Pill mills contribute to deaths, officials say

Before Larry Plunk got wise to them, he used to watch people who had just come into his pharmacy go out into the parking lot and divide up the pills he had just dispensed to them.

"What comes in our front door are kids 25 to 30 years old with prescriptions for muscle relaxers and pain pills," the Port Arthur pharmacist said. "People are addicted and selling half the prescription and taking the other half. We don't know, but that's what we suspect."

It's a trend that Plunk and others think is leading to deaths.

In 2008, in fact, exactly 61 deaths.

That's the number of Jefferson County deaths in which prescription drugs were a factor, according to statistics from the Southeast Texas Forensic Center.

Doctors, pharmacists and law enforcement officials all believe that illegal prescription drug use and the pain management clinics that illegally supply such drugs are behind much of the problem.

"Narcotic medicines have surpassed all others as the second leading drug of abuse only behind marijuana," said Dr. Daniel Harris, a trained pain management specialist with Coastal Pain Care in Beaumont. "In the long run, people with legitimate pain are going to get short-changed because the situation calls for some more stringent rules."

In the past two years, opiate narcotics commonly prescribed for pain have become a leading drug of choice for abusers.

"Without a doubt, it's our fastest growing narcotics problem," said Maj. Jim Singletary with the Jefferson County Narcotics Unit. "The majority of our operations involve pain management drugs in some form or fashion."

Jefferson County Sheriff Mitch Woods calls the three-drug cocktail commonly prescribed at so-called pain management clinics - Soma, Xanax and hydrocodone, usually sold as Lorcet, Lortab and Vicodin - "three of the most highly abused drugs out there."

A recent problem

Woods said local law enforcement didn't realize there was a problem until the deaths in which prescription drugs were a factor suddenly jumped from nine in 2005 to 56 in 2006.

"We had that increase, and it wasn't amazing to anyone, and the reason was because it was prescription drugs," Woods said.

People have a prescription from a doctor, so many people think taking the drugs are okay, he added, even if someone is taking 10 times the amount prescribed.

"Just because it's a prescription drug doesn't mean it isn't dangerous," said Resident Agent-in-Charge Ray Troy of the U.S. Drug Enforcement Agency office in Beaumont.

In 2007, there were 41 deaths, but law enforcement officials attribute the decline to two major pain management clinics that were closed in June of that year.

Last year, the number shot back up to 61.

"People are dying more from these drugs than from methamphetamine and crack cocaine combined," Singletary said.

At the pain management clinics, also known as "pill mills," patients typically pay cash for the visit and walk out the door with a prescription for the three-drug cocktail, he said.

Minus wait time, a typical visit to a local pill mill might last five minutes, and one or even two other people might be in the exam room at the same time, said Sheriff Mitch Woods.

An undercover officer for the Jefferson Co. Narcotics Unit recently paid $130 cash and waited five hours to be seen at a local pill mill. Once in an examining room, the officer was seen by a physician's assistant who conducted "virtually no" exam, said Singletary.

After visiting the connected pharmacy, the officer walked out with a three-month supply, 270 tablets, of Soma, Xanax and hydrocodone.

"It's called 'non-therapeutic prescribing,' and it's illegal," Singletary said. "They're dispensing prescriptions to patients with no medical need."

The problem has become so big that a diversion agent, who concentrates solely on such issues, recently was assigned to the DEA office in Beaumont.

Pain management clinics vs. pill mills

A visit to a legitimate pain management clinic might mean a drug test, a 45-minute consultation and treatment options that include injections and physical therapy as well as, and sometimes instead of, prescription medications.

"You don't have to go to a pill mill if you have pain, but you don't have to live with the pain either. It's not all narcotics," said Harris.

For he and his partner, Dr. Craig Charleston, who have trained specifically in pain management, the pill mills are hindering sufferers from getting the treatment they need.

"Pain management is not just prescribing by any means," Harris said. "It's medications, physical therapy, psychotherapy, intervention procedures…"

The two see themselves as patient advocates.

"Being an advocate does not mean we're going to write a prescription and everyone'll be happily ever after," Harris said.

Instead, they create a treatment plan that includes all aspects of pain, from the physical to the psychological.

Many times, Charleston said, patients walk in the door afraid they will be put on an addictive drug.

"I think there should be a genuine fear of narcotics," he said. "There's overdoses everyday and it's not something that happens to someone else."

A typical initial consultation session at Coastal lasts about 45 minutes, the doctors said, and a follow-up session averages about 25 minutes.

Often, treatment at Coastal includes injections that combat the patient's pain and make pills unnecessary. And, at some point, Harris and Charleston say that surgery can be needed.

"If you're continuing to write 'scripts and not sending to surgery, you are doing a disservice to patients," Harris said. "A lot of patients lose that opportunity to have further treatment."

Filling the 'script

The other side of the problem, officials say, are the pharmacies that fill the drug-cocktail prescriptions.

Larry Plunk, pharmacist and owner of King's Pharmacy in Port Arthur, is one who does not.

That means he has, on a peak day soon after Hurricane Ike, turned away 70 people in one day.

"I asked one of them where they had been getting these filled and they said the pharmacy was down because of the hurricane," Plunk said.

On a regular day, he says he turns away at least 10 people.

Plunk broke his own rules, however, when a woman in her 80s came in with the drug cocktail prescription from what Plunk suspects is a pill mill.

"Her insurance called and said they had assigned her to that clinic and she really did need the medication," he said. "There are some people who actually need these things, and those people are falling through the cracks."

When someone comes in with a prescription, pharmacists have to make a judgement call on whether or not to fill it, Plunk said.

"It puts us in the position of being judge and jury," he said. "There's some little old lady who's falling through the cracks."

Plunk advocates for stiffer laws for doctors who write such prescriptions and pharmacists who are asked to fill them.

"Pharmacists are going to have to recognize their ethical professional responsibilities and stop it at that point," he added.

Fixing the problem

Law enforcement officers, doctors, pharmacists and law makers all agree that the only way to fix the problem is legislation.

"We're not going to get a handle on it until we get some laws passed," said Sheriff Mitch Woods.

Assistant U.S. Attorney Brit Featherston said that cases against pain management clinics are "very delicate."

"We're trying to make sure that what they're doing is within the realm of normal medical practice," he said. "Once it's outside that norm, they start going into the same function as a drug dealer."

Such cases are document and resource intensive and even then, it is hard to get a solid case unless doctors are straight-out selling prescriptions or trading them for sex, Featherston said.

In Louisiana, laws penalizing so-called "doctor-shopping," have been passed. The term refers not to picking your doctor, but to going from doctor to doctor trying to get prescriptions for drugs.

A similar bill is being drafted in the Texas Senate, said Sen. Tommy Williams (R-Woodlands).

A second bill, also in the draft-stage, would license pain management clinics, making them submit to an annual review and renew the license every two to three years, Williams said.

"This is not unique to Southeast Texas. It's happening all over the state," he said. "I think we have a particular problem because of some of the changes in regulations in Louisiana pushed people over here."

The bills won't be filed for at least a month, Williams said, and might not be voted on until the end of the session in April or May.

Local law enforcement officials are hoping the bills become law as soon as possible.

"It's hard to dedicate a lot of time and effort to this when the laws aren't there," said Commander Ron Hobb of the Jefferson Co. Narcotics Unit.