“That is the equivalent of one opioid dose for every man, woman and child” in the region, Brian Benczkowski, an assistant attorney general in charge of the Justice Department’s criminal division, said in an interview. “If these medical professionals behave like drug dealers, you can rest assured that the Justice Department is going to treat them like drug dealers.”

The charges include unlawful distribution or dispensing of controlled substances by a medical professional and health-care fraud. Each count carries a maximum 20-year prison sentence, and many of the defendants face multiple counts. One doctor in Tennessee is charged in connection with an overdose death caused by opioids, officials said.

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The indictments are part of a broader effort by the Justice Department to combat the nation’s prescription pain pill epidemic, which claimed the lives of nearly 218,000 Americans between 1999 and 2017, according to the Centers for Disease Control and Prevention.

Over the past two years, Justice Department officials said they have targeted doctors, health-care companies and drug manufacturers and distributors for their roles in the epidemic. Last year, the department charged 162 defendants, including 76 doctors, for their roles in prescribing and distributing opioids and other dangerous narcotics.

Benczkowski said he created the Appalachian Regional Prescription Opioid Strike Force late last year to target the region, which has been devastated by the epidemic. The department analyzed several databases to identify suspicious prescribing activity and sent 14 prosecutors to 11 federal districts there.

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“The opioid epidemic is the deadliest drug crisis in American history, and Appalachia has suffered the consequences more than perhaps any other region,” Attorney General William P. Barr said in a statement.

Once they had the data indicating suspicious prescriptions, investigators used confidential informants and undercover agents to infiltrate medical offices across the region. Cameras and tape recorders were rolling as they documented how medical professionals used their licenses to peddle highly addictive opioids in exchange for cash and sex, officials said. The arrests began early Wednesday morning.

In one case, a doctor operated a pharmacy in his office, just outside the exam room, where patients could fill their prescriptions for opioids immediately after receiving cursory exams, according to the Justice Department. In another, prosecutors said, patients consented to having their teeth pulled so they could obtain opioid prescriptions from a dentist and then paid in cash.

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In a number of cases, according to the indictments, doctors across the region traded prescriptions for oxycodone and hydrocodone for sexual favors. Some physicians instructed their patients to fill multiple prescriptions at different pharmacies. Prosecutors also documented how patients traveled to multiple states to see different doctors so they could collect and then fill numerous prescriptions.

“What these doctors have done is pretty remarkable in its brazenness,” Benczkowski said.

In Dayton, Ohio, which has been hit particularly hard, a doctor who authorities say was the state’s highest prescriber of controlled substances, along with several pharmacists, was charged with operating a “pill mill.” Prosecutors say that the health-care professionals dispensed more than 1.7 million pills between October 2015 and October 2017.

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In Tennessee, a doctor who branded himself the “Rock Doc,” allegedly prescribed dangerous combinations of opioids and benzodiazepines, sometimes in exchange for sexual favors. Over the course of three years, prosecutors say he prescribed nearly 500,000 hydrocodone pills, 300,000 oxycodone pills, 1,500 fentanyl patches and more than 600,000 benzodiazepines.

In Alabama, a doctor allegedly recruited prostitutes and other young women to become patients at his clinic and allowed them to use drugs at his home, prosecutors said. Another Alabama doctor allegedly prescribed opioids in high doses and charged a “concierge fee” of $600 per year to be one of his patients.

Prosecutors allege that a doctor in Kentucky prescribed pain killers to his Facebook friends who would come to his home to pick up their prescriptions in exchange for cash.

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Prosecutors also said some health-care professionals prescribed opioids for themselves. An orthopedic surgeon in West Virginia allegedly wrote fraudulent prescriptions for pain pills using the name of a relative and a stolen driver’s license from a colleague. In Pennsylvania, a state outside the targeted region, prosecutors say a nurse filled out phony prescriptions for oxycodone in her name and in the names of others to obtain pills for herself.

The arrests could leave thousands of addicts and legitimate pain patients without access to their doctors and health-care professionals. Federal and local public health officials say they are working together to “ensure continuity of care.”

“It is also vital that Americans struggling with addiction have access to treatment and that patients who need pain treatment do not see their care disrupted,” Health and Human Services Secretary Alex Azar said in a statement.

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The opioid indictments come as more than 1,500 cities, counties, Native American tribes and unions are suing drug companies in one of the largest and most complicated civil cases in U.S. history.

A federal judge in Cleveland is overseeing the cases, which accuse some of the biggest names in the industry of fueling the opioid epidemic by failing to report suspicious orders of narcotics and falsely marketing opioids to pain patients. The companies have blamed the epidemic on corrupt doctors and pain management clinics and say the epidemic is too complicated to attribute to their actions.

Justice officials Wednesday did not discuss the companies that have supplied opioids to the seven states. Benczkowski said this investigation targeted medical professionals because they were “the gatekeepers to the patients.”