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April 3, 2010

The Michael Jackson Effect And "Pill Mills"

By William Cormier

The DEA is using fear and intimidation to force physicians to quit prescribing, or drastically lower the dosages of drugs that are medically necessary for some chronic pain and anxiety patients and is referred to by Chronic Pain Clinics as the "Michael Jackson Effect."


From previous cases, the death of Elvis Presley being the most notorious, we know that the rich and famous often "buy" the services of physicians to prescribe them absurd amounts of pain medications and diazepams, most notably Xanax and Valium, so they can quickly get to sleep during tours and events that would make most of us collapse in utter exhaustion; unfortunately, some of these celebrities also use "uppers" to give them the energy to perform these exhaustive schedules and then need a "downer" to make them sleep, a vicious cycle of drug abuse that has caused the loss of some of our most venerated celebrities. Michael Jackson's case was extreme and also included the use of "Propofol," a powerful anesthetic which is used almost exclusively in hospitals. I haven't heard any evidence that Michael Jackson also used uppers, but most of us are aware that when we are stressed and engaging in extreme activities, it's often hard to wind-down, which may explain Michael Jackson's drug abuse, which is still a matter of speculation.

Celebrities who hire their own physicians to prescribe what they "want rather than what they "need" are not anything new, and we've heard about it for years; however, the manner in which the Federal Drug Enforcement Agency has responded to this national problem is not halting the rich and famous from getting their drugs, but instead, is causing more pain and suffering to those who do suffer from chronic pain and are often treated like criminals simply because they suffer from chronic ailments. Some states are plagued with "Pill Mills" and it's a situation that affects everyone, not only those who choose to abuse their medications, but patients that desperately need these medications to have a decent quality of life. A recent situation in the Atlanta area has highlighted this issue again, and from a law enforcement perspective, I can appreciate that something must be done to close-down these "Pill Mills" that are masquerading as Chronic Pain Clinics:

Prescription "pill mill" under scrutiny in Kennesaw

By Andria Simmons

The Atlanta Journal-Constitution

The city of Kennesaw is exploring ways to block so-called prescription "pill mills" from opening after one local pain clinic began attracting customers from as far away as Tennessee and Kentucky.

The Pain Express clinic on Cherokee Street, which opened about a month ago, was doling out painkiller prescriptions so quickly and in such large quantities that one local pharmacist ran out of a prescription pain medication, according to Kennesaw Police Chief William Westenberger. The clinic temporarily closed last week after federal authorities raided three other locations in Florida that were operated by the same owners.

Georgia is the only state in the Southeast without a program to track dispensing of prescription drugs using an electronic database. The state Senate voted Wednesday to approve SB 418, the Georgia Patient Safety Act, but the bill still has to clear the House.

Rick Allen, deputy director of the Georgia Drugs & Narcotics Agency, said the Georgia Patient Safety Act would allow law enforcement to track "pill mills" and prosecute physicians for prescribing medications illegally. Pharmacists and physicians can also check an electronic database to see if a patient has been doctor-shopping before issuing a prescription.

Pain clinics are not licensed through the state, so there is no way to know how many are operating in Georgia. Allen said his agency is keeping an eye on between 5 and 10 suspected "pill mills." However, he said more seem to be popping up lately because Georgia's regulations are more lax than surrounding states.

The increasing popularity of heavy-hitting opiods like Oxycontin in the Southeast has cemented its reputation as "hillbilly heroin." With a legal prescription, the pills can be obtained in Georgia for $3 to $4 each and resold for up to $60 each in Kentucky and Tennessee, police say.

"These pain clinics don't take insurance and they don't take credit cards, it's all cash," Allen said. "These doc-in-the-box places can open up overnight and unless we get complaints, we don't know about them."

Westenberger wants the city to institute a moratorium of anywhere from 6 to 12 months to prohibit more pain clinics from opening until the city can figure out how to reshape its ordinances to prohibit them. In Kennesaw, arrests related to prescription drug abuse increased by 13 percent between 2008 and 2009, and accounted for over a quarter of all drug-related arrests last year. MUCH MORE

Prior to writing this story, I contacted Andria Simmons to correct what I believe casts a pall on legitimate Pain Clinics, and from a prior experience on a local matter that I was involved with, and also covered by Ms.Simmons, I can attest to her integrity and diligence as a Journalist. However, as she related to me, she can only report upon what she is able to verify and what is relayed to her by her sources within the local community and law enforcement agencies. She also pointed out that she has a limited amount of space to cover a news event, and unlike a private investigative reporters/bloggers, she does not have the luxury of delving into issues that are not mentioned by her sources and must rely upon them to supply the factual aspects of the case. We can appreciate her position, and since we do have the space to add to her excellent reporting, we have chosen to expand upon and dispel some aspects of this story that we believe may be incorrectly associated with other legitimate Pain Clinics throughout the state by the AJC's audience.

Through personal experience as a chronic pain patient, I'm able to offer some insight into this situation and for months have been working on substantiating the "Michael Jackson Effect" that is causing physicians throughout the United States to change how they do business, as they constantly have the DEA looking over their shoulders whenever they prescribe powerful narcotics or diazepams. If the DEA believes that a doctor is prescribing too many of these aforementioned substances, even though their patient load may be representative of patients that need these prescriptions, they often (The DEA) utilize a tactic which causes duress and financial hardship on physicians, which we believe is inappropriate and is affecting the health and welfare of millions of Americans who have verifiable medical conditions that warrant the use of these medications.

If a Doctor doesn't knuckle-under to the DEA's demands to quit prescribing these medications, they send field agents out to pore over the medical records of their patients, scrutinizing each and every patient who is prescribed substances on their "hit lists" and demand justification for each and every prescription they write. This is costly for Doctors who are already struggling under heavy patient loads, who have neither the time nor resources to withstand the inquisitions by DEA agents who use this tactic as a method of intimidating them into violating their "Hippocratic Oath" and cave-in to DEA demands. This practice of intimidation and fear has proven to be remarkably successful, and Family Practice physicians as well as some specialists have quit prescribing medications for their patients who do suffer from chronic pain and refer them to "Chronic Pain Clinics," birthing another "medical specialty" that is costing taxpayers millions, if not billions, of dollars per year. In attempting to corral the majority of those who require chronic pain care into separate medical practices to allow them to monitor these patients more effectively, the DEA has created the "Pill Mills" that now require even more taxpayer money to uncover and prosecute for illegally prescribing dangerous drugs to addicts who illegally "Doctor Shop" and visit multiple physicians to satisfy their own cravings and/or seek these prescriptions to sell on the streets; this is a threat to the health and safety of those who purchase these drugs and do not understand the danger that these substances pose to recreational drug users, who often underestimate their power and, inadvertently, pay the ultimate price for their ignorance by overdosing and losing their lives.

In retrospect, I am able to appreciate the position that the DEA finds itself in as they attempt to curb illegal drug use and "Pill Mills" that do pose a threat to our communities; I believe they have now created their own Catch 22 and we need Washington to create legislation that will halt "Doctor Shopping," which can be accomplished by creating a regional and/or national database(s) that will expose those who travel across state lines, and even within their own states, to illegally obtain these powerful narcotics. I also understand that tying-in pharmacies to this database would solve the issue of "Doctor Shopping," and at the same time, raise valid privacy issues.

We are against any legislation that further infringes upon our constitutional rights; however, in creating a system that would alert law enforcement to those who misuse our medical system, such privacy issues could be alleviated by creating a reasonable "trigger" that would identify these criminals that Congress could easily implement and also protect our rights to privacy. There are times when a patient visits another physician, who, because of another medical issue that has changed for that particular patient, justifies prescribing stronger medication. However, this situation only presents itself once in a great while, and such a pharmacy database legislation, if it contains reasonable language, could be implemented and would reveal those who have a history of abusing Pain Clinics, not isolated incidents. (IMO) Any legislation that is enacted should require stringent monitoring and restriction to ensure that only those who abuse the system are targeted, not legitimate chronic pain patients!

Now, to address the issues that I believe cast a pall on legitimate Chronic Pain Clinics; in the above article, it states:

"These pain clinics don't take insurance and they don't take credit cards, it's all cash," Allen said. "These doc-in-the-box places can open up overnight and unless we get complaints, we don't know about them."

The above statement can be true, however it overlooks two (s) important facts:

1. When a new Pain Clinic opens its doors, Medicare approval does not occur instantaneously! I am a patient of Gainesville Pain Management, and when they first opened their doors, it took over a year for them to receive Medicare approval, and they are hardly a "Pill Mill" and have extremely stringent rules that each patient must obey. One must sign a "Contract with their Doctor" and are advised that Doctor Shopping in the State of Georgia is a felony, so those that do abuse their policy essentially have no legal defense if law enforcement catches them attempting to procure prescriptions from another source.

2. I have confidential sources (Physicians) who have told me that some Pain Clinics are attempting to divest themselves of Medicare recipients, and will not accept new Medicare patients because the government does not properly compensate them for their services, and after looking carefully at my monthly Medicare statements I wholeheartedly agree that they are underpaid for the services they provide. This is another issue that Washington must correct; if they continue cutting Medicare payments to physicians, especially those that engage in "specialty practices," we can expect this phenomenon to increase, and more and more elderly and disabled Americans will find that they have nowhere to receive adequate medical attention if Congress continues to "steal from Peter to pay Paul."

I haven't made it a secret that I have been searching for a legitimate pain clinic that is closer to home, as I'm experiencing transportation problems, and the drive to Gainesville is quite a ways from Lawrenceville, and I recently called a handful of Pain Clinics that were listed on the Internet to see if I could find one closer to home. One of those clinics was Pain Express, the one currently under investigation in Kennesaw, Georgia, that helped to prompt the publication of this article. A few days before this story was released by the Atlanta Journal Constitution, I received a call from a young  physician, who sounded extremely pleasant and sexy, who stated she was a Doctor at Pain Express and wanted to know if I still wanted to be considered for their services. (I now realize that this wasn't likely a Dr. at all, as they had closed their doors; it was most likely a DEA Agent attempting to entrap me into doing something illegal.) Luckily, my son had informed me that Kennesaw was even further away than Gainesville, and I had also taken the time to examine their Internet advertising, and that they were a "Pill Mill" was evident from their own foolish advertising. Talk about dumb criminals" Anyway, when they called, I promptly refused to become one of their patients.

If you follow the above link to Pain Express's advertisement, please note that they advertise that they "Specialize in Oxycodone Pain Treatment." This is a red flag to anyone that understands Chronic Pain Clinics, and that goes double for the DEA! Don't they have Internet access too? Why did they have to wait for complaints to know that this clinic was not above-board? When a new patient is evaluated at a pain clinic, the first thing that usually occurs is a drug test to ensure that the patient isn't using any illegal substances or a variety of different pain medications. Then, during the course of the interview, the physician may question the patient on what has or has not worked for them in the past. However, when a patient demands a specific pain killer like Oxycontin, that immediately sends a red flag to the Doctor. When you have cancer, you don't "advise" your physician which methodology should be used to treat your disease, and when you demand a specific medication to treat chronic pain, most Doctors take issue with patients attempting to dictate their treatment, and it's the quickest way I know of to be thrown out of a reputable Pain Clinic. When a Pain Clinic advertises that they "specialize in oxycodone" to treat chronic pain, that should immediately send the same red flags to law enforcement agencies, which is why I question why it took too long to identify Pain Express as a Pill Mill.

Finally, I have a question for the medical community, or in the alternative, for the DEA. Two months ago, I almost died when my blood pressure spiked to 248/196, and when I went to the Gwinnett Medical Center for treatment (An extremely reputable Hospital, and one of the best in our area.), they stated that I was extremely lucky that I didn't stroke-out and die in my sleep. I had recently been taken off an anti-anxiety medication (Not Xanax or Valium) that I have been on for several years and was informed that Chronic Pain Clinics should not be prescribing diazepams and associated anti-anxiety medications and was advised to see a psychiatrist. The hospital promptly put me back on an anti-anxiety medication and informed me that chronic anxiety is usually managed by "General Practice" physicians, and alluded to the fact that my blood pressure spike may have been caused by withdrawal from my anxiety medication. The Primary care physician stated that for chronic pain patients, anxiety, sometimes caused by chronic pain, is handled by Pain Clinics and I have verified through phone calls that several do exactly that, so right now, I'm in a state of confusion.

This reminds me of the Old Abbot and Costello routine of "Who's on first base; No, "Who is on second base," etc., etc. For them it was a great comedy routine; however in reality, I don't see the humor in the situation. Is the DEA forcing all patients who suffer from chronic anxiety to receive their medications from psychiatrists, and if so, what will that cost the American taxpayers? Right now, there's a long waiting period for psychiatrists, as the toll of the economy and global events has been a boon to their specific medical specialty, and being on Medicare, many psychiatrists as well as Pain Clinics are underpaid and are not accepting new Medicare patients. I guess this will require another visit to the emergency room, and until I figure out "Who's on first base," I'm in danger of stroking-out in my sleep again. For me, that's enough to cause a great deal of anxiety, which is now untreated, and I face the same risks I did two months ago.

I do support the Federal Drug Administration in their efforts to stop those who abuse our medical system and sell these powerful drugs on the streets, and I agree that "Pill Mills" should be shut down for the health and welfare of the general public; however, as you do fight to control drug abuse and those who endanger our children, I would request that you change your methods and find a logical way to handle this issue rather than using the "shotgun approach" that is harming people from all walks of life, and especially the elderly, whose systems are unable to handle the strain of constantly being referred from doctor to docto,  all the while receiving the same run-a-round that I have experienced. I have verified through independent sources that this is adversely affecting other people as well; if you want the majority of Americans to support your policies, then I'd suggest that you find one that doesn't harm innocent people.

Submitters Bio:

My Bio is as varied as my life. In 2012, my twin sons murdered a Journalist in Pensacola, Fl., for 100K worth of "Magic The Gathering" playing cards and buried the body in my backyard. I was once a regular writer here, but PTSD from my son's actions took their toll. First, I lost everything I had. Second, I lost my fiancee. Third, I almost lost my life. Recovery has been a hard and lonesome road, and it isn't quite over yet. I will overcome this disaster as I have others, and return to college to resume my quest to receive a Bachelor's Degree in Journalism.

Admittedly, I have chosen to get back in the mix and do my duty to help destroy any chance that Trump may have of being elected to a second term.