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Sheriff Calls for 1-Year Pill-Mill Freeze in Flagler Through County and City Ordinances

| November 11, 2010

florida pill mills

Florida snacks.

Around 7 p.m. Wednesday a Palm Coast woman called sheriff’s deputies to report a robbery. The robber was her boyfriend. The couple had gone to an Orlando drug store, likely a pill factory, to fill out a prescription for Oxicodone, the pain killer. The woman told deputies that she’d promised to give half the pills to her companion when they were back in Palm Coast. When they stopped at a Bank of America ATM on Palm Coast Parkway, the man pulled out a box cutter, took the pills, and drove off in the woman’s vehicle, according to the Flagler County Sheriff.

The vehicle was later returned to the parking lot by an unknown woman.

There was a slight silver lining in the story: the couple had to travel to Orlando to get its hands on those pills. Unless regulations are strengthened, pill-popping individuals or traffickers in prescription drugs, now a leading form of drug addiction, especially in Florida, may not have to go far for long to get their pills.

Flagler County Sheriff Don Fleming is warning that pill factories are making their way up from South Florida. He’s asking the Flagler County Commission to pass an ordinance imposing a one-year moratorium on new pill factories in the county. The commission takes up the proposal at its Nov. 15 meeting. The sheriff is also asking cities to do the same: the Flagler Beach City Commission considers that proposal on Nov. 18.

“We’re at an epidemic in the United States with Oxycontin, Oxycodone, Xanax,” Fleming said at a town hall meeting at the Flagler County Library Wednesday evening. “We have seven people die every month in the state of Florida from overdose on one of these pills.”

The sheriff was low-balling the actual numbers: According to the latest report by the Florida Medical Examiners Commission, some 8,600 deaths in Florida last year involved at least one prescription drug, a 20 percent increase over the previous year, with much of the increase due to a spike in oxycodone addiction. In Flagler County’s district, which includes St. Johns and Putnam counties, 22 deaths were attributed to oxycodone last year.

Sheriff Fleming at Wednesday's town hall meeting.
(© FlaglerLive)

“What we’ve seen in the last year or so, and the state Legislature has yet to take any action on it, other than proposing legislation where they limit the amount of pills a pharmacist or a doctor can write after he writes the first one, is that we have—we call them pill factories, mostly in South Florida. Somebody goes down there with five or six prescriptions, picks up 60 pills at a clip, and then they sell them on the streets for about $20 to $25. Now they’re starting to move further north. Volusia County is starting to get inundated with them, Broward County is inundated with them.”

They’re in Flagler County, too, the sheriff said. “Currently we have three that we would call pill factories in our county.” He named them: Lou Salvagio, Robert Fruehan, and a multi-doctor pain management clinic next to Florida Hospital Flagler. The three, the sheriff said, are “technically legit, but I don’t want to see other ones come in the county.”

Fleming described a “classic” illegal pill mill in Daytona Beach : “It had a doctor’s office, it had an MRI, so you’d go in to the doctor’s, you do an MRI, you make money on that, then he’d write your prescription and you’ll walk out and walk right next door into a pharmacy that was his brother filling prescriptions.” The pill mill was shut down.

“So I’ve asked the county commission to put a moratorium on them for one year. That will give enough time for state Legislators to come up with a bill that’s strong enough to prohibit these things unless they have very, very strict guidelines.”

A law designed to regulate pill mills went into effect on Oct. 1. It limits pill-dispensing to a few days’ supply for anyone paying cash or by credit card, and forbids pain clinics from advertising that they sell pain pills. More stringent regulations due to take effect in December—a statewide database designed to prevent doctor-shopping and stop pill mills—is on hold because of bid disputes between companies seeking to develop the system. So Florida, for years the only state not to have a prescription-drug monitoring system, continues to be the nation’s leading pill-mill.

Florida’s existing law is being challenged on constitutional grounds by pain management clinics. It’s not clear how broad or effective an anti-pill mill ordinance can be locally. “I’ve asked the county, they’re looking at right now and they’ve agreed with me, we can do it for a year,” Fleming said. “We’re going to put a freeze.”

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20 Responses for “Sheriff Calls for 1-Year Pill-Mill Freeze in Flagler Through County and City Ordinances”

  1. f. r. fruehan D.O. says:

    unforantunately addiction to narcotics is rapament in our society, filled with enablers, which can’t be judged unless their flagrant violators, I can tell you I ve never run a pill mill. Patients in my practice have to have a legitamate work-up prior to me providing narcotics for pain relief, pain relief, to legitamate patients, allows people to lead more productive and quality lives This part of the duty of compasionate caring primary care. most of us have expirenced narcotics abusers in our lifetime, healthcare professionals and layman alike. to group legitamate practices with mills is simply wrong.

  2. IDontGetit says:

    I’m a little confused…I was present at the meeting at the library and at no time did the Sheriff make reference to these people operating pill mills.

  3. Mike says:

    Did the Sheriff actual name these individuals? Someone who was there said he didn’t name names.

    • Pierre Tristam says:

      You’re right Mike: the sheriff didn’t name those three outfits during his presentation, but he did say that there were three pill mills in Flagler County. I interviewed him for 20 minutes afterward: it’s what we do as reporters. We ask for verification. I asked him to name them, to be sure that he wasn’t throwing allegations in the wind to scare us. He named them. On tape (I recorded both segments: the sheriff’s presentation and my interview with him). That “someone who was there” you’re referring to is a pissant commenter who sounds like a cop flacker, judging from his (or her) various comments, who hides behind a half dozen different identities here (talk about accountable) and slanders my work for kicks instead of contributing something to the conversation. “Idontgetit” is little more than confused. He, or it, doesn’t know his ass from Isfahan, so he ends up falling on it.

  4. Mike says:

    Thank you, I didn’t think an experienced reporter would make these things up.

  5. Haw Creek Girl says:

    I have to agree with Dr Fruehan. I have been his patient in the past. He is generous when it comes to pain medication but ONLY after he establishes a medical need for it. I am not Dr Fruehan’s patient now but only because I left his practice for a while and now he isn’t accepting new patients. I haven’t been his patient for at least 6 yrs but unless something has changed drastically, Dr Fruehan is a compassionate, accountable professional. The Sheriff shouldn’t have put those names out there unless he had an indictment or warrant with those names on it.

  6. emile says:

    Pierre, can you clarify?

    Does this mean that physicians can write prescriptions for pain meds, but can’t DISPENSE them? Or that only patients who have insurance cards at local drug stores can receive these medications? And how else would you pay except by cash or credit card?

    I have been in other states where after hours clinics were allowed to dispense various drugs from antibiotics to small quantities of pain meds, or the doctor would write you a prescription to fill at your own pharmacy.

    I understand the principle here is to put pill pushers out of business, but I wonder what the criteria are to be put in this classification.

    • Flaglerlive says:

      Emile, as far as the sheriff’s initiative is concerned, the aim is not to touch existing pill mills, whatever they’re doing and however they’re going about doing it, but to suspend issuing business licenses to new pill mills for a year.

      As far as the new law itself is concerned, the relevant provision makes that distinction between insured and uninsured patients: the uninsured may only buy three days’ worth of pills at a time, presumably because cash buyers are in it for different reasons than those who really need to be medicated. That provision is problematic of course, in a state with the second-highest rate of uninsured people in the country, and pain management clinics are making that argument, since the law makes it more difficult for people to get medicines they need.

      Another provision of the law: pain clinics may be inspected once a year, and their records examined without a search warrant, which also raises privacy issues. But the state database necessary to track pill-hopping buyers is not in place, so the law is still full of loopholes.

  7. Flagler Mom says:

    I don’t understand how Dr. Louis Salvagio, who is a Chiropractor and Physical Therapist, can run a so called Pill Mill. He is not licensed to prescribe any medications, let alone narcotics. He Owns a Chiropractic Practice and gym, along with an attached dance studio run by his wife. They also have acting and music classes for kids in the building.

  8. helen henriksen says:

    From what I understand, chiropractors, nurses, etc. can work under the umbrella/supervision of a doctor’s license. Let’s say a patient goes to a chiropractor and needs some pain killers, as well as therapy–the chiropractor can contact the partnership doctor and write a script–something like that anyway. I used to go to a Women’s wellness center where nurses, cna”s would do routine exams and treatments that way. If a serious condition arose, the patient gets referred to the sponsoring doctor.

  9. mariodigir says:

    No, no additional regulations period. The sheriff has absolutely no business being involved in regulating medicine of any type. He is out of his realm of jurisdiction. I am sick of all these proposals to regulate pain medications. These are available to all of us as a medical necessity. Leave this alone. We do not pay the sheriff to meddle in people’s personal medical needs. Publishing those three names opens the door for slander & liable lawsuits. This concept to regulate everything that appears to be bad, which by the way, can always be the case depending upon your viewpoint, is a violation of our basic rights as a free society.

  10. tootalljoan says:

    I can’t believe that Florida is putting their statewide database on hold because of disputes between companies!! HEL-LO! people’s lives are at stake here!! I work in a drug/alcohol rehab and the majority of the clients are there for abusing prescriptions. These people have so much potential, but their lives are being ruined by “doctors” who are more interested in making a few extra bucks than doing their job of ensuring the health of their fellow human beings. These “doctors” need to be stopped now, not when some companies decide to hash out their differences! C’mon people!

  11. Imagine says:

    In reply to tootalljoan. Would you like your medical records to be available for all to see? Would a statewide database make those records public records? How many could hack into the system?

    Maybe the government could just implant a chip into everyone and when someone takes a pain pill an alarm would go off in the police station and the person can be tracked via the implant and be arrested. Sound Good? Hey, this could be done for alcohol abusers and food addicts as well. The government need to get a grip.

  12. tulip says:

    I think the moratorium meana that no more pain management centers could open for a year? As far as a data base goes, there are OTC meds that have to be obtained through the pharmacist and signed for. Things such as Sudafed w/ephedrine, Aleve D, etc. That is because people were buying them and coverting them into drugs. The data base shows who bought them, how many and when. This prevents people from going place to place and buying the product. Same with drugs—it’s well known that people who are addicted or want them for illegal reasons, go from dr. to dr., clinic to clinic to get them. A data base of people on certain addictive meds would prevent most of that.

  13. Dorothea says:

    When Rush Limbaugh’s medical records were seized by the state the ACLU filed a brief contesting this seizure. The brief was based on Florida’s Constutional right of privacy and Florida law. In Limbaugh’s case, the office of the state attorney of Palm Beach County had a warrant. However it was still deemed a violation of Limbaugh’s rights. Now the Florida government wants to go on the same sort of fishing expedition with everyone’s medical records.

    As for tootalljoan’s comment, you only see those patients who became addicted, not those who are able to fulfill their potential because they are freed from chronic and severe pain by doctors who carefully monitor and oversee their patients’ care. Don’t condemn the many doctors for the illegal actions of a few and certainly don’t condemn the many patients who truly need to have their pain controlled just because you only see those who unfortunately become addicted.

    Keep the government out of personal medical records. It’s the law!

  14. mariodigir says:

    Again, it’s nobody’s business. This is personal, private and protected information between and doctor and patient. NO ONE should have a separate database about who takes controlled substances. We already have more than enough regulations. We are regulating ourselves to death. What next, a database about who buys beer and alcohol, where, when and how much?

  15. Dr. Louis Salvagio says:

    I received several calls this morning and over the weekend about the article posted Thursday November 11th, on Flagler live about the Sheriff requesting to shut down pill mills in Flagler County. After reading the article this morning I was not concern. First of all I’m a chiropractor and chiropractors do not have a DEA license to prescribe any medication nor can a pharmacist fill any prescription without one! Lastly, we had hired an interventional pain management physician in February of this year so we could be the first clinic in Flagler County to start detoxifying patients who were addicted to narcotics. Our mission was to help the victims of narcotic addition through a 7 step comprehensive approach. Our 7 step detailed program was four months long which included weekly urine screenings, Steroid Nerve Block injections, nutritional counseling, aggressive physical, massage and aqua therapy, chiropractic spine manipulation and exercises with spiritual guidance. Our program started to worked very well but with Flagler County’s economical state many patients could not afford to pay the difference the insurance company’s would not pay so our interventional pain doctor left in July. Therefore, to categorize our clinic as a pill mill is the simply erroneous. I don’t know why Sheriff Fleming would specifically mention my name since he knows me personally and understands our clinic mission. I believe Sheriff Flemings comments are just misguided publication and a simple elucidation from him is all that is needed to clarify this matter.


    Dr. Lou Salvagio, DC

  16. tootalljoan says:

    As for my comment, yes there should be a database so that pharmacies can see if a person has recently had a prescription filled. This way the abusers won’t be able to go from pharmacy to pharmacy refilling more than the allotted amount during a certain period of time. I don’t recall saying anything about plastering people’s private medical records all over the place.

    Also, I said nothing in regard to ALL doctors. I said the doctors who are abusing their position are the ones that need to prosecuted.

  17. Emily says:

    I have seen to many lives destroyed by pain pill addictions. The death of a friend’s son, death of my childrens’ former classmates, people losing thier jobs and all they own.. The addiction affects the addict and their family and friends. I totally support the moritorium and the data base. My own child has been struggling with pain pill addiction and it is so painful for our family. I saw his Walgreen’s prescription print out,. 220 pain pills prescribed in 1 month. The doctors who prescribe and the pharmacy that fill these prescriptions need to be held responsible also. The response from the Walgreen’s pharmacist was, “If the doctor prescribes them we fill them.” My response, ” Really? Do you really think someone can take that many pills in one month and live? and again the response, “If the doctor prescribes it we fill it.”

  18. Amy Odom says:

    I have went to Dr Salvagio many many times and he is a wonderul Doctor/Chiro he cares deeply for his patients and he is not the type of person to run a pill mill! He wants to help people feel better, the last thing he would do is be part of a pill mill!
    I think people’s concerns should be about the rumor mill that is making the good doctors look bad and it takes the focus off the ones that need to be stopped!
    Also, it isnt so much as the pill mills that are causing the problems, its about the patients who take more than they should instead of the doctors orders, then they form a addiction and the doctors get blamed for it.
    People become doctors to help people and to make them better, not to make them worse and become junkies!
    Stop putting the blame on the doctors, start looking at the ones who abuse their prescriptions instead of directed!

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