They arrive at pain management clinics in south Florida by the carload.
Armed with cash and phony MRIs, the out-of-state visitors travel from clinic to clinic with concocted stories of pain. The clinic doctors perform cursory exams before prescribing hundreds of potent pills.
The visitors return to Kentucky, Ohio, West Virginia and Tennessee with enough painkillers to get their own fix and sell the rest for a handsome profit. The doctors and clinic owners make out well, too, sometimes pocketing tens of thousands of dollars in a single day.
It's a booming tourism industry, but one that officials in Florida, the largest state without a functioning prescription drug monitoring program, are scrambling to eliminate. They say many of the state's 1,000-plus pain management clinics are nothing more than pill mills that operate outside the scope of legitimate pain medicine practices, which are often associated with hospitals and universities, and put addictive painkillers in the hands of drug traffickers, dealers and abusers.
And the doctors who work at them? They are “really a drug dealer with a white coat on,” said Bruce Grant, director of Florida's Office of Drug Control.
In Florida, six people die each day from prescription drug overdoses, Grant said. That's more than three times the number of deaths from all other illicit drugs combined.
In Kentucky, where police busted a prescription drug trafficking ring with Florida connections last fall, the number of overdoses is greater than that of highway fatalities.
“This is the number one problem facing America, period,” said Chris Mathes, sheriff of Carter County, Tenn. “People don't have to do heroin no more. They can go to a pain clinic and get the same high.”
$60 A Pill
Mathes, who served as a U.S. Drug Enforcement Administration agent before becoming sheriff, said his rural county has been flooded with the painkillers that people bring back from Florida clinics.
Users will pay dealers $60 to $80 for a single pill on the street, he said.
In April, the trip south turned deadly for one of the residents of Carter County.
Authorities say Terry E. Williams, 46, of Johnson City, Tenn., drove to Florida with his ex-wife and another man to obtain prescription drugs. Williams' traveling companions said he often gave them orders and wouldn't let them do what they wanted to while in south Florida, prompting them to beat and strangle him, according to investigators.
They returned to Tennessee in his truck, taking off with $1,600 of his money and a large amount of oxycodone pills, before getting caught.
Williams' body was found in a room of a Red Roof Inn in Broward County, Fla., an area that has been described as the nation's pill mill capital.
Here's how quickly things went sour in Broward: In 2007, the county had just four pain clinics. By the end of 2009, there were 115.
Officials say the proliferation of Florida pill mills was due in large part to the fact that other states created monitoring programs that curtailed doctor shopping. As of June, 33 states had operational drug-tracking databases that allow physicians, pharmacists and law enforcement officers to track the flow of controlled substances and spot the people who collect narcotics from multiple clinics.
When residents of those states could no longer obtain large quantities of prescription drugs with ease, they went someplace where they still could.
“It's amazing how much word of mouth has fueled this epidemic,” said Sgt. Richard Pisanti,, who leads a Broward County Sheriff's unit that fights prescription drug diversion. “People knew to stop in Broward County because they thought it was a gateway.”
Crime spiked around the pain clinics. Users passed out in the parking lots patrolled by armed guards. Though the clinics quickly drew scrutiny from law enforcement, building cases against them proved difficult.
Unscrupulous doctors and their so-called patients claimed the prescriptions were legitimate. Going after the street-level dealers and their buyers had its own set of problems, namely that the pills could be sold and consumed with virtually no evidence trail.
Raids and Moratoriums
But law enforcement officials say they are slowly gaining ground.
As local governments throughout Florida have passed moratoriums on pain clinics, the businesses already in operation have been the target of a number of recent raids.
At one clinic alone, five doctors ordered more than 2 million oxycodone pills in 2009, according to a forfeiture complaint filed in U.S. District Court. Their prescriptions ranked them each among the nation's top 20 practitioner buyers of the medicine.
In October, Kentucky authorities obtained arrest warrants for more than 500 people involved in a drug trafficking organization that obtained painkillers in Florida and distributed them back home illegally. The roundup, dubbed “Operation Flamingo Road,” was the largest ever in Kentucky.
“It put a small dent into the problem,” said Lieutenant David Jude, spokesman for the Kentucky State Police.
The Florida Department of Health now has about a half dozen investigators working with law enforcement around the state, including one embedded in Broward County since the beginning of this year in an effort to improve communications between the agencies.
And, under a new law passed this spring, the department will conduct annual inspections of the previously unregulated pain clinics. Starting this fall, investigators will be allowed to review medical records and seek legal action against clinics that practice bad medicine.
The new law also bars people convicted of drug felonies from owning clinics, and limits doctors to dispensing no more than a 72-hour supply of painkillers to patients who pay by cash, check or credit card.
And in December, Florida is slated to finally join the ranks of states that have prescription drug monitoring programs in operation. Nationwide, 42 states have enacted legislation for drug-tracking databases. Arkansas, Georgia, Maryland, Missouri, Montana, Nebraska and the District of Columbia have no such programs, while legislation is pending in Delaware and New Hampshire.
Grant, the director of the Florida's drug control office, doesn't expect the pill mill problem to vanish overnight. But he is optimistic that the tougher restrictions will deter some, shut down others and keep new clinics from opening.
“Hopefully,” he said, “they'll scatter like roaches in the night when you shed a light on them.”
Colleen Jenkins covers criminal justice issues for the St. Petersburg Times.
Photo by quimby via Flickr.