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Do you have a source for this? This sounds wrong, pain pills are rich/middle income people drug as I perceive it. You can't really get hooked up on pills if you never got them by a doctor first.
There are definitely pill mills in the poorer parts of town. And usually poor populations receive Medicaid, which will typically pay for the stuff. Just anecdotal evidence as a pharm tech in a rough part of town during college, but after a while we had to actually stop taking scripts for most pain meds (still got a ton of people using trazadone and stuff, though) because the pharmacist just didn't think it was worth his license if the scripts were tied back to a pill mill.
The poor people often sell the pills as well.
Can't afford a day off work lazing about on pain pills.
You're assuming doctors are the only source for these.