An epidemic has hit Florida. In 2007, prescription drug abuse claimed the lives of up to 9 people per day. In addition, a total of 8,620 Floridians died as a result of drug related deaths and the number continued to rise in 2008, according to the Florida Medical Examiners 2008 Interim Report (1). Florida contains the nations top twenty-five oxycodone prescribers according to the United States Drug.
Nationally, prescription drug abuse increased 94% from 1992-2003. During the same period, mortality rates for prescription drugs have increased significantly (2); however, more alarming is the 542% increase in new starts of prescription drug abuse amongst teenagers (2). Although drug abuse has been present for centuries, the more traditional drugs of abuse, including heroin, cocaine, met-amphetamine and marijuana, have recently taken a back seat to legal prescriptive pharmaceuticals. In fact, pharmaceutical grade drugs are in more demand on the streets today than the more traditional illicit drugs (5). The current street value in Florida for a 30mg oxycodone (oxys or roxis) is approximately $10-15. Prescription drug abuse is not limited to dark alleys and drug dealer street sales. Due to their potency and highly addictive characteristics, these compounds are also drugs of choice amongst middle and upper socioeconomic classes of all ages. The most commonly diverted or abused prescription drugs include opioids, central nervous system depressants, and stimulants. Oxycontin, oxycodone and Vicoden, which are used most often to treat pain, are among the opioid drugs most commonly prescribed and abused. Medications used to treat anxiety and sleep disorders include the CNS depressants such as Valium and Xanax. Stimulants such as Ritalin and Adderall are commonly prescribed for attention deficit disorders as well as certain sleep disorders. Very effective for treatment of their respective indicated diseases, these medications have gained popularity as recreational drugs. Reasons for Prescription Drug Abuse There are many reasons why people abuse prescription drugs. There is a false sense of safety because a doctor prescribes these medications. Pharmaceutical grade drugs are felt to be less dangerous than illegal drugs. Many mistakenly think that abuse of prescriptive drugs is not a crime or, at least, a lesser crime because these drugs have a legitimate legal use. There is also relative ease in obtaining prescriptive drugs. When surveyed, most teens admitted that they obtained abused prescriptive drugs rather easily from the medicine cabinets of family and friends (2). The increased demand for pain management from medical establishments has also fueled this problem. The recent epidemic is a byproduct of compassion and lack of understanding of the complexities of pain, chemical dependency and opioid pharmacology (2). Pain Management and Opioid Prescribing Opioid prescribing for chronic nonmalignant pain has experienced a paradigm shift. Twentyfive years ago opioid prescribing was deterred due to fear of causing addiction. It was reserved for primarily the treatment of cancer pain, and not non-malignant pain. Then in the mid-late 90s, physicians were encouraged to prescribe liberally for all pain maladies. Overprescribing of opioids is considered to be at the root of the epidemic. Our society has incurred significant costs due to prescription opioid abuse. In 2001, the total cost of prescription drug abuse in the United States was estimated to be $8.6 billion (3). The growth of this problem continues to escalate. Prescription Drug Monitoring Programs (PDMPs) Today, in the United States, thirty-eight states have adopted legislation to create prescription drug monitoring programs (PDMP) to fight prescription drug abuse. Furthermore, in 2005, President Bush signed into law NASPER (National All Scheduled Prescription Electronic Registry), a bill that created federal funds and standards for state initiated prescription drug monitoring programs. These programs have been shown to deter doctor shopping and decrease prescription drug abuse by as much as 30% (1). To date, Florida is the largest state without such a program and has become a prescription drug trafficking preferred site. Broward County has the worst problem with respect to prescription drug abuse and proliferation of pain clinics. The Broward Commission on Substance Abuse has led the fight for over a decade to pass a PDMP in the state. Additionally, Florida organizations, including the Florida Society of Interventional Pain Physicians, the Florida Academy of Pain Medicine, the Florida Society of Anesthesiologists, the Florida Office of Drug Control and the Florida Medical Association (FMA) have endorsed prescription drug monitoring program legislation that supports the creation of a mandatory reporting system. The push for regulation has not been in vain. On June 18, 2009 the SB 462 bill that requires the Department of Health to develop a comprehensive electronic database system for the purpose of controlled substance prescription drug monitoring was signed into law by Governor Charlie Crist. In addition to the database, the legislation allows “rule making authority” by the Florida Board of Medicine for regulation of “pain clinics”.