DEATH BY PRESCRIPTION: FLORIDA'S PILL PIPELINE

Driving north from Polk County on Interstate 75, one will spot a big,
bright-yellow billboard around the Ocala area with "PAIN CLINIC"
printed in bold black letters. There's no name, no address, just a
phone number.

It is a brazen beacon for prescription-drug addicts, abusers and the
couriers who supply them.

The billboard is a reminder of why I-75 is often called the "pill
pipeline." The highway is one that dealers travel to buy drugs from
shady clinics in Florida - a state that, until recently, lacked
regulations to track and stem the exploitative sale of prescription
painkillers.

New rules instigated over the past year should shrink the problem,
once they are fully implemented. A new report by the Florida Medical
Examiners Commission shows why there is no time to waste.

The report noted that the state's 2009 deaths from the prescription
painkiller Oxycodone increased 26 percent over 2008. Meanwhile, deaths
from heroin and cocaine - which are illegal, unlike prescription
medicines - declined about 20 percent in 2009.

The report from medical examiners does not include data on all
prescription-drug deaths, nor is it limited to prescription drugs.
Instead, it focuses on statewide fatalities involving abuse-prone
substances, including opioids, narcotics, amphetamines, tranquilizers,
cannabinoids, alcohol and certain inhalants. The report is compiled
from information found through autopsies.

More Than One Drug

Sometimes, toxicology tests found that death was caused by a particular
drug. But in the vast majority of cases, the dead people had more than
one drug (prescription or not) in their systems, the report emphasizes.
Here is further detail from the report, covering 2009 in Florida:

Overall, 8,653 drug-related deaths were reported.

2,488 of the people died with at least one prescription drug in their
systems that was identified as the cause of death. That is a nearly 14
percent increase over 2008.

Oxycodone was the identified cause of 1,185 deaths. Alprazolam (a
prescription drug often known as Xanax) was the identified cause of
822 deaths. Methadone caused 720 deaths. Alcohol was identified as the
cause of 559 deaths. Cocaine was deemed the cause of 529 deaths.
Heroin, morphine and other drugs each caused a much smaller number of
deaths.

Alcohol was present in nearly 3,500 of the victims.

The prescription-drug problem may get worse, according to some medical
examiners. Dr. Russell Vega, medical examiner for the district that
encompasses Sarasota, Manatee and DeSoto counties, told The Sarasota
Herald-Tribune that he "expects a significant spike in
prescription-drug abuse and overdoses in 2010."

Clinical Requirements

Law-enforcement agencies have stepped up efforts to fight this
scourge, but regulatory changes at the state and local level are under
way as well.

As we've said before, regulation should not preclude legitimate,
health-oriented, therapeutic pain management. Severe, intractable,
long-term pain is a reality for some people, especially among
Florida's older population. Wrongdoing by some clinics should not
prevent patients from getting the qualified help they need.

But Florida's regulations had been far too lax, inviting a flood of
businesses that make big money off these often-addictive, often-abused
drugs.

Belatedly, laws were enacted this year and last that will do a better
job of weeding out exploitative practices.

A growing number of communities are establishing moratoriums on new
pain clinics that do not meet certain criteria. The state, meanwhile,
is creating a database to track narcotics prescriptions in order to
prevent doctor-shopping.

New rules to take effect this year will also toughen clinic
requirements. For example, clinics would have to be owned and operated
by qualified physicians, who would face escalating training mandates.
The clinics would have to be registered with the state and undergo
annual inspection.

Furthermore, doctors would be banned from advertising or promoting the
use, sale or dispensing of a controlled substance.

It's anyone's guess whether the advertising restriction will bring
down the likes of the I-75 pain clinic billboard. But we certainly
hope the regulatory changes bring down the rate of prescription-drug
abuse.