Will Banning Doctors from Dispensing Pain Meds Curb Opioid Misuse?

Florida lawmakers have called for a ban on the dispensing and direct sale of controlled substances by physicians. Will this prove more effective than the prescription drug monitoring program it is intended to replace?

In an update to an article we recently ran on HCPLive (“Police and Pain Practitioners Oppose Cancellation of Florida PDMP Database”), there is further news out of Florida regarding efforts by lawmakers there to kill the state’s proposed prescription drug monitoring program (PDMP). Florida Governor Rick Scott and his allies in the Florida House of Representatives recently came out in favor of cutting funding for Florida’s PDMP (which has not yet started operations, despite being approved two years ago), calling the program an ineffective, intrusive waste of taxpayer money. They proposed replacing the database with what they called a “front-end” solution that focused on stricter fines, regulations, and enforcement.

Supporters of the Florida PDMP, including many physicians and state medical leaders, decried the move to eliminate the program, pointing out that more than 30 other states have used their versions of the PDMP to curb abuse of pain medications. For example, according to an article in The Palm Beach Post, Tennessee, which authorized the creation of its PDMP in 2005, reported that from 2006 to 2009, “the level of controlled substances given to patients dropped significantly. The database has allowed law enforcement and pharmacists to collaborate on reducing prescription-drug abuse.” Many Florida law enforcement officials have also come out in favor of the PDMP, with Broward County Sherriff Al Lamberti calling it a critical weapon in the fight against the state’s flourishing pill mills and illegal prescription pain medication trade.

Last week, the opponents of the PDMP unveiled their front-end solution, described by speaker pro tempore of the Florida House of Representatives John Legg (R-Port Richey) in an editorial as “an across-the-board ban on the dispensing and direct sale of dangerous controlled substances by physicians.” Pointing to a small minority of “doctor-dealers” who “often have no ongoing clinical relationship with patients and provide no general medical care,” instead “profiting by prescribing and dispensing addictive drugs,” Legg said that Florida’s prescription drug abuse epidemic “stems from a dispensing problem. And instead of merely tracking the dispensing and sale of these controlled substances, we need a front-end solution that cuts the supply off at its source.”

Claiming that a ban on the dispensing and direct sale of controlled substances would allow “state and local officials, law enforcement and the medical community” to “cut to the heart of this critical problem,” Legg said that under the proposed ban, physicians would still prescribe pain medications, but patients would only be able to fill the prescriptions at licensed pharmacies, with the proposal also providing for “distributers to buy back medications from doctors and prevent inappropriate or unlawful disposal of those drugs.”

Florida House Speaker Dean Cannon, (R-Winter Park), echoed these sentiments, telling colleagues in the Florida House of Representatives that “We must look beyond awkward regulations and downstream databases and send a message to the drug dealers and the drug seekers that, when it comes to the pill mill industry, Florida is now closed for business,”

In a news release issued late last week, Florida Rep. Rob Schenck, R-Spring Hill, chair of the Florida House Health and Human Services Committee, said that “Up until this point, there has been no front end solution to the significant drug abuse problem that our state faces… Statistics show that practitioners are dispensing medically unbelievable amounts of controlled substances, making Florida a haven for addicts and dealers alike to purchase controlled substances from these doctor-dealers.”

According to Schenck, “The only feasible solution to this problem is to cut the supply of these drugs off at its source -- the dispensing physicians. The current bureaucratic regulatory scheme has failed to address the problem and the PDMP will only serve to track the symptoms, not stop the next drug-related overdose. I am confident that, by adopting an across-the-board dispensing ban on controlled substances by physicians, we will effectively cut to the heart of this problem and eliminate the prescription-drug abuse problem that has overwhelmed our state.”

HCPLive wants to know:

Does your state operate a prescription drug monitoring program? If so, has it been successful in helping curb the misuse and abuse of opioid medications and other controlled substances?

As part of his arguments in favor of killing the Florida PDMP, Rep. Legg noted that “Recent studies clearly demonstrate that states that have implemented a PDMP have not had a decrease in drug-related deaths. In fact, all states have experienced increases in death rates since 1999, indicating that the creation of a PDMP does not significantly change the number of drug-related deaths.” Is this the proper metric by which to measure the success or failure of the PDMP?

What are your thoughts on physicians directly selling and dispensing controlled substances at their practices? Do you support Florida’s move to ban this practice? Are there any medical benefits from allowing physicians to continue with this practice?

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