title: Associations between pain clinic density and distributions of opioid pain relievers, drug-related deaths, hospitalizations, emergency department visits, and neonatal abstinence syndrome in Florida.
abstract: BACKGROUND
  Community-level associations between pain clinics and drug-related outcomes have not been empirically demonstrated.
  
  
  METHODS
  To explore these associations we correlated overdose death rates, hospital-discharge rates for drug-related hospitalizations including neonatal abstinence syndrome, and emergency department rates for drug-related visits with registered pain clinic density and rate of opioid pills dispensed per person at the county-level Florida in 2009. Negative binomial regression was used to model the crude associations and associations adjusted for exposure measures and county demographic characteristics.
  
  
  RESULTS
  An estimated 732 pain clinics operated in Florida in 2009, a rate of 3.9/100,000 people. Among the 67 counties in Florida, 23 (34.3%) had no pain clinics, and three had 90 or more. Adjusted negative binomial regression determined no significant association between pain clinic rate and drug-related outcomes. However, rates of drug-caused, opioid-caused, and oxycodone-caused death correlated significantly with rates of opioid and oxycodone pills dispensed per person in adjusted analyses. For every increase of one pill in the rate of oxycodone pills per person, there was a 6% increase in the rate of oxycodone-related overdose death.
  
  
  CONCLUSIONS
  Although pain clinics, some of which are "pill mills," are clearly a source of drugs used nonmedically, their impact on health outcomes might be difficult to quantify because the pills they prescribe might be consumed in other counties or states. The impact of "pill mill" laws might be better measured by more proximal measures such as the number of such facilities.
authors.affiliation: Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway, N.E., Mailstop F62, Atlanta, GA 30341, United States. Electronic address: ige7@cdc.gov.
authors.forename: Erin K
authors.initials: EK
authors.lastname: Sauber-Schatz
authors.forename: Karin A
authors.initials: KA
authors.lastname: Mack
authors.forename: Shane T
authors.initials: ST
authors.lastname: Diekman
authors.forename: Leonard J
authors.initials: LJ
authors.lastname: Paulozzi
mesh_terms: D017677:Age Distribution; D000701:Analgesics, Opioid / Q000633:toxicity*; D002423:Cause of Death; D062787:Drug Overdose / Q000401:mortality*; D004363:Drug Utilization / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005431:Florida / Q000453:epidemiology; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D015233:Models, Statistical; D009357:Neonatal Abstinence Syndrome / Q000453:epidemiology*; D018710:Pain Clinics / Q000706:statistics & numerical data*
chemical_list: D000701:Analgesics, Opioid
keywords: Drug overdose death; Drug-related hospitalization; Florida; Neonatal abstinence syndrome; Pain clinic; Pill mill