New Manatee County ordinance discourages bogus pain management clinics, officials say

Nov. 18--MANATEE -- Manatee County had 21 pain management clinics last year before a strict new ordinance regulating them took effect, but since then nine have closed, according to county data.

The ordinance, designed to shut down bogus pain management clinics that really just peddle prescription drugs for profit, regulates facilities that give out more than 25 prescriptions in a single day for controlled substances for pain.It requires each clinic to have a permit issued by the county. The ordinance also banned "cash-only" payments, set hours of operation and required record-keeping subject to inspections. It also included a number of exemptions, for such facilities such as hospices and surgery centers. "I hand-delivered 21 (permit) applications," recalled Peyt Dewar, a code enforcement officer for the Manatee County Building and Development Services Department. "Some clinics closed, one doctor consolidated with another, one clinic did not qualify ... and others felt the applica

tion process wasn't for them, and they left town."

No new applications are pending, he said.

"We think it's been effective," said Rita Chamberlain, associate director for the Manatee County Substance Abuse Coalition.

"Some people folded their tents and left," she said. "They haven't come back."

Prescription drug abuse is among the most threatening substance abuse issues in the state, said a draft report compiled by the coalition.

"The illegal diversion of pharmaceutical drugs in Florida results in significant costs in terms of lives lost, increased crime, human misery from addiction and substantial costs in treatment, medical expenses and Medicaid fraud," it said.

Implementation of the new ordinance began in August of 2012; data it required covers the year since it went into effect.

The report shows:

? As of Sept. 30, 20,627 individual prescriptions have been recorded by nine registered pain management clinics, staffed by 13 physicians.

? Patients got scheduled prescription drugs during 83 percent of all visits.

? 58 percent of patients received two or fewer prescriptions for controlled drugs per visit.

? Manatee's average pain management clinic patient is female, white and between the ages of 40-69 years old.

? About 35 percent of pain medication clients hail from outside the county, but they could be seasonal residents or those from neighboring counties whose physicians operate multiple office locations, the report said.

? The top five patient zip codes include 34205, 34209, 34207, 34203 and 34221.

Pain clinic patients in Manatee County are not mostly young, as is the case in Sarasota County.

Those 29 and younger make up 15 percent of the county, but represent only 3 percent of all pain medication patients, the report said.

"This is a good thing because young people are not supposed to be getting these scripts," Chamberlain said.

Two local clinics are identified as "high prescribers," accounting for almost half of all prescriptions written in Manatee County. They are operated by Dr. Fabian Ramos and Dr. Steven Chun, according to Chamberlain.

The population of those getting potent prescription drugs that are highly addictive and frequently abused has been winnowed to those really in need, Chamberlain said.

Many local doctors who had been treating patients with such potent medications referred them to specialists like Ramos and Chun, rather than try to meet requirements of the new ordinance themselves, said Chamberlain.

That was confirmed by Ramos, a doctor who operates the Pain Relief Center of Florida, with offices in Bradenton and Sarasota.

"I think that, overall, it is a very positive impact to the community," said Ramos about the new ordinance.

There are fewer prescription drugs on the street, he said, noting that the amount previously was "creating a problem for the people abusing them."

An unfortunate side effect is reports that heroin use has increased because the ordinance has choked off access to narcotic prescription drugs, he said, adding, "It's in a positive way, they're less."

Earlier this month, a string of 13 overdoses caused at least eight deaths during a seven-day stretch ending Nov. 5, with heroin blamed for most, if not all, of the deaths.

"When the pills dry up, people who are dependent on pills look for something else," said Sharon Kramer, executive director of the substance abuse coalition.

Another new tool in the battle to halt abuse of prescription drugs is the Florida Prescription Drug Monitoring Program, created in 2009 by the Florida Legislature.

"The purpose of the PDMP (monitoring program) is to provide the information that is collected in the database to health care practitioners to guide their decisions in prescribing and dispensing these highly-abused prescription drugs," said the Florida Department of Health website.

It augments the county's new ordinance, Kramer said.

"You have a tool to keep people from shopping doctors and going to a number of doctors, and getting duplicate controlled prescriptions," she explained.

County records do not show patients' names; they are identified instead by number, along with a doctor identification, zip code, race, age and type of medication prescribed, said Kramer.

Now, it's easier to identify legitimate patients because there is public information about their records, said Ramos.

He described himself as "very strict" in his use of narcotic pain medication.

"That allows us to be very precise when we educate patients, and we show them what the record shows, and it's very difficult to dispute the fact," said Ramos.

Now, patients know it is not going to be as easy just to switch doctors, which they sometimes do in order to get a large supply of prescription drugs, he said.

"Now, they know it's different, and they're much more willing to listen to the doctor and to comply with what we feel is best for the patient," he said, adding that his clients have a better understanding that such medications are controlled.

Ramos' clinic supplies about 5,000 pain medication prescriptions each year, and county data indicate that he is one of two of the highest-prescribing doctors.

But Ramos said the opposite is true, once one looks at the size of his practice and the number of milligrams per patient.

"I have a large number of patients, we see so many patients," said Ramos. He said he tries to educate them and help them to decrease their medicines to low dosages.

A very small number of addicts come to him, but he refers them elsewhere for treatment.

"I don't take them," he said.

"I actually have reports from the insurance (companies) that put me among the lowest prescribers of local doctors in the community," which are not based on numbers alone, Ramos said.

His practice includes many older people suffering from degenerative diseases, whom he helps with small "maintenance" doses of medication.

Last week, his spotless waiting room was full of elderly people hobbling around with canes and walkers.

Chun did not grant the Herald a full interview, but left a voicemail message saying, "There has been so many new regulations and laws or ordinances in the last 24 months, it is even difficult to keep track."

He described the last two years as "very difficult" for pain management doctors, especially those who treat legitimate patients.

Chun's clinic also provides his patients with about 5,000 pain medication prescriptions each year, according to county data.

Meanwhile, the new county ordinance got a thumbs up from the local sheriff's office.

"Yes, it's working," said Dave Bristow, a spokesman for Manatee County Sheriff Brad Steube.

Both state and county efforts to halt prescription drug abuse have been effective, Bristow said.

One shut down the pill mills, while the other eliminated doctor shopping, he said.

Asked what happened to addicts who could no longer get legally-prescribed pain medicine, Bristow said, "They're trying to get other types of pain killers, getting help, or moving to another narcotic -- or else moving out of the county and state."

Florida has seen a 17 percent drop in Oxycodone deaths and a 58 percent reduction in "doctor shopping" cases since the database began operations two years ago, the Florida Sheriff's Association website reported in June, citing Florida Health Department statistics.

"The PDMP (Prescription Drug Monitoring Program) has been a critical tool in solving cases and bringing perpetrators to justice," it said.

Some of those who treat addicts concur that the new county ordinance, when paired with the state prescription tracking system, has been effective.

"We haven't seen new ones (clinics) open up," said Mary Ruiz, president and chief executive officer at Manatee Glens Mental Health & Addictions Specialty Hospital and Outpatient Practice.

"I think it has been effective in stemming the tide."

Clinic operators that just peddle prescription drugs for profit are opportunistic and prefer unregulated counties or those with lax regulation, she said.

However, pain medication is still a huge issue because people can easily become addicted through legitimate prescribers, Ruiz said.

"What we encourage consumers to be aware of is if you have a history of parents, siblings or grandparents with addictions, be reticent of a synthetic opoid," she said.

"Ask the doctor for other alternatives, like acupuncture or medical massage," she added.

"Be hypervigilant about medications prescribed for you."

Sara Kennedy, Herald reporter, can be reached at 941-745-7031. Follow her on Twitter @sarawrites.

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