How do pill mills contribute to the opioid crisis?

How Pill Mills Contribute to the Opioid Crisis

The opioid crisis in America has been raging for over 20 years now. Many people have become addicted to prescription opioid painkillers, leading to misuse, overdoses, and deaths. One of the key contributors to this crisis has been the rise of so-called “pill mills.”

Pill mills are clinics, doctors’ offices, or pharmacies that prescribe and/or dispense prescription opioid painkillers unethically or illegally. They often prescribe extremely high doses without any medical justification, fail to examine patients properly, accept only cash payments, and show other suspicious patterns. This flood of prescription opioids into communities has fueled the opioid epidemic.

What Exactly Are Pill Mills?

Pill mills are facilities that prescribe and/or dispense prescription opioid medications in an unethical, illegal, and unregulated way. They are set up to maximize profits by prescribing as many opioid pills as possible, without regard for responsible medical practice.

Common characteristics of pill mills include:

• Minimal acceptance criteria for new patients seeking opioid prescriptions
• Brief patient visits without substantive medical evaluation or documentation
• Prescribing extremely high doses of opioids, well beyond responsible practice
• Accepting only cash payments, not insurance
• No counseling or referrals given on risks, side effects, or addiction potential
• Patients travelling long distances, often from other states, to visit the pill mills
• Armed security guards, long lines of patients, and signs of illicit drug use on premises

While some pill mills may have legitimate-looking medical facades, their prescribing practices are irresponsible and solely driven by profit. They give little thought to the effects of flooding a community with addictive and dangerous opioids.

How Do Pill Mills Get Started?

Pill mills often get their start when unethical doctors and pharmacists realize they can make huge profits by overprescribing opioid painkillers. They set up clinics designed to maximize the number of prescriptions written or dispensed.

Some common ways pill mills get established include:

• Doctors losing their medical licenses for irresponsible opioid prescribing set up “cash-only” clinics to keep up their profits from overprescribing.
• Greedy or financially-motivated doctors establish fake pain clinics for the sole purpose of handing out opioid scripts.
• Criminal groups convince, coerce, or bribe real doctors to lend their name to fraudulent pill mills.
• Pharmacists order excessive quantities of opioids from distributors for sale directly to drug dealers and abusers.

Sadly, pill mills have cropped up all over the country to feed the demand for prescription opioids. Any doctor can write a script for these medicines, enabling these facilities to operate outside the responsible medical system.

What Role Have Pill Mills Played in the Opioid Crisis?

Pill mills have played a major role in directly supplying the opioid pills that have driven addiction, abuse, and overdoses during the opioid crisis. By doling out opioids indiscriminately for cash, they enable almost anyone to easily obtain these dangerous and addictive drugs.

Some of the main ways pill mills have fueled the opioid crisis include:

• Flooding communities with opioid pills – Pill mills prescribe opioids in absurdly high volumes, putting far more pills onto the streets to feed misuse and addiction.
• Enabling “doctor shopping” – Patients visit multiple pill mills to obtain opioid scripts from different doctors, accumulating massive supplies of unneeded opioids.
• Supplying pills to drug dealers/traffickers – Dealers re-sell the pills from pill mills on the street, expanding access to these drugs.
• Creating addiction and dependency – Easy access removes barriers to trying opioids, enabling more people to get hooked and dependent on the drugs.

By acting as major suppliers, pill mills provide the fuel that ignites and sustains opioid addiction and abuse. They make it simple for people to get hooked on these dangerous medications.

Pill Mills Often Escape Scrutiny and Oversight

Despite clearly unethical and dangerous practices, pill mills frequently avoid attention from law enforcement and medical oversight agencies. There are several reasons for this:

• They maintain a veneer of medical legitimacy with a licensed doctor and pharmacy board registrations.
• Regulators struggle to distinguish “bad actors” from legitimate doctors.
• Remote areas and lax oversight enable pill mills to crop up unnoticed.
• They follow some standard medical formalities like medical histories and written prescriptions.
• High patient demand pressures oversight agencies not to intervene.

In many cases, pill mills operate openly for years before authorities finally step in to stop them. All the while they pump huge volumes of opioid pills into circulation, worsening addiction, abuse and overdoses.

What Has Been Done to Stop Pill Mills?

As awareness of the role pill mills play in the opioid crisis has grown, both state and federal authorities have taken action to crack down on them, including:

• Passing laws and regulations to monitor/control pain clinic operations more closely.
• Establishing prescription drug monitoring programs to identify suspicious prescribing.
• Prosecuting doctors and pharmacists involved in operating pill mills.
• Revoking controlled substance licenses and medical licenses for those running pill mills.
• Educating doctors on responsible opioid prescribing practices.

Law enforcement has also targeted pill mills directly by raiding their operations and arresting those involved. High-profile prosecutions have led to major prison sentences in some cases.

These efforts have succeeded in shutting down many pill mills. However, when one closes, others often spring up to take its place as long as demand remains high. Stopping pill mills completely remains an ongoing challenge.

The Lasting Impact of Pill Mills on the Opioid Crisis

Even as many pill mills get shut down, their impact on the opioid crisis lingers in the form of addiction, abuse, and overdoses. By flooding communities with pills for years, they created disease burdens that will cost many lives even after the pill mills close.

Some of their lasting impacts include:

• Hundreds of thousands addicted to the opioid pills supplied by pill mills.
• Rising addiction and overdoses as cheap heroin and fentanyl replace harder-to-get pills.
• Overdose deaths from fentanyl-laced pills originally prescribed by pill mills.
• HIV, Hepatitis C, and other side effects of IV opioid abuse that was enabled by excess pill supplies.
• Loss of life expectancy and health complications for those with long-term opioid addiction.

These effects will continue for years, even if pill mills fade away. This represents the true costs of the reckless and greedy behavior of those who ran the pill mills.

What More Can Be Done to Address This Issue?

Ending the opioid crisis in America requires attacking it from every angle. Even as pill mills get shut down, more action is needed to address their impacts.

Some steps that could help include:

• Increasing access to addiction treatment programs.
• Improving oversight of all opioid prescribing, not just pill mills.
• Cracking down on the influx of illicit fentanyl and heroin.
• Expanding drug courts and diversion programs to get people with addiction into treatment rather than prison.
• Removing barriers to medications like methadone and buprenorphine to help treat opioid addiction.
• Launching more public education campaigns to prevent opioid misuse and promote safe storage/disposal.

A comprehensive approach across all areas of prevention, treatment, and enforcement is needed. Shutting down the pill mills was one good step – but much work remains in dealing with the crisis they helped create and sustain for so many years.

The opioid epidemic is a complex issue with no single fix. But cutting off the supply of pills flooding communities, as has been done by targeting pill mills, represents real progress. It offers hope that with enough commitment we can overcome this crisis that has impacted so many lives across the country.