People who engage in narcotics abuse and drug diversion (i.e. selling drugs on the street) have been cut off by the Tennessee legislation examined in the previous column. Instead, they have turned to Florida, where last year that state dispensed five times the national average of oxycodone prescriptions. The drugs are then transported back to Kentucky, Tennessee and surrounding states where narcotics cannot be easily obtained. The documentary The Oxycontin Express (video below) details how the drugs are making it from Fort Lauderdale to the Appalachian region. So pervasive is the activity that terms like “pillbillies” in search of “hillbilly heroin” have emerged to describe the car loads of Appalachian drug seekers visiting Florida. The picture is alarming, unsettling, possibly even worthy of the adjective “crisis” and above all, accurate.
Medical law requires that for a prescription to be legitimate, an established doctor patient relationship must exist. This is why internet pharmacies are a frequent target of state law enforcement and medical boards. Not the kind like drugstore.com where one sends their prescription for filling, but sites where you fill out a form and you get your drugs without the hassle of an actual physical exam. Obviously people traveling hundreds and hundreds of miles from Tennessee so they can obtain prescriptions for large quantities of oxycodone, Soma, Xanax cannot have such a relationship—unless one is willing to buy into the idea they make that trip on a monthly basis to have their pain managed.
If the patient is coming from some specialized treatment center in Florida, that is believable. Never mind that legitimate pain management could be managed by any number of Tennessee physicians in that specialty. But such activities can be tracked here in Tennessee so the unmonitored land of Florida has become the go to spot.
The reality is this: obtaining narcotics prescribed in Florida and having a home address in some small town in Tennessee or Kentucky and attempting to fill the medications for cash at some point in between fire off virtually every red flag there is. Meanwhile, the DEA cannot gather evidence and shut the store front pain clinics down fast enough. States like Tennessee and Kentucky have very few such physician problems because of the state’s laws and Controlled Substance Monitoring Database (see Part One) prevent it. So narcotics must be obtained outside the state and transported back in.
Tennessee has noticed the drug trafficking. On July 16 in Knoxville, police arrested a man involved in the Tennessee-Florida drug pipeline. South Carolina has noticed, too, where five Tennessee residents were arrested while trying to fill large quantities of pain medications they had obtained from a clinic in Orlando, Florida. And here is another Tennessee diversion case where the perpetrator parlayed a legitimate injury into a business gold mine. Even the law offices are taking note of the problem as seen in this article from a Nashville defense office. Here is another involving a Cookeville man arrested in Florida, who had over eight hundred Oxycontin pills in his car. Your Intrepid Pharmacist typed out that number so he was clear this was not a typographical error. And here is a Kingsport woman who was visiting Florida and several other states as well for a mountain of narcotics. Obviously, not many bright crayons in this box.
And if you are feeling like this point is being hammered to death thanks to ease of internet interlinking, go back and check the dates on every arrest article cited. They are all from July 2010! And this month still had a full week to go at the time this column was written!! Imagine what a gathering of articles for the year must look like!
If you want to see how far this can go on the internet, check out the topics in this discussion forum and count the number of threads selling oxycodone or trying to score a source for it.
Florida, for its part, has garnered such a negative reputation among heath care providers and law enforcement in nearby southern states that Florida finally took action in a sweeping new law. Provisions in the new law include elimination of cash payments, new tougher requirements to be a pain management physician, a detailed list of examination requirements, and limits on advertising. Even now, the repercussions of the new law are already being felt. In the face of forthcoming changes in Florida, the pain clinics have started northward migration. They will never operate in Tennessee or Kentucky as laws exist to prevent it. But with Georgia, they are in luck….for now.
Six weeks ago, prescriptions from a pain clinic in Georgia started to turn up. Georgia, like Florida, has no method of monitoring controlled substances. Your Intrepid Pharmacist’s first encounter with the new locale was in the form of a late 20’s male and female. In the 10 minutes he observed them, hopping up and down from chairs and wandering the isles of the building, they had the physical dexterity of any normal functioning person; not even the slightest hesitation or wince from any movement.
Each person had an address in two different small towns north of Knoxville, and here the two were, in Chattanooga at 9:45 at night, trying to get them filled for cash. And the them of the previous sentence? Six prescriptions between the two people containing identical drugs, doses and quantities totaling 480 oxycodone tablets, 240 Xanax tablets and 180 Soma tablets (yes, you read those numbers right!). Your Intrepid Pharmacist turned rhese two people down, but this became the first of a tidal wave of people all from the same office in Georgia; people from places as far away as northern Kentucky, all filling for cash, all with the same three drugs, at the same doses, and the same quantities. Ask any legitimate pain management physician and they will tell you that is not how pain management works!
As the arrest chronicles above indicate, a large number of pills are making it on to the street in Tennessee and a large number of Tennessee residents are seeing jail time for trafficking between states or just trying to sell the drugs locally—never mind the issue of drug overdose deaths, in-state pharmacy robberies, stolen physician prescription blanks or the whole methamphetamine problem.
The dictionary defines crisis as meaning “an unstable or crucial time or state of affairs in which a decisive change is impending, especially one with the distinct possibility of a highly unfavorable outcome.” If that definition is remotely accurate, Tennessee has much to fear from the destructive forces within the state being created by actions outside its borders.
The choice faced by legislators as prescription drug trafficking approaches the crisis point is whether or not to try and control the controlled substances, which means more laws and even more jail time and all its associated costs to state taxpayers, or to just give in and allow the proliferation to run its course through the mainly rural areas of the state and, as Dickens’ Scrooge put it, “decrease the surplus population.” Either way, the Tennessee’s health care and legal systems have a rough road ahead. Probably even a crisis.