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Doctor Shopping is Still an Element of the Opioid Crisis

Doctor Shopping is Still an Element of the Opioid Crisis

Author: Justin Mckibben

When discussing the very real devastation of the opioid crisis some people are still skeptical as to how big of a part prescription opioids play in the problem. While all patients should have access to comprehensive care for conditions relating to severe pain, ignoring the fact that prescription drug abuse is a crucial element of the epidemic is far too careless.

Many states had to face the issue of pill mill clinics and doctor shopping. Now one state, in particular, is now taking massive action in hopes of ending a very serious problem that has only grown over the years. Authorities in North Carolina took a close look at how prescription drugs wind up on the streets.

One of the key factors to narcotic medications hitting the illicit market was doctor shopping.

Doctor Shopping Stats

First, let us explain what doctor shopping is for those unfamiliar with the concept. Innovations in Clinical Neuroscience described the practice of doctor shopping, saying it:

“- entails the scheduling by patients of office visits with multiple clinicians for the same agenda, either for a continuing illness or to procure prescription drugs illicitly. As expected, the explicit definitions in the literature vary considerably, with a significant proportion focusing on a given illness episode.”

Essentially, doctor shopping is when patients visit multiple doctors with the intention of having a prescription given and then filled from each physician, giving them an abundance of medications.

Now in the case of North Carolina, this tactic grew a great deal of momentum as the opioid epidemic spiraled out of control in the past few years. According to WRAL, a Raleigh-based news outlet:

  • In 2010, the State Bureau of Investigation says there were 88 doctor shopping cases.
  • In 2016, that number rose to 184
  • That is a 110% increase in doctor shopping incidents!

According to NBC Charlotte:

  • Approximately three people North Carolina die every day in due to drug overdoses.
  • Around half of those deaths are due to opioid painkillers.

So now, what moves is North Carolina making to try and fight back?

The Strengthen Opioid Misuse Prevent Act

After realizing just how big of an issue prescription drugs were playing into their current drug problem, officials in North Carolina have decided to put measures in place to try and prevent doctor shopping.

Starting January 1st with the new year, North Carolina enacted a new law, referred to as the Strengthen Opioid Misuse Prevent Act. So what does this new measure do?

  • It allows doctors to only give a five day supply of opioids for pain from certain injuries, like broken bones.
  • After a surgery, it allows doctors to prescribe a seven day supply.
  • Refills can be given as needed, but the first refill will be limited.

North Carolina also gave some thought to protecting those in severe need of pain management resources. The new law does not apply to those with:

  • Chronic pain
  • Nursing home residents
  • People in hospice care

Local Authorities Unsure of the Future

The executive director of the North Carolina Board of Pharmacy, Jay Campbell, told reporters that while the action is being taken, it will probably never be completely eliminated. Campbell states,

“We’re certainly hoping that we can radically reduce the scope of drug diversion from pharmacies or any place else. But it is a problem that is never going to go away.”

However, Campbell believes there are certain indications of doctor shopping that pharmacists can keep an eye on as well, such as:

  • The patient is visiting a pharmacy far outside their normal location.
  • The patient brings in prescriptions from doctors the pharmacy is not familiar with.

Officials trying to stop doctor shopping in the area are asking pharmacists to be alert and ask questions when appropriate. Meanwhile, they are also working to develop other means of drug monitoring, including a system in which North Carolina doctors can register when they prescribe opioids to monitor records and catch patterns of doctor shopping.

There may now be some light at the end of the tunnel. Overdose death rates due to many legal prescription opioids are still rising, but they are rising far more slowly than that of fentanyl and other synthetic opioids according to a CDC report. While it is terrible that the death rates are still increasing, the fact that the rate of progression has slowed noticeably could suggest that many of the recent efforts aimed at curbing widespread over-prescribing practices could be starting to have a positive impact on the extent of the opioid crisis.

Medical Detox for Opioids

An important thing to remember is that for those suffering from substance use disorder or a physical dependency to opioids should always seek safe medical treatment in order to get off these powerful drugs. Opioid abuse presents an inherent risk to the body and the brain. Because of the often difficult and uncomfortable withdrawals, detoxing from opioids is best done in a safe medical environment.

Palm Healthcare Company’s detox facilities will offer a more comprehensive model for recovery from opioid addiction. Medical detox consists of both psychological treatment from professionals for both addiction and co-occurring mental health issues, as well as pharmacological treatment from medical specialists who can decide if there are optional medications to help ease the detox process.

What a medical detox for opioids should always do is provide a trained staff to monitor important vital signs like:

  • Respiration levels
  • Blood pressure
  • Body temperature
  • Heart rate

Abruptly discontinuing opioids can be painful or even damaging to the body. Make sure to seek the appropriate help. If you or someone you love is struggling, do not wait. Please call toll-free now. You are not alone.

CALL NOW 1-800-951-6135

Florida’s Overdose Death Rate Declines

Florida's Overdose Death Rate Declines

In the past years there has been so much concern in regards to the growing drug problems this country has been facing, especially in areas like Florida where the prescription drug market was a serious concern, and the fatality rate due to overdose was rising across the board. However it has been recently documented that along with a new wave of reform in the regulation of pain clinics and prescription narcotics, there has also been a steady slope of decline in the number of deaths credited to overdose in Florida. Much of this is a result of the investigations, restrictions, and enforcement efforts put forth to resolve these issues and give new hope.

Declining Death Rates

Between the year 2003 and 2009, the number of deaths attributed to drug overdose in Florida had increased by 61%. The number of drug overdoses in the region shot up from 1,804 to 2,905 in that 6 year time span, with especially notable increases in these overdoses caused by the opioid pain reliever known as OxyCodone and the Benzodiazepine known as Alprazolam. In response to this drastic surge of fatal drug use Florida implemented various laws and added efforts to take action for enforcement of legislation as part of a all-inclusive effort to reverse the developing drug problem.

Between the year 2010 and 2012, the number of drug overdose deaths decreased by an exceptional 16.7%. Lowering the number of fatal overdoses from 3,201 to 2,666, and the deaths per 100,000 persons decreased 17.7%, from 17.0 to 14.0. There were many notable changes in the trend of overdose for Florida, especially in regards to prescription drugs:

  • Death rates for prescription drugs overall decreased 23.2%, from 14.5 to 11.1 per 100,000 persons.
  • The decline in the overdose deaths from oxycodone (52.1%) exceeded the decline for other opioid pain relievers,
  • The decline in deaths for alprazolam (35.6%) exceeded the decline for other benzodiazepines.

These averages were determined based on estimates of resident populations made by Florida Department of Health.  Many of these overdose deaths may have had more than one of the dangerous prescription drugs contributing to the death, so in some cases there was no way to directly credit the overdoses to one in particular.

Florida Taking Action

There is a definite relation to the declines which occurred regarding overdoses and the decline in the rate of these drugs being prescribed during this period. The connection between the new legislation with progressive enforcement and the considerable declines in written prescriptions and overdose deaths, especially for the more dangerous narcotic drugs favored by pain clinics, suggests that these proactive initiatives in Florida had a deep impact on reducing prescription drug overdose fatalities.

There is a time-line of events that took place between January of 2010 and July of 2012 that shows how the state of Florida, along with the United States Drug Enforcement Agency became actively involved in combatting the rise in fatal prescription drug overdoses. This movement had taken its toll on the ‘pill mill’ empire that had sprung up in the area.

  • January 4, 2010- Pain clinics must by registered and recognized
  • February, 2010- Operation Pill Nation- U.S. Drug Enforcement Agency (DEA) and state and local law enforcement officials began investigations into Florida pain clinics.
  • October 1, 2010- Regulation of Florida pain clinic policies was expanded.
  • February 23, 2011- Operation Pill Nation- Joint law enforcement raids began taking down larger illegal drug operations.
  • July 1, 2011- Physicians regulated for dispensing controlled substances and statewide regional strike forces activated.
  • September 1, 2011- Program for mandatory reporting to prescription drug monitoring program was initiated and enforced.
  • July 1, 2012- Wholesale prescription narcotics distributor regulations were expanded.

Given all the recent reforms and head-line worthy arrests that have taken place in the last few months alone, it is hopefully safe to assume that this new diminishing percentage will continue to drop, and the more action that Florida authorities take toward rooting out those responsible for the past plague of illegal pill distribution in the area the more we will see survivors of the war on addiction.

With so many changes in legislation and in the community Florida is quickly facing the issue with substance abuse and addiction head on, and there are so many people who are taking the opportunity to escape those harmful habits by seeking out reliable and effective treatment programs. If you or someone you love are struggling with substance abuse or addiction, please call toll-free 1-800-951-6135.

In the News: Boca Raton Pill Mill Owner Arrested

In the News: Boca Raton Pill Mill Owner Arrested

For many years, South Florida has gradually become a notorious destination for prescription drugs for those seeking them with less than legal intentions. Dealers and addicts would drive hundreds of miles from Appalachia, attracted by advertisements advising them to take advantage of the local areas relaxed restrictions on prescription painkillers. Dealers, addicts, and even law enforcement labeled the well-traveled route to South Florida the ‘Oxy Express’ or the ‘Oxy Highway’. Now South Florida may be making even more progress on shutting down the under-ground industry and cutting off the ‘Oxy Express’. Authorities have apprehended another alleged drug-dealing pain doctor by the name Joel Shumrak. The 66 year old Boca Raton resident is the owner of a South Florida pain clinic, and is currently facing criminal charges after being accused of running a $15 million pill mill operation that is estimated to have supplied Oxycodone to drug dealers and addicts, even reaching out to other states.

Shumrak was arrested after a raid was carried out by federal law enforcement on his Broken Sound home and his business which was located elsewhere in Fort Lauderdale. The Pain Center of Broward located on the 5400 block of North Federal Highway is the alleged drug-dealers suspected ‘base of operation’.

The Hearing: 

The amount of money from the pain clinic is described by the Assistant U.S. Attorney Brent Tantillo as “staggering”. The official stated in front of a federal court in Fort Lauderdale during a hearing that the profit was estimated around $15 million. Federal agents seized around $4 million on the day of the raids, as well as vehicles and other assets that belong to Shumrak and his wife, Amy Shumrak. Amy Shumrak teaches science at Lyons Creek Middle School in Coconut Creek- Broward County school district. Amy and their adult children are also being considered as alleged co-conspirators though none of them have been criminally charged in the case at this time.

Due to the allegations of offshore accounts the judge ordered Joel Shumrak be kept in custody without bond. The suspect is currently being held at the Broward County Jail. Shumrak will be detained during his transfer to Kentucky, where he will be facing a federal indictment that has been filed there against him. Prosecutors said the South Florida-based drug conspiracy distributed well over one million pills and supplied an estimated 25% of all of the Oxycodone distributed in the eastern district of Kentucky.

The Topics of Debate:

  • Prosecutors argued that Shumrak was a definite flight risk and an immediate threat to the community. The prosecution compelled the judge by showing that the suspect had access to some $15 million, including money they suspected was being kept in offshore accounts on the Mediterranean island Republic of Cyprus and even the Caribbean island Nevis.

Shumraks lawyer Bernard Cassidy stated in the court hearing that it was misleading to suggest that Shumrak was “hiding money” offshore. He claims Shumrak used “strategic tax shelters’ to operate some of his insurance businesses overseas, but most of the money remained in the U.S.

  • Drug Enforcement Administration agents from Kentucky and South Florida also gathered evidence that Shumrak was photocopying his financial and patient records so that he could continue to commit crimes at a different location.

Bernard Cassidy told the judge that there was nothing “nefarious” about Shumrak’s copying of records and that he himself had instructed Shumrak to make copies to use in his defense. In court Cassidy went on to tell the U.S. Magistrate Judge Alicia Valle that Shumrak has known since 2011 that he was under investigation, but never fled prosecution or arrest because has done nothing wrong.

  • Prosecutors said in court that Shumrak had been secretly recorded talking about fleeing to avoid possible prosecution.

Bernard Cassidy again fired back quickly, claiming these were “jokes” intended to make light of the pending investigation.

  • Shumrak’s lawyer said his client will defend himself against the allegations, pointing out that the pain clinic Shumrak owned was licensed and inspected by the state in Fort Lauderdale.

Other Public Opinions

Shumrak has been frequently described as a well-known businessman who often served as an informal spokesman for South Florida’s pain management community. He constantly claimed he was operating legally, and even openly criticized doctors in other states who he said were unwilling to appropriately treat chronic pain.

However community activists have picketed Shumrak’s business many times over the years, and many of these people even blame him and his employees for the drug-related deaths of at least two people, and report that they were delighted and relieved to hear of his arrest. Some hope that this is just the beginning of a shift in the direction the area is going as far as drug law enforcement. Investigators said Shumrak organized the conspiracy in connection with a Georgia-based doctor between June of 2008 and May of this year when the grand jury indictment was eventually issued. If convicted of the drug distribution and money-laundering conspiracy charges, Shumrak could face over 20 years in federal prison.

 If you or someone you love is struggling with substance abuse or addiction, please call toll-free 1-800-951-6135




The George Brothers and the Rise of the Florida Pill Mill

9 Things Drug Companies Don’t Want You to Know

By August 25, 2011, the George twins, Chris and Jeff, had amassed $40 million in cash – and probably more (it’s believed that they were able to hide their total earnings – perhaps in Belize – before authorities finally took them down), high-end cars, mansions, oh, and the deaths of 56 people who had overdosed on the powerful painkillers that they had been in the business of doling out, hand over fist. All of this in the course of two years.

How It All Started

The Georges got the idea of going into the pain clinic business from a fellow criminal and mentor known as “the Candy Man.” Back in 2007, it was this unnamed physician who told the twins, two bad-boy rich kids that, to make a fortune, they should open a pain clinic.

“The Candy Man,” nicknamed by authorities for his large volume of pill prescriptions, is responsible for launching the brothers, 27 at the time, to the top of a pill mill empire that raked in $40 million in two years in Broward and Palm Beach counties, according to officials.

The Formula

The Wellington entrepreneurs formulated what was to become their bread-and-butter formula that also quickly inspired others to follow suit. Their pill mill blueprint that others copied would turn South Florida into ground zero of the narcotic prescription drugs black market, prosecutors said.

The Georges insisted on accepting cash and credit only in order to avoid state regulation of clinics that accept insurance. They catered to drug dealers from Kentucky and other states with high rates of painkiller abuse. Their customers could walk away with hundreds of pills a month. And they paid their doctors on staff for each patient seen as a way to motivate them; the doctors spent no more than a few minutes with each customer before writing prescriptions.

The George brothers also “kept it in the family” – hiring only friends and family when it came to staffing their pain clinics. As for the doctors? They were hired through Craig’s List ads.

Chris George was secretly recorded telling one of his managers that he had hired Jupiter physician Augusto Lizarazo, 70, despite his heavy accent and lack of experience with prescribing pain pills.

“You know what, people don’t care as long as he’s writing the scripts,” Chris George said.

Fraud Goes Deeper

Officials said that the Georges were careful to control the operation from top to bottom. For example they set up one of their steroid telemarketers in a mobile MRI business that operated behind a strip club. That aspect of the operation netted $2 million.

They expanded their business model to control how and where the prescriptions their doctors were writing. Chris George financed two of their clinic staffers to start pharmacies in Boca Raton and Orlando to disguise the volume of pills being sold. The sale of the pain pills also financed two phony time-share companies that swindled another $4.7 million from their victims.

The George Brothers: Thug Businessmen

Officials said the George brothers used violence in their business tactics.

For one thing, they threatened the operators of other pain management clinics. They also ordered their staffers to vandalize the buildings and cars of their competitors and others who opposed them.

Once, the thug twins and their aides kidnapped and handcuffed a man whom they believed had stolen $50,000 from them. The man was thrown to the ground and Jeff George fired a bullet next to his head to intimidate him.

What It Translated To

“They were swimming in money. Obscene.” said one federal official.

By the time police and federal agents shut down their four clinics in March 2010, the brothers had sold 20 million pain pills.

Each of their four clinics made up to $50,000 a day. Their employees carried the receipts to the bank in garbage bags. Their mother – who worked for and was arrested with her sons – kept about $4.5 million of their spare cash in two safes in the attic of her house.

And while desperate opiate addicts were scraping together money to buy their scripts, the George brothers enjoyed six-bedroom houses, four-figure Rolex watches, a shopping plaza, high-end boats and fast cars.

If you or someone you love is struggling with substance abuse or addiction, please call toll-free 1-800-951-6135.

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