The bill, approved in the Senate Thursday, would license and regulate pain management clinics, and require the owner to be a doctor. The law would stop short of requiring doctors or pharmacists to use a state registry to track how much of a painkiller a person is receiving, which some neighboring states have done. The bill, which already passed the House, now goes to Republican Gov. Nathan Deal. A spokesman declined to say whether the governor would sign it.
For Bartow-Cartersville Drug Task Force Commander Capt. Mark Mayton, whose agency was lead in busting a pill mill operating at 16 Collins Drive, Cartersville, in 2011, said the law, if signed by Deal, would be the beginning of what needs to be tougher legislation targeting such operations.
“Honestly, I don’t think it’s enough. We need to be tracking the amount that’s being dispensed, who it’s being dispensed to,” he said. “It’s a good first step. I believe having the doctors own the clinics is a good first step because there’s ... a higher accountability level for the physicians. They stand to lose a lot more than just what they have in their pocket. They lose their licenses, their livelihoods, so the accountability will be better there. I do believe they need to get the tracking system up and running.”
Georgia passed legislation in 2011 to create a program to track prescription drugs dispensed here, but it isn't expected to start operating until May, in part because of a delay in funding.
A pain clinic is defined in the bill as a medical enterprise where at least half of the patient population is being treated for chronic pain. Affected businesses would have to get a state license beginning in July. Licenses would have to be renewed every two years.
The proposal would also require new pain clinics to be owned by physicians licensed in Georgia. Existing clinics where non-physicians have ownership with doctors would be allowed to remain open.
As with the Collins Drive facility, the dozens of pain clinics across Georgia that authorities believe are illegally prescribing or dispensing the drugs often have parking lots full of out-of-state license plates, evidence that people are coming from hundreds of miles to seize on an unregulated industry.
“There are legitimate pain clinics out there. People have chronic pain, but when we have people traveling to these pain clinics and none of them live in the state of Georgia, that is a clue,” Mayton said. “That’s a red flag to us that it is not a legitimate medical facility rendering legitimate medical care to people who have chronic pain.”
Kentucky, Ohio, Tennessee, West Virginia, Texas, Louisiana, Florida and Mississippi have all passed laws targeting such pain clinics, according to the National Conference of State Legislatures.
"We're one of the few states in the Southeast that hasn't touched it, so we're the place that all these out-of-towners come," said Attorney General Sam Olens. "It's a huge problem that's killing our kids, and we need to be going after the bad actors and protecting the professionals."
“Sometimes — and I stress sometimes — what happens is you get people who have legitimate injuries that take these pain medications to relieve the pain and they become addicted to them,” Mayton said. “But, the back side of that is, there are people out there who will exploit their weaknesses — dealers, you know, ‘I’ve got all you need.’ ... They will actually send multiple people to multiple clinics, pay them to go, pay their bill, give them a little bit of the pills to bring back the bulk of the pills to them so they can distribute them and sell them.”
The most common pills dealers and addicts want are oxycodone and hydrocodone, which are highly addictive. Some shop around the state, gathering prescriptions from numerous clinics before returning home to sell the drugs.
“We call it the slang term, hillbilly heroin, because it has the same properties as heroin,” Mayton said. “You get the same physiological effects from oxycodone and hydrocodone as you would from heroin. Probably the best way to describe it is, it’s a downer. It depresses all your senses, your central nervous system. You get a stuporing, drunken, lethargic effect from it.”
According to estimates from the Georgia Drugs and Narcotics Agency, there were fewer than 10 pill mills in the state in 2010, while the number has exploded since then, fluctuating between 90 and 140 over the last year.
Because some pain clinics are legitimate, prosecuting those that aren't can be difficult, said Barbara Heath, the head of the Drug Enforcement Administration's diversion program in Georgia, Tennessee, North Carolina and South Carolina. If the prescriber is a doctor — and not someone forging prescriptions — prosecutors must prove the pills aren't for a medical need.
Currently, the Georgia Medical Board oversees the guidelines for how physicians prescribe medication to patients.
“When we first initiated this pill mill case, we consulted with several physicians, some of whom were on the medical board. And one of the statements that was made to us was the amount of drugs that they were ... prescribing at the pain clinic they would give to a stage IIWI cancer patient. So, you know, you’ve got a stage III cancer patient who’s getting less than a person who’s going in here to buy these drugs to sell on the street. Where’s the justice in that?” Mayton said.
Other red flags include clinics with a large percentage of out-of-state patients, patients receiving the same large amount of the same drug and clinics with a bouncer at the door.
“Certainly, we do not want to deprive anybody who has legitimate medical conditions, but by the same token, we don’t want to be putting drugs on the street, increasing the addiction, the crime rate, so there needs to be some intervention there,” Mayton said. “I was a proponent for it early on to do some legislation, but I said that, in that legislation, there needs to be some teeth in that gives us ... authority to deal with those pill mills other than administratively dealing with them. There needs to be criminal consequences or penalties for running an illegitimate pill mill.”
Mayton said the tough stance on the Collins Drive clinic has sent a message to such operations about the county’s position on pill mills.
“I honestly don’t believe we will see any pain clinics here in the near future, referring to our current case that we have going on with the pill mill, without going into any details because the case hasn’t been adjudicated yet totally,” he said. “There has been some pleas entered in the case, some guilty pleas, and we are waiting for the rest of the case to come to a close so we can get full adjudication on the case.”
“I would note that we were first to criminally charge a pain clinic in the state of Georgia,” he added.
In 2012, the city of Cartersville approved an ordinance that tightened regulations surrounding the establishments known as pill mills in hopes of detering their existence within the community.
— The Associated Press contributed to this story.