Big business of 'pill mills' drawing scrutiny

Unregulated pain management clinics are coming under fire by critics calling them “pill mills” and “medical crack houses.” Some have called for moratoriums on the clinics until greater national oversight can be established.

But the doctors who run pain management clinics say they resent being called pushers and drug dealers. They say they provide a much-needed service and relief to millions of pain-racked Americans nationwide.

According to the American Medical Association, more than 48 million Americans receive treatment from pain management clinics. Treatment ranges from physical therapy to surgery and the prescription of narcotics.

Pain management is big business. In 2004, the pharmaceutical industry generated more than $250 billion in painkiller sales, according to industry reports. Twenty-five states have prescription-monitoring programs. The states without such programs including Colorado, gave rise to “pill mills” that profit by dispensing narcotics freely.

In April, the DEA raided three clinics in Louisiana where pain clinics are unregulated. Louisiana Sen. Tom Schedler introduced a bill in April calling for a statewide ban on new pain clinics to go with similar prohibitions already approved in other areas of Louisiana.

Public officials say the moves are necessary to prevent the rise of one-stop prescription pill shops. But pain management physicians say the moratoriums are “knee-jerk” reactions that hurt those most in need and drive honest doctors out of the state.

Dr. J.S. Hochman, executive director of the National Foundation for the Treatment of Pain in Houston, called Louisiana’s ban “stupid on the other side of ridiculous. It’s like banning diabetes treatment because some addicts got a hold of the insulin needles,” he said. Legitimate pain clinics, Hochman said, weed out addicts through urine tests and comprehensive histories and consultations.

A Colorado Springs doctor said there are other ways to prevent prescription abuse. “I am a big proponent of legislation that promotes a computer-based physician prescribing tracking mechanism, which allows pharmacies or hospitals to track patients who use controlled substances,” said Dr. Steve Benecke, the medical director for Colorado Pain Institute and the chief of pain services at Memorial Hospital in Colorado Springs. “It’s a safety mechanism to ensure that patients aren’t going from one physician to another.”

Benecke said Gov. Bill Owens could sign into law legislation that will allow Internet tracking of physician prescribed controlled substances. “We are hoping in the next two years to have that online,” he said. “It would enhance safety greatly – Utah and Wyoming have already implemented it.”

Regulation is one thing but physician responsibility is another.

Pain management is used in conjunction with other modes of medicine like physical therapy and psychological support, Benecke said. He is board certified in pain management through the American Academy of Pain Medicine and board certified in anesthesiology through the American Board of Anesthesiologists.

He said pain management practices in Colorado Springs could withstand “any kind of scrutiny.” There are pain treatment plans and random pill counts and drug screening for people suspected of misusing medications, he said.

But nationally, measures to prevent pain medicine abuse are currently in the hands of Congress.

In March, the American Society of Interventional Pain Physicians reintroduced a bill in Congress to establish a national database to monitor all prescriptions. The National All Schedules Prescription Electronic Reporting Act is expected to come up for a vote as early as June. Dr. Laximaiah Manehikanti, chief executive officer of the American Society of Interventional Pain Physicians in Paducah, Ky., said a national database is the best way to ensure that neither patients nor doctors abuse the system.

Many pain management doctors and patients, however, believe the combination of DEA raids, moratoriums and databases will drive medical professionals out of the practice and limit the treatment choices of patients.

Hochman said it costs doctors up to $1 million and can take five years to prove their innocence after a drug-dealing indictment. Schedler said these fears are unfounded and paranoid. The moratoriums and the law enforcement actions are aimed at clinics with no examination rules that prescribe inordinate amounts of narcotics and operate cash-only businesses. Legitimate doctors, he said, have nothing to worry about.

Eliminating illegal clinics will make it easier for legal clinics to operate, he said. None of the pain management professionals dispute the need to eliminate “pill mills.” But they claim Louisiana’s approach demonizes their practices and the sickness of addiction. “It used to be a nightmare for just the poor addicts but now they