Narcotics — Florida's great health threat

Prescription drug abuse is the fastest growing drug problem in the United States. According to the Office of National Drug Control Policy, abuse of painkillers is the second most prevalent drug problem in the nation, with the 2009 National Survey on Drug Use and Health showing 2.2 million new users last year. Narcotics Detective Don Kennard, who has worked with the Sarasota County Sheriff’s Department for more than 13 years and has been a narcotics detective for the past five years, considers Florida’s prescription drug problem to be worse than that of any other state in the U.S.

In recent years people have turned away from street drugs such as heroin and cocaine in favor of prescription medications. “Drugs are very transient, cyclical — they tend to come in patterns and waves throughout time,” Kennard said. “And this time, I think it’s pretty clearly pharmaceuticals.”

According to Kennard, the most widely abused drugs in Florida include the painkillers oxycodone, hydrocodone and hydromorphone, benzodiazepines such as alprazolam (Xanax) and diazepam (Valium) and amphetamines like Adderall. Of all these, he regards oxycodone as the most prevalently abused.

The Florida Medical Examiner’s Office keeps track of deaths in the state involving drugs. In 2009, most drug related deaths were caused by oxycodone (1,185) and the majority of these occurred in St. Petersburg, with 68 cases in Sarasota. Between 2008 and 2009, the number of deaths attributed to oxycodone increased by 23.9 percent.

Prescription drug abuse presents unique problems for law enforcement officers. To start with, since the drugs are legal for medical use, they are easier to obtain than illegal drugs. This is especially true in Florida, the largest state without a prescription drug monitoring program. Such a program in part enables doctors to view a patient’s prescription history, which could lower instances of doctor shopping, a practice in which patients go to numerous doctors to obtain several prescriptions of the same medication. In 2009, a bill was passed to put a monitoring system into effect by this December but the start date has been postponed. Even once the program goes into effect, however, doctors will not be required to check the system and will have 15 days after writing a prescription to enter it into the database, providing time for a round of undetected doctor shopping.

Florida particularly provides access to a large number of painkillers, as it is home to 49 of the nation’s top 50 medical dispensers of oxycodone. Kennard said it is common for people from other states to come to some of Florida’s notoriously lenient pain management clinics, so called “pill mills.” These clinics dispense medications on site and up until this month were not required to be run by doctors. Ownership by formerly convicted felons was not barred either. In some cases, relevant medical records and physical examinations are not required for patients to obtain narcotic prescriptions.

On Oct. 1, a Florida law targeting pill mills took effect. One aspect of the law requires pain management clinics to be owned by doctors licensed to practice in the state. For on site dispensaries, patients who do not pay through insurance will be limited to a three day supply of medication.

Such regulations are only useful if doctors prescribe reasonably. Some medical professionals intentionally over prescribe patients, a practice which is a third degree felony.

“Having spoken with various pain management legitimate professionals, they are appalled by some of their counterparts in what is prescribed and how they prescribe,” Kennard stated. “Some of those [legitimate] doctors will be the first to tell you that there are people who are quacks that have ruined the name of medicine and are killing people … root of all evil, if you will.”

A St. Petersburg Times investigation published last month reviewed nearly 200 cases of Florida medical professionals who came to the attention of the Florida Department of Health for their painkiller prescription practices. At least 99 fatal overdoses have been linked to these cases. The report found that almost a quarter of those disciplined are still allowed to prescribe, and that following the investigation of a doctor, it takes an average of 18 months for disciplinary action to be taken.

Dealing in narcotics is a lucrative business for enterprising doctors and street dealers alike.  Kennard said that while one 30 milligram tablet of oxycodone costs about $1.50 purchased as a prescription, the current street value of one “blue” (referring to the color of the pill) ranges from $10 to $15. He estimated that a 10 member ring of doctor shoppers could make upwards of one million dollars a year, and called this a conservative estimate.

Obtaining data related to narcotics investigations and arrests can pose a challenge in itself. Kennard said that such information is “not broken down [in a] way that would probably be useful.” Last year, there were 2,596 drug arrests in Sarasota county, according to the Florida Department of Law Enforcement’s Uniform Crime Report, but the arrests were not categorized according to substances.

“There’s certainly an increase in investigations and arrests related to pharmaceuticals,” Kennard stated, adding that numbers for drug specific arrests can be difficult to obtain. “I’ll admit, law enforcement doesn’t always give us exactly what we want when we want it. Information is generally there, but may be more difficult to obtain than we would like.”

Up until this year, pain management clinics in Florida were not required to register with the state, and so the number of operating pain clinics has been uncertain. With the monitoring program on hold and data on issued prescriptions still unavailable, Kennard said he could not wager a guess as to the amount of pharmaceuticals on the streets of Sarasota. Without such numbers, estimating the regional scope of the problem is impossible.

Even with restrictions on clinics, internet pharmacies and home medicine cabinets remain a  source of prescription drugs. Aware that teenagers often get their drugs from their parents supply, the DEA recently held its first national “Prescription Drug Take-Back Day.” Over 4,000 sites across the nation took part, including the Sarasota Sheriff’s Office and the New College of Florida Campus Police Department. A similar program, Operation Medicine Cabinet, will be held Nov. 13, with the University of South Florida Sarasota-Manatee acting as a dispensing site.

The sheriff’s office has taken a multifaceted approach to help tackle Sarasota’s prescription drug problem. Earlier this year, permanent prescription drop-boxes were installed at both of its offices. In addition to investigation and arrests the police have made education and prevention a goal. Kennard said the Sarasota Police are working to educate youth through high school programs such as the Narcotics Overdose Prevention and Education. Police also aim to increase the awareness of pharmacies and healthcare professionals to prescription and medical document fraud.

As for the future of Florida’s prescription drug problem, Kennard predicts the worst has yet to come. “Has it hit the top of the mountain? I would say probably not,” he admitted. “I would anticipate that we’re still  gonna be rising over the next couple of years.”

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