Atlanta flirts with pill mill ban

City Councilman Kwanza Hall worries pain clinics and pill mills are too easy to open in Atlanta

The business at the northeast corner of North Avenue and Boulevard hasn't been a welcome addition to the neighborhood. A large sign in the parking lot still announces the presence of Atlanta Event Spaces, an identity the nondescript building possessed for some time after it was a Payless shoe store and before it was leased by its current tenant several months ago. Nowadays, the parking lot fills up early with cars displaying license plates from outlying counties like Douglas, Franklin and Henry. Only a decal on the door indicates that it's now the Premier Chronic Pain Care clinic.

The influx of suburbanites seeking medical relief from this relatively small, poorly marked pain care clinic on the edge of Poncey-Highland has raised residents' eyebrows. Kit Sutherland, president of the Fourth Ward Alliance, says she and her neighbors are suspicious of the new business.

"Why would anyone be driving all the way into Atlanta for medical services?" she wonders. "What's being provided that they can't get in their own neighborhoods?"

The unspoken fear is that this clinic is what so many other pain care clinics turn out to be: A so-called "pill mill" doling out dubious prescriptions for pain meds from a city-licensed storefront.

To temporarily stem the tide of similar businesses opening in Atlanta, Councilman Kwanza Hall has introduced an ordinance that would impose a year-long moratorium on new business licenses to pain care clinics, which he describes in the legislation as typically having "little or no interest in treating pain or the symptom of pain, but interested in only dispensing prescription pain medication with little or no diagnosis of the 'patient.'"

The terms "pill mill" and "pain care clinic" are used almost interchangeably in the proposed ordinance, underscoring the ambiguity that exists between legitimate businesses catering to chronic pain sufferers and shady clinics that cater to drug addicts and dealers. Not all pain care clinics are pill mills, but most pill mills are pain care clinics — and, currently, getting a license to open one is easier than getting a license to open a restaurant.

Hall explains that until there's a more rigorous vetting process in place and until a statewide prescription drug database approved earlier this year is set up, "This moratorium is something that needs to happen, because clinics are just springing up all over the place."

City licensing officials did not respond to a request for the number of pain management clinics that have opened locally.

Atlanta wouldn't be the first area municipality to impose a moratorium on pain care clinics. Marietta, Woodstock, Cartersville, Milton and Kennesaw all temporarily banned the issuance of business licenses to pain care clinics after nearby pill mills were either suspected of or busted for taking cash for prescriptions of large quantities of otherwise legal, but highly addictive drugs like Xanax, Oxycodone and Soma. Just last week, following a long-term investigation, the Drug Enforcement Agency and local authorities raided a Henry County business that law enforcement officials say had been charging $350 cash for prescriptions of narcotics without actually examining patients to determine medical necessity.

Statistics from the Georgia Bureau of Investigations — which performs autopsies for counties that don't have their own medical examiner — indicate that prescription drug abuse is reaching near-epidemic levels. In 2010, 560 of the state's 729 drug-related deaths were caused by prescription drugs. Sixty-eight more resulted from some combination of illegal and prescription drugs. And those numbers don't include statistics from Fulton, DeKalb and several other metro Atlanta counties — including Henry County, which doesn't keep track of drug-related deaths. In Fulton County, cocaine overdose remains the most common cause for drug-related deaths. Still, around 50 of the 111 people who died from drug overdoses in Fulton last year had legal drugs in their systems.

State Sen. Buddy Carter, R-Pooler, a pharmacist by trade, was successful this year — after years of failed attempts — in passing the Patient Care Act, a law establishing a state-wide prescription drug database that will allow physicians to ensure their patients aren't doctor-hopping to get large quantities of drugs, as well as allow pharmacists to ensure that doctors aren't doling out improperly large amounts of drugs. Florida had long been a hub for pill mills, but as it and other states crack down on illicit prescriptions, the fear is that Georgia will take their place.

"There are legitimate pain specialists out there who serve our communities and do a fine job and perform a needed service," Carter explains. "The biggest problems are pill mills — rogue doctors who open up for no other reason than to generate funds."

Asked how municipalities might tell if a license applicant is planning to open a legitimate clinic or a pill mill, Carter says an out-of-state residence — Florida in particular — is a telltale sign. And how can communities tell if there's a pill mill operating in their midst?

"Oh, they can tell," he says. "First of all, you'll probably see a line out the door. Second, they'll probably be advertising. And you can by the clientele most of the time."

Asked to clarify, Carter offers a nervous laugh and says, "Well, I don't know how to describe that except to say that most of the time you can tell by the clientele."

Despite the constant coming and going of out-of-county patients that's concerned neighbors in the Old Fourth Ward, Premier Chronic Pain Care doesn't appear to fit the pill mill profile. It takes patients only by appointment, doesn't accept cash and services only Georgia residents. The clinic also requires patients to supply three months of doctor's notes, six months of pharmacy records, an MRI and an official discharge letter. A notice on the wall of its small waiting room informs patients that, beginning in November, it will no longer prescribe benzodiazepines like Xanax because they're too addictive.

Atlanta police don't monitor pain clinics unless a credible complaint is filed. According to department spokesman Carlos Campos, "Pain clinics are currently able to operate in the City of Atlanta by obtaining a general business license. APD will conduct compliance checks on the licenses, as they do at any other business to ensure proper displaying and validation, and will respond accordingly if specific allegations of illegal activity are made."

Hall's moratorium wouldn't affect existing clinics, and he says he doesn't want it to hamper legitimate businesses. But the ease with which pain clinics can open currently is a loophole he says needs to be closed.

"I can't say all of these places are pill mills. I'm still kind of looking into that," Hall says. "We just want to raise the bar so that people can't just open one of these with no vetting."

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