With an additional $600,000 from lawmakers to hire five full-time employees, the Texas Medical Board  said this week it hopes to patch holes in the regulation of pain management clinics that were revealed in a recent state auditor’s report .
“We haven’t had resources to conduct audits outside of complaint investigations,” said Leigh Hopper, the agency's public information officer.
A report released by the State Auditor’s Office on June 13 said the board “should make improvements to ensure that it registers pain management clinics in accordance with statutes, rules, policies, and procedures.” Lawmakers gave the board oversight of pain clinics in 2011, hoping to address reports of abuse of prescription painkillers from so-called pill mills. But the agency said it hasn’t had the funds to provide adequate oversight.
Pain management clinics primarily dispense prescription drugs, including opioids, barbiturates and other highly addictive medications. Currently, there are 330 pain management clinics registered with the medical board. The clinics are sometimes associated with pill mills — facilities where drug abusers illegally obtain prescription medications. Pill mills have been linked to the rise in prescription drug abuse  in the U.S. over the last decade.
“A lot of these pain clinics are criminal operations,” Hopper said. “They don’t even resemble a medical office.”
Harris County is home to the largest number of pain management clinics in Texas with 121, or 37 percent, of all clinics registered with the state. Five counties — Harris, Dallas, Tarrant, Bexar and Travis — account for 62 percent of the state’s clinics, according to the state auditor.
Hoping to reduce prescription drug abuse and deaths caused by overdoses, lawmakers approved legislation  in 2009 that requires pain management clinics to obtain certification every two years. Prior to that, Hopper said, there was no regulation of the industry.
According to the audit, the board had not verified ownership of 41 of 60 clinics that the auditors reviewed, and the agency could not validate that the ownership had not changed for 22 of those clinics. The Texas Occupational Code requires that a clinic be owned and operated by a licensed physician who practices in Texas.
As of Jan. 31, 2013, the certificates of 111 pain management clinics that had registered with the medical board since 2010 had expired, and the board had no information about whether those clinics continued to operate, according to the audit.
Hopper cited a lack of money and manpower for the lapses in regulation. The board, she said, has only been able to investigate clinics after complaints have been filed.
“The way that we have been operating, it’s not like there has been any down time in between complaints,” Hopper said. “But with more money, that translates into more people, it will increase our ability to regulate.”
Sarah Kelsey, an attorney for the National Alliance for Model State Drug Laws, a resource organization for lawmakers and others hoping to reduce drug abuse, said a major challenge with regulating pain management clinics is that prescription medications are legal substances and have legitimate uses.
“That is a great part of the problem in the whole prescription drug abuse problem that ties back to making sure that people that really need these medications can get them,” Kelsey said.
And pain management is complicated by the fact that doctors not only must treat pain, but must work with patients whose pain may have not been properly treated by other physicians, who have turned to medication not prescribed for them for relief and who have become addicted to those drugs, said Jane Maxwell, a professor and expert in substance trends at the University of Texas at Austin.
Proper oversight of the clinics and physicians by the state, Maxwell said in an email, would help law enforcement efforts to identify pill mills and shut them down.
Lawmakers this year approved more money the board can use in the 2014 to 2015 biennium to increase oversight of the clinics.
"Because of the high potential for abuse, it is important that we ensure our pain management clinics are properly registered, inspected and monitored," state Sen. Jane Nelson , R-Flower Mound, chairwoman of the Senate Health and Human Services Committee, said in an email.
With the additional money, the agency plans to hire three full-time investigators, one attorney and one administrative assistant and inspect about 380 sites each year.
The board will also implement a number of changes suggested in the audit, including conducting in-person clinic audits, using the Department of Public Safety’s prescription drug tracking system and improving its own computer system, Hopper said.
Not all pain management clinics are illegal operations, Hopper said, and eliminating the corrupt ones will make regulation easier. Despite the problems noted in the audit, she said, the regulation of the industry has improved significantly since 2010.
“The long and the short is that the criminal operations are easy to identify once we know about them. And being able to audit clinics and have the manpower to do that in the absence of complaints will help out a lot,” Hopper said.
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This article originally appeared in The Texas Tribune  at http://www.texastribune.org/2013/06/20/state-audit-pill-mill-regulation/ .