Pubdate: Thu, 09 Jun 2011 Source: Sarasota Herald-Tribune (FL) Copyright: 2011 Sarasota Herald-Tribune Contact: http://www.heraldtribune.com/sendletter Website: http://www.heraldtribune.com/ Details: http://www.mapinc.org/media/398 Related: http://www.mapinc.org/drugnews/v11/n365/a06.html COUNTY CRACKDOWN ON DRUG ABUSE Pressed by a community increasingly affected by prescription drug abuse, Sarasota County commissioners responded Tuesday with a new, strict set of regulations. The rules are designed to preserve access to legitimate pain-management practitioners but keep out illicit businesses -- those that feed a black-market trade in addictive narcotics. The county's new requirements represent a step forward -- if they withstand potential legal challenges and can be properly enforced. The community also should recognize that crackdowns alone cannot solve the growing problem of opiate addiction. Prevention and educational efforts, as well as broader treatment options, are needed. The county's new measures affect only medical establishments defined as "pain management clinics." (Among the criteria, the clinic must be one that issues more than 20 prescriptions a day for controlled substances or is advertised as being in the business of pain treatment. Surgery centers and hospitals are not included.) To acquire and keep their county operating license, pain-management clinics will have to follow a stringent code. The doctor in charge will have to swear that the clinic will operate in accordance with all applicable county and state laws as well as state administrative rules. Clinics that fail to live up to these sworn statements can lose their license and face perjury charges. Going Beyond State Law Most prominently, the new rules require a pain-clinic physician to check a statewide drug monitoring database for each patient, before writing him or her a prescription for a controlled substance. The doctor must document this review by keeping a printout in the patient's file. (Privacy rights must be protected.) The required database check helps assure that a patient isn't "doctor shopping" to serve an addiction or the illicit drug trade. The county's rule goes beyond that of a new Florida law, which calls for pharmacies to update a statewide drug monitoring database after filling a prescription for a controlled substance. The state's database isn't expected to be implemented until this fall. Whether Sarasota County could enforce its requirement in the meantime is not clear. In general, the county's pain-clinic regimen builds on recently approved state standards that toughen rules and requirements for operating these centers. The county's new ordinances appear to be more comprehensive, however, than the recently signed state law, which exempts certain pain management specialists. Strict Requirements Other aspects of the county's measures include requirements that pain-management clinics submit to certain inspections; not be "cash only" operations; close by 7 p.m. weekdays; maintain precise personnel records; keep a tally of prescriptions broken down by drug and age group; and other details. The clinics (and to some extent their landlords) must ensure that no loitering, unlawful conduct or alcohol consumption occurs on the property or neighboring areas. These provisions present enforcement challenges. Under new zoning rules also approved this week, the clinics cannot be on the same property as a pharmacy. They also are required have adequate parking, a waiting area and restrooms. Clearly, the regulatory requirements are onerous, but that's the point: The rules are supposed to discourage shady, irresponsible operators from setting up shop in the county. Still allowed -- and necessary -- are establishments that responsibly serve patients' genuine medical pain-control needs. In Florida, an average of seven deaths a day are linked to prescription drugs such as methadone, the painkiller oxycodone, and the sedative alprazolam. In many cases, autopsies find the presence of multiple drugs and alcohol, a combination that can lethally suppress the cardiopulmonary system. Tuesday's public hearing included wrenching testimony from local mothers whose teenage children fell down the black hole of prescription drug addiction. These experiences, along with other data including a reported 86 percent increase in narcotic-addicted newborns, show that prescription drug abuse is not just a crime. It is a tragedy that cannot be allowed to proliferate. - --- MAP posted-by: Richard R Smith Jr.