Florida's Fight Against Prescription Drug Abuse Seven people die every day in Florida from prescription drug overdoses, by one estimate. Many of those deaths have been linked to pill mills — medical facilities that illegally prescribe or dispense strong narcotics. Local authorities are taking steps to combat the crisis.


Florida's Fight Against Prescription Drug Abuse

Florida's Fight Against Prescription Drug Abuse

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Seven people die every day in Florida from prescription drug overdoses, by one estimate. Many of those deaths have been linked to pill mills — medical facilities that illegally prescribe or dispense strong narcotics. Local authorities are taking steps to combat the crisis.


Amy Pavuk, reporter, Orlando Sentinel
Tom Parkinson, Morning Edition host, WMFE


Prescription drugs from pain centers here in Florida cause seven deaths a day from overdoses in the state, and nobody knows how many more across the country. Interstate traffickers, local dealers and addicts take advantage of loose regulations that allow doctors to establish so-called pill mills. Of course, there are many legitimate doctors and legitimate patients as well.

If prescription drug abuse has hit your family, give us a call: 800-989-8255. Email: talk@npr.org. Amy Pavuk is a crime and courts reporter for the Orlando Sentinel, and she joins us here at member station WMFE in Orlando. Pleasure to have you with us.

AMY PAVUK: Thank you for having me.

CONAN: Also with us is Tom Parkinson, MORNING EDITION host here at WMFE and a reporter at member station covering this issue. Nice to have you with us, Tom.

TOM PARKINSON, BYLINE: Nice to be here.

CONAN: And, Amy, I have to ask, one of the questions that thought my regulate this was a registry that recorded every prescription and every sale. Thirty-five other states have it. Florida's supposed to take effect last October.

PAVUK: Florida now has a prescription drug monitoring program. That was something that drew sharp criticism from leaders across the country, including from the White House because it is touted as a tool that is one of the most effective in combating the state and the nation's prescription drug epidemic.

CONAN: And how effective has it been in the months since it's taken effect?

PAVUK: It is a little bit too soon to tell. It hasn't been in effect that long, but law enforcement who I've spoken to have started using it. They use it to track what doctors are prescribing and what citizens are receiving in prescription.

CONAN: Meanwhile, there are hundreds of these so-called pill mills that says, you know, pain center, pain medication. The purposes are quite legitimate.

PAVUK: There are. This is one of the things that law enforcement and legislators made clear, which - our state has plenty of legit pain clinics. It is just this small number of so-called pill mills that are causing the problem.

CONAN: And these are individual places run by individual doctors who issue a lot of scripts.

PAVUK: They do. They are accused of just prescribing a plethora of pills without any true legitimate need.

CONAN: And so these end up in the hands of, well, either local dealers or, in fact, sometimes interstate dealers.

PAVUK: They do. There's a term that law enforcement has coined here called the pillbilly. That is referred to as citizens in - from Kentucky, Ohio, you name it, who travel here specifically to get pills. They can get them, and then they return to their home state and fill them.

CONAN: And the markup, as I gather, if you buy an OxyContin pill, for example, from a prescription, it's about $1, maybe $10 then on the street here in Florida, maybe $40 a pill if you're selling that in, just to pick a place, Kentucky.

PAVUK: That's true. And we're hearing that the amount is actually going up now that the supply is dwindling.

CONAN: And, Tom Parkinson, what kind of an effect is all this having on this community?

PARKINSON: It's just been devastating, Neal. It's - as one of Amy's sources actually said recently, if there were seven people a day dying from any other disease, authorities would be all over it. This was allowed to continue for far too long. And that's one of the reasons why it became so severe here in Florida because for at least a decade, there was lax to no regulation on these clinics. No pill mill - or pill monitoring database, so doctor shopping was relatively easy to do. And I wanted to go back to your point about the pill mills.

I recently interviewed Sheriff Jerry Demings, Orange County Sheriff Jerry Demings about this and asked the sheriff, you know, how can you tell? What's - how can you tell the difference between a legitimate pain management clinic and a so-called pill mill? These places, you have to understand, Neal, they were - look like just storefronts. They would be wedged between a laundromat and a pawnshop or something. A patient would basically show up with any kind of vague complaint of back or neck pain or whatever, receive a perfunctory, if any, physical examination and then be written a scrip for hundreds of doses of these highly addictive pills on a cash-only basis. They're open 24 hours a day, till 3:00 a.m. or something, armed guards, sign saying you're not allowed to sell your drugs to other patients.

This doesn't describe the picture of when I go to my physician. It's not like that. There are no armed guards there. So clearly, if you have a line of people outside a building at 3:00 a.m. paying cash, something is not right there.

CONAN: Amy Pavuk, is that accurate? These are places that dispense as well as prescribe?

PAVUK: Well, technically they can't dispense themselves anymore. That was part of the legislation that was recently enacted. But yes, I've been to these pill mills myself. It is not uncommon to see lines of people standing outside. As Tom mentions, armed security. It's just - it's not routine. It's not standard, what people would consider general care.

CONAN: Yet when law enforcement tries to intervene, the person says here's my prescription and here are my pills. It's perfectly legal.

PAVUK: Right. And that's one of the defenses that the patients and the doctors have, particularly the doctors who say, you know, I prescribed this to this patient. I told them to take one pill a day. I did not tell them to take 30 pills at one time, and I certainly didn't tell them to sell them either.

CONAN: And the - and they have a legitimate complaint. This my business and why are you messing with me?

PAVUK: Right. And that's what makes these criminal investigations so difficult, is because law enforcement essentially has to hire or get doctors involved to assess these and look at these and say, OK, if this person came in with a back pain, what would you ordinarily do? Would you do this? Would you do that? Would you send them to a specialty doctor? And they really have to assess this on a case-by-case basis, which makes building these cases so tedious and time consuming.

CONAN: Tom Parkinson, you think a pattern would indicate - well, a pattern - if you're dispensing large numbers of pills to large numbers of people, maybe people should get suspicious.

PARKINSON: Yes. And to their credit, law enforcement is cracking down, and it apparently is having a tremendous impact. They're just getting started on it, but the latest figures I've had is more than 400 clinics have been closed down in the last year. Prosecutors have indicted dozens of pill mill operators. Eighty doctors have lost their licenses. A number of doctors have gone to prison, and we're talking, you know, five, 10, 15-year sentences. So they really are cracking down. It seems to be having an effect. One telling number, I think, is the doctor purchases of oxycodone dropped from 35 million doses in period of 2010 to less than a million, 925,000.


PARKINSON: So it obviously is having an effect. But there are a number of unintended consequences, Neal, because these are highly addictive medications, and you don't just wake up - if you're addicted to one of these pills, you don't just wake up one morning and say, oh, it's illegal now or my pill mill is closed, I'm going to quit. These people are going elsewhere, and those are some of the unintended consequences that I talked to Jerry Demings, the sheriff, about. They're seeing a huge spike in illegal street drug sales and also a huge spike in armed robberies of pharmacies, drug cargo heists, all kinds of...

CONAN: Ancillary...

PARKINSON: Ancillary, yeah, unintended consequences.

CONAN: We'll get to the calls in just a minute. But, Amy Pavuk, where do these places get their pills from?

PAVUK: Well, it used to be the doctors in Florida could buy their pills directly from the manufacturers, hence why we saw the numbers that we were seeing for years, such as in 2010, 90 of the top 100 oxycodone-dispensing doctors in the nation were from Florida. It's a huge number. It's obviously decreasing now. And so now drug addicts and abusers, when they can get their pills from doctors, or if they don't buy them on the street, they are going to have to turn to pharmacies. But with that said, at least one pharmacy chain is implementing some changes. CVS recently sent a letter to what it deemed high-dispensing doctors, telling them that it was no longer going to fill their prescriptions for pain killers and other scheduled substances.

CONAN: I assume doctors are saying, wait a minute, how do you get to decide which doctor's prescriptions to fill and which you don't?

PAVUK: Exactly. They're calling it discriminatory. One, you know, several people are referring to it as a black list and saying that, you know, look, you're pegging us as criminals when we haven't been arrested. We're not under investigation. But a story that I investigated that ran recently showed that quite a few people on that list actually either have been arrested or under investigation, so there is some correlation between CVS's list and what law enforcement and health department officials are doing.

PARKINSON: That should be pointed out, Neal. These people - we're not talking Dr. Kildare here. People - you uncovered some of the people in your - on that list in your piece, excellent piece that ran on Saturday in the Sentinel. Could you tell us a little, Amy, about who some of these doctors were? I mean, pretty shady characters.

PAVUK: Sure. Sure. I looked at the doctors from Central Florida. There is one doctor who was arrested for not just allegedly - again, he hasn't gone to trial, hasn't been convicted - not just for allegedly running a pill mill, but also hosting wild sex and drug parties at his home. He invited...

PARKINSON: With his patients.

PAVUK: With his patients. You have people who range from him to simply doctors who have a lot of fatal overdoses associated with their patients, and law enforcement looks in and says, why is this person having four and five overdoses of their patient base in a year or two?

CONAN: Let's get a caller in on the conversation. 800-989-8255. Email: talk@npr.org. Sam's with us from Merritt Island here in Florida.

SAM: Yeah, how are you doing?

CONAN: Good, thanks.

SAM: Yeah, I don't know how relevant it is, but I have a sister-in-law who was recently arrested for selling OxyContin, and she would use several people to purchase pills for her, from Miami to Orlando. They would pick doctors from Miami or Orlando that they could get their pills from. And she was arrested, and none of the doctors were prosecuted, as far as I know. But she is back out, and she is doing the same thing again and using the same people. And I was just wondering, you know, if they couldn't possibly put certain people on a list that, I mean these people don't need and shouldn't be prescribed these drugs, you know? I mean, they're using the same mules each time.

CONAN: Amy Pavuk, any prospect of such a list?

PAVUK: Well, two things come to mind: One, what you're referring to about your sister, those are actually what law enforcement in Florida refers to as sponsors. There's a lead person who quote-unquote "sponsors" other people to get drugs for them. That's one thing. The other aspect is this database that Florida now has will track that.

So if your sister has four people going and getting drugs for her, law enforcement and pharmacists can now track who those people are and what they're buying. They don't have free access to that database. Law enforcement has to prove that they're already investigating the person, but that is what Florida's new database, which really has only been unveiled actually just a matter of weeks, if not just a few months - that's what it's intended to do.

CONAN: Sam, we hope your sister gets out of the trap.

SAM: Sorry?

CONAN: Thanks very much for the - we hope your sister gets out of the trap she's in.

SAM: Yeah, my sister-in-law, and I sure hope so too. And I was just upset that they had all the prescriptions with the names on them and none of the other people were sought either.

CONAN: All right. Thanks very much. We're talking about prescription drugs and so-called pill mills here in Florida. You're listening to TALK OF THE NATION from NPR News.

This email from Ashley: I'm pharmacist, newly graduated in May. I currently work for Walgreens, and I have found that I am more of babysitter against pain and stimulant drug abusers than a health care professional. People abuse these drugs at a ridiculous rate and get angry when I tell them the risks they're putting themselves to by taking too many. In regards to prescribers, I see legitimate and potentially illegitimate prescribing practices. However, I can't prove any illegitimacy, so I'm stuck with dispensing hundreds of pain and stimulant meds to one person at a time. It's extremely frustrating. She's writing from Davenport, Iowa. And I assume, Tom, that's the situation a lot of pharmacists here find themselves in.

PARKINSON: Yeah, it seems to be that way. And as Amy and I have both said, law - there are new laws in place, state laws and county and municipal laws, and they seem to be working. They seem to be taking effect, but it's probably going to take a long time to know if that's really going to work. And Neil,, I think it needs to be said, as this caller pointed out, that many of these people, you know, they didn't set out to become junkies. They were injured in a car accident or some other way and some legitimate physician prescribed these drugs to them, and then they became addicted.

And there's many others, it should be said, that have a legitimate need for these medications and use them responsibly, as prescribed and do not abuse them, just as there are many doctors who legitimately prescribe the drugs. But these new laws, including the prescription drug database, are just riddled with loopholes, all kinds of loopholes.

CONAN: Let's see if we can go next to - this is Fred. Fred with us from Ocala, Florida.

FRED: Yeah, I had to laugh when you said about legitimate doctors. My son was in an auto accident and he went and saw a, quote, "legitimate doctor," who due to the pain of the injury gave him prescription for 180 OcyContins. Well, that was about $40,000 out of my bank book ago, and it - we've been fighting(ph) it for three years. He gives him a script for the OcyContins without even a return visit. So - and this was a respected doctor in the community, supposedly.

But my son, I constantly try to get him off. I get him clean. I even put him in jail for nine months. I get him clean. He goes fine for months, falls back off the wagon. It's a horrible, horrible disease, if you want to call it a disease or an addiction. But his sources - when he goes straight and we talk a lot, trying to get him straight - his main sources - and he tells me they're going for 20 to 40 dollars a pill on the street - are the - he tells me a lot of senior citizens are getting prescriptions.

They're supporting themselves off it because people you would never expect to be drug dealers are, you know, 60, 50, 60 years old getting prescriptions because they don't have a good pension, and they're supporting themselves by reselling their pills. Also, a great deal of the pills he was purchasing were coming from guys who were getting them from the VA. You know...

CONAN: Fred.

FRED: ...it's a horrible, horrible thing. Like I say, I fight every day, you know, trying to get my son so he's going to stay alive.

CONAN: Fred, you must be...

FRED: And the doctors are just - oh, the doctors, I - they are the ones who should be thrown in jail. And...

CONAN: Well, Fred...

FRED: ... pass out scrips without any follow up or without any recourse to them, you know?

CONAN: Fred, I know you must be worried sick, and we hope your son deals - well, finds a way out of the addiction. But he raises a good point, and I wanted to read it - raise it again in the context of this email from Christopher in Orlando. My mother was a regular visitor of a local Central Florida pill mill. She overdosed Christmas Eve, 2011. These doctors should be made responsible for their dangerous actions. Well, they're talking about actually charging some doctors, aren't they, Amy?

PAVUK: They are, and law enforcement and prosecutors are doing what they can. Locally, the numbers are skyrocketing of prosecutions, of drug trafficking charges, and they are going after these doctors. It's just a very difficult and slow process.

CONAN: Amy Pavuk of the Orlando Sentinel, thanks very much. Our thanks also to Tom Parkinson of the WMFE here in Orlando. We have to thank Mark Simpson, Mac Dula, Melissa David, Vierka Kleinova and everybody here at WMFE for their hospitality as they hosted us here today. Tomorrow, Jennifer Ludden will host with a conversation about the growing number of multi-generation household. This is TALK OF THE NATION from NPR News. I'm Neal Conan.

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