Florida Trends in Prescription Drug Abuse Jennifer A. Fass, PharmD, CPh Clinical Assistant Professor fass@nova.edu Roadmap Discuss Florida Medical Examiners Report Illustrate prescription drug abuse cases Describe Florida pain clinics i and prescription drug abuse Identify severity of healthcare professionals involved in drug diversion Discuss implementation of Florida s prescription monitoring program National Prescription Drug Threat Assessment (NPDTA) 2009 Evaluates prescription drug abuse in the U.S. Medical costs approximately $72.5 billion per year Non-medical use of prescription drugs most common among age group 18-25 Over 8,500 deaths in the U.S. involved prescription pain medications in 2005 Increase of 114% since 2001 Oath of a Pharmacist I promise to devote myself to a lifetime of service to others through the profession of pharmacy. In fulfilling this vow: I will consider the welfare of humanity and relief of suffering my primary concerns. I will apply my knowledge, experience, and skills to the best of my ability to assure optimal outcomes for my patients. I will respect and protect all personal and health information entrusted to me. I will accept the lifelong obligation to improve my professional knowledge and competence. I will hold myself and my colleagues to the highest principles of our profession s moral, ethical, and legal conduct. I will embrace and advocate changes that improve patient care. I will utilize my knowledge, skills, experiences, and values to prepare the next generation of pharmacists. I take these vows voluntarily with the full realization of the responsibility with which I am entrusted by the public. Oath of a Pharmacist. Adopted by AACP House of Delegates July 2007; Approved by APhA http://www.aacp.org/resources/academicpolicies/studentaffairspolicies/documents/oathofapharmacist2008-09.pdf09.pdf National Prescription Drug Threat Assessment 2009 http://www.usdoj.gov/ndic/pubs33/33775/33775p.pdf www.dea.gov Physician and Pharmacist South Florida Drug Trafficking Dr. Robert Hunt and Michael Kenney, RPh arrested for dispensing prescription narcotics without a legitimate medical purpose Drugs included hydrocodone, alprazolam, Subutex Plantation Chemist Busted Seth Mahler: President elect of Broward County Pharmacy Association Felony charges for trafficking prescription pain killers Jail and loss of pharmacy license 1
Fatal Prescription? OxyContin #180 Xanax #60 Soma #60 Percocet #120 Duty to Warn Gail Powers died October 2002 from multiple prescription drug overdose OxyContin, Percocet, Soma, Xanax, Valium Medications dispensed by two pharmacies over 6 month period Your Druggist and Medicine Shoppe Florida Supreme Court set duty to warn precedent Powers V. Thobani, et al., No 4D04-2061 Pharmacist Disciplinary Case Board of Pharmacy Meeting June 9-10, 2009 Pharmacist took controlled substances from pharmacy without prescription License suspended and required to enter Professional Resource Network Probation 5 years Administrative fees $2,707.37 PRN-3 Case No. 2008-2046 Florida Stats: 2009 Florida Medical Examiners Report 8,653 drug related deaths in 2009 2,488 individuals died with at least one prescription drug identified to be the cause of death 7 people die each day* Broward County Highest number of deaths of state s 67 counties Drugs causing the most deaths oxycodone, alprazolam, methadone http://www.fdle.state.fl.us/content/getdoc/daa6ef40-6b68-4770-b0b7-cc496a715b6b/2009-drug-report.aspx Florida Drug Deaths: 2009 Top 3 Oxycodone Alprazolam Methadone 1,185185 822 720 http://www.fdle.state.fl.us/content/getdoc/daa6ef40-6b68-4770-b0b7- cc496a715b6b/2009-drug-report.aspx 2008 Florida Youth Substance Abuse (FYSAS) Survey Florida Legislature s 1999 Drug Control Summit recommended establishing statewide substance abuse survey Conducted by four state agencies in 2008 90,000 students from 714 schools completed the FYSAS Goal is to establish prevention and treatment services 2008 Florida Youth Substance Abuse Survey http://www.dcf.state.fl.us/mentalhealth/publications/fysas/08survey/2008fysasstatewidetablesfinal.pdf 2
2008 Florida Youth Substance Abuse Survey Cont. Nonmedical use of prescription pain medications in past 30 days Statewide: 3.9% Miami-Dade: 19% 1.9% Broward: 2.3% Palm Beach: 3.2% 2008 Florida Youth Substance Abuse Survey http://www.dcf.state.fl.us/mentalhealth/publications/fysas/08survey/2008fysasstatewidetablesfinal.pdf Hall JN. Indicators of prescription drug nonmedical misuse and abuse in South Florida: 2008 Drug Abuse Warning Network (DAWN Live!) 2009 Public health surveillance program for drug related visits to the emergency department Nonmedical use of prescription opioids emergency department reports Broward and Palm Beach: 2,364 Miami Dade: 165 Hall JN. Indicators of prescription drug nonmedical misuse and abuse in South Florida: 2009 https://dawninfo.samhsa.gov/default.asp Michigan Wholesaler License Suspended Harvard Drug Group LLC distributed > 13 million doses of oxycodone over two years to South Florida 39 of 50 pharmacies purchasing largest amounts located in South Florida DEA suspended license to sell oxycodone http://www.justice.gov/dea/pubs/states/newsrel/2009/mia103009.html http://www.palmbeachpost.com/news/crime/dea-suspends-license-of-michigan-wholesaler-that-sold- 758915.html?printArticle=y Putting Florida on the Map DEA registered physicians dispense prescription narcotics directly to patients Individuals travel to Florida from Kentucky, Massachusetts, New Jersey, Ohio, and West Virginia i i to obtain prescription narcotics- especially oxycodone Buses, drug flights South Florida Pill Mills A new pain clinic opened in South Florida approximately every 3 days between August 2008 and November 2009 176 pain clinics in South Florida 115 located in Broward County National Prescription Drug Threat Assessment 2009 http://www.usdoj.gov/ndic/pubs33/33775/33775p.pdf Hall JN. Trends of Nonmedical prescription drug misuse in Miami-Dade, Broward, Palm Beach Counties, and the State of Florida: 2009. 3
Pill Mill Investigation http://www.justnews.com/news/20211199/detail.html http://www.justnews.com/news/20211199/detail.html http://www.justnews.com/news/20211199/detail.html 7 News on the Net http://www.justnews.com/news/20211199/detail.html http://abcnews.go.com/print?id=10022791 Pill Pipeline Putting a Stop to Pain Clinics http://www.wate.com/global/story.asp?s=12457092 http://www.wate.com/global/story.asp?s=12457092&clienttype=printa ble 4
New Florida Pain Clinic Laws Pain management clinics must be registered with Florida Department of Health by January 4, 2010 Effective October 1, 2010 Prohibited from advertising or promoting use, sale, or dispensing of controlled substances New Florida Pain Clinic Laws Cont. Effective October 1, 2010 Prohibited from dispensing more than a 72 hour supply of controlled substances for patients paying in cash, check, or credit card Physicians must complete specialized training http://www.doh.state.fl.us/mqa/medical/info_sb2272.pdf http://www.doh.state.fl.us/mqa/medical/ap_pmcapp.pdf http://www.doh.state.fl.us/mqa/medical/info_sb2272.pdf Tallahassee Drug Trafficking Case Christopher Michael Scott sentenced to 25 years in prison for trafficking oxycodone Approximately 250 pills per prescription Obtained oxycodone at pharmacies in Hillsborough, Pinellas, and Pasco counties What s the Going Rate for OxyContin 80 mg? City Price Quantity/Weight Jacksonville $60 80 milligrams Miami $20 80 milligrams Sarasota $40-50 80 milligrams Ft. Lauderdale $20 80 milligrams West Palm Beach $25 80 milligrams National Prescription Drug Threat Assessment Diverted Controlled Prescription Drug Prices Reported July 2008 http://www.usdoj.gov/ndic/pubs33/33775/33775p.pdf Florida OxyContin Scam August 6, 2008 sixty-two individuals arrested for health insurance fraud to obtain OxyContin 5 year operation Approximately 130 prescriptions written for OxyContin Over 12,000 tablets Estimated street value $400,000 5
http://myfloridalegal.com/ Top 50 Oxycodone Dispensing Practitioners 49 of the top 50 dispensing practitioners of oxycodone in U.S. are located in South Florida 25 located in Broward County The 25 Broward pill mill pain clinics dispensed 5,233,785 oxycodone dosage units in same 6 months Broward pain clinics decline from 33 in previous six months Oxycodone pills dispensed declined by 1,250,415 Hall JN. Trends of Nonmedical prescription drug misuse in Miami-Dade, Broward, Palm Beach Counties, and the State of Florida: 2009. Florida Law and Dispensing Practitioners Must register as a dispensing practitioner and pay a $100 fee Comply pywith all laws and rules governing pharmacists and pharmacies inspections Provide written prescription to patient Physician Sentenced to Life Chapter 465 Regulation of Professions and Occupations Dispensing Practitioner 465.0276 http://www.leg.state.fl.us/statutes/index.cfm?app_mode=display_statute&search_string=&url=ch0465/sec0276.htm&title=- >2008->Ch0465->Section%200276#0465.0276 6
http://myfloridalegal.com/ Prescription Monitoring Programs (PMPs) Thirty-nine states enacted legislation to establish a PMP Monitor controlled substances dispensed to prevent abuse and diversion Bordering states without PMP see increased abuse Federal grants include Harold Rogers and NASPER State Prescription Drug Monitoring Programs http://www.deadiversion.usdoj.gov/faq/rx_monitor.htm Florida Prescription Monitoring Program (PMP) Florida PMP bill signed June 18, 2009 Established by Florida Department of Health Program Implementation and Oversight Task Force Interdisciplinary 12 member governor appointed task force Florida PMP Cont. Monitor schedule II, III, and IV controlled substances Establish rules by December 1, 2010 Must report controlled substances within 15 days of dispensing Establishes pain clinic regulations Senate Bill 462 http://laws.flrules.org/files/ch_2009-198.pdf Assessing Florida Pharmacists Attitudes Towards PMPs Surveyed 5,000 Florida pharmacists Randomly selected participants through Florida Department of Health Licensee Data Center Ten question voluntary and anonymous self-administered survey Prescription Drug Abuse Task Force 7
To Flush or Not To Flush FDA has recommended medications that may be flushed down the toilet Medications not contained on this list: Disposed of in trash after mixing with unpalatable substance (e.g. coffee grounds, cat litter) Seal in bag or container Remove personal identifying information Actiq Medications Recommended for Disposal by Flushing Avinza Dilaudid tablets and oral liquid Dolophine hydrochloride Daytrana Duragesic patch Methadone tablets and oral solution Demerol tablets and oral solution Diastat/Diastat AcuDial rectal gel Embeda Fentora Onsolis Percodan Kadian Opana Xyrem Morphine tablets and oral solution Oramorph SR Oxycontin Exalgo MS Contin Percocet http://www.fda.gov/drugs/resourcesforyou/consumers/buyingusingmedicinesafel y/ensuringsafeuseofmedicine/safedisposalofmedicines/ucm186187.htm http://www.fda.gov/drugs/resourcesforyou/consumers/buyingusingmedicinesafel y/ensuringsafeuseofmedicine/safedisposalofmedicines/ucm186187.htm Operation Medicine Cabinet Secure and Responsible Drug Disposal Act of 2010 Passed in U.S. Senate August 3, 2010 Amends federal Controlled Substances Act for take-back disposal of controlled substances Change requirements for requiring permission from DEA and law enforcement to be present http://sheriff.org/safety/operation%5fmedicine%5fcabinet/flyer.pdf http://www.gpo.gov/fdsys/pkg/bills-111s3397rfh/pdf/bills- 111s3397rfh.pdf?utm Pharmacist s Role Prescription Drug Abuse Prevention Program Public awareness of dangers of prescription drug abuse Continuing education Interdisciplinary approach Prescription verification ASHP Statement Pharmacist s can play an active role in substance abuse prevention, education, and assistance Substance abuse assistance programs Public substance abuse education and prevention programs Primary and secondary schools, colleges, religious groups http://www.ashp.org/doclibrary/bestpractices/specificstsubstance.aspx 8
Drug Abuse Screening Tool: NIDA-Modified ASSIST Web based interactive tool to screen for substance abuse Consists of series of screening questions Calculates substance involvement score Represents level of intervention needed http://www.nida.nih.gov/nidamed/screening/ Take Home Points Prescription drug abuse in Florida has reached epidemic proportions PMPs will not completely solve the drug abuse problems Statewide education is crucial Become proactive in state legislature to help shape the profession Questions 9