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NJ Pill Mills

A report released by the New Jersey Commission of Investigation made news last month because it “named names.” News outlets were quick to tell about clinics that were dispensing large amounts of narcotics to patients, and one doctor in particular, Randy Zeid, was identified as prescribing opiates in suspicious quantities. No charges have been filed against the doctor, but the allegation was enough to get him fired.

It would seem, at first glance, that the number of pills prescribed, when they are in excess of some reasonable amount, would be enough to identify a clinic or physician who has crossed the line and is simply passing out pain meds to whomever wants them – including opiate addicts. But there are legitimate reasons why one doctor or clinic might appear to be a problem when they are not.

For example, in any ranked list of quantities of narcotics dispensed, someone will be at the top. And, in an environment where “regular” doctors are fearful of prescribing strong pain meds, patients will tend to go to specialized pain clinics. The combination of these two factors means that specialty clinics will naturally prescribe more, even a lot more, opiates than other facilities. The situation parallels what happens with other specialized drugs – cancer clinics prescribe more cancer drugs for the same reason.

To make the case that a physician is running a pill mill, more investigation is needed.
Law enforcement has two main methods of doing so. The first is to track back drugs they find on the black market. Just as they would work up the chain with meth or cocaine, police can find out where an “Oxy” or other narcotic came from and whether it was originally prescribed for a legitimate purpose. Some of the prescription meds on the street come from theft, some from fraud, and some by way of a pill mill – often imported from out of state.

The second method, once law enforcement suspects malpractice, is to send in a fake patient. The undercover officer mimics symptoms that might require pain meds and documents what medical procedures are in place at the clinic. If a physician uses due diligence in diagnosis and prescribing, there is no crime occurring. Physicians, after all, can be fooled by patients. In the classic case, a doctor will only ask a few general questions, not perform a thorough exam or get tests, and write a prescription for what the patient requests. This is when charges can be filed.

For now, the report is interesting, but won’t be significant until and unless charges are actually filed.

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