Fla. raids target sellers of pain pills

Fla. raids target sellers of pain pills

By Donna Leinwand, USA TODAY

Federal agents and police raided doctors' offices across South Florida on Wednesday in a sweep aimed at what authorities say are operations that illegally deal prescription pain pills.

The raids and tough new state laws that can result in criminal charges for doctors who overprescribe narcotics are part of a nationwide crackdown on an explosion of pain management clinics that have sprung up in storefronts and office buildings to supply the USA's growing appetite for prescription drugs.

Often the cash-only clinics require just a cursory exam — if any — before a doctor will prescribe large amounts of narcotic pain medication such as oxycodone and hydrocodone, which can be highly addictive. Some of the clinics have in-house pharmacies to fill the prescriptions, says Rusty Payne, a spokesman for the Drug Enforcement Administration (DEA).

The DEA and local police call them pill mills.

In South Florida on Wednesday, authorities arrested 22 people, including four doctors, and seized dozens of exotic cars including Dodge Vipers, Lamborghinis and a Mercedes-Benz SLR McLaren.

An indictment made public Wednesday alleges that Vincent Colangelo of Davie, Fla., has been the owner of a seven-clinic operation that has used 1,600 websites to trawl for patients and sold more than $22 million in prescription drugs since 2008.

Federal agents have been investigating hundreds of South Florida clinics and doctors for a year and have made 340 undercover drug buys, says Mark Trouville, special agent in charge of the DEA's Miami office. He says more arrests are likely.

"We have probably already bought dope in your clinic and we are coming to see you next," Trouville warned owners of rogue clinics.

About 7 million people age 12 or older regularly abuse prescription drugs, making such drugs the third-most abused substance after alcohol and marijuana, the National Survey on Drug Use and Health reports.

"It's the fastest-growing addiction in the United States," says Marvin Seppala, chief medical officer at Hazelden, a drug rehabilitation system with programs in Minnesota, Florida, Oregon, Illinois and New York.

The drugs are easy to get, Seppala says. Patients in Hazelden's rehab programs say they often sought out pill mills as their addictions deepened, Seppala says.

"You can go anywhere in the country and find ways to obtain them — from unscrupulous physicians to elderly people on fixed incomes who sell (their) prescriptions for extra money," Seppala says.

The effectiveness and safety of narcotic prescription pain medications has improved dramatically during the past 30 years.

That has led many doctors who previously might have avoided prescribing narcotic pain medicines to begin doing so, says Peter Delany, director of the Center for Behavioral Health Statistics and Quality at the Substance Abuse and Mental Health Services Administration.

In 2000, substance abuse analysts noticed an uptick in the number of people abusing prescription pain medicines, says Carol Falkowski, drug abuse strategy officer for the Minnesota Department of Human Services.

"Nobody really knows why it happened, but I think the more we use prescription drugs, the more they reach the illicit market," she says. "There is a perception that they are more predictable and safer than street drugs."

The drugs, sold under brand names such as Percocet and OxyContin, produce feelings of relaxation and euphoria comparable to heroin, she says.

'The destination for dealers'
Florida leads the nation in prescription drug misuse, DEA records show.

Broward County, home to Fort Lauderdale and a popular spring break getaway for college students, is at the epicenter of the illicit trade in prescription drugs.

Doctors operating in Broward County dispensed more than 16 million prescription painkillers in 2009 among a population of 1.8 million, DEA records show.

For one narcotic drug, oxycodone, Florida practitioners purchased 41.2 million pills, compared with the total of 4.8 million purchased by practitioners in the other 49 states, Payne says.

Of the top 25 oxycodone prescribers nationwide in 2008, 18 were in Broward County and three others were in neighboring Palm Beach County, says Detective Sgt. Richard Pisanti of the Broward County Sheriff's Office.

"We've become the honey hole of drugs," he says.

Florida Attorney General Pam Bondi has asked her state's Legislature to enact tough penalties for doctors who abused their prescribing powers or use fraud to register as a pain clinic.

"Our state needs a unified effort at every level to eradicate Florida's pill mills," Bondi says. "We lead the nation in diverted prescription drugs. Our state has become the destination for dealers."

If adopted by the Florida Legislature, the new rules would require pain-clinic doctors to perform a physical examination on a patient.

The state also would establish a formula for how many pills could be prescribed at once, Bondi says.

Doctors who overprescribe could face six-month suspensions of their licenses and $10,000 fines. Doctors who failed to perform physical exams before prescribing, or who use fraud to open and run pain clinics, could go to jail.

The Office of National Drug Control Policy (ONDCP) is working with physicians to set standards of practice for prescribing the correct doses of prescription narcotics.

ONDCP Director Gil Kerlikowske, who is visiting Kentucky and West Virginia this week to assess their prescription drug abuse problems, urges states to set up prescription-drug monitoring programs.

To curtail "doctor shopping," — the practice of seeing multiple doctors to collect several prescriptions — 35 states now have prescription-drug monitoring programs, databases that track prescriptions for controlled substances, including narcotics.

Doctors can access the database to see whether a patient has received narcotics from other doctors before they obtain a new prescription. In some states, medical boards can use the system to identify doctors who are writing excessive prescriptions.

"It's not a panacea, but it's one more tool that can be very important," Kerlikowske says. "It's something every state should have."

Next, the states should coordinate their programs so addicts can't "doctor shop" across state lines, he says.

"The pipeline" to Kentucky, West Virginia and Tennessee "is clearly Florida," Kerlikowske says. "That's well-documented."

Florida is among the states without a monitoring program. Gov. Rick Scott, a Republican, has said the program is too expensive and an invasion of privacy.

Case study: Florida
Pill mills emerged in Broward in 2006, Pisanti says.

"We started to see cases of people coming from out of state and going to a hotel and overdosing," Pisanti says. "We were seeing a spike in deaths and a lot of the people were from Tennessee, Kentucky. Why is this happening? We started researching."

In most of the overdose cases, the medical examiner found opioid narcotics, Pisanti says. Police also noticed spikes in crime around some new pain management clinics near the county's Interstate 95 corridor, he says.

The number of pain management clinics soon exploded, he says. In 2006, the Broward Sheriff's Office tracked six pain clinics. By 2008, there were 116, Pisanti says. At the peak in mid-2009, Broward County had 140.

There are legitimate pain clinics run by doctors who are specially trained in pain management, but many clinics appeared less professional, Pisanti says.

Dozens of patients have waited in long lines outside such clinics, which often are manned by armed guards, Pisanti says. The clinics demand cash payments and never take insurance, he says. Some advertise on Craigslist, seeking doctors willing to sign off on prescriptions, he says.

The clinics often advertise out of state, particularly in Kentucky and Tennessee, where abuse of prescription pain pills has taken root, Pisanti says.

Cracking down elsewhere
Those states have tightened state laws to make it more difficult for doctors to prescribe narcotic painkillers and cut the supply diverted to addicts. Tennessee and Kentucky have Prescription Drug Monitoring Programs, which allow state medical and pharmacy boards to identify doctors who overprescribe pain medicine and patients who receive pain pills from multiple doctors.

"People were coming down from Kentucky to Broward, going from clinic to clinic and going back with thousands of pills," Pisanti says. "Their demand caused the supply to grow."

The patients could purchase 100 pills for $225, but could sell them by the milligram and make about $5,400, he says.

At first, law enforcement in Broward took a traditional approach to the drug dealing: Arrest as many people as possible, Pisanti says.

In one year within a mile's radius of Broward County's Commercial Boulevard in Oakland Park, police arrested 715 people for illegal possession of prescription narcotics and other drug-related offenses, Pisanti says.

"We did busts every single day," he says. "But we'd be arresting one patient and other patients would walk right by us to another clinic. We had to find a new approach."

List of 'bad doctors'
Now investigators, partnering with the DEA and the Florida Board of Medicine, focus on identifying bad doctors and closing illegitimate clinics, he says. Pain clinics must be owned by doctors and must register with the state. The Health Department can examine their records. Physicians who run such clinics must complete pain management training by 2012.

"Bad doctors are so easy to identify now," Pisanti says. "The amount of opioids they prescribe is skyrocketing."

In South Florida, Trouville says the clinics operated so brazenly that local residents called them in to police. The clinics his agents investigated had armed guards and security cameras in the reception rooms, cars with tags from Tennessee and Kentucky parked in the lot, and patients sleeping in their cars as they waited for the clinics to open.

"If you have cash in your pocket, you're coming out with drugs in your hand," Trouville says. "These folks are clearly only in it for the cash. They don't care one bit about the patients."

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This is just the tip of the iceberg. Sheriff Al Lamberti claims that there are more pill mills in Broward County than there are McDonalds. I was watching one in Hollywood, Florida on Sheridan St. It was next door to the UPS store and you could tell by the people there. They would line up early everyday and the UPS people would complain. Most were young adults with tattoos, many piercings and looked like they never had or could get a job. Then they would leave and tell another to go to the same owners other clinic in Hallandale which is the neighboring city to the south. They ended up moving as police were turning up the heat on them.