Crossing Over State Lines with Painkiller Prescriptions

John Burke, commander of the Warren County, Ohio, drug task force and retired commander of the Cincinnati Police Pharmaceutical Diversion Squad, is a 40-year veteran of law enforcement. Cmdr Burke also is the current president of the National Association of Drug Diversion Investigators. For information, he can be reached by e-mail at burke@choice.net, via the Web site www.rxdiversion.com, or by phone at 513-336-0070.

For some time now, the Midwest and other locations in the United States have been inundated with prescription drugs flowing in from Broward County, Florida (Fort Lauderdale). The root of the problem appears to be the almost 200 pain management practices located in Broward County and the constant flow of Ohioans and others to these clinics. Some of these clinics are not owned by physicians but by energetic entrepreneurs.

Vanloads of midwesterners have traveled the 1000-plus miles to obtain multiple prescriptions for oxycodone and other controlled substances. Our task force is seeing this firsthand, as we receive offers to purchase as many as 400 tablets at a time, ranging from $6 to $8 per pill and sometimes even more, depending on supply and demand.

The Florida-Midwest Link

Although many of the prescriptions are filled in Florida and then brought to our region, a significant portion also is brought to pharmacies in Ohio, Indiana, Kentucky, and Pennsylvania by individuals attempting to have these prescriptions filled. This understandably has caused concern with the pharmacists in these states, prompting many of them to contact their state board for guidance.

This led the Ohio Board of Pharmacy to issue a statement in response to this problem. The board correctly advised pharmacists to use their own judgment in filling these prescriptions and to make attempts to verify the validity of the clinics and the patients. I think the old standby of corresponding responsibility applies here if a pharmacist feels uncomfortable in filling any of these prescriptions. Although this may not be the answer all pharmacists want to hear, I have great faith in America's pharmacists and always think this decision is one that should be in their hands.

Last year, my office found a significant connection between Broward County and our jurisdiction. Offenders living in Florida with a past Ohio residency were shipping oxycodone from the Broward County clinics back to their associates for sale on our streets. This activity was combined with a less-than-scrupulous physician in southwest Ohio, creating an enormous amount of Schedule II controlled substances for sale to addicts.

Rx Monitoring Needed

The good news is that, as of this writing, the Sunshine State appears to be very close to a prescription monitoring program. This is good news for Florida-and the Midwest-as a valuable tool will soon be in the hands of law enforcement. Those of us, with very successful prescription monitoring programs like the one in Ohio, will be eager to compare profiles to pursue those who are engaged in "doctor shopping" offenses while crossing state lines.

Law enforcement in Florida is working hard on this continuing problem, and with the addition of a prescription monitoring program in the state--combined with aggressive police work in the Midwest--perhaps some meaningful results can occur.

In the meantime, the problem appears to only be getting worse. I recently spoke at a large gathering of Jacksonville, Florida, pharmacists, and they expressed concern for this situation, as they, too, were besieged with these prescriptions.

As always, pharmacists can help in this fight by reporting suspicions to your local police agency and being cautious in filling prescriptions that raise red flags with you. Be especially diligent in attempting to verify Schedule II controlled substance prescriptions written by physicians more than 1000 miles away from your pharmacy and presented by a patient with whom you have no history.