by John Temple
In 2003, the Lexington Herald-Leader released a trove of stories about how painkillers were crippling eastern Kentucky. The series included dozens of stories about how the drug had turned eastern Kentucky into the Wild West, sketches of backwoods judges and their connections to drug defendants, nuggets about how the Kentucky State Police didn’t trust local law or prosecutors. The package detailed how no less than four former sheriffs who’d been removed from office due to criminal charges—mostly drug-related—had run for office again in eastern Kentucky in 2002. How two sheriff’s candidates in different counties had been murdered that election season—again, drug-related. One piece reported on the state’s biggest pill mill, a clinic located in a tiny Greenup County town forty miles down the Ohio River from Huntington, West Virginia. Five doctors there eventually pleaded guilty to churning out prescription after prescription.
Hal Rogers, the US representative from eastern Kentucky since 1980, read the Herald-Leader series and reacted like the twelve-term congressman he was. Two months later, he unveiled a regional drug task force called Operation UNITE. The organization, funded by federal grants, would combine law enforcement, treatment, and education under one umbrella. Over the next three years, UNITE’s officers confiscated more than fifty thousand pills and arrested some eighteen hundred people. The state also passed tighter controls on doctors and painkillers.
Purdue Pharma was also changing how it did business in Kentucky. In 2001, Purdue retooled its sales pitch for drug reps in fifteen Kentucky counties. Those reps were told to discuss only abuse prevention with their doctors. Purdue also told its reps that the company would no longer pay them bonuses on OxyContin sold to doctors who were arrested for improper prescribing.
And the measures worked. Sort of. After 2003, the number of pain-killers prescribed and sold in Kentucky plateaued. Reporters turned to other matters.
But officials soon noticed contradictory trends. Despite the leveling off of sales figures in Kentucky, and outright decreases in eastern Kentucky, the number of fatal drug overdoses in the state continued to rise. Steeply. In 2001, there were 339. The next year, 435. Year after that, 551. In 2006, 711.
Same went for babies born addicted to drugs. In 2001, sixty-two Kentucky newborns were hospitalized for neonatal abstinence syndrome. The next year, ninety-three. Two years after that, 166. By 2007, 275.
Most overdose deaths in Kentucky involved a mixture of drugs. The most common drugs, by far, were alprazolam and oxycodone. There might be thirty or forty cocaine-related deaths in a typical year. Maybe one heroin death, often none.
So where were the drugs coming from?
What gradually became clear in 2005 and 2006 and 2007 was that Kentucky users were leaving the state for their drugs. Seven states border Kentucky, with seven different sets of drug laws and regulations and seven different levels of prescription drug scrutiny. Few states kept track of prescriptions as closely as Kentucky. Eastern Kentuckians were arrested with pills from doctors in Detroit; Philadelphia; Cincinnati; Slidell, Louisiana. But increasingly, the destination for painkillers was Florida, which didn’t track prescriptions of controlled substances at all.
One early Florida pill runner was a sixty-four-year-old Kentucky grandmother named Jewell Padgett. Two-dozen people were traveling from Kentucky to Florida to buy pills, and Padgett paid for expenses and kept a portion of the pills. After Padgett was arrested in 2006, her son blamed the whole thing on Kentucky doctors who were afraid to prescribe painkillers since the crackdown. His ailing mother was forced to travel to Florida. He said: “They wouldn’t give her medication she needed. They’re scared up here.”
Around that time, another go-to candyman for several Kentucky oxycodone rings was Dr. Roger Browne, who had a practice in Coral Springs, Florida. Dr. Browne made the mistake of getting too close to his patients. First, a girlfriend got arrested for selling pills back home in Carter County. She told the feds in Lexington about Dr. Browne. Another patient started working with the feds and wore a wire one night when he met the doctor for drinks. The informant told the doctor that he’d bring some buddies on his next trip to Florida.
“That’ll work,” Dr. Browne said.
The buddies were federal drug agents. In April 2008, they raided Dr. Browne’s clinic and found the medical records of almost five hundred Kentucky residents. Dr. Browne pleaded guilty to conspiring to distribute oxycodone and was sentenced to two and a half years in prison.
Didn’t matter. By mid-2008, the word was out all over eastern Kentucky: New pain clinics were opening every week in Broward County. Kentuckians began traveling to Florida by the van-load.
In Rockcastle County, Sheriff Peters was just beginning to learn about the pill pipeline in early 2009. That’s around the time his friend Shelby told him about the trip she and her daughter and Alice Mason had made to Florida to confront some pill mill doctor. The sheriff knew Lisa’s mother pretty well. They’d worked together years ago at Renfro Valley, the country music concert venue. He wasn’t happy that she’d put herself in harm’s way like that. But he wasn’t surprised. That was Shelby. No, what surprised him was that Alice Mason had traveled that far from Hummingbird Lane. He couldn’t believe Shelby was talking about the same gap-toothed farmwoman he’d met. Folks like Alice Mason didn’t travel to Lexington, let alone Fort Lauderdale.
Sheriff Peters was right. Only once had Alice spent more than a day outside of Kentucky. The big trip had happened around 1969. Alice had been thirteen or fourteen. Her mom’s sister had moved down to Winter Haven, Florida, and one day she came back to Kentucky and picked up the whole family, except Alice’s father, and took them to Florida for two weeks. Alice told her sons about the experience sometimes, how flat it was in Florida, the strange weather, how one time she saw the sky pouring rain on one side of her aunt’s house and nary a drop on the other side. It was exciting. But Alice was glad to get back home to Rockcastle County after that trip, and she never left again, other than a couple of daytrips to state parks in Tennessee when the boys were little. She went to Mount Vernon a couple of times a week to pick up groceries, and that was about it. Young Kevin seemed to go everywhere in the world, but not Alice. She stayed home. Florida had so many people, and not people she knew.
But she had to understand what happened to Stacy, why the doctor had prescribed him so many oxycodones. She thought about this question all the time, what she would say to Dr. Cadet, wondering what Dr. Cadet would say. There had to be a reason.
So when Lisa said they should go to Florida, Alice surprised herself by saying, yes, she wanted to go.
Almost four weeks after Stacy died, a massive storm moved south through Kentucky. Driving rain fell through an upper layer of warm air, then froze in the colder layer below. Shelby woke to find all of Mount Vernon coated in a half-inch sheath of ice. Every surface was glazed over and glittering—twigs, power lines, fences, mailboxes.
Shelby got in her car to head to her shift at Walmart, and just made it off her hill before sliding backward into someone’s yard. She called the store to let them know she wouldn’t be in. No answer. She called another number, and someone picked up and said the ice storm had pulled off an impossible feat. It had shut down Walmart.
Shelby called Lisa.
Shelby told her daughter: I’m off work, so I can go, if we go now. If you and Alice are bound and determined to go, I got the money and the time off. Let’s go to Florida.
Somehow the three women made it out of ice-covered Kentucky, heading south in Lisa’s little white Suzuki sedan, Lisa driving, Shelby in the passenger seat, Alice alone with her thoughts in the back seat. Alice reckoned Stacy also had taken 1-75 to Florida a month earlier. Tracing his last trip made the journey even harder. The women didn’t talk much. Alice cried more than once.
Shelby was skeptical about the trip, what it would accomplish. But she wasn’t about to let Lisa and Alice go by themselves. Shelby had talked to some people about American Pain. The clinic had security guards. People thought t
here were police officers involved in the operation too. Alice and Lisa were deep in grief and anger. Shelby was worried they’d just bust into the place and get in trouble or get hurt. Shelby believed she was good at listening to people, at finding out things, paying attention to the clues of their posture and gestures and expressions. She had experience with security, both at Renfro Valley and Walmart. She figured she could help.
They left in the early afternoon and drove straight through the night, stopping only for fuel and McDonalds. In Georgia, a tire went flat and they put on the feeble-looking spare doughnut tire. They pulled into a roadside service station to get the tire changed, but the service station didn’t have the right kind of tire.
A Georgia State Police trooper was there, a woman. She saw the Kentucky tags on Lisa’s Suzuki and started aggressively asking all three women questions. Where were they going? Why?
Even after all those miles, Lisa was loaded with energy, oddly excited. She’d insisted on driving the whole way down. She wasn’t intimidated by the state trooper’s tone. The opposite, in fact. She got out of the car, pulled out Stacy’s American Pain appointment card, the one with the American flag on the front, said she was going down to Fort Lauderdale to confront the doctor who’d given Stacy the oxycodone that killed him.
The trooper didn’t seem to understand.
She said: I just want to know why all you Kentuckians are coming through my state all the time.
By this time, both women were red-faced, in each others’ faces. Shelby was in the car. She didn’t want the lady cop to arrest Lisa. But she also didn’t want to get out and make things worse. Then Lisa let the trooper have it.
Lisa said: I’ll tell you why all us Kentuckians are coming through your state. It’s because your fucking doctors down here are killing our men!
Shelby cringed, convinced this was going to end with Lisa in handcuffs.
But something in Lisa’s words seemed to satisfy the woman. She got in her patrol car and took off, burning rubber.
They never got the tire fixed, so Lisa drove the rest of the night on the doughnut tire, refusing to give up the wheel. They reached Fort Lauderdale around 10:00 a.m., and the temperature was in the mid-70s, a completely different world than the frozen mountains they’d left the previous afternoon, the air earthy and wet, the streaming multitude of cars shiny like they’d just exited a car wash, not covered in a gray film of salt and road grit. Even in her distracted state, Alice’s eye was caught by the exotic flowerbeds around the fast-food restaurants, especially the amazing purple-leaved plants she didn’t know the name of.
The American Pain Clinic looked like everything else in this part of Fort Lauderdale not near the beach: low to the ground, nondescript, well planned. It was just another business in a complex of tan and featureless office buildings, surrounded by geometric plots of green Bermuda grass and perfect rows of identical palms, like telephone poles on a highway. A red sign at the entrance of the complex displayed dozens of agencies by their office suite number: real estate, insurance, home nursing care. And the pain clinic in office suite 204.
Shelby knew from the folks she’d questioned back home that they were supposed to park in a separate fenced-in lot behind the complex reserved for out-of-state vehicles. Only Florida drivers could park near the entrance of the clinic. But Lisa was so agitated to finally be there that she just pulled right up to the door marked 204. A big man in a black shirt approached, and Shelby thought she could tell that he knew the women didn’t belong there. His shirt read SECURITY. He asked who they were, annoyed. He said they were violating the parking rules. Out-of-staters had to go to the cage in back.
Lisa and Alice weren’t concerned with the guard. They got out and beelined for the door, leaving the car where it was. Apologetic, Shelby took Lisa’s place behind the wheel.
Shelby said: I’m sorry, she’s in a lot of pain. She’s in a hurry to get inside. Where do you want me to park?
Alice went inside the clinic.
Lord, the waiting room was full of people. Loud, too, everyone talking and sitting in chairs and standing in lines and people who worked there hollering names. Alice stood in line for a window. When her turn came, she told the person behind it that she wanted to talk to Dr. Cadet. Alice wasn’t sure she was saying the doctor’s name right, but the employee told her to take a seat and they’d have someone talk to her.
Alice sat and watched the people coming and going. The room filled up and emptied three times while she waited. People shuffled in and joined a line, and sat down, and went back to the doctor, came back out. And the staff herded the people here and there, in and out. One patient dawdled in the waiting room after getting his medication, but a security guard moved him on his way.
The security guard said: You got what you came for. Now it’s time to go.
It put Alice in mind of a crowded stockpen, a line of hogs waiting for the slaughter. It made her mad.
When Shelby entered the waiting room, she recognized someone: a dark-haired man who’d pulled a knife on her at Walmart back home. He had a black-ink tattoo creeping up his neck. Shelby often caught people in the store tucking items in their bags or under their shirts. Once, she’d watched a family eat their way through the entire grocery section, but she let them go because they looked like they needed the nourishment. The man with the knife had been stealing car batteries or Sudafed or rock salt, she couldn’t remember. What she did remember was the knife in her face when she confronted him. She’d let him run out of Walmart, and the cops picked him up later.
Now he was sitting here in Fort Lauderdale. He glanced at Shelby, looking like he might have recognized her, and she felt afraid. She was wearing a gray T-shirt and jeans and looked haggard and unkempt after a day and night in the Suzuki. She wasn’t sure the knife man could place her or that he could or would do anything if he did. But it made her realize even more that this was a bad scene, nowhere for Lisa and Alice to be. Shelby messed up her hair even more, hoping no one else would recognize her.
A man came out and introduced himself to the three women. Around fifty, thin with a long dark ponytail. He looked like a biker. He and a security guard asked the women to come outside with him.
Outside, the women explained who they were, said they’d come to speak to Dr. Cadet about Stacy Mason’s death. The man with the ponytail said he remembered Stacy, the musician. He’d spoken to him. Stacy was a nice guy, he said. He was sorry to hear that Stacy had passed away. Stacy was in a lot of pain, the man said, and if the doctors in Kentucky had helped him, he wouldn’t have had to come all the way to Florida.
But he said he couldn’t let all three women talk to Dr. Cadet. Only Stacy’s mother. Shelby wasn’t happy about this. She didn’t think Alice would get much information. But it didn’t seem right to tell Stacy’s mother that she thought she or Lisa should be the one to confront Dr. Cadet.
So Shelby and Lisa began asking questions then and there. The women asked why the doctor had given Stacy so much oxycodone. That amount of oxycodone was dangerous.
The man with the ponytail said: People build up a tolerance to these medications.
Shelby said: But he’d never been down here before! If you read his file, you’d know that.
She asked the man if he was a doctor, and he said no.
Shelby said: That would explain why you don’t know what you’re talking about. You’re used to giving prescriptions to drug dealers who are selling it and know what it’ll do. We want to talk to the doctor.
The ponytailed man said: Well, I’m sorry. I’m sorry. But not all of you can go back there.
A police cruiser drifted up to the clinic door, and an officer stuck his head out the window.
He said: Y’all got a problem here?
The ponytailed man said no and explained what was going on. Shelby thought the officer would take her side, but he didn’t.
The officer told the women: You need to go on back to Kentucky.
Even the police are against us
, Shelby thought.
Shelby and Lisa went back inside to wait with Alice. A couple other faces in the waiting room looked familiar to Shelby, but she wasn’t certain that she knew them. Shelby noticed the towering stack of filing cabinets behind the clerks. Drawers and drawers, full of patient files. And each of those files was a person, Shelby thought, someone who maybe had a mother and a girlfriend who was worried about them. All those people, all that misery, filed away in those cabinets.
Finally they called Alice’s name, and they took her back to Dr. Cadet’s office.
Dr. Cadet came in and introduced herself, and Alice was surprised that she was a black woman. And so young and small and quiet. Alice finally asked the question she’d been wondering every moment for the past month.
She said: I want to know, why in the world you gave my son two bottles of oxycodone? The same kind of medicine?
Dr. Cadet just stared at the floor. Two men entered the room. They said they were doctors at the clinic. They did the talking for Dr. Cadet, like the little doctor needed to be protected from Alice.
Alice repeated her question, and the men doctors answered, not Cadet. They seemed to know about Stacy, like they’d read his paperwork. They said he was in bad shape with his back and needed medication. But they didn’t say why he needed so much.
Alice asked if they could make a copy of Stacy’s file for her.
The doctors said no.
Alice said: That’s all right. I got all the proof I need at home anyway.
And she left.