SEEKING A CURE FOR 'PILL MILLS'

Governor Should Sign Bill Restricting Private Pain Clinics

Florida's governor should sign recently approved legislation that aims
to clamp down, hard, on "pill mills" -- businesses that earn a fortune
off the shady and exploitive dispensing of narcotic
painkillers.

If signed into law, much of the measure, SB2272, would not take effect
until late this year. In the meantime, the city of Bradenton is
considering a moratorium on any new permits for such
establishments.

Several other Florida cities and counties have either passed similar
restrictions or are considering them, the Herald-Tribune's Halle
Stockton reported last week. (In Sarasota County, a community
consortium is preparing a measure.)

These local moves are well advised and deserve support, as long as
they don't preclude legitimate, health-oriented, therapeutic pain
management. Severe, intractable, long-term pain is a reality for some
people, especially among Southwest Florida's older demographic.
Wrongdoing by some clinics should not prevent patients from getting
the qualified help they need.

Feeding Narcotics Trade

SB2272 is another in the state's continuing efforts to rein in the
abuse of addictive and often dangerous prescription drugs such as
Oxycontin and Xanax.

Enabled by the laxity of past rules, a virtual cottage industry of
questionable pain clinics had cropped up in South Florida, feeding an
illegal narcotics trade that stretched to Appalachia and beyond.

Several municipal governments fought back with new ordinances. The
state also joined in with a new law to spur pain-clinic standards and
a database to track painkiller prescriptions. (Both are still works in
progress.)

SB2272, if signed into law, would go considerably further to restrict
privately owned pain clinics, lessening opportunities for them to be
turned into pipelines for the illegal drug trade.

The measure would:

Mandate that the clinics be owned and operated by qualified
physicians. (Those who've been disciplined in connection with
controlled substances would not be allowed to own or work for a pain
clinic. By July 2012, doctors could not practice at the clinics unless
they complete a pain medicine fellowship or residency, or are
board-recognized as a specialist in pain management.)

Require these establishments to be registered with the state and
undergo annual inspection. (Those with suspended or revoked licenses
would have to cease operating.)

Require the pain-clinic physician to perform a physical examination of
a patient on the same day the controlled-substance prescription is
issued.

Bar clinics from dispensing more than a three-day supply of controlled
substances to a patient. (Additional supplies would require a
prescription, filled at a pharmacy. Some exemptions would apply.)

Ban doctors from advertising or promoting the use, sale or dispensing
of a controlled substance.

Set criminal penalties for violations.

These rules, combined with an improved ability to spot "doctor
shopping" and excessive prescriptions, would curtail the opportunities
for exploitation -- without making it impossible for legitimate
patients to get prescriptions.

Enforcement Is Key

The success of this bill will depend on heightened enforcement, which
presents a potential pitfall. There are so many private pain clinics
that it remains to be seen whether the state can assemble the
necessary administrative infrastructure to monitor them -- while still
respecting patient privacy. Furthermore, money to do this is lacking.

Still, it is a major step toward safer, saner use of painkillers.