“A Pharmaceutical atomic bomb”
Introduction
In the previous article we discussed the body’s natural pain killer chemicals, namely Endorphins, and
how the opiate crisis mushroomed in the 1990’s fuelled by one insignificant letter published in 1986 and the birth of a new synthetic opiate designed to slowly release its contents into the body called Oxycontin. A little known billionaire family that made their fortune on manufacturing and selling this drug on a mass market scale fuelled by a handful of revolutionary pain clinic physicians that desperately needed a solution to their patients who were withering in painful misery’
Antifebrin
The Antikamnia Chemical company dating back to the late 1800’s published their famous skeleton calenders ((an example is shown above ) developed a pain killer called Antifebrin; actually the product was developed in Germany by Kalle & Company and sold as an antipyretic ( fever reducer ) and an Analgesic ( pain killer ). This acetanilide was boiled in water or alcohol and then taken, unfortunately it had a habit of stopping the flow of oxygen to the blood. The actual ingredient of Antifebrin was paracetamol which needed to be modified to become active to survive the body’s metabolic process, but the paracetamol was not, so the ‘active ingredient’ was useless, and the drug was toxic. The company was shut down because they failed to disclose that Antifebrin was acetanilide, an Aniline ( 19th century analgesic) based pain killer that could cause cyanosis ( blue withery skin due to low oxygen saturation) and Methemoglobinemia causing oxygen to gather into heme (iron) sites reducing the red cells ability to release oxygen to the tissues causing potential liver and/or kidney damage. Opiates have been used for thousand of years derived from the opium poppy, and its active ingredient was named after Morpheus the Greek God of Dreams, but morphine and its derivatives are powerful but highly addictive, so why would 21st man believe that they could convert a natural highly addictive substance to a non-addictive substance just by administering it more slowly into the bloodstream. As Dr Alex Cahana of Seattle once said :
“ All of a sudden, we can’t go to college without Adderall, we can’t do athletics without Testosterone, and we can’t have intimacy without Viagra, as doctors we are focused on the stuff (drugs) and not on the people…Forget all that..the treatment is you “
“Hooray for somebody who has seen the light”‘
Ready for action
Although pain clinics did exist before the mid 1990’s, the unprecedented pain clinic explosion in line with the 1996 introduction of the timed-release opiate Oxycontin, the panacea that everybody thought would kill pain without addiction, began in the 1990’s. The infamous one page letter by Hershel Jick confirming that opiates were non addictive, but neglected to understand that the low non-addictive statistics referenced in the letter was the result of tightly controlled administration of opiates to hospitalized patients in tiny amounts. Despite the fact that nobody had or were unable to prove that opiates were non-addictive, Purdue, manufacturers of OxyContin managed to get their approval from the FDA in 1995 to sell 10,20,40,80 and 160 mg pills that were basically similar to heroin without any additives. The manufacturers inadvertently advertised how it could be abused by a warning label that recommended not to crush the pill since it would release a potentially toxic amount of the drug and because there were no additives it could be liquified and injected. This was like giving an anarchist a bomb.
…if the patient does not respond to the first dose..give them some more..it’s safe..
Purdue encouraged pain doctors to administer the drug aggressively to combat pain especially those inflicted by life threatening cancer. Purdue’s sales reps were drilled to market the drug with a no-risk tag, and no fear of addiction, so if the first administration of the drug doesn’t work, up the dose and don’t worry. Although no study existed, it did not deter the sales reps from telling the physicians that there was one, but the physicians did not ask, nor did they care since they could just prescribe the drug, satisfy their pain patients, without fear of any addictive consequences. Despite physicians, who were taught at medical school, that opiates were highly addictive and to use them as a last resort, Purdue sales people convinced them that this new type of opiate avoided the characteristic highs and lows of opiates that led to eventual addiction, by the timed release mechanism. The Purdue call list during this time amounted to 70,000 health practitioners nationwide serviced by the 1,000 strong Purdue salesforce. Like the military term ‘Boots on the ground’ the industry referred this sales onslaught as ‘Feet on the street’. In the words of Sam Quinones in his book ‘Dreamland’..’A pharmaceutical wild west emerged’, with Purdue’s sales conferences, and thousands of videos that were sent around the country attesting to OxyContin’s use to improve lives of the pain inflicted, without fear of addiction
The Pill Mill
Once the tide had turned toward the way the medical industry viewed opioid use for pain management, pain clinics were sprouting up all over the place. Since there were millions of pain sufferers as there are today ( 100 million Americans, 1.5 Billion + worldwide, costing $2000/US citizen/annum = $635 billion/ann), they just soaked up the millions of opiate pain killers that would be prescribed. So what is a Pill Mill?. Basically it is a Pain ‘clinic’ run by a licensed physician, no physical exams are given, no medical records or x rays used, prescribed pain killer medicine, cash only and directed to their own pharmacies for the medicine. Pain is treated with pills only, and once they run out you have a specific date to return for another prescription. There are generally security guards present and some have video surveillance. Because of the lose way of prescribing medicine, almost anybody could be prescribed painkillers with no questions asked, so these ‘establishments’ were always crowded, drawing a lot of attention especially when the occasional fight broke out within the crowds waiting to pick up their supply of painkillers. The way the Pill Mill was conducting their ‘business’ was tantamount to ‘drug trafficking’ (Federal Law says that physicians can be prosecuted if pain medication is prescribed without a legitimate medical purpose, rendering prescriptions to be invalid…was this enforced ? only to very few).
Dr Paul Volkman
Within this twisted opiate story, and pill mills, various infamous characters emerged such as Drs David Procter and Paul Volkman. Both physicians made the town of Portsmouth Ohio famous ( not for its past glories of steel, shoe and bricks manufacturing), but by establishing the Pill Mill of America, a town of 20,000 people. Volkman operated his place of business within a first floor apartment on Center street, a pain clinic accepting cash only ( $150 charge/patient), no insurance, no Medicaid required. Within 3 years Volkman ended up running 4 pain clinic ‘Pill Mills’, 3 in Portsmouth, and 1 in Chillicothe southern Ohio. Residents in the neighborhood witnessed the large crowds queueing to see Volkman, and years later a prosecutor remarked that its was like people waiting to get into a Led Zeppelin concert, six a.m sharp six to ten cars parked outside many with out-of-town license plates, and some people would drive hundreds of miles to get to the clinic. Shocked neighbors answering the door to slurred speech junkies wondering where the doctor’s office was. What is laughable was that Volkman operated out of ‘unmarked premises’ to maintain obscurity, but the crowds and vehicles parked on both sides of the street, armed guards patrolling outside, the occasional fight, and junk food wrappers strewn around ( some patients would wait for hours eating meals in their car) painted a huge target on the place..so much for obscurity.
Volkman was described by acquaintances in medical school as a scruffy individual, shy ( around women ), fierce intellect and a strong work ethic, however, previous to his pill mill practice between the 1980s and early 2000s he was in the middle of 4 malpractice suits. One suit involved a man who had been brawling in a bar, suffered serious internal injuries,and as result of Volkmann’s treatment, he suffered lasting brain damage. Another suit involved a baby that stopped breathing and the equipment intended to resuscitate the baby, failed because the batteries were dead, so not only were the batteries dead, but the baby to. Anyway two were settled by Volkman, and the other two by medical insurance. Although he could no longer acquire malpractice insurance, it was fortunate for Volkman when he was hired by a Pill Mill practice that did not require it, so he was able to assume the position as a Pain management physician at Tricare Healthcare with a starting salary of $5000/week.
Volkman was hired in 2003 by Denise and Alice Huffman a mother daughter duo who had been employees of Dr David Procter ( another infamous Pill Mill physician who we will discuss in the next article) and founded Tri-State Healthcare. By 2005 the DEA had already instituted a formal investigation into Paul Volkman and between 2003-2005 Volkman had prescribed 1 million pills and another million that was unaccounted for due to the poor record keeping of Tri-State Healthcare. A Portsmouth police informant had visited Volkman who prescribed 180 OxyCodone, 180 Lorcet, 120 Soma and 90 Xanax pills. Two days later another informant was prescribed 270 OxyCodone, 270 Percocet, 120 Soma and 60 Xanax pills. One 30 year old and a 39 year old died from acute multiple drug intoxication, and one mother visited Volkman pleading with him to stop prescribing pills to her son, a recovering addict but had relapsed due to the carefree prescribing habits of Volkman. Volkman said he would take it under consideration, but the mother told him that if he wrote another prescription for her son she had a .38 that would convince him not to. It got to a point where their pharmacists would refuse filling the prescription so Tri-State became physician and pharmacist. Finally Volkman was arrested in 2007, and 2012 a jury found him guilty of causing the overdose deaths of at least 4 of his patients and he received four consecutive life terms for prescription drug dealing. During the sentencing in Cincinnati he stood unrepentant, saying he had no regrets and no apologies to make, and then he had the gaul to say
“ In sentencing an innocent man to jail, you ( US District court judge Sandra Beckwith) are revealed as the heinous criminal in this courtroom”.
He’s lucky they didn’t fry his ass in the chair, which he deserved, now the state will have to waste money keeping him a guest of the Cincinnati prison system.
“Pain is my greatest enemy. I’ve searched far and wide to find ways to kill it. But eventually i realised that pain is not the enemy. It’s a no nonsense, no bullshit, honest friend. Pain is a signal for you to heal. It’s a sign that there’s something wrong and I’m not just talking about the physical, it tells you there’s a relationship that needs attending to, that challenges your strength, your faith and humility. .. the best way to recover from pain is to endure it. Then and only then can we heal. Simply put… If there is no healing there is no pain.”
– Adam Castrances (Derek Ramsay in Ex with benefits)
References/Acknowledgments :
- Antifebrin National Musuem of American History Smithsonian
- Seriously who wouldn’t buy pain medication from these guys/A brief History of Painkillers ( and why they work) I09 2013
- cyanosis, acetanilide, aniline Wikipedia
- Chronic pain statistics +he Good Body 2017
- What’s a pill mill ? CBS 2007
- The Pill Mill that ravaged Portsmouth 2017 Philip Eil Cincinnati Magazine
- Dreamland Book 2015 Sam Quinones
- The Antikamnia Chemical Company’s skeleton calenders
- Movie quote Ex with Benefits The Humorless Humorist 2015