A pill mill is a doctor’s office or medical clinic whose purpose is not to treat sick or injured patients, but instead to reap enormous profits through the illegal diversion of prescription drugs. Law enforcement estimates that there may be tens of thousands of these pill mills currently operating in the United States.

While not all pill mills look alike, they can often times be spotted by the crowds of people gathering in their parking lots or the makeshift banner advertising "pain management" or "pain clinic". Pill mill doctors rarely have any pain management credentials, usually do not have hospital privileges, see 80-100 patients per day and typically only accept cash.

Pill mills work in conjunction with shady pharmacies and unethical pharmacists who are willing to turn a blind eye to apparent non-therapeutic prescribing practices.  Remember, the prescriptions are only worth the paper they are written on until a willing pharmacist agrees to dispense the drugs.

Some pill mills may have the appearance of a legitimate medical practice. However, the encounter will typically be very brief. Oftentimes, there will be very little medical history, little or no physical examination, no laboratory or diagnostic studies performed.  Some pill mills routinely write prescriptions for a drug cocktail, which is a combination of Lorcet or Vicodin, Soma and Xanax. This combination of drugs is commonly referred to as a "party pack", "Holy Trinity" or in some parts of the country a "Las Vegas Cocktail".

A legitimate pain management practice may also dispense narcotic pain medications, but only after a thorough physical examination, detailed understanding of the patient’s medical history, and diagnostic tests. Typically, medical treatment such as physical therapy, injections, surgical procedures and psychotherapy are provided in conjunction with the prescription. 

Some pill mill operators have become smarter about flying under the radar screen and have adopted ways of looking more like legitimate medical practices.

Partially gathered by the CBS Evening news and myself, here are some tell tale signs of a typical pill mill:

  • It accepts cash only
  • You may or may not be seen by a physician
  • No physical exam required or performed
  • No medical records or X-rays are needed
  • Prior medical records not required
  • You ask for the medications rather than the doctor deciding what you need
  • The same drugs and combinations of drugs are prescribed over and over to most patients
  • There is scant medical documentation
  • You’re directed to "their” pharmacy
  • They treat pain with pills only
  • They give you a set number of pills and tell you specific date to come back for more
  • Huge quantities of drugs are prescribed at one time
  • They may have security guards
  • They may have a line of people outside or in the waiting room
  • They may accept out of town or out of state patients
  • Patients may arrive in carloads

Again, pill mills come in all shapes and sizes and some are better at hiding their true colors. However, there are a staggering number of pill mills that are operating right under the noses of law enforcement, medical licensing boards and other government regulatory agencies. Law enforcement is well aware of these types of clinics, but little has been done to eradicate them.  Meanwhile, enormous fortunes are being made and people continue to die from prescription drug addiction.