Chronic pain patients coming to Florida for treatment. Do you know anyone that has to do this...

[sandee1818]

I was talking about this in another post and was wondering if anyone knows someone who has become so desperate for treatment that they would drive from Virginia, Tennessee, Ohio, and Kentucky to Florida.
My PMP told me that Florida was like McDonald's , sold over 10 billion referring to oxycodone. The oxycodone 15mg and 30mg are very popular with the out of state Pt's. Although the doctor I use doesn't allow out of state Pt's many do.
In my opinion there may be some that really can not find pain management in their state and drive to Florida for legitimate pain but I believe the majority of them are only coming in to buy the pills to sell. This really infuriates me. I seen one report where the Kentucky jails are so full from pill runners that have been caught driving here to Florida to get the pills and then going back to their state to sell them.There was more than a couple of them that had gone to several Doctor's and pharmacies and had received 1000's of pills! Thousands! I have seen reports of other states having this problem too. Mainly the states I mentioned.
Now I am the first one to admit that the State is allowing it in a way but they are trying to remedy the problem.  We all know how this kind of activity affects not only  us as CP Pt's but the community's having to put up with these places, the pill mills in their home towns. With this kind of activity it always brings crime and violence with it.
There were two pill mills closed in Jacksonville on Thursday and the community was celebrating! I do not blame them. One of the owners of the clinic's was an ex con.
Florida is beginning to enforce some laws to cut down on these places in October but we all know where there are criminals seeking drugs they will find away around the laws as they do not feel they have to follow them as we do.
When I found out that the reason there was an oxycodone shortage and the reason why according to the Doctor's and Pharmacist and reports here is the out of state pain patients coming into buy them to sell I was fit to be tied. I mean think how many legit pain Pt's here in Florida now have none and have to try and find a new medication. I was lucky but not everyone will be. Most have tried the main medicines such as hydrocodone and hydromorphone and Morphine in the various strengths and formulas and they have found oxycodone to be the one that helps their pain.
I really feel bad for people here. I talked to a couple people yesterday and they had been looking for their prescription of oxycodone for weeks to be filled and everyone is out. I heard some have gone to the compounding pharmacies.
I don't know how to help the situation other than to let people know if they see this kind of activity report it and let the law close these deplorable places down. They are nothing but drug houses.
Thanks for your input and listening to me rant:)

[Tuckamore]

According to what I have read Sandee is correct. It is only part of FL's new bill.

I think your physician is correct Sandee. The criminals will find ways around these new requirements. It may take awhile but they will do it.

It appears as if the new bill was aimed at these pill mills and not at the legitimate PM Clinics and their patients. However I am sure this will some how affect we CP patients. Every good intended law seems to impose more problems for the innocent than it does for the abusers.  

[sandee1818]

The 72 hour prescription is going to be a Florida law only, atleast that is my understanding. According to my Doctor the reason for this is to stop the pill mills. It only applies to in house pharmacies. So if you see a doctor in Florida that has an in house pharmacy then you can only have 72 hours worth of medications filled at one time. I was worried about this and asked my Doctor and Pharmacist.
Most of the pill mills operate in house pharmacies and they require that you fill there so Florida law will require they only give 72 hours worth of meds.
This will be effective in October. So the out of state people coming in to buy all the pills they want to sell will only be able to get 3 days worth at a time. How many do you think will do this? Not many.
My doctor says they will just open outside pharmacies and then make their Pt's fill there so they always find ways around the law. It just makes it hard on us the legit CP Pt's.

[mellie4]

My heart breaks for the people that cannot get adequate pain relief.  I have not run into that problem here at all.  I know there are several reputable pain clinics near me.  I've only used the one I'm at now, and I am so grateful in the way they run their office.

I'm on worker's comp.  The way mine works is that before I can get an appointment I must be pre-approved for it.  Now, my surgeon's office will not even book me an appointment until that pre-approval is done.  He has only one woman on staff that works with worker's comp so between that and the fact that the insurance company takes its time with things means that I sometimes have to wait for an appointment.  Now, if it's a true emergency, they will ee me the same day but they don't like doing it.

My pain clinic, on the other hand, also requires the pre-approval for an appointment. The difference is they will make the appointment (for a regularly-scheduled appointment they book about two weeks out.)  They figure by the time I come in the pre-approval will be in place.  Also, they are willing to see me the same day or the next day for an emergency appointment ... and they're willing to back-request the approval and never give me a hard time about it.

Generally I go to the pain clinic about once every 4 to 6 weeks and in between we may email and/or talk on the phone.  This is generally for updates about how things are going or for simple changes in the pain plan.  But my clinic has no hard and fast rules about appointments.  JadedSweetheart, it makes me so sad that you can't get in other than every 28 days.  That makes no sense to me.  I know a lot of pain clinics are very busy but it's their job to take care of you properly, and that includes getting in for an appointment early at times.

Mummy3too, I think it's criminal that you're undertreated like you are.  I've had no problem getting a prescription from my PM team for oxycodone or oxycontin, though I do no some orthopedic offices here will not prescribe it under ANY circumstances. To me, those doctors and offices are too afraid but to me, they are practicing bad medicine.  I know Vicodin doesn't touch my pain.

I have had trouble getting my oxycodone filled at pharmacies here.  I have to get mine filled at Walgreens in order for worker's comp to pay up front.  If I use a different pharmacy, I have to pay and then submit the receipt but WC takes too long to reimburse me so I can't afford that.  The Walgreens I use (two different ones near by) do not carry oxycontin.  If you need that, they mail it to you, though you do receive it the next day.

I prefer oxycodone to Percocet for a couple of reasons.  I don't seem to be able to tolerate the Tylenol in the Percocet.  Within a day or two, I end up vomiting and can't stop, even with medications given to prevent it.  And personally, I don't like having Tyelnol added in.  Tylenol has never worked for me, and if I need something to go along with the oxycodone, I'd rather take ibuprofen (which I do.)

The problem is the pharmacies don't seem to stock plain oxycodone, particularly in some strengths.  It is next to impossible to get 10 mg. filled.

I don't understand the purpose of a 72-hour supply for people paying cash.  Due to the fact my ex-husband let our health insurance lapse without me knowing, we don't have health coverage at the moment.  I have to pay cash if my prescriptions aren't covered by my WC.  I will be able to enroll in my company's health plan but I have to wait until open enrollment in May.  If my WC ended for some reason before I get new insurance in place, I would be in serious trouble if I could only get enough for 72 hours.  This worries me.

[Tuckamore]

This winter will be our first full season in FL. Although I have a ways to go to reach retirement age my husband just took early retirement. Until we identify the area of FL that we want to reside we will be residents of WI. We won't purchase a FL home until 2011, than it will be our primary residence. We previously owned in FL and know the benefits of residency.

So I am concerned with the continuation of my pain management. If I have major issues obtaining care and treatment in FL it will not be our new home. That makes me sad. :(
And it will be one more thing that cp has taken from me. So you can understand my concern with the "out of state" situation in FL. However I am the eternal optimist and believe that some how this will all work out.

~Tuck

[JadedSweetheart]

Very true about the Snow-birds.  My grandfather's main residence is in Massachusettes.  He has his car registered there and his main home there.  He comes to Florida in the winter and while he is here he has to see doctors for his on-going conditions.  He's not a CP patient, won't even take an aspirin for a headache, but he has to keep up with his doctors and prescriptions in both states and has a Mass. Driver's License.
So if he were in CP, and were on opiate therapy, he would have to see a doctor down here and be considered an "out of state" patient.
We also have a lot of tourist who come to the state and partake in our wonderful water-sports and etc and end up hurting themselves and needing pain relief, although that generally seems like something that could be taken care of by the hospital or GP rather than a PMP.

It would be nice if there were a way to really weed out the drug seekers from the CP patients.  Maybe a board of physicians, CP patients, and former addicts/drug runners.
In a perfect world, I suppose.

[Tuckamore]

I've heard good and bad from all states. I cannot account for this but if you've been reading posts for over two years you will see that it is basically true.

I have close friends/relatives that live in KY that are in the medical field. There are patients that are prescribed high doses of opiates for pain in KY. They are treated daily in hospitals and clinics. I have no idea why some are legally obtaining adequate pain management and others are not.

I also agree that the FL physicians must prescribe for out of state residents because of the snow-bird population. Plus they have a high population of tourists. If they refuse to meet their pain management needs they will not come to that state. Snow-birds (as they are called in FL) contribute greatly to the wealth of FL. Take them away and the state would suffer economically.  

Again, just my opinion. :)

~Tuck

[JadedSweetheart]

I wrote my previous message in haste and I'm afraid I left out one important point.  The second PM doctor, the "medicaid mill" one, would not even talk about changing my meds or upping the dose.  I was on the lowest dose of methadone possible with 1 norco a day for BT and it just wasn't cutting it.  I lived like that, mostly bedridden, for almost a year.  Even my mother who does not understand CP and narcotic pain medication felt that I needed something else to help me.  I really felt that my only option was surgery.  The PM even told me not to tell the neurosurgeon that I was taking medication to see if that's why they wouldn't do the surgery.
That is where I learned about Florida's "shot jockeys".  They performed all procedures in house and made their money there.  The clientele was sketchy but local.  Sometimes I had to wait 4 hours for my appt. there.

That is why I pay for PM now.  My doctor is actually very holistic in his approach to everything but pain relief.  He insists on my drinking water and eating a healthy diet, etc.  He used to be an OBGYN and used to work in West Virginia with the CDC.  I really do like the guy.  He doesn't do any procedures, though, and his on-site dispensory prices are actually lower than Walgreens.  The clientele isn't as bad as the medicaid doctor, and there is never a wait longer than 20 mins.  That is what makes me feel comfortable.  
On the other hand I have seen a few people whom I thought were less-than-reputable, and met one person from out-of-state in the waiting room.  I also don't like the fact that he won't see me sooner than 28 days.  It doesn't feel to me that he is really "patient-oriented" if he won't.  I turned in the entire amount of the last script he wrote for endocet, so I don't understand why he won't see me.  It seems to be some sort of policy that I have heard of other people having as well.  It just stinks for me right now when I really need to talk to him about the meds.  I tried calling on Thursday, went to the ER on Friday, and I'm going to try again on Monday.  We will see what happens.

It does feel like finding good PM in Florida is more difficult than it should be.  It's either doctors who don't do opiate therapy, or doctors that do and are inudated with shady clients.  It's kind of like once you find a doctor that you can deal with, you stick with him no matter what.  Maybe it's like that in all states, I don't know.  

[sandee1818]

Most of the pill mills do require you to have an MRI and pharmacy records and a valid ID. If you do not have a current MRI a year or earlier then they will refer you to a place they have an agreement with. There are some that even have in house MRIs at a rate of 500 dollars and they will all find something to verify you need narcotics.
It is all a scam of course but they work it to their advantage, the laws.
The law says they must have proof you need opiates so they pretty much will create the proof.
It is difficult to tell sometime which are legit and which are not, the way I see it if they have lines of people at the door at 5 am waiting and the clientele is the typical drug abuser type that are unkempt and the clinic has guards then you can pretty much count on them being a pill mill. And I forgot to mention most of the patients cars have out of state tags. The pill mill will always make you fill your scripts in house too at gouged prices.
It is really easy to tell if you see one in person as you will just know from how the staff, the patients and the office look.

[Sarajmt]

If I weren't able to get pain relief in my home state of Texas, I might cross the border into Mexico or go to Florida.  I don't know.  I don't like to think about such a horrible fate.

[JadedSweetheart]

Living in FL myself, this is something I am very passionate about.  Especially being young and in pain.  I would just like to give an idea of the types of doctors I have seen since my pain began.
The first I saw was a "pain medicine" specialist.  He basically told me in very unsympathetic terms that I was too young to be experiencing the pain I had, that I shouldn't even have been prescribed darvocet, that he was a real humanitarian for taking me as a patient because I had "poor insurance", because most doctors would not.  He did, however think I might benefit from an epidural which was administered with no prior anestesia, except maybe a valium "if you're jumpy", because then "how would you know if it works?"  
I left that office hyperventilating for the first time in my life.  I knew my pain was real.  I had an MRI and I was so afraid of being in pain for the rest of my life.  I was going to have the epidural done, but at the last minute my "poor insurance" dropped out and I never heard from "Dr.Evil", as I call him, again.
I went to the PCP after that not expecting anything but stress and she put my on 8 lortabs a day.  My stomach was so torn up I had to see a G.I. Specialist, then the PCP put me on Fentanyl, gradually increasing the dose to 100mcg.  I was happy I was finally being treated for the pain.  She had to refer me to PM, though, per the state laws.
The second PM I saw accepted medicaid and understood what medications were covered by the "Medicaid HMO".  They did not cover Fentanyl, only straight medicaid did, so I was put on MSContin 30 with 2 percoset a day.  It really wasn't anything comparable to the Fentanyl, but I couldn't afford it at the time.  Then when I told them it wasnt' enough pain relief and after I had a few epidurals there which made my pain worse, they put me on methadone 5mg 4x daily.  With 1 Norco a day for BT pain.  It was like playing russian roulette with the pain and the BT med because I didn't know when I would need it most.  Finally I accidently became pregnant and they told me to self-taper and quickly discharged me from the practice.  That office is what I would call a "medicaid mill".  I was on medicaid, but the other clientelle of that doctor's office wasn't the most upstanding.
When I was looking for a new PM I googled "Pain clinic in South Florida".  There were some that advertised on their website "Oxycontin and Oxycodone" in big bold letters.  I decided on the one I have now because they seemed the most legit.
So I finally found the doctor I have now who I have to pay cash to see, because dealing with medicaid and referrals is a real nightmare.  When I first saw him he took me off the methadone and put me on oxycodone 30 mg 3x daily.  So I went to my pharmacy and tried to get the prescription filled and there was just no where that would fill it.  I ended up having to get it filled at the doctor's office.  That worked out okay, expensive, but okay.  Then he increased my dose.  I had a problem once and asked for an early appointment and they said no.  It was only a week until my appt so it wasn't a big deal.  With this last situation he's had to change my medication and it's not working but apparently he just sees patients every 28 days and prescribes.  I don't know if I would classify it as a true pill mill because one does need an MRI or X-ray to prove an injury or condition.  He does see out-of-state patients, and dispense on site.  I've often felt it was somewhere in-between.
My point is that he has been the only one (up until this point) who would listen to me and treat my pain accordingly.  Even while pregnant.  
Many times in Florida we have the choice between a doctor who won't prescribe more than tylenol-3 and darvocet, or a doctor who dispenses in office.  I have yet to find that "happy medium" in a doctor.  Maybe i haven't seen enough doctors, but I see no reason to go looking around when I am being treated adequately by a doctor.

I apologize for the long post.  I just wanted to share how difficult it has been to find a doctor who will treat my pain.  I think one of the problems with Florida is that a lot of doctors take out-of-state patients because of snow-birds who live in the north part of the year and keep their primary residency there for whatever reason.  
I hate the drug runners who are making it so difficult for real people in CP to be treated.  I'm also not too thrilled with the politicians who pass "tough laws" that make it difficult for people with real CP to be treated.
CP in Florida *****.

[mummy3too]

Thanks Sandee, No... You did not offend me..lol!!  I just hope what has happened to us here in KY does not happen to you. It would be tragic to have it spread through out the country.... There just has to be a way the doctors can weed out the fakers... so that they can focus on the real pain issues.

Again, no worries. Your post was fantastic!

[sandee1818]

I am sorry Mummy. I knew we had members here that were in the states I named and I certainly hope I did not offend you or anyone else here. I do know you have had an extremely hard time dealing with your pain management and I am so sorry you have to. I want these pill mills shut down as they are hindering not only the legit patients here but in the other states I have named too. You should NOT have to live in pain because of the absolute scum that just want to sell the very medications you need to function to make money!
I do hope and pray when the new laws do go into effect it will stop this and you can begin to get the treatment you deserve.
I wanted to also comment on Tuck's information she took the time to find out. The 72 hours worth of medications allowed to cash paying patients applies to pharmacies that fill on site. These are how the pill pills operate, they have in house dispensing so they make their money on the Doctor's visit and the medications they price gouge.
It is deplorable!
I so hope you can finally get some pain relief soon Mummy:)

[mummy3too]

Thanks Sherry. Until I became a CPatient, I had no idea how these dealers affected the entire community. You would just read in the paper and say, 'oh, good! Another bunch got caught!'... but then you begin to see the other side. The side we are all on. The side where we stuggle to make it through the day with the lowest doses possible because doctors are afraid to prescribe. I had no idea it was like this. I thought pain management was where you went to get pain relief... at least more than this...

I hope, too, they can someday fix the problem.

Thanks again.

[namnam46]

Oh Mummy that is just so awful!!!

I'm hoping that it will JUST mean that they will have the ability to close the "Pain Mills" down. I certainly hope that the legitimate PM Patients can get their meds AND their Oxycodone back without any additonal burdens placed on them.

Maybe IF they are able to shut these "Pill Mills" down that will open the door up for the people of KY and TN to FINALLY receive the PM that they need!!

I feel so sad that you can't get the help that you so badly need and deserve.

My Dear, I Hope and Pray that you can get MORE help and SOON!!!!!.....Sherry

[mummy3too]

Sherry, I hope you are right but what has happened here in KY is the opposite. Sure, the PM doctors got strict on the medications they would prescribe and also put very strict limits, etc... but that left the REAL chronic pain patients with very little. Many doctors here are now very afraid to prescribe anything stronger than hydrocodone. (this is why the druggies go to Florida to get their oxy!! No doctor here will prescribe it..) I am not the only one here on this forum from the states mentioned above and many, many of us are undertreated because of the JERKS going to Florida to get pills to sell back here! I know I have already posted about my story on here.. but although my doctor confirms I am a chronic pain patient and one of my conditions has been likened to terminal cancer pain, he wants me to continue on daily hydrocodone. It does nt allow me to have a life outside of the house but at least it allows me to stay home and get through the day. A mom of 3 at the age of 45 and I am pretty much homebound.

I am also angered when I read about the druggies who drive to Florida to get thir stash to sell. i just wish they could somehow recognize the REAL chronic pain patients and treat them appropriately. Easier said than done. It seems those dealers will always find a way.

[namnam46]

Yes, Thank you Sandee and Tuck,

I REALLY appreciate this information about the new laws!  

This means that family (by marriage) will NO LONGER be able to get what they are NOT LEGALLY allowed to get!!! Which in their case will mean NOTHING!!!!  YAY!!!

The new law sounds like it WILL be the beginning of the end for the "Pain Mills". I KNOW that it will take some time BUT eventually they will be able to get the UPPER hand in this BATTLE. Finally, the PM Patients will be able to get the meds that they so rightly deserve AND need!

Thank  you to yo both for bringing this to our attention. Again OUR CL'S at their best!!!

Good Job.......Sherry

[Tuckamore]

I know how busy you are Sandee so I did some reading and researching on my own. Here's what I discovered.

Compared to other states, "Florida's drug regulation has been looser." The new bill will include these regulations. "It will prevent felons from owning the clinics, limit anyone paying cash for the prescription narcotics to a 72-hour supply, ban advertisements for specific treatments like the opiate oxycodone and require specific training for doctors to practice pain management."

I also found a copy of FL's 1996 Medical Practice Guidelines. If I understand what I have read correctly these guidelines will remain in place. The new bill appears to be in addition to this. I read it and it appears to be chronic pain patient friendly. Very unlike other states. Here is just a paragraph from it along with the "Practice Guideline" legal address.

BEGIN:
"MEDICAL PRACTICE GUIDELINES
for practitioners licensed under Florida Statutes Chapter 458 (Medicine) or Chapter 459 (Osteopathic Medicine)
MANAGEMENT OF PAIN USING DANGEROUS DRUGS AND CONTROLLED SUBSTANCES

Endorsed on October 25, 1996
Florida

Concerns about regulatory scrutiny should not cause physicians to be reluctant to prescribe or administer dangerous and controlled substances, including Schedules II-V drugs as provided for in Florida Statutes s. 893.03, for patients with legitimate medical needs. Physicians need not fear administrative action when prescribing dangerous drugs and controlled substances to patients in their care for a pathology or condition when the prescription is issued after a good faith examination and there is medical indication for the prescription." END

According to what I have read one of the largest concerns with the passing of the new bill is the requirement for specific pain management training for all physicians that are prescribing any narcotic. Apparently those training resources centers are very sparse. The concern is that these laws discourage and make it difficult for new physicians to practice in FL. Again this is not my opinions, only from reading what is available on line.

I thought this may be interesting to our FL members. I found it of interest. I hope your new bill will meet it's intended goals.

Again thanks for sharing Sandee. I enjoy learning.

~Tuck

[Tuckamore]

I here your anger and frustration. It is understandable. It makes my blood boil when others make it even more difficult for legitimate chronic pain suffers to obtain much needed pain management narcotics.

It amazes me that this has happened only in FL. Can you tell us why this has occurred? Is it because of the larger population of senior citizens that bring with them chronic pain issues and needs? Why is FL facing this problem and other states are not?

Will these new laws that are expected to go into effect in October change the way you are prescribed narcotics? Will it effect the retires that require pain management? I would be very interested to earn more about these problems. As you know it is our goal to be in FL by the first of November.

I am not yet of retirement age but I will be an out of state person. How may I find more information on these new laws and how it will impact FL?

I am so very happy that you have obtained better pain management. Sometimes we don't even realize how much pain we were in until suddenly it's better controlled.

Thank you for sharing your thoughts and FL experiences. You are always so informational.

Peace,
~Tuck

[namnam46]

I've known for YEARS how bac the State of Florida when it comes to the "Pill Mills" as I have family (by marriage) there that has ALWAYS talked about how "easy" it is to get ANY kind of med that they need from their Doctors!! It was VERY sad!!!

Sandee, I, TO, feel VERY sorry for the CP Patients, LIKE YOU, and ALSO the Retirees that have moved to Florida and now find that they and NO longer get the medications that they need to be able to have ANY type of a life!!

I HOPE and PRAY that Florida can get this UNDER CONTROL!!! I feel VERY sorry for what you have gone through these past few weeks!! However, I'm VERY happy that YOU were able to find a TERRIFIC solution to your pain problems!!!

VERY Happy for YOU :)........Sherry