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Chasing Dr. Feelgood Texas Medical Board shuts down pill mills BY CRYSTAL CONDE Texas has fewer pill mills churning out


massive volumes of prescriptions for powerful narcotics thanks to the Texas Medical Board (TMB). “We’re seeing blatant violations,” said TMB Executive Direc- tor Mari Robinson, JD. “This is crime, pure and simple; it’s not the legitimate practice of medicine. Pill mills are the largest problem TMB must tackle in Texas right now.” The “blatant violations” Ms. Robinson cites include clinics


registered to a physician who has never visited the site, clinics run by unlicensed foreign medical graduates, midlevel practitioners working at pain clinics with no physician oversight, and doctors who see 300 people a day and is- sue each one the same three pre- scriptions. “What the board is doing right now is cutting off drug dealers’ sources of income,” she said. Since Sept. 1, 2010, pain man-


“We’re seeing


agement clinics must be TMB-cer- tified to continue operating. The board has been busy enforcing the law. At press time, TMB had suspended 11 pain management clinic certificates and five physi- cians’ medical licenses because of rule violations. The board had received 491 applications for pain clinic certification. Of those, the board denied 26 and granted 362, while 34 were withdrawn and 69 were pending. Ms. Robinson says the board may deny applications if the physician owner has a restricted license, a felony on his or her criminal record, or has been disciplined by the board for past nontherapeutic prescribing violations.


When it comes to disciplining physicians for violating pain management clinic regulations, Ms. Robinson says, the board pursues the most egregious offenses first. According to the U.S. Drug Enforcement Administration


blatant violations.


This is crime, pure and simple; it’s not the legitimate practice of medicine.”


(DEA), diversion of hydrocodone products and pseudoephed- rine continues to be a problem in Texas. Primary methods of diversion are illegal sale and distribution by health care profes- sionals and workers, “doctor shopping” (going to a number of doctors to obtain prescriptions for a controlled pharmaceuti- cal), forged prescriptions, pharmacy theft, and the Internet. Cris Schade, MD, PhD, a Garland pain medicine specialist and past president of the Texas Pain Society, says the state is in the midst of “Generation Rx,” a national public health crisis of more overdoses from prescription medications than from heroin, co- caine, and inhalant use combined. For example, Scientific American reported in 2010 that a West Vir- ginia University School of Medi- cine study of deaths and hospi- talizations caused by prescription drugs between 1999 and 2006 showed that “overdoses of opi- oid analgesics alone … were al- ready causing more deaths than overdoses of cocaine and heroin combined.” According to Dr. Schade, phy-


sicians involved in pill mill activ- ity often share the following com- mon characteristics:


• They’re self-declared experts in pain management with little or


no training in the field.


• They’re not up to date on pain management literature. • They don’t attend pain management education courses or conferences.


• They have ethical problems and cognitive impairment. In the long run, the law relating to the certification of pain


management clinics will benefit Texas’ health care system and the state’s residents, Dr. Schade says. “The law addresses this serious prescription pill pandemic


July 2011 TEXAS MEDICINE 41


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