“There could be more than 500 patients a day at a clinic,” says John Temple, a journalism professor at West Virginia University who has researched Florida’s pill mills. “All going into the building, seeing a doctor and coming out with drugs.”
Temple’s new book, American Pain, delves deep into South Florida’s pain clinic years through the lens of the country's biggest mega-clinic: American Pain. In Palm Beach County, the cash-only clinic was the mother lode during those years, bringing in up to $400,000 a day, Temple found, and making millionaires of its founders.
After being introduced to the lightly regulated prescription pain management industry by a doctor in 2007, by 2009 a 29-year-old Chris George had raked in $40 million. By 2010, he and his twin brother Jeff, the sons of a wealthy Florida real estate developer, owned four pain clinics in Palm Beach and Broward Counties.
“They didn’t know what they were getting into,” Temple says. “Once they found out they were selling pills to addicts, they were thrilled.”
Throughout three years of research and extensive interviews with the federal agents and prosecutors, as well as with Chris George and Derrick Nolan, who are currently serving time in prison, Temple paints a picture of a business that rose and fell in rapid succession.
It’s a surreal portrait: Former strippers operating the pharmacy, doctors carrying guns under their lab coats, and guys in golf carts directing traffic in the clinic parking lot. All along the supply chain, bribes helped speed up the process, to get patients in and out as quick as possible. Up to 90 percent of the pills that left American Pain's doors in Lake Worth were being trafficked to other states.
And Temple also explores stories of the desperate addicts who found their way into the clinic. Like the patient found sleeping in her car in the parking lot, whose cigarette was burning through her skin without her noticing. Or the 17-year-old girl from Louisville, Kentucky, who would drive a carload of people to Florida and back once a week — “seventeen hours one way,” Temple says, “and then seventeen hours back.”
Temple believes American Pain was the deadliest clinic in the country, given that the number of dosages it prescribed dwarf that given at any other. After it was shut down in March 2010, the FBI found that 53 American Pain patients had died of overdoses in Florida.
In 2010, Florida passed a law that put tougher regulations on pill mills. Notably, clinics now have to register with the state. It also made it illegal for doctors to dispense opioid prescription painkillers from their offices. Since then, there have been “modest decreases” in the use of opioid, according to a new study by the JAMA Internal Medicine.
But the nation’s current opioid crisis sprang directly out of the American Pain years, Temple says. Before the clinic, Florida was a relatively easy place to get pills. But Chris George “sort of stumbled into this magic formula,” he says. He hired multiple doctors and ran a huge volume of pills. Once people saw the success of the model, hundreds of similar clinics followed, that indiscriminately prescribed opioids to tens of thousands of people traveling in from all over the country.
Now, prescription opiates have overtaken car crashes as the leading cause of accidental death in the U.S.
Though regulation of the sale of pain pills is important, Temple says the DEA and drug manufacturers are largely to blame for the scourge. The DEA works with pharmaceutical companies to set a production quota for each controlled substance, including oxycodone and other painkillers. After looking at the numbers, Temple found that the U.S. now produces 40 times more oxycodone than it did in 1993.
And that increase doesn’t reflect any increase in pain or any new-fangled drug, he says, but rather a change in the mindset around prescribing and marketing it.
“What’s changed is a massive education campaign put on by pharma to convince doctors to prescribe it,” he says, “and it’s been incredibly successful.”