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Prescription for fighting abuse

By Staff | Feb 12, 2011

Pill mills are a growing problem statewide, and Lee County is not immune.
Over the past year or two, the Narcotics Unit at the Lee County Sheriff’s Office has encountered an increasing number of pill mill clinics opening up in the Fort Myers area. Though more prevalent along the east side of Florida, the problem has infiltrated the adjacent coast.
“It’s a huge problem here,” Sgt. Karl Albenga said. “Without a doubt, it’s something we’re constantly dealing with and constantly working on.”
Pill mills are pain management clinics that issue prescription medications without adhering to a general standard of care, such as conducting thorough examinations before dispensing prescriptions or offering alternatives like physical therapy to work in place of or in conjunction with medications.
“There are good pain management clinics,” Albenga said. “Not just you go straight in and get hardcore opiates.”
The majority of the prescription drugs involved in pill mills are essentially synthetic opium or synthetic heroin, mainly Oxycodone and Roxycodone, he said. Percocet and Valium are other drugs typically dispensed at pill mills.
“Usually those opiate medications are issued in conjunction with an anti-anxiety (prescription drug), like Xanax or Soma,” Albenga said.

Pill mills and doctor shopping
According to Albenga, pill mill investigations are far from simple.
“These investigations are a lot of labor and time-intensive, depending on how we attack it,” he said. “We want to make sure we do it the right way.”
Pill mills are also a lot harder to attack than the people in the streets, forcing law enforcement to turn to those who frequent the clinics.
“Doctor shopping is the biggest problem that we run into with these pill mills,” Albenga said. “They go hand-in-hand.”
In September, one Cape Coral man was accused of doctor shopping and charged with 18 counts of fraud conceal information to obtain prescription controlled substance. He reportedly visited multiple doctors within a month and got at least $41,000 in drugs by not mentioning his other doctor visits.
The next month, another Cape Coral man was accused of doctor shopping and charged with 35 felony counts of fraud concealing information to obtain prescription. The LCSO stated that the man received controlled substances from two doctors at the same time without the two physicians knowing it.

Cracking the mills
The LCSO employs a mix of tactics in the fight against pill mills.
“It’s a multi-pronged effort,” Sheriff Mike Scott said.
Raising public awareness, reminding residents to maintain their home medicine cabinets and enforcement by law enforcement all play a part.
“We build some good relationships with our local doctor’s offices, the ones that we feel are legitimate,” Albenga added, noting that this can lead to tips.
Clinics used by suspected doctor shoppers are noted and surveillance is set up at suspected mill pills. Pill traffickers will “sponsor” individuals by driving a group to a pill mill and paying for each individual’s doctor visit. Afterward, the sponsor provides each individual with money in exchange for the drugs.
“They know who the easy ones are and which pill mills to go to,” he said.
Albenga said in the most extreme cases, he has heard of pill mills ordering lunch or pizza for those in the waiting room because the clinic is so packed.
“These are doctor’s offices where people show up in carloads,” he said.
And it pays off. If a sponsor has five people that are taken to two doctors per day, five days a week, the pill count adds up. For example, if prescribed 240 pills per visit, that totals 2,400 pills in one week. One 30 mg Oxycodone or Roxycodone has a street value of $10-$15 — up to $30 in other states.
“Now, probably 90 percent of what we buy in narcotics is Oxycodone or Roxycodone,” Albenga said.

More help needed
One tool that Albenga and the LCSO Narcotics Unit has been waiting for is a statewide electronic prescription monitoring program. About 38 to 40 states have passed similar legislation, and law enforcement was expecting Florida’s program to kick off in December. Officials are now projecting June or July.
“That’s something we’ve been waiting for and counting on to help us out,” he said.
The computer-type database would track what doctors are prescribing and what pharmacies are distributing, helping law enforcement to better identify doctor shoppers and potential pill mills. It would also serve as a deterrent.
“It’s all going to be linked together,” Albenga said.
One obstacle to the prescription monitoring program is newly elected Gov. Rick Scott’s opposition to the project based on funding and privacy issues.
“He doesn’t realize how much this would help the state,” Albenga said.
Scott’s office did not immediately respond Friday to questions about his stance on the prescription monitoring program or newly elected Attorney General’s Office Pam Bondi’s pill mill strategy.

Larger issue at hand
According to the Attorney General’s Office, Florida leads the nation in diverted prescription drugs because of the pill mills and it has become the destination for distributors and abusers. In response to the growing issue, Bondi announced a strategy to address pill mills.
“Our state needs a unified effort at every level to eradicate Florida’s pill mills,” she wrote in a prepared statement released last week. “We are working with state and local law enforcement, as well as our federal partners, to curtail the dangerous dispensing and abuse of prescription drugs.”
Bondi’s strategy includes a series of legislative recommendations for the upcoming legislative session. The provisions aim to provide law enforcement with enhanced tools to investigate and prosecute pill mills and crack down on doctors who engage in drug trafficking, according to the statement.
The recommendations include:
* Strengthening the penalties for doctors and osteopaths who violate standards of care when prescribing controlled substances to a mandatory six-month suspension and a $100,000 fine per incident.
* Creating a criminal penalty for doctors and osteopaths who fail to perform a physical examination before dispensing 72 hours worth of a controlled substance and for any person who attempts to register or registers a pain management clinic using misrepresentation or fraud.
* Requiring anyone who maintains an inventory of controlled substances to report the discovery of any theft of the substances to law enforcement or FDLE within 48 hours or face penalties and fines, and requiring pharmacists to report fraudulent prescriptions of controlled substances and to maintain a record of the evidence or face a criminal penalty.
* Enhancing the criminal penalty for a burglary with the intent to obtain controlled substances.
* Clarifying existing law that allows law enforcement to access pharmacy records without a subpoena and clarifying that thefts of all controlled substances are felonies regardless of the wholesale value of each pill.
Bondi also stressed the need for aggressive administrative enforcement on pain clinics and doctors, increased criminal prosecution through partnerships between the Office of Statewide Prosecution and state attorneys, and long-term prevention strategies such as drug takebacks and drug courts.