Florida DOs welcome, wary of constraints under new ‘pill mill’ law
- Posted Sept. 1, 2011, 4:05 p.m.
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However, “the law has adverse unintended consequences,” notes Paul D. Seltzer, DO, the legislative chairman and a former president of the Florida Osteopathic Medical Association. He points out that in rural areas, pharmacies can be scarce and physicians sometimes need to dispense medications themselves. Florida’s law, thus, limits some patients’ access to Schedule II and Schedule III medications.
The legislation, moreover, affects not just access to opioids for pain relief but also stimulants used to treat patients with attention-deficit/hyperactivity disorder and weight-control problems, as well as antidepressants and other psychotropics.
And some Florida physicians are unhappy about the requirement to purchase new prescription pads for controlled substances, adds Dr. Stager. Because too many physicians were still using their old prescription pads and pharmacies were refusing to fill their patients’ prescriptions, the state suspended this provision of the law for two months to give physicians more time to comply.
On a brighter note, the state’s once-unfunded prescription drug monitoring program started on Sept. 1. Some 35 states have similar programs, which the federal government has been pushing, and eight other states have authorized such programs. Florida’s electronic database collects patient-specific data from pharmacies and hospitals on prescriptions for Schedule II, III and IV medications. Physicians can use the data to determine who might be “doctor shopping.”
No easy answers
At the federal level, the most overreaching piece of proposed pain management legislation, according to the AOA, is the “Ryan Creedon Act of 2011,” named for a California man who died at age 21 due in part to his addiction to oxycodone. Introduced by Mary Bono Mack, R-Calif., the bill would essentially allow only anesthesiologists and pain management specialists to prescribe controlled substances. So family physicians, general internists, pediatricians, psychiatrists and most other specialists would be stripped of these prescribing privileges.
In combating pill mills and prescription drug abuse, lawmakers must not lose sight of the approximately 116 million Americans who have chronic pain, observes AOA Trustee James J. Dearing, DO, who chaired the AOA Bureau of State Government Affairs in 2010-11. “That is more than heart disease, diabetes [mellitus] and cancer combined,” he stressed during the bureau’s meeting in July in Chicago.
But legitimate physicians are prescribing opiates too cavalierly, countered Ronald H. Kienitz, DO, who practices physical medicine and rehabilitation in Honolulu. The pendulum has swung from the time when patients’ pain concerns were not taken seriously “to the point where opiates are being truly overprescribed.”
“Studies have shown that opiates are being prescribed and prescribed and prescribed. Yet if you look at the studies, [patient] function has not been maintained,” Dr. Kienitz said during the meeting. “Function has gone down. If you’re not maintaining function, you’re not helping your patient.”
A big problem is that most health professionals are not adequately trained to provide the full range of pain care, Dr. Dearing said. According to a study cited by a recent National Academies’ Institute of Medicine report, only four of the 117 surveyed U.S. and Canadian medical schools have elective courses on pain.
Recognizing that most physicians receive inadequate training in pain management, the White House Office of National Drug Control Policy recommends requiring continuing medical education as a prerequisite to prescribing opioids. Both chambers of Congress are considering bills requiring at least 16 hours of pain management CME every three years.
While seeing little chance for the California bill to become law, the AOA Department of Government Relations believes that physician education will eventually be tied to prescribing authority for controlled substances.
Some DOs are wary of the new prescription drug laws and bills. But Georgia family physician Carolyn B. Petrey, DO, for one, wishes her state would pass a law like Florida’s. “As a result of Florida’s crackdown, many pill mills have moved to Georgia,” Dr. Petrey says.