Pill mills: They seem as innocuous as a street-side accounting office or yoga studio. But what can go on inside these facilities is certainly far from getting your taxes done, or as beneficial as an hour’s worth of tree and downward dog poses.

In fact, behind the walls of most pill mills you will find what some say is the beginning of opioid abuse and addiction.

Pill mills have long been thought of as a source for a pain sufferer to get their drugs. Through these pill mills, most of which are located in Florida and Texas, the drugs are as easy to get as liquor from a liquor store or marijuana at a dispensary. Pill mills have also been the focus of increased scrutiny by law enforcement and the criminal courts. The Drug Enforcement Agency (DEA) claims these facilities are partly to blame for the near-epidemic rise of opioid abuse in the U.S.


Studies have shown that those suffering from chronic pain as well as addiction to opioids such as OxyContin, Percocet, or Vicodin will go to great lengths to get their painkillers, including driving over not one, but several state borders.

Healthline, a website devoted to healthy living, details one mother’s struggles with her son’s opioid addiction. The mother, April Rovero, spoke at a high school assembly in Virginia, a state noted for its high opioid prescriptions and opioid-related deaths.

According to Ms. Rovero, her son Joey traveled from the San Roman area near San Francisco to Los Angeles to acquire his prescription painkillers. Ms. Rovero’s speech centered as much on the length a person can take to get their drugs as it did the wake-up call authorities and the legal system have received as to the public dangers of opioids and those who sell them.

In fact, just this February, Southern California authorities arrested Dr. Hsiu-Ying “Lisa” Tseng, who was the Los Angeles doctor who prescribed the opioids that killed Ms. Rovero’s son, Joey.1

“We’ve reached an extreme level of closure. We feel very blessed,” Rovero said. “I talk to parents all over the country who never get a drop of closure.”


The same Southern California authorities who arrested Tseng look out for what is called a “holy cow moment.” When investigating a pill mill, according to John Niedermann, the LA County deputy district attorney and prosecutor who worked on the Tseng case, one such moment came about when one pill mill was found to prescribe more opioids in one month than the entire staff at Johns Hopkins Hospital.

“Unfortunately, it’s not hard to find these moments,” Niedermann said.

Other holy cow moments involved an undercover police officer who bought illicit opioids and muscle relaxants simply by using the X-ray of a dog.

In Tseng’s case, Niedermann explains, the tip off was how often police or the coroner’s office called to let Tseng know one of her patients had died, which in one instance was eight days apart.

“Her prescribing didn’t change in the least,” Niedermann recalls.

All-in-all, the pill mill industry is coming under increasing examination by every level of authority from local law enforcement upward to the state and federal level. This coincides with what the U.S. Centers for Disease Control and Prevention (CDC) says is a “doctor driven” epidemic that has law enforcement firmly focused on the medical profession in an effort to slow the growing number of painkiller-related deaths in America.

As for identifying a pill mills vs. a legitimate pain specialists, authorities consider the number of patients seen and prescriptions written, limited medical exams, and cash-only payments for painkillers as strong indicators that an operation is a pill mill.

So far doctors in Georgia, Texas, Philadelphia and Nevada, in addition to Dr. Tseng in California, and doctors in Tennessee, West Virginia and south Florida, have been arrested for selling over-prescriptions of pain medicine.


In at least two cases, doctors who were found guilty of over-prescribing and selling opioids stated they were not properly trained in pain management, yet nonetheless continued to prescribe painkillers to hundreds of patients.

At the same time, other doctors feel the pill mill investigations would be better handled by state medical boards than the criminal courts, giving the argument the courts may compromise the ability of well-meaning doctors to responsibly prescribe opioids.

In response, Niedermann has one answer: “If you’re doing your job, you have nothing to worry about. If you’re not breaking the law, you don’t have to look over your back.”


Healthline reports that in 2014, 28,000 people died from opioid abuse, which is more deaths than any other year.

As a response to her son, Joey’s death, April Rovero started the National Coalition Against Prescription Drug Abuse (NCAPDA), which advocates for change in prescription drug policy, addiction treatment, education, and outreach. In fact, Rovero regularly receives phone calls from parents who have lost a child to a doctor’s over-prescription or to a pill mill’s carelessness.

But even with her loss, Rovero has had some fortune: she at least faced those responsible for Joey’s death, while other parents won’t in the least be able to put a face nor a name to the individuals who are to blame for their children’s death.

In Niedermann’s view, for a parent to find out how and who is responsible for their child’s opioid overdose can be purely cathartic.

“I think it is kind of a relief since many parents feel kind of responsible for what happened to their children, even though they didn’t have the skill set to deal with something like this. It helps them put it into perspective.”

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  1. More ‘Pill Mill’ Doctors Prosecuted Amid Opioid Epidemic, Healthline. Retrieved May 23, 2016.

The Pill Mill Pile Up