Pill Mill Legislation: Is It the Answer?

Pill mills are a problem nationwide, but new legislation against these questionable practices may not always the best solutions.

There has certainly been a huge outcry by many, including law enforcement, to do something about the “pill mills” in the United States, especially those located in great numbers in Florida, most noticeably Broward County. Florida certainly seems to have the most, but other states also are experiencing these issues— my home state, Ohio, is one of them.

One of the first considerations is defining what the term pill mill really means, especially in the eyes of the law. I don’t know any particular official definitions, but most of us probably think of a physician’s office where the prescriber(s) are either recklessly writing or dispensing very large amounts of controlled substances, usually pain medication, to patients who have questionable symptoms.

These often seem to be located in strip malls, with some sort of security to handle the vehicular and pedestrian traffic, keep an eye out for signs of investigative reporters and undercover cops, and, of course, keep the peace while “patients” stand in long lines waiting to see the doctor. During training, I often ask law enforcement officials, after describing the scenario above, if this is what they experience at their doctor’s office. They quickly get the point.

Dispensing large amounts of controlled substances out of a physician’s office has long been a red flag for law enforcement and regulatory agents. It is difficult in my mind to understand why a prescriber would want to do this, except for the fact that they do not want retail pharmacists to review their prescribing habits, plus it can put some additional money in their pockets. Ohio’s new law will put a strict limit on how many dosage units can be dispensed and over what period of time.

Sometimes when people get frustrated with a problem, however, and especially when it is not easily contained, they overreact and cause more problems than they solve. Politicians are great at this, and sometimes they are spurred on by local or federal law enforcement. They have good intentions, but tend to forget that most states, including Ohio, have good laws already on the books that allow for aggressive investigation and prosecution of these rogue prescribers and their staff.

Please don’t misunderstand me, I am very much in favor of pursuing prosecution against any and all illegal prescriber operations, wherever they may be found. These mills contribute to the heavy body count associated in most states with pharmaceuticals. They perpetuate enormous addiction and trafficking levels in and around the community in which they are located—or way beyond, as has been true with the Florida-Ohio connection and many other Midwestern states.

I frankly get concerned when I hear of some of the proposals that have come up in various states’ proposed legislation to curb the problem of pill mills. Some, I believe, are putting restrictions on physicians and their practices that will surely be challenged in court, putting more burden on the appeals courts and possibly ending in a win for the prescriber, whether they were legitimate or not.

Some of them are making it so that only a physician can have any ownership in the practice, or that the doctor must have privileges at 1 or more of the local hospitals in order to have a pain management practice, or that if 51% or more of their practice involves treating pain, the prescriber falls under strict rules. It is only a guess, but I wouldn’t be surprised if many family practices meet or exceed that percentage. I am certainly not a lawyer, but some of these issues seem to be problematic. The last thing that I think we want to see is a flurry of new laws governing pain clinics that either hurt legitimate practices or become overzealous, with the result being lengthy court battles.

I am still a firm believer that most states have sufficient laws on their books that cover criminal activity, such as trafficking in drugs, health care fraud, money laundering, tax evasion, conspiracy, and organized crime, to help pursue illegal prescribers and bring them to justice. This is primarily a law enforcement problem, and we need to work even harder to identify the criminal prescribers while safeguarding the vast majority of physicians who provide compassionate care to their patients. PT

Cmdr Burke is commander of the Warren County, Ohio, drug task force and retired commander of the Cincinnati Police Pharmaceutical Diversion Squad.