High-prescribing Florida pain docs being blacklisted by CVS

In the state of Florida CVS pharmacies are refusing to fill pain-pill prescriptions written by certain high-prescribing doctors. A letter was sent to the affected physicians saying that the chain was cutting off their patients from all Schedule 2 narcotics, a class of painkiller that includes oxycodone. That high-powered, widely prescribed pain medicine is at the heart of a lethal drug-overdose epidemic in Florida that kills seven people a day.

Head of public relations for CVS, Mike DeAngelis, confirmed the new policy at its Florida stores, but would not provide details other than to say it was developed with the help of the federal Drug Enforcement Administration.

You can imagine the amount of questions that went unanswered once this policy went public. One that many wanted to know was how many physicians were being affected, but all we divulged, over an email, was that it is "a small number."

The Orlando Sentinel obtained a list which identified 28 Orlando-area doctors whose patients were being cut off. The list includes pain specialists, wellness-center doctors and other physicians from Orlando, Kissimmee, Winter Park, Longwood, Sanford, Lake Mary and Celebration.

"You are being instructed," the company informed its pharmacists, "to not fill schedule II prescriptions for these prescribers listed below." The list is titled "CVS — DEA: Florida High Prescribers."

David Melenkevitz, a Miami DEA agent and spokesman, said his agency wasn’t aware that CVS was sending out the letters. When he was personally asked how CVS identified which doctors to cut off, he responded with, "I can't comment on any ongoing investigation." Melenkevitz would not say whether any Florida CVS pharmacists were under investigation.

The Central Florida list included two Orlando doctors already with legal problems: Mladen Antolic, arrested in October and charged with drug trafficking; and Riyaz A. Jummani, whose medical license was suspended after drug agents raided his south Orange Avenue office in June. Employees at those separate medical offices said Thursday that those doctors were no longer on staff.

Jeffrey A. Zipper, a Delray Beach physician and official of the Florida Academy of Pain Medicine, on Monday sent an email to other Florida pain specialists, decrying the CVS action. "I will be directing all of my patients to fill their prescriptions at a pharmacy other than CVS until they decide to change their position" he wrote.

CVS sent letters to doctors two weeks ago via FedEx.

The drugstore chain "has become increasingly concerned with escalating reports of prescription-drug abuse in Florida, especially oxycodone abuse," it says. In the first half of 2010, 1,268 people died in Florida, victims who overdosed on drugs with at least one prescription medicine in the mix. In Orange and Osceola counties, the total for the same six-month period was 147.

"Absolutely, it's a public-health scourge," said Dr. Jan Garavaglia, medical examiner in Orange and Osceola counties. "Young people are dying, middle-aged people, old people are dying needlessly, and it's not just dying. Getting hooked on these meds affects the quality of life."

Florida is quickly becoming a magnet for pain clinics. Ninety of the nation's top 100 oxycodone-buying doctors in 2010 were in Florida, according to federal records.

Three months ago, in an effort to combat prescription abuse, the state implemented a Prescription Drug Monitoring Program, a database that collects information on who's using what and who's prescribing to whom. Its intention is to allow physicians to monitor what drugs their patients are taking and from what other sources they might be getting them. Its design works very well with monitoring distribution of medications.

The Florida Department of Health would not say whether the CVS blacklist was based on information first gathered in that database.

In his e-mail, DeAngelis, the CVS spokesman, made no mention of the database or state law-enforcement agencies. It made reference solely to the DEA. "CVS/pharmacy is unwavering," he wrote, "in its compliance and measures to prevent drug abuse and keep controlled substances out of the wrong hands."

The truth is, oxycodone is often resold on the street by patients and has become a popular target of thieves. The numbers of injury and death due to these controlled substances are also increasing by the day. Due to these facts…if those who can legally prescribe these medications need to have a little extra surveillance put on them, I’m ok with that. And I’m happy that CVS is too.

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