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The most shocking single aspect of the problem of prescription drug abuse is the existence of pill mills. Unscrupulous pain clinic operators and unscrupulous physicians join together to distribute large quantities of prescription opiates to pseudo-patients. For many years the center of pill mill operations has been Florida. Florida laws allowed physicians to purchase opiates and distribute them in clinics. By 2010, Florida doctors purchased 89% of all oxycodone purchased by medical practitioners in the United States! (New York Times, Aug. 31, 2011)
However, new Florida laws have markedly changed the Florida pill mill industry. Tougher laws have shut down approximately 40% of the pill mill clinics. 80 doctors have had their licenses suspended. As of July, 2011, Florida doctors are barred, with a few exceptions, from dispensing narcotics in their offices or clinics.
In October, 2011, Florida started a prescription drug monitoring system, similar to that already adopted in most states (see state laws).
The changes in Florida law have by no means eliminated the pill mill industry. Even within Florida, pill mills continue to flourish. Many of them have moved operations from southern Florida to northern Florida, where enforcement is not as tight. And this last September, Florida Surgeon General Frank Farmer spoke of his dismay that it takes an average of 134 days to suspend a doctor's license even if law enforcement had found probable cause that the doctor had been indiscriminately writing prescriptions to cash in on the illegal painkiller trade.
Many Florida pill mills have simply moved elsewhere. After a raid on 19 businesses and homes in metropolitan Atlanta on Nov. 15, 2011, prosecutors said the pill mill conspiracy they had busted had moved to Georgia two years ago when the operation was shut down in Florida. John Comer, acting special agent in charge of the Drug Enforcement Administration Atlanta field division, commented, “Georgia is the epicenter of the pill mill pain clinic issue in the Southeast and, to a greater extent, the nation." He also stated that Georgia is “the place to come for pills.”
Internet "Rogue" Pharmacies
Sadly, recent newspaper articles out of Florida suggest that as pill mills are shut down, sales of pescription opiates over the internet may increase. Internet "rogue" pharmacies selling controlled substances are easily found on the internet. These illegal operations have the disadvantage to the purchaser of the time it takes for the drugs to get to the purchaser, uncertainty as to whether the purchaser is getting an active substance, and the possibility that the drugs will be intercepted as customs.
The role of internet "rogue" pharmacies in the distribution of controlled substances is uncertain at this time. In 2007, the DEA called the Internet a major contributor to prescription drug abuse. However, implementation of the Ryan Haight Act in April 2009 gave DEA additional power to crack down on the dispensing of controlled substances online without a valid prescription. Recent reports from both Substance Abuse and Mental Health Services Administration (SAMHSA) and the Drug Abuse Warning Network (DAWN) suggest that the contribution of internet "rogue" pharmacies to abuse of prescription opiates is relatively small, but warnings that this may underestimate both the present problem and the potential for internet "rogue" pharmacies to make up for the loss of sales from pill mills are sounded not only in the Florida newspaper articles mentioned above, but also in the Internet Drug Outlet Identification Program Progress Report for State and Federal Regulators:July 2011 from the National Association of Boards of Pharmacy (NABP) ( http://www.nabp.net/news/assets/IDOIReportJuly11.pdf).
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