Pill mill

A pill mill is an illegal facility that resembles a regular pain clinic, but regularly prescribes painkillers (narcotics) without sufficient medical history, physical examination, diagnosis, medical monitoring, or documentation. Clients of these facilities usually receive prescriptions only against cash. Pill mills contribute to the opioid epidemic in the United States and are the subject of a number of legislative initiatives at the state level.

A pill mill in Jasper, Alabama,[1] DEA photo from 2015

Business model and characteristics
Customers at a pill mill in Florida, which was operated by Jeff and Chris George, wait on the sidewalk until it's their turn. Surveillance footage from the Palm Beach Sheriff's Office.

In pill mills, doctors or staff supervised by them prescribe opioids for non-existent or exaggerated pain. The primary purpose behind this prescribing practice is not to relieve pain or cure it, but to make high profits. This makes pill mills a criminal enterprise.[2]

Characteristics of such facilities include that they are often owned by non-medical personnel and only cash is accepted (no credit cards or insurance payments). Medical records, findings, or X-rays are not required; no medical examinations are performed or are merely pro forma; alternatives to treatment with tablets are not discussed; strong painkillers are prescribed; and prescriptions can only be redeemed at certain pharmacies. Additionally, long queues are visible in front of the facilities, parking spaces in front of or near the facility are heavily frequented, and security personnel or doormen are used.[3][4]

According to investigating authorities and scientists, such facilities come in different shapes and sizes, but for them it is important to give the impression that they are independent pain treatment centres. To avoid prosecution, pill mills' managers tend to run their facilities like pop-up stores.[3] Clients of pill mills are addicted to pills or trade their pills.[5]

Origin and development

David Herbert Procter is considered the inventor of pill mills.[6] The Canadian-born doctor established an office specializing in pain treatment in South Shore, Kentucky near Portsmouth, Ohio in 1979. In the mid-1980s, he was one of the first to prescribe painkillers that often contained opiates; he also combined them with benzodiazepines (tranquilizers) such as Xanax. His business expanded with the advent of OxyContin (active ingredient: Oxycodone), the blockbuster of the pharmaceutical company Purdue Pharma.[7] He hired more doctors to run new practices. Some took over the business idea of the "godfather of pill mills" and later became self-employed.[8]

Pill mills subsequently spread to other states,[4] including for instance West Virginia,[9] Texas,[10] New Mexico,[11] and New York.[12] They gained great importance especially in Florida. There, the pill mills of Chris George had a prominent position.[13]

Consequences

Facilitated access to powerful painkillers is contributing to the opioid epidemic in the United States, as clients who take these drugs over a long period of time become accustomed to them and may need higher doses to achieve the same alleviating or pleasurable effect (drug tolerance with subsequent high-dose dependence). In addition, the opiates in these drugs have a euphoric effect. When used regularly, the foreign opiates can replace the functions of the body's own endorphins, resulting in high addiction.[14] Drug abuse leads to increasing numbers of cases in emergency rooms, cost-intensive treatment of addictions and frequent overdose deaths.[15]

Excessive prescription practice, negligent and absurd practice, and the promotion of drug addiction and illegal drug trafficking are violations of medical ethics and laws. For this reason, a large number of police operations,[16] measures by the Drug Enforcement Administration (DEA)[17] and closures of these facilities[18] have occurred. Many perpetrators were convicted by the courts, and by the end of 2016 there were 378 physicians in Florida alone, with 95 more under indictment there by that time.[4]

In response to the growing problems with narcotics abuse, a number of states have tightened their laws. In Kentucky, for example, a law to improve monitoring of prescription practices, known as the Pill Mill Bill (KRS 218A.175 et seq.), has been in effect since 2012.[19] By 2012, 41 U.S. states had implemented such monitoring programs, and by 2019 all states except Missouri had implemented such programs.[20] There is debate in the literature whether and about the extent to which the tightening of narcotics laws is causing addicts to turn to other addictive substances such as heroin,[21] with many heroin addicts generally claiming that they have previously abused prescription opioids.[22] Addicts also switched to fentanyl, often with fatal consequences.[23]

Adaptations

The OxyContin Express, a 2009 documentary by Portuguese journalist Mariana van Zeller, which follows the sales channels of pill mills in Florida,[24] received further awards and nominations for the Emmy[25] in addition to the Peabody Award (2010).[26] The American television series American Greed, which has been dealing with white-collar crime since 2007, focused on pill mills in episodes 137 (first broadcast: March 2017)[27] and 152 (first broadcast: March 2018).[28] Money laundering for a pill mill plays an important role in the TV series Claws.[29] The documentary The Pharmacist, released on Netflix in 2020, shows how Dan Schneider uncovered a pill mill in St. Bernard Parish, Louisiana through private investigations.[30]

Literature
  • Moreto, William D.; Gau, Jacinta M.; Brooke, Erika J. (April 2019). "Pill mills, occupational offending, and situational crime prevention: a framework for analyzing offender behavior and adaptation". Security Journal.
  • Quinones, Sam (2015). Dreamland. The true tale of America's new opiate epidemic. New York, NY: Bloomsbury Press. ISBN 978-1-62040-250-4.
  • Temple, John (2015). American Pain. How a Young Felon and His Ring of Doctors Unleashed America's Deadliest Drug Epidemic. Guilford, Connecticut: Lyons Press. ISBN 978-1-4930-0738-7.
  • Rigg, Khary K.; March, Samantha J.; Inciardi, James A. (2010). "Prescription Drug Abuse & Diversion: Role of the Pain Clinic". J Drug Issues. 40 (3): 681–702. doi:10.1177/002204261004000307. PMC 3030470. PMID 21278927.
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References
  1. See Drug Enforcement Administration (2016-04-08). "Jasper Pain Clinic Physician Sentenced To Nearly Three Years In Prison For Illegally Dispensing Narcotics". Dea.gov. Retrieved 2020-05-03.
  2. Moreto, William; Gau, Jacinta M.; Brooke, Erika (2020). "Pill mills, occupational offending, and situational crime prevention: a framework for analyzing offender behavior and adaptation". Security Journal. 33 (2): 161–178. doi:10.1057/s41284-019-00180-y. Retrieved 2020-06-01.
  3. Malbran, Pia (2007-05-31). "What's A Pill Mill?". CBS News. Retrieved 2020-06-25.
  4. Judy McKee. ""First, Do No Harm": Criminal Prosecutions of Doctors for Distributing Controlled Substances Outside of Legitimate Medical Need". NAGTRI Journal. II (II): 40–46.
  5. Rigg, Khary K.; March, Samantha J.; Inciardi, James A. (2010). "Prescription Drug Abuse & Diversion: Role of the Pain Clinic". J Drug Issues. 40 (3): 681–702. doi:10.1177/002204261004000307. PMC 3030470. PMID 21278927.CS1 maint: date and year (link)
  6. Eil, Philip (2017-07-05). "The Pill Mill That Ravaged Portsmouth". Cincinnati Magazine. Retrieved 2020-06-25.
  7. Quinones, Sam (2015). Dreamland : the true tale of America's opiate epidemic (ePub ed.). New York: Bloomsbury Press. ¶14.30. ISBN 978-1-62040-250-4. OCLC 893857896.
  8. Firth, Shannon (2016-11-26). "'Dreamland' Author Takes an Opioid Epidemic Trip — Investigative journalist Sam Quinones talks about the crisis". MedPage Today. Retrieved 2020-06-25.
  9. "Chronicle". Appalachian Journal. 43 (1/2): 136–139. Autumn 2015/winter 2016. At page 137 Check date values in: |date= (help)
  11. "Pawankumar Jain Pleads Guilty to Unlawfully Dispensing Prescription Painkillers and Health Care Fraud". Department of Justice. U.S. Attorney’s Office. District of New Mexico. 2016-02-11. Retrieved 2020-06-25.
  12. Dyer, Owen (2015-05-13). "Doctors in New York "pill mill" worked under daily threats, court hears". British Medical Journal (Clinical Research Ed.). 350: h2596. doi:10.1136/bmj.h2596. ISSN 1756-1833. PMID 25972385. S2CID 206905605.
  13. For the extensive pill mill business of twin brothers Christopher and Jeffrey Georg see Temple, John (2015). American Pain. How a Young Felon and His Ring of Doctors Unleashed America's Deadliest Drug Epidemic. Guilford, Connecticut: Lyons Press. ISBN 978-1-4930-0738-7.
    also Felix, Gillette (2012-06-06). "American Pain: The Largest U.S. Pill Mill's Rise and Fall". Bloomberg News.
    See also "Thirty-two Indicted in Broward and Palm Beach Countries in Second Coordinated Pill Mill Takedown" (Press release). United States Attorney's Office. Southern District of Florida. 2011-08-23.
  14. Chubinski, Jennifer; Walsh, Sarah; Sallee, Toby; Rademacher, Eric (Autumn 2014). "Painkiller Misuse among Appalachians and in Appalachian Counties in Kentucky". Journal of Appalachian Studies. 20 (2): 154–169. doi:10.5406/jappastud.20.2.0154. JSTOR 10.5406/jappastud.20.2.0154. At p. 155
  15. For the Kentucky example see Chubinski, et. al., 2014, p. 158.
  16. See for example:
    McGreal, Chris (2019-10-02). "Why were millions of opioid pills sent to a West Virginia town of 3,000?". The Guardian. Retrieved 2020-06-25.
    Coote, Darryl (2019-08-29). "Dozens arrested for running alleged Houston 'pill mill'". Retrieved 2020-06-25 – via UPI.
    "Woman at center of East Tennessee pill mill investigation found guilty". Knoxville, Tennessee: WVLT. 2020-02-14. Retrieved 2020-06-25.
  17. "Pill Mill Search Results". Drug Enforcement Administration. Retrieved 2020-05-02.
  18. In 2010, for example, around 400 pill mills in Florida were closed. See Alvarez, Lizette (2011-08-31). "Florida Shutting 'Pill Mill' Clinics". The New York Times. Retrieved 2020-06-25.
  19. "New Kentucky "Pill Mill Bill" Places New Restrictions on Pain Management Facilities and Controlled Substances Prescribing". Taft Stettinius & Hollister LLP. 2012-05-08. Retrieved 2020-06-15.
  20. Weber, Lauren (2019-05-20). "Why Missouri's The Last Holdout On A Statewide Rx Monitoring Program". Kaiser Health News.
  21. Rhodes, Emily; Wilson, Maria; Robinson, Alysia; Hayden, Jill A.; Asbridge, Mark (2019-11-01). "The effectiveness of prescription drug monitoring programs at reducing opioid-related harms and consequences: a systematic review". BMC Health Services Research. 19 (1): 784. doi:10.1186/s12913-019-4642-8. PMC 6825333. PMID 31675963.
  22. "How is heroin linked to prescription drug abuse?". National Institutes of Health. Archived from the original on 2014-02-28.
  23. "Understanding the Epidemic". Centers for Disease Control and Prevention (2020-03-19 ed.). Retrieved 2020-06-25.
  24. "The OxyContin Express". 2009. Retrieved 2020-06-25 – via The Documentary Network.
  25. "Fourth Television Academy Honors Entries Now Accepted". Emmy Awards. Television Academy. Retrieved 2020-06-25.
  26. "Current TV's Documentary Series 'Vanguard' Receives 69th Annual Peabody Award and 2010 Television Academy Honor". Current TV. 2010-04-07. Retrieved 2020-06-25 – via PRNewsWire. (Press release)
    "The OxyContin Express (Current TV)". Peabody Awards. Retrieved 2020-06-25. (Recording of the tribute)
  27. "American Greed (Season 11)". TV Guide. Retrieved 2020-06-25.
  28. "American Greed (Season 12)". TV Guide. Retrieved 2020-06-25.
  29. Harvin, Darian Symoné (2019-10-06). "Nail Tips from 'Claws'". The New York Times. Interview with Morgan Dixon, chief manicurist of the series
  30. Gajanan, Mahita (2020-02-06). "Netflix's The Pharmacist Depicts the True Story of Grieving Father's Fight Against the Opioid Epidemic". Time. Retrieved 2020-05-10.
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