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Florida crackdown on 'pill mills' saved a thousand lives: report

Researchers say findings imply that tough rules for doctors and clinics that prescribe opioids can prevent overdoses

A state government crackdown in 2010 on Florida’s notorious “pill mills” — which had been dispensing some of the country’s highest volumes of prescription painkillers, often without medical exams — saved more than a thousand lives in the three-year period that followed, according to researchers’ estimates released Monday.

The researchers said their findings imply that restricting doctors and clinics that have been overprescribing addictive oxycodone drugs like OxyContin not only helps prevent painkiller overdose deaths, but may reduce heroin overdose fatalities as well.

“There wasn’t as big of a substitution to heroin that we might have feared among the people who were getting access to these medications at pill mills” after Florida changed its laws, said Alene Kennedy-Hendricks, an assistant scientist in the Department of Health Policy and Management at Johns Hopkins University’s Bloomberg School of Public Health and lead author of the study, which was published in the American Journal of Public Health.

Kennedy-Hendricks and her team sought to find out whether tougher laws regulating doctors and clinics that had freely dispensed oxycodone to customers who paid them in cash would cut down on overdose deaths from prescription painkillers — or whether addicts might just switch over to heroin and continue to overdose, a pattern that law enforcement and public health officials have observed. 

Adding urgency to the issue, opioid overdose deaths nationally shot up by 14 percent in 2014 to record levels, the U.S. Centers for Disease Control and Prevention (CDC) reported last week.

For their study the scientists chose to look at Florida, which starting in 2003 saw an explosion of so-called pill mills, defined as clinics or doctors writing numerous prescriptions for opioids beyond the scope of standard medical practice. They often dispensed the pills on-site, rather than requiring a pharmacy visit, and sometimes didn’t even perform exams.

"At one point, there were counties in Florida that saw a new pain clinic open every few days,” Kennedy-Hendricks said.

Between 2003 and 2009, overdose deaths in Florida from prescription opioids skyrocketed by 61 percent to 2,905, according to the Florida Department of Health. The U.S. Drug Enforcement Agency decided a crackdown was needed after noting that 90 of the 100 doctors in the U.S. prescribing the most oxycodone were in Florida.

Florida passed a law in 2010 limiting doctors to prescribing 72-hour oxycodone supplies and barred any advertising of such medications. In 2011, the state also toughened criminal penalties for the doctors and clinics involved in illegal painkiller subscriptions and banned dispensing the drugs on-site.

The CDC found dramatic declines in drug overdose deaths in Florida after the state passed the laws, but Kennedy-Hendricks and her team noted that the federal study didn’t use a comparison group so as to identify broader trends.

So the Johns Hopkins team looked at data from two states’ public health departments, comparing Florida’s 11,721 opioid overdose deaths in 2003-2012 with North Carolina’s 3,787 deaths in the same period. North Carolina had also experienced an upswing in such deaths, but unlike Florida it hadn’t passed new restrictions on pain clinics or doctors.

Looking at the rates at which overdose deaths had been increasing in Florida, and comparing them with continuing increases in North Carolina, the researchers determined that 1,029 overdose deaths were prevented in Florida from the start of the legal crackdown until the end of 2012.

While North Carolina's opioid overdose death rates still rose — increasing fourfold from early 2011 to late 2012 — Florida’s slowed. Between March 2010 and December 2010, for example, the death rate was 7.4 percent lower than it would have been without Florida’s new laws, the researchers said. They calculated that the rate was 20 percent lower in 2011 and 34.5 percent lower in 2012 than it would have been without the crackdown.

And while heroin overdose death rates grew in both states at the beginning of 2011, North Carolina’s continued to increase by an average of 18 percent per month, the scientists said. Florida’s increased more slowly, by 8 percent per month during the first half of the year. By the end of 2012 heroin overdose deaths were increasing by 10 percent per month in North Carolina, but only by 6 percent per month in Florida.

The researchers did see an initial “substitution” effect in which Florida prescription opioid addicts switched over to heroin in 2010 as the stricter laws made prescription drugs tougher to come by, but that substitution appeared to taper off as time passed.

“By preventing potentially new prescription opioid use disorders from developing, perhaps Florida shrank the pool of people who might have been susceptible to heroin use,” Kennedy-Hendricks said.

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