Painkiller peddlers: Pharmacies targeted in pill-mill crackdown [The Miami Herald]

Dec. 24--From the outside, Robert's Drug Store seemed like an ordinary mom-and-pop pharmacy, conveniently located on the first floor of the Stephen P. Clark , the 28-story heart of Miami-Dade County government.

But federal authorities say the pharmacy, steps from a heavily used Metromover stop, was actually operating as a pill mill illegally trafficking in painkillers, part of a wave of rogue pharmacies that have become the new front line in the continuing war on prescription drug abuse in Florida.

The pharmacy's owner, Aiman Izzedin Aryan, has had his pharmacy permit suspended by state regulators, and the store, while open, no longer fills prescriptions for oxycodone -- or any other drug.

"This is an epidemic, a public health crisis that has killed thousands in Florida. Our strategy is to attack the problem from all angles, from all the sources of oxycodone,'' said U.S. Attorney Wifredo Ferrer. "This is all a very tight web of doctors working with clinics and using pharmacies to make the business look legitimate and everybody is making money. We are seeing more and more pharmacies involved.''

In the constant battle to crack down on the newest method of peddling prescription drugs to the addicts who crave them, authorities have recently broadened their strategy to focus on pharmacies in addition to pain clinics and doctors. Ferrer says criminal investigations will at least slow the epidemic, especially in tandem with rigorous new anti-pill mill legislation that went into effect in Florida in July. Under the law, the state Department of Health will play a role in determining the appropriate monthly dosage limit that pharmacies can dispense. The permit process to open new pharmacies in the state has also been made far stricter.

At least one major pharmacy has recently stopped filling the prescriptions of certain drugs by a small number of doctors in Florida.

"In the beginning of our takedowns, we were seeing more of the pain clinic owners but as the fraud has evolved so have the kinds of businesses involved,'' Ferrer said. "This is at the top of my agenda and we are hoping the new law and regulations will help stem the problem.''

In the past several years, as Florida became known as the nation's painkiller capital , local, state and federal agencies concentrated initially on the growing number of storefront pain clinics -- at one point there were 150 in Broward County alone -- that liberally doled out prescriptions for highly addictive medicines with little or no medical cause. But that didn't stop the vast river of pills flowing through the state, attracting drug tourists from as far away as Kentucky, Tennessee, Turkey and Mexico, and pushing overdose rates to new heights, so authorities were forced to widen their probes.

Doctors working with the clinics who wrote the tainted prescriptions came under scrutiny along with healthcare billing fraud schemes involving the clinics and, now, the complicit pharmacies that fill the prescriptions.

Part of the strategy: Use criminal laws to charge unscrupulous doctors with homicide and pill mills and pharmacies as organized criminal enterprises.

Since the summer, federal investigations have uncovered drug trafficking rings involving oxycodone and seven pharmacies in Broward and Miami-Dade, the stores collectively distributing millions of pills. One Plantation pharmacy named in an indictment filled 72 prescriptions for painkillers in one day for a total of 13,387 pills and $30,532.

In October, federal agents indicted 24 defendants in South Florida including a doctor, two pain clinic operators and Aryan, owner of four Robert's Drug Stores, including the government center location. In the nine-count indictment, Aryan is accused of conspiring with a doctor and pain clinic owners to traffic large amounts of oxycodone and oxymorphone and defraud Medicare and private insurance plans in a far-reaching enterprise that brought in $40 million. He was charged with one count of conspiracy to possess with intent to distribute controlled substances.

Said Aryan's attorney, David O. Markus: "Robert's has been a pillar of the Miami community for many, many years and Aiman and his family are really good people. So we are looking forward to defending this.''

In the 1990s, Aryan family purchased the original Robert's Drug Store, which opened in 1922.

Announcing the indictment, Ferrer noted that "each day, individuals die from prescription drug overdoses. To stop this drug epidemic, we have previously charged clinic owners, operators and doctors who deal drugs while hiding behind a medical license. Today, we have focused our efforts on those pharmacies that are churning out pills that are fraudulently prescribed at area pain clinics.'' Federal agents described the scheme as a drug-peddling ring in which a group of "sponsors" recruited Medicare, Medicaid and private insurance "beneficiaries" -- fake patients -- to visit pain clinics and doctors in Miami, Hialeah and Plantation to get prescriptions for oxycodone, oxymorphone and other controlled substances. The recruiters often provided transportation and coached the beneficiaries on symptoms to claim in order to get a pain medication prescription. Those patients then filled the prescriptions -- generally the same combination of drugs and dosage -- at one of the four Robert's Drug Store locations and other pharmacies in Miami. The "patients" were paid $600 for their services, according to the indictment. Aryan allegedly received extra cash -- it's not clear how much -- for filling the prescriptions and then filed fraudulent Medicare and Medicaid claims.

In the emergency order suspending Aryan's pharmacy permit based on the U.S. Drug Enforcement Administration investigation, the Florida Department of Health said he posed a serious danger to the public health and showed reckless disregard for pharmacy laws and rules by dispensing excessive or inappropriate dosages of oxycodone and oxymorphone.

Aryan's four Robert's Drug stores purchased a total of 1,692,700 tablets of oxycodone between Jan. 1 and June 1 this year, according to the DEA. A state expert said in state documents that an 80-mg. daily dose of oxycodone "is potentially lethal" for some people but that Aryan's customers routinely received far more.

"Mr. Aryan consistently acted with indifference to the health of his customers and the public by dispensing highly addictive and potentially harmful drugs based upon prescriptions that he knew or had reason to believe were not valid,'' the state order reads.

The pharmacy, which competed against Walgreens for the prime spot in county hall, has a five-year lease -- with two two-year renewal options -- that runs out in 2014. The $2,350 monthly rent is current but county officials are reassessing the operation because they need a space that can fill prescriptions.

"We are in the process of drafting a request for proposal for pharmacy service,'' says Wendi Norris, of the Miami-Dade Internal Services Department, which manages county buildings and leases. "They are not in default of the contract, but we are looking for a space that can operate in its entirety.''

The war against prescription drug abuse continues in Florida. After a three-year investigation, federal authorities dismantled four of the nation's largest pain clinics in August along with two pharmacies and one pharmaceutical supplier. Thirty-two people from across South Florida were indicted. Over the years, the enterprise doled out 20 million pills and profited $40 million from illegal sales of controlled substances. In July, federal authorities arrested a family of five charged as part of a drug and money laundering enterprise based at a Plantation pharmacy. From April, 2009 to May, 2010, the pharmacy ordered 1,038,560 tablets of oxycodone, more than 28 times the national average for dispensing pharmacies, according to federal documents. The profits: nearly $2 million.

Last month, CVS -- with more than 700 stores in the state -- notified a small number of Florida physicians that it will no longer fill their prescriptions written for Schedule II narcotics, including oxycodone, a measure to "prevent drug abuse and keep controlled substances out of the wrong hands,'' according to a statement.

CVS spokesman Michael DeAngelis said in an email that letters were sent in late November.

"CVS Pharmacy Inc. has become increasingly concerned with escalating reports of prescription drug abuse in Florida, especially oxycodone abuse,'' the letter read. "CVS will continue to review information, and will alert you if CVS pharmacy stores may fill these Schedule II narcotic controlled substance prescriptions in the future.''

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(c)2011 The Miami Herald

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