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Cocaine Cowboys: Circa 2009

Bernd Wollschlaeger destroyed the old notion that doctors and medical associations would never express criticism of their fellow doctors. In a letter to his association, the president of the Miami-Dade Medical Association goes after storefront pain clinics with an astounding ferocity. He calls their operations “cocaine cowboys, Version 2.0.”

        His letter:

        Cocaine Cowboys is a 2006 documentary film, which chronicles the development of the illegal drug trade in Miami during the 1970s and 1980s with interviews of both law enforcement and organized crime leaders. The film reveals that much of the economic growth, which took place in Miami during this time period, was a benefit of the drug trade.

      As members of the drug trade made immense amounts of money, this money flowed in large amounts into legitimate businesses. As a result, drug money indirectly financed the construction of many of the modern high-rise buildings in southern Florida. Later, when law enforcement pressure drove many major players out of the picture, many high-end stores and businesses closed because of plummeting sales.

      But drug dealers and their cronies have learned their lessons and refined their approach. Their basic premise: why go underground if one can deal narcotics legally?

      What ingredients do you need? A medical
office, a doctor
s license, a DEA number, on-site drug dispensing and plenty of advertisement space.

      All of the above results in a booming cash business in our midst, attracting clients from as far away as Alabama, Kentucky and Georgia. One street newspaper features a Health &
Wellness
section brimming with almost fifty pain clinic ads strategically placed after the “adult business” section.

      In those ads “renowned” pain “doctors” want you to “get back the life you once knew, to help you to “break free from pain” and suggest that “in all this madness, good doctors matter.”

      Naturally, most of those clinics are happy to provide you with any narcotics of your choice if
you provide the “proof” that you’re in pain. An MRI indicating an abnormality suffices to qualify you as a legitimate pain patient. From then on one can receive a variety of narcotics of choice from their menu, dispensed on-site, and with an almost guaranteed refill option. Otherwise their
business model would suffer.

      In many cases these unscrupulous modern
narco cowboys make millions of dollars a year in CASH!

      I have had the “pleasure” of encountering several of those colleagues” who in many cases have no formal training in pain medicine, are semi-retired, had licensure problems, and appear to be board certified in predatory medicine.

      The unprecedented concentration of those pain clinics” in the midst of our community contributes to out-of-control opioid abuse, narcotic drug dealing and endangers the public health.

      In my opinion, several of those pain clinics are financed and operated by criminal gangs and the proceeds of their activities are being invested in local businesses, including real estate.

      It requires the concerted efforts of law-enforcement, political leadership and the medical community to root out his problem.

      Several steps can be taken right now:

1)   Impose a moratorium of dispensing narcotics in physicians’ offices, unless the prescribing physician is board-certified in anesthesiology and pain medicine and operates within a licensed and certified facility to be approved by a designated agency. This will immediately reduce the phenomenon of “pill shoppers” who are pretending to suffer from pain, receive narcotics in numerous pain clinics and then sell those for a huge profit on the street.

2)   Mandatory monthly inspection of all pain clinics in South Florida. Skilled inspectors can be trained to randomly audit charts, on-site pharmacies and monitor the patient flow at so-called pain clinics.

3)   Criminal background checks of all operators and their financial backers to be reviewed and updated on a quarterly basis.

4)   Implementation of a prescription drug monitoring system as a tool to identify drug-seekers and doctor-shoppers.

5)   Requiring the Board of Medicine to suspend the license of any physician who violates the standards of care as it pertains to inappropriate prescription of narcotics.

I want to emphasize that the above proposed sanctions would not apply to most physicians in private practice who in almost all cases legitimately prescribe narcotic for pain.

The “physicians” in question in those pain clinics prescribe hundreds of powerful narcotics at a time to anyone pretending to be in pain!

Their "standard of practice” does NOT equate our high standards of care. Let’s act together to rid our community from these narco cowboys. Lets protect our families, friends and patients from those predators.

Don't be afraid to call them by their name: drug dealers in a white coat.

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