By Jamal Thalji and Tia Mitchell, Times Staff Writers
Tuesday, February 7, 2012
New laws, tougher enforcement and the prescription drug monitoring database have cut sales of oxycodone from doctors' offices and pharmacies dramatically. That's the word from a federal report that some officials say shows Florida is starting to win the fight against prescription painkiller abuse.
But Pinellas Sheriff Bob Gualtieri said there's just as much oxycodone as ever being sold illegally. The narcotic caused the most drug-related deaths — 1,516 — in Florida in 2010, records show.
"It's a step in the right direction," he said of the new initiatives. "But we're not seeing any difference at the street level."
The sheriff said his measuring stick is the price of one illegally obtained tablet of oxycodone. It's $17 in his jurisdiction — and has been for the past eight to 10 months. That's compared with the $1 someone with a legitimate prescription would pay for one pill, according to Gualtieri.
"We see fluctuations in heroin and cocaine costs," he said. "When there are some significant drug seizures, you'll see the price go up because supply was down. It's a simple business concept."
But in the street price of oxycodone, the sheriff said: "We're not seeing any changes."
Plus, he said, there are just as many people struggling with prescription drugs as ever, to judge from his deputies' workload.
Last week the Drug Enforcement Administration said new state laws and local and federal law enforcement efforts have struck at Florida's reputation as the "epicenter" of the nation's pill mills. That status was solidified in 2010 when the DEA said Florida had 90 of the top 100 doctors in the nation who purchased the most oxycodone to sell from their offices. Such direct sales are a hallmark of notorious storefront operations that drew streams of drug-seekers from around the country.
But in 2011, thanks to the state's new measures, the DEA said the number of Florida doctors on that dubious list fell to just 13.
In July a new state law took effect that forbids most doctors from dispensing prescription painkillers like oxycodone, hydrocodone and Vicodin. The result: There was a 97 percent drop in the amount of oxycodone sold out of physicians' offices in 2010 compared with 2011, according to the DEA.
Last year the prescription drug monitoring database, which tracks patients' prescriptions to deter doctor-shopping, was strengthened by the Legislature, but only after it survived opposition from some Republican legislators and, initially, from Gov. Rick Scott.
Sen. Mike Fasano, R-New Port Richey, the bill's champion, recalled colleagues' efforts to not only repeal the database, but also loosen existing regulations on drug sales.
The senator was not surprised to hear that law enforcement is still seeing a brisk street trade in prescription drugs.
"Although we've made some significant inroads in addressing this prescription narcotic epidemic, we still have a long way to go," Fasano said. "The database, though, is working. I know that for a fact."
The database now contains information on 26 million prescriptions dating back more than a year, according to a Brandeis University study.
The DEA said Florida's stringent new measures have forced out-of-state addicts who used to visit the state's pill mills to seek painkillers elsewhere. Officials say that's why more doctors in Georgia, Kentucky and Tennessee are dispensing oxycodone.
Tampa Bay area law enforcement officials say there has been a decline in pill mills all over the region. In Pinellas, there were 65 to 70 about 18 months ago, Gualtieri said. Now, he estimated, it's in the low 20s.
The pill mill problem also has hurt those who need pain relief the most, said David Craig, a pharmacist at Moffitt Cancer Center in Tampa.
"This whole front for illegal activity has cast a cloud over the legitimate care of patients," he said.
Craig is also concerned that the state's efforts have made it harder for legitimate pain patients to obtain the painkillers they need. Fewer pharmacies are carrying oxycodone now for fear that the authorities will investigate them. Late last year, for instance, CVS announced it wouldn't accept narcotics prescriptions from some doctors.
"The financial reward to managing a patient's pain is very little," Craig said. "So a lot of people who are in it are asking themselves, do I want to be investigated by the DEA? Do I want to stick my neck out?"
Craig said that he even knows cancer patients who see news reports of oxycodone being abused, and then wonder if they should be taking such a drug.
"It's not in vogue to prescribe oxycodone," Craig said. "I think it strikes fear in a lot of doctors, patients and pharmacists.
"Oxycodone is a bad word these days."
Dr. Rafael Miguel, a pain physician and professor at the University of South Florida, said there are still enough pill mills to harm pain patients in other ways: They're soaking up so much oxycodone that they're making it harder for patients to obtain them legally.
"The shortage is being produced because pill mills continue to write scripts for massive and unjustified numbers of oxycodone," he said.
The sheriff said a day doesn't go by that his deputies don't have to wrestle with the prescription painkiller in some fashion.
"Whether it's a theft call, a domestic call, a mental health call, it permeates our calls for service every day," he said.
The sheriff said he thinks the oxycodone crisis has peaked, but ultimately the prescription painkiller problem is really about treating addiction.
"As long as they're addicted, they're going to find another opiate," Gualtieri said. "That's why the answer to this is dealing with the addiction problem."
Information from the Miami Herald was used in this report. Jamal Thalji can be reached at thalji@tampabay.com or (727) 893-8472.