Data from Two Studies Show Routing Pill Mills in Florida Saved Lives

By John Henry Dreyfuss,

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  • State crackdown on high prescribers is associated with more than 1000 fewer deaths.
  • CDC reports that prescription drug-related deaths have continued to rise.
  • Johns Hopkins researchers find the Florida program to be effective.
  • Physicians are being urged to prescribe opioids in fewer cases, to fewer patients, in lower dosages.
  • The epidemic of prescription and non-prescription opioid deaths makes clear the need for drug treatment programs and for the widespread use of naloxone kits.
  • Word of a patient's overdose rarely filters back to the prescribing physician.

The crackdown by Florida state law enforcement officials on so-called pill mills in Florida has been associated with a significant decrease in opioid-related deaths, according to a study published recently in the American Journal of Public Health (AJPH)

The researchers found that an estimated 1,029 fewer people in Florida died as a result of prescription analgesic overdoses over a 34-month period than would have died had the state not cracked down on the pill mills. Florida passed new laws in 2010 and 2011 establishing oversight over pain clinics and restricting the dispensing of opioids there, while major drug law enforcement initiatives arrested and prosecuted those operating them, according to a press release from the Johns Hopkins Bloomberg School of Public Health.

Figure 1. A model of enkephalin.

The Shift in Prescribing Habits Continues Slowly

Whether Florida’s opioid culture is anomalous or mainstream, the results of the state crackdown there may well reflect our national opioid culture. A study published recently in JAMA Internal Medicine found that primary care physicians prescribe more opioid analgesics than other physicians, by far.

Researchers continue to report that opioids are prescribed too often, often for the wrong types of pain, for too long a period, and in numbers that are too great. In general, physicians should be prescribing lower dosages of opioids, for shorter periods, in fewer patients. There are many effective analgesic alternatives to opioids. Responsible physicians have begun to implement these in medical practice.

Figure 2. A stick and ball model of naloxone.

Did the Law Cause the Shift?

These findings raise as many questions as they answer. For instance, did the state crackdown cause the changes that led to fewer opioid-related deaths? Is Florida a case study for the many other states with prescription drug problems, or is it an outlier? According to the AJPH study, 90 of the top 100 purchasers of oxycodone in the U.S. resided in Florida when the program began in 2010.

The findings of these two teams of Johns Hopkins researchers suggest that the institution of the program resulted in fewer opioid prescriptions and fewer opioid-related deaths. The evidence that this program has been effective would likely lead to the implementation of such programs in other states. The Centers for Disease Control and Prevention (CDC) reported recently that drug-related deaths continued to increase in the U.S., according to the current data

“We found that the state actions were associated with much lower total narcotic overdose death rates than we would have expected had Florida not implemented these interventions. It is possible that these actions targeting pill mills prevented new prescription narcotic addictions from developing, thus reducing the risk of heroin use,” lead researcher Alene Kennedy-Hendricks, PhD, told Dr. Kennedy-Hendricks is Assistant Scientist at the Johns Hopkins Bloomberg School of Public Health in Baltimore.

The press release also said:

The researchers also found substantially fewer deaths in Florida from overdoses involving either prescription painkillers or heroin during 2011 and 2012, a finding that calls into question claims that reducing prescription painkiller diversion will increase overall heroin use. Rates of prescription painkiller addiction are at historic highs and a portion of those abusing these medications have switched to heroin, which can be cheaper and, in some cases, easier to obtain. Other research has found that four out of five new heroin users first used prescription painkillers. What could be happening in Florida, they say, is that with less access to prescription painkillers, fewer people may be developing an addiction, which in turn may prevent people from later transitioning to heroin.

Figure 3. The mu-opioid agonist and antagonist.

Time to Help the Addicted

A separate report published in Annals of Internal Medicine found that 90% of patients who suffer opioid-related overdose are continued on the same opioid medication. Of these, 70% receive a prescription from the same physician.

Generally, word of the patient’s trip to the OD-related trip to the ER is not filtered back to the primary care physician, according to the AJPH report. The primary care physician is precisely the one who needs to know, because PCPs write the vast majority of prescriptions for opioids. This is a problem that could be easily solved with the appropriate technology. In the mean time, without knowing it, well-meaning physicians are prescribing opioids to patients who overdose on them.