Cash-only clinics fuel fears of new ‘pill mills’ in Ohio

As Ohio struggles COLUMBUS — to contain the fallout from a still-raging epidemic of drug addiction, some experts worry that too many of the state’s opioid-treatment clinics follow a business practice like that of the “pill mills” that fueled the crisis: They deal in cash.

“When you see exponential growth in a clinical service, then there probably is a huge margin in terms of profit. It’s called capitalism,” said Dr. Ted Parran of St. Vincent Charity Medical Center in Cleveland. “But when capitalism calls for asking for cash from desperate addicts, then you have to worry about whether the appropriate services are being provided.”

The proliferation of officebased opioid-treatment providers who require payment upfront is especially troubling in a state where public officials champion Medicaid coverage as key to expanding access to treatment.

In a study released in June, Parran and other researchers surveyed active buprenorphine prescribers in Ohio — Suboxone is the most-common brand name for the synthetic opioid medication widely prescribed in Ohio and elsewhere to treat addiction to heroin and other opioids — and found that nearly half of those who responded said they did not accept insurance for officebased therapy.

Addicts know the landscape well. And they know that being cash-poor isn’t necessarily a deterrent to becoming a patient at a cashonly practice.

“I caught on to the whole Suboxone thing,” said Kyle Berry, a recovering addict from Grove City who used to obtain prescriptions for the drug.

Suboxone also is a popular street drug, one that state reports on drug-abuse trends say is “highly available for illicit use.” Berry saw that a prescription could be a means to other ends.

Drug dealers happily front the money for so-called “cash-n-carry” clinic visits in exchange for a share of the Suboxone, he said. Or, addicts sell it themselves, typically $15 to $20 for one of the “film strips” or pills.

Berry said he wasn’t cut off when he failed the urine tests that prescribers are supposed to use to check for the presence of buprenorphine and other drugs. No one called him in for a pill count, and he wasn’t questioned about the proof-of-counseling documents that he forged multiple times.

“The doctors poorly regulate it,” he said. “And if I bring somebody else in, that’s 25 bucks off.”

Parran, who was one of the first doctors to prescribe Suboxone in Ohio after it was approved for use in 2002, said that more study is needed to determine whether the cash model increases the risk of overprescribing and misuse.