The ‘Pill Mill’ State

Friday, August 20th, 2010

Earlier this summer, SAMSHA released disturbing findings that abuse of opiate painkillers has surged 400 percent over the last decade. This frightening figure reflects the most predominant trend I’ve observed during my 15-year career in the field. At our Phoenix House adult residential program in Florida, where prescription opiate abuse now accounts for 95% of admission calls, this problem is all that many of us see and hear. So on Monday, I was grateful that a Tampa Tribune story brought greater attention to the issue.

The article accurately portrays Tampa Bay as a hotbed for so-called “pill mills,” storefront pain management clinics that sell prescription drugs in large quantities. Driving down streets in the area, I see these places everywhere, often with long lines of people waiting outside. At some of these clinics, physicians truly believe they’re helping people with their pain. But far too many are in the business of selling Oxycontin to addicts and dealers—a number of whom are from out of state. According to Tampa Police Lt. Kenneth Morman, “Billboards at the state line display more ads for pain clinics than Walt Disney World.”

There’s no doubt that state and local officials need to crack down on these sham clinics. And the new city and county laws requiring pain clinics to obtain permits and register with the state health department may help us get a better handle on the problem. But these new regulations are unlikely to be enough. Without a statewide prescription drug monitoring system, we have no way to track how many times someone fills a prescription for a particular drug or class—and where they do it. 34 states have developed electronic databases to track this information. Massachusetts expanded its monitoring system last week to include a broader range of medications. We need a similar system in Florida.

Unfortunately, even if we effectively reduce the number of “pill mills,” those who have become addicted to opiates will find another way to satisfy their addiction. Individuals who once “doctor shopped” for Oxycontin may transition to heroin and a far more dangerous drug world than their pain clinics. This transition may also result in higher rates of HIV, Hepatitis C, and other injection-related illnesses. The renewed interest in heroine will increase its profitability to dealers, resulting in greater drug violence and crime.

For these reasons, we must be prepared to expand and enhance public treatment options. Much of our public substance abuse treatment system, while greatly improved with the influx of new evidence-based initiatives, is still rooted in the cocaine crisis of the 1980s and 90s, particularly in its infrastructure. But those who are addicted to opiates have different needs, including medically supervised detox and opiate replacement therapy. Just as importantly, we need to increase the availability of easily accessed care, including outpatient and residential treatment. These treatments need to include therapies validated to help those entering recovery from opiate addiction. We must change the system if we truly want to help those struggling with opiate dependency—and to prevent a major public health disaster.

Sadly, because the state is in fiscal crisis, legislators put an approved monitoring system on hold and claim that even the current levels of care cannot be sustained. However, this perspective is extremely short sighted. If we don’t tackle our prescription drug problem today, the overall financial costs in public health and crime will far exceed the necessary investment in monitoring and treatment. Other states are taking bigger steps to address the gravity and pervasiveness of painkiller abuse. It’s time for Florida to get with the program.

Jack Feinberg
Clinical Director, Phoenix Houses of Florida

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  • “prescription opiate abuse now accounts for 95% of admission calls [at Phoenix House adult residential program in Florida]”

    95%?! That’s incredible. I agree – there absolutely needs to be a better monitoring system in place as it pertains to pain clinics and their distribution of painkillers. How disturbing that presriptions written to improve quality of life end up destroying the lives of so many. And greed is a big motivator – this certainly appears to be the case in these FL pill mills.

    Keep up the good work in your region, Jack. We’ll be keeping a hopeful eye out that Florida lawmakers address this issue.

  • Yes opiate dependancy recovery is much longer and requires a whole different approach. Watching friends and family trying to recover and fail because of the lack of support from the system and family makes it hard. We need social and systemic changes if we are to deal with the coming WAVE of addicted.

  • Jon

    Fla will drag its feet, do to the simple fact that the mega drug company lobbyists will never let that happen. Way too much money at stake, Fla lawmakers are rich and oddly powerless, very sadly.