Imagine comparing The New York Times to the National Inquirer. Or Lawrence Olivier to Fabio. Or Van Gogh to Thomas Kinkade.
What Are Pill Mills?
Lawmakers and law enforcers have been cracking down recently on clinics, as well as doctors and pharmacies, that illegally or irresponsibly dispense prescription narcotics. These clinics, known as “pill mills”, sell prescription drugs to those who have no medical need of them, or in excessive amounts, and have directly contributed to many of the recent restrictions that have been placed on the distribution and availability of prescription drugs. Although they can be found all over the country, they have made most notable headlines in Florida and Texas, which the Drug Enforcement Agency believes to have the greatest numbers of mills.
“The typical pill mill,” says Vinod Malik, a West Coast physician with several board certifications and the director of PRC Associates for 11 years, “you walk in, no appointment needed, no evaluation by a physician, you pay cash, you get your prescription, and you go home.”
How are Pain Management Clinics Different?
A pain management clinic (in the general legal definition) is a facility providing pain treatment options or that has at least one doctor licensed to prescribe controlled medication for pain. Pain clinics are subject to legal rules and standards, such as being licensed, being subject to inspection by the board and the state, employing licensed staff, etc. Prescription pain medication is regulated by federal law, so doctors who prescribe it “without a legitimate medical purpose or outside the usual course of medical practice” can be charged with drug trafficking. At “pill mills”, the doctor, pharmacist, or other operators sell these medications to people without valid medical reason, or in large quantities, making a significant profit for themselves in the process. People even travel from out of state to purchase medication from these mills. This flood of powerful and easily-accessible drugs has contributed to a significant rise in street usage of and addiction to narcotics; overdosing on prescription drugs is now the second-leading cause of accidental death in the United States.
One particular Palm Coast pain management practice, as Kavita Sharma, a pain management doctor, prefers to identify it (rather than a mere “clinic,” because “no one can walk in and say, I want to be seen today”), couldn’t be further from that. No walk-ins are accepted. It’s a referral-only practice. It’s an elaborate, “interventional” pain management operation staffed by board certified doctors, each with at least two board certification, each predisposed to shun pills, each dealing directly and exclusively with his or her patients without the intercession of nurse practitioners or physicians’ assistants. The four doctors have privileges at all Florida Hospital facilities. Pill mill doctors not only would generally be denied such privileges: they’d be segregated from the rest of the medical community, which doesn’t want to be associated with them.
“Pill only” therapy generally goes against the doctors’ principles and medical philosophy: they’re there to cure patients of their pain or their dependence on narcotics, not to feed it. And they do so mostly through “interventional” means such as injections, radiofrequency ablations, and other, equally tongue-twisting procedures that pill mill patrons have no use for.
Patients are required to sign a narcotic agreement and submit to urine tests to ensure that they’re following their prescribed regimen. If any diversion is detected, it’s a sign that the patients are either abusing the drugs or selling them. If, for example, they’ve been prescribed certain pills but their urine doesn’t show that they’ve been using them at the correct dosage, they’re not in compliance with their narcotic agreement.
“If they don’t comply with that they get fired,” Sharma says. “You actually discharge the patient if they don’t comply with or fail a narcotics screening.” She adds: “Word on the street is, if you want your pills, don’t go top these doctors. They won’t write prescriptions for it.”
The general public has been made little aware of the challenges posed by pill mills or of the important nuances and differences between pill mills and pain management practices.
In response, some states have now placed limits on the amount of drugs doctors can prescribe, which some argue has made it more difficult and expensive for people who actually need them to obtain them. Either way, doctors engaging in criminal activity with their prescriptions at pill mills have made even legitimate doctors subject to closer scrutiny.
Signs that a facility may actually be a pill mill include not requiring a physical exam, x-rays or medical records before being prescribed drugs, being able to pick your preferred medication, being directed to “their” specific pharmacy, and treating pain solely with pills. Pill mills also tend to open and close very suddenly, as an attempt to evade law enforcement.
So pill mills, for now, continue to thrive, feeding addictions—and damaging the reputation of the legitimate and necessary pain management profession.