Pill Mills Are Death Traps — Marginally Legal

Here are some phrases that you might not expect to hear sweet, friendly Dr. G use very often:

“No, there is no way in hell I am going to renew that prescription as written.”

“Read my lips.  No more oxycodone.  We gotta get you into a rehab, sweetie.”

“Sure, you can see another doctor.  I don’t know how long it will take to get an appointment.  If I am your doctor, you go on a tapering schedule.  Today.”

“If I did what you want, I could kiss my license goodbye.  I am not prescribing outside my specialty and certainly not this crap.  Yes it is crap.  I am sorry you don’t like how I talk, but it is crap.  I can start getting you off it.”

These are all things I have actually said.  Usually loud, yelling over the patient.

No — this is not my style. My first tactic is to show that I am basically a nice girl, and ask for pity.  Sometimes it works – but not really very often with drug seekers.

If somebody is desperate for pills, I can usually scare up a little empathy, but I am no good at pity.  I can try to reason with them, I can ask them to understand what a risk I would be taking, I can even ask them to consider how much damage they are doing themselves by continuing their drug abuse.

But it never really works.  The addiction is the most powerful force in nature.  More powerful than gravity, more powerful than tsunami, more powerful than nuclear reactor melt-down. I don’t usually see many patients from “pill mills” in the rural counties of California.  That is because such institutions are generally concentrated in Texas and Florida, and cater to patients who pay cash up front, something the rural poor of California could not do on a good day, even a little. I did have a patient once who asked me if I knew where there was a “no questions asked” facility so he would get all the morphine he “needed.”  He had limited intelligence, was over-medicated, but had enough animal strength to throw a “hissy fit” when I said such facilities were illegal and if the county had one I would not send him anyway. The folks at Fox News give a fairly graphic description of what a raid on a “pill mill” is like. CBS news tells you how to know if you are stuck in one. Basically, I would think people would know if the law is being broken, but that would imply a degree of awareness that simply may not exist in folks who are in the vice-like grip of a dependency on prescription drugs. People may even need to be reminded that just because it is prescription, does not mean this is not as real an addiction problem as any street drug. The guidelines bear clarification: These facilities are cash only facilities, and the cash is always demanded prior to service. There is no physical examination, no medical records, and additional tests are not requested nor required. Hmmm – sounds like our California medical marijuana mills, doesn’t it? Bust in the Pill Mills, pain is treated with nothing but pills. The patient even gets to pick which, but the prescription must be filled at the pharmacy that is part of the facility.  A set number of pills is dispensed, and there is a date to come back for more. There are security guards, and plenty of patients. Prescription drugs are second only to marijuana in terms of abuse. They are second only to traffic accidents as a cause of death. Doctors are not supposed to give these things out in this manner. This is “drug trafficking” pure and simple.  It is a felony, and the doctor can get up to life in prison.  “Doctors to the stars” have learned this lesson the hard way – such as the doctors of Elvis Presley, Anna Nicole Smith and Michael Jackson. So much for the concept of “victimless crime.”  The patient is a victim, for deaths by accidental overdose skyrocket.  We hear about a few high-profile deaths each year, such as Howard Hughes, Judy Garland and Marilyn Monroe.

Shift gears — Addictive narcotics stop helping the pain for which they are prescribed, and do so fairly quickly. Pain receptors get less sensitive to narcotics, and people get habituated.  It takes increasing amounts to produce the same effect. That means we are looking at a slippery slope from the get-go, when addictive narcotics are prescribed.  There are non-drug treatments for pain that work great, things like emotional freedom technique (EFT) or related techniques that use acupuncture meridians of the body.  There are drugs that are not addictive, like Tegretol (carbamazepine) and Dilantin (diphenylkhydantoin) and most people never even get tried on these drugs, which work for certain kinds of pain.  A real pain management clinic will come up with a plan, not just a bottle of pills. Real pain management starts with a physical examination. Real medicine is very different from a “pill mill.” The addict can’t make rational decisions, so his or her life depends on others involved.

Sometimes, the doctor is the problem.  Mostly, doctors are the first-line in intervention and help.

But if you are a spouse, family member or friend of someone involved in such risky business, please take action to save the life of a loved one.

Every life is precious.  There is no such thing as a hopeless addict.

Just one who is mis-managed.