Dozens of medical professionals in five states were charged Wednesday with participating in the illegal prescribing of more than 32 million pain pills, including doctors who prosecutors said traded sex for prescriptions and a dentist who unnecessarily pulled teeth from patients to justify giving them opioids.

The 60 people indicted include 31 doctors, seven pharmacists, eight nurse practitioners and seven other licensed medical professionals. The charges involve more than 350,000 illegal prescriptions written in Kentucky, Ohio, Tennessee, Alabama and West Virginia, according to indictments unsealed in federal court in Cincinnati.

“That is the equivalent of one opioid dose for every man, woman and child in the five states in the region that we’ve been targeting,” 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. At least one doctor is charged in connection with a death caused by the opioids, officials said.

The indictments are part of a broader effort by the Justice Department to combat the nation’s opioid epidemic, which claimed the lives of 47,600 people in 2017 alone, the latest year that federal overdose data is available.

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 nine federal districts there.

“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 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.

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.

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.

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 American 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. 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.