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After Privacy Breach, Critics Of Fla's Drug Database Say Crackdown Efforts Have Gone Too Far

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The ACLU of Florida is recommending law enforcement have warrants before approaching state health officials for patient information housed in the prescription drug database. The names of more than 3,000 Central Florida residents were released to prosecutors and defense attorneys as part of a probe into doctor shopping.  The news is renewing concerns about the balance between privacy and access, and some say the state’s efforts to crack down on prescription drug abuse has gone too far.

Since Florida began cracking down on prescription drug abuse, the number of deaths caused by controlled substances has decreased. Halfway through 2013 there are fewer than 400 deaths caused by such drugs. That’s on pace to meet levels not seen since at least 2007. But that was not always the case.

“I’ll tell you, we are known as the oxy express....and that is not what we want our state to be known for,”   said Florida Attorney General Pam Bondi in 2011.

The number of overdoses peaked in 2010 at more than 1,500 statewide. Florida was known as the pill mill capital, with lax rules governing the prescribing of such drugs. The legislature chipped in with tough new laws on what doctors could prescribe, regulations aimed at shuttering pain clinics, and a database that houses information on patients who take controlled substances.

The database has been the most controversial part of the crackdown. Before the state adopted it, there were concerns about patient privacy and who could gain access to such data. Under the state’s rules, the Florida Department of Health oversees the system, and doctors and pharmacists input information. Law enforcement can request information in the database from the Florida Department of Health. But the American Civil Liberties Union of Florida’s Assistant Legal Director Maria Kyanan says the rules around searching the database need to be clarified.

“Law enforcement doesn’t have to use a specific name of an individual. They can use a wildcard search, they can use a “sounds like” search...searches like that that encourage unspecific, very broad fishing expeditions that yield 3,300 names. And that’s not what the PDMD was for," she said.

The organization wants law enforcement to have a warrant before requesting information from the database. The Department of health is considering changes after a federal probe into doctor shopping in Central Florida netted the names of 3,300 Volusia county residents. Those names were later turned over to defense attorney’s. Kyanan said the requests made to the Department were too broad, and didn’t turn up much:

"It was the red flags that should have been raised with so many results...that yielded six prosecutions. Do the math. It’s wrong.”  

But law enforcement officials like former Duval County Sheriff’s Office Investigator Lisa Abromowitz says the ACLU’s recommendations are going in the wrong direction:

“I don’t have a problem with redacting other people’s names who aren’t involved in the investigation," she said. "But having to obtain a subpoena or a warrant to obtain that information would slow that process and put us going backward rather than forward in my opinion.”   

The federal probe that led to the release of information to defense attorneys came about because doctors noticed some of their prescription pads were missing and raised the alarm. One man who had been prescribed one of the prescription drugs tracked by the database learned his name was handed over to authorities from a defense attorney. He is now suing the state.

Donna Ratliff, who heads Fight for Pain Care Action Network, an advocacy group for chronic pain paitents, say the state’s pill mill crackdown has gone too far.

“Most people are under treated now because doctors are afraid to write the right amounts of medication. Everything they write goes into this database and if it shows the doctors writing large amounts for people who legitimately needed, they’re afraid so they’re not going to write as many. So they’re turning people away or giving them something that is not effective.”  

And the ACLU of Florida’s Kyanan says she recently ran into problems getting her prescription filled:

“I had rotator cuff surgery in December and I was in a lot of pain...it took 12 pharmacies to find one that would fill my orthopedic surgeon’s lawful prescription for me.”  

There have been many similar complaints since the state began its crackdown in 2011. Big chain pharmacies like Walgreens and CVS are also filling fewer prescriptions after two stores in Central Florida were also accused of being pill mills last year by the state. much of the difficulty stems from a greater demand to fill prescriptions after the state shut down and placed limits on other dispensaries, like doctor’s offices:

“You really don’t understand the magnitude of pain until you have it. And when you have it, you want it taken care of. But what we’re dealing with now is, we’ve had such a large run on many pharmacies in Florida, that its somehow had an impact on supply," said Michael Jackson, CEO of the Florida Pharmacy Association.

The companies that supply pharmacies are also heavily monitored as are the pharmacies and doctors. The Florida Medical Association says it’s heard about the problems with patients getting their prescriptions filled, along with the reports of doctor’s hesitant to write prescriptions. The Association says it disagrees with state requirements that doctors consult the database before prescribing the medications. FMA General Counsel Jeff Scott says in a statement:

“This puts patients with legitimate pain needs in limbo and makes it more difficult for physicians to treat their patients. The FMA also has serious concerns about patient privacy in light of recent leaks of patients’ personal data. Until those issues are resolved, forcing physicians to use the database is not good public policy.” 

Other doctor groups say they’re members have had more positive reactions to the database and say it’s been instrumental in preventing doctor-shopping, but share similar concerns.

The recent release of what is supposed to be confidential patient information has re-ignited the debate about privacy in Florida. During the 2013 legislative session, Republican Representative Rob Schenk filed a bill to get rid of the database. The measure failed. And fellow Republican Representative Mike Fasano of New Port Ritchey, an early backer of the system, says while he believes there should be some changes to the database, it shouldn’t be scrapped altogether.

“There are some out there who want to do away with it because we’ve put them out of business. Let’s not go back in time and let them come back into the state and start killing our young people once again.”   

And even pain management advocates like Donna Ratliff agree the database and other state efforts have been effective on cracking down on prescription drug abuse, they just want the state to find other ways to help legitimate patients get their needs met too.

Follow @HatterLynn

Lynn Hatter is a Florida A&M University graduate with a bachelor’s degree in journalism. Lynn has served as reporter/producer for WFSU since 2007 with education and health care issues as her key coverage areas.  She is an award-winning member of the Capital Press Corps and has participated in the NPR Kaiser Health News Reporting Partnership and NPR Education Initiative. 

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