Pubdate: Sun, 23 Aug 2015
Source: Tampa Bay Times (FL)
Copyright: 2015 St. Petersburg Times
Note: Named the St. Petersburg Times from 1884-2011.
Author: Darryl Paulson
Note: Darryl Paulson is professor emeritus of government at the 
University of South Florida St. Petersburg. He wrote this exclusively 
for the Tampa Bay Times.
Page: P1


As America entered the 21st century, Florida became the home of 
retirees, tourists and prescription drug abusers. Law enforcement 
officials referred to Interstate 75 as the 'Oxy Express,' as people 
flooded into Florida to take advantage of the state's easy access to drugs.

'Florida was ground zero for pill mills,' said Assistant U.S. 
Attorney Simon Gaugush.

During a six-month period in 2010 at just one pill mill in Tampa, 
1,906 patients from 23 states made 4,715 visits. Doctors at this one 
facility wrote prescriptions for 1 million oxycodone pills.

In 2010, 650 million oxycodone pills were prescribed in Florida, 
enough for 34 pills for every resident in the state. That same year, 
of the one hundred doctors nationally who were dispensing the most 
oxycodone, 98 were from Florida. The system was badly abused.

But some people need prescription pain medicine. And I am one of 
them. I have had chronic pain for more than half a century. For all 
of the good done in shutting down pill mills, it has come at a high 
cost for those of us who actually need the medications. As we'll see, 
a few simple changes could fix a lot of woe.

Florida Responds To the Crisis

In 2012, Gov. Rick Scott and Attorney General Pam Bondi created the 
Florida Regulatory Drug Enforcement Task Force. The goal was to stop 
corruption in the wholesale distribution of pain meds to the pill 
mills. Several of the nation's largest drug store chains would be 
found guilty in the distribution of hundreds of thousands of opioids 
to pill mills. The task force also focused on unscrupulous doctors 
writing pain prescriptions without proper examinations. Another major 
goal was to end the practice of 'doctor shopping,' where patients 
would go from one doctor to another and collect multiple 
prescriptions for pain pills.

The task force arrested 3,742 people, including 67 physicians, seized 
848,037 pills, 121 vehicles, 538 weapons, more than $10 million in 
cash and shut down 254 pill mills.

At about the same time, the Florida Legislature passed HB 7095, which 
prevented most doctors from prescribing Schedule II and III 
controlled substances. Only doctors certified in pain management 
could prescribe them. That ruled out most family doctors.

Doctors were required to electronically prescribe controlled 
substances or to use counterfeit-proof prescription pads. The state's 
new drug policies had an immediate effect. Where 650 million 
oxycodone pills were shipped to Florida in 2010, by 2013 the number 
dropped to 313 million - less than half the total from three years 
earlier. The 856 pain clinics in Florida were reduced to 367 by 2014. 
Finally, where 98 of the top 100 doctors in America dispensing 
oxycodone were Floridians in 2010, that number dropped to zero by 2013.

The laws reduced the deaths from overdoses. It was a victory, but one 
with costs. The primary losers in the war on prescription drug abuse 
are those who need the medicines the most: those who suffer from 
chronic, debilitating pain. People like me.


Many of you may be thinking that the inconvenience that I and other 
chronic pain sufferers experience is a small price to pay to control 
prescription drug abuse. But you'll think differently if you know 
anyone suffering from chronic pain.

I am not talking about people who had an operation and have temporary 
pain. I am not talking about people who wake up in the morning and 
have sore joints and stiff muscles. I am talking about people who 
hurt 24 hours a day, year after year.

My first bout with chronic pain started when I was 12, some 55 years 
ago. I was a very active and athletic youth, but I woke up one 
morning with excruciating pain in my hip an leg. My mother or one of 
my brothers had to help me put my shoes and socks on so that I could 
go to school.

After a few weeks, the pain went away. A few months later the pain 
would come back for a couple of weeks and then disappear.

While in my last year at college, the pain came back and stayed. I 
could no longer sit in my classes. It felt like I had a hundred razor 
blades imbedded in my hip. My mother watched me squirm while sitting 
down and said I 'looked like a maggot in a hot skillet.' Mom always 
had a way with words.

I was referred to an orthopedic surgeon and had the first of what 
have now been six surgeries. It was 1970, and I was in my last 
quarter of college. The Vietnam War was still going on and, while in 
the hospital having my back surgery, I received a notice from the 
draft board to report for my physical exam. The surgeon who operated 
on me said, 'You're not going anywhere.' He wrote a letter to the 
draft board describing my 'chronic discogenic back pain.' Without my 
college education, I might have thought he was referring to my poor dancing.

In my 30s, I awoke one morning and my left leg was numb. I thought I 
had just slept on it the wrong way and that the numbness would go 
away. It's now 35 years later, and the numbness has not gone away.

Around age 40, the back and leg pain returned to become a permanent 
part of my life. I remember going to the hospital to visit the 
orthopedic doctor and the pain was so intense that I had my arms 
stretched over my head with my hands clawing the wall.

For the next two decades, I had numerous epidurals, needles stuck in 
my knee to inject fluids to ease the bone-on-bone pain, wires 
threaded up my spine and many other procedures to try to alleviate 
the pain. Eventually, it became apparent that I needed to take pain pills.

Few people want to take pain meds. Like many drugs, they have 
terrible side effects. Most people who get pain meds have 
constipation problems. My testosterone level went to virtually zero. 
As a result, I had to have testosterone pellets injected in my hip 
during a minor surgical procedure every three or four months. That 
became cost prohibitive when Medicare stopped paying for the 
procedure. Now, I have to have testosterone injected in my hip every 
two weeks by a needle.

I took pain meds under the direction of my family physician. I have 
received no better care from pain specialists than I did from my 
family physician. We had a doctor/patient relationship for 20 years. 
He knew my medical history and we developed a trust relationship 
essential for good medical care.

But family doctors can no longer prescribe controlled substances on a 
long-term basis. The new laws require that all of those suffering 
from chronic pain must go to certified pain specialists. As part of 
the new law, I had to see a psychologist and go through a series of 
screening questions to make sure I was not trying to 'game' the 
system. It did not matter that I had a 30-plus year record of chronic 
pain and never once abused drugs.

I also must pee in the cup on most monthly visits to make sure I am 
not taking any drugs not prescribed to me, including illegal drugs. 
These screenings cost several hundred dollars. I no longer have to 
pay for this since I am on Medicare, but the taxpayers must pick up 
this expense even though I have never abused the system once in more 
than 30 years. It is expensive and demeaning.

Chronic pain can be debilitating. I have trouble standing in one spot 
for more than a few minutes. I can't walk more than a quarter-mile 
without intense pain in my back and legs. Sleep is usually sporadic 
and painful. Although opioids are supposed to make you sleepy, I 
seldom sleep more than two hours before waking because of pain. It is 
not uncommon for me to sleep in three or four places each night. I 
may start in a guest bed, then move to the couch, a recliner and then 
I try to sleep the last two hours with my wife.

Many of my friends have noticed I wear sandals quite often, even to 
church. I have not adopted the casual look; it's impossible for me to 
put on my shoes and socks. Every grandparent looks forward to playing 
ball, biking or swimming with the grandchildren. I can't do any of 
those things.

Impact On Those With Chronic Pain

One effect of the new law is increased cost to the patient and to 
taxpayers. Under the old system, if I needed pain meds I would call 
the doctor and pick up the prescription. He made sure that every 
three months he would run lab tests on my blood and urine to check 
for problems. It was relatively stress-free, quick and inexpensive. 
The new procedures are none of those things.

The worst problem? Although many who suffer from chronic pain can 
still get a prescription from their pain doctor, they can't get it 
filled in a timely manner. Over the past five years, I would guess 
that at least 20 to 25 percent of the time the pharmacy does not have 
the needed pain meds. Many of the largest chains do not carry a 
sufficient supply because they fear they will be investigated if they 
fill too many pain prescriptions.

I have often had to wait two to three days after my meds have run out 
to get a new prescription filled. That can be unbearable. About six 
months ago I had a total knee replacement. My pain meds ran out about 
a week after the surgery.

When I went to have the new prescription filled, the pharmacy was 
once again out of the pain meds. I had to go for three days without 
them after having a total knee replacement in addition to my other 
chronic pain issues. I would not wish that on anyone.

Pharmacists are little help, often simply blaming the suppliers. On 
one occasion when I was trying to get a pain prescription filled and 
the pharmacy was once again out of pills, my wife actually drove to 
seven different drug stores before finding one that would fill the 

You can't simply call a pharmacy to see if they have pain pills. They 
require you to visit the pharmacy where they can then tell you they 
don't have any pain pills. Anyone who goes from one pharmacy to 
another is treated suspiciously by the pharmacy and fears being 
accused of trying to game the system.

Some months ago, my daughter in Massachusetts was about to deliver 
her second child. She asked me and my wife to visit for three weeks 
to help take of her other child and prepare meals. It should have 
been a time of great joy and celebration.

But as a pain patient, I could only envision the worst, and that's 
what happened. I visited the pain specialist, who wrote a 
prescription for my 30-day supply of pills and he noted on the script 
that it should be filled early because my current 30-day supply would 
run out about one week into our three-week visit.

I had early refills filled previously. No more. The pharmacy refused 
to fill it before the 30 days were up. They did not care about my 
situation and told me to have it filled at their pharmacy in Massachusetts.

When it was time to have the prescription filled in Massachusetts, 
the pharmacy refused, because it was an out-of-state prescription. I 
was told I had two choices. I could go to a local hospital and see if 
a doctor would write a Massachusetts prescription for the same 
medicines, or I could fly back to Florida and have it filled there. 
The doctor option would cost at least $300 with no guarantee of a new 
prescription; the trip to Florida would have cost at least $750 and 
taken three days out of my three-week visit.

No one should have to deal with that in what should be a time of joy. 
If you travel for business, you'd better hope your pain medicine 
refills don't come in the middle of your trip. If you plan a 
vacation, especially one overseas, you'd better make sure the airline 
schedules coordinate with your prescription refills.

No one should have to decide whether to see a grandchild, travel for 
business or take a vacation, or just stay home in order to get 
necessary medications. Florida needs to honor early refills for those 
who must travel for business, for those who take vacations and for 
those who must travel for family emergencies such as illness, births 
or death of family members.

Restoring Fairness

No one denies that Florida had a prescription drug abuse problem that 
resulted in the deaths of thousands. We know that the numbers of 
deaths in Florida from prescription drug overdoses have dropped since 
the laws were revised, but we also know that the number of deaths 
from illegal drug overdoses have increased. People who abuse drugs 
will abuse drugs whether they are legal or illegal.

The state of Florida should do what it can to assist those in chronic 
pain, not to make their suffering worse by making it difficult to get 
the medicines they need to function.

Chronic pain sufferers know that pain is both a physical and 
emotional issue. The physical pain is real; the emotional pain can be 
worse. Pain normally comes and goes for most people. For those 
suffering chronic pain, the pain is always there. Enduring pain for a 
year or five years or longer can wear you out. There comes a point 
where you know the pain is not going to go away. Depression sets in.

You become frustrated because people don't understand your pain. 
Being told to toughen up and get over it and stop whining doesn't 
help. Pain hurts emotionally because you know you are limited in what 
you can do. You know you can't play with the grandchildren the way 
you want to play. Pain hurts because it can cause you to treat 
people, especially those you love, differently. You become 
short-tempered and withdrawn. Loved ones, knowing you are limited in 
what you can do, unknowingly begin to exclude you from activities.

Pain hurts you both physically and emotionally. You just want to stop 
feeling miserable. You just want the pain to end. You are tired of 
being a burden to friends and family and, the thing you fear the 
most, is reaching the point where you can't take care of yourself.

I would like to see family physicians be involved in pain management. 
I never had better care than what I received from my family doctor. 
Bad doctors will take advantage of the system just as they did in 
Florida, but most of the new regulations will prevent the abuse we 
previously experienced. I don't think this will happen, but I still 
think it is a reasonable solution.

Pharmacies must be responsible to their clients. That means making 
sure that they have the necessary supply of drugs on hand. Have you 
ever heard of a pharmacy running out of Viagra?

Drug companies and pharmacies make a lot of money on those drugs. 
Both drug manufacturers and pharmacies must take responsibility and 
make sure that pain sufferers can get pain relief. Pharmacies must be 
allowed to honor early refills in case of vacations, natural 
disasters, business trips and family emergencies.

In the past few months my right leg and lower back is becoming much 
worse. I have had two epidurals to try to relieve the pain, but 
neither has helped.

Unless things change, I will likely be looking at my third back 
surgery in the next couple of months. That will be my seventh surgery 
overall. Until then, I want to be able to get my pain meds when 
needed and not to have to wait several days with no pain relief.

I and other chronic pain sufferers are not looking for your sympathy, 
but we would like your empathy. We want people and policy makers to 
understand that our pain is real. We want people to understand that 
we have enough pain already; we don't need additional emotional pain 
in trying to get access to the medicines we desperately need.

cations. Florida needs to honor early refills for those who must 
travel for business, for those who take vacations and for those who 
must travel for family emergencies such as illness, births or death 
of family members.

I had numerous epidurals, needles stuck in my knee to inject fluids 
to ease the bone-on-bone pain, wires threaded up my spine and many 
other procedures to try to alleviate the pain. Eventually, it became 
apparent that I needed to take pain pills.
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