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Prescription Drug Abuse

Floridas Health Crisis

Office of the Attorney General


Dave Aronberg
Special Prosecutor, Prescription Drug Trafficking

Overview
Prescription drug diversion is the #1 public
safety threat confronting Floridians today.
Florida has become the epicenter for the
availability and abuse of controlled
prescription drugs.
Prescription drugs are now responsible for
killing 7 Floridians per day, and has been on an
upward trend for the past six years.

Increasing Oxycodone Deaths

What are Pill Mills?


A pill mill is a doctors office, clinic, or health
care facility that routinely conspires in the
prescribing and dispensing of controlled
substances outside the scope of the prevailing
standards of medical practice in the
community or violates the laws of the state of
Florida regarding the prescribing or dispensing
of controlled prescription drugs.

Pill Mill Tip-Offs

Non-traditional medical office locations


No insurance accepted
Security guard at front door
Out of state license plates in parking lot
Parking lot loitering
Long lines inside and outside
Lack of medical equipment
Treatment options limited to pills only
Affiliations with specific pharmacies
Recent business name changes
Angry dog behind counter

Extent of the Problem


Between 2003 and 2009, the number of
deaths caused by at least one prescription
drug more than doubled.
Among young people ages 12-17, prescription
drugs have become the second most abused
illegal drug, behind marijuana.

Ground Zero
Broward County
In 2007, there were 4 pain
clinics operating in Broward
County.
In 2010, Broward Sheriffs
Office listed 144 pain clinics
operating in the county.
Today, there are 105 registered
pain clinics in Broward County.
There are more pain clinics in
Broward than McDonalds in
Broward.

Nationwide Comparison of Oxycodone Purchases by Practitioners


January - June 2010
45,000,000
41,285,772

40,000,000

35,000,000

30,000,000

25,000,000

20,000,000

15,000,000

10,000,000

5,000,000
1,021,933

794,124

489,942

302,873

255,442

240,768

231,877

188,102

174,208

OH

GA

MD

CA

TN

KY

PA

NV

NC

1,102,120

FL

Remaining
States

Nationwide Comparison of Oxycodone Purchases by Practitioners


January - June 2010
45,000,000
41,285,772
40,000,000

35,000,000

Units Purchased

30,000,000

25,000,000

20,000,000

15,000,000

10,000,000
4,801,389

5,000,000

Florida

Remaining States

Attorney Generals
Statewide Strategy

1. Criminal
2. Civil
3. Administrative
4. Legislative
5. Prevention

Regulating Pain Management

F.S. 458.3265(1)(a) defines a pain management clinic.


F.S. 465.0276(1)(b) creates the 72-hour dispensing rule.
Department of Health (DOH) regulates pain clinics that are
owned by a medical and osteopathic physician.
Agency for Healthcare Administration (AHCA) regulates
pain clinics that are not fully owned by medical and
osteopathic physicians.
Pill Mills are attempting to evade our new laws and
regulations:
Wellness Centers
Urgent Care Centers
Rejuvenation Clinics

Detox Centers
Massage

New Rules for Osteopaths


Rules 64B15-14.0051 & 14.0052
Standards of Practice:
Evaluation of Patient: complete medical history and physical exam
required, including urinalysis.
Treatment Plan: individualized, with objectives for reaching a
rehabilitative end-state.
Patient records: includes maintenance of file with duplicate prescription
scripts written.
Still to be adopted: Limiting the number of pills a doctor can prescribe.

Local Moratoria
Temporary moratoria have helped communities limit
the growth of pill mills that fuel continued
prescription drug abuse.
As of December 2010, there are more than 30 cities
and counties that have passed local ordinances
prohibiting new pain clinics.
These successes belong to those in the community
local officials, concerned citizens, anti-drug
coalitions, law enforcement agencies and others who
are taking a pro-active approach.

Best Practice Recommendations


Pain clinics have to be licensed by the city/county
and pay an annual fee.
Hillsborough County
Titusville

Clinics can only be located in areas that have


hospital/medical zoning.
Titusville
Delray Beach

Clinics are prohibited co-locating in the same office


or building with a pharmacy.
Martin County
Oakland Park (DRAFT)

Best Practice Recommendations


Prohibit cash-only pain clinics
Orange County
Orlando
Satellite Beach

Limit the hours of operation

Martin County
Davie
Orlando
Broward

Create city/county-wide taskforces for local solutions


Broward
Orlando

Prescription Drug Monitoring Program


FS 893.055 creates the PDMP and the accompanying
Public Records law, FS 893.0551, that limits access to
confidential and private information in the PDMP
database.
Requires dispensing practitioners to report
dispensed II IV controlled drugs to the database no
later than 15 days from the date of dispensing.
The PDMP allows practitioners to:
request access to the patients prescription history
information during office visit to ensure better patient
standard of care
avoid prescribing medications that may be dangerous
when taken in combination with other medications
identify possible doctor shoppers

Conclusion
The proliferation of pain clinics that dispense
and prescribe legal opiates such as
Oxycodone, has helped fuel the problem of
prescription drug diversion and has made
Florida the pill mill for the entire country.
Prescription drug diversion costs lives,
increases crime, and accelerates costs
connected to treatment, medical expenses
and Medicaid fraud.

PAUL VIDELA/pvidela@bradenton.com Local residents gathered along Manatee Avenue


outside of the 1910 Medical Clinic, a pain management clinic, to protest.

Office of the Attorney General

Dave Aronberg
Special Prosecutor, Prescription Drug Trafficking
dave.aronberg@myfloridalegal.com
(561) 837-5000

Pain Management Clinic Ordinance


City of Oakland Park

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Problem

End of 2008 - Emerging street crime trend

20 Pain clinics operating within City boundaries.


Increase in the rates of street level narcotic sales

From August 2008 November 2009 Proliferation of Clinics & Drug Cases
Pain clinics opened every 3 days in South Florida
Broward County went from 47 clinics to 115
Late 2009 50% of 1600 active drug cases being heard were for prescription
drugs.

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Problem (contd.)

BSO Oakland Park Special Investigations Unit Activities:


2009
714 arrests associated with narcotics and pain clinics
7,200 prescriptions pills seized
$119,447 in cash seized
95 vehicles seized
January 1 to July 31, 2010
301 Total Arrests made
229 Felony Arrests (Includes 43 Drug Trafficking Arrests)
72 Misdemeanor Arrest
Over 14,407 Prescription Pills Seized
$58,073.00 in Cash Seized
60 Vehicles Seized

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6,584,200
Dose Units
6 month period in 2008

2,738,700 units of oxycodone

Why Oakland Park?


Lack of modern zoning regulations to address specific
demands of a pain clinic compared to surrounding cities;
parking, change of use regulations.
Proximity of clinics to interstate highways
Vacant office/retail space and low commercial lease rates
Clustering of existing clinics & pharmacies created
demand for even more clinics

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Pain clinics advertise, cluster around each


other and create problems for
neighborhood

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Impact within the City of Oakland Park


Homicide and violent crime
Increase in neighborhood burglaries and
robberies
Increase in drug trafficking of prescription
drugs street level sales
Identity theft
Organized crime
Parking issues
Loitering, littering and other nuisances for
adjoining neighborhoods
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Oakland Parks Draft Ordinance Outline


Chapter 24, Land Development Code
New Business Categories: Pain Management Clinic, Pharmacy
& Rehabilitation, Drug Addiction Treatment, Therapy and
Counseling.
Prohibits new clinics in NB and B-1 zoning districts.
Conditional use for new pain clinics in B-2 & B-3.
New Parking Requirements: 1 per 10 gross sq. ft. of customer
waiting area including the lobby and seating area; plus 1 per
200 gross sq. ft. of the remainder of the building.
Change of Use. All new clinics would need to bring a property
up to current parking and landscape codes if they occupy
more than 25% of a building on a site.

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Proposed Master Business List & Parking Code Changes


Chapter 24, Article III, Section 24-41, Master Business List:
Business Listings

Prohibited

NB

B1

B2

B3

*7

*7

*7

*7

*7

Pain Management Clinic (see Chapter 7, Section 7151 of the Code of Ordinances for definition and
additional regulations)
Pharmacy (see NB zoning district regulations for
additional restrictions)

Rehabilitation, Drug Addiction Treatment, Therapy


and Counseling

I1

(* = Permitted by Right; *7 = Conditional Use; Blank = Not permitted)

Chapter 24, Article VI, Section 24-80(C):


Use
Parking Requirement Spaces
1 per 10 gross sq. ft. of customer waiting area including the lobby and
Pain Management
seating area; plus 1 per 200 gross sq. ft. of the remainder of the
Clinic
building.

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Oakland Parks Draft Ordinance Outline (contd)


Chapter 7, Licenses & Business Regulations
Provides for the definition of a pain management clinic.
Exceptions: Medical facilities and Hospitals, Surgical doctors offices
orthopedics, medical schools, any other medical clinic, office or facility
that does not prescribe controlled substances i.e., Chiropractor, Nonprofit
Organizations, Walgreens, CVS and Publix pharmacies.
Pain Management Clinic Permit
Applicants must include the business operator, Medical Director and the
property owner.
No employees of the clinic can have a felony conviction involving a
controlled substance.
Disclosure of Interest Affidavit will detail all natural persons who are
involved in the business.

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Oakland Parks Draft Ordinance Outline (contd)

Clinics must be registered and provide proof of registration with DOH.


All clinics new and existing must be owned by a physician or a group of
physicians.
No outdoor seating areas, queues or customer waiting areas.
Prohibits on site prescription drug dispensing for controlled substances.

Separation Requirements
mile separation between each clinic regardless of municipal
boundaries.
mile separation FROM community or special pharmacies regardless of
municipal boundaries.
Discourages doctor shopping and mitigates the negative impacts from the
clustering of clinics.

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Oakland Parks Draft Ordinance Outline (contd)


Conditional Use. Approval for new clinics required, existing clinics will be
legal nonconforming to having a conditional use approval.
Inspections. All clinics must allow representatives of the City of Oakland
to enter and inspect their places of business during business hours or at
any time the business is occupied to verify compliance with the Citys
Code of Ordinances.
Revocation of permit. Violations of the City Code of Ordinances and/or
clinics that are determined to be harmful to the public health, safety or
welfare of the city may have their permits revoked.
Penalties & Enforcement.
Arrest and imprisonment for up to 90 days;
Fines up to $500 per day for each offense;
Special Master process and procedures.

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Existing Pain Clinics


All existing clinics must file for the Pain Management Clinic Permit within
60 days of the adoption of the ordinance.
Immediate compliance with the following is required:
No employees of the clinic can have a felony conviction involving a
controlled substance.
No outdoor seating areas, queues or customer waiting areas.
Prohibits on site prescription drug dispensing for controlled
substances.
Removal of all signage, symbols or vehicles identifying the
premises as a pain clinic from a building, site or parcel of land
where pain clinics have vacated and are no longer in operation.
All existing clinics must comply with the distance separations within 5
years.

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Working with Law Enforcement


Lisa McElhaney
Sergeant
Broward County Sheriffs Office
Lisa.mcelhaney@gmail.com

Ways to Work with Law Enforcement


Have a Defined Strategy
Identify Resources
Identify Stakeholders

Develop a Networking System to Coordinate


Efforts
Organize Specific Rolls & Responsibilities
Organize a Recordkeeping System to Track ALL
Related Incidents, Actions, and Results

Law Enforcement Needs


Primarily Focus on Public Safety Issues
Immediate Threats receive higher priority

Enforcement of Laws
Criminal, Civil, Regulatory & Administrative
Specialized Area requires Clarification of Violations
Identify Appropriate Agency of Enforcement

Department of Health
DEA
Local Law Enforcement
Code Enforcement

Strategic Tactics
Require Preplanning
Education for ALL Stakeholders on Laws,
Regulations & Viable Responses
Establish a Network with Local Stakeholders

Identify Levels of Recognition & Authorization


for New Businesses (Prevention)
Establish a Vetting Process
Establish a Swift Response Mechanism for
Violations

Todays Webinar Presenters


Senator Dave Aronberg
Special Prosecutor, Prescription Drug Trafficking
Office of the Florida Attorney General
Dave.aronberg@myfloridalegal.com
Justin T. Proffitt, AICP
Senior Planner, Engineering & Community Development Department
City of Oakland Park
justinp@oaklandparkfl.org
Lisa McElhaney
Sergeant
Broward County Sheriffs Office
Lisa.mcelhaney@gmail.com
Kenneth Pratt, Esq.
Legislative Advocate
Florida League of Cities, Inc.
kpratt@flcities.com

Thank you for participating in todays webinar. For further


information on the FLCs monthly webinars go to www.flcities.com.

301 South Bronough Street Suite 300


P.O. Box 1757 Tallahassee, FL 32302-1757
(850) 222-9684 Fax (850) 222-3806
www.flcities.com