Cracking Down on Pill Mills

It’s no secret that prescription drug abuse can lead to heroin addiction. But it most likely does not happen in a cut and dry manner. It starts with doctors. Unfortunately, many of the doctors in pill mills do not care about their patients’ health. They only care about one thing: making money. And doling out prescription meds like candy is what they do. This can ultimately lead to an addiction to heroin.

Legitimate physicians usually run pill mills. They dispense prescription pills and conduct all monetary exchanges on a cash basis. The physicians who dispense the prescriptions may have legitimate licenses in the specific state where they conduct business. However, they may be on the run from malpractice lawsuits from other states. Many of these doctors have also been accused of laundering the money that they make from their pill mills. A pill mill prescribes OxyContin, Oxycodone, Percocet, Vicodin, Ritalin, and other prescription drugs without legitimate medical purposes.

Until recently, Florida was the go-to state for pill mills. Although the Sunshine State is not the U.S. state with the most serious prescription drug abuse epidemic, it plays an important role in the current pill mill trend. At one time, Florida was known for its relaxed drug law enforcement and its absence of a prescription drug monitoring program. This allowed pill mills to proliferate. They even advertised in newspapers and offered “reward points” to frequent customers. 90% of the nation’s opioid pain medication prescriptions were written in Florida at one point during the height of the trend.

What Are Pill Mills?

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Pill mills are medical offices that over-prescribe painkillers and other addictive medications to people who may be struggling with drug abuse and addiction. These pill mills differ from legitimate pain management clinics in that they conduct only cursory examinations rather than thorough exams. They also see an excessive number of patients in a short amount of time and write an excessive number of prescriptions. Many of these doctors accept cash payments only.

The pill mill rush on Florida began in the mid-1990s, which was around the time chronic pain management became popular. Physicians who were aware of Florida’s liberal drug laws and unscrupulous enough to take advantage of it flocked to Florida and opened the first pill mills.

Law Enforcement Cracking Down

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Local, state, and federal law enforcement agencies are beginning to investigate doctors who work at these pill mills. In one case, a doctor in Los Angeles County wrote more prescriptions in a single month than the entire staff of Johns Hopkins Hospital did. Another case involving a doctor who lost three of her patients to prescription drug overdoses made investigators suspicious with the number of calls the doctor received from the coroner letting her know that her patients had passed away.

The latter case was that of Dr. Hsiu-Ying “Lisa” Tseng. Sentenced to 30 years in prison for her role in the three deaths, Dr. Tseng was the first doctor in the U.S. to be convicted of second-degree murder for over-prescribing opioid pain medications. She is not the only physician to face charges for deaths related to the opioid abuse epidemic. Dr. Narendra Nagareddy, a psychiatrist in the Atlanta, Georgia area, was indicted on three counts of murder. Thirty-six of his patients died after abusing fentanyl, hydrocodone, methadone, and oxycodone that Dr. Nagareddy prescribed.

In Philadelphia, three doctors are now facing charges related to a supposed drug addiction clinic that allegedly operated as a pill mill. A similar story takes place in Reno, where a physician is charged with running a pill mill along with eight accomplices.

Another Legal Challenge to Pill Mills

Many lawsuits have addressed the opioid epidemic by confronting the doctors responsible for over-prescribing addictive control substances. Governmental agencies have begun to sue pill mills for defrauding Medicaid and Medicare. One such lawsuit against a doctor and chiropractor who ran four pain clinics alleged that they billed federal health care programs for more than $1 billion in fraudulent claims.

Florida’s Pill Mills

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People drive to Florida from its neighboring states because of the relative ease of obtaining prescription drugs, particularly OxyContin. An influx of drug tourists from Kentucky and West Virginia is part of the reason why West Virginia has the dubious distinction of having the nation’s highest rate of opioid abuse today. OxyContin abuse ravaged Kentucky that the state sued Purdue Pharma, the maker of the prescription drug, for misrepresenting the addictive nature of the medication. That case culminated in a $24 million settlement. In all, Purdue Pharma has had to pay out $634 million in penalties for its role in the opioid abuse epidemic.

American Pain was Florida’s largest pill mill and thought to be the largest ever to operate in the U.S. Law enforcement officials believe the illegal pain pill clinic took in as much as $43 million dollars in a 3-year period.  American Pain may have caused 50 overdose deaths.

When American Pain was shut down, its owner, Jeff George, was charged with homicide for one of those deaths. He was convicted and sentenced to 20 years in prison. His brother, Chris George, testified with information about the doctors that he hired. As a result, he received a reduced sentence of 14 years. Cynthia Cadet was the doctor who wrote the largest number of prescriptions of any doctor at American Pain. She was charged with but not convicted of writing fraudulent prescriptions. She testified that she didn’t know whether or not patients were lying about their pain levels. The jury agreed with her.

The Link Between Pill Mills and the Heroin Epidemic in Florida

Florida began cracking down on its pill mills in 2010. The state saw its number of prescription drug overdoses drop by 50% within two years and 69% within five years. Unfortunately, some of those who could no longer easily access these pill mills turned to heroin as a cheap substitute for prescription opioids. The state of Florida saw a rise in its number of heroin overdose deaths. Nationwide, the number of deaths due to heroin overdose has quadrupled since 2010.

Along with a spike in heroin use and the number of overdose deaths, the heroin epidemic in Florida has also seen a spike in babies born addicted to heroin. The number of cases of HIV infection is also rising due to heroin users sharing drug needles. According to the National Institute on Drug Abuse, Florida’s heroin addiction problem reached the level of an epidemic in 2014.

The rise of the heroin epidemic abuse is linked to the synthetic opioid medication fentanyl. Fentanyl is 50-100 times more powerful than morphine. Fentanyl is a surgical anesthetic in the legitimate medicine world. As a street drug, its abuse greatly increases the chance of accidental overdose for heroin users.

Heroin is one of the most addictive drugs. By cracking down on its pill mills, Florida solved one deadly problem but gained another.