PAIN CLINICS FEEDING HABIT

PALM HARBOR - The addiction started after he injured his shoulder and
spine in two car crashes.

He was prescribed seven tablets of Vicodin a day to numb the pain, but
it didn't take long for Robert Palmisano to crave stronger doses.

His family physician refused to prescribe more potent medication. So
Palmisano found relief at pain management clinics, where he paid cash
for up to 120 opiate-based pills during each visit. "I was just trying
to get right," said Palmisano, of Palm Harbor. "That's when all hell
broke loose."

He was 19 when he got hooked on painkillers.

"I used to crush them," Palmisano, now 26, said of the pills, "then
snort them or shoot them up. It was really hard to quit."

Palmisano's going from patient to pill addict is not uncommon, medical
professionals said.

And an increase in the number of people addicted to pills is linked to
the glut of pain clinics in the Tampa Bay area doling out a massive
volume of prescriptions, law enforcement officials said.

"The more there is out on the street, the more people are getting
addicted," Pinellas County sheriff's Capt. Robert Alfonso said of
opiate-based painkillers such as oxycodone, hydrocodone and methadone.

Rick Sponaugle, owner and medical director of the Florida Detox and
Wellness Center, said most of the cases he has seen involved patients
with legitimate pain developing a dependency on pills.

"It starts with a legal pain doctor," Sponaugle said. "Then the
patients need more and more."

Recovering addict Todd Noble of Sarasota said that's how he got hooked
on OxyContin.

Noble, 45, who has since been treated by Sponaugle, said a dental
procedure led to his addiction.

Noble, like Palmisano, was prescribed Vicodin but eventually sought
out stronger doses. Noble said he bought his pills from a drug dealer
who procured them at pain clinics.

"It became a full-blown addiction in a couple of weeks," said Noble,
45. "I had to detox off OxyContin seven times. Sometimes I would
relapse on the way home."

Local private and public treatment centers continue to be filled with
people addicted to painkillers. At Hillsborough County's public drug
treatment center, there are 20 beds for people who volunteer, or are
court-ordered, to undergo a four-day detox program.

Most of the beds are occupied by people recovering from addictions to
opiate-based pills, said Michael Strolla, the assistant medical
director of the clinic run by the Agency for Community Treatment Services.

"If they're 40 or under, it's going to be opiates," Strolla said. "And
they got them at pill mills. It's out of control."

Most patients had legitimate pain before addiction took hold. They
tried physical therapy and other treatments, but getting prescriptions
was more convenient and provided immediate relief, Strolla said. "It's
a common story. These people, most of them, truly thought they were
doing the right thing after tweaking their back or getting injured,"
Strolla said.

Because opiate-based pills aren't outlawed like other narcotics, more
pain clinics started opening up shop in the Tampa Bay area and
elsewhere in Florida, Alfonso said.

"They're legally available. It's a legitimate medication," Alfonso
said. "People think, 'Well, doctors prescribe it, so it won't hurt
you.' "Palmisano said when he first got addicted in 2003, there were a
small number of pain clinics in Pinellas that would dole out large
prescriptions.

"I had to search hard for doctors that were a little dirty," Palmisano
said. "Back then, it wasn't as common as it is now."

Painkiller abuse and overdoses weren't as rampant seven years ago,
Palmisano said, which made it easier for him to "exploit the system"
by buying more pills and selling extra tablets for $15 each.

Since then, lax regulations have also contributed to an increase in
"pill mills" in the Tampa Bay area, authorities said.

"It's definitely been increasing in the last couple of years," Alfonso
said, "and the legitimate clinics' reputation is getting damaged by
illicit doctors."

Tips from residents, confidential informants and other sources led
detectives to those suspicious clinics. Some clinics shut down by
Pinellas investigators had customers buying hundreds of pills from the
business, then selling them for a profit in the parking lot, Alfonso
said.

Hillsborough sheriff's narcotics Detective Chris Rule said illicit
clinics have doctors who are not on the premises but have placed their
signatures on stacks of prescriptions. These businesses could
prescribe more than 200 tablets of oxycodone and 100 Xanax pills per
person, he said.

"How many doctors' clinics have you been to where all they accept is
cash?" Rule said. "If they don't accept different forms of payment,
that's a key indicator."

Investigators estimate there are about 70 pain clinics in Hillsborough
and 35 in Tampa. There are about 1,000 clinics registered in Florida,
Bruce Grant, the director of the state Office of Drug Control said.

"That's a heck of a lot of pain clinics," Grant said. "Some of these
are legitimate. A whole bunch of them are not."

Lawmakers and law enforcement have since caught on to what they say
has mushroomed into a statewide epidemic. New state laws went into
effect Oct. 1 making it tougher to register and operate pain clinics.
Tampa and Hillsborough have similar ordinances.

It's too early to tell whether the stricter rules have had any effect,
but health investigators are gearing up to begin inspections, Grant
said.

A statewide prescription drug monitoring program "" which allows
health professionals to view patients' prescription histories "" may
also help slow the flood of prescriptions, said Sen. Mike Fasano,
R-New Port Richey.

The $1 million program, which had trouble finding start-up money
before private donations and grants were collected, starts in March,
Fasano said.

Lindsay Roberts, a paralegal for a Tampa law firm, said tougher laws
may have helped prevent some of her friends from overdosing on
painkillers.

"I've lost 16 friends in three years. I've lost so many people to the
same thing," Roberts said. "I'm to the point where I can't cry any
more. I'm just angry," she said.

Overdoses from prescription medication now outnumber other drug
deaths, health officials said.

There were 277 drug deaths in the county in 2009, with 199 caused by
oxycodone overdoses or a mix of painkillers and other drugs,
Hillsborough County Medical Examiner's records show. In 2005, the
agency reported 179 drug overdoses; 76 involved opiate-based pills.

In Florida last year, oxycodone was involved in 1,948 deaths,
according to a state Medical Examiner's Commission report. Methadone
was linked to 985 deaths, and hydrocodone was linked to 865, the
report said. Addiction is rampant because hydrocodone, methadone and
other opiate-based pills are basically synthetic heroin, one of the
most addictive drugs, Alfonso said.

"For every addict, there are five people who are affected," said Don
Wood, the admissions coordinator for HealthCare Connection, a private
center in Tampa. "The insanity of addiction is unbelievable."

Sponaugle said too much of one chemical in the brain "" or too little
"" is a factor in addiction. Along with biochemistry, genetics plays
a role, Strolla said.

"A lot of people are predisposed to addiction," Strolla said. "Drugs
affect their brains in different ways, giving them not only pain
relief but pleasure."

Palmisano said the high he got from prescription pills "killed all the
pain "" physical pain, but emotional, too."

He conquered his addiction because he was forced to. In 2005,
Palmisano was sentenced to one year in Pinellas County Jail on
multiple drug charges. He had been "doctor shopping," he said, getting
one prescription filled at different pharmacies.

Palmisano, sober since 2006, said jail doctors put him through detox.
Drug-induced fever dreams provided no solace from the physical pain,
such as stomach cramps, he felt while he was awake.

"The withdrawal was really horrible," he said. "You would rather
die."

Noble said he was passed out when friends took him to Sponaugle's
clinic two years ago: "I don't even remember being here. It's a total
blackout."

There is one thing he recalled about that time.

"I was sick. I just wanted to feel better," Noble said. "My theory is
that people change when the pain of change is less than the pain of
things staying the same."