by John Temple
Pedro said the deputy sheriff was some kind of DEA task force member, and he’d shown Pedro a big board with Chris and Derik’s photos on it, along with half the American Pain staff. Like something out of a gangster movie, Pedro said, all these mugshots and arrows pointing from one guy to the next. Magnets with titles on them. Derik’s title was “Enforcer.”
Derik was surprised, and a little hurt, that the cop had been just posing as his buddy, even asking him to go out for a beer.
Pedro said: Well, these guys got you all marked up like you’re going down like some big organized crime ring.
Derik said: Man, these guys are taking this shit a little too seriously.
Pedro’s story didn’t seem quite real, but it lingered in the back of Derik’s mind, the Mafia-movie poster with his mugshot on it, and the title: Enforcer. Was the DEA really investigating American Pain? The lawyers had told them they were in the clear, that the doctors were ultimately responsible for what they prescribed. Pedro’s story was bullshit. Had to be.
Footnotes
* This is based on Dianna’s court testimony. She declined to be interviewed, and Chris did not discuss his relationship with her in detail.
* This is according to interviews with Derik and court testimony. The only prescriptions actually found in Derik’s patient file were from Dr. Jacobo Dreszer.
7
Early in 2009, Jennifer Turner flew to Kentucky to take a look at the flip side of the pill mill disaster—the Appalachian front.
The FBI special agent was no longer working alone. She was now heading up a rapidly growing task force that included the IRS, the US Attorney’s Office, the Broward and Palm Beach sheriff’s offices, local police departments, and the initially reluctant DEA. It had been only a few months since Turner had overheard the group of cops talking about pill mills at the watercooler, but there was a fresh urgency around her investigation. The state’s prescription drug overdose death rate had risen to eleven a day, topping cocaine’s. Florida doctors and pharmacists were distributing almost twice as many oxycodone pills as the next-highest state, Pennsylvania.* All the federal agencies now agreed; something had to be done.
Turner’s partner on the Kentucky trip was a broad-shouldered DEA special agent named Mike Burt, a former cop with an expertise in wiretaps. In Lexington, Turner and Burt met with members of the Appalachia High Intensity Drug Trafficking Area (HIDTA) task force to trade information and discuss their shared problem. They decided that the HIDTA team would focus on sponsors and traffickers in their area, and the Florida task force would go after the biggest pill mills.
The special agents also interviewed anyone who could tell them more about the beach-to-mountains pill pipeline. They met with people like Barry Adams, a HIDTA member and a deputy sheriff of Rockcastle County. Adams was a farmer when he wasn’t working, and he looked the part in boots, jeans, and flannel. Like any Kentucky lawman, Adams was long familiar with 10-milligram Lortabs and 40-milligram or 80-milligram OxyContin. But the first time the sheriff’s office had run across oxy 30s from Florida was the first day of 2009, when a young fellow named Stacy Mason had died on the Mason family farm.
Then, one cold afternoon ten days after Stacy Mason died, Adams was off-duty when he saw two men exchange something in the parking lot of Rose’s One Stop gas station in Brodhead. One of the men drove away in a gray pickup truck, and Adams followed him. The truck wove across the centerline, other cars swerving to avoid it, before it slammed into a ditch. Adams tried to conduct a sobriety test, but the driver could barely stand. Adams searched him and found a magnetic key holder containing a bunch of pills, including some he’d never come across before: twenty-five round white tablets marked with 446 ETH. He looked them up and found they were 30-milligram oxycodone pills, manufactured by Ethex Corporation in St. Louis, same dosage as the ones Stacy Mason’s mother had found on his body. Oxy 30s were new to Rockcastle County, and now the sheriff’s office had come across them twice in less than two weeks.
That was the beginning. Adams and the other HIDTA members kept hearing more and more information about what they began calling “that Florida dope.” Details about the new pill pipeline kept piling up, arrest by arrest, interrogation by interrogation.
The pill smuggling spread like a contagion, most often through family relationships, though police in West Virginia said Detroit gangs had moved into Huntington to take over the oxy trade. To Adams’s mind, the rural trafficking networks grew like a spider’s legs. One person—usually the head of a marijuana-growing or meth-dealing family—would begin sponsoring pill runs to Florida. The runners themselves were usually addicted to the pills. This gave the sponsors a hold over the runners, because addicts were always out of money and pills and would therefore make any deal. But junkies were terrible employees, always getting arrested or overdosing on the road or claiming the pills had been stolen.
A few of the most enterprising runners would eventually save a little money and begin sponsoring their own mules. Because the drugs were legal, the pill-running business didn’t have the same barriers to entry as, say, the cocaine trade, where you had to know a supplier. Anyone with a car and a few hundred bucks could make a pill run. And profits from one run were enough to sponsor a carful of mules.
The pipeline inspired its own lingo. For self-evident reasons, the junkies called the oxycodone 30-milligram pills made by Mallinckrodt “blues,” and the traffickers began calling I-75 “The Blue Highway.” State police staked out the Tennessee-Kentucky border, pulling over multi-passenger cars in what they termed “pill stops.” Allegiant Air offered a multitude of cheap round-trips between the mountains and South Florida, and the planes were so packed with drug runners that the flight was nicknamed “The Oxy Express.” Observers found it interesting that the Allegiant planes were the same powder blue as the oxycodone pills.
Police in the states between Kentucky and Florida began to figure it out. If a multi-passenger car with Kentucky tags was heading north through Georgia, state troopers would find a reason to pull it over. They’d often find not just pills but brochures and business cards from clinics and pharmacies, and handwritten ledgers that detailed travel expenses for the sponsor. Sometimes the traffickers behind the wheel were high or they had illegal drugs along with the pills, which made it easy to make an arrest. If half the pills were gone from a twenty-eight-day prescription that had been issued the day before, that was probable cause to suspect drug dealing, and the cops would confiscate the pills. Some traffickers had visited multiple doctors and had more than one prescription for oxyco-done, which was illegal. Those were relatively easy arrests to make.
But as the racket had matured, the traffickers were wising up, adapting to police pressure. Word got around that patients shouldn’t sell their pills until they were safely home so their pill counts wouldn’t be short if they got pulled over. Doctor shoppers who went to multiple pain clinics began to visit FedEx stores in between each doctor’s visit, mailing home the pills so they wouldn’t be caught with more than one oxycodone prescription at a time. Sometimes, patients would drive just over the Georgia line, then rent a car so they could slip past police who were on the alert for Tennessee or Kentucky or West Virginia plates. And police rarely found illegal drugs in pill runners’ cars anymore.
As major Kentucky sponsors grew into kingpins, it became too complicated to make all the arrangements in Kentucky, handing out as much as $2,000 apiece to a carload of addicts in the hope that they would return intact with the pills. So a few of the biggest operators in Kentucky sent subordinates to live in South Florida, renting them a car and a long-term hotel room or even a bungalow. The sponsor in Kentucky would organize and send down the groups, and the coordinator in South Florida would take over from there, meeting the groups, giving them directions and cash, telling them which clinic employees to connect with, the peculiarities of specific doctors, explaining the unwritten and written rules of the pain clinics, guiding them through the process. The pill runners would meet
the coordinator in the clinic waiting room. Sometimes they hadn’t met the coordinator before, so one coordinator took to wearing a court jester hat or a Rastafarian hat with fake dreadlocks so he’d be easy to pick out in the waiting room. The runners were told: Look for the guy in the funny hat—he’ll hook you up.
One day during their trip to Kentucky, Turner and Burt learned that a group of pill runners had wrecked while driving back from Florida. One of the traffickers was in the Lexington County Detention Center, and the special agents were invited to talk to him. Turner and Burt went to the jail and took seats in an interview room. Turner’s back was to the door; Burt was sitting on the other side of the table. The door opened behind her, and Turner saw Burt’s eyes widen in astonishment. She turned around to see a prisoner being led into the room. Bloody bandages concealed his massively swollen face and left ear. The accident had nearly severed the flesh from the front of his skull, and doctors had stitched his face back on.
Turner couldn’t imagine the guy was able to speak, but she asked him if he was OK.
He mumbled through the bandages: Yes, ma’am.
So Turner went ahead with the interview, and the defendant willingly told her about his travels to Florida. Near the end of the interview, Turner was shocked when the man said he’d be heading back to Florida as soon as he got out of jail.
Turner said: Hold on. You’re in jail, you just had this major accident, and you almost lost your life. Why on Earth would you go back to Florida to get pills?
The man explained, patiently: Well, ma’am, I’m addicted to them.
Turner wanted to understand. She had no addicts in her family, and she’d never met anyone like this. She could tell that he wanted her to understand too.
She said: OK, but why Florida? Why not just go somewhere closer?
The man turned to face her more directly.
He said: Because it’s so easy to get pills there. Florida is the candy store.
When she left the jail, Turner was shaking. She thought: How are we ever going to stop this? It’s so much more powerful than we are.
Whitney Summitt was seventeen the first time she made the run to American Pain. Her mother was an addict, her father in prison, and Whitney herself had started using drugs when she was fourteen. Her aunt, Pat Sand-lin, had raised her, so when Aunt Pat told her to drive some folks from Louisville to Florida and back, Whitney did it. The doctors at American Pain wouldn’t write for a minor, so during Whitney’s first runs, she just drove and collected the pills afterward. Whitney had dropped out of school after the ninth grade, a young doughy girl with a moon face, but she was bold and businesslike. She made the seventeen-hour drive with as few stops as possible, and she told the three adults in the car exactly what their cut would be: their choice between fifty oxy 30s or $500. Most took the drugs.
Over the next few months, Whitney made the long drive about once a week with carloads of uncles, aunts, cousins, friends, even her father. She got to know the American Pain staff, knew she could slip the clerk at the window $50 and ask him to rush a patient, knew Dr. Graham and Dr. Cadet were considered to be the biggest writers. She showed her passengers how to tilt their hips in the MRI machine so their spines would look out of whack. If she didn’t have a passenger who had clean urine that everyone could share, she brought a bottle of clean urine (clean-ish, actually—there was supposed to be some oxycodone in there, since you were supposedly a pain patient). It wasn’t hard to get urine. Folks back home had taken to selling Mason jars of it at flea markets.
Whitney knew the fees by heart: $200 for a first-time visit, $250 for an MRI, $50 to bump a patient to the head of the line. Plus maybe $500 to fill the scrips. So sponsoring one runner’s trip might set Aunt Pat back a thousand bucks, plus fifty of the oxy 30s, plus gas. The remaining 190 oxy 30s might net her $20 each back home, which was $3,800. And that didn’t even include the ninety oxy 15s and ninety Xanaxes that the docs at American Pain usually tossed in.
A couple months after she turned eighteen, Whitney told Aunt Pat she reckoned she was old enough to do more than just drive. Aunt Pat agreed: It was time. In March 2009, Whitney took a full carload of people to American Pain and got her own paperwork. She paid the clerk $50 to sign off on her drug screen, since she knew she definitely had marijuana in her system, and possibly coke, in addition to oxycodone, which she was hooked on by now. She filled out the paperwork as quickly as possible. She knew it didn’t really matter. One question asked where her pain was. She wrote: “Low back.” On a scale of one to ten, how would she rate her pain? This was a no-brainer: Whitney circled ten. She circled a bunch of words that sounded painful. She said she’d taken prescription Lortabs for her back problems, which was true except that the pills hadn’t been her prescription, and she hadn’t been in pain.
Finally she was escorted to the office of a young male doctor she didn’t recognize. He took one look at her, said: Exactly how old are you?
Whitney said: Eighteen.
The young doctor wasn’t happy.
He said: I’m not comfortable writing you a prescription.
But he didn’t outright say he wouldn’t. So Whitney sat down next to the doctor’s desk, and the doctor started checking items off on his paperwork, still looking unhappy. And maybe ten minutes later, she walked out with the scrip in her hand and went to wait for her passengers in the waiting room. When they came out, they went straight to the American Pain pharmacy to get them filled. Whitney waited until she got home to go to the pharmacy; the retail drugs were cheaper in Kentucky.
Whitney kept returning, but eventually a doctor at American Pain refused to write for her because she was under twenty-one. An employee sent her to Executive Pain, and she continued to get her pills. In between her own once-a-month appointments, she continued running other folks down every week or so.
By the time she turned nineteen, Whitney was no longer chubby. She’d lost weight and had stopped paying attention to her hair and clothing. Needle marks scarred her hands, the only place on her body she could still find a vessel. She was dissolving and injecting ten to twenty pills a day. The highs weren’t really highs anymore, just a break from the bone-deep pain of withdrawal.
By this time, Florida’s new pill-based economy was in full swing. Billboards plugged pain management. Dive motels catered to “oxy-tourists.” Drugstores and MRI facilities flourished. And the pain clinics’ parking lots were clogged with out-of-state vehicles.
Clinics opened and closed and changed locations and owners, and no one kept track of them, so it was hard to pin down an exact number, but officers in the Broward Sheriff’s Office Pharmaceutical Drug Diversion Unit said the county had been home to four pain clinics in 2007.
Now, two years later, the unit tallied 115 pain clinics.
Odd connections had begun to emerge between flat, scorching, teeming South Florida and the green hills and slow brown rivers of the Appalachian Mountains. Broward County drug court judges saw defendants from places like Harlan County or Hazard at nearly every arraignment. Pain clinic staffers kept an eye on weather patterns in Kentucky and West Virginia; if a winter storm hit the mountains, business in Florida would be slow. Lots of Kentuckians and Tennesseeans began dying in South Florida motels that catered to the oxy-tourists. Likewise, coroners and ER doctors and airport security in Kentucky began recognizing the names of certain South Florida physicians after seeing them repeatedly on amber pill bottles they’d confiscated.
Sandwiched between Miami-Dade and Palm Beach Counties, Bro-ward County was the epicenter of the new painkiller trade. The newspapers were catching on to the story. Board of Medicine members had been calling reporters at the major South Florida papers for some time, trying to get them to write about the proliferation of pain clinics, to little avail. The phrase “prescription drug abuse” sounded lackluster, especially to reporters who were used to covering huge, international, illegal cocaine busts. But suddenly the pill mills were everywhere, and business owners and residents in oxy hots
pots seethed and politicians mulled legislation. A Broward County grand jury was appointed to study pill mills.
And reporters at the Palm Beach Post and the Sun-Sentinel began to pay attention. The Sun-Sentinel ran a story in April 2009 that said every single one of the fifty largest-selling oxycodone clinics in the United States was located in Florida. Thirty-three of them were in Broward County. A single small municipality, Oakland Park, was home to eighteen clinics within a two-mile radius.
Many people were upset about the pill mills, but parents of pill seekers had the deepest reservoir of rage—people like Karen Perry, a Palm Beach County woman who founded the Narcotics Overdose Prevention & Education (NOPE) Task Force after her son died in 2003. NOPE ran support groups and conducted educational presentations in schools. Pete Jackson, a biologist in Illinois, whose eighteen-year-old daughter died after taking a single oxycodone pill in 2006, founded Advocates for the Reform of Prescription Opioids, dedicated to ensuring that regulations surrounding prescription narcotics made scientific sense.
Tina Reed, a diminutive woman who worked at a sporting goods store in Broward County, had little money or scientific knowledge. But she possessed a deep and abiding anger, fueled by fear, not grief. She was lucky. Her son was still alive.
The fear and anger had taken over her life one November morning in 2007, when she walked into her son’s room and saw him hiding something on his desk, a bill rolled up behind one ear. Her son was twenty-three years old and a marine mechanic. He’d already been arrested two months earlier for possession of oxycodone, which had led to his move back home.