The term “pill mill” can describe a doctor, pharmacy, or clinic. Often, the drugs are given for non-medical reasons. Prescription opioids are very popular at pill mills. In recent years, states have taken measures to close these businesses. However, the current laws may not being doing enough. Learn more about what pill mills are, how they work, and how to spot one in your community.
What Are Pill Mills?
The definition of a “pill mill” is a business where narcotics are prescribed in large numbers. This term was coined by local and state investigators. It often refers to a doctor, pharmacy, or clinic. Pill mills are known to prescribe narcotics for inappropriate and non-medical reasons. They flood communities with cheap and easily accessible drugs.
Pill mill doctors don’t offer patients any warnings or education. Often dealing in cash, these businesses make a lot of money. They see addiction as something to profit from. Mostly, they write prescriptions for opioids like oxycodone. Patients travel long distances because of their no-questions-asked policies. Many times, the people they attract are from out of state.
Opioids: The Pill Mill Bestseller
Prescription opioids offer a high that is very similar to heroin. Their main purpose is for pain relief. Pill mills make most of their money from these drugs. Oxycodone, or “hillbilly heroin”, is very popular. Of all prescription drugs, opioids are the most heavily abused. This is because of the euphoric feeling they give. They come in natural, synthetic, and semi-synthetic forms.
Prescription opioids include:
- Oxycodone (OxyContin, Oxecta, Roxicodone)
- Hydrocodone (Hysingla ER, Zohydro ER)
- Codeine (only available as a generic)
- Morphine (Astramorph, Avinza, Kadian, MS Contin, Ora-Morph SR)
- Fentanyl (Actiq, Duragesic, Fentora)
- Hydromorphone (Dilaudid, Exalgo)
- Methadone (Dolophine, Methadose)
- Meperidine (Demerol)
- Hydrocodone and acetaminophen (Lorcet, Lortab, Norco, Vicodin)
- Oxycodone and acetaminophen (Percocet, Endocet, Roxicet)
- Oxycodone and naloxone (Targiniq ER)
Prescription Opioid Abuse in the U.S.
In the past 25 years, abuse of prescription opioids has skyrocketed. Our nation has seen a huge increase in overdoses caused by these drugs. There are a few explanations for this. Prescribing practices have changed, for one. New, powerful drugs also became available during the early 90’s. The rise of pill mills became a large factor in decades to follow. Since 1991, prescriptions have risen from 76 million to nearly 207 million in 2013. The U.S. accounts for most of these.
- Americans use almost 100% of the world’s hydrocodone supply.
- 81% of worldwide oxycodone prescriptions are written in the United States.
- In 2012, health care providers wrote 259 million prescriptions for painkillers.
With these numbers, every adult in the U.S. could have their own bottle of pills. The results have been terrible. Recent statistics show that drug overdose has become our country’s leading cause of death. In 2015, there were 52,404 deaths related to drug misuse. 20,101 of these were a result of prescription opioid abuse. Of Americans with struggling with an addiction, nearly 10% use prescription opioids. This problem doesn’t seem to be slowing down, either.
How Do Pill Mills Work?
They come in different forms. Many are called “independent pain-management centers”. Usually, pill mills are marketed along these lines. They open and shut down quickly to avoid law enforcement. Hours of operation are sometimes random for the same reason.
Pill mill doctors aren’t normal physicians. Most will have complaints filed against them in another state. Often, they’ve had some trouble with their license. They still carry one, but have a history of poor behavior. Usually, physicians who run pill mills have a partner that funds them. Business owners with no medical experience will seek these doctors out. Basically, they just need someone with a valid DEA license.
Some pill mill doctors encourage patients to bring old health records and X-rays. A few will include a physical exam as part of the visit. However, this is mostly for show. Records are not kept on file and exams are hurried. These doctors are interested in fast, easy money. They will write a prescription no matter what. Actually helping people isn’t what matters to them. Patients pay an office fee of $200 – $400 dollars in cash, and leave with large amounts of drugs.
The Beginning of an Epidemic
A South Florida mega-clinic may have been the starting point for a rise in pill mills across the country. In 2007, Chris George opened his first clinic in Palm Beach. He was a 27 year-old former convict with no medical experience. By 2010, he and his twin brother were running multiple pill mills in Florida. The largest was called American Pain. Doctors were paid per patient. Because of this, they wrote many prescriptions for large amounts of drugs.
At the time, pill mills operated without any oversight in Florida. With nothing to stop them, the brothers quickly became kingpins. Former strippers worked in the pharmacy and doctors carried guns. In the parking lot, tattooed bouncers directed traffic in golf carts. Bribes for a spot on the waiting list were common. The drugs were also being trafficked up and down I-75. This highway was soon nicknamed the “Oxy Express”.
It was later discovered that:
- By 2010, the brothers were making up to $400,000 per day, in cash.
- They had prescribed nearly 20 million pills in almost three years.
- Up to 90% of these drugs turned up in other states.
In the end, the brothers were finally shut down and arrested by the FBI and DEA in March, 2010. By then, their clinics were believed to be the deadliest in the country. The FBI found that 56 American Pain patients had overdosed and died. This doesn’t even include those who overdosed on the trafficked drugs.
What Is Being Done About This?
While open, the success of American Pain inspired many other pill mills to open their doors. Florida became completely overrun. In 2010, there were 176 mills in South Florida alone. People were traveling hundreds of miles to get their fix. Most came from states with tougher prescription drug regulations. Luckily, citizens and officials worked together for a solution. The closure of American Pain was a turning point. By 2011, more than 400 of Florida’s pill mills were shut down or closed. This was possible for a few reasons.
- It was made illegal for doctors to give out narcotics in their offices.
- With only a few exceptions, patients now have to visit a pharmacy.
- Background checks were put in place for people with access to these drugs.
- Serious penalties have been created for violators.
- A prescription drug sale monitoring system was made.
The new laws in Florida caused a nationwide domino effect. Addicts living there had to go elsewhere. Neighboring states, like Georgia, began having a larger problem with pill mills. Soon, they too put similar prescription drug laws in place. The rest of the country took notice. Missouri was the last to create a prescription drug monitoring database in 2017. As of today, every state has one. Also in 2017, the Department of Justice started a pilot program to crack down on opioid-related health care fraud. Unfortunately, these measures aren’t perfect.
Will Current Measures Be Enough?
Doubling down on pill mills was an important first step. Still, much more should have been done. Cutting users off from their drug of choice only got rid of the supply. The demand for these drugs has not gone away. In order to see real change, states needed to give addicts better treatment options. Unfortunately, most didn’t follow through on this. Prescription opioid abusers turned to the next best thing – heroin. As a result, heroin overdoses are back on the rise.
Suboxone clinics have also become an option for opioid addicts. Right now, this problem is very bad in Kentucky. Attorney General Andy Beshear believes it could be “the second coming of pill mills”. Suboxone is used to treat opiate addictions. The drug is partly an opioid, however, so it can be addictive too. Loopholes in the laws that regulate it are allowing doctors to overprescribe them. It seems impossible to keep up when addicts always have somewhere else to turn.
There are problems with the prescription drug monitoring databases, too. Some states have done a worse job than others. Missouri’s program sets a pretty bad example. For unknown reasons, their database isn’t even available for doctors to see. This allows drugs and “doctor shoppers” to fall right through the cracks. These databases might not be a solution after all.
According to Johns Hopkins researchers who surveyed 420 doctors:
- 72% of doctors are aware of prescription drug monitoring databases
- Only 53% of doctors actually use them
- 58% reported that the information takes too long to get to
- 28% said they aren’t easy to use
Online Pill Mills
With so many pill mills closing, addicts have started using the internet to get their fix. Many websites sell narcotics without a prescription. Some of these will have a doctor who does quick oral or written exams. Others have you pay to access a site that sells drugs without an in-person doctor visit. These shady pharmacies are mostly based in other countries. It’s very hard to figure out exactly where. A quick Google search pulls up list after list of online pill mills.
An investigation by the Palm Beach Post found that these websites accept most credit cards. They also use the U.S. Postal Service for deliveries. John Heaton is the founder of LegitScript, a company that monitors internet pharmacies. According to him, “If a website is offering 100 drugs, one-third would be the same drugs you would get here, one-third would be pretty close, and one-third would be counterfeit.” Because most online pill mills aren’t American, they are very hard to shut down. Also, they can easily pop back up under a different web address.
Signs That Point to a Pill Mill in Your Community
Pill mills have shown up in just about every state in America. Mostly, these operations are found in the south. Still, the rest of the country is no exception. If you believe a pill mill may have opened in your community, here are some signs to watch for:
- No physical exams are given
- Only cash payments are accepted
- Pain is only being treated with pills
- Huge crowds waiting outside in the parking lot
- Complaints from pharmacists about the doctors in charge
- The business makes large cash deposits at the bank
- Complaints from neighboring businesses
- Medical records are not kept on file
- Patients are in and out of the office in minutes
- No medical records or x-rays are needed
- Patients can choose their own medicine
- Doctors direct patients to “their” pharmacy
- People are doing drugs in full view outside the clinic
- There are security guards present
- Patients are given a date to come back for more pills