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Doctors urge block of coming drug law

The Board of Medicine says new regulation of hydrocodone will impair treatment and raise costs.


© St. Petersburg Times, published August 5, 2000

TAMPA -- As many as 200,000 Floridians, young and old, take low doses of a common drug called hydrocodone to control their pain each year. But unbeknown to many physicians, a new law will make it illegal to simply phone in a prescription or a refill.

On Friday, the state Board of Medicine voted to ask Attorney General Bob Butterworth to intervene and allow doctors to continue prescribing hydrocodone as they have for years.

Hydrocodone, a key ingredient in Lorcet, Vicodin and some children's cough syrups, was included in a bill that toughened penalties for selling so-called designer drugs, including Ecstasy and certain amphetamines.

Under the law, as of Oct. 1, all doses of hydrocodone will be upgraded from a Class 3 narcotic to a Class 2 narcotic, which requires stricter recordkeeping and a physical examination of a patient each time it is prescribed.

Prescriptions for Class 2 narcotics also may not be ordered over the telephone. Until now, hydrocodone up to 15 mg was considered a Class 3 narcotic.

The new law was prompted by the concerns of a Fort Lauderdale-area prosecutor who asked for more leeway to prosecute people who fraudulently obtain the drug, state Department of Health officials said.

But Board of Medicine member Rafael Miguel, an anesthesiologist and pain management expert at the H. Lee Moffitt Cancer Center in Tampa, said the Legislature's change would penalize thousands of people who take it in low doses.

"We aren't protecting the public, but we may be impairing our ability to provide effective treatment for patients," he said of the law.

Florida doctors last year wrote 3.6-million prescriptions for low doses of hydrocodone for 150,000 to 200,000 patients.

It is often used to alleviate back pain, arthritis or other chronic pain. Doctors say it's common for them to phone in prescriptions after hours, or when patients are out of town, or when they're suffering intense bouts of chronic pain.

Hydrocodone also is especially helpful for elderly patients who don't tolerate other pain medications, Miguel said. "It's the only significantly potent analgesic, or pain reliever, that I can call in for them."

Hydrocodone is a narcotic and can be habit-forming; Brett Favre, the star quarterback of the Green Bay Packers, was once hooked on the Vicodin he took for back pain. But doctors noted that higher doses already are regulated as Class 2 narcotics.

The Board of Medicine now joins Hospice of Florida, the Florida Society of Anesthesiologists and the Florida Academy of Pain Medicine in asking Butterworth to continue to regulate hydrocodone as a Class 3 drug.

Under Florida law, the attorney general may override the Legislature's prescription drug classifications "to allow for the beneficial medical use . . . so that more flexibility will be available than is possible through rescheduling legislatively."

Members of the Board of Medicine and several doctors' groups said they didn't know about the law until after it passed.

All but one board member, Tallahassee lobbyist Carolyn R. Pardue, supported asking Butterworth to intervene.

Matthew D. Weidner, an attorney for anesthesiologist and pain management groups, told the board the new law would cost Floridians millions of dollars for office visits. If it goes into effect, it will make Florida the only state to regulate low doses of hydrocodone as Class 3 narcotics, he said.

Also Friday, the board levied a $5,000 fine against a Seminole physician, John David Young, for failing to practice up to an acceptable standard of care.

According to state records, Young failed to properly diagnose an obese, 41-year-old man who complained of chest pains and shortness of breath when he arrived at the Daytona Beach Medical Center in June 1995.

Young, an emergency room physician in Daytona at the time, ran tests and treated him, but the man died early the next day when a blood clot lodged in his lung.

Attorneys for the state Department of Health had recommended a reprimand and $500 fine. But the board voted to increase the fine because Young could have done more. Young also must attend courses on diagnosing pulmonary trouble.

"He should have found the underlying cause of it in order to treat it," said Dr. Miguel, the board member from Tampa. "I believe this was diagnosable."

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