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3-day pill limit sparks fight

 By Jim Saunders
 3/2/2010 © Health News Florida

As Florida lawmakers try to crack down on notorious pain clinics, a debate is seething on whether to limit dispensing of pain pills to three days' worth. Such a cap would help in the fight against pill mills, advocates say, but it would also cut off a lucrative sideline for legitimate practices that can bring in $10,000 a month.

The Florida Medical Association and some other groups object to a provision in a House bill that would impose a 72-hour supply limit on often-abused drugs such as oxycodone, Soma, Xanax and Vicodin.

FMA argues that many doctors, such as oncologists or orthopedic surgeons, legitimately dispense those medications in their offices, sparing patients a separate trip to the pharmacy. Rep. Ronald "Doc" Renuart, a Ponte Vedra Beach Republican and physician, said the limit should be more narrowly tailored to apply only to pain clinics.

"We're still looking for the right way to filter between the legitimate care of patients in Florida and those who are just in it for profits'' and are hurting the state, Renuart said.

Despite the protests, the House Health Care Regulation Policy Committee on Monday approved a bill that includes the 72-hour dispensing limit and other proposals to stem the flow of drugs from the clinics.

Those drugs are carried to many other states that took effective steps earlier to curtail the illicit trade in prescriptions. The U.S. Drug Enforcement Administration says that all 50 of the top prescribers of oxycodone in the country are in Florida, according to a House staff analysis.

"This is a national issue,'' said Rep. Joseph Abruzzo, a Wellington Democrat who is a bill sponsor. "Florida's truly the gateway to supply the rest of the nation.''

Last year Florida lawmakers passed a bill to rein in the pain-management industry, including establishing a database of controlled substances dispensed in the state. But that database is at least a year away from reality, and continuing reports of flagrant drug abuse through the clinics is pushing lawmakers to pass additional measures during the 2010 legislative session.

During Monday's committee meeting, Capt. James Durr, commander of the Palm Beach County Sheriff's Office narcotics division, described the spread of prescription drugs in Southeast Florida: "Once where you could get crack cocaine and heroin on the street, now you can get pharmaceuticals.''

A group of students from Hialeah Gardens Middle School in Miami-Dade County also spoke in favor of the bill. They attended the meeting with science teacher Kerri Navarro, who told lawmakers of finding her mother dead in 2003 because of an overdose of prescription drugs.

The House bill's proposed changes include some that are controversial, such as requiring that pain-management clinics be owned by physicians and placing doctors at risk of disciplinary action if their clinics advertise controlled substances.

But the debate Monday focused heavily on the part of the bill that would prevent doctors from dispensing more than a three-day supply of potentially addictive drugs. 

While most doctors simply write prescriptions for patients to get filled at a pharmacy, some become "dispensing physicians" by registering with the Department of Health and paying $100. According to a House staff analysis, about 7,100 physicians are registered to dispense drugs in the state.

Tallahassee orthopedic surgeon Steve Jordan told the committee that doctors have legitimate reasons for dispensing drugs. As an example, he said, many patients have problems getting around, making it more convenient to get medications from their doctors. 

Renuart briefly proposed --- and then withdrew from consideration --- a change to the bill that would have sought to exempt most doctors from the three-day rule. The proposal would have barred pain-management clinics from dispensing more than 72 hours' worth of pills to patients who pay with cash or credit cards.

Jeff Scott, general counsel for the Florida Medical Association, said the physicians' organization opposes the broader 72-hour restriction in the House bill but supported Renuart's proposed change. The proposal would have tried to differentiate between cash buyers and legitimate patients, whose care is more likely to be covered by insurance.

"The problem (is) the clinics that see nothing but cash-paying patients,'' Scott said. 

Rep. John Legg, a Port Richey Republican who also is sponsoring the bill, said the three-day supply limit is important to the bill. He said pain clinics will find ways around other regulations, but that the 72-hour provision can help serve as a "breaking point.'' 

Allan Escher, a board-certified pain specialist and member of the Florida Board of Osteopathic Medicine, told Health News Florida that dispensing is "where the money is," especially for generics, where the markup is huge.

Escher was a dispensing physician doing full-time pain control until about a year and a half ago, when he went back to anesthesiology for a break, he said. In his practice, dispensing brought in $8,000 to $10,000 a month in insurance payments. That, he said, was "small potatoes" compared to pill mills that do a cash business. 

Escher served as co-chair on a joint committee of the state's medical boards, which were charged with drawing up rules for pain clinics. The rule adopted by the osteopathic board last weekend and scheduled for a vote by the Board of Medicine on Wednesday does not include a 3-day limit on dispensing. 

So the three-day limit on dispensing is up to the Legislature.

--Carol Gentry, Editor, contributed to this report. She can be reached at 727-410-3266 or by e-mail. Capital Bureau Chief Jim Saunders can be reached at 850-228-0963 or by e-mail