More than 18 months ago, Florida lawmakers passed a law to help cut the pipeline of pain pills coming from their state to Kentucky's streets.
But the prescription-monitoring system it mandated might not be in place for months, and there are concerns about continued funding for the program when it is up and running.
Meanwhile, pills from the Sunshine State continue to flow into Kentucky, feeding the state's debilitating drug problem, authorities here say.
"Florida dope's still a huge problem," said Dan Smoot, law enforcement director for Operation UNITE, which does drug investigations in 29 Eastern and southern Kentucky counties.
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It's not clear when that will change.
It has become routine over the past four years for addicts and drug traffickers from Kentucky to travel to clinics in other states to get prescriptions for pain pills and anti-depressants, then bring back the narcotics to sell or abuse.
That has been a particular problem in Eastern Kentucky, with vanloads of people making the trip of 14 hours or more to South Florida clinics.
When police arrested Michael R. Shook, a doctor from Boca Raton, in May on charges of improperly prescribing tens of thousands of pills, most of the 1,400 files they found at his office were for patients from Eastern Kentucky, according to an affidavit from James R. Hunter, a Kentucky State Police detective assigned to a federal task force.
One reason people leave Kentucky for prescriptions is to avoid the state's system for monitoring prescriptions, commonly known as KASPER.
The program, a national model, allows doctors to see whether a patient has been doctor shopping, or going to multiple physicians to get prescriptions for drugs.
Police also use the system to investigate whether legal drugs are being sold illegally.
South Florida has been a key destination for doctor shoppers because it had no prescription monitoring system. There are more than 900 registered pain clinics in the state, with a third of them in the coastal counties of Broward, Palm Beach and Miami-Dade, according to the Florida Department of Health.
Some clinics there are lucrative, cash-only "pill mills" where doctors hand out prescriptions for potent painkillers without really examining people, authorities said.
"They prescribe medically unbelievable amounts of drugs to these people," said Bruce Grant, director of the Florida Office of Drug Control.
The combination of no monitoring system and lax oversight made Florida a "drug tourist destination" for people from Kentucky, Ohio, West Virginia and other states, Grant said.
So Florida lawmakers passed a bill in April 2009 to set up a prescription-monitoring system, a move hailed by Kentucky officials, who said it would help shut off the pill pipeline.
However, it took many months for Florida officials, with the help of Kentucky leaders, to draw up specifications and seek proposals to implement the system.
The state named an Alabama company the top bidder on Dec. 21, but the losing bidder plans to challenge that, said Michelle Dahnke, a spokeswoman for the Florida Department of Health.
That will further delay the system, which Grant said he would not expect to see up and running until June.
The law authorizing the system said no state money could be used to put it in place, creating concern about how the program will be funded, Grant said.
The state got donations and grants to start the system, including $800,000 through a federal program named for U.S. Rep. Harold "Hal" Rogers, a Republican who represents Kentucky's 5th District.
But Grant said it would take about $500,000 a year to run after that. And, with the state facing a budget shortfall of more than $3 billion, it's not clear lawmakers will provide the money, he said.
"Right now the danger is that it's not funded at all," he said.
The Office of Drug Control has helped raise donations for the program, but incoming Florida Gov. Rick Scott plans to eliminate the office, Grant said.
Police in Kentucky said it is imperative Florida have a prescription monitoring program.
Several groups who brought in pills from Florida and elsewhere have been prosecuted, but many more are still at work, authorities said.
"It's like fighting a forest fire," said David Keller, director of the Kentucky section of the Appalachia High Intensity Drug Trafficking Area task force, based in London.
With KASPER in place, doctor shopping is down dramatically in Kentucky, authorities said.
Most of the pills sold illegally in Kentucky are brought in from elsewhere, said Assistant U.S. Attorney Roger West, who has prosecuted many trafficking cases in federal court.
Money and addiction explain why people drive hundreds of miles to bring drugs to Kentucky.
In one case, Dayton, Ohio, resident Jay A. Shephard was accused of heading a group that grossed $1 million by bringing tens of thousands of oxycodone and methadone pills from Michigan to Eastern Kentucky between May 2006 and February 2009.
A jury convicted Shephard in November.
The drugs that flow into Kentucky from other states drive up crime, notably thefts, and play a role in hundreds of overdose deaths, police said.
Some police said they've seen a slight drop in the number of pills flowing to Kentucky from Florida because of enforcement in both states.
But several officers noted the problem appears to have increased in Central Kentucky, and that Michigan has grown as a source of oxycodone being sold illegally in Kentucky.
Boyd County Sheriff Terry Keelin said that in drug raids, his officers also have started finding pill bottles from Georgia and other states.
"It used to be all Florida. Now it's mostly Florida," Keelin said.
In one case Keelin's office investigated, Charles E. Meadows pleaded guilty Dec. 13 in federal court, acknowledging he helped bring 15,000 pain pills from Florida and Georgia between May 2009 and September to sell in Ashland.
Even if Florida's system succeeds in shutting down widespread prescription drug diversion, traffickers might move on to states that do not have a system.
Currently, 35 states have prescription monitoring systems, though Washington's is temporarily down because of budget problems, according to the Alliance of States with Prescription Monitoring Programs.
Of the other 15 states, eight have approved systems, but don't have them in place.
Seven states have not approved the systems, including Georgia, where the legislature last year voted down a bill to create one.
"We need a national monitoring system ... before we can really get our hands around this monster," Keller said.
David Hopkins, manager of Kentucky's KASPER system, said work is under way to link the systems in Kentucky and Ohio, with a pilot program scheduled to start early in 2011.
Hopkins, an officer in the alliance of states with monitoring systems, said he thinks the initiative will lead to other states linking their databases.
The states don't collect the same information or give access to the same groups of users, so those issues will have to be worked out.
"Our goal really is to have a national-level solution" while allowing states to keep control of their own systems, Hopkins said.