RX for Danger: How did Florida become 'pill-mill' hotbed?

Grant, who was appointed director of the Office of Drug Control in 2009 by Gov. Charlie Crist and held that role until Gov. Rick Scott abolished the department in January, said he and other public officials failed to convince lawmakers years ago that prescription-drug abuse was reaching epidemic levels.

What started as a South Florida problem extended northward as doctors and entrepreneurs realized running pill mills could be lucrative.

Not only were Floridians willing to pay cash for office visits and prescriptions, but the customer base extended throughout the South and East. Users and dealers from Kentucky, Ohio and West Virginia — which have monitoring programs that track prescriptions — would simply drive or fly to Florida for easy access.

And so the number of pain clinics, often nothing but fronts for pill mills, began to skyrocket.

In South Florida, the number of pain clinics went from 66 in August 2008 to 176 by November 2009, according to a 2009 Broward County grand-jury report.

InOrange County today, there are about 80 pain-management clinics. Statewide, there are more than 800, according to the best estimates.

It's also impossible to know which are legitimate pain clinics and which are fronts for pill mills, because there is little regulation — either on the local or state level. So law enforcement concentrates on stings and other operations to bust crooked doctors and shut down their clinics, one at a time.

"In years past, Florida had little oversight of pain clinics," Florida Attorney General Pam Bondi said. "Florida is the epicenter of the pill-mill crisis because of our lack of tough regulations and laws."

Only recently did state leaders take action by creating a Prescription Drug Monitoring Program similar to one found in dozens of other states.

This month, Scott signed legislation that toughens criminal and administrative penalties against doctors and clinics engaged in prescription-drug trafficking. When it takes effect July 1, the bill also will ban doctors from selling pills at clinics or their offices, and punish pharmacies and drug wholesalers if they don't report suspicious prescriptions.

Multifaceted approach

In Central Florida, law enforcers are attacking the problem from all angles: They are arresting dealers, abusers and the doctors who dole out the addictive drugs. And they strongly encouraged state leaders to get the monitoring program up and running.

In the past two years, at least five Central Florida doctors have been arrested in multiagency investigations, each accused of running pill mills. Some of those doctors have been linked to overdoses.

Criminal cases against doctors are complicated, time-consuming and require much greater resources than typical drug investigations. Prescription drugs are, after all, legal. And doctors arrested say they were prescribing the drugs in good faith, based on a patient's complaint of pain, and cannot control whether a patient doctor-shops to get multiple prescriptions.

Earlier this month, dozens of drug agents raided the pain-clinic offices of Dr. Riyaz Jummani and took records and evidence as part of a yearlong ongoing investigation.

Jummani and his associates were not arrested, but several clients at his Pro Relief Center just south of downtown Orlando on South Orange Avenue were arrested on drug-related charges.

Since 2007, the Orange County Sheriff's Office has doubled its arrests for pharmaceutical-related cases. And in Orange, the number of hydrocodone- and oxycodone-trafficking charges filed by prosecutors has increased nearly 800 percent from 2005, when prosecutors filed 17 such cases, to 2010, when there were 151.

"It is a significant problem for us in the law-enforcement community, primarily because what we're dealing with are drugs that are legal in most cases to possess," said Orange County Sheriff Jerry Demings. "What unscrupulous individuals are doing at that point are simply trying to take legal medications and distribute them illegally."

Despite law-enforcement efforts, the death toll continues to climb.

During the first half of 2010 — the most recent period for which statewide data are available — 1,268 people died in Florida with at least one prescription drug in their system that the medical examiner determined caused their death.

In Orange and Osceola counties, 147 people died from an accidental prescription-drug overdose in 2010, an increase of more than 30 percent from the year prior. The five-county medical examiner's district that includes Lake and Marion experienced a similar increase — jumping from 120 accidental prescription-drug overdoses in 2009 to 160 in 2010.

And this year's death toll shows no sign of slowing, said Orange-Osceola Medical Examiner Dr. Jan Garavaglia.

"It's just frustrating because the tide isn't stopping," she said. "I have to call the families up, tell them why their loved one died, and they just are so angry that something more isn't done."

apavuk@tribune.com or 407-420-5735