Georgia trying to control pill mills

Pain clinics are surging in Georgia, where drug overdose deaths are rising

With help from local police in tracing the label, the McClures learned the drug was prescribed at a suspected illicit pain clinic — or “pill mill” — in Stockbridge that was shut down by federal authorities in February. Cameron’s parents claim the physician arrested in the raid was partially responsible for their son’s death.

“If he hadn’t have made it so easy to get to, then Cameron couldn’t have got it,” McClure’s father, Wayne, said of the drugs involved. “And, possibly, he would still be here.”

State Attorney General Sam Olens and state Rep. Tom Weldon, R-Ringgold, are among those seeking a pill mill law that would impose regulations on pain management clinics and allow law enforcement to shut down clinics that don’t abide. Olens and Weldon have put the proposal at the top of their respective agendas for the next legislative session.

Rick Allen, Georgia Drugs & Narcotics Agency director, also has offered support for a pill mill law. He said the number of pain-management clinics in the state has mushroomed from fewer than a dozen to more than 90 in less than two years.

On Tuesday, local and federal authorities indicted on racketeering charges a dozen people who allegedly were affiliated with two pain clinics in Chamblee and Sandy Springs, and six metro Atlanta pharmacies that filled prescriptions for them. The raids at 19 businesses and homes were the culmination of a yearlong investigation.

DeKalb County District Attorney Robert James said the clinic operators moved to Georgia after the DEA shut down a similar business in Florida. The owners allegedly made hundreds of thousands of dollars, if not millions, from the clinics. Two on-staff doctors evaluated patients for less than three minutes before doling out prescriptions for up to 250 30 mg tablets of oxycodone — a potentially fatal dosage usually reserved for terminal cancer patients in their last days, James said.

Legitimate pain clinics examine patients using medical tools such as X-rays and MRIs, and inquire into medical histories; pill mills are less concerned with making an accurate diagnosis and more with profiting from the sale of pain medications.

“It’s nothing less than a bunch of thugs trying to move in, because we’ve had a policy that needed more teeth in it regarding who can open a pharmacy and run a pain clinic,” Weldon said.

The provisions of the potential law are unclear at this early stage. However, the desired effect would be to empower law enforcement officers in the Georgia Drugs & Narcotics Agency and officials from the Georgia Medical Composite Board to closer scrutinize activities of questionable pain clinics, Weldon said. Businesses not in compliance with regulations could be penalized or shut down.

Currently, local or federal investigators spend months building a criminal case against pain clinic operators — often employing wiretaps and undercover agents — before businesses can be shuttered.

While there are plenty of legitimate pain clinics affiliated with hospitals and hospices, pill mills are distinctly different operations that dole out scores of narcotics such as oxycodone and Xanax.

Pill mills, like the suspected one in Stockbridge, frequently advertise their services on billboards and roadside signs. Some keep security guards on staff to discourage unwelcome visitors.

Weldon said he called a phone number from a billboard just over the Tennessee line from his home district of Ringgold, and it rang back to a Georgia number. The lawmaker was asked why he was calling, where he was calling from and who he was, but nothing about his symptoms.

“All they wanted to know was, ‘When can you come in and see a doctor?’ ” Weldon said.

Many pill mills operate on a cash-only basis to avoid having their customer payments tracked. Henry County investigators say the Stockbridge pain center charged $350 on the first visit and $250 on subsequent ones to obtain prescriptions for oxycodone.

Undercover agents posing as patients allegedly were able to obtain pills on site without prescriptions.

Marion Lee, a physician whose recognized Centers for Pain Management are located in Cordele, Tifton and Douglas, said the health care community is concerned about pill mills. Lee said there is an obvious need for regulation on pain care clinics, and he’s collaborating with Weldon to help the Legislature find solutions.

“Our Georgia Society of Interventional Pain Physicians, which includes 75 doctors, also feels strongly there needs to be regulation to preserve access to care for legitimate patients,” Lee said.

Gil Kerlikowske, the nation’s drug czar, has called prescription drug abuse America’s fastest-growing drug problem. Georgia ranks third in the nation for the amount of Oxycodone purchased by medical practitioners, exceeded only by Florida and Ohio.

Pill mills appear partly to blame for the rise in prescription drug overdose deaths statewide. Overdoses climbed 10 percent between 2009 and last year. Of 729 drug overdose deaths recorded last year, 560 involved prescription drugs, according to the Georgia Bureau of Investigation.

Pill mills are proliferating in part because Georgia has lacked a database to track the dispensing of prescriptions and has no pill mill law, unlike some neighboring states, according to First Assistant U.S. Attorney John Horn.

Georgia lawmakers approved a prescription drug monitoring program to track the dispensing of prescription drugs this spring, but it won’t come online until January 2013.

The prescription monitoring program is designed to deter doctor-shopping — visiting multiple doctors to obtain multiple prescriptions — by allowing physicians and pharmacists to access a database and check patient records before writing or filling prescriptions. The database also helps the state identify doctors who are improperly prescribing drugs.

In the absence of a state pill mill law, some cities in Cobb and Cherokee counties have adopted local ordinances that impose strict business licensing requirements upon these companies. Others, like Milton, have temporarily banned new pain clinics from opening.

Kennesaw Police Chief William Westenberger pushed for an ordinance earlier this year after a suspected pill mill operated briefly in his city. Business applicants who want to dispense controlled substances now have to provide more documentation about their owners, investors and physicians.

Employees also have to submit to background checks, and a business application won’t be accepted if felony records are evident. Furthermore, a business can’t employ doctors who have been on probation or suspension from a medical board for issues related to drug dispensing.

Since Kennesaw’s ordinance was enacted, no new pain clinics have opened.

“It’s done its job so far, the best we can tell,” Westenberger said.

Several neighboring states have moved more swiftly to tackle the problem than Georgia. Tennessee passed pill mill legislation that takes effect Jan. 1. Florida lawmakers adopted a bill in June to regulate pain-management clinics. Some form of pill mill regulations also exist in Louisiana, Ohio and Texas.

Sherry Green, chief executive officer of the National Alliance for Model State Drug Laws, said there are common components to the laws:

They require clinics that prescribe controlled substances to be certified by the state; the certification must be renewed every year or so.

Certification can be revoked and the clinic shut down if operators fail to maintain required records, submit required reports, make false or misleading statements to state inspectors, or if they are convicted of a crime related to the prescribing, distribution or provision of controlled substances.

Anyone who has a felony record is banned from owning a clinic. Doctors must have an unrestricted license to practice in the state with no history of disciplinary action.

Clinic operators who violate regulations are subject to penalties ranging from fines of $1,000 per day in Tennessee to $5,000 per offense in Florida, or prison time of up to five years in Louisiana.

Pain-management clinics affiliated with hospitals, as well as surgical facilities, nursing homes and hospice care providers, are usually exempted from having to comply with the statutes and regulations, Green said.

A spokesperson for the Medical Association of Georgia declined comment on the bill.

Georgia has lagged behind other states in passing legislation to curb prescription drug abuse, primarily because some state lawmakers have been concerned about violating patient privacy rights or creating onerous hurdles for legitimate businesses, Allen said.

“Big Brother,” Allen said. “I heard that more times than I could count.”

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The story so far

• February 2010: Kennesaw Police identify the Pain Express clinic as a suspected pill mill, but the business shuts down within a month on its own accord. State officials at the time say they are tracking five suspected pill mills and authorities worry more could come to Georgia.

• March 2010: Kennesaw imposes a moratorium on the opening of any new pain clinics in the city. In subsequent months, Cobb County and its other cities, some municipalities in Cherokee County and the city of Milton follow suit.

• December 2010: A Cobb County Prescription Drug Task Force — the first of its kind in the state — recommends that city and county leaders could help stop the spread of unethical pain clinics by tightening their business licensing regulations.

• April 2011: State lawmakers approve the creation of a prescription drug monitoring database to help authorities track patients who are doctor-shopping and physicians who are over-prescribing medications. The Georgia Drugs and Narcotics Agency, responsible for administering the database, says it will not be operational until January 2013.

• May 2011: Federal, state and local authorities raid Atlanta Medical Group clinic in Cartersville in the first takedown of a suspected pill mill in Georgia.

• July 2011: State authorities say they are tracking more than 50 suspected pill mills that have moved primarily into the northwest corner of the state and into the Savannah area.

• November 2011: A dozen people from seven metro Atlanta counties are indicted as part of a pill mill ring that supplied customers from numerous other states. The DEA says there are now 90 or more suspected pill mills in Georgia.