debate. We hope proponents seize this opportunity to not only maintain the program but make it more effective — in order to meet the state's fundamental duty to save and protect lives.

(Published by Herald Tribune - March 21, 2011)