Lives on the line@

Associated Press Published: October 6, 2012
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By JOHN WOODROW COX,

c.2012 Tampa Bay Times@

One year ago, Florida created a weapon meant to help stop the prescription drug epidemic that kills an average of more than six people a day in this state.

Since then, anyone filling prescriptions for controlled substances such as OxyContin or Xanax has been required to record the details into a database known as the Prescription Drug Monitoring Program. In less than a minute, doctors and pharmacists who use the program can see where and when their patients filled previous prescriptions, the type and quantity of drugs they got and who prescribed them.

The system can help medical practitioners determine whether a patient has a legitimate medical need for these highly addictive medications — or is a drug abuser seeking the next high.

But the program came with a major loophole: Nobody is required to check it.

Now, a Tampa Bay Times investigation has discovered what experts feared — the vast majority of medical practitioners have never touched the much-touted database:

• Since the system's inception on Sept. 1, 2011, more than 48 million prescriptions have been written in Florida for controlled substances — that's about 2.5 for every man, woman and child in the state. Prescribers, however, checked the database before writing just 2 percent of them.

• Among physicians in the Tampa Bay area permitted by the federal government to prescribe these potent drugs, fewer than one in 12 has ever used the database.

• A Times reporter surveyed all 91 local pain-management clinics registered with the state and that appeared to be in business. Fewer than half reported using the program. Employees at 46 of the clinics declined to answer questions or did not respond to calls. One acknowledged never using the program.

Many who backed the system — including drug abuse experts, lawmakers, law enforcement officials, pharmacists, doctors and parents who lost children to overdoses — were stunned to hear that it's barely ever used.

Others saw it coming.

"People think it's this silver bullet, this magic thing," said Pinellas County Sheriff Bob Gualtieri. "But it's so underutilized."

That's hard for Cindy Harney to hear. Her son, Garrett, died of a prescription drug overdose in 2006. He was 20.

The Sarasota woman pleaded with legislators to create the monitoring program. Harney fought for it in Tallahassee and formed an organization that has advocated on its behalf. She can't comprehend why a physician wouldn't check the database before prescribing a potentially deadly medication.

"It's not going to save my boy," she said. "But think of all the others it could save."

• • •

So, why aren't more doctors using it?

Kurt Schultz, owner of Fix All Medical Clinic in Tampa, says he knows the answer.

"It's not required. That's the problem," he said. "I think it should be mandated any time pain medication is prescribed. Why would you not use it?"

Schultz said his medical staff checks it regularly, but he knows of many practices that never do.

At a registered pain management operation called Glory Medical Center & Weight Loss Clinic in Tampa, no one answered several calls or returned a voicemail asking if they use it.

A recording says first visits cost $350; insurance is not accepted.

"When speaking to one of the staff members," it says, "please remember to ask if we are currently running any specials for pain management."

Physicians or owners at only nine of the 91 clinics surveyed by the Times agreed to interviews.

Most said use of the database should be mandated.

"This monitoring program is a godsend," said Dr. Joseph Rashkin of Bay Area Pain Management in Tampa. "The health care providers who are prescribing this medication ought to be checking very frequently."

Rashkin said he personally consults it 10 times per day. He runs reports on new patients and, every few weeks, on established patients. He used to get at least 20 visitors a week he considered "doctor shoppers," people who seek multiple prescriptions. Now, like other clinics that spoke to the Times, he hears from just one or two a week.

Checking patient histories inevitably means turning some away. That potential loss of business could be a reason for certain doctors to ignore the database, speculated Christopher Wittmann, a physician's assistant at Trinity Pain Clinic who uses the program.

"If they're making a lot of money … they may just not want to know," he said.

Though experts say all doctors who prescribe these medications should check the database, they are adamant that pain management physicians — who typically prescribe thousands of the addictive drugs every year — should use it as a standard of practice.

But Dr. Manjul Derasari of Professional Pain Management in Tampa said he has never consulted the program.

"Should I be using it?" he said. "I think I should be using it. At present, I am not using it."

Derasari explained that he reviews his patients' medical records and his staff periodically checks the Hillsborough arrest records. The doctor also said he screens potential clients before accepting them.

If the doctor suspects someone is doing something wrong or has a problem, he said he asks pharmacists to check for him.

"Am I missing somebody?" he mused. "I probably am missing somebody."

• • •

Between 2002 and 2008, the Legislature rejected proposals to create a drug monitoring database each year but one, when it wasn't proposed at all.

In that same period, more than 10,000 Floridians died from prescription drug overdoses.

People from across the country flocked here, lured by the state's easy access to drugs. Embarrassed by the mounting death toll and a growing reputation as the "pill mill capital of the nation," in 2009 legislators followed the example of many other states and approved a database.

But lawmakers refused to budget money for the program. Then, in February 2011, Gov. Rick Scott announced that he would repeal the law, citing concerns about patients' privacy.

He eventually relented, but even now the program's future is tenuous. According to the Department of Health, funding has only been secured through the end of June 2013.

To its backers, the program is a watered-down casualty of compromise. The law includes just one requirement: dispensers of the drugs, primarily pharmacies, must enter the prescription's details into the state database within seven days.



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