Pill Mills: What Veterans Need to Know About a Dangerous Practice

Question: 

What are pill mills? 

Answer:

For many veterans, prescription medications were first introduced as part of legitimate medical care—often for service-related injuries, chronic pain, or mental health conditions like PTSD. While these medications can play an important role in treatment, some prescribing practices have caused serious harm. One of the most dangerous examples is the rise of pill mills. 

Understanding what pill mills are, how they operate, and why veterans are especially vulnerable can help prevent misuse, addiction, and long-term health consequences—and point the way toward safer, more effective care. 

What Is a Pill Mill? 

A pill mill is a medical practice, pain clinic, or individual prescriber that routinely issues controlled substance prescriptions—particularly opioids—without legitimate medical justification. These operations masquerade as legitimate healthcare facilities while functioning primarily as distribution points for powerful narcotics. 

The contrast with legitimate pain management practices is stark. Proper pain medicine involves thorough patient evaluations, documented medical histories, diagnostic imaging like X-rays and MRIs, treatment plans that include non-opioid therapies, and ongoing monitoring. Pill mills skip these steps entirely or perform them as mere formalities. 

Typical pill mill behaviors include: 

• Brief or superficial “exams” lasting only a few minutes 

• Standardized opioid regimens are prescribed to nearly all patients regardless of condition 

• High daily patient volumes are designed to maximize prescription output 

• Emphasis on specific high-demand brands like OxyContin and Roxicodone during the 2000s 

• Cash payments preferred or required, avoiding insurance paper trails 

Pill mills became highly visible during the late 1990s and 2000s as opioid prescribing expanded dramatically across the United States. The term’s origins trace back to David Herbert Procter, a Canadian-born doctor who opened a pain treatment office in South Shore, Kentucky, near Portsmouth, Ohio, in 1979. By the mid-1980s, Procter pioneered the model of prescribing opiate-laden painkillers combined with benzodiazepines like Xanax, setting the blueprint for profit-driven overprescribing that would devastate communities for decades. 

Regions such as South Florida and Appalachia are seen by law enforcement as ground zero for these operations. The term “pill mill” is now widely used by the Drug Enforcement Administration, law enforcement agencies, media outlets, and unfortunately, by people who misuse or divert prescription drugs to describe these illegal operations. 

Common Drugs Prescribed by Pill Mills 

Pill mills often focus on medications with a high risk of dependence, including: 

• Opioids: Oxycodone, hydrocodone, morphine, fentanyl 

• Benzodiazepines: Xanax, Valium, Ativan, Klonopin 

• Sleep medications: Ambien and similar sedatives 

• Stimulants: Adderall or other amphetamine-based medications 

When prescribed together—especially opioids and benzodiazepines—the risk of overdose increases significantly. 

How Pill Mills Operate 

Pill mills use the trappings of medical practice to run what is essentially a high-volume drug distribution business. They exploit the legal authority of physicians to prescribe controlled substances while abandoning any pretense of genuine patient care. 

The operational hallmarks of a pill mill include several consistent patterns: 

• Cash-only or cash-preferred payment: Avoiding insurance companies eliminates oversight and creates no paper trail for regulators to follow 

• Minimal or repetitive paperwork: Medical records are disorganized, incomplete, or simply fabricated to create an appearance of legitimacy 

• Extremely short visits: Patients spend more time in line than with the doctor, with exams lasting mere minutes 

• On-site or closely affiliated pharmacies: Some operations dispense drugs directly, capturing additional profit and ensuring patients fill prescriptions without outside scrutiny 

• Heavy security presence: Security guards at small clinics suggest the operation anticipates confrontation rather than typical patient visits 

Some pill mills advertised explicitly with language targeting people seeking easy access to opioids. Phrases like “pain clinic,” “quick appointments,” and “walk-ins welcome” drew patients from other counties and states. This phenomenon became known as “pill mill tourism,” where people from other states come visit clinics responsible for massive diversions of Schedule II through V controlled substances. 

Ancillary staff often play active roles in maintaining the operation. Receptionists and clinic managers may coach patients on what symptoms to report, which phrases to use, and how to appear legitimate during brief encounters with the prescribing physician. This coordinated approach allows clinics to process high volumes of patients while maintaining minimal documentation.