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).[3] Medical records,
findings, or X-rays are not required; medical examinations are not 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.[4][5]
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.[4] Clients of pill mills are
addicted to medications or
trade their medications to others.[6]
Origin and development
David Herbert Procter is considered the inventor of pill mills.[7] 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.[8] 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.[9]
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.[15]Drug abuse leads to increasing numbers of cases in
emergency rooms, cost-intensive treatment of addictions and frequent
overdose deaths.[16]
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,[17] measures by the
Drug Enforcement Administration (DEA)[18] and closures of these facilities[19] 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.[5]
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 (
KRS218A.175et seq.), has been in effect since 2012.[20] By 2012, 41 U.S. states had implemented such
prescription monitoring program, and by 2019 all states except
Missouri had implemented such programs.[21] 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,[22] with many heroin addicts generally claiming that they have previously abused prescription opioids.[23] Addicts also switched to
fentanyl, often with fatal consequences.[24]
Adaptations
The OxyContin Express, a 2009 documentary by
Portuguese journalist
Mariana van Zeller, which follows the sales channels of pill mills in Florida,[25] received further awards and nominations for the
Emmy[26] in addition to the
Peabody Award (2010).[27] 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)[28] and 152 (first broadcast: March 2018).[29]Money laundering for a pill mill plays an important role in the TV series
Claws.[30] 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.[31]
Quinones, Sam (2015). Dreamland. The true tale of America's new opiate epidemic. New York, NY: Bloomsbury Press.
ISBN978-1-62040-250-4.
Temple, John (2015). American Pain. How a Young Felon and His Ring of Doctors Unleashed America's Deadliest Drug Epidemic. Guilford, Connecticut: Lyons Press.
ISBN978-1-4930-0738-7.
^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.
JSTOR10.5406/jappastud.20.2.0154. At p. 155
^For the Kentucky example see Chubinski, et al., 2014, p. 158.