Initiatives to Shut Down "Pill Mills" (Florida)

Initiatives to Shut Down "Pill Mills" (Florida) Peggy Kelley Thu, 10/25/2018 - 02:38 PM EDT


The initiatives to shut down “pill mills” in Florida began in 2010. “Pill mills” are pain clinics that inappropriately prescribe large quantities of prescription drugs to patients. They can comprise a single physician or a group of physicians, often operating over a large geographic area, who cater to individuals seeking prescription drugs for nonmedical reasons. They accept only anonymous payment methods—primarily cash (Betses & Brennan, 2013).


To prevent physician-driven diversion of prescription drugs and to limit the supply of prescription drugs available for diversion

Typical Elements

Florida’s widespread effort employed a variety of strategies to achieve its objectives:

  • Maintaining a medical examiner report system that required medical examiners to provide detailed information on every death in which a drug (prescription or illicit) was identified as a cause of death. Florida’s system enables the state to report more detailed overdose information than other states (Johnson et al., 2014).
    • Note: From 2003 to 2009, Florida experienced a large increase in the number of pill mills operating in the state and saw a 61% increase in the number of annual fatal prescription drug overdoses (1,804 to 2,904) (Johnson, Paulozzi, Porucznik, Mack, & Herter, 2014).
  • Implementing pain clinic regulations and certification requirements, which are designed to prevent facilities from prescribing controlled substances indiscriminately or inappropriately, and which grant authority to state agencies to shut down violating pain clinics (Johnson et al., 2014).
    • Note: Prior to Florida, in 2010, only three states had specific pain clinic regulations. By 2013, 13 states had implemented such regulations.
  • Having state law enforcement agencies conduct raids on pill mills—seizing assets and arresting owners and prescribers. Florida established regional task forces to focus on pill mills in specific areas and cooperated extensively with the Drug Enforcement Administration.
  • Enacting prescription drug limits of sale, which forbid physicians from dispensing Schedule II or III prescription drugs from their offices.
  • Putting into practice the mandatory use of Prescription Drug Monitoring Programs (PDMPs) by pharmacies, requiring all pharmacies to register with the state PDMP and to report patient and prescriber data.


Physicians, pharmacists, patients, law enforcement 


Florida’s initiatives were associated with a 23.2% reduction in the state’s prescription drug overdose rate, from 14.5 to 11.1 overdoses per 100,000 individuals, a statistically significant decrease (Johnson et al., 2014).


See guidelines for related records, such as Model Pain Clinic Regulations, Law Enforcement Training on Supply Reduction, Limits on Prescription Drug Dispensation and Sales, and Mandatory Use of Prescription Drug Monitoring Programs.

Acknowledged by

National Conference of Insurance Legislators. Best Practices to Address Opioid Abuse, Misuse and Diversion. 


Betses, M., & Brennan, T. (2013). Abusive prescribing of controlled substances: A pharmacy view. New England Journal of Medicine, 369(11), 989–991. Retrieved from

Johnson, H., Paulozzi, L., Porucznik, C., Mack, K., & Herter, B. (2014). Decline in drug overdose deaths after state policy changes—Florida, 2010–2012. Morbidity and Mortality Weekly Report, 63(26), 569–574. Retrieved from