‘It’s much easier in America to get high than it is to get help.’
Introduction
Between the years 1997-2011, the US population had only increased 16% yet the sales from retail pharmacists for Oxycodone increased by 1,259%, Hydrocodone (Lorcet) 356%, Methadone 1,099%, Fentanyl 711%, Morphine 246% and Buprenorphine from 17 grams in 2002 to 1,639kg in 2011. If you were working in a government group like the Drug Abuse Warning Network (DAWN), National Institute on Drug Abuse (NIDA), National Household Survey on Drug Abuse, Substance Abuse and Mental Health Services Administration (SAMHSA), The US Department of Health and Human Services or the DEA some red flags must have been spotted from statistics. OxyContin abuse first surfaced in rural areas of Maine, and then spread to West Virginia,Kentucky, southern Ohio, including rural Appalachia and the Ohio valley. I know the evidence in these cases take years to compile, but substantial opiate abuse was on the rise as early as 1996 and reached epidemic levels well before 2000 and by all accounts it’s still going on. In this article we will discuss ‘Dr Shopping’ and how pills became the new currency and well as a review of another infamous Pill Mill physician Dr David Procter.
Dr Shopping
Some individuals who are prescribed drugs can always ‘buck’ the system and acquire drugs from various sources as was the mode of action especially from Pill Mill operations that became rampant in various states in the US during the 1990’s. One such individual as described by Sam Quinones in his book ‘Dreamland’ became an entrepreneurial illicit business woman who was taken to a Pill Mill Doctor for the first time and was prescribed a months supply of Lorcet and Xanax ( Alprazolam, a mild benzodiazepine tranquilizer). After she gave half of the pills to her friend as repayment for the payment of the doctor’s visit she kept the other half. The 2 women then visited another pill mill doctor ( the infamous David Proctor ) and repeated the exercise. One woman bought MRI results from an individual who had a sprained lumbar and used the MRI scans repeatedly to acquire multiple supplies of pain pills by just changing the name on the copies. She then recruited street addicts to take the MRI scans to acquire more painkillers. Procter charged $250/visit which she would pay for on behalf of the members of her ‘Fagin’ type members and pocket half of the haul of which typically would be 90 * 80 mg OxyContins, 120 * 30mg generic Oxycodone and 90 * 2mg Xanax bars ( long pills). However, the local pharmacists ‘got wind’ of the scam so ‘Fagin’ and her members would troll Pharmacists in other rural towns who did not know them to acquire even more pills.
The OxyContin Economy
Since cash payment for the drugs was high, the entrepreneur needed insured people who were either on state welfare or a federal disability program like SSI ( Supplemental Security Program). Because a town like Portsmouth was depressed with low employment prospects, and many workers who had become disabled from lung conditions working in the mines that had long since closed, so there were many such individuals, who more importantly, had Medicaid cards that could pay for illicit opiates. A Medicaid patient would typically pay $3/bottle of 100*80mg OxyContin tablets, and in high unemployment areas like Portsmouth Ohio the cost would only be $1/bottle of 100 tablets Since a months supply of opiates were worth several thousand dollars. The pills transformed into a new currency to either buy commodities/food or simply sell them for money ( typically $1/mg). So Madame ‘Fagin’ opened up her OxyContin trading post at her home, and at one time buying a car for herself using the new OxyContin currency. She established a local OxyContin economy buying goods with pills and then selling on the goods for cash. Some clinics began insisting on urine tests so a urine black market erupted..as Sam Quinone describes in his book.. a pure kids urine sample would fetch 1 Oxy 40 mg pill….$40 for a urine sample..the kids laughing all the way to the toilet.
Walmart inadvertently fuels the Opiate crisis
The addicts would go into full-time thievery to get their fix by stealing garden ornaments, and shoplifting from Walmarts..not shop ’til you drop..but steal ‘ til your stopped. The addicts would even take orders..a pair of shoes or a car stereo lifting them from Walmart to pay for their drugs. Madame ‘Fagin’ accepted goods in payment for OxyContin, and if there was no price tag on the item she would call Walmart’s for a price check, and whatever the price, the addict would receive half its value in pills. The store was ‘easy pickings’ since the employees were on minimum wage or were drug users themselves so they didn’t care what was lifted. Even senior citizens were selling pills. Around Christmas time the OxyContin junkie could play Santa Claus around his family thanks to Walmart. It was estimated that by 2008 the 19 million US patients who purchased opiates within the first 60 days, 135,000 were members of this extreme population of Dr Shoppers, which resulted in them purchasing 1.9% ( 4.3 million ) of all 223 million opioid prescriptions (that’s 80 or so million short of one prescription for the whole population of the US) dispensed during 2008 and 2.8% of all oxycodone prescriptions.
FDA comes to the rescue
Reports of illegal use, misuse, abuse and diversion of OxyContin came across the desk of FDA officials including the high rate of OxyContin related emergency visits from 6429 in 1999 to 18,409 in 2001. The FDA cited Purdue Pharma twice for potentially false or misleading medical journal OxyContin advertisements ( so what’s new, this is the case for all drug advertising). In 2002 the FDA viewed Purdue’s Video and noticed that it minimized the drug’s risk and made unsubstantiated claims. The ‘black box’ warning was also an issue basically informing users how they could abuse the drug, warning them not to crush the pill, which would unleash a toxic dose. Purdue responded with a comprehensive risk management plan including the distribution of 400,000 brochures on diversion * prevention to pharmacists and health care employees and revised the black box warning. Purdue also released RADARS (Researched Abuse,Diversion & Addiction Related Surveillance) system to study the nature and the extent of abuse of OxyContin. This was a typical example of ‘closing the barn door after the horse has bolted’..fruitless efforts to curb what had already become a national crisis. From 2000-2015 500,000 people had died from drug overdose where more than 60% have been attributed to prescription opioids, which equates to 91 Americans dying from opioid overdose daily.
*Drug diversion refers to the illicit transfer of a drug from the prescribed recipient to a un-prescribed third party.
Sadness and shame
How could human society stoop so low ??..who suffers the most ?..the innocents..the Children. How could a government whose military motto is ‘leave nobody behind’..leave behind society’s children ?..it is criminal to grease the hands of the wealthy and neglect the poor and down and out to fester and rot in depravity. They are people to..humans like us but trying to survive with empty pockets..carving out a living without a job, without prospects..living in a sewer of hopelessness. The case workers in the Clinton County child protection office were worn down by the epidemic, awash with the opioid poison that had abandoned a generation of traumatized children,so much so, they could not be entered into the foster program. Most of the caseworkers remembered the horrific days of the crack cocaine outbreak in the 1990’s and the crystal meth horrors in the 2000s, but this opiate epidemic was unprecedented.
The children who were left behind
In the past the drug addicted family members used to fight tooth & nail to keep their children, but now with this new epidemic they just discarded them, leaving behind multiple generations of addicts. Law enforcement brought neglected children into the centre, such as a 3 year old who needed every tooth extracted because they were never taught to brush their teeth, kids sleeping on a bug infested mattress using a bucket for a toilet because the water had been shut off. A 4 year old girl whose mother had died of an overdose right in front of her, but she did know how to roll up a dollar bill and snort cocaine off the table, and be able to describe how to cook heroin. Most children ‘crash’ when taken into new surroundings within foster care, where they begin to process the nightmare they were living through. Caseworkers dealing with 2 sisters, an infant born, drug exposed, and the other 4 year old, being weaned off opiates, who then suffered chronic respiratory problems ( I hope the Sackler family are comfortable with their $14 billion earned from the misery and suffering of these innocents, why don’t they invite some of the Purdue executives to help out in the centre and clean up their mess ). This 4 year old was forced to witness a family friend overdose in a car and turn purple, and watched a small child drown in a swimming pool while its parents got high on opiates. What is so heartbreaking is that these children wanted to return to their parents to look after them, feeling guilty now for sounding the alarm that their parents were overdosing. Some parents who lost their newborns after testing positive for drugs strived to get their children back by multiple visits from parents who are trying to make amends and stay clean from their habit. Unfortunately, some failed, as was the case with one child who began screaming and wailing after her mother left, and as the case worker recalled :
“We’d sit in our offices and just sob..but that girl’s cries weren’t enough to keep mom off heroin”
and when the parents failed to turn up for a visit because maybe they were getting high again:
“You see the hurt in their eyes..its a look of defeat, and just breaks your heart”
One woman failed to show up for months but made it for her twin boys birthday:
“ The next day she overdosed and died “
I hope that government officials, pharmaceutical companies, the Sackler family and the like, can rest easy in their beds, and enjoy a nice meal and a glass of wine while walking on the corpses of the overdose victims and their CHILDREN THEY LEFT BEHIND…shame..shame..shame..on you.
Dr David Procter..Pill Mill physician extraordinaire
While most people in Portsmouth were just trying to get by, many relying on disability benefits or workers compensation, Dr David Procter lived in a $750,000 mansion and drove around in one of his 3 automobiles, a choice of a Mercedes, Porsche or Corvette, flaunting the divide between the haves and the have nots. Procter, a Canadian from Nova Scotia set up shop initially in South shore Kentucky with the local doctor Bill Riddle, who, within 2 years distanced himself from Procter, but then soon after died of a heart attack in 1979. However, the once thriving industrial town of Portsmouth with 7 shoe factories, a brickyard & foundry, and a large Detroit steel company was dying: one by one these once booming industries began to close and by 1980 most had disappeared. Procter operated a cash only business, and by all accounts he was popular and was not afraid to prescribe painkillers and opiates during the mid 80’s taking advantage of the opiate evangelists like Dr Kathleen foley, Russell Portenoy, Dr Lynn Webster and Cicely Saunders, who were still advocating a greater use of opiates to relieve the chronic pain from their many patients.
One month’s worth of 60* 40mg OxyContin tablets = Three and a half years of rehab
Sam Quinones in his informative book ‘Dreamland’ recalls a state prison guard who visited Procter in 1996 for a painful back injury that was inflicted during a fight with an inmate, and Procter prescribed 2*40 mg OxyContin/day for 30 days. After the 30 days, his back felt better so he did not return to Proctor for a refill, but soon after he began to feel ill, with severe flu symptoms, coupled with aches that made it difficult for him to get up in the morning, diarrhea and vomiting. He was puzzled, until a friend suggested he might be going through some type of drug withdrawal ( so much for opiate non addiction..and this was after only 1 month). He was ‘forced’ to return for a prescription refill, and when he did, he noticed other prison guards in the waiting room, so he left right after he received his refill. After a short while he began getting OxyContin pills from street dealers, and his job was suffering, arriving late, making excuses. In the finish he came clean with the deputy warden and he was put into detox program and three and a half years later his addiction was over. So for the sake of taking this addictive poison for 1 month it took him 3 1/2 years to kick the habit.
Patient complaints
Although Procter was doing well, some of his patients began filing complaints to the Kentucky board of Medical Licensure concerning his over prescribing of opiates with little diagnosis, and as a result he was put on probation. The complaints continued into the 1990’s when he regularly prescribed Valium.Vicodin ( an opioid containing Acetaminophen and Hydrocodone),Soma ( A muscle relaxant called Carisoprodol), Xanax ( Alprazolam for anxiety) and Redux diet pills ( A very dangerous drug that was withdrawn in the 1990’s because it killed people due to serotonin flooding and subsequent heart valve damage) accompanied with no diagnosis nor suggestions of alternative therapies like diet and exercise. Procter, had become a corrupt ‘Godfather of the Pill Mills’ handing out drugs for some who he talked into having imaginary pain, prescribing life long Vicodin to a girl with broken ribs from a car accident ( Last year I cracked 3 ribs sliding down the stairs because my feet were wet from a swim, although the proprioception caused me some discomfort, I took no pain medication and 2 visits to the chiropractor and they were healed in 6 weeks ). He even explained to one patient to be careful but it was possible to snort the pills he had prescribed, and as he handed out prescription OxyContin, he also said to one patient that he is prescribing the same as he was taking himself ( OxyContin 007..License to Kill).
The law finally catches up to Procter
After addicting an untold number of people, poisoning hundreds with opiates, 3 women reported that they had sex ( under intimidation and blackmail) repeatedly with Procter in his offices, which all leaked back to the Kentucky medical inspector. It was 1998, and Procter was involved in a car accident, after which he relinquished his medical license claiming that the accident had left him with short term memory problems. However he still maintained management of the Pill Mill business hiring other doctors to carry on his criminal practices. Finally, he pleaded guilty in 2003 to a charge of conspiring to illegally distribute narcotic substances, but he received a lighter sentence in 2006 due to his testimony during the trials of his hired associates. His initial sentence of 200 months was reduced to 141 months after his appeal which was completed in 2013 when he was released. Procter was also fined $250,000 which he was paying off monthly from his disability pension ( presumably he was awarded this after his stay in a rehab facility). What happened to the money he must have accumulated from his ill-gotten gains ?, the $750,000 mansion, his 3 luxury cars ?. What baffles me is the light sentence he received, and why he was not connected to any drug overdose fatalities, and even Dr Santos, one of the doctors who Procter hired to continue his business received 16 years in prison compared to the 11.5 years that Procter ended up with.
“ Normally I include a quote here, but I want to leave it blank as a writers equivalent
to a minute of silence to honor those Children and their families who WERE LEFT
BEHIND “
Conclusions
I don’t understand how one person in possession of a narcotic, can get the same or more years incarcerated compared to David Procter and his gang of criminals who destroyed many lives and families from narcotic addiction. What I did not discuss was the ravaging Pill Mill business in Florida and other states and other indicted Pill Mill doctors but the pattern was the same. The saddest part of this story are the children left behind, the suffering traumatized innocents..the ballast off a sinking ship. In the concluding article I will discuss the outcome of Purdue Pharma..yes, they did not escape prosecution in this tale of unscrupulous criminality, the parallel operations of Rancho families from Mexico selling Black tar heroin during this time and the opiate situation today.
“ A special thanks to Mr Quinones for the courtesy of my using some of his well documented/written content contained in his excellent book ‘Dreamland”..A highly recommended read
References/Acknowledgments :
- Estimating the prevalence of Opioid Diversion by Dr Shoppers in the US Mcdonald, Carlson 2013 NCBI
- The controversy surrounding OxyContin abuse: issues & solutions Jayawant,
- Its just horrific: caseworkers break their silence to reveal toll of addiction on children Bryan Mealer 2017 The Guardian article
- Redux for weight loss Livestrong
- Xanax, Soma, Vicodin Drugs.com
- Former Pill Mill doctors home to become drug treatment centre 2016 WSAZ News Channel 3
- Dreamland Book 2015 Sam Quinones
- Pill Mill doctor wants to go home Ben Fields 2007 The Daily Independent