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Limits on pain pills defeated

By Jim Saunders
4/14/2010 © Health News Florida 

In a win for the Florida Medical Association, both the House and Senate have dropped proposals that would have barred pain-management physicians from dispensing more than 72 hours' worth of controlled drugs from their own offices. The proposals would have forced patients to get prescriptions filled through pharmacies if they wanted more.

Now another contentious issue has cropped up: A House bill would require the state to contract for a new drug computer network --- a requirement that has drawn concerns from the Senate and questions about whether it would be targeted at one vendor.

Even as Florida continues to serve as the East Coast supplier of narcotics to addicts and drug-runners, a key senator said Tuesday he does not know whether the two chambers will be able to agree on a bill at all this year.

"We're not even near the House,'' said New Port Richey Republican Mike Fasano, who is a lead sponsor of the Senate bill. "Our bill is light years away from what the House is proposing.''

The FMA and other physicians' groups lobbied to eliminate proposals that would have barred doctors from dispensing more than three-day supplies of controlled substances from their offices. An initial House bill included the limit, while a Senate proposal would have prevented such dispensing when patients pay with cash, checks or credit cards rather than insurance.

Doctors' groups argued that the three-day limit would hurt legitimate physicians who essentially fill their own prescriptions for controlled substances by dispensing them directly. They say it's more convenient for patients, many of whom have mobility problems, to get pills from their doctors. Such dispensing, which requires a separate license, can be lucrative.

A Senate committee approved a bill Tuesday that does not include the 72-hour limit; instead it requires most pain-management doctors to document in patients' records the reasons for dispensing more than a three-day supply. A House committee last week also eliminated a proposed limit.

Instead, the House committee would have state officials request information about potential dispensing doctors from state and local physicians groups and other sources such as hospital medical chiefs. If the state received negative information about the doctors, it would not allow them to dispense controlled substances.

Jeff Scott, general counsel of the FMA, said that sort of self-policing system would be effective.

"The doctors in the locality know who the bad dispensing physicians are,'' Scott said.

The bill would provide immunity from civil liability to people who provide information about the doctors. Also, there is an accompanying bill that would allow the information to remain confidential unless it is used in an investigation that results in a probable-cause finding.
The issue about dispensing more than a three-day supply of drugs has been one of the highest-profile parts of a debate about trying to shut down Florida's notorious "pill mill'' industry. The clinics have been blamed for supplying drugs such as oxycodone and Xanax to Floridians, while also drawing abusers from states such as Kentucky, West Virginia and Ohio.

Lawmakers passed a measure last year to try to clean up the industry but are tackling the issue again because of continued problems with clinics, particularly in South Florida. As an indication, U.S. Drug Enforcement Administration statistics show that the top 25 pain-management clinics for dispensing pain pills are all in Florida.

The Senate Criminal Justice Committee on Tuesday approved a wide-ranging bill that has the backing of the state Office of Drug Control. Bruce Grant, the office's director, said the bill would increase regulation of the clinics through such things as inspections and review of patient records. Also, it details circumstances that could lead to the state revoking clinics' ability to do business.

A House committee approved a different bill Friday that includes steps to try to rein in the industry. But the bill has spurred controversy --- and opposition --- because of a provision that would require using a multistate computer network that would eventually receive and provide information about controlled-substance dispensing.

Part of the debate stems from the Legislature's decision last year to create a state database of controlled substances dispensed to patients in Florida. The Department of Health is working on that database, which is supposed to begin operating in December.

The House bill, however, would require the Agency for Health Care Administration to contract with a private company that operates a multistate network. Dispensing doctors would have to transmit information to the network beginning in 2013.

Critics, including Grant, say they are concerned that approval of the multistate network could pre-empt use of the state database. He said it took years to get agreement to develop the state database. Also, critics say only one company, Surescripts, could contract with the state.

House sponsor John Legg, R-Port Richey, said Friday the multistate network is not meant to duplicate or replace the state database. But he said, in part, that questions remain about whether the state database will come online as scheduled.

--Capital Bureau Chief Jim Saunders can be reached at 850-228-0963 or by e-mail at