article

07.29.09

Pill Mill Capital Cracks Down

In the wake of Michael Jackson’s death, a South Florida town that’s ground zero for pain-management clinics—which critics say cater to drug abusers—has begun to curb the so-called pill mills. But Gerald Posner says the age of the pill mill is far from over.

Editor's Note: In an earlier version of this article, five sentences were copied from a Miami Herald report without attribution. The Daily Beast regrets the error.

Dania Beach, a town of 30,000 just 25 miles north of Miami, became the first South Florida city to address Broward County’s reputation as the American pill-mill capital by unanimously approving an ordinance late Tuesday night.

Under the new law, future pain-management clinics would be banned from redevelopment zones that include the primary tourist and shopping areas. They also will not be allowed to dispense medications on site, one of the major draws for the clinics.

In April, Dania Beach issued a moratorium on the clinics over the objections of supporters who contended they provide a critical medical service for those in chronic pain. Critics charge that most cater to drug abusers, and many of the prescriptions filled in Florida’s clinics end up on the streets of other states where they reap huge profits for dealers.

Incredibly, Florida has no law to track the prescriptions written, so it is possible for someone to go to multiple clinics the same day and fill one prescription after another.

Nearby Oakland Park, which has 18 pain clinics within a two-mile radius, had considered a moratorium in March but decided it was too difficult to determine the difference between a pain clinic and a medical office.

“What we are trying to do is to tell them to not come here; they are not welcome,” said Dania Beach Mayor Anne Castro.

The Dania Beach action is the first by any Florida city since Michael Jackson’s death has drawn attention to the issue of addictive prescription-pill abuse. Almost 100 new clinics had opened since January 2008 in Broward and Palm Beach counties alone. Florida has always been slow to adopt laws to restrict access to the most potent prescription drugs. Until Quaaludes (a powerful sedative) were made illegal in 1984, Florida had more Quaalude clinics than the rest of the country combined. Just 45 South Florida doctors are responsible for prescribing nearly 9 million Oxycodone pills in only six months. Thirty-three of the top 50 Oxycodone-dispensing doctors in the United States practice in Broward County.

Even before the Jackson death focused attention on prescription-drug abuse, Florida law enforcement and medical officials had been blaming the pain clinics for a sharp increase in overdose deaths. Nearly 1,000 deaths last year involved Oxycodone, the main component in such brand-name painkillers as OxyContin, Roxicet, and Percocet, a 33 percent increase in a year. Prescription drugs accounted for 75 percent of the drugs found in fatalities last year, and overdoses from painkillers and antianxiety drugs cause more deaths than cocaine, according to the Florida Medical Examiners Commission.

According to the Miami Herald's Scott Hiaasen: "Until now, pain clinics have escaped rigorous state inspections because of a quirk in the law that exempts facilities that don’t take insurance--and many clinics accept cash only. This loophole also allows clinic employees and owners to avoid the background checks required at other health clinics." The Herald "has identified more than a dozen doctors and clinics owners in South Florida with disciplinary records or criminal convictions. One man continues to own an Oakland Park pain clinic while in jail awaiting trial on charges of trafficking Oxycodone."

On June 18, Gov. Charlie Crist signed a bill aimed at regulating pain clinics and establishing a statewide prescription-monitoring program. Incredibly, Florida has no law to track the prescriptions written, so it is possible for someone to go to multiple clinics the same day and fill one prescription after another. Health advocates had been pushing for a monitoring system for eight years, but their efforts were blocked annually in Tallahassee by lawmakers who worried a database might threaten patient privacy.

The easy access to some of the most potent and controlled prescription pills has made South Florida popular with visitors who drive in from as far as West Virginia, Kentucky, Ohio, and Georgia—the most successful Florida clinics advertise discounts for out-of-state patients and offer coupons for gasoline. In a racketeering indictment handed down in May, federal prosecutors charged that Bonanno crime family members used pain clinics to distribute and sell prescription drugs.

As Hiassen reports, "The new law, passed nearly unanimously in the legislature, will require doctors and pharmacists to record patient prescriptions for most drugs in a state-controlled database." It was supposed to begin in 2010, but delays in building the database may mean there won’t be any monitoring until 2011.

Until the new law is in effect, it’s up to the Florida Health Department to monitor the pain clinics. In June, the state board took strong action against three doctors. Delray Beach pain doctor Douglas Smith lost his medical license for his third painkiller-related violation in 18 months. In one instance, Smith had repeatedly prescribed a potentially deadly combination of 270 narcotic pills and 15 pain patches a month to an unnamed 49-year-old man. In 2008, Smith had been fined $20,000 for giving 240 pills to treat pain and anxiety to a 22-year-old first-time patient, who was found dead the next day of an overdose.

The medical board fined Dr. Lowell Adkins of Pompano Beach $10,000, imposed two years of probation, and suspended his license to prescribe addictive drugs for six months. In 2007, Adkins prescribed 180 pills a month for a 23-year-old man, even after the man’s mother pleaded with Adkins to cut off the medication because her son was addicted and snorting the drugs. The patient, now clean, has admitted he pretended to have knee pain to get drugs for himself and friends.

The third doctor, Rachael Gittens, was suspended for 90 days and given one year of probation (she has appealed). The complaint against Gittens contended she signed 33 painkiller prescriptions with the names left blank for patients she never saw while working at a now-closed pain clinic in Wilton Manor. Gittens’ employer at her former clinic was Christopher George, a Palm Beach County man with a criminal record of grand theft and illegal steroid possession. Pills prescribed by Gittens were seized in a narcotics investigation in Kentucky in 2008.

But since the legislature passed the bill, at least 17 new clinics have announced grand openings in South Florida. Although the audience at Tuesday night’s Dania Beach vote applauded the new law, three new clinics that had opened since January will be grandfathered in.

“Now that we have run them off from here, I am sure they will be opening up in other cities,” said Commissioner Albert Jones. “I am hoping other cities now do the same thing we did here tonight.”

Until other cities follow Dania Beach’s lead, the age of the pill mill is far from over.

Gerald Posner is The Daily Beast's chief investigative reporter. He's the award-winning author of 10 investigative nonfiction bestsellers, ranging from political assassinations, to Nazi war criminals, to 9/11, to terrorism. He lives in Miami Beach with his wife, the author Trisha Posner.