Although regulations have clamped down some on over-prescribing, authorities are still finding pill mills in operation.
Since late last year, federal authorities have charged 87 doctors with operating pill mills where they overprescribed opioids. Data collection has allowed the feds to make those arrests and has helped contribute to guilty pleas from nine of the doctors so far.
Brian Benczkowski, head of the Justice Department’s Criminal Division, told CNN that while traditional tips are helpful, collecting and analyzing data on prescribing practices allow authorities to work efficiently at targeting the most egregious over-prescribers.
He said, “I think before we employed a data driven model it was a lot harder to find them in the first instance. You had to rely on local law enforcement providing tips. You had to rely on individuals in the community providing tips. The data tells us exactly where to go very quickly.”
How They Locate Pill Mills
The feds look at a few different pieces of information when analyzing prescription data: they see how far patients are traveling to a doctor, how many deaths are linked to that doctor, and the dosage strength that the doctor provides.
Federal guidelines recommend that doctors not prescribe opioids that measure more than 90 morphine milligram equivalents, or MMEs, per day. However, doctors operating pill mills prescribe up to 500 MMEs per day to patients. When that is outlined in hard data, it’s easy to know who to investigate, because “usually nothing can justify” writing prescriptions for so many pills, authorities say.
Once law enforcement knows where to look, spotting a pill mill is easy.
“When you go and observe this doctor’s office and you see lines down the block, you see people shuffling around waiting to go into the doctor’s office, you see behavior that looks very much like behavior you see in traditional street corner hand-to-hand drug distribution, it’s stark. It’s readily apparent what’s going on,” Benczkowski said.
How Do Pill Mills Work?
He explained how the pill mill operations work.
“They [the doctors] are taking cash and putting it in their pockets. [Patients] go into the doctor’s office, they leave $300 with the receptionist. They have a two-minute consultation with the doctor who writes them an opioid prescription and they walk out the door. And that line is processed like a conveyor belt all day every day. It doesn’t look like a normal doctor’s office.”
A Drug Enforcement Administration official said that investigating pill mills is a unique operation.
“We’ll do surveillance or send a confidential source in, and we’re really looking at the type of prescriptions doctors are writing and then asking medical experts, are these within the norms? It’s more of a chess game in a way than a traditional narcotics investigation. We’re a cross between investigating white collar crime and narcotics.”
Although regulations have clamped down on over-prescribing, authorities are still finding pill mills in operation, something that frustrates Father Brian O’Donnell of Catholic Charities West Virginia.
“I thought the fear of God had been put into doctors in the past few years,” he said. “I’m very disappointed to hear this is still going on.”
Patients Not Targeted in Opioid Prescription Crackdown
Benczkowski emphasized that the feds are focused on charging the doctors, not people addicted to opioids.
“We recognize that we can’t just prosecute our way out of this problem,” he said. “The individual patients are not criminal defendants, they’re victims. And we wanted to make sure that they had access to appropriate medical care and appropriate treatment resources.”