Sunday, February 21, 2010
Palm Beach Post

Despite new rules targeting the pain management industry, unscrupulous clinics that supply narcotics traffickers and addicts will keep spreading across Florida unless lawmakers enact tougher restrictions immediately, according to a top state medical official.

“It’s been frustrating that it’s taken so long to recognize the significance of this problem,” said Dr. Steven Rosenberg, a West Palm Beach dermatologist and state Board of Medicine member.

“The Board of Medicine for the past three years now has been begging the legislature to take some action,” Rosenberg said.

Legitimate pain management centers offer a needed service, but authorities say a disturbing number of doctors and entrepreneurs are more interested in making money than in easing pain.

As things stand now, no measure exists to detect doctor shoppers, and felons are free to team with troubled physicians to operate high-volume, cash-and-carry pain clinics. Doctors can dole out as many pills as they please from their offices.

Among the people profiting from pain clinics in Palm Beach County are convicted drug smugglers and doctors fined for breaking state rules, a Palm Beach Post review found last year.

After eight consecutive attempts to establish a Florida prescription drug monitoring program, a bill signed last summer allowed for the creation of a database to track prescriptions for addictive pills. It also defined pain clinics as businesses that advertise in any medium and specialize primarily in treating pain by prescribing narcotics.

But Rosenberg, also a member of a panel working to establish enforceable pain clinic standards, said state health inspectors will be powerless to stop unscrupulous clinic operators who lie about what they do.

“One of the concerns that I have is that we will see some of these centers just not advertising,” Rosenberg said, noting that drug dealers and addicts have a knack for finding drug suppliers. “I’m concerned that there will be centers basically functioning as pill mills under the radar.”

He said the only answer was for Florida to get its still-unfunded drug monitoring program operational. The computer tracking system is supposed to come online by December, but some observers say setting up the database might take as long as three years. Without that database, the state’s efforts to regulate illegal pain clinics will rely on self-reported information.

“People who are going to provide services illegally will continue to provide services illegally unless there is a way of finding them,” Rosenberg said, “and the only way to find them is having that databank.”

Rosenberg also on Friday called on legislators to pass better, tougher pain clinic laws, and soon.

Top Republican and Democratic leaders said last week they expect pain management regulation will be a high priority going into the legislative session, which kicks off next week.

Spokeswomen both for Senate President Jeff Atwater, R-North Palm Beach, and House Speaker Larry Cretul, R-Ocala, said the lawmakers were deeply concerned about the burgeoning pain clinic industry, and the illicit pill trade it’s fueling.

“This is still a real crisis that needs to be dealt with,” said House Majority Leader Adam Hasner, R-Delray Beach. “We take this problem very seriously and are working on a meaningful response that should put an end to Florida being the pill mill capital for the U.S.”

At least four legislators are proposing bills to build on the pain clinic law passed last year.

“I do feel like there’s a political will,” said Sen. Dan Gelber, D-Miami Beach, who’s sponsoring a bill that would bar felons from owning clinics, among other things. Gelber, a former federal prosecutor, is seeking the Democratic nomination for Florida attorney general.

“I’ve talked to some of my Republican colleagues,” Gelber said. “They all seem more than casually interested. They feel like they want to do something.”

As the legislature readies to tackle the issue, legitimate pain management physicians are wary.

“I’m definitely in favor of more regulation. What concerns me now is we have the state, counties and we have cities now that are all trying to come up with regulations,” said Dr. Lawrence Gorfine, referring to a crush of new county and municipal ordinances aimed at curbing the explosive growth of pain clinics in Palm Beach County.

“The problem that is going to occur is that reasonably sick people are not going to be able to get medication if we become over-regulated,” said Gorfine, a pain management doctor and president of the Palm Beach County Medical Society.

Gorfine said legitimate doctors often treat patients in need of “continual narcotic therapy,” including elderly men and women who undergo surgeries and then live with chronic pain.

“It’s not such a simple problem,” he said. “Our concern is that in looking for the simple fix, we burden the public, create a lot of regulation that may not be necessary, and not really solve the problem.”

Source: Palm Beach Post