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Study examines Florida's pill mill law, prescription drug monitoring program

The JAMA Network Journals

Legislative efforts by the state of Florida to reduce prescription drug abuse and diversion appear to be associated with modest decreases in opioid prescribing and use, according to an article published online by JAMA Internal Medicine.

Prescription opioids provide necessary pain relief to millions of Americans but rates of opioid diversion, addiction and overdose deaths have soared since the mid-2000s. Florida was at the epicenter of this problem. In 2010, the Florida legislature addressed so-called pill mills or rogue pain management clinics where prescription drugs were inappropriately prescribed and dispensed. The law required these centers to register with the state and have a physician owner. The law also established prescribing and dispensing requirements. In September 2011, Florida's Prescription Drug Monitoring Program (PDMP) became operational as an electronic database to collect information about prescription drugs dispensed within the state, according to the study background.

G. Caleb Alexander, M.D., M.S., of the Johns Hopkins Bloomberg School of Public Health, Baltimore, and colleagues measured the effect of Florida's PDMP and pill mill laws by analyzing prescription claims data and comparing it to Georgia, a neighboring state that had not implemented such control measures.

The final study group included 2.6 million patients, 431,890 prescribers and 2,829 pharmacies associated with approximately 480 million prescriptions in Florida and Georgia, 7.7 percent of which were for opioids, from July 2010 through September 2012, according to the results.

The authors report that a year after Florida's policies were implemented, they were associated with about a 1.4 percent decrease in opioid prescriptions, a 2.5 percent decrease in opioid volume and a 5.6 percent decrease in average morphine milligram equivalent (MME) per transaction in an analysis of the differences between actual and predicted outcomes had the policies not been implemented. The reductions were limited to prescribers and patients with the highest baseline opioid prescribing and use.

"To curb epidemic rates of prescribing, morbidity and mortality associated with opioid misuse and diversion, states have spent millions of dollars implementing policies designed to reduce excessive dispensing of these products. Paramount to these efforts are studies empirically testing these policies' effectiveness and a growing evidence base informing policy makers of the benefits and harms that may result. Our study adds to this evidence base and using pharmacy claims data shows that implementation of Florida's PDMP and pill mill law was associated with modest decreases in opioid use and prescribing among patients and providers with high levels of opioid use at baseline relative to Georgia, a comparison state," the authors conclude.


(JAMA Intern Med. Published online August 17, 2015. doi:10.1001/jamainternmed.2015.3931. Available pre-embargo to the media at

Editor's Note: An author made a conflict of interest disclosure. This work was funded by the Robert Wood Johnson Foundation Public Health Law Research program and by the Centers for Disease Control and Prevention. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures

Media Advisory: To contact study corresponding author G. Caleb Alexander, M.D., M.S., call Barbara Benham at 410-614-6029 or email

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