MIAMI — As more people die from prescription drug abuse, the White House drug czar on Tuesday unveiled a new strategy to cut misuse of powerful painkillers like oxycodone by 15 percent within five years and take particular aim at Florida-based "pill mills" that have fueled an explosion of the drugs along the East Coast and into Appalachia.
The new approach will depend on education, stepped-up law enforcement and pill-tracking databases.
Under one part of the plan, more than 1 million doctors would have to undergo training on proper prescription practices as a condition for their ability to prescribe the highly addictive drugs known as opioids.
"The key is that everyone realizes there is no magic answer to this," Gil Kerlikowske, President Barack Obama's national drug policy director, said in an interview with The Associated Press. "It's a really complex problem."
An addiction expert who has advised FDA says 15 percent is doable and about right, in the face of a decades-long U.S. drug abuse problem that defies eradication.
"To say we are going to do away with the problem in five years, we cannot do that," said Dr. Roland Gray, medical director of the Nashville-based Tennessee Medical Foundation and a Food and Drug Administration adviser on addiction issues. "I think they are headed in the right direction."
The first-ever comprehensive federal plan focuses on four main areas: education for prescribing physicians and the public, including a media campaign about the drugs' dangers; pushing for tracking databases in all 50 states; better methods of throwing out unused or expired prescriptions; and more intense training and attention by law enforcement on illegal pill mill clinics.
Florida is the epicenter of the deadly rise in abuse of oxycodone and similar addictive painkillers, with doctors in the Sunshine State prescribing far more of the drugs than all other states combined, according to the Drug Enforcement Administration. And Florida's pill mills are the supplier of choice for much of the eastern U.S., causing a ripple effect of drug overdoses and addiction in Appalachia and other points to the north — where phenomenon dubbed the "OxyContin Express" includes busloads of people coming to Florida just for pills.
Danny Webb, sheriff in rural Letcher County, Ky., said he would welcome a 15 percent drop in misuse of prescription drugs.
"Anything would help, because we're drowning in it up here in eastern Kentucky," Webb said, adding that he is skeptical any government plan will ultimately work. "I don't know if there's ever going to be a winning to this war on drugs."
When used properly, oxycodone and similar medications help people deal with chronic pain by slowly releasing key ingredients over many hours. Abusers crush the pills and sniff or inject them, resulting in a euphoric heroin-like high.
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Government efforts to curb abuse have shown little success, with emergency room visits from prescription drug overdoses doubling from 2004 to 2009 when they topped 1.2 million, according to federal health officials. And more overdose deaths are connected to prescription drugs than heroin and cocaine combined.
A recent report by Florida medical examiners found that in the first six months of 2010 — the most recent data available — 1,268 deaths in the state were caused by prescription drugs, or about seven fatalities a day during that span. Kentucky's governor says 82 people die of overdoses each month in his state.
Renee Doyle, a Fort Lauderdale mother whose son Blayne was in an oxycodone haze when he was struck and killed by a car in 2009, said he was able to get 240 pills on each monthly visit to a local pain clinic by doing little more than asking for them. More than 850 pain clinics are currently registered in Florida, where doctors prescribe 85 percent of all such pills in the nation.
"I think people were just not paying attention and then greed took over," she said. "They are legal drug dealers and they should be outlawed."
Although the DEA and local police recently arrested more than 20 people, including five doctors, in a crackdown on South Florida pill mills, Kerlikowske said it's not strictly a law enforcement issue.
"It's a real collaboration. It's not just a prosecutor and DEA. It isn't just the medical profession. It's everybody," he said.
Each part of the strategy has several goals. On physician education, the plan calls for Congress to require a certain amount of training on responsible prescription practices for medical practitioners who seek DEA registration to prescribe certain controlled substances.
The FDA proposal, which would apply only to the extended-released versions of these opioid drugs, would be the largest of its kind.
"There has been a flood of new medicines and many of the physicians out there weren't trained in using them, so there's a big gap in understanding how to manage these drugs," said Dr. Janet Woodcock, who directs the agency's Center for Drug Evaluation and Research.
Another piece would be a national education campaign featuring ads like the famous frying-egg "this is your brain on drugs" ad used in past antidrug efforts. Key to that is making sure parents keep prescription drugs out of the hands of their children, who are now abusing them more than any illegal drug except marijuana.
The plan envisions prescription drug monitoring programs in all 50 states. Currently, 35 have such programs up and running. They are authorized but not yet operational in eight more states, including Florida. The databases can help detect abuses and illegal diversion of pills by tracking physicians' prescriptions and how much pharmacies are dispensing.
The plan also calls for continued aggressive law enforcement efforts and better training. In Florida, Miami DEA chief Mark R. Trouville said he expects some physicians to be indicted based on a recent undercover probe involving 340 pill purchases.
"We're trying to make a statement that if you think you're sliding by in a gray area, you're not, and we're coming," Trouville said.
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