How to Spot a Pill Mill Webinar

8/19/2019 How to Spot a Pill Mill Webinar

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Prescription Drug Abuse

Florida’s Health Crisis

Office of the Attorney GeneralDave Aronberg

Special Prosecutor, Prescription Drug Trafficking


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Overview

• Prescription drug diversion is the #1 public

safety threat confronting Floridians today.

• Florida has become the epicenter for the

availability and abuse of controlled

prescription drugs.

• Prescription drugs are now responsible for

killing 7 Floridians per day, and has been on anupward trend for the past six years.


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Increasing Oxycodone Deaths


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What are Pill Mills?

• A “pill mill” is a doctor’s office, clinic, or health

care facility that routinely conspires in the

prescribing and dispensing of controlled

substances outside the scope of the prevailingstandards of medical practice in the

community or violates the laws of the state of

Florida regarding the prescribing or dispensingof controlled prescription drugs.


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Extent of the Problem

•

Between 2003 and 2009, the number ofdeaths caused by at least one prescription

drug more than doubled.

•

Among young people ages 12-17, prescriptiondrugs have become the second most abused

illegal drug, behind marijuana.


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Ground Zero –

Broward County

• In 2007, there were 4 pain

clinics operating in Broward

County.

•In 2010, Broward Sheriff’sOffice listed 144 pain clinics

operating in the county.

• Today, there are 105 registered

pain clinics in Broward County.

• There are more pain clinics in

Broward than McDonalds in

Broward.


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41,285,772

1,021,933 794,124 489,942 302,873 255,442 240,768 231,877 188,102 174,2081,102,120

-

5,000,000

10,000,000

15,000,000

20,000,000

25,000,000

30,000,000

35,000,000

40,000,000

45,000,000

FL OH GA MD CA TN KY PA NV NC Remaining

States

Nationwide Comparison of Oxycodone Purchases by Practitioners

January - June 2010


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41,285,772

4,801,389

-

5,000,000

10,000,000

15,000,000

20,000,000

25,000,000

30,000,000

35,000,000

40,000,000

45,000,000

Florida Remaining States

U n i t s P u r

c h a s e d

Nationwide Comparison of Oxycodone Purchases by Practitioners

January - June 2010


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Attorney General’s

Statewide Strategy

1.Criminal

2.Civil

3.Administrative

4.Legislative

5.Prevention


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Regulating Pain Management• F.S. 458.3265(1)(a) defines a pain management clinic.

• F.S. 465.0276(1)(b) creates the 72-hour dispensing rule.

• Department of Health (DOH) regulates pain clinics that areowned by a medical and osteopathic physician.

•

Agency for Healthcare Administration (AHCA) regulatespain clinics that are not fully owned by medical andosteopathic physicians.

• Pill Mills are attempting to evade our new laws andregulations:

“Wellness Centers”

“Urgent Care Centers”

“Rejuvenation Clinics”

“Detox Centers”

“Massage”


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Rules 64B15-14.0051 & 14.0052

Standards of Practice:

Evaluation of Patient: complete medical history and physical exam

required, including urinalysis.

Treatment Plan: individualized, with objectives for reaching a

rehabilitative end-state.

Patient records: includes maintenance of file with duplicate prescriptionscripts written.

Still to be adopted: Limiting the number of pills a doctor can prescribe.

New Rules for Osteopaths


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Local Moratoria

•

Temporary moratoria have helped communities limitthe growth of pill mills that fuel continued

prescription drug abuse.

• As of December 2010, there are more than 30 cities

and counties that have passed local ordinancesprohibiting new pain clinics.

• These successes belong to those in the community –

local officials, concerned citizens, anti-drugcoalitions, law enforcement agencies and others who

are taking a pro-active approach.


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Best Practice Recommendations• Pain clinics have to be licensed by the city/county

and pay an annual fee. – Hillsborough County

– Titusville

• Clinics can only be located in areas that have

hospital/medical zoning. – Titusville

– Delray Beach

• Clinics are prohibited co-locating in the same officeor building with a pharmacy. – Martin County

– Oakland Park (DRAFT)


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Best Practice Recommendations• Prohibit cash-only pain clinics

– Orange County

– Orlando

– Satellite Beach

• Limit the hours of operation

– Martin County

– Davie

– Orlando

– Broward

• Create city/county-wide taskforces for local solutions

– Broward

– Orlando


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Prescription Drug Monitoring Program

• FS 893.055 creates the PDMP and the accompanyingPublic Records law, FS 893.0551, that limits access toconfidential and private information in the PDMPdatabase.

•

Requires dispensing practitioners to reportdispensed II – IV controlled drugs to the database nolater than 15 days from the date of dispensing.

• The PDMP allows practitioners to:• request access to the patient’s prescription history

information during office visit to ensure better patientstandard of care

• avoid prescribing medications that may be dangerouswhen taken in combination with other medications

• identify possible “doctor shoppers”


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Conclusion

•

The proliferation of pain clinics that dispenseand prescribe legal opiates such asOxycodone, has helped fuel the problem ofprescription drug diversion and has made

Florida the “pill mill” for the entire country.

• Prescription drug diversion costs lives,

increases crime, and accelerates costsconnected to treatment, medical expensesand Medicaid fraud.


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PAUL VIDELA/[email protected] Local residents gathered along Manatee Avenue

outside of the 1910 Medical Clinic, a pain management clinic, to protest.


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Office of the Attorney General

Dave Aronberg

Special Prosecutor, Prescription Drug [email protected]

(561) 837-5000


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Pain Management Clinic OrdinanceCity of Oakland Park

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Problem• End of 2008 - Emerging street crime trend

• 20 “Pain clinics” operating within City boundaries.

•Increase in the rates of street level narcotic sales

• From August 2008 – November 2009 Proliferation of Clinics & Drug Cases – Pain clinics opened every 3 days in South Florida

– Broward County went from 47 clinics to 115

– Late 2009 – 50% of 1600 active drug cases being heard were for prescription

drugs.

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Problem (cont’d.)• BSO Oakland Park Special Investigations Unit Activities:

• 2009

– 714 arrests associated with narcotics and pain clinics

– 7,200 prescriptions pills seized

– $119,447 in cash seized

– 95 vehicles seized

• January 1 to July 31, 2010

– 301 Total Arrests made

– 229 Felony Arrests (Includes 43 Drug Trafficking Arrests)

– 72 Misdemeanor Arrest

–

Over 14,407 Prescription Pills Seized – $58,073.00 in Cash Seized

– 60 Vehicles Seized

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6,584,200

Dose Units

6 month period in 2008

2,738,700 units of oxycodone


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Why Oakland Park?

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• Lack of modern zoning regulations to address specific

demands of a pain clinic compared to surrounding cities;

parking, change of use regulations.

• Proximity of clinics to interstate highways

• Vacant office/retail space and low commercial lease rates

• Clustering of existing clinics & pharmacies created

demand for even more clinics

Pain clinics advertise cluster around each


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Pain clinics advertise, cluster around each

other and create problems for

neighborhood

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Impact within the City of Oakland Park

•

Homicide and violent crime• Increase in neighborhood burglaries and

robberies

• Increase in drug trafficking of prescriptiondrugs street level sales

• Identity theft

• Organized crime

• Parking issues

• Loitering, littering and other nuisances foradjoining neighborhoods

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Oakland Park’s Draft Ordinance Outline


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Chapter 24, Land Development Code

• New Business Categories: Pain Management Clinic, Pharmacy

& Rehabilitation, Drug Addiction Treatment, Therapy andCounseling.

• Prohibits new clinics in NB and B-1 zoning districts.

• Conditional use for new pain clinics in B-2 & B-3.

• New Parking Requirements: 1 per 10 gross sq. ft. of customerwaiting area including the lobby and seating area; plus 1 per

200 gross sq. ft. of the remainder of the building.

• Change of Use. All new clinics would need to bring a property

up to current parking and landscape codes if they occupymore than 25% of a building on a site.

Oakland Park s Draft Ordinance Outline

Proposed Master Business List & Parking Code Changes


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Proposed Master Business List & Parking Code Changes

Chapter 24, Article III, Section 24-41, Master Business List:

Business ListingsProhibited NB B-

1

B-

2

B-

3

I-

1

Pain Management Clinic (see Chapter 7, Section 7-151 of the Code of Ordinances for definition and

additional regulations)

*7 *7

Pharmacy (see NB zoning district regulations for

additional restrictions)* * * *

Rehabilitation, Drug Addiction Treatment, Therapy

and Counseling*7 *7 *7

(* = Permitted by Right; *7 = Conditional Use; Blank = Not permitted)

Chapter 24, Article VI, Section 24-80(C):

Use Parking Requirement Spaces

Pain Management

Clinic

1 per 10 gross sq. ft. of customer waiting area including the lobby and

seating area; plus 1 per 200 gross sq. ft. of the remainder of thebuilding.


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Oakland Park’s Draft Ordinance Outline (cont’d)


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Chapter 7, Licenses & Business Regulations

• Provides for the definition of a pain management clinic.

• Exceptions: Medical facilities and Hospitals, Surgical doctors officesorthopedics, medical schools, any other medical clinic, office or facility

that does not prescribe controlled substances i.e., Chiropractor, Nonprofit

Organizations, Walgreens, CVS and Publix pharmacies.

Pain Management Clinic Permit

• Applicants must include the business operator, Medical Director and the

property owner.

• No employees of the clinic can have a felony conviction involving a

controlled substance.

• Disclosure of Interest Affidavit will detail all natural persons who are

involved in the business.

Oakland Park s Draft Ordinance Outline (cont d)



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• Clinics must be registered and provide proof of registration with DOH.

• All clinics new and existing must be owned by a physician or a group of

physicians.• No outdoor seating areas, queues or customer waiting areas.

• Prohibits on site prescription drug dispensing for controlled substances.

Separation Requirements

– ½ mile separation between each clinic regardless of municipal

boundaries.

– ½ mile separation FROM community or special pharmacies regardless of

municipal boundaries.

–

Discourages doctor shopping and mitigates the negative impacts from theclustering of clinics.



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• Conditional Use. Approval for new clinics required, existing clinics will be

legal nonconforming to having a conditional use approval.

•

Inspections. All clinics must allow representatives of the City of Oaklandto enter and inspect their places of business during business hours or at

any time the business is occupied to verify compliance with the City’s

Code of Ordinances.

• Revocation of permit. Violations of the City Code of Ordinances and/or

clinics that are determined to be harmful to the public health, safety orwelfare of the city may have their permits revoked.

• Penalties & Enforcement.

– Arrest and imprisonment for up to 90 days;

– Fines up to $500 per day for each offense;

– Special Master process and procedures.


Existing Pain Clinics


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• All existing clinics must file for the Pain Management Clinic Permit within

60 days of the adoption of the ordinance.

•Immediate compliance with the following is required:

• No employees of the clinic can have a felony conviction involving a

controlled substance.

• No outdoor seating areas, queues or customer waiting areas.

• Prohibits on site prescription drug dispensing for controlled

substances.

• Removal of all signage, symbols or vehicles identifying the

premises as a pain clinic from a building, site or parcel of land

where pain clinics have vacated and are no longer in operation.

• All existing clinics must comply with the distance separations within 5

years.

Existing Pain Clinics


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Working with Law Enforcement

Lisa McElhaney

Sergeant

Broward County Sheriff’s [email protected]


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Ways to Work with Law Enforcement

• Have a Defined Strategy

– Identify Resources

– Identify Stakeholders

• Develop a Networking System to Coordinate

Efforts

– Organize Specific Rolls & Responsibilities

– Organize a Recordkeeping System to Track ALL

Related Incidents, Actions, and Results


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Law Enforcement Needs

• Primarily Focus on Public Safety Issues – Immediate Threats receive higher priority

• Enforcement of Laws

– Criminal, Civil, Regulatory & Administrative – Specialized Area requires Clarification of Violations

– Identify Appropriate Agency of Enforcement

•

Department of Health• DEA

• Local Law Enforcement

• Code Enforcement


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Strategic Tactics

• Require Preplanning

• Education for ALL Stakeholders on Laws,Regulations & Viable Responses

– Establish a Network with Local Stakeholders• Identify Levels of Recognition & Authorization

for New Businesses (Prevention)

–

Establish a Vetting Process – Establish a Swift Response Mechanism for

Violations


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Today’s Webinar Presenters

Senator Dave AronbergSpecial Prosecutor, Prescription Drug Trafficking

Office of the Florida Attorney General

[email protected]

Justin T. Proffitt, AICPSenior Planner, Engineering & Community Development Department

City of Oakland Park [email protected]

Lisa McElhaneySergeantBroward County Sheriff’s Of [email protected]

Kenneth Pratt, Esq.Legislative AdvocateFlorida League of Cities, [email protected]

mailto:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]


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301 South Bronough Street • Suite 300

P.O. Box 1757 • Tallahassee, FL 32302-1757(850) 222-9684 • Fax (850) 222-3806www.flcities.com

Thank you for participating in today’s webinar. For further

information on the FLC’s monthly webinars go to www.flcities.com.
http://www.flcities.com/http://www.flcities.com/

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