非法药物诊所
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![](http://upload.wikimedia.org/wikipedia/commons/thumb/0/0b/Jasper_Alabama_Pill_Mill_2015.jpg/275px-Jasper_Alabama_Pill_Mill_2015.jpg)
非法药物诊所(英语:Pill mill)是那些不需充分知道患者的病史、不做身体检查、不做诊断、不做医学监测、或在没病历的情况下,就为顾客开立镇痛药(麻醉药物)处方笺的医疗机构,它的模样和一般诊治疼痛的诊所类似。这种机构通常只收现金。它们是加剧鸦片类药物在美国泛滥的罪魁祸首,而成为各州要立法整治的对象。
商业模式及特性
[编辑]![](http://upload.wikimedia.org/wikipedia/commons/thumb/6/6c/Customers_of_a_Florida_pill_mill_run_by_Jeff_and_Chris_George_wait_in_chairs_on_the_sidewalk.jpg/275px-Customers_of_a_Florida_pill_mill_run_by_Jeff_and_Chris_George_wait_in_chairs_on_the_sidewalk.jpg)
在这类诊所,医生本人,或是医生带领的其他医事人员为患者所不具有,或者是被他们夸大的疼痛疾患,开立鸦片类药物的处方。目的不在减轻或是治愈患者的疼痛,而是谋取高额利润。从事这类营运模式的诊所成为犯罪型企业。[2]
这类机构的特性是它们的东家通常不是医事人员,并且只收现金(不接受信用卡付款,也不接受医疗保险支付)。[3]对于病历、诊断资料、照X光、身体检查,全不需要,或只做形式上的身体检查,没讨论用替代药物治疗,就可开立强效镇痛药的处方笺;患者拿了处方笺,只能去特定的药房取药。此外,在这类机构之前会看到长条的人龙,在机构前或旁边的停车场,车辆进出频繁,并雇有安全警卫或保镖负责维持秩序。[4][5]
根据调查机构和科学家的资料,此类诊所的长相和大小各有不同,但对业者而言,重要的是给人有独立疼痛治疗中心的印象。为避免遭受起诉,这类诊所的经营者会把店面用类似快闪店的方式经营。[4]诊所的客户都是物质依赖者,甚至会参与贩售他们手上多馀的药物。[6]
起源与演进
[编辑]一位名为David Herbert Procter,在加拿大出生的医生,被认为是这种诊所的发明者。[7]他于1979年在肯塔基州的小城South Shore开设一家专门做疼痛治疗的诊所。他在1980年代中期,是最早经常开立含有鸦片剂镇痛药的医生。他还加上如阿普唑仑的苯二氮䓬类药物(镇定剂)混合使用。随著普渡制药的重磅炸弹产品OxyContin(活性成分:羟考酮,在台湾译名为奥施康定,或是疼始康定)上市后,他的业务得以扩展。[8]他因此增加雇用医生来经营新设立的诊所。其中有些医生复制这位“非法药物诊所教父”的商业模式,出来自行创业。[9]
这种经营模式随后扩散到其他各州[5] ,包括西维吉尼亚州[10]、德克萨斯州[11]、新墨西哥州[12]、和纽约州[13]。这类诊所业务兴旺,尤其是在佛罗里达州由克里斯·乔治拥有的诊所,业务尤其突出。[14]
后果
[编辑]在美国,由于很容易取得强效镇痛药,鸦片类药物的泛滥受到助长,吸食者因为长期服用,而需要用更高的剂量才能达到与前相同的缓解或是愉悦的效果(药物耐受性而生成的高剂量依赖性)。另外,这些药物中的鸦片剂能产生欣快的效果。经常使用鸦片制剂会取代人体自行生产内啡肽(人体内自行生成的类鸦片肽生物化学合成物)的功能,导致高度药物成瘾。[15]药物滥用导致患者被送往急诊室作紧急治疗的案例数量增加、产生高额的医疗成本、和引发频繁的药物过量致死案例。[16]
这类乱开处方笺的疏失和荒谬的做法、以及倡导药物成瘾和非法贩售药物,都违背医学伦理,以及法律。因此,警方发动多次行动,[17]和美国缉毒局(DEA)采取的措施,[17] 许多犯案者受到法院定罪,到2016年底为止,仅在佛罗里达州就有378位医生被定罪,同时另有95位受到起诉。[5]
为应对麻醉药物滥用日益严重的问题,许多州都修订法律,严加处理。例如在肯塔基州,“非法药物诊所法案”(KRS 218A.175等)在2012年起开始生效,用于改进对开立处方笺的监控。[18]到2012年,美国有41个州实施此类监测计划,到2019年,除密苏里州之外,美国各州均实施此类监测计划。[19]对于是否严格的麻醉药物法案会促成药物使用者转往使用其他如海洛因等的成瘾性物质,发生过文字上的辩论,[20]许多海洛因成瘾者会声称他们以前是鸦片类药物的滥用者。[21]吸毒者也会改用芬太尼,使用者经常因此丧命。[22]
大众传媒引用
[编辑]《奥斯康定特快车》(OxyContin Express)是葡萄牙新闻工作者马里亚纳·范·泽勒在2009年跟踪位于佛罗里达州非法药物诊所销售管道所拍摄的纪录片,[23]这部片子除得到2010年的皮博迪奖之外,[24]还获得其他奖章,并得到艾美奖[25]的提名。从2007年以来一直以美国白领犯罪为主题的电视影集《贪婪的美国人》(American Greed),在第137集(2017年3月首次播出)[26]和152集(2018年3月首次播出),两集主要是谈论这类非法诊所的问题。[27]这类非法诊所的洗钱活动在电视戏剧影集《美甲师》中有重要的戏份。[28]描述真实犯罪的纪录片《药剂师》于2020年在Netflix上播映,演员丹·施耐德在剧中透过私人调查,揭发一家在路易斯安那州圣贝尔纳堂区非法药物诊所的故事。[29]
参见
[编辑]参考文献
[编辑]- ^ See Drug Enforcement Administration. Jasper Pain Clinic Physician Sentenced To Nearly Three Years In Prison For Illegally Dispensing Narcotics. Dea.gov. 2016-04-08 [2020-05-03]. (原始内容存档于2021-01-07).
- ^ Moreto, William; Gau, Jacinta M.; Brooke, Erika. Pill mills, occupational offending, and situational crime prevention: a framework for analyzing offender behavior and adaptation. Security Journal. 2020, 33 (2): 161–178 [2020-06-01]. S2CID 159271129. doi:10.1057/s41284-019-00180-y.
- ^ Rigg KK, March SJ, Inciardi JA. Prescription Drug Abuse & Diversion: Role of the Pain Clinic. Journal of Drug Issues. Jul 2010 [10 Sep 2020]. PMC 3030470
. PMID 21278927. doi:10.1177/002204261004000307. (原始内容存档于2021-01-11).
- ^ 4.0 4.1 Malbran, Pia. What's A Pill Mill?. CBS News. 2007-05-31 [2020-06-25]. (原始内容存档于2022-07-16).
- ^ 5.0 5.1 5.2 Judy McKee. "First, Do No Harm": Criminal Prosecutions of Doctors for Distributing Controlled Substances Outside of Legitimate Medical Need. NAGTRI Journal: 40–46. [2021-06-16]. (原始内容存档于2020-10-25).
- ^ Rigg, Khary K.; March, Samantha J.; Inciardi, James A. Prescription Drug Abuse & Diversion: Role of the Pain Clinic. J Drug Issues. 2010, 40 (3): 681–702. PMC 3030470
. PMID 21278927. doi:10.1177/002204261004000307.
- ^ Eil, Philip. The Pill Mill That Ravaged Portsmouth. Cincinnati Magazine. 2017-07-05 [2020-06-25]. (原始内容存档于2021-07-28).
- ^ Quinones, Sam. Dreamland : the true tale of America's opiate epidemic ePub. New York: Bloomsbury Press. 2015. ¶14.30. ISBN 978-1-62040-250-4. OCLC 893857896.
- ^ Firth, Shannon. 'Dreamland' Author Takes an Opioid Epidemic Trip — Investigative journalist Sam Quinones talks about the crisis. MedPage Today. 2016-11-26 [2020-06-25]. (原始内容存档于2022-03-30).
- ^ Chronicle. Appalachian Journal. Autumn 2015/winter 2016, 43 (1/2): 136–139 [2021-06-16]. (原始内容存档于2021-01-08).
At page 137
- ^ * Dan Rather. Report on Pill Mills. Dan Rather Reports. 2013-01-15 [2020-06-25]. (原始内容存档于2021-01-18) –通过YouTube.
- ^ Pawankumar Jain Pleads Guilty to Unlawfully Dispensing Prescription Painkillers and Health Care Fraud. Department of Justice. U.S. Attorney’s Office. District of New Mexico. 2016-02-11 [2020-06-25]. (原始内容存档于2021-06-22).
- ^ Dyer, Owen. Doctors in New York "pill mill" worked under daily threats, court hears. British Medical Journal (Clinical Research Ed.). 2015-05-13, 350: h2596. ISSN 1756-1833. PMID 25972385. S2CID 206905605. doi:10.1136/bmj.h2596.
- ^ For the extensive pill mill business of twin brothers Christopher and Jeffrey Georg see Temple, John. American Pain. How a Young Felon and His Ring of Doctors Unleashed America's Deadliest Drug Epidemic. Guilford, Connecticut: Lyons Press. 2015. ISBN 978-1-4930-0738-7.
also Felix, Gillette. American Pain: The Largest U.S. Pill Mill's Rise and Fall. Bloomberg News. 2012-06-06 [2021-06-16]. (原始内容存档于2022-05-06).
See also Thirty-two Indicted in Broward and Palm Beach Countries in Second Coordinated Pill Mill Takedown (Press release). United States Attorney's Office. Southern District of Florida. 2011-08-23 [2021-06-16]. (原始内容存档于2021-04-27) (英语). - ^ Chubinski, Jennifer; Walsh, Sarah; Sallee, Toby; Rademacher, Eric. Painkiller Misuse among Appalachians and in Appalachian Counties in Kentucky. Journal of Appalachian Studies. Autumn 2014, 20 (2): 154–169. JSTOR 10.5406/jappastud.20.2.0154. doi:10.5406/jappastud.20.2.0154.
At p. 155
- ^ For the Kentucky example see Chubinski, et. al., 2014, p. 158.
- ^ 17.0 17.1 See for example:
McGreal, Chris. Why were millions of opioid pills sent to a West Virginia town of 3,000?. The Guardian. 2019-10-02 [2020-06-25]. (原始内容存档于2022-07-05) (英语).
Coote, Darryl. Dozens arrested for running alleged Houston 'pill mill'. 2019-08-29 [2020-06-25]. (原始内容存档于2021-01-10) –通过UPI (英语).
Woman at center of East Tennessee pill mill investigation found guilty. Knoxville, Tennessee: WVLT. 2020-02-14 [2020-06-25]. (原始内容存档于2021-01-08). - ^ New Kentucky "Pill Mill Bill" Places New Restrictions on Pain Management Facilities and Controlled Substances Prescribing. Taft Stettinius & Hollister LLP. 2012-05-08 [2020-06-15]. (原始内容存档于2021-06-13) (英语).
- ^ Weber, Lauren. Why Missouri's The Last Holdout On A Statewide Rx Monitoring Program. Kaiser Health News. 2019-05-20 [2021-06-16]. (原始内容存档于2022-05-13) (英语).
- ^ Rhodes, Emily; Wilson, Maria; Robinson, Alysia; Hayden, Jill A.; Asbridge, Mark. The effectiveness of prescription drug monitoring programs at reducing opioid-related harms and consequences: a systematic review. BMC Health Services Research. 2019-11-01, 19 (1): 784. PMC 6825333
. PMID 31675963. doi:10.1186/s12913-019-4642-8.
- ^ How is heroin linked to prescription drug abuse?. National Institutes of Health. (原始内容存档于2014-02-28) (英语).
- ^ Understanding the Epidemic. Centers for Disease Control and Prevention 2020-03-19. [2020-06-25]. (原始内容存档于2020-11-23) (英语).
- ^ The OxyContin Express. 2009 [2020-06-25]. (原始内容存档于2021-08-14) –通过The Documentary Network.
- ^ Current TV's Documentary Series 'Vanguard' Receives 69th Annual Peabody Award and 2010 Television Academy Honor. Current TV. 2010-04-07 [2020-06-25]. (原始内容存档于2021-01-07) –通过PRNewsWire. (Press release)
The OxyContin Express (Current TV). Peabody Awards. [2020-06-25]. (原始内容存档于2022-03-28). (Recording of the tribute) - ^ Fourth Television Academy Honors Entries Now Accepted. Emmy Awards. Television Academy. [2020-06-25]. (原始内容存档于2021-03-04) (英语).
- ^ American Greed (Season 11). TV Guide. [2020-06-25]. (原始内容存档于2021-01-10).
- ^ American Greed (Season 12). TV Guide. [2020-06-25]. (原始内容存档于2021-01-12).
- ^ Harvin, Darian Symoné. Nail Tips from 'Claws'. The New York Times. 2019-10-06 [2021-06-16]. (原始内容存档于2022-04-14).
Interview with Morgan Dixon, chief manicurist of the series
- ^ Gajanan, Mahita. Netflix's The Pharmacist Depicts the True Story of Grieving Father's Fight Against the Opioid Epidemic. 时代杂志. 2020-02-06 [2020-05-10]. (原始内容存档于2022-04-26).
出版物
[编辑]- Moreto, William D.; Gau, Jacinta M.; Brooke, Erika J. Pill mills, occupational offending, and situational crime prevention: a framework for analyzing offender behavior and adaptation. Security Journal. April 2019.
- Quinones, Sam. Dreamland. The true tale of America's new opiate epidemic. New York, NY: Bloomsbury Press. 2015. ISBN 978-1-62040-250-4.
- Temple, John. American Pain. How a Young Felon and His Ring of Doctors Unleashed America's Deadliest Drug Epidemic. Guilford, Connecticut: Lyons Press. 2015. ISBN 978-1-4930-0738-7.
- Rigg, Khary K.; March, Samantha J.; Inciardi, James A. Prescription Drug Abuse & Diversion: Role of the Pain Clinic. J Drug Issues. 2010, 40 (3): 681–702. PMC 3030470
. PMID 21278927. doi:10.1177/002204261004000307.
外部链接
[编辑]维基词典中的词条“非法药物诊所”
- Pia Malbran. What's A Pill Mill?. CBS News. 2007-05-31 [2021-06-16]. (原始内容存档于2022-07-16).