Several Eastern Kentucky counties have banned certain types of pain clinics, or are considering doing so, to try to keep out facilities that officials fear would pour more pills into an area where prescription-drug abuse already reaches crippling levels.
Knott, Carter, Morgan and Greenup counties have approved ordinances banning pain clinics.
Residents in Johnson and Owsley counties are pushing for new controls on such clinics, and officials say they've heard from people in other counties who also are interested in the idea.
The local laws are aimed at preventing the operation of so-called pill mills — clinics that churn out large amounts of prescriptions for pain and anti-anxiety pills, often with little examination.
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Abuse of prescription pills drives up crime and overdose deaths, and local officials are concerned that a resurgence of pill mills would inflame the problems.
Some of the counties that have adopted laws banning pain clinics, or are considering doing so, don't have any such clinics.
Officials hope the laws will be a warning to stay away.
"I guess the ordinance is more of a preventive measure," said Morgan County Judge-Executive Tim Conley.
Carter County had no pain clinics when the fiscal court adopted a law banning them in September 2009, but one business later decided not to come in after the sheriff sent the owner a copy of the law, said Judge-Executive Charles Wallace.
"We kind of wanted to get the upper hand on this thing," Wallace said.
The local initiatives come as state Sen. Jimmy Higdon, R-Lebanon, plans to push a measure in this year's legislative session, Senate Bill 47, that would bring greater regulation of pain-management clinics.
Higdon became concerned about the issue after doctors opened a clinic in Lebanon last year but advertised for customers in Eastern Kentucky, more than 150 miles away.
The operation later closed, but illustrated a potential problem. "There's just not a lot of regulation" for such clinics, he said.
Past and present problems help explain concerns about pill mills.
A decade ago, Eastern Kentucky had several notorious clinics where police said greedy doctors wrote pill prescriptions by the thousands for cash, after little or no real examination of the people seeking drugs.
In one case, a doctor from Albuquerque, N.M., Frederick Cohn, who worked in Greenup and Johnson counties, admitted conspiring to illegally distribute as many as one million Lorcet pain pills.
Cohn and a Russian doctor who worked at his Paintsville clinic, Yakov Drabovskiy, sometimes spent as little as three minutes with patients, and often had new drug orders filled out for patients before the people came in, investigators said.
"You could go by there in the winter and there'd be people lined up down the sidewalk, standing out in the weather," said the Rev. Ronnie Spriggs, pastor of Hager Hill Freewill Baptist Church, who is pushing for more control of pain clinics in Johnson County.
In another case, the scene at a Lewis County clinic operated by Fortune Williams, a physician from Baltimore, looked like a tailgate party because so many people were milling around the parking lot, an investigator said.
All three doctors, and several others, went to prison in the early 2000s.
That crackdown by state and federal authorities, along with the state's system for tracking prescriptions, known by the acronym KASPER, helped quell the problem with such wide-open pill mills.
However, police and local officials said they are concerned about more pain clinics opening in Eastern Kentucky, where poverty and other factors help drive substance abuse.
One factor behind that worry is that it's become routine the last few years for people from Eastern and Central Kentucky to travel to Florida to get prescriptions at pain clinics there, then bring the pills home to sell and abuse.
Pill mills flourished in Florida in part because the state had no prescription-tracking system.
In one raid on a South Florida doctor last year, police found patient files on more than 1,000 people from Eastern Kentucky who had been driving 14 hours or more to get prescriptions at the clinic.
Some police and local officials believe people will try to open facilities in Kentucky to take advantage of that obvious demand for pills.
"You're going to see a bunch of cash-only, here today, gone tomorrow" operations, said Dan Smoot, law enforcement director for Operation UNITE, which investigates drug trafficking in 29 counties in the southern and eastern parts of the state.
A recent law-enforcement analysis concluded that prescription-pill trafficking could be causing an increasing number of overdose deaths in Kentucky.
An average of 82 people die monthly from intentional and unintentional prescription-drug overdoses, the report said.
The report also concluded prescription-drug trafficking will increase in the state over the next five years.
Several of the local ordinances banning pain clinics note that prescription drug abuse causes "wholesale destruction" of addicts and their families.
Knott County Judge-Executive Randy Thompson said he's been told more than half the county's children live with someone other than a parent because so many parents have drug problems.
The rural county had three overdose deaths the first two weeks of January, he said.
Prescription-drug abuse is taking a toll not only in lives, but also in increased crime, impaired driving, child abuse and neglect and jail and treatment costs, local officials said.
Spriggs, the Johnson County pastor, said 90 percent of the 300 people at a Sunday-morning service two weeks ago raised their hands when he asked how many had a family member affected by drugs.
"It's a massive problem in this area," Spriggs said.
Spriggs started a petition drive at that service calling for a local law to regulate pain clinics.
Dr. Gordon Tobin, president of the Kentucky Medical Association, said the KMA is deeply concerned about prescription-drug abuse, and urged patients to report suspected inappropriate practices by doctors to the Kentucky Board of Medical Licensure.
Still, he urged lawmakers to be careful that attempts to crack down on abuse don't hinder patients' access to medicine they need.
"There are thousands of Kentuckians who suffer from chronic pain, and they seek relief from their family physician, surgeon, pain specialists, and other physicians," Tobin said in a statement. "Laws aimed at drug abuse should take that into consideration along with the fact that those abusing prescription drugs need help for their addiction."
However, Tobin said pill mills have no place in Kentucky.
Officials and residents in several counties said they are not opposed to legitimate pain-management facilities and don't want to hinder people who have a real need for pain medication. "There are pain clinics that operate ethically," Spriggs said.
In fact, some officials said the laws had been tricky to write because of the desire to keep out pill mills while not hurting reputable medical practices.
The Knott County law defines an unlawful pain clinic as a facility not affiliated with a hospital within 100 miles that gets most of its revenue from prescribing pain medication. The law also says authorities can consider whether the clinic does a "disproportionately high" amount of cash business and how many customers come from outside the county.
Johnson County Attorney Michael Endicott said he questions the enforceability of a ban on any kind of medical practice, particularly when doctor-patient confidentiality is involved. He sent a letter Friday to Attorney General Jack Conway's office seeking guidance.
There is only one physician in Johnson County whose license lists pain management as his specialty — Dr. Richard W. Albert.
The clinic was so busy Friday — payday — that sheriff's deputies parked outside to spot traffic violations.
The high volume at the clinic has caused some concerns, but Albert told state regulators last year he guards against patient drug abuse by random pill counts and drug tests, and checking the KASPER system for patients seeking multiple prescriptions.
Albert said he takes cash for his services. Some see that as a red flag, but he said he does it because he got disgusted with delayed payments and how insurance companies handle claims.
The medical licensure board admonished Albert last year for improperly advertising the availability of a controlled substance at his clinics. He said he didn't know that was against the law.
Albert did not respond to requests for an interview.
Some local officials acknowledged their laws against pain clinics might be hard to enforce in court.
But they hope clinic operators who are only interested in generating cash by writing lots of prescriptions will decide setting up shop in a county with a law against pain clinics won't be worth the potential fight.
"I'm not sure how enforceable the ordinance is, but we wanted to send a strong message" against pill mills, Thompson said. "We don't have them, and we don't want them."