Florida’s Crack Down On Pill Mills Results In Substantial Reduction In Drug Overdose Deaths

162017_132140396847214_292624_nThe CDC earlier this month reported on the successes of Florida’s regulatory efforts to reduce drug overdose deaths in response to the proliferation of pain clinics in Florida since 2007, which were prescribing large quantities of drugs for pain with little medical justification and were being used primarily by persons abusing or diverting opioid analgesics, benzodiazepines, and muscle relaxants. The CDC’s findings are quoted extensively below.

Before Regulatory Changes

The rate of drug overdose deaths in Florida increased 58.9% from 2003 to 2010 (from 2003 to 2009, the number of deaths caused by drug overdose in Florida increased 61.0%, from 1,804 to 2,905, with especially large increases in deaths caused by the opioid pain reliever oxycodone and the benzodiazepine alprazolam). By 2010, Florida was home to 98 of the 100 U.S. physicians who dispensed the highest quantities of oxycodone directly from their offices.

Florida’s Regulatory Changes

Florida responded to the drug overdose deaths crisis by enacting measures to address prescribing that was inconsistent with best practices: the Florida legislature required that pain clinics treating pain with controlled substances register with the state by January 4, 2010; in February 2010, the Drug Enforcement Administration and various Florida law enforcement agencies began to work together in Operation Pill Nation; later in 2010, Florida further expanded pain clinic regulations; in February 2011, law enforcement conducted statewide raids, resulting in numerous arrests, seizures of assets, and pain clinic closures; in July 2011, the Florida Surgeon General declared a public health emergency (regional strike forces were activated to address the emergency) and the Florida legislature prohibited physician dispensing of schedule II or III drugs from their offices; in September 2011, mandatory dispenser reporting to the newly established prescription drug monitoring program began; and, in 2012, the Florida legislature expanded regulation of wholesale drug distributors and created the Statewide Task Force on Prescription Drug Abuse and Newborns.

After Florida’s Regulatory Changes

As a result of Florida’s regulatory efforts to crack down on pill mills in the state, the number of drug overdose deaths decreased 16.7% during 2010 to 2012, from 3,201 to 2,666, and the deaths per 100,000 persons decreased 17.7%, from 17.0 to 14.0. Death rates for prescription drugs overall decreased 23.2%, from 14.5 to 11.1 per 100,000 persons (the lowest rate since 2007). The decline in the overdose deaths from oxycodone (52.1%) exceeded the decline for other opioid pain relievers, and the decline in deaths for alprazolam (35.6%) exceeded the decline for other benzodiazepines. There were similar declines in prescribing rates for these drugs during the same period.

Prescription drug-related deaths peaked at 2,722 in 2010 and decreased to 2,116 in 2012. Opioid analgesic overdose deaths declined from 2,560 to 1,892, with a corresponding rate decrease of 27.0%. Oxycodone, methadone, and hydrocodone rates decreased (for oxycodone, the greatest declines were among males (57.0%) and non-Hispanic whites (52.6%)), whereas morphine and hydromorphone rates increased. Benzodiazepine overdose death rates decreased 28.4%, with alprazolam rates down 35.6%. The rate of carisoprodol-related deaths also declined, but not significantly. Prescribing declined for drugs whose overdose rate declined and increased for drugs whose overdose rate increased (oxycodone prescribing declined 24.0%, whereas morphine prescribing increased 37.6%).

Overall illicit drug overdose death rates did not change significantly, although heroin overdose deaths increased from 48 to 108, a change from 0.3 to 0.6 per 100,000 persons. Alcohol overdose death rates were unchanged. The semiannual time trends in overdose rates for specific drugs indicate a steady decline beginning in 2011 rather than an abrupt decline following any one of the legislative and enforcement actions taken in Florida.

Approximately 250 pain clinics in Florida were closed by 2013 and the number of high-volume oxycodone dispensing prescribers declined from 98 in 2010 to 13 in 2012 and to zero in 2013.

Source

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This entry was posted on Friday, July 25th, 2014 at 7:35 am. Both comments and pings are currently closed.

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