Pain management clinics have become a national focus in an effort to prevent so-called “pill mills.” Deaths from prescription drug overdoses have escalated 360 percent within the last decade in the Appalachian region, considered to be the original epicenter of the painkiller epidemic. Georgia is the ninth state to require that pain clinics be doctor-owned,1 but Florida led the initiative in 2011 by prohibiting physicians, except in limited instances, from dispensing Schedule II and III drugs. 2 In 2010, there were only 10 pain clinics in Georgia. By 2011, that number jumped to 140 following the crackdown on pain clinics in Florida, previously the focal point of the black market for drugs such as oxycodone or hydrocodone. 3
On July 1, 2013, House Bill 178, known as the “Georgia Pain Management Clinic Act”, went into effect. The state’s House and Senate overwhelmingly voted in favor of the initiative, which attempts to gain control of the prescription drug abuse epidemic. 4 The legislation amends O.C.G.A. Chapter 34 of Title 43 and regulates pain clinics and how they interact with end users and requires sole ownership by physicians licensed in the state of Georgia as opposed to laypersons and/or mid-level or advanced nurse practitioners. 5 The Act also grants the Georgia Composite Medical Board (“Board”) the authority to license, regulate and establish related minimum standards for pain management clinics.
The Act requires clinic licensure and renewal every two years. 6 Any person operating a clinic without a license would be in violation of the act and guilty of a felony. 7 The act defines a “pain management clinic” to be “any medical practice advertising ‘treatment of pain’ or utilizing ‘pain’ in the name” or a clinic “with greater than 50 percent of its annual patient population being treated for chronic pain for nonterminal conditions by the use of Schedule II or III controlled substances.” 8 Clinics owned by a hospital, health system, ambulatory surgery center, skilled nursing facility, hospice or home health agency are exempted from this definition. 9
Further requirements include the following:
- No pain management treatment is to be administered unless an authorized provider is on-site. 43- 34-283(g).
- The Board may exchange clinic license information with other states or third parties. 43-34-283(h).
- The Board requires immediate notification if there are changes in the clinic structure (i.e., change of ownership, management or location), in the event of a theft or loss of drugs, or if criminal charges have been or are being brought against any employee of the clinic that involves fraud or drug laws. 43-34-285.
- All clinics that dispense controlled substances or dangerous drugs must be registered with the Georgia State Board of Pharmacy. 43-34-286.
- If a license is not renewed prior to its expiration date, the Board will consider the license revoked and has full discretion regarding reinstatement. 43-34-287(a).
- The Board may require additional continuing medical education (CME) for physicians who own and/or practice in the pain management clinic, as well as any other licensed health care professional practicing pain management. 43-34-283(c); 43-34-287(b).
- Should a death occur, the investigating agencies are authorized to send pertinent records to the Board. Those records will remain confidential and will not be disclosed without the approval of the Board. 43-34-290.