RX for Danger: Local officials, law enforcers step up prescription-drug battle

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Should doctors be charged with murder when their prescriptions are linked to fatal overdoses?

It's one idea being considered in Central Florida as local officials and law-enforcement agencies wrestle with the prescription-drug epidemic sweeping the state.

"This is all about greed," said Orange-Osceola State Attorney Lawson Lamar. "These doctors prey on the weakness of these patients."

In the absence of clear direction — or action — fromTallahassee, "we've got to deal with this ourselves," Metropolitan Bureau of Investigation Director Phil Williams recently told a group made up of Orange County officials with a stake in the battle against the proliferation of prescription-drug abuse.

Unlike 35 other states, Florida doesn't have an operational database that tracks prescriptions doctors write for certain drugs, and those who are prescribed the drugs. Florida lawmakers adopted plans for one in 2009, but a bid dispute kept it from running.

It didn't help that Gov. Rick Scott was opposed to the Prescription Drug Monitoring Program for privacy reasons, prompting the White House and officials from other states to implore that he change his stance.

Florida lawmakers responded to the crisis this year by approving legislation aimed at cracking down on the state's so-called pill mills that was signed by Scott earlier this month.

It was a step forward, considering Scott had axed the state Office of Drug Control when he took office in January. Like the Orange County group, state leaders seem to be acknowledging the prescription-drug battle must be fought on several fronts.

"I truly see that this is not just a law-enforcement issue. It is one that our entire community, our entire society needs to embrace and understand," said Ken Tucker, assistant commissioner of the Florida Department of Law Enforcement. "In order to deal with it, you have to take a multipronged approach. We can't arrest our way out of it."

'On the right track'

When the Orange County work group met in April, it was the first time in Central Florida that law-enforcement, health-care, pharmacy and public-policy officials had gathered in one place to discuss their concerns.

Pharmacy representatives said they were frustrated by the lack of action taken against doctors who overprescribe, because they are the ones who come face to face with drugs addicts or traffickers looking to fill prescriptions after doctor shopping. Law-enforcement officials said they don't have the legislative tools needed to go after bad doctors or traffickers.

"I am impressed that we can bring together all of these different components of our community to solve a problem," Orange County Mayor Teresa Jacobs said. "I think we're absolutely on the right track."

Jacobs recently appointed her predecessor, Rich Crotty, to chair a new prescription-drug task force that will analyze Florida's new pill-mill law and also look at issues surrounding the county's moratorium on new pain-management clinics — a ban that will expire in December.

Jacobs said she wants to make sure that when the county's moratorium expires and the new state law takes effect, "that we're doing everything at a local level that we can to stop these pill mills — these clinics that clearly are not there to serve legitimate pain-management needs."

"We're not tolerating this in Orange County," Jacobs said. "It's not just a public-safety issue … this state, this community, cannot afford the continued reputation that we've developed in a very short period of time."

Database debuts in fall

Though it will be significantly behind schedule, Florida's Prescription Drug Monitoring Program is slated to debut in October. Supporters say it is one of the best tools for combating the prescription-drug epidemic.

Law enforcers say it will discourage doctor shopping and help officials catch doctors who overprescribe. The lack of one, until now, has fostered Florida's reputation as a state where dangerous, addictive prescription drugs are easy to come by.

Here's how the PDMP works: Anytime a prescription is dispensed for certain powerful, addictive pain and sedative medications, the doctor and the patient's name are entered into the database. Just the notion that the names and drugs are being tracked can serve as a deterrent, local and state officials say.

Scott's initial opposition to the PDMP outraged many across Florida and the nation.

"I, along with a host of national leaders, have expressed our continued frustration that an inordinate number of the drugs on Main Streets around the country are heralding from South Florida," said U.S. Rep. Hal Rogers, a Republican from Kentucky, the state that leads the nation in the nonmedical use of prescription drugs. "Florida's participation will be vital to the success of our nation in fighting this problem. We need to shut down this pipeline across state lines, and it is vital for Florida to move forward with its PDMP."

Many states — including Kentucky, Ohio and Tennessee — have PDMPs; public officials there have lamented that their residents can come to Florida, where their drug purchases are not tracked.

Florida Attorney General Pam Bondi, a former prosecutor elected to office in November, has championed the PDMP and tougher penalties for pill-mill operators and rogue doctors.

"The prescription-drug crisis is a tragic and far-reaching drug epidemic that Florida and many other states are facing," Bondi said. "Unfortunately, children and teenagers think that because these drugs are legal that they are not dangerous. Drugs like oxycodone … have surpassed illicit drugs in killing our youth."

Noting the rising death toll, some prosecutors across the country, including in South Florida, have charged doctors with murder when their prescriptions are linked to fatal overdoses. Prosecutors in some other states, including Nevada, have done this as well, though it is by no means a widespread practice.

It's a concept that Lamar said he would consider here — when he has the perfect case.

Central Florida law enforcement and the Medical Examiner's Office already know which doctors are associated with fatal overdoses.

When someone dies, the responding agencies gather clues — sometimes it's as obvious as a pill bottle or prescription. But the cases are complicated, and many thresholds have to be met before Lamar is willing to take that next step.

"It is murder," Lamar said. "These people don't die by a gunshot. They die by going to sleep."

apavuk@tribune.com or 407-420-5735

Copyright © 2014, Los Angeles Times
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