Fewer deaths after Florida cracks down on ‘pill mills’

"An added benefit of Florida's increased oversight of unethical businesses and providers dispensing large quantities of narcotics may be that they may have prevented new cases of heroin addiction from developing as well," says Alene Kennedy-Hendricks. (Credit: Charles Kaiser/Flickr)

Florida saw a dramatic drop in deaths from prescription painkillers after the state passed laws to crack down on “pill mills.”

An estimated 1,029 fewer people in Florida died from prescription painkillers during a 34-month period than would have had the state not taken action, researchers say.

“Florida’s focus on these pill mills seems to have been an effective way to reduce overdose deaths in the state,” says study leader Alene Kennedy-Hendricks, an assistant scientist in health policy and management at Johns Hopkins University’s Bloomberg School of Public Health.

“Pill mills” are pain clinics that prescribe and dispense unusual quantities of prescription painkillers, often on a cash-only basis and without proper medical exams. In 2010, 90 of the 100 physicians purchasing the most oxycodone in the United States were in Florida.

[Empathetic chats lower risk of painkiller abuse]

The state passed laws in 2010 and 2011 establishing oversight of pain clinics and restricting opioid dispensing; law enforcement arrested and prosecuted pill mill operators.

The researchers found substantially fewer deaths in Florida from overdoses involving either prescription painkillers or heroin during 2011 and 2012, a finding that calls into question claims that reducing prescription painkiller abuse would increase overall heroin use.

Rates of prescription painkiller addiction are at historic highs and a portion of those abusing these medications switch to heroin, which can be cheaper and, in some cases, easier to obtain. Other research has found that four out of five new heroin users first used prescription painkillers.

“An added benefit of Florida’s increased oversight of unethical businesses and providers dispensing large quantities of narcotics may be that they may have prevented new cases of heroin addiction from developing as well,” Kennedy-Hendricks says. “Other states should consider restrictions on pill mills as one potential way to reduce prescription painkiller overdose deaths.”

[Painkiller deaths top heroin, cocaine combined]

For the study, published in the American Journal of Public Health, researchers compared Florida, before and after pill mill laws were passed, with North Carolina, a state with similar trends of prescription painkiller overdose death rates before 2010 but with no new restrictions on pill mills during the study period.

They analyzed data on 11,721 Florida deaths and 3,787 in North Carolina between 2003 and 2012. An opioid (either a prescription painkiller or heroin) was identified as the primary cause of death in each death. They examined changes in trends in death rates in North Carolina and pre-2010 trends in Florida to predict how many deaths were likely to have occurred in Florida had there not been this effort to rein in pill mills.

Over the nearly three years, an estimated 1,029 lives of potential opioid prescription users were saved in Florida; and the number grew dramatically each year as new measures were instituted. From March 2010 until December of that year, the prescription painkiller overdose death rate in Florida was 7.4 percent lower than would have been expected absent Florida’s interventions, 20.1 percent lower in 2011 and 34.5 percent lower in 2012.

Heroin overdose mortality rates rose in both states at the beginning of 2011, but North Carolina’s increased much more rapidly than Florida’s. North Carolina’s rate continued to rise, increasing four-fold from early 2011 to late 2012. In contrast, Florida’s rate of increase in heroin overdose mortality rates during this period was substantially lower, below what would have been expected absent the pill mill crackdown.

Since 2010, Florida has seen substantial reductions in oxycodone-prescribing physicians, opioid prescribing and the diversion of prescription painkillers to people for whom they are not prescribed, earlier research found.

“This study underscores that the sharp rise in prescription opioid overdose deaths has become a public health epidemic that is driven, in part, by major criminal enterprises,” says study coauthor Daniel Webster, professor of health policy and management. “Our new study demonstrates that the right laws and strategic enforcement can prevent addiction and save many lives.”

Expanding distribution of naloxone (a drug that can reverse the effects of an overdose) and implementing evidence-based, medication-assisted treatment programs for opioid use disorders may also reduce overdose deaths, the researchers say.

An unrestricted research grant from AIG Inc. funded the work.

Source: Johns Hopkins University