A new law designed to stem the proliferation of unregulated “pill mills” in the state of Florida could place additional emphasis on the activities of drug testing laboratories. The law will require periodic drug testing of patients in Florida pain clinics, although the specifics of implementing regulations are somewhat in question amid plans for legislative and administrative review of a number of regulations in the state.
State legislators in 2010 adopted Senate Bill 2272, which became known around the state as the “Pill Mill Bill.” The law requires all pain clinics to register with the state and to record all information about prescriptions given to patients, also granting law enforcement authorities more leeway in conducting inspections and obtaining patient records.
The law officially took effect in October, but implementing regulations that were expected to be finalized by November remained on hold at the start of 2011. State legislators and Florida's new governor were indicating an interest in re-examining all state rules that carry a significant price tag. However, most observers believe the regulations that include drug testing requirements will become official in early 2011.
“We're gearing up to have the services in place to handle whatever comes our way,” says Brian Slattery, co-owner of Avee Laboratories, Inc., a Clearwater-based toxicology lab established in 2008.
Slattery says providers of pain management services in Florida can be placed into one of three categories: legitimate clinics with board-certified pain management specialists, illegal clinics where prescriptions are written with no consideration of medical necessity, and clinics somewhere in the middle where a physician most likely saw a new business opportunity. While he says the new law mainly will weed out the pill mills, “It will help the ones currently in the middle to meet standards.”
The new law does not require pain management clinics to be operated by board-certified pain management specialists (an early version of the legislation had called for this), but it does mandate training of practitioners. Slattery sees drug testing requirements under the law as critical for a number of reasons.
“This provides the physician with objective information about what a patient is doing at a particular time,” Slattery says. A test could uncover use of a substance of abuse that the patient has not been forthcoming about, or perhaps the absence of a prescribed pain medication that could indicate that diversion activity is occurring, he says.
Because of the potential that a substance abuse problem could be detected through testing, Slattery agrees with practice standards that recommend that pain clinics initiate drug testing during their very first encounter with a patient.
Yet overall, he has seen a reluctance among pain clinics to embrace drug testing. “Pain management physicians are not utilizing it the way they should be,” he says. “Only about 10 to 25 percent of patients are being tested.”
Interestingly, officials at Avee Laboratories say that recently they have seen a much more enthusiastic response to testing from the community of addiction treatment centers, particularly as technology has advanced to allow test results to be reported and confirmed to centers more quickly.
“The treatment centers have been quicker to adapt to standards of care than the pain clinics have,” says Mike Nolan, who heads Avee's addiction division.
Issue of urgency
Somewhere between 500,000 and 3 million Floridians are believed to receive pain management care. But with only a little over 200 board-certified pain management specialists in the state, it is clear to see why there has been so much activity among both legitimate and unethical pain management clinics.
A relatively new organization in the state, the Florida Society of Pain Management Providers, is seeking to establish a voice for legitimate pain management practices. The group currently numbers about 50. Association director Warren Pearson generally sees the new pain clinic law and its impending regulations as ushering in important safeguards.
“This will give a boost to drug testing companies; they're going to see an increase in business,” adds Pearson. “There's no negative to having an objective measure, especially when you're dealing with pain, which is so subjective.” He adds, “I would always advise that the drug testing be done immediately.”
Pearson says that under the anticipated regulations, patients who fail a drug test for a substance of abuse would have to be referred from a pain clinic to an addiction specialist. So he also sees the new law as highlighting the importance of addiction professionals.
Pearson says the new law will not spell out many specifics on how the pain clinics' drug testing procedures need to be structured. This leaves some issues up in the air, such as the extent to which clinics will want to include marijuana on test panels-since there is some dispute as to whether the presence of marijuana should be seen as an indicator of a potential addiction problem.
“So will [clinics] refuse to test for marijuana?” Pearson says. “I wouldn't advise that.”
Addiction Professional 2011 January-February;9(1):36