The DEA has investigated and closed many of these clinics. In 2010, during the 82nd Legislative Session, through the Texas Occupational Code, Chapter 168 the Texas Medical Board mandated Pain Clinic Registration. The mandate requires practices whose M.O. is to prescribe greater than 50% controlled substances to register with the Medical Board, adhere to certain rules, and present themselves for periodic TMB inspection. In the Houston area, some of these “Pill Mills” simply never registered with the TMB. Many renamed their clinics to “Wellness Clinics” or “Urgent Care Clinics” and have been able to conceal their high volume of controlled substances with the aid of a conspiring pharmacy.
Texas DPS has initiated a Prescription Access Texas (PATx) website to assist physicians, midlevel providers and registered nurses to screen patients for potential diversion and the procurement of multiple controlled substance prescriptions (“Doctor Shopping”).
The new “2.0 Pill Mill” is so simple as to be genius: no “doctor” to pre-sign prescriptions, no “clinic” to maintain, no individuals to pose as “patients” and no revenue to “split” with participating pharmacies. Operating solely by “Prescriptive Identity Theft” is much more efficient and cheaper to run than the old “Pill Mills”. The individuals usually present a fraudulent ID at pharmacies to make them less traceable. It is unclear whether or not certain pharmacies are also in cahoots. Physicians’ practices that take the time to check their profile on the PATx can readily detect alteration in their prescribing habits and profiles, alerting them to fraudulent use of their prescribing credentials. Knowingly or not, pharmacists have placed themselves squarely in the center of this new Pill Mill, and physicians’ credentials have been compromised.
Law enforcement contacts across several counties are aware of this criminal activity. In addition Texas’ pharmacy associations, the Texas Pain Society, and the TMA are knowledgeable. The DEA can’t truly put an end to these crimes without legislative changes involving how we prescribe controlled substances, as well as, how we fill these prescriptions at pharmacies.
At the end of the day, when the money is followed and the buck stops, the Pharmacists are still filling fraudulent prescriptions, often without checking the DPS PATx because it’s cumbersome, difficult to navigate and time consuming. Pharmacists, their techs, physicians and RNs currently legally get access to this site. Currently, Medical Assistants are not allowed to access the PATx, but are often calling in prescriptions for controlled substances. 
