It's only 8:45 a.m., but the storefront is already busy. Men and women in jeans, baseball hats and leather jackets keep the tinted door swinging open and closed. But this is not a retail outlet. It's a pain-management clinic. The people have come for pills.
The waiting room at Broward Pain Clinic is swarming. A woman begs a receptionist, "There's no way he can squeeze me in?" "We're packed," the receptionist explains. "Packed, packed, packed."
There are more of these pain clinics here in Broward County than there are McDonald's restaurants: 115 so-called pill mills, vs. about 70 of the burger franchises. And that profusion contributes to one big problem: there is no tracking system to prevent patients from getting multiple pill prescriptions at once and immediately, because the clinics hand out the pills rather than making people go to a pharmacy. The business card of the Broward Pain Clinic announces, "Dispensing on Site!" a service that's also trumpeted by dozens of other clinics. Because of that, cocaine is no longer king in South Florida, as it was during the Miami Vice era. Prescription oxycodone now reigns supreme.
The nation's top 25 oxycodone-dispensing doctors were all in Florida in the first half of 2008; 18 of them were in Broward County, according to a Broward County state attorney grand-jury report. In South Florida overall, there were 176 pill mills, up from 66 just 14 months before. This has contributed to tourism pill-shopping trips to the Sunshine State from Tennessee and Kentucky, where authorities have cracked down hard on similar clinics, seem to be as common as Disney vacations nowadays. In the parking lot of the Broward Pain Clinic, there are just as many license plates from Ohio, Tennessee and Kentucky as there are from Florida.
Broward County sheriff Al Lamberti says he isn't sure why his jurisdiction has become the hotbed. "There's no reasonable explanation," he says. "It seems like it's just happened. I don't know why. Maybe we have better beaches, I don't know."
Meanwhile, deaths related to prescription-drug use in Florida rose from 2,780 in 2006 to 3,317 in 2007, and then to 3,750 in 2008. The last figure is equivalent to about 10 reported deaths a day. That's more than the number of fatalities from street drugs like cocaine and heroin. It doesn't help that in Florida, you don't need to be a doctor to run a pain-management clinic, Lamberti says. "You need a background check to get a liquor license you can't be a convicted felon and open up a bar but you can be a convicted felon and open up a pain clinic."
And so the clinics continue their march northward. The latest front line is Palm Beach County, just north of Broward County. That county had 372 suspected overdose deaths from legal pain pills in 2009, up from 248 in 2005, according to published reports. Alarmed by the spread of the clinics, Palm Beach County commissioners just passed a moratorium to keep new clinics from opening while officials try to hammer out a solution. Other local governments are passing similar moratoriums. A commissioner in one city, Delray Beach, wants to require patients to be fingerprinted when they pick up their pills, for better monitoring.
The clinics are coming under more fire than ever. Florida legislators have already passed a law that is supposed to create a database to track pain-pill purchases as 38 other states already have. And there's more legislation in the pipeline this year, including laws that would make it illegal for anyone other than a doctor in good standing to run one of the clinics, ban advertising by the clinics and limit how much pain medicine can be dispensed at one time.
But legislating good intentions is one thing. Real solutions are harder to come by. Although the state has approved a database to track pill dispensing, there is no dedicated funding source the legislation merely gave officials the ability to seek grants for it. The Broward County grand-jury report concluded that the monitoring program should be "swiftly implemented and adequately funded, by any means necessary." But that's a tall order in a state hard hit by the recession.
State senator Dave Aronberg, who represents part of South Florida and is sponsoring anti-pill-mill legislation, acknowledged that money is an unsolved matter. "There are grants to get it going. Then we have to figure out a recurring funding mechanism," he says. Action must be taken, he says, because anyone can end up ensnared by addiction, given how easy it is to get pills. "I get all these stories people telling me about their brother dying, their sister dying," he says. "These are heads of families who end up in a terrible situation because of a workplace injury." But it's like walking a tightrope, he adds: "It's a delicate balance here. You want to stop the pill mills. At the same time, you don't want to stop legitimate patients from getting pain management."
Case in point: a man outside the Broward County clinic who says he makes the 11-hour drive from Tennessee every month just to get his medication. He says he is prescribed medicine for chronic neck pain stemming from a forklift injury but cannot get the medicine he needs anywhere near his home. He won't divulge what he is prescribed. "I'd rather not say, but it's helping me," he says. "I'm not a junkie." The medicine allows him to keep working as an excavator, he says. "They help people that can't get medication that they need," he says. "Thank God there are places like this." Though he agrees that some people take advantage of the clinics, efforts to shut them down are misguided, he says, and pain medication is essential. "It's everybody's constitutional right."