Originally published by Benson Varghese.
Today President Trump declared the opioid crises a Public Health Emergency. Earlier this year, Attorney General Jeff Session vowed a federal crackdown on doctors and pharmacists who are doling out a disproportionate number of opioids. The declaration that the crisis is public health emergency frees up federal money to for the DOJ and federal investigators to focus on perceived “pill mills.”
What are Opioids?
An opiate is a chemical derived from opium. An opioid is “opiate-like” but is man-made. Common opioids include common drugs – oxycodone (OxyContin), hydrocodone (Vicodin), morphine, and methadone. They are commonly used for pain relief. Many opioids, such as OxyCodone, Hydrocodone, Vicodin, and Percocet, are regularly prescribed by doctors. Other painkillers, such as morphine and fentanyl, are used during surgery or to ease the suffering caused by cancer. The illegal and highly addictive street drug heroin is also an opioid.
What is the Opioid Crisis?
According to the CDC, In 2012, 259 million prescriptions for opioids were written in the United States. To understand the sheer number of prescriptions being written, that would be 82 prescriptions for opioids written for every 100 Americans.
Every 19 minutes someone dies from an accidental drug overdose – most often from opioids. Opioids are highly addictive and as a person’s tolerance builds up they need more and more of the drug to have the same effect.
Many people’s introduction to opioids begins innocently enough — with a prescription from their doctor. Unfortunately, these highly-addictive and powerful painkillers can take users down a dangerous path that can lead to charges for them and the doctors prescribing the medication.
What are Opioid Pill Mills?
Recently, dozens of doctors across the country have been charged with running “opioid pill mills” out of their clinics. From Dallas to Detroit, doctors have been indicted on federal charges for illegally prescribing opioids, such as hydrocodone, oxycodone, and even the highly addictive fentanyl.
A pill mill refers to a clinic or doctor’s office that prescribes medication without a medical purpose or outside the normal course of medical practice – meaning they are prescribed for profit rather than medical necessity.
Arrests and charges related to the illegal prescription, possession, sale or distribution of opioids are being taken very seriously. Here’s a look at the drugs, possible charges and punishments stemming from opioid-related crimes, and examples of doctors and pharmacists who have found themselves in legal trouble for opioid pill mills.
Doctors who overprescribe or sell powerful and addictive opioids without medical justification to increase revenue are often said to be running “opioid pill mills.” Many run “pain clinics” and only accept cash payments (no insurance or credit cards.) Some dispense medications directly from their office and may have lines of people waiting to get inside.
How are Doctors Landing in Legal Trouble for Prescribing Opioids?
Federal agents are now using a new analytics program that tracks drug prescription and sales. The program is supposed to expose doctors writing prescriptions at a faster rate than their peers and identify pharmacies dispensing disproportional numbers of pills. Traditional investigations also include federal agencies like the DEA obtaining physicians’ prescription records. The government asks paid experts if the prescriptions were being written in a manner the expert agrees with. If not, the prosecution may initiate charges or seek a statement from the doctor, or even issue a target letter or grand jury subpoena to elicit incriminating statements from the physician. It is also not uncommon for law enforcement to reach out to current or former employees to try to get dirt on the doctor. In other instances, the Government may send in a person to see how easy it is to get a prescription without a legitimate medical purpose.
The government will target and arrest doctors and clinic owners, but employees can also be arrested and charged.
Doctors who are improperly prescribing or pushing opioids, including fentanyl, face serious repercussions. Not only could their medical license be in jeopardy, but they could face charges including drug conspiracy, money laundering, health care fraud and, even, murder. They are also subject to asset forfeiture. Here’s a look at recent examples of doctors who received lengthy federal sentences:
- Hsiu-Ying “Lisa” Tseng was convicted of second-degree murder in February 2016 and sentenced to 30 years to life in connection with the overdose death of three patients. Authorities said she was selling pain pills from her office in a strip mall in Los Angeles County. The case marked the first time a doctor had been convicted of murder in the U.S. for overprescribing drugs.
- In March 2016, Theodore Okechuku was sentenced to 25 years in federal prison for running a “pill mill” operation in Dallas. Specifically, he was convicted of conspiracy to unlawfully distribute a controlled substance. Officials said he conspired with drug dealers by handing out prescriptions for hydrocodone at his Medical Rehabilitation Clinic for case payments, often without examining patients. The dealers sold the drugs on the street.
- In May 2017, Xiulu Ruan and Dr. John Patrick Couch were sentenced to 20 years and 21 years in federal prison, respectively, after being convicted of drug and fraud charges stemming from drug raid at two of their Mobile, Ala., pain clinics. Officials said they overprescribed potent narcotic pain medications, including fentanyl-based drugs.
- An Arkansas pharmacist was sentenced to 10 years in prison in September 2017 for dispensing hydrocodone while falsely billing Medicare. Christopher Watson sold tens of thousands of pills outside of the drugstore’s regular hours and forged prescriptions to account for the missing pills, officials said.
The Opioid Black Market
While many people get opioids with a prescription from a doctor, others turn to the black market to find the powerful painkillers. Opioids, including fentanyl and its more powerful counterpart, carfentanil, are being manufactured and sold on the black market, including the dark web, at an alarming rate.
What is Fentanyl?
Fentanyl is a synthetic opioid that made headlines when music icon Prince overdosed on it in the spring of 2017. It is reportedly 50 to 100 times stronger than morphine. While it is available as a prescription, it is also being manufactured illicitly. Just touching the drug can be fatal. It’s often produced in Mexico and China and often mixed into heroin or other street drugs.
What is Carfentanil?
Carfentanil is related to Fentanyl, but is 100-times stronger, according to the Drug Enforcement Administration. It’s a tranquilizer for elephants and other large animals and was never intended for humans. It is the most potent commercial opioid in the world and is often added to heroin to give it a more powerful kick. It is regularly bought on dark web markets, sometimes using bitcoin, and shipped from China.
What are the Street Names for Fentanyl?
Street names for fentanyl or fentanyl-laced heroin include Apache, Dance Fever, China Girl, China White, TNT and Jackpot, Poison, and Goodfella.
What State or Federal Charges Can Stem from Fentanyl and Carfentanil?
State and federal charges can stem from possessing, manufacturing or selling synthetic opioids such as fentanyl and carfentanil. How an individual is charged depends on a variety of factors, including the amount involved, criminal history and whether someone was seriously injured or died as a result of ingesting or coming in contact with the drugs. Here’s an overview of the potential consequences in Texas, as well as at the federal level.
Texas: Possession of a Controlled Substance
Under Texas law, it is illegal for residents to possess a controlled substance without a prescription. Opiates and opium derivatives, which would include fentanyl and carfentanil, fall under penalty group 1 in Texas. Depending on the quantity of the drug, the punishment for possessing a penalty 1 drug can range from 180 days in jail to up to 99 years in prison.
| Amount | Penalty | Fine |
| Over 400 grams | 15 to 99 years or life in prison | Up to $250,000 |
| 200-400 grams | 10 to 99 years or life in prison | Up to $100,000 |
| 4-200 grams | 5 to 99 years or life in prison | Up to $10,000 |
| 1 to 4 grams | 2 to 20 years in prison | Up to 10,000 |
| Under 1 gram | 180 days to 2 years state jail | Up to 10,000 |
Texas: Manufacturing, Delivery or Intent to Deliver
Drug manufacturing usually involves creating illegal synthetic drugs in labs for the purpose of distributing or selling drugs. In fact under Texas law, the state assumes that a person who manufactures drugs is intending to distribute them. The punishment for manufacturing or delivering a controlled substance can range from a state jail felony up to a first-degree felony.
| Amount | Penalty | Fine |
| Over 400 grams | 15 to 99 years or life in prison | Up to $250,000 |
| 200-400 grams | 10 to 99 years or life in prison | Up to $100,000 |
| 4-200 grams | 5 to 99 years or life in prison | Up to $10,000 |
| 1 to 4 grams | 2 to 20 years in prison | Up to 10,000 |
| Under 1 gram | 180 days to 2 years state jail | Up to 10,000 |
Federal: Trafficking Fentanyl or the Fentanyl Analogue Carfentanil
Under federal law, how individuals are charged and sentenced depends on a variety of factors, including the amount of drugs, prior criminal history and whether serious bodily injury or death occurred. Below are the federal penalties that apply to drug trafficking fentanyl or a fentanyl analogue. Carfentanil is an analogue of fentanyl. As you can see, the consequences are severe:
| Substance/Quantity | Penalty | Substance/Quantity | Penalty |
| Fentanyl, 40-399 grams mixture
(Schedule II drug)
Fentanyl Analogue 10-99 grams mixture (Schedule I drug) |
First Offense: Not less than five years and not more than 40 years. If death or serious bodily injury, not less than 20 years or more than life. Fine of not more $5 million if an individual, $25 million if not an individual
Second Offense: Not less than 10 years and not more than life. If death or serious bodily injury, life imprisonment. Find of not more than $8 million, $50 million if not an individual.
|
Fentanyl, 400 grams or more mixture
(Schedule II drug)
Fentanyl Analogue, 100 grams or more |
First Offense: Not less than 10 years and not more than life. If death or serious bodily injury, not less than 2 years or more than life. Fine of not more than $10 million if an individual, $50 million if not an individual.
Second Offense: Not less than 20 years, and not more than life. If death or serious bodily injury, life imprisonment. Fine of not more than $20 million if an individual, $75 million if not an individual.
2 or More Prior Offenses: Life imprisonment. Find of not more than $20 million if an individual, $75 million if not an individual. |
These cases can also be charged as:
Federal Drug Conspiracy Charges
Investigated or Arrested for an Opioid-Related Offense or Opioid Pill Mill?
Individuals who are the target of a criminal investigation stemming from opioids, should contact a skilled criminal defense attorney who specializes in drug and white collar crimes as soon as possible. These are extremely serious charges that could impact your life and livelihood. Our defense team is made up of former prosecutors who have more than 100 years of collective experience handling drug charges at state and federal levels. We can help.
Contact Us
If you have become the target of a federal investigation or are facing federal criminal charges for operating a pill mill, contact us immediately. We will get to work analyzing the Government’s case, and the opinion of their “expert” to build a defense focused on the legitimacy of the prescriptions. Give us a call at (817) 203-2220 or contact us online:
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