'PILL MILL' LAWS BEING FELT

Some Pleased; Others Squeezed

TAMPA -They walked into the clean, red brick medical offices and
demanded prescription painkillers.

The doctor shoppers and drug addicts thought the Tampa Pain Relief
Center on East Fletcher Avenue was just another storefront clinic
that freely dispensed powerful painkillerswithout proper background checks.

When they were turned down by the nurse at the front desk, they grew
angry, refused to calm down and were removed from the lobby by police.

'Some patients were threatening,' said Douglas Constant, a pain
management physiA-cian and anesthesiologist at the practice. 'We've
had some people come in thinking they can get anything.' It's a
common occurrence in a town known as a hotbed for so-called 'pill
mills' and in asociety grappling with an epidemic of prescripA-tion
drug addiction, law enforcement and health officials say.

Those factors, along with an increase over the past few years of
unscrupulous doctors prescribing massive doses of opiate-based pills,
have tarnished the reputations of physicians who strive to care for
patients with legitimate pain, Constant said.

'There's a stigma,' he said. 'When you introduce yourself as a pain
physician, it brings about a pejorative reaction.' Measures taken
recently by state legislators may help change the public's perception
of pain doctors and stop the illicit distribution of pills.

Since Gov. Rick Scott approved tougher laws in June, most legitimate
pain doctors and pharmacists have praised the changes and adapted to
them, state officials say.

'Overall, things are moving along. There have been no complaints from
doctors,' said Greg Giordano, chief aide to state Sen. Mike Fasano,
R-New Port Richey. Fasano sponsored the Senate version of the bill,
which strengthened ordinances regarding the ownership and operation
of pain clinics.

Lawmakers and law enforcement officers say once-lax laws made Tampa
and parts of South Florida hubs for the illegal distribution of
pills. Visitors from other states were known to travel here to buy
pills then return to their home states to sell them at higher prices.

From October 2008 to March 2009, about 9 million tablets of
oxycodone were prescribed in Florida, according to the Drug
Enforcement Administration. About 5 million pills were prescribed in
Broward County, and 376,730 pills were dispensed in Pinellas and
Hillsborough counties during that period, the DEA said.

The new laws establish standards of care for doctors who prescribe
narcotic-grade pills, require them to register with the state
Department of Health and increase penalties against doctors who
overprescribe to a minimum $10,000 fine and sixmonth suspension.

The laws also ban pain physicians from dispensing the most abused
pills, such as oxycodone and hydrocodone. Patients at the Tampa Pain
Relief Center once were able to pick up the pills they needed at the
practice soon after doctors examined them and prescribed medication.

The dispensary room, located behind the front desk, now is empty and
its pickup window has been shuttered. Constant said his office, at
3450 E. Fletcher Ave., hasn't taken a financial hit since the new
ordinances prohibited him and his colleagues from dispensing medication.

What the clinic lost is convenience for its customers.

'The nice thing was the on site dispensing,' Constant said. 'It
wasn't a revenue generator, it was a convenience. But overall, it's
not a big change for us.' Deborah Tracy, a pain management doctor in
Spring Hill, said some physicians depended on dispensing pills and
that the new laws are crippling them.

'It's putting the squeeze on doctors,' said Tracy, president of the
Hernando County Med ical Society and past president of the Florida
Society of Interventional Pain Physicians. 'It's a valid revenue
stream for physicians who do it right. If doctors can no longer
dispense, pharmacies are going to make out big from this.' Dan
Fucarino, owner of Carrollwood Pharmacy, said he won't. He refuses to
sell oxycodone at his store and has signs on the front door
proclaiming it. Calling himself more paranoid than other pharmacy
owners, Fucarino said offering opiate-based pills may make him a
target of thieves, drug addicts and other criminals. He has survived
two robberies, in both cases facing gunmen, he said, and in 1989, one
of his employees was killed during a robbery.

'I don't need that kind of business,' Fucarino said. 'There's some
pharmacies out there, that's all they do, dispense painkillers. We're
going to be around when all those pharmacies close down.' The
standards for getting and keeping a pharmacy permit were raised this
year. Inspections, financial disclosures and criminal background
checks for owners and employees now are mandatory.

But there's one component built into the new laws that pain doctors
and pharmacists say they are looking forward to using, a tool that
will provide the most help: the creation of an online database that
will track when, where and in what quantities narcotic-grade drugs
are prescribed.

'It will stop doctor shopping and it will stop double-dipping,' said
Michelle Lese, an assistant professor at Palm Beach Atlantic
University in West Palm Beach. 'We'll be able to tell what's going on
with a particular patient.' More than 30 states already have
prescription drug monitoring systems in place. Florida's version will
launch in mid-October. Doctors and pharmacists will have no more than
seven days to enter prescription information into the database after
medication is prescribed.

The system will give pharmacists more confidence that the
prescriptions they are filling are valid, Lese said.

'No pharmacist wants to fill a prescription for a patient who will
potentially overdose,' she said.

Constant, the pain doctor, said he hopes the new regulations will
improve pain management practices in Florida and help restore the
reputations of physicians. Doctors, he said, must educate the
community about what they really do.

'I'm always going to be an optimist because I love what I do,'
Constant said. 'We can restore the confidence of the public. It's
based on trust.'