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Pill Mills Epidemic: The Changing Face of Addiction

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The heroin epidemic today has reached epic proportions. Perhaps the most alarming statistic involves the dramatic rise in the number of heroin-related deaths in the last 10 years. Shockingly, the most recent data shows that heroin fatalities quadrupled from 2003–2013, increasing an unprecedented 26% according to the Centre for Disease Control (CDC).

But how did we get to this point where, in the most recent CDC report in 2014, there were nearly one million heroin users (914,000) in the US, an increase of 145% since 2007, contributing to a heart-wrenching 10,500 heroin-induced deaths?

The heroin epidemic – widely viewed as the most devastating public health crisis involving drug abuse in our nation’s history (according to PBS) – can be attributed to a number of factors: a series of missteps, dishonest moves, oversights, criminal activity, and good old-fashioned greed.

The perpetrators, or ‘basket of deplorables’ if you will, have included: health officials, government organisations, politicians, pharmaceutical companies, policymakers, physicians, patients, and drug cartels.

The heroin epidemic owes its origin to 1980 when a one paragraph, non-peer-reviewed letter to the editor espousing the benefits of painkillers was published in the New England Journal of Medicine. The medical community gradually warmed up to the concept that chronic pain was a serious problem for lots of Americans and that we needed to start exploring other options. At the time, doctors wielded a cautious approach to prescribing pain medication. Some physicians went as far as withholding painkillers for patients suffering from stage 4 cancer.

The medical community’s ideological shift in addressing pain was precipitated by an aggressive marketing campaign by Purdue Pharmaceuticals – the drug maker of the blockbuster pain medication OxyContin. They advertised the pill subliminally by giving out OxyContin-branded ‘swags’ like fishing hats and stuffed animals to primary physicians. Pharmaceutical companies produced inspirational videos where real people provided uplifting stories about how they got their life back by using OxyContin, which eliminated their debilitating chronic pain.

The 1% lie

Purdue spread propaganda about their prized product. They used unsubstantiated claims, which were eventually found to be fraudulent, that had been issued by the non-peer-reviewed New England Journal of Medicine letter-to-the-editor, stating that less than 1% of its opiate pain medication users become addicted to the drug. And, by the way, this data was referring to people using pain medication for short-term use.

It wasn’t until 2007 that big pharmaceutical companies like Purdue Pharmaceutical paid dearly for their mistruths. Purdue alone paid a whopping $634 million for lying to the public. Meanwhile, other opiate-making pharmaceuticals like Cephalon and Insys also paid out substantial remunerations. 

Once this notion that doctors were undertreating pain was put in place, the pharmaceutical companies unleashed their well-oiled marketing machines to convince doctors that the only recourse for short term pain was the prescription of their company’s very own pain killers. So doctors responded like good soldiers by prescribing legal opiates like OxyContin, Percocet, and Vicodin to their patients.

As doctors began to increase the number of painkiller prescriptions, proportional deaths from these opiate prescription medications began to rise as well. By 2010, just in Florida alone, the de facto pill mill capital of the US, Oxycodone caused 1,516 overdose deaths. The situation started getting out of control when an outbreak of ‘pill mills’ started sprouting up throughout the state of Florida in the mid-2000s, reaching its peak in 2012. It was in 2012 that the DEA had signed off on the manufacture of 98 million grams of oxycodone in the US, which was up 40% from 2008.

What’s a ‘pill mill’?

By definition, a ‘pill mill’ was an operation in which a doctor, clinic, or pharmacy prescribed and/or dispensed narcotics such as opiate prescription drugs without a legitimate medical purpose. During the pill mill era, doctors were literally passing out drugs like Oxycodone, a powerful narcotic intended to treat intense short-term pain, like candy.

Florida ‘pill mills’ were so successful for so long because of liberal drug enforcement laws as well as a lack of prescription drug monitoring programmes. At one point, pain clinics were advertising in the back of newspapers and had customer rewards programmes.

Finally, in early 2011, law enforcement began aggressively cracking down, using laws against street drugs to prosecute doctors. Pain clinics were investigated and raided. Drug-dealing doctors were put on trial and sent to prison. Among the actions was ‘Operation Pill Nation‘, led by the Drug Enforcement Administration (DEA), which targeted rogue pain clinics in Florida.


The end result, a precipitous decline in opiate pain medications use, appeared to be good news. But actually, the opiate epidemic became even more dire as people addicted to drugs like OxyContin moved over to heroin, which was far less expensive and in the same opiate family, thus yielding similar effects to the drugs that they had initially become addicted to. What appeared to be good news created a much bigger problem in years to come – the heroin epidemic.

Karen Corcoran-Walsh is an expert in the treatment of mental health and drug or alcohol abuse and addiction, also known as dual diagnosis, with a specialty in working with teenagers.

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