The 2011 national drug strategy singled out South Florida as the epicenter of the Nation’s prescription drug abuse epidemic, due to a tremendous growth in “pill mills.” Between January and June of 2010, Florida practitioners purchased more than 40 million oxycodone pills, compared with only 4.5 million bought by practitioners in the rest of the country (see chart below).
When federal and state law enforcement agencies began to crack down on Florida’s pill-mill operations in July 2010, among the first to feel the effects were opioid treatment programs (OTPs). Need for treatment increased when pill mills were closed and the supply of prescription opioids—oxycodone among the most favored—started to dry up. The state helped by increasing the number of OTPs, adding seven new “parent” clinics and seven new satellites as of March 2011. “We knew this opioid prescription drug problem would take a while to resolve, so we needed to add OTPs,” said Darran M. Duchene, state opioid treatment authority for Florida, in an interview with AT Forum this fall.
The new clinics were selected through a competitive bidding process to avoid having too many OTPs in one geographic area and too few in another. “We have filled all the gaps geographically,” said Mr. Duchene.
Satellite Programs for Dosing and Counseling
Florida OTPs may set up satellite programs (off-site dosing stations) where they can provide methadone doses at locations other than the parent clinic, which is a way to expand capacity and make treatment more convenient for patients. “Providers can ask to set up a satellite program to reduce hardship for commuting patients,” said Mr. Duchene. The satellite program can be no more than 25 percent of the size of the parent clinic. All an OTP has to do to set up a satellite is to show that the need is there—that a critical mass of patients is traveling significant distances to get to the parent clinic. “It’s open enrollment at the satellites,” he said. “If the need is there, we’ll approve them.” Satellites are only for dosing and counseling; patients must go to the parent clinic for their initial intake evaluation, annual physicals, other medical services.
According to Mr. Duchene, the Florida system had the capacity to treat 15,000 patients before the expansion; the expansion added at least 3,000 slots.
The most prevalent problem is oxycodone, traced to both pill mills and “unscrupulous doctors,” said Mr. Duchene. After the law enforcement crackdown, people who preferred oxycodone tried to find other opioid drugs. “If you shut down one avenue, drug users will turn to whatever they can get their hands on,” he said.
From fiscal year 2009 through fiscal year 2010, there was a 37-percent increase in substance abuse admissions listing oxycodone as the primary drug of abuse, from 3,655 to 5,023, and an increase of 30-percent in admissions for all non-heroin opioids, from 6,317 to 8,233. Heroin admissions declined slightly. There has been no significant change in admissions for hydrocodone, hydromorphone, or morphine sulfate as primary drugs of abuse.
The other big drug abuse problem in Florida is benzodiazepines, which have shown a dramatic increase in deaths due to overdose, and small increases in treatment admissions.
The benzodiazepine overdose deaths are not associated with OTPs, because every new patient admitted to an OTP is tested for these drugs. Additional testing is done depending on the phase of treatment. “The OTPs here do a much better job of testing patients than other behavioral health centers,” said Mr. Duchene. Patients being treated for mental and substance use disorders in non-OTPs may be prescribed something, and then go home and take something else they have in the medicine cabinet, and not realize that the two could interact, he said.