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.
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]
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]
Pill mills subsequently spread to other states, [5] including for instance West Virginia, [10] Texas, [11] New Mexico, [12] and New York. [13] They gained great importance especially in Florida. There, the pill mills of Chris George had a prominent position. [14]
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 (KRS 218A.175 et 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]
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]
Oxycodone, sold under various brand names such as Roxicodone and OxyContin, is a semi-synthetic opioid used medically for treatment of moderate to severe pain. It is highly addictive and is a commonly abused drug. It is usually taken by mouth, and is available in immediate-release and controlled-release formulations. Onset of pain relief typically begins within fifteen minutes and lasts for up to six hours with the immediate-release formulation. In the United Kingdom, it is available by injection. Combination products are also available with paracetamol (acetaminophen), ibuprofen, naloxone, naltrexone, and aspirin.
Opioids are substances that act on opioid receptors to produce morphine-like effects. Medically they are primarily used for pain relief, including anesthesia. Other medical uses include suppression of diarrhea, replacement therapy for opioid use disorder, reversing opioid overdose, and suppressing cough. Extremely potent opioids such as carfentanil are approved only for veterinary use. Opioids are also frequently used non-medically for their euphoric effects or to prevent withdrawal. Opioids can cause death and have been used for executions in the United States.
Oxymorphone is a highly potent opioid analgesic indicated for treatment of severe pain. Pain relief after injection begins after about 5–10 minutes, after oral administration it begins after about 30 minutes, and lasts about 3–4 hours for immediate-release tablets and 12 hours for extended-release tablets. The elimination half-life of oxymorphone is much faster intravenously, and as such, the drug is most commonly used orally. Like oxycodone, which metabolizes to oxymorphone, oxymorphone has a high potential to be abused.
Drug diversion is a medical and legal concept involving the transfer of any legally prescribed controlled substance from the individual for whom it was prescribed to another person for any illicit use. The definition varies slightly among different jurisdictions, but the transfer of a controlled substance alone usually does not constitute a diversion, since certain controlled substances that are prescribed to a child are intended to be administered by an adult, as directed by a medical professional. The term comes from the "diverting" of the drugs from their original licit medical purpose. In some jurisdictions, drug diversion programs are available to first time offenders of diversion drug laws, which "divert" offenders from the criminal justice system to a program of education and rehabilitation.
Sally L. Satel is an American psychiatrist based in Washington, D.C. She is a lecturer at Yale University School of Medicine, a visiting professor of psychiatry at Columbia University, a senior fellow at the American Enterprise Institute, and an author.
Purdue Pharma L.P., formerly the Purdue Frederick Company (1892–2019), was an American privately held pharmaceutical company founded by John Purdue Gray. It was sold to Arthur, Mortimer and Raymond Sackler in 1952, and then owned principally by the Sackler family, and their descendants.
Codeine is an opiate and prodrug of morphine mainly used to treat pain, coughing, and diarrhea. It is also commonly used as a recreational drug. It is found naturally in the sap of the opium poppy, Papaver somniferum. It is typically used to treat mild to moderate degrees of pain. Greater benefit may occur when combined with paracetamol (acetaminophen) or a nonsteroidal anti-inflammatory drug (NSAID) such as aspirin or ibuprofen. Evidence does not support its use for acute cough suppression in children or adults. In Europe, it is not recommended as a cough medicine in those under 12 years of age. It is generally taken by mouth. It typically starts working after half an hour, with maximum effect at two hours. Its effects last for about four to six hours. Codeine exhibits abuse potential similar to other opioid medications, including a risk of habituation and overdose.
The American Pain Society (APS) was a professional membership organization and a national chapter of the International Association for the Study of Pain (IASP). The organization closed in 2019 amid the opioid epidemic as the organization faced allegations that it colluded with opioid producers to promote opioids.
In the United States, the opioid epidemic is an extensive ongoing overuse of opioid medications, both from medical prescriptions and illegal sources. The epidemic began in the United States in the late 1990s, according to the Centers for Disease Control and Prevention (CDC), when opioids were increasingly prescribed for pain management, resulting in a rise in overall opioid use throughout subsequent years. The great majority of Americans who use prescription opioids do not believe that they are misusing them.
"Addiction Rare in Patients Treated with Narcotics" is the title of a letter to the editor written by Jane Porter and Hershel Jick and published in the January 10, 1980, issue of The New England Journal of Medicine. The letter analyzed data on patients who had been treated with opioids in a hospital setting, and concluded that addiction was uncommon among such patients. It has since been frequently misrepresented to claim that opioids are not addictive when prescribed for use at home, which has been blamed for contributing to the opioid epidemic in the United States.
MedPage Today is a medical news-focused site owned by Ziff-Davis, LLC. It is based in New York City, and is geared primarily toward medical and health professionals.
Richard Stephen Sackler is an American billionaire businessman and physician who was the chairman and president of Purdue Pharma, a former company best known as the developer of OxyContin, whose connection to the opioid epidemic in the United States was the subject of multiple lawsuits and fines, and that filed for bankruptcy in 2019. It has been claimed that Richard Sackler's Purdue is among ”the worst drug dealers in history” and the Sackler family have been described as the "most evil family in America". The company's downfall was the subject of the 2021 Hulu series Dopesick and the 2023 Netflix series Painkiller.
Massachusetts v. Purdue is a lawsuit filed on August 14, 2018, suing the Stamford, Connecticut-based company Purdue Pharma LP, which created and manufactures OxyContin, "one of the most widely used and prescribed opioid drugs on the market", and Purdue's owners, the Sacklers accusing them of "widespread fraud and deception in the marketing of opioids, and contributing to the opioid crisis, the nationwide epidemic that has killed thousands." Purdue denied the allegations.
Barry Meier is a writer and former New York Times journalist who wrote the 2003 non-fiction book Pain Killer: A Wonder Drug's Trail of Addiction and Death. His articles "have led to Congressional hearings and changes in federal laws".
The opioid epidemic, also referred to as the opioid crisis, is the rapid increase in the overuse, misuse/abuse, and overdose deaths attributed either in part or in whole to the class of drugs called opiates/opioids since the 1990s. It includes the significant medical, social, psychological, demographic and economic consequences of the medical, non-medical, and recreational abuse of these medications.
The timeline of the opioid epidemic includes selected events related to the origins of Stamford, Connecticut-based Purdue Pharma, the Sackler family, the development and marketing of oxycodone, selected FDA activities related to the abuse and misuse of opioids, the recognition of the opioid epidemic, the social impact of the crisis, lawsuits against Purdue and the Sackler family.
Christopher Paul George, called Chris George is an American drug dealer and convicted felon. Together with his twin brother Jeffrey Frank George and other parties involved, he ran several pill mills in Florida, which contributed to the opioid epidemic in the USA. George was sentenced to 17.5 years imprisonment in 2012 for these and other crimes. The media called him Pill Mill Kingpin, because he was the owner of the largest network of such clinics in Florida between February 2008 and March 2010.
Prescription drug addiction is the chronic, repeated use of a prescription drug in ways other than prescribed for, including using someone else’s prescription. A prescription drug is a pharmaceutical drug that may not be dispensed without a legal medical prescription. Drugs in this category are supervised due to their potential for misuse and substance use disorder. The classes of medications most commonly abused are opioids, central nervous system (CNS) depressants and central nervous stimulants. In particular, prescription opioid is most commonly abused in the form of prescription analgesics.
Curtis Wright IV is an American former government official known for his role in the Food and Drug Administration's approval of OxyContin for Purdue Pharma in 1995, followed by his subsequent employment by the company, which led to portrayals in films and reports in nonfiction books, magazines, and news media outlets of his alleged role as one of the key figures in the current opioid epidemic in the United States. Wright was implicated in a criminal conspiracy outlined in a 2006 United States Department of Justice review document that was first made public in Purdue Pharma's 2019 bankruptcy proceedings. Although that case was settled in a 2007 plea agreement deal, members of United States Congress have requested the full 2006 documentation from the Department of Justice with the goal of opening a new case based upon the evidence then gathered. Parts of Wright's sworn depositions in 2003 and 2018 have internal contradictions and differ from documentary evidence described the 2003–2006 U.S. Federal Government investigation into Purdue Pharma.
In response to the surging opioid prescription rates by health care providers that contributed to the opioid epidemic in the United States, US states began passing legislation to stifle high-risk prescribing practices. These new laws fell primarily into one of the following four categories:
At page 137
At p. 155
Interview with Morgan Dixon, chief manicurist of the series
The dictionary definition of pill mill at Wiktionary