December 19, 2011

Prescription drug abuse is a growing problem in the United States, and mayors have taken a leadership role in addressing the issue. For example, through the "Safeguard My Meds" national public awareness campaign (a partnership between The United States Conference of Mayors and pharmaceutical company Purdue Pharma LP) more than 150 mayors have recorded television and radio public service announcements (PSAs) on the dangers of prescription drug abuse. In addition, mayors have hosted town hall meetings and taken other important steps to raise awareness of this critical public health concern.

But mayors understand all too well that public awareness is only one component of a comprehensive response to the issue. In addition to public awareness efforts, and support for education and treatment programs and initiative, mayors and cities are increasingly focusing on addressing prescription drug abuse through policy initiatives.

New York City Mayor Michael R. Bloomberg announced on December 13 the launch of a multi-agency task force to combat the growing prescription drug abuse epidemic in his city. Over the past twenty years, there has been a tenfold increase in New York City in the use of prescription opioids to manage pain, and between 2004 and 2009, the number of emergency room visits related to opioid misuse/abuse doubled. (An "opioid," generally speaking, is any synthetic narcotic that has opiate-like activities but is not derived from opium.)

In addition, prescription opioid use is spreading among the city's youth. In 2008 and 2009, four percent of New Yorkers who were 12 years old or older – 263,000 people – reported misuse of opioid prescriptions. And ten percent of students in grades 7 to 12 said in a 2008 survey that they had used a prescription opioid recreationally at least once in their lives.

Bloomberg's Task Force will focus on prevention and response efforts by reviewing information on the marketing, distribution, prescription, diversion, and use of these drugs. Among its duties, the Task Force plans to analyze data on opioid use to identify suspicious prescription patterns. This information will allow law enforcement to target their efforts accordingly.

Ultimately, the group will make recommendations on pharmaceutical industry practices, provider and patient education and responsibility, and enforcement approaches for curbing irresponsible distribution of opioids. The Task Force is due to deliver its first round of recommendations to Bloomberg by the end of January 2012.

This week, the New York City Health Department also released guidelines that for the first time give doctors guidance on how to safely prescribe opioids. The guidelines are available online at http://www.nyc.gov/html/doh/downloads/pdf/chi/chi30-4.pdf

Orlando city leaders voted December 5 to extend a moratorium the opening of new "pill mills," as they are commonly known – pain management clinics that sell prescription drugs to people who don't necessarily need them. "Abuse of prescription medicine being used illegally has become an epidemic," said Orlando Mayor Buddy Dyer in a recent media interview. Across Florida, there are more than 900 of these pain management clinics – just within Orlando city limits, there are 23. According to officials, there are more "pill mills" than Burger King outlets in Orlando.

The moratorium, originally enacted earlier this year, prevents new pain clinics from opening under city jurisdiction. It also prohibits existing pain clinics from relocating or expanding. Furthermore, pain management may only operate between the hours 8:00am to 8:00pm, and clinics are no longer allowed to accept cash payments for medications.

The moratorium is meant to serve as a temporary fix until appropriate new legislation can be crafted – which the city is in the process of developing. Once the Moratorium Ordinance is repealed, a new Pain Management Clinic Ordinance is expected to be passed to institute new requirements for new pain management clinics.

This summer, Dyer and other city and county leaders – as has happened in New York – convened a task force to study the issue and to develop recommendations. The Task Force presented its findings to city leaders in November. Among its recommendations contain provisions of the new ordinance that include new zoning and location requirements for pain clinics, as well as, use of the State's Prescription Drug Monitoring Program, which was recently implemented. The Prescription Drug Database is expected to serve as an effective tool in reducing successful doctor shopping, multiple prescriptions or multiple pharmacy filling of prescriptions, as the new ordinance makes it a requirement for physicians, physician's assistants and pharmacists' agents to check the database within 24 hours prior to prescribing any dangerous drugs to a patient.

Among the Healthcare and Pharmacy Subcommittee recommendations are:

• Zoning: new pain management clinics will only be allowed in the city's I-4 Industrial Zone and will be prohibited as a home occupation; building and use permits will be required; pain management clinics will not be allowed to co-locate on the same property as a pre-existing pharmacy; and cannot operate within 1,000 feet of any pre-existing pharmacy, school, daycare center, or home.

• Pharmacy Regulation: prior to filling or dispensing any prescription for a dangerous drug a pharmacist or pharmacist's agent shall require and record government issued identification; pharmacies must keep records of all prescriptions filled for no less than two years, and provide records of dangerous drug prescriptions to law enforcement or code enforcement within seventy-two (72) hours of the request; it will be unlawful to pay any pharmacist a bonus, incentive compensation or reward solely for filling a prescription for specific dangerous drug.

• Prescription Drug Monitoring Program (PDMP): within 24 hours prior to prescribing dangerous drugs, prescribing physicians or agent must access and review patient information in the Prescription Drug Monitoring Program (PDMP). Created by state legislation, the PDMP includes a database of specific controlled substance prescriptions in the state, requires pain management clinics to register with the state, and prohibits dispensing of prescriptions in pain management clinics, among other regulations. However, Florida local leaders and advocates have complained that under state law doctors and pharmacists are not required to check the PDMP before prescribing or dispensing drugs to a patient. The city's ordinance aims to close that loops for the residents and citizens of Orlando.

A number of other local jurisdictions in Florida, including Hallandale Beach, Tampa, Sarasota, and Miami-Dade, as well as Broward and Pinellas counties, have enacted a variety of measure to regulate pain management clinics and the dispensing of opioids, ranging from placing moratoria on new pain management clinics to requiring pain management clinics to obtain permits and adhere to strict regulations. Outside Florida, such policy initiatives are not as widespread – though New York's movement on the issue is likely to create a nationwide visibility and may signal the beginning of a trend.