How to recognize a pill mill in your community

By Erika Norton
MILFORD, Pa. — When pill mills get shut down, they’re usually in heavily populated urban areas, but the latest pill mill was found a lot closer to home.
On July 20, Fuhai Li, a physician practicing at the Neurology and Pain Management Center in the small borough of Milford, Pa., was arrested and indicted on charges of allegedly distributing controlled substances, such as oxycodone and other narcotics, without a legitimate medical purpose, according to the U.S. Attorney’s Office for the Middle District of Pennsylvania. Authorities said Li had $1 million in cash in his home and in his office.
So with the rise in the opioid crisis nationwide and an alleged local pill mill recently shut down, The Warwick Advertiser asked local and federal law enforcement officials what are some of the red flags that readers can look out for in their communities to try and recognize a pill mill operation?

What to look out for

Barbara Carreno, a spokesperson at the Drug Enforcement Administration which enforces the federal controlled substance laws and was instrumental in the Milford investigation, said that while there are legitimate pain clinics, there are some common patterns and indicators of illegal pill operations that the public should be aware of.
“If you go to a clinic the first thing in the morning when it's time for it to open and there’s long lines and you see cars with out of state license plates in the parking lot," Carreno said, “if you go into the clinic and it’s a cash only business, they don’t want to take your insurance, and you see armed security guards there, those kinds of things are indicative of being a pill mill as opposed to a legitimate pain clinic.”
Things such as a lot of people coming into the clinic at the same time or close together with the same prescription, meaning not just for the same drug but for the same dosage, that’s also a sign of illegal activity, according to Carreno. Excessively large quantities of controlled substances being prescribed, large numbers of prescriptions being issued compared to other physicians in an area, and warnings to the patient to fill prescriptions at different drug stores could all mean the practitioner is inappropriately prescribing, according to DEA literature.
Carreno said that not just doctors, but dentists, veterinarians, podiatrists and nurse practitioners are all required to follow the guidelines laid out in the Controlled Substances Act (CSA). An important specification within the law is that practitioners are required to do a physical examination before prescribing or dispensing medication.
“If a doctor doesn’t do an examination,” Carreno said, “that’s a big red flag.”
A Town of Warwick Narcotics Unit Officer, who requested to remain anonymous due to his undercover work, also echoed similar indicators of pill mills, saying that lots of out of state license plates in the parking lot and security guards are a bad sign. He said that while there haven’t been any doctor’s offices shut down for illegal activity in the town of Warwick, from his training and research, he knows that there was at least one pill mill operation shut down in New York City that some Orange County area residents were travelling to.
He also said that there are some signs to look out for if someone suspects a neighbor is selling controlled substances out of their residence.
“As far as a person selling the prescription pills, some of the things I would say would be indicators would be a high volume of traffic at the person’s residence,” he said, ”people coming out going to a vehicle and then going back into the house or vice versa.”

Part of the nationwide opiate crisis

The Warwick police officer said that he thinks these sorts of illegal pill mill operations are a concern in every town in the Unites States with the opiate crisis affecting not only big cities, but suburban area all over the country.
In the entire state of Florida where pill mills were a big problem, a tougher law regulating pain management clinics went into effect in 2011 requiring clinics to be registered with the state. Doctors can also no longer dispense opioid prescription painkillers from their offices, according to Carreno, because previously, pain clinics would hire retired physicians to come in and just dispense medications.
“There’s people that have legit injuries that get put on pain medication by their doctor,” the Warwick narcotics officer said. “It’s either the body becoming addicted to it or the doctor overprescribing. I don’t think most people want to get addicted to it.
“I think that’s just what the doctors are doing right now is that they prescribe the pain medication for a lot of injuries and then the person becomes addicted to it, maybe they’re not weaned off it correctly, maybe they just develop an addiction and that’s what we're finding is causing people to try to obtain the pill illegally because they are not ready to come off the pill or they have such a bad addiction, they have to have that pill.”
What’s becoming more common is that someone who is addicted to opioids such as oxycodone or hydrocodone will often turn to heroin because it is much cheaper. The Warwick officer said that pills are usually sold illegally for a dollar a milligram, so just one ten milligram pill would be $10.
He said in Paterson, N.J., bags of heroin go for about two to three dollars a bag. In the Orange County area, the average cost of heroin for one bag is around $10, so dealer's up in the Orange County area are making a 60 to 70 percent profit.