‘Pill Mill’ Laws Worked, Cutting Opioid Overprescribing and Deaths

Measures in 11 States Also Reduced Doctor Shopping Without Pushing Patients Into Illicit Drug Use, a New RAND–Penn Study Finds

May 19, 2026

By:

Julia Hinckley, JD

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An image of white pills spilling out of a bottle onto a white surface

As opioid-related deaths mounted in the 2010s, policymakers realized that often, small numbers of providers were responsible for a staggeringly high share of overall prescribing activity: in Florida, 4% of prescribers were responsible for 40% of prescriptions. In Philadelphia, 1% prescribed 25% of opioid prescriptions. In response, 11 states adopted “pill mill control laws” that either raise the qualifications for clinic ownership and practice, enhance oversight of clinic operations, or both.

But should more states adopt these laws even as the opioid crisis has shifted and deaths have begun to decline? A new study from LDI Senior Fellow David Powell and a team from RAND examines the effectiveness of these state laws across a broad range of measures. The study concludes that even in an era when illicit drugs, rather than prescription opioids, are the most prominent driver of overdoses, states should consider enacting pill mill control laws to curb high-risk prescribing.

Prior studies have shown that these laws generally reduce prescribing and overdoses, but evidence has been mixed on whether such laws cause a shift to the illicit market. This paper is the first to examine how these laws affect doctor shopping and the profit mechanisms underlying pill mill behavior. The team concludes that pill mill laws accomplish their primary goal of reducing the profit incentives that drive these entities’ overprescribing and do not cause substantial movement of patients to illegal drugs.

Powell and his collaborators used Medicare claims to examine patient behavior and outcomes. They found that these laws are “especially effective” in deterring overprescribing and doctor shopping. States with such laws saw decreases in total opioid prescribing, overprescribing, and doctor shopping among Medicare beneficiaries.

Additionally, the team found outsized mortality reductions compared with the reduction in prescribing, a pattern showing that the laws successfully target inappropriate opioid access, rather than overall opioid prescribing in a state. While these findings are based only on Medicare-paid prescribing, the mortality effects point to decreased access to opioids overall.

Policy changes that reduce the supply of prescription opioids without adequate treatment alternatives have sometimes been shown to have unintended negative consequences, driving some patients to the illicit drug market. Unlike prior research, the new paper’s mortality findings suggest that these laws do not create such unintended consequences.

Overprescribing in problematic pain clinics is driven by profit motive, which increases when opioids are both prescribed and dispensed by the provider. Pill mills typically dispense opioids directly or coordinate with a local pharmacy (in return for kickbacks) to fill inappropriate opioid prescriptions. To examine whether the laws reduced this type of arrangement, the team analyzed transaction-level information on opioid shipments. They found that pain management control laws reduced opioid shipment quantities to practitioners by 74%. They also documented “strikingly large” reductions in the volume of opioids dispensed directly by practitioners to patients. The team also found limited evidence that pill mill control laws reduce the number of pain management clinics in states.

Pill mill control laws have not been widely adopted, perhaps because they are often opposed by physician organizations and require resources from law enforcement, state medical boards, and health agencies. The results of this study, however, suggest that policies that target high-risk pain management practices, rather than imposing blanket limits on prescribing, might be more effective at reducing harmful prescribing while also minimizing the risk of substitution into illicit drug use.

The authors conclude that this policy intervention warrants greater attention from policymakers. Even amid the declining role of prescription opioids, the authors find that such laws can target high-risk prescribing with less effect on legitimate pain management access.

Noting that the study period focused on the time after the illicit opioid crisis had started, Powell notes: “While the opioid crisis has transitioned to the point that most deaths are from illicit opioids, inappropriate opioid prescribing may operate as an important pathway to illicit opioid use, suggesting that promoting policies and resources to identify and shut down pill mills will continue to meaningfully curb overdose rates.”

The study, “Regulating Quasi-Legal Markets: Evidence From Pain Management Clinic Laws” was published December 2025 in The Journal of Public Economics. Authors include Yuji Mizushima, David Powell, Rahi Abouk, and Cheryl Damberg.