La. Law Blocks Pill Mills on Louisiana Medical News

La. Law Blocks Pill Mills

By: TED GRIGGS

Louisiana's effort to crack down on "pill mills" is spreading, with Texas enacting a law this year that requires pain clinic owners to register with the state government.

Dr. Keith F. DeSonier, a Lake Charles physician and former president of the Louisiana State Medical Society, helped lead the Louisiana effort that made "doctor shopping" a crime punishable by up to five years in jail and a $5,000 fine, and created a statewide prescription data base.

DeSonier said a meeting with Calcasieu Parish district attorney John DeRosier, shortly after his election in 2005, was an early step to the law enacted in 2007.

"We were seeing a lot of young folks, 13-30, in the emergency room because of overdosing drugs.... When we actually ran the numbers we were averaging one and a half deaths a week," DeSonier said.

And for every person who died, there might have been 10 or 20 kids coming in comatose, needing to get their stomachs pumped, or in the Intensive Care Unit with a tube in their throat and a ventilator breathing for them until the drugs wore off, DeSonier said.

The overdoses knocked out people's kidneys, lungs and hearts, DeSonier said.

DeSonier said he suggested to DeRosier that the state establish a data bank to keep track of all the prescriptions.

The legitimate pain management clinics weren't the problem, DeSonier said. The abuse was committed by a few doctors who are in the business of selling pills instead of helping patients.

Law enforcement officials first suggested stringent rules governing the number of pain management clinics and doctors that write prescriptions. But DeSonier suggested the state establish a data bank to keep track of all these prescriptions.

"Let's just track the abuse of the prescriptions," DeSonier said.

The abuse worked like this. A patient would go to a doctor with what appeared to be a legitimate medical condition. After an exam and tests, the doctor might write a prescription for a 90-day supply of medication. Later that day, the patent would go to another doctor and repeat the process.

The process would be repeated over and over again, DeSonier said. The result was that law enforcement agents were stopping people on the highway with 6,000 or 10,000 or even 12,000 pills in their trunk.

"That's a lot of pills," DeSonier said.

With the statewide database, the second doctor can check and see when the patient's last prescription was for pain pills or muscle relaxants. If the patient got a prescription a week earlier for 90 pills, it's going to look very suspicious.

Once Louisiana established the statewide database, DeRosier and other law enforcement officials and the Medical Society started looking at neighboring states – Arkansas, Mississippi and Texas – to help.

The idea was to go to those states' governors and ask them to put some sort of legislation in place to stop the pill mills, and then the effort would spread state by state DeSonier said.

"We were kind of early on the curve with this. We weren't the first," DeSonier said. "There were some other states, but we've kind of organized it some."

Healthcare and law enforcement officials say the laws are badly needed.

The Houston Chronicle has reported that since 2006, more than 1,200 accidental pill deaths were recorded in Harris County and 223 in neighboring Jefferson County. There were 190 such deaths in Calcasieu Parish, according to the Chronicle.

DeSonier said area hospitals are still seeing a bunch of overdoses.

The "trinity, a combination of hydrocodone, a narcotic; alprazolam, an anti-anxiety drug; and the muscle relaxant carisoprodol, remains popular, he said. The combination delivers a powerful high.

And more kids are poisoning themselves with caffeine-alcohol drinks and ending up in emergency rooms, he said.

However, DeSonier said DeRosier feels that law enforcement has been able to make more arrests and convictions because of the Louisiana law.

The database allows the district attorney's office to document the date of prescriptions and the amounts, which makes for a strong argument in court DeSonier said.

Texas might have gotten its law passed two years ago but the state's budget battle shut everything down until the most recent session.

Texas' situation is different than Louisiana's, where the demand is higher than the supply, DeSonier said. Texas has more doctor problems than prescription recipient problems.

The concern for Texas is to try not to hurt the doctors doing good work or their patients, while preventing fraud, he said.

The Texas law requires pain management clinics to be certified by the Texas Medical Board. The board can inspect clinics to determine whether they are operating legally.

Florida has also passed a pain management clinic certification law and plans to launch a prescription database next year.