KNOXVILLE, Tenn. -- For years, pain clinics that knowingly overprescribe highly addictive painkillers were allowed to operate in Florida, attracting addicts and drug dealers alike, lawmakers, police and pain management specialists say.
But since October, when the Sunshine State began cracking down on such pill mills, clinic operators have crossed the border into other Southeastern states. In East Tennessee, storefront pain clinics have increasingly popped up because of lax state laws and a high demand for painkillers, said state Rep. Bob Ramsey.
"There's been a migration that tends to ebb and flow based on law enforcement in these other states," said Ramsey, a Republican.
Tennessee has taken steps to toughen oversight of pain clinics. A new law, co-sponsored by Ramsey, passed this year aimed at restricting ownership and requiring certification. Detailed rules are due by October from the Department of Health and various licensing boards.
The state already maintains a controlled-substance monitoring database, which is credited with reducing the number of narcotics being dispensed by 10 percent since 2008.
Dr. Joe Browder, of Pain Consultants of East Tennessee, welcomes the effort to close down pill mills. "It's a start," he said..
When he began practicing pain management in 1992, it was a new medical specialty. Research during the 1990s and early 2000s indicated the use of pain pills was safe and effective. "When OxyContin first came out, it was marketed as ... a completely safe medicine," Browder said.
In recent years, clinics specializing in pain treatment have opened. Now, when a patient requires more medication than the primary care or referring doctor wants to prescribe or can monitor, the patient is typically sent to a pain clinic.
The Tennessee Board of Medical Examiners' website outlines a nine-step process for providers who prescribe controlled substances, but compliance varies.
"It's a basic guideline back from '95 on how you should do it. Some practices are not even halfway following it," Browder said.
The pill mill phenomenon exploded over the last three or four years as more providers sought big money in what has been an unregulated industry. Recently, states begin to craft laws that toughen oversight of pain clinics.
"There are some people who don't understand at all the damage these medications can do, and there are those who don't care. For $1 million a year, it's easy to not care," Browder said.
If a clinic sees 30 patients per day at a cost of $300 each, it's generating nearly $10,000 daily, or about $2.2 million annually under a standard work year.
"The cash rewards are tremendous to prostitute your medical license for this type of pill-mill practice," Browder said.
Meanwhile, an enterprising patient with a 90-count supply of 40 milligram Oxycodone can sell the drug for $1 a milligram, or $3,600. Subtract the $300 clinic visit and $600 to get the prescription filled and the patient can pocket around $2,700 in profit.
"It's very tempting for people to get into that business and even if they get shut down, as long as they don't go to jail, they'll just pop up somewhere else," said Dr. Christopher Vinsant, medical director at Mercy Pain Management in Knoxville, Tenn.
Vinsant said reputable clinics first try to alleviate pain through methods such as procedures, physical therapy, psychological evaluations and non-narcotic medication.
Still, questionable operators have elicited a negative connotation for all pain clinics.
"The illegitimate practices have tainted the entire specialty," Browder said, "and it really makes me sad that what I do is hard to separate from the profiteers out there who are using it as way to make money and not to be a physician."
Earlier this year, Browder spent several days in Nashville lobbying for new legislation regulating pain clinics. The bill, signed into law May 31, takes effect Jan. 1.
Rules governing pain clinics must be established within the next two months. Among the requirements: A pain clinic must have state certification. Its owner can't have a felony or misdemeanor conviction related to the distribution of illegal prescription drugs or controlled substances. Pain clinics also won't be allowed to operate on a cash-only basis.
Currently, pain clinics are not required to register with the state. Pain clinics owned by a physician also are not required to have a business license.
Tennessee does require pharmacists and health care providers to report controlled substance transactions twice monthly. The information, put into a searchable database, helps monitor patient drug habits.
(Contact Carly Harrington of The Knoxville (Tenn.) News Sentinel at firstname.lastname@example.org.)