A potentially dangerous option that would generate another kind of pill mill epidemic

As a former state senator and chairwoman of the Senate Committee on Children, Families and Elder Affairs and as a member of the Statewide Drug Policy Advisory Council, I am deeply concerned about a new federal law that could take us back to the days of pill mills, and cost lives.

The federal law in question is called the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act, and it does a lot of good things to help stop the scourge of opioid addiction in our nation.

But there is one vital element that our Florida Department of Health must pay special heed to.

The law allows – allows but does not (thankfully) mandate – a non-prescribing physician to administer a special type of narcotic to someone who is not his or her patient.

Imagine one doctor would be responsible for the patient and hold the prescription pad but another doctor would see this patient to administer the scheduled controlled substance.

This could end up being a very bad and very dangerous idea in our state. Why? Having worked extensively on pill mill legislation in our state, I worry that this could spawn a whole new kind of pill mill.

One where that second doctor, who may or may not be responsible for the first doctor’s patient, would not be DATA 2000 educated and waivered — and yet would be in possession of the controlled substance (not just the prescription pad).

And he or she could be stocking and administering the controlled substance all day long to patients.

The initial doctor — with the prescription pad — has a federally mandated limit on the number of patients he sees. In stark contrast, the administering physician, in possession of the highly diverted, high street value narcotic — would face no such limits.

Why would the federal government imagine such a scenario and create such a crazy, convoluted and potentially dangerous framework for treating patients with a substance use disorder? A framework fraught with all sorts of unintended consequences? I can’t say.

What I can say — and know from experience — is that this raises the specter of people lined up all down the street and around the corner, waiting to get an injection from a non DATA 2000 doctor who isn’t even these patients’ doctor.

And what if the patient doesn’t show up? How will this so-called administering doctor return the drug? And will he or she return it to the prescribing doctor? To the pharmacy? Pharmacies do not usually accept narcotics back into inventory. So maybe they’ll just keep it? For how long? Or simply administer it to the next patient in line? That last one is illegal.

And how will all that be tracked in our state’s PDMP? How will DEA keep track? Most worrisome of all, a patient could be intoxicated or using another narcotic when he shows up to this administering doctor’s office and the very drug used to help patients break the cycle of addiction could actually kill them!

Florida ensures that this special class of drugs (known as “Medication Assisted Treatment” or MAT) is prescribed by specially trained physicians (known as DATA 2000 doctors) and we do not contemplate such an open-ended delivery scheme.

If this provision is allowed to go into effect in Florida, we could see more unnecessary deaths, more lawsuits and a chaotic mess on our hands. The good news is that Florida does not

have to allow this new provision and in fact, the Department could simply let DATA 2000 physician know that we are “status quo” until further notified.

The Department of Health should then review our laws, regulations and rules through the Board of Medicine or the legislature could examine this and pass tough new laws to protect doctors and patients alike.

In either case, safety should come first. And, no matter which path they take, we must always keep in mind that these are potentially lethal controlled substances and we should never let them out of our control.

Unfortunately, this one provision of the SUPPORT Act — allowing controlled narcotics to be out of a doctor’s control — is just not a good thing. Eleanor Sobel served as a state senator from 2008-16 and was deeply involved in health care policy and pill mill legislation. She served as chairwoman of the Committee on Children, Families and Elder Affairs and as a member of the Statewide Drug Policy Advisory Council.