NDN Guest Commentary by Dr. Weiss - Closing Florida's Pill Mills

Allen Weiss, MD, MBA

December, 2010

Closing Florida's Pill Mills

Every day in Florida, seven people die of drug overdose. One reason: Our state has become a major supplier of prescription drugs for illicit use.

This past fall, the Florida legislature and Governor supported legislation to stop this abuse by closing down so-called “pill mills.” Regrettably, the legislation was never passed. This spring's legislative session should correct this oversight and close down Florida's pill mills.

Pill mill clinics cater to drug dealers, addicts and others, who unfortunately and sometimes unknowingly have become addicted to prescription narcotics. These clinics have become prevalent in Miami and Tampa. While a normal primary care office will see a couple dozen patients per day, a pill mill will see upwards to 60 patients every day—including Saturday!

Pill mills are a lucrative cash and carry business. Patients walk in, undergo a meager history check and physical exam, and then request narcotics and/or tranquilizers. Prescriptions are then given. This, of course, is a travesty on its face. But even worse, many of the unfortunate people addicted to these drugs often resort to crime in order to feed their habit.

According to the Centers for Disease Control and Prevention, deaths from unintentional drug overdoses have risen sharply since the early 1990s. In fact, prescription drug overdose is the second leading cause of accidental death—more than deaths caused by heroin and cocaine combined.

There is a particularly strong correlation between drug-poisoning mortality and the use of prescription pain relievers from the opioid family, such as methadone and oxycodone. A recent New England Journal of Medicine article quoted Utah's state epidemiologist Robert Rolf, “In some ways, this [use of prescription opioids] is an unintended consequence of an intent to treat pain better.”

Nationally, there are one million prescribers of controlled substances and about four million people receiving long-acting or extended release opioids yearly. In response, the Food and Drug Administration (FDA) plans to require opioid makers to provide physician training and patient educational materials for those prescribing and receiving addictive drugs. The FDA has formed a Risk Evaluation and Mitigation Strategy (REMS) committee designed to educate and regulate the prescribing of these narcotics.

The FDA sent back the initial REMS recommendations because they weren't strict enough. This is a step in the right direction.

Obviously, there must be a balance between controlling legitimate pain and the illegitimate use of pain medications. Ethical prescribers, principled pharmaceutical manufacturers, responsible patients, and prudent lawmakers must work together to control pain without causing accidental opioid deaths.

Locally, our state's legislators can do their part at the spring session by closing down Florida's pill mills.