Florida ‘pill mills’ were ‘gas on the fire’ of opioid crisis
FORT LAUDERDALE, Fla. — Florida survives on tourism, but a decade ago thousands of visitors made frequent trips to the state not to visit its theme parks or beaches. Instead, they came for cheap and easy prescription painkillers sold at unscrupulous walk-in clinics.
For a while, few in authority did much about it even though it was all done in the open with little oversight.
The clinics started in the 1990s and began proliferating in about 2003, their parking lots filled with vehicles sporting license plates from Ohio, Kentucky, West Virginia and elsewhere. The customers were drawn by billboards on southbound interstates advertising quick and easy relief — code for “We’re a pill mill and we’re ready to deal.”
The clinics’ doctors did no diagnostic work. They just signed prescriptions and shuffled the “patients” to the clinics’ onsite pharmacies to buy oxycodone and other narcotics at $10 a pill, cash-only. Some pill-mill tourists would visit a dozen or more clinics before returning home with thousands of pills, which would be sold to their neighbors for up to $100 each. Within a few days, many again headed south to buy more.
The thriving “pill mills” helped seed an overdose epidemic that ended up devastating many of the communities where the pills were sent. This past week’s release of federal data showing the flow of prescription opioids throughout the U.S. from 2006 through 2012 has again put the spotlight on Florida’s pill mill industry, which in hindsight provided a blaring fire alarm about a crisis that eventually would claim tens of thousands of lives every year.
“You could think about the manufacturers as having lit the fire, and the distributors and pill mills were really pouring gas on the fire,” said Andrew Kolodny, who researches addiction at Brandeis University.
By the clinics’ peak in 2010, 90 of the nation’s top 100 opioid prescribers were Florida doctors, according to federal officials, and 85 percent of the nation’s oxycodone was prescribed in the state. That year alone, about 500 million pills were sold in Florida. The number of people who died in Florida with oxycodone or another prescription opioid in their system hit 4,282 in 2010, a four-fold increase from 2000, with 2,710 of the deaths deemed overdoses, according to a state medical examiners’ report.
The tide turned against Florida’s pill mills in 2011 when the pressure in the media and the public reached critical mass after several newspaper and TV investigations of the industry.
A new Republican governor, Rick Scott, agreed to a state narcotics tracking system. The newly elected Republican attorney general, Pam Bondi, made shutting down the pill mills a top priority, and the Legislature tightened the state’s drug laws. That included a ban on doctors and clinics dispensing opioids onsite, which is where the big money was made, and set limits on the number of pills most patients could receive.
Law enforcement received $3 million to target pill mills that violated the new laws.
The impact was immediate: Within a year, the number of pain treatment clinics registered with the state fell from 921 to 441 and by 2014 there were 371. Jim Hall, a Nova Southeastern University epidemiologist who studies Florida’s drug problems, said any pill mills that didn’t close voluntarily or comply with the new laws got raided.
“They would hit 16 or 20 a day,” Hall said.
While the pill mills closed, their legacy is the current heroin crisis. Opioid addicts switched back to heroin after foreign cartels learned how to bypass post-9/11 security, Hall said.
In 2018, because of the abuse of heroin and its even deadlier synthetic cousin, fentanyl, Florida’s opioid death rate reached 25 deaths per 100,000 residents, according to the National Institute on Drug Abuse, a 67% jump from the peak of the pill mill crisis.