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Lives on the line@

Associated Press Published: October 6, 2012
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Pharmacists do not, however, have to check the patients' histories before handing over the medications.

Bruce Grant, former director of the now-defunct Governor's Office of Drug Control, foresaw the program's future.

"If it isn't utilized, then it doesn't accomplish anything," Grant told the state Board of Medicine in 2010. "It doesn't reduce prescription drug abuse. It doesn't reduce the crime. It doesn't reduce the addiction."

• • •

Florida physicians are not alone in their resistance to a drug monitoring database.

"There are a fair number of doctors who really feel they can tell what their patients are doing just by having a conversation with them," said David Hopkins, project manager for Kentucky's database. "They don't feel they need to check the monitoring program."

After years of voluntary use, just one in five Kentucky prescribers were using the system. Though impressive compared to Florida's one in 12, Kentucky last year mandated participation.

When it was still voluntary, the system processed about 2,900 requests for patient information a week. Now, it's 95,000.

Every state but Missouri has a database or has enacted legislation to create one, according to the National Alliance for Model State Drug Laws. Twelve states have approved mandates. The measures are too new to know how they will affect overdose deaths.

Since Ohio ordered participation, according to program administrator Danna Droz, doctors have been shocked to find out how many patients were abusing drugs.

"We had the program for five years, and people weren't using it enough," Droz said. "Now, they're seeing why they should be using it."

New York recently passed the most aggressive mandate in the country, largely to combat abuse of oxycodone, which like heroin is classified as an opioid drug.

"We've decided that heroin is so dangerously addictive that under no circumstances will we allow it to be sold," said New York state Sen. Andrew J. Lanza. "And yet we have the very same drug, only better because it's pure, that we dispense as medication."

As in Florida, Lanza said, most of the oxycodone that makes it to the street there is first prescribed by physicians, which is why a mandate is so important.

"The problem is so serious," he said, "you just can't leave it to chance."

• • •

Dr. John H. Armstrong, Florida's surgeon general, said he already considers the state's monitoring program a success.

Armstrong, appointed to the position by the governor earlier this year, said the Times should not have focused on the number of prescribers who have used the program — about 8 percent.

"We would define 'use' as being registered in the system," he said. "We think that describes a readiness of use."

The group of prescribers registered, he noted, represents a larger figure: 14 percent.

That's more important, he said, than the fact that nearly half of those registrants have never actually used the program.

Others have also praised the system. Law enforcement officials have applauded their access to information from the database if it pertains to an active investigation. Also, the doctors and pharmacists who do use the program sometimes call to report suspicious patients.

But one key measure indicates that the street supply of oxycodone hasn't changed since the program's creation. Investigators say the price of a 30-milligram pill in Tampa Bay has remained at about $17.

"I think we're making progress," said Gualtieri, "but not to the level we need it to be."

Hillsborough sheriff's Detective Chris Tuminella said he has talked to physicians who haven't even heard of the program. Others know of it but don't use it.

"You see some that don't even pull it up," he said. "They're totally clueless."

The solution, officials say, is to require doctors to use it.

"It would cut down on the number of pills hitting the street, which contributes to people dying," said Hernando sheriff's Detective Chris Erickson. "You cut the numbers down, you cut down the number of people dying."

Like the physicians, investigators say the program's mere existence appears to have reduced doctor shopping.

Preliminary evidence shows that deaths have declined, though the most recent data is from the first half of 2011 — before the program existed.

Those signs of progress are often attributed to other new laws requiring pain-management clinics to register with the state and undergo annual inspections. Plus, doctors in most cases can no longer dispense drugs directly to their patients.

Beyond a crime preventive, supporters say, the program has potential to improve the care of legitimate patients suffering from pain.

To be sure, the database can illustrate patterns of substance abuse. But it can also indicate potentially dangerous drug interactions and, when used properly, it may help show whether the medications are truly alleviating pain or if other therapies should be explored.

• • •

If this program has a face, it belongs to state Sen. Mike Fasano. The Pasco Republican fought for it over more than a decade.

When Fasano heard the Times' findings, he sighed.

"I'd like to see every medical physician in the state use it," he said. "If they don't, I think we're going to have to mandate it."

But how likely is that to happen?

"Neither the Legislature, nor this particular governor, would ever go along with that," said Claude Shipley, who worked in the state's Office of Drug Control before Scott shut it down. "For the foreseeable future, this is it."

Garrett Harney's mother, Cindy, can't accept that. She saw her son collapse into drug abuse after a friend offered him pills legally prescribed by a physician.

Why, she wonders, wouldn't every doctor use a tool that could help ensure these powerful drugs go to the people who need them — and not land in the streets?

"Who would be opposed to this?" she said. "Who would ever be opposed to saving a life?"

Researcher Caryn Baird contributed to this report . John Woodrow Cox can be reached at jcox@tampabay.com.

In the past decade, prescription drugs have killed more than 15,000 Floridians. • In September 2011, the state set up a database for health practitioners to see if patients have a history of abuse. • Prescribers checked the database for only 2 percent of the 48 million controlled substance prescriptions written in the past year. • Meanwhile, people are still dying.