PAIN CLINICS FEEDING HABITS

Here are two seperate articles that are related to each other that I found interesting. This goes to validate what we have been saying all along about most diverted methadone coming from pain mgt clinics and not MMT clinics. Just like with other things such as MMT patients, teachers, law enforcement officials, welfare recipients etc, it's also another sad but perfect example of a few "bad" ones giving all of them, even the "good" ones a bad name. .

PAIN CLINICS FEEDING HABITS

By Ray Reyes from the Tampa Tribune

PALM HARBOR - The addiction started after he injured his shoulder and spine in two car crashes.

He was prescribed seven tablets of Vicodin a day to numb the pain, but it didn't take long for Robert Palmisano to crave stronger doses.

His family physician refused to prescribe more potent medication. So Palmisano found relief at pain management clinics, where he paid cash for up to 120 opiate-based pills during each visit. "I was just trying to get right," said Palmisano, of Palm Harbor. "That's when all hell broke loose."

He was 19 when he got hooked on painkillers.

"I used to crush them," Palmisano, now 26, said of the pills, "then snort them or shoot them up. It was really hard to quit."

Palmisano's going from patient to pill addict is not uncommon, medical professionals said.

And an increase in the number of people addicted to pills is linked to the glut of pain clinics in the Tampa Bay area doling out a massive volume of prescriptions, law enforcement officials said.

"The more there is out on the street, the more people are getting addicted," Pinellas County sheriff's Capt. Robert Alfonso said of opiate-based painkillers such as oxycodone, hydrocodone and methadone.

Rick Sponaugle, owner and medical director of the Florida Detox and Wellness Center, said most of the cases he has seen involved patients with legitimate pain developing a dependency on pills.

"It starts with a legal pain doctor," Sponaugle said. "Then the patients need more and more."

Recovering addict Todd Noble of Sarasota said that's how he got hooked on OxyContin.

Noble, 45, who has since been treated by Sponaugle, said a dental procedure led to his addiction.

Noble, like Palmisano, was prescribed Vicodin but eventually sought out stronger doses. Noble said he bought his pills from a drug dealer who procured them at pain clinics.

"It became a full-blown addiction in a couple of weeks," said Noble, 45. "I had to detox off OxyContin seven times. Sometimes I would relapse on the way home."


* * * * *

Local private and public treatment centers continue to be filled with people addicted to painkillers. At Hillsborough County's public drug treatment center, there are 20 beds for people who volunteer, or are court-ordered, to undergo a four-day detox program.

Most of the beds are occupied by people recovering from addictions to opiate-based pills, said Michael Strolla, the assistant medical director of the clinic run by the Agency for Community Treatment Services.

"If they're 40 or under, it's going to be opiates," Strolla said. "And they got them at pill mills. It's out of control."

Most patients had legitimate pain before addiction took hold. They tried physical therapy and other treatments, but getting prescriptions was more convenient and provided immediate relief, Strolla said. "It's a common story. These people, most of them, truly thought they were doing the right thing after tweaking their back or getting injured," Strolla said.

Because opiate-based pills aren't outlawed like other narcotics, more pain clinics started opening up shop in the Tampa Bay area and elsewhere in Florida, Alfonso said.

"They're legally available. It's a legitimate medication," Alfonso said. "People think, 'Well, doctors prescribe it, so it won't hurt you.' "Palmisano said when he first got addicted in 2003, there were a small number of pain clinics in Pinellas that would dole out large prescriptions.

"I had to search hard for doctors that were a little dirty," Palmisano said. "Back then, it wasn't as common as it is now."


* * * * *

Painkiller abuse and overdoses weren't as rampant seven years ago, Palmisano said, which made it easier for him to "exploit the system" by buying more pills and selling extra tablets for $15 each.

Since then, lax regulations have also contributed to an increase in "pill mills" in the Tampa Bay area, authorities said.

"It's definitely been increasing in the last couple of years," Alfonso said, "and the legitimate clinics' reputation is getting damaged by illicit doctors."

Tips from residents, confidential informants and other sources led detectives to those suspicious clinics. Some clinics shut down by Pinellas investigators had customers buying hundreds of pills from the business, then selling them for a profit in the parking lot, Alfonso said.

Hillsborough sheriff's narcotics Detective Chris Rule said illicit clinics have doctors who are not on the premises but have placed their signatures on stacks of prescriptions. These businesses could prescribe more than 200 tablets of oxycodone and 100 Xanax pills per person, he said.

"How many doctors' clinics have you been to where all they accept is cash?" Rule said. "If they don't accept different forms of payment, that's a key indicator."

Investigators estimate there are about 70 pain clinics in Hillsborough and 35 in Tampa. There are about 1,000 clinics registered in Florida, Bruce Grant, the director of the state Office of Drug Control said.

"That's a heck of a lot of pain clinics," Grant said. "Some of these are legitimate. A whole bunch of them are not."

Lawmakers and law enforcement have since caught on to what they say has mushroomed into a statewide epidemic. New state laws went into effect Oct. 1 making it tougher to register and operate pain clinics. Tampa and Hillsborough have similar ordinances.

It's too early to tell whether the stricter rules have had any effect, but health investigators are gearing up to begin inspections, Grant said.

A statewide prescription drug monitoring program — which allows health professionals to view patients' prescription histories — may also help slow the flood of prescriptions, said Sen. Mike Fasano, R-New Port Richey.

The $1 million program, which had trouble finding start-up money before private donations and grants were collected, starts in March, Fasano said.

Lindsay Roberts, a paralegal for a Tampa law firm, said tougher laws may have helped prevent some of her friends from overdosing on painkillers.

"I've lost 16 friends in three years. I've lost so many people to the same thing," Roberts said. "I'm to the point where I can't cry any more. I'm just angry," she said.


* * * * *

Overdoses from prescription medication now outnumber other drug deaths, health officials said.

There were 277 drug deaths in the county in 2009, with 199 caused by oxycodone overdoses or a mix of painkillers and other drugs, Hillsborough County Medical Examiner's records show. In 2005, the agency reported 179 drug overdoses; 76 involved opiate-based pills.

In Florida last year, oxycodone was involved in 1,948 deaths, according to a state Medical Examiner's Commission report. Methadone was linked to 985 deaths, and hydrocodone was linked to 865, the report said. Addiction is rampant because hydrocodone, methadone and other opiate-based pills are basically synthetic heroin, one of the most addictive drugs, Alfonso said.

"For every addict, there are five people who are affected," said Don Wood, the admissions coordinator for HealthCare Connection, a private center in Tampa. "The insanity of addiction is unbelievable."

Sponaugle said too much of one chemical in the brain — or too little — is a factor in addiction. Along with biochemistry, genetics plays a role, Strolla said.

"A lot of people are predisposed to addiction," Strolla said. "Drugs affect their brains in different ways, giving them not only pain relief but pleasure."

Palmisano said the high he got from prescription pills "killed all the pain — physical pain, but emotional, too."

He conquered his addiction because he was forced to. In 2005, Palmisano was sentenced to one year in Pinellas County Jail on multiple drug charges. He had been "doctor shopping," he said, getting one prescription filled at different pharmacies.

Palmisano, sober since 2006, said jail doctors put him through detox. Drug-induced fever dreams provided no solace from the physical pain, such as stomach cramps, he felt while he was awake.

"The withdrawal was really horrible," he said. "You would rather die."

Noble said he was passed out when friends took him to Sponaugle's clinic two years ago: "I don't even remember being here. It's a total blackout."

There is one thing he recalled about that time.

"I was sick. I just wanted to feel better," Noble said. "My theory is that people change when the pain of change is less than the pain of things staying the same."

This one comes from the Tampa Bay Online and the original link is

http://www2.tbo.com/content/2010/oct/31/pain-clinics-feeding-habit/news-metro/



PILL MILL DOCTORS HARD TO CONVICT



TAMPA - The clinic owner peddled the painkillers in large doses, and high school students were among his best customers.

There was only one doctor on the payroll for the six clinics that Troy Wubbena owned. That doctor, Jeffrey Friedlander, signed his name on blank prescription pads.

Wubbena admitted to selling more than 62,000 oxycodone tablets to teens and addicts statewide before Tampa authorities investigated and the operation unraveled.

Typically, cases against pain clinic physicians are difficult to prosecute, authorities said.

When it comes to convicting pain doctors who are accused of breaking the profession's most sacred oath, the case of Fried- lander, 51, and Wubbena, 44 - both have pleaded guilty to federal drug conspiracy charges - is an exception.

It takes time to "remove the professional veil of legitimacy these rogue doctors hide behind," said Joseph Ruddy of the U.S. attorney's office in Tampa.

Authorities look for evidence that doctors are involved in a drug trafficking ring, and "while you can have an arrest here or a seizure there, dismantling the whole operation takes time," said Ruddy, chief of the agency's narcotics division.

Tampa continues to be a hotbed for so-called pill mills, Ruddy said.

"These are the new street corner drug dealers," he said. "It's becoming alarming."

Steve Rosenberg, a member of the state medical board, said it's difficult to link a pain doctor to a crime, except in cases where "somebody dies of an overdose and the doctor's name is on the bottle."

Some doctors accused of doling out a high number of pills avoid criminal charges because it's hard for authorities to prove a doctor's judgment is wrong, said Bruce Grant, the director of the state Office of Drug Control.

Even if a doctor is prescribing three times the average amount of pills for one person, that patient may have legitimate chronic pain that justifies a large prescription, Grant said. "Doctors are perceived by society as they should be: fine, upstanding citizens who uphold the Hippocratic Oath."

There are "renegade doctors who are in it to make money," he said. "Do the math. They see at least 20 to 30 patients a day for $200 or more a visit."

Some are "80-year-old doctors who haven't practiced in years" and fill out blank prescriptions to make extra money in their retirement, said Ryan Lynch, special agent in charge of the U.S. Department of Health and Human Services.

"The Department of Health has to investigate fully, because you're potentially taking away from a physician his or her livelihood," Grant said.

"These are the most difficult, complex cases law enforcement can prosecute," he said.

Tampa clinic case

Tampa police found that out last week.

Investigators had built a case against Jorge Betancourt-Gonzalez and the clinic he owns at 2314 N. Dale Mabry Highway.

Detectives had seized about $222,000 in cash when the clinic was closed in July, arrested Betancourt-Gonzalez on money-laundering charges and accused him of earning money by dispensing painkillers such as oxycodone "outside the scope of professional practice."

But a judge ordered police to return the money to Betancourt-Gonzalez, ruling investigators did not have sufficient probable cause to arrest him and close his business.

Investigators said the clinic "had only one doctor on staff at any one time and that it used prescription pads with pre-filled drug information," according to the order signed by Circuit Judge Robert Foster.

Betancourt-Gonzalez's clinic, Foster said, had a "rotating staff of four licensed physicians whose work is overseen by a fellowship physician." All were "licensed to dispense the types of medication at issue here," the order said.

None of the doctors was charged with a crime or had their licenses taken away after the clinic was closed on July 26, Betancourt-Gonzalez's attorney, Dale Sisco said. He declined to comment on the judge's order.

Detectives did not release the doctors' names. The investigation is ongoing, police spokeswoman Laura McElroy said.

Suspension of license

The state Board of Medicine can place an emergency order on doctors suspected of illegal or unethical activity, suspending their licenses temporarily until a formal hearing or investigation is completed, said Eulinda Smith, spokeswoman for the state health department.

This year, the board has taken emergency action against 24 pain management doctors or clinics, health department records show. Two clinics are based in the Tampa Bay area.

One case involved Pinellas County physician Michelle Lee Snyder, accused of prescribing about 94,000 pills to five patients over a two-year period, according to a health department order signed in April.

Snyder's license has been suspended. A formal medical board hearing on her case is pending.

Investigators said prescriptions filled by Snyder included oxycodone, methadone, Xanax and the muscle relaxant Soma.

"That's the preferred cocktail of addicts," Grant said of the combination of oxycodone, Xanax and Soma that can produce a high similar to heroin.

Pinellas sheriff's deputies turned in information about Snyder's clinic to the state health department in July 2008 and medical investigators took over the case.

It is a common procedure, and complaints against doctors can be filed by other medical professionals, patients or their families and law enforcement, Smith said.

Hearings on the 23 other doctors and clinics who had emergency action taken against them this year are pending. Doctors can also file appeals, prolonging a final ruling, Grant said.

Some pain physicians voluntarily turn in their licenses when called before the board. That's what Tampa doctor Kevin Denny did on Aug. 19, 2009, three days after he pleaded guilty in federal court to two counts of wrongly prescribing drugs, including oxycodone.

Denny traded pills to feed a cocaine habit, prosecutors said. Last month, he was sentenced to six years in prison.

Health department data is not clear on whether there has been an increase in actions taken against doctors prescribing painkillers. The agency recently switched to a new tracking system and before that, cases against pain doctors were lumped into a broad category that included other medical specializations, Smith said.

Using the old tracking system for fiscal year 2009-10, the medical board saw 42 doctors who surrendered licenses, - pain clinic physicians are included in this category - suspended 37 and revoked 13, records show.

The profession receiving the highest number of disciplinary actions is registered nurses: 241 suspensions, 24 revocations and 63 who turned in licenses.

This one comes from the same paper and the link for it is

http://www2.tbo.com/content/2010/sep/07/na-pill-mill-doctors-hard-to-convict/