They are called "scrip rings," and police call them one of the fastest-growing types of crime around.
Two big local cases show just how cunning scrip ring leaders can be.
Angela Hicks used to be a pediatric medical assistant at University Hospitals. But she wasn't interested in helping sick kids.
What she wanted were the blank prescription pads that abound in a hospital setting and in doctor's offices.
"There's a real market, a black market, for stolen prescription pads," says Ohio Attorney General Mike DeWine. "You can imagine if someone got hold of a whole pad of a doctor's, what they could do with that. It's like you're sitting there with something that's worth thousands of dollars."
Hicks knew that -- she got her hands on about 640 blank prescription sheets with doctors' names on them. On the street, each sheet is worth between $50 and $100 and that could have meant a haul of $30,000 to $60,000.
But Angela and her husband, Joshua, wanted drugs more than cash. So they rounded up some of their friends and had them fill prescriptions for Percocet at 17 local drugstores, including various locations of CVS, Rite Aid, Walgreens and Marc's.
In 2012, Destiny Ramos was training to be a phlebotomist, drawing blood from patients at hospitals. She worked at Southwest General Hospital.
She and her boyfriend, Donte Jones, recruited 18 people to hit local pharmacies -– for Percocet and Vicodin.
"There's always going to be a vacuum (for getting drugs illegally) and I guess some of that vacuum will be filled by people getting the prescriptions their own way," says James Gutierrez, an assistant county prosecutor for the Cuyahoga County Prosecutor's office.
So they'll take low-level jobs at hospitals or in medical buildings – as medical assistants or lab techs, or as cleaning people – just for access to prescription pads.
DeWine has led a crackdown on pill mills, drying up some sources of drugs, which has the side effect of making another illegal way to get pain pills more popular, such as getting fake prescriptions filled.
But someone's got to take those once-blank prescriptions to drug stores -– and it won't be the ring leaders. Often, it's people they know –- in Destiny Ramos' case, it was fellow tenants of her West Side apartment building.
Most often, these people have government insurance -– or at least the friends whose insurance cards they use have it.
"They need other people's names to put the prescription in because they know they can't just keep going to the pharmacy in their own name," says Gutierrez.
As a result, says Detective John Prince, of the Cleveland Police Department, scrip rings have become another go-to method for opiates in pill form.
"What we've seen is a morphing from individuals, to groups of people as organized entities, as criminal enterprises," Prince says. "It's a way of withdrawing pills from a pharmacy, as opposed to money from a bank."
Homeless people are also sometimes recruited for such purposes by the ring leader, says Prince.
Brian Davis, an advocate at the Northeast Ohio Coalition for the Homeless, has seen it himself.
"We know that the drug dealers come down to the shelters to try and sell drugs and to recruit people to be involved in their enterprise," Davis says.
While the heroin epidemic is getting a lot of attention, that drug isn't every addict's choice.
"There's always been a subsection of addicts that want prescription drugs and not street drugs," says Gutierrez. "So they're going to find a way to do it."
The prosecutor says he is surprised at the availability of the prescription pads. He's seen them in plain sight at his own doctor's offices.
"You would think that medical facilities would be more careful with their prescription pads and things of that nature and my experience is they haven't (been)," he says.
University Hospitals declined to speak to us on the subject. So did the Cleveland Clinic and MetroHealth Medical Center. Prescription pad theft is a sensitive subject.
UH did give us a statement, which noted:
"Prescription pad theft is an ongoing challenge for hospitals and physician offices. Obviously, the theft not only victimizes the hospitals and doctors themselves, it also corrodes a law-abiding society."
The one thing that stops scrip ring drug traffickers? Vigilant pharmacists. That's how Ramos and the Hicks eventually got caught.
"They are the gatekeepers," says Prince.
Jesse Wimberly, an agent with the Ohio State Board of Pharmacy, also shares that message.
Not many drug stores are like Sheliga Pharmacy, on Cleveland's East Side.
"We basically know everyone that comes in here," says Tim, one of three pharmacists at the store. "So if you get a strange person not from around here, and a prescription from a strange doctor you've never seen, the antenna go up."
Scrip ring mules look for pharmacies where they can blend in. They'll choose busy times, or evenings, when doctors can't be reached.
But some pharmacists are on to them.
"You can ask them, 'we need to verify the prescription, would you like to leave it till tomorrow?' and guess what the answer is?" says Tim.
Detective Prince was among law enforcement officers who went down to Columbus recently to testify in favor of legislation – House Bill 381 - that would make it mandatory for pharmacies to check photo IDs.
That would make it easier for pharmacies to have a record of whose prescription they are filling, as well as a provide law enforcement with a way to track that person down and bust a ring that much sooner.