Florida’s Pharmacies — Gatekeepers of Dangerous Prescription Drugs

Many Americans suffer from long term, chronic pain requiring intensive pain management.  Complex pain management is a recognized specialty, typically involving anesthesiologists trained in how to properly treat and manage chronic pain, including patients that require powerful narcotic medications.   The management involves detailed and thorough physical examinations, laboratory and radiologic studies, and careful attention to ensure that patients are not abusing these highly addictive medications.  The cycle of abuse can be deadly, and very difficult to break.

In 2010, authorities in the State of Florida identified a large surge in prescriptions being filled and dispensed for narcotic medications by “pain clinics.”  The clinics were commonly operated by doctors practicing outside their specialty such as pediatrics, OB/GYN, and gastroenterology- not anesthesiology.  The pain clinics were financially lucrative, resulting in a significant increase in the narcotic prescription abuse and diversion.  The officials also noticed a large increase in the number of narcotic prescription drug overdoses and deaths.   The epidemic affected Floridians from all walks of life, husbands, wives, parents and children- good people caught in the cycle of addiction.

The Florida legislature passed a law in 2011, restricting pain clinics from dispensing controlled substances including narcotic medications.   Customers were now required to obtain controlled substance prescriptions from pharmacies registered to dispense such medications with the United States Drug Enforcement Agency (DEA).  Registered pharmacies must comply with the Controlled Substances Act, which mandates that pharmacies only fill and dispense controlled substances prescriptions for legitimate medical purposes.  Pharmacies must address any “red flags” which may suggest that a prescription is not legitimate, such as:

• Prescriptions from practitioners that only accept cash, commonly known as “cash only clinics”;
• Prescriptions from practitioners that have been disciplined or are under investigation for dispensing illegitimate prescriptions for controlled substances;
• Prescriptions for combinations or “cocktails” of controlled substances known to be highly abused, such and oxycodone and/or oxycontin and benzodiazepines, such as alprazolam, and carisoprodol;
• Prescriptions from practitioners located long distances from the pharmacy;
• Patients residing long distances from the practitioners from whom the prescription was obtained;
• Patients filling prescriptions for controlled substances from multiple practitioners;
• Patients filling prescriptions for controlled substances at multiple pharmacies;
• Patients filling prescriptions for controlled substances prior to the expiration of a prior controlled substance prescription;
• Patients filling prescriptions for controlled substances from practitioners whose specialty is unrelated to pain management, such as pediatricians, gastroenterologists, obstetrician/gynecologists, and plastic surgeons.

In many respects, the pharmacy is the final gatekeeper with the power and ability to keep these dangerous drugs out of the hands of addicted patients, while ensuring that legitimate chronic pain patients receive the help they need.  The pharmacist has a legal obligation to make sure that any red flags are resolved before dispensing a controlled substance.

If a pharmacy or pharmacist dispenses a controlled substance without resolving red flags, resulting in injury or death to a person, the pharmacy may be held responsible for failing to meet its responsibility as a final gatekeeper of these dangerous drugs.