{{Short description|Illegal pain clinic}} [[File:Jasper_Alabama_Pill_Mill_2015.jpg|thumb|275px|A pill mill in Jasper, Alabama,<ref>See {{Cite web |last=Drug Enforcement Administration |date=2016-04-08 |title=Jasper Pain Clinic Physician Sentenced To Nearly Three Years In Prison For Illegally Dispensing Narcotics |url=https://www.dea.gov/press-releases/2016/04/08/jasper-pain-clinic-physician-sentenced-nearly-three-years-prison |access-date=2020-05-03 |periodical=Dea.gov}}</ref> DEA photo from 2015]] 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.
== Business model and characteristics == [[File:Customers_of_a_Florida_pill_mill_run_by_Jeff_and_Chris_George_wait_in_chairs_on_the_sidewalk.jpg|thumb|275px|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.<ref name="Moreto-etc">{{Cite journal |last1=Moreto |first1=William |last2=Gau |first2=Jacinta M. |last3=Brooke |first3=Erika |year=2020 |title=Pill mills, occupational offending, and situational crime prevention: a framework for analyzing offender behavior and adaptation |url=https://www.researchgate.net/publication/332688482 |journal=Security Journal |volume=33 |issue=2 |pages=161–178 |doi=10.1057/s41284-019-00180-y |s2cid=159271129 |access-date=2020-06-01}}</ref>
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).<ref>{{cite journal|vauthors=Rigg KK, March SJ, Inciardi JA|title=Prescription Drug Abuse & Diversion: Role of the Pain Clinic|journal=Journal of Drug Issues|date=Jul 2010 |volume=40|issue=3|pages=681–701|url= |doi=10.1177/002204261004000307|pmid=21278927|pmc=3030470}}</ref> 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.<ref name="Malbran-2007">{{Cite web |last=Malbran |first=Pia |date=2007-05-31 |title=What's A Pill Mill? |url=https://www.cbsnews.com/news/whats-a-pill-mill |access-date=2020-06-25 |periodical=CBS News}}</ref><ref name="McKee-2017">{{Cite journal |last=Judy McKee |title="First, Do No Harm": Criminal Prosecutions of Doctors for Distributing Controlled Substances Outside of Legitimate Medical Need |url=https://www.naag.org/publications/nagtri-journal/volume-2-issue-2/first-do-no-harm-criminal-prosecutions-of-doctors-for-distributing-controlled-substances-outside-of-legitimate-medical-need.php |volume=II |issue=II |pages=40–46 |periodical=NAGTRI Journal |access-date=2020-06-04 |archive-date=2020-10-25 |archive-url=https://web.archive.org/web/20201025053925/https://www.naag.org/publications/nagtri-journal/volume-2-issue-2/first-do-no-harm-criminal-prosecutions-of-doctors-for-distributing-controlled-substances-outside-of-legitimate-medical-need.php }}</ref>
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.<ref name="Malbran-2007" /> Clients of pill mills are addicted to medications or trade their medications to others.<ref>{{Cite journal |last1=Rigg |first1=Khary K. |last2=March |first2=Samantha J. |last3=Inciardi |first3=James A. |year=2010 |title=Prescription Drug Abuse & Diversion: Role of the Pain Clinic |volume=40 |issue=3 |pages=681–702 |doi=10.1177/002204261004000307 |pmc=3030470 |pmid=21278927 |periodical=J Drug Issues}}</ref>
== Origin and development == David Herbert Procter is considered the inventor of pill mills.<ref>{{Cite web |last=Eil |first=Philip |date=2017-07-05 |title=The Pill Mill That Ravaged Portsmouth |url=https://www.cincinnatimagazine.com/features/pill-mill-portsmouth |access-date=2020-06-25 |periodical=Cincinnati Magazine}}</ref> 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.<ref>{{Cite book |last=Quinones |first=Sam |title=Dreamland: the true tale of America's opiate epidemic |publisher=Bloomsbury Press |year=2015 |isbn=978-1-62040-250-4 |edition=ePub |location=New York |at=¶14.30 |oclc=893857896 |author-link=Sam Quinones}}</ref> 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.<ref>{{Cite web |last=Firth |first=Shannon |date=2016-11-26 |title='Dreamland' Author Takes an Opioid Epidemic Trip — Investigative journalist Sam Quinones talks about the crisis |url=https://www.medpagetoday.com/psychiatry/addictions/61691 |access-date=2020-06-25 |periodical=MedPage Today}}</ref>
Pill mills subsequently spread to other states,<ref name="McKee-2017" /> including for instance West Virginia,<ref>{{Cite journal |issue=1 (Autumn 2015)/2 (Winter 2016) |title=Chronicle |url=https://www.jstor.org/stable/i26341150 |journal=Appalachian Journal |date=2015 |volume=43 |pages=136–139 |doi=10.1353/apl.2015.a955750 |quote=At page 137 }}</ref> Texas,<ref>* {{Cite news |last=Dan Rather |author-link=Dan Rather |date=2013-01-15 |title=Report on Pill Mills |work=Dan Rather Reports |url=https://www.youtube.com/watch?v=9-u5J0SX1yg |access-date=2020-06-25 |via=YouTube}}</ref> New Mexico,<ref>{{Cite web |date=2016-02-11 |title=Pawankumar Jain Pleads Guilty to Unlawfully Dispensing Prescription Painkillers and Health Care Fraud |url=https://www.justice.gov/usao-nm/pr/pawankumar-jain-pleads-guilty-unlawfully-dispensing-prescription-painkillers-and-health |access-date=2020-06-25 |website=Department of Justice. U.S. Attorney's Office. District of New Mexico}}</ref> and New York.<ref>{{Cite journal |last=Dyer |first=Owen |date=2015-05-13 |title=Doctors in New York "pill mill" worked under daily threats, court hears |journal=British Medical Journal (Clinical Research Ed.) |volume=350 |article-number=h2596 |doi=10.1136/bmj.h2596 |issn=1756-1833 |pmid=25972385 |s2cid=206905605}}</ref> They gained great importance especially in Florida. There, the pill mills of Chris George had a prominent position.<ref>For the extensive pill mill business of twin brothers Christopher and Jeffrey Georg see {{Cite book |last=Temple |first=John |title=American Pain. How a Young Felon and His Ring of Doctors Unleashed America's Deadliest Drug Epidemic |publisher=Lyons Press |year=2015 |isbn=978-1-4930-0738-7 |location=Guilford, Connecticut}}<br />also {{Cite news |last=Felix |first=Gillette |date=2012-06-06 |title=American Pain: The Largest U.S. Pill Mill's Rise and Fall |publisher=Bloomberg News |url=https://www.bloomberg.com/news/articles/2012-06-06/american-pain-the-largest-u-dot-s-dot-pill-mills-rise-and-fall}} <br />See also {{Cite web |date=2011-08-23 |title=Thirty-two Indicted in Broward and Palm Beach Countries in Second Coordinated Pill Mill Takedown |url=https://www.justice.gov/archive/usao/fls/PressReleases/2011/110823-04.html |publisher=United States Attorney's Office. Southern District of Florida |language=en |type=Press release}}</ref>
== 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.<ref>{{Cite journal |last1=Chubinski |first1=Jennifer |last2=Walsh |first2=Sarah |last3=Sallee |first3=Toby |last4=Rademacher |first4=Eric |date=Autumn 2014 |title=Painkiller Misuse among Appalachians and in Appalachian Counties in Kentucky |journal=Journal of Appalachian Studies |volume=20 |pages=154–169 |doi=10.5406/jappastud.20.2.0154 |jstor=10.5406/jappastud.20.2.0154 |quote=At p. 155 |number=2}}</ref> Drug abuse leads to increasing numbers of cases in emergency rooms, cost-intensive treatment of addictions and frequent overdose deaths.<ref>For the Kentucky example see Chubinski, et al., 2014, p. 158.</ref>
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,<ref>See for example:<br />{{Cite news |last=McGreal |first=Chris |date=2019-10-02 |title=Why were millions of opioid pills sent to a West Virginia town of 3,000? |language=en |work=The Guardian |url=https://www.theguardian.com/us-news/2019/oct/02/opioids-west-virginia-pill-mills-pharmacies |access-date=2020-06-25}}<br />{{Cite news |last=Coote |first=Darryl |date=2019-08-29 |title=Dozens arrested for running alleged Houston 'pill mill' |language=en |url=https://www.upi.com/Top_News/US/2019/08/29/Dozens-arrested-for-running-alleged-Houston-pill-mill/5881567051237 |access-date=2020-06-25 |via=UPI}}<br />{{Cite web |date=2020-02-14 |title=Woman at center of East Tennessee pill mill investigation found guilty |url=https://www.wvlt.tv/content/news/Hofstetter--567872791.html |access-date=2020-06-25 |publisher=WVLT |location=Knoxville, Tennessee}}</ref> measures by the Drug Enforcement Administration (DEA)<ref>{{Cite web |title=Pill Mill Search Results |url=https://search.dea.gov/search?utf8=%E2%9C%93&affiliate=justice-dea&sort_by=&query=Pill+Mill |access-date=2020-05-02 |website=Drug Enforcement Administration}}</ref> and closures of these facilities<ref>In 2010, for example, around 400 pill mills in Florida were closed. See {{Cite news |last=Alvarez |first=Lizette |date=2011-08-31 |title=Florida Shutting 'Pill Mill' Clinics |language=en |work=The New York Times |url=https://www.nytimes.com/2011/09/01/us/01drugs.html |access-date=2020-06-25}}</ref> 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.<ref name="McKee-2017" />
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 [https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=44313 218A.175] ''et seq.''), has been in effect since 2012.<ref>{{Cite web |date=2012-05-08 |title=New Kentucky "Pill Mill Bill" Places New Restrictions on Pain Management Facilities and Controlled Substances Prescribing |url=https://www.taftlaw.com/news-events/law-bulletins/new-kentucky-pill-mill-bill-places-new-restrictions-on-pain-management-facilities-and-controlled-substances-prescribing |access-date=2020-06-15 |website=Taft Stettinius & Hollister LLP |language=en}}</ref> By 2012, 41 U.S. states had implemented such prescription monitoring program, and by 2019 all states except Missouri had implemented such programs.<ref>{{Cite journal |last=Weber |first=Lauren |date=2019-05-20 |title=Why Missouri's The Last Holdout On A Statewide Rx Monitoring Program |url=https://khn.org/news/why-missouris-the-last-holdout-on-a-statewide-rx-monitoring-program |language=en |periodical=Kaiser Health News}}</ref> 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,<ref>{{Cite journal |last1=Rhodes |first1=Emily |last2=Wilson |first2=Maria |last3=Robinson |first3=Alysia |last4=Hayden |first4=Jill A. |last5=Asbridge |first5=Mark |date=2019-11-01 |title=The effectiveness of prescription drug monitoring programs at reducing opioid-related harms and consequences: a systematic review |volume=19 |issue=1 |page=784 |doi=10.1186/s12913-019-4642-8 |pmc=6825333 |pmid=31675963 |periodical=BMC Health Services Research |doi-access=free }}</ref> with many heroin addicts generally claiming that they have previously abused prescription opioids.<ref>{{Cite journal |title=How is heroin linked to prescription drug abuse? |url=https://www.drugabuse.gov/publications/research-reports/heroin/how-heroin-linked-to-prescription-drug-abuse |language=en |archive-url=https://web.archive.org/web/20140228181328/https://www.drugabuse.gov/publications/research-reports/heroin/how-heroin-linked-to-prescription-drug-abuse |archive-date=2014-02-28 |periodical=National Institutes of Health}}</ref> Addicts also switched to fentanyl, often with fatal consequences.<ref>{{Cite web |title=Understanding the Epidemic |url=https://www.cdc.gov/drugoverdose/epidemic/index.html |access-date=2020-06-25 |website=Centers for Disease Control and Prevention |language=en |edition=2020-03-19}}</ref>
== Adaptations == ''The OxyContin Express'', a 2009 documentary by Portuguese journalist Mariana van Zeller, which follows the sales channels of pill mills in Florida,<ref>{{Cite web |year=2009 |title=The OxyContin Express |url=https://documentary.net/video/oxycontin-express |access-date=2020-06-25 |via=The Documentary Network}}</ref> received further awards and nominations for the Emmy<ref>{{Cite web |title=Fourth Television Academy Honors Entries Now Accepted |url=https://www.emmys.com/news/news/fourth-television-academy-honors-entries-now-accepted |access-date=2020-06-25 |website=Emmy Awards |publisher=Television Academy |language=en}}</ref> in addition to the Peabody Award (2010).<ref>{{Cite web |date=2010-04-07 |title=Current TV's Documentary Series 'Vanguard' Receives 69th Annual Peabody Award and 2010 Television Academy Honor |url=https://www.prnewswire.com/news-releases/current-tvs-documentary-series-vanguard-receives-69th-annual-peabody-award-and-2010-television-academy-honor-90082357.html |access-date=2020-06-25 |publisher=Current TV |via=PRNewsWire}} (Press release)<br />{{Cite web |title=The OxyContin Express (Current TV) |url=http://www.peabodyawards.com/award-profile/the-oxycontin-express |access-date=2020-06-25 |website=Peabody Awards}} (Recording of the tribute)</ref> 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)<ref>{{Cite web |title=American Greed (Season 11) |url=https://www.tvguide.com/tvshows/american-greed/episodes-season-11/341778 |access-date=2020-06-25 |website=TV Guide}}</ref> and 152 (first broadcast: March 2018).<ref>{{Cite web |title=American Greed (Season 12) |url=https://www.tvguide.com/tvshows/american-greed/episodes-season-12/341778 |access-date=2020-06-25 |website=TV Guide}}</ref> Money laundering for a pill mill plays an important role in the TV series ''Claws''.<ref>{{Cite news |last=Harvin |first=Darian Symoné |date=2019-10-06 |title=Nail Tips from 'Claws' |work=The New York Times |url=https://www.nytimes.com/2019/06/10/style/self-care/nail-tips-from-claws.html |quote=Interview with Morgan Dixon, chief manicurist of the series}}</ref> 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.<ref>{{Cite magazine |last=Gajanan |first=Mahita |date=2020-02-06 |title=Netflix's The Pharmacist Depicts the True Story of Grieving Father's Fight Against the Opioid Epidemic |magazine=Time |url=https://time.com/5778759/the-pharmacist-netflix |access-date=2020-05-10}}</ref>
== Literature == * {{Cite journal |last1=Moreto |first1=William D. |last2=Gau |first2=Jacinta M. |last3=Brooke |first3=Erika J. |date=April 2019 |title=Pill mills, occupational offending, and situational crime prevention: a framework for analyzing offender behavior and adaptation |url=https://www.researchgate.net/publication/332688482 |journal=Security Journal}} * {{Cite book |last=Quinones |first=Sam |title=Dreamland. The true tale of America's new opiate epidemic |publisher=Bloomsbury Press |year=2015 |isbn=978-1-62040-250-4 |location=New York, NY}} * {{Cite book |last=Temple |first=John |title=American Pain. How a Young Felon and His Ring of Doctors Unleashed America's Deadliest Drug Epidemic |publisher=Lyons Press |year=2015 |isbn=978-1-4930-0738-7 |location=Guilford, Connecticut}} * {{Cite journal |last1=Rigg |first1=Khary K. |last2=March |first2=Samantha J. |last3=Inciardi |first3=James A. |year=2010 |title=Prescription Drug Abuse & Diversion: Role of the Pain Clinic |journal=J Drug Issues |volume=40 |issue=3 |pages=681–702 |doi=10.1177/002204261004000307 |pmc=3030470 |pmid=21278927}}
== See also == * Doctor shopping * Substance abuse * Drug diversion * Opioid epidemic * Timeline of the opioid epidemic
== References == {{Reflist}}
== External links == *{{wiktionary-inline}} * {{Cite news |last=Pia Malbran |date=2007-05-31 |title=What's A Pill Mill? |work=CBS News |url=https://www.cbsnews.com/news/whats-a-pill-mill}}
Category:Commercial crimes Category:Healthcare in the United States Category:Opioid epidemic Category:Social problems in medicine