Florida Policy Changes are the Correct Medicine for Drug Overdoses

A significant decline in deaths related to drug overdoses was recorded in Florida after the implementation of various laws and enforcement actions aimed at reversing the trend of skyrocketing overdose deaths in the state between 2003 and 2009. The Centers for Disease Control and Prevention’s (CDC) Morbidity and Mortality Weekly Report highlighted the decline in overdoses between the years 2010 and 2012, especially with respect to overdoses related to the opioid pain reliever oxycodone and the benzodiazepine alprazolam. The report opined that the decline was catalyzed by a host of Florida initiatives aimed at attacking poor prescribing practices among providers throughout the state.

Background

Between the years 2003 and 2009, the number of deaths caused by drug overdoses in the state of Florida increased 61 percent, rising from 1,804 to 2,905 deaths. According to the CDC, this increase included a large increase in deaths causes by the opioid pain reliever oxycodone and the benzodiazepine alprazolam which is commonly known under the trade name Xanex®. The CDC report also noted that “Florida gained notoriety after 2007 because of the proliferation of pain clinics in the state that were prescribing large quantities of drugs for pain with little medical justification and were being used primarily by persons abusing or diverting opioid analgesics, benzodiazepines, and muscle relaxants.” Additionally, in 2010, the CDC stated that 98 of the 100 U.S. physicians’ offices where the highest quantities of oxycodone were directly dispensed were located in Florida.

Enforcement, Legislative Actions

Based on these alarming statistics, officials in the state of Florida began to adopt measures to counteract these trends. Specifically, the Florida legislature enacted a requirement that clinics that used controlled substances to treat pain register with the state and eventually completely prohibited physician offices from dispensing schedule II or III drugs. The legislature followed that prohibition with “mandatory dispensing reporting to the newly established prescription drug monitoring program,” further regulation of wholesale drug distributors, and the creation of the Statewide Task Force on Prescription Drug Abuse and Newborns. Additionally, Florida law enforcement agencies conducted raids throughout the state, which resulted in “numerous arrests, seizures of assets, and pain clinic closures.”

Findings

The CDC report emphasized the reversal of the drug overdose trend that was identified through 2009 in the following years. In particular, the report found that in 2010 through 2012, the total number of overdose induced deaths in Florida dropped 16.7 percent from 3,201 to 2,666 deaths. Prescription drug overdoses, which resulted in death, also decreased 23.2 percent in that time. Additionally, “the decline in overdose deaths from oxycodone (52.1 [percent]) exceeded the decline for other opioid pain relievers, and the decline in deaths for alprazolam (35.6 [percent]) exceeded the decline for other benzodiazepines.” In addition to these reported declines, 250 Florida pain clinics were closed by 2013 and the number of “high-volume oxycodone dispensing prescribers” in the state was reduced from 98 to 2010 to 13 in 2010 and then to zero by 2013.

According to the CDC, the time frame between the enforcement actions and the sharp decline in overdose deaths in addition to the decline in deaths related to those particular drugs favored by pain clinics throughout the state was indicative of the large role the state’s new policies played in reducing the number of overdose deaths.