Sober N Clean

A pilot program based in Broward County would help police and doctors track prescriptions.

Broward County, scene of the most famous prescription-drug overdose this year, might become the testing ground for a new database aimed at curbing doctor-shopping.

Florida legislators are proposing a pilot program that would create a computerized system to track the prescriptions that are requested, written and filled in Broward for some of the most addictive medicines.

Certain prescription drugs -- including those like Oxycontin, Vicodin and Xanax -- were implicated in more than 300 Broward deaths last year.

Earlier this year, celebrity Anna Nicole Smith died during a stay at the Seminole Hard Rock Hotel & Casino near Hollywood. An autopsy concluded that a lethal mix of at least nine prescription drugs caused her death.

While high-profile cases like Smith's -- and that of conservative pundit Rush Limbaugh, who admitted an Oxycontin addiction in 2003 -- grab headlines, supporters of stricter prescription monitoring say the abuse of legal medication is causing a growing number of deaths, arrests and emergency-room visits. In recent months, they say, out-of-state visitors have been shopping for Florida doctors, creating a form of prescription-drug tourism.

''It's a serious problem,'' said state Rep. Jack Seiler, a Wilton Manors Democrat and House sponsor of the proposal. ``And if you think for a moment those costs aren't being borne by the taxpayer, you're wrong. The North Broward Hospital District, the South Broward Hospital District, the courts, the jails -- those are all things that we pay for.''

Supporters say they will continue to push for a statewide program as in years past, but want to present the one-county pilot as an alternative.

Opponents say most tracking systems do little to reduce abuse and might discourage doctors from writing prescriptions for those who need them.

''If doctors know they're being watched, then they won't do as much,'' said David Brushwood, a professor at the University of Florida's College of Pharmacy. ``It's like going through a speed trap. When people go through a speed trap, we want them to slow down to the speed limit. We don't want them to slow down below the speed limit because that's dangerous.''

OVERDOSE DEATHS

Statewide, prescription drugs caused more than twice as many overdose deaths last year as illicit drugs, such as heroin or cocaine, said Bill Janes, director of the state's Office of Drug Control. Drugs like Oxycontin, Vicodin, Valium and Xanax were involved in more than 500 deaths in Broward and Miami-Dade counties.

''There's something more socially acceptable in taking a prescription medication than taking cocaine on the street,'' said Dr. Jeffrey N. Bernstein, medical director of the Florida Poison Control Center and an attending physician at Jackson Memorial Hospital. ``It's easier to go to a doctor and pretend you have back pain and try to get a prescription for a painkiller than it is to go into a bad neighborhood and look for an illegal drug.''

The number of cases in Broward's drug court involving doctor-shopping has at least doubled in the past few years, said Judge Marcia Beach.

A decrease in the number of cocaine arrests has helped prevent a backlog, she said. But Beach said many prescription-drug patients have built up a high tolerance for the drugs and need more-expensive care.

''It's difficult for them to detox,'' Beach said. ``And it's more difficult for them to succeed on an outpatient basis. . . . Many of them require residential treatment.''

The proposed $1.6 million Broward database would keep a record of a patient's prescriptions and could be accessed by doctors, pharmacists, patients, law-enforcement agencies and the Agency for Health Care Administration. It would be funded privately and with federal grants and would be designed to look for people who are ''doctor-shopping,'' that is, visiting multiple doctors in search of duplicate prescriptions.

''If they go to one ER, then 30 minutes later they go to another ER, then 30 minutes later they go to another ER -- that's not a person in real pain,'' said Dr. Nabil El Sanadi, chief of emergency medicine for Broward Health. ``If they were tracked in that database, we could see it better.''

About 35 states have passed legislation to create a monitoring system, and at least 24 are in use. Florida is the largest state without one, which worries law-enforcement and drug-abuse experts who say they have seen a growing number of prescription-drug tourists.

''They find it cheaper to come to Florida, stock up, have a nice vacation and head back and have enough pills to feed their habit and to sell and pay for the trip,'' said Jim Hall, director of the Center for the Study and Prevention of Substance Abuse at Nova Southeastern University, which has a partnership with the Commission on Substance Abuse of the United Way of Broward County.

BUY AND SELL

Sgt. Lisa McElhaney, of the drug diversion unit of the Broward Sheriff's Office, said that in the past couple of months, the BSO has found at least 600 people trying to buy prescription medications in Broward to sell in other states.

''Florida has become a source state for prescription-drug seekers,'' she said.

Lawmakers have tried to create a statewide database for the past five years -- with powerful backers, including former Gov. Jeb Bush.

Concerns about patient privacy and how to pay for the database have stalled previous attempts at monitoring.

Brushwood questions the effectiveness of such systems. Many don't include enough personal information to tell whether prescriptions were issued to one person or several with similar names, he said. The systems could be circumvented with fake IDs.

''The question is: Does it reduce diversion and substance abuse?'' Brushwood said. ``I don't think it does.''

Opponents of the one-county Broward proposal argue that people would just move on to Miami-Dade or Palm Beach.

''Limiting it to just Broward won't capture the kinds of data and control substance abuse like we'd like to see,'' Broward Mayor Lois Wexler said. ``It's too easy to cross county lines here, so I would encourage the program to be regional.''

Bernstein, of the Florida Poison Control Center, said that the details need to be worked out, but that without better tools, doctors can be left relying on instinct.

''Nobody wants to see anybody in pain,'' he said. ``But you have no way to know that he's been to five other ERs in town.''

source: miamiherald.com