“The best doctor gives the least medicines.” — Benjamin Franklin

Ohio Attorney General Mike DeWine said although progress has been made in the war against pill mills since he took office in 2011, there’s still a statewide pain management epidemic going on. “We still have a number of cases under investigation,” DeWine said in a recent telephone interview from his Columbus office. “What we found is there were doctors who were really just drug dealers. Sometimes it was cash, sometimes it was Medicaid. Many times, taxpayers were paying for these overdoses.”

DeWine said since 2011, 61 doctors and 15 pharmacists have lost their Ohio licenses for improperly prescribing or dispensing prescription drugs Out of those doctors, 51 of them have had their licenses permanently revoked. “We certainly don’t want to deny these pain medications to anybody who really needs them, but they can be very addicting,” he said. “Many times, these people who were addicted to pain medication would switch to heroin because heroin is cheaper. Babies are born to addicted mothers.

“We have a very drug-dependent culture. It’s important for everyone to keep in mind that these pain medicines can help you, and they can also hurt you.” The attorney general said the good news is that a relatively small number of doctors are contributing to the state’s pill addiction problem.

The most notorious local “pill mill” case involved Dr. Peter Franklin, a Middlefield Village doctor who was later murdered by his wife. The couple was being investigated by authorities on suspicion of illegally selling prescription drugs from the office. Sandra Franklin, now 63, worked at the office as her husband’s office manager.

On Aug. 16, 2009, the doctor was fatally stabbed by his wife at their Bainbridge Township home. Sandra Franklin, who argued she killed her husband in self-defense, is serving 15 years to life in prison after a Geauga County Common Pleas Court jury found her guilty of murder, felonious assault and involuntary manslaughter.

“We were involved with that case because more than half his patients were from Lake County,” said David Frisone, director of the Lake County Narcotics Agency. “This doctor was seeing patients — no examinations — and then charging them like $500 to get prescriptions.”

Last year, the narcotics agency arrested two doctors for inappropriately prescribing drugs to patients. “One was a joint case with the DEA,” Frisone said. “This doctor moved from Lake County to Cuyahoga and then fled the country. The case is still open.”

Chris Begley, a sergeant with the Lake County Narcotics Agency, said pill mills are becoming less common in Lake and Geauga counties. “I think the reason is the doctor in Bainbridge got so much publicity,” said Begley. “The message went out to all prescribers loud and clear that even if you’re not doing anything illegal, there are law enforcement agencies out there watching and keeping track. The pendulum is really swinging toward almost nonprescribing of opiates, or really slowing it down. “When I first started working pharmacy cases almost 12 years ago, reputable physicians would prescribe right to the limit. Even the pain management physicians have cut way back now. I think the physicians are becoming more aware and are monitoring their patients more.”

In most cases, tips the agency receives about doctors overprescribing pain medicine involve “sloppy prescribing” rather than true “pill mills,” Frisone said. “Pill mills are an orchestrated attempt to make money,” he added. “Our focus is to try to cut down on the availability of the bad prescription drugs. We’re not especially targeting doctors. We’re trying to cut down on the amount of opiates on the street. It just adds to the heroin problem.”

Begley said the good news is that overdose deaths from pharmaceutical drugs are down 25 percent this year. “I don’t know why. I’d like to say our work is responsible for that, but there’s really no way to tell,” he said. “Hopefully it’s a trend that will keep up.”

Begley estimates that just 1 percent to 5 percent of pain management patients are plain drug seekers. In addition, he said doctors are now more apt to try alternative methods for pain including muscle relaxers, steroids and surgery — rather than relying on painkillers.

“We put agents undercover occasionally,” Frisone said. “We do that if we have a complaint about a doctor or pharmacist who may not be following the rules. We put confidential informants in the exam rooms. In many cases, the physicians are doing what they’re supposed to do, which is good. The vast majority of health care providers do everything right and their goal is to try and treat pain and illness and try to prevent people from being addicted to these drugs.”