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Pharmageddon: how America got hooked on killer prescription drugs

White House declares prescription drug abuse in US 'alarming' as thousands flock to Florida - the home of oxycodone pill mills

Fort Lauderdale
A man protests against pill mills in Fort Lauderdale. 98% of doctors who prescribe oxycodone work in Florida, and Americans travel far to get the drug - many arriving on the 'Oxycodone Express'. Photograph: Alan Diaz/AP

The Kentucky number plate on Chad's pick-up truck, parked round the back of a doctor's clinic in Palm Beach, Florida, reveals that he has just driven a thousand miles, 16 hours overnight, to be here - and he's not come for the surfing.

"It's my back," he says, rubbing his lower vertebrae. "I'm a builder. I fell off the roof and hurt my back."

That's odd, as we have just watched him run out of the clinic and over to his truck without so much as a limp. He's clutching a prescription for 180 30mg doses of the painkiller oxycodone.

Chad is one of thousands of "pillbillies" who descend on Florida every year from across the south and east coasts of America. Some come in trucks bearing telltale number plates from Kentucky, Georgia, Tennessee, even far-away Ohio. Others come by the busload on the apocryphally named Oxycodone Express.

It's a lucrative trade. Chad tells us he has just paid $275 (£168) to the doctor inside the clinic, or pill mill, as it is pejoratively called. The doctor, who can see up to 100 people in a sitting, can make more than $25,000 in a day, cash in hand.

For Chad the profits are handsome too. He will spend $720 at a pharmacy on his 180 pills, giving him a total outlay of about $1,000. Back in Kentucky he can sell each pill for $30, giving them a street value of $5,400 and Chad a clear profit of more than $4,000. If he goes to 10 pill mills in Palm Beach on this one trip he could multiply that windfall tenfold. But then there's the other cost of the oxycodone trade, a cost that is less often talked about, certainly not by Chad or his accommodating doctor.

Every day in Florida seven people die having overdosed on prescriptiondrugs - 2,531 died in 2009 alone. That statistic is replicated across the US, where almost 30,000 people died last year from abusing pharmaceutical pills.

It's an American catastrophe that has been dubbed pharmageddon, though it rarely pierces the public consciousness. Occasionally a celebrity overdose will attract attention - Anna Nicole Smith, Heath Ledger, Michael Jackson - but they are specks in a growing mountain of human mortality.

The White House last month said the abuse of prescription drugs had become the US's fastest-growing drug problem.

Declaring the trend an "alarming public health crisis", it pointed out that people were dying unintentionally from painkiller overdoses at rates that exceeded the crack cocaine epidemic of the 1980s and the black tar heroin epidemic of the 1970s combined.

At the heart of the disaster is the powerfully addictive painkiller oxycodone, which comes in various brands - OxyContin, Roxicodone and Percocet. It is a legitimate therapy for those in great pain but has spawned a generation of addicts and, in turn, attracted crooked doctors who massively expanded the prescription of the drugs in up to 200 pill mills, most in southern Florida.

The epidemic has affected people of all ages but is becoming more prominent among teenagers and young adults.

Ric Bradsaw, the sheriff in Palm Beach, said: "There's a culture that's taking hold among teenagers that because a doctor prescribes these pills they can't be bad. Kids don't have the fear of pharmaceuticals that they do of illegal drugs."

Eleanor Hernandez was introduced to "oxies" when she was 14. "I had no idea it was dangerous at all. Other people were taking it for pain, so why would I worry about it?"

Her mother had just died and Hernandez found that she felt care-free when she took a pill. "It took the pain away, of my mother's death, and physically too. It numbed you, made you feel like you were in a bubble."

By 15 Hernandez was selling oxycodone from the park across the street, making money to pay for her own habit. It was a downward spiral. She was in and out of rehabilitation clinics, in and out of custody. Then she overdosed twice and was resuscitated both times in hospital.

But Hernandez was one of the lucky ones. Now 20, she works in a treatment centre helping 14 to 17-year-olds beat addiction. "To this day I thank God that I found help because if I hadn't I probably wouldn't be here."

Rich Perry did not find help. He died aged 21 from a cocktail of oxycodone and other prescription and illegal drugs. He began taking prescription pills three years previously, in his last year at high school. He confided in his mother, Karen, that he had a drug problem and went into rehab.

He was clean for a year, but then, without his parents realising, he relapsed, obtaining oxycodone from three separate doctors. He overdosed once but carried on using the drug. The first Karen knew that her son had gone back to the pills was when two officers knocked at her door at 2am to tell her he was dead.

Now, like Hernandez, Perry seeks solace by helping others to avoid her son's fate. She runs the Florida group Narcotics Overdose Prevention and Education - Nope. Together with the American Society of Interventional Pain Physicians it is battling to persuade the state to introduce a monitoring database that would allow police and medical authorities to identify where the oxycodone is coming from, and in turn identify and shut down the pill mills. Though Florida is the epicentre of the oxycodone epidemic, with 98% of all the nation's doctors who handle the drug located here, astonishingly the state has no comprehensive database recording prescription histories.

Even more astonishingly its recently elected governor, the Tea Party favourite Rick Scott, has blocked the introduction of a database on grounds of cost.

That makes Perry see red. "Cost! For heaven's sake! What is the cost of a human life?"

The police are even more baffled. They point out that Florida's lack of regulation has allowed the pill mills to flourish.

Eric Coleman, a narcotics detective in Palm Beach, said the true cost of Florida's oxycodone disaster would surpass that of the database many times over if all costs related to the crisis - state subsidies for prescriptions, policing and incarceration of addicts, hospital visits for those who overdose, autopsies and paupers' burials for the dead - were added up.

The Palm Beach police force has many of the pill mills under surveillance and is steadily shutting them down. Over the past year 33 healthcare professionals have been arrested in Palm Beach alone and several have had their medical licences revoked.

Yet the police know that until a proper monitoring system is in place, the clampdown they are carrying out will only displace the problem. Pill mills are popping up in other parts of Florida, around Tampa and Orlando, as pill mill doctors move to new pastures.

"This crisis is going to get worse before it gets better," Coleman says. "It's heartbreaking to watch all the families ripped apart, the young lives ended, the damage these doctors - that honourable, esteemed profession that we trust to look after us - are leaving behind."

Comments in chronological order (Total 113 comments)

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  • Foxest

    9 June 2011 8:22PM

    Unpleasant. But outlawing would have little benefit.

    Maybe we should start with asking ourselves why people derive such little satisfaction from modern life that they grasp any and every opportunity to chemically suppress it?

  • Strummered

    9 June 2011 8:24PM

    But it's all legal right? Big Pharm will have a whole host of lobbyists and politicians in their pocket, all bought and paid for - How many people overdose smoking a joint? None.

  • Bauhaus

    9 June 2011 8:24PM

    Maybe we should start with asking ourselves why people derive such little satisfaction from modern life that they grasp any and every opportunity to chemically suppress it?

    Thats a loaded question.


    If your asking "Why do people take drugs?" I suspect you would not like the answer.

  • alex13

    9 June 2011 8:25PM

    I was on that s**t last year and it was a right pain to get off, I became a grumpy s**t as well. But I was determined and won the battle, if your doctor offers them to you think on whether you can put up with the pain the stuff is evil

  • nzgeezer

    9 June 2011 8:28PM

    Foxest
    9 June 2011 8:22PM
    Unpleasant. But outlawing would have little benefit.

    Maybe we should start with asking ourselves why people derive such little satisfaction from modern life that they grasp any and every opportunity to chemically suppress it?

    Modern life is rubbish.

  • ElQuixote

    9 June 2011 8:32PM

    -- They point out that Florida's lack of regulation has allowed the pill mills to flourish- --

    Hey, "lack of regulations" --- now where have I heard that before? Land of the free, I suppose.

  • CordwainerBird

    9 June 2011 8:34PM

    Pharmageddon: how America got hooked on killer prescription drugs

    Interesting article, but you do realise that headline reads like it's straight off the front page of the National Inquirer?

  • Jacksavage

    9 June 2011 8:34PM

    Message to all those who think that legalising all drugs everywhere is the "solution"

    "It is all a bit more complicated than that."

    I actually do not have a problem with people killing themselves and/or ruining their lives by overdoing their drug of choice ( mine is alcohol) but you would have thought that "doctors" would.

    When the penalties for illegal drugs are so draconian in the USA, it is hardly surprising that the law-abiding have siezed on this legal one for a bit of self-medication.

    The reason why they will never make ganja legal is that it is too easy to grow it yourself. That would never do!

  • AfraidOfSunlight

    9 June 2011 8:37PM

    I'll echo @alex13. I had a bone graft last Weds evening and was on this stuff just until Monday (I actually wanted to come off it Saturday, but was advised to wait until I saw a doctor). As a painkiller it was very effective, but the comedown I've had over the last couple of days would mean I'd think very hard before taking it again.

  • imipak

    9 June 2011 8:37PM

    Ah, so the governor thinks that there's more votes in supplying than there are in law and order, at least for now. Says a lot.

    It also says a lot that the doctors involved aren't being struck off the register. I rather think the Hippocratic Oath has quite a lot to say on the subject of doing harm and fraudulant diagnosis is about as "malpractice" as you can get.

    As for how this is necessarily superior to an NHS-style healthcare system -- well, I guess this is one of the effects of the drugs they're taking.

  • idawson

    9 June 2011 8:39PM

    it is affecting many middle class kids too... the problem is the (lack of) regulation in the state of florida. "pain clinics/centers" are quite prevalent.

  • skipperD

    9 June 2011 8:41PM

    well, hopefully when the tea party governor gets the pills he'll realise the problem (not holding my breath though).

  • AfraidOfSunlight

    9 June 2011 8:42PM

    @superbarnsley. 40??? That's bloody ridiculous. I don't know what dose you were on but mine were the 10mg ones. Can't imagine what the 30mg ones referred to in the article would be like.

    Surprised the article doesn't explain the drug a bit more. It's a long-acting (12 hr) painkiller. One of the main problems with abusers is they crush them (and, unsurprisingly also inject, apparently) which means you get the whole - over - dose very quickly.

  • holgate

    9 June 2011 8:47PM

    Even more astonishingly its recently elected governor, the Tea Party favourite Rick Scott, has blocked the introduction of a database on grounds of cost.

    Why the astonishment? Rick Scott, after all, was the chairman of the company found responsible for the largest Medicare fraud ever perpetrated. Pill-pushing doctors are small fry compared to billion-dollar crooks like him.

    It's an open secret in the US that for-profit medicine creates a subculture of pharma pushers. You might have trouble buying over-the-counter decongestants because they're used in meth labs, but if you know the right clinics and pay cash, you can walk out with a prescription for opioids. Just ask Rush Limbaugh.

  • oosdadaddy

    9 June 2011 8:47PM

    Strummered
    9 June 2011 8:24PM
    But it's all legal right? Big Pharm will have a whole host of lobbyists and politicians in their pocket, all bought and paid for - How many people overdose smoking a joint? None

    Perhaps so but I know very many for who smoking joints has literally sent them mad, irretrievably so.

  • alex13

    9 June 2011 8:55PM

    AfraidOfSunlight

    9 June 2011 8:42PM

    @superbarnsley. 40??? That's bloody ridiculous. I don't know what dose you were on but mine were the 10mg ones. Can't imagine what the 30mg ones referred to in the article would be like.

    Surprised the article doesn't explain the drug a bit more. It's a long-acting (12 hr) painkiller. One of the main problems with abusers is they crush them (and, unsurprisingly also inject, apparently) which means you get the whole - over - dose very quickly.

    I was on 90mg a day and they had stopped doing what they were supposed to ages before so were of little to no benefit but they did create a fog in my head as an added hindrance

  • chiquita23

    9 June 2011 9:00PM

    Perhaps so but I know very many for who smoking joints has literally sent them mad, irretrievably so.

    And I know many people who smoke joints on a regular basis without any problem whatsoever.

    Man-made drugs are nearly always more dangerous and addictive than natural ones, that's the truth.

  • Zoob1

    9 June 2011 9:00PM

    Wouldn't live in USA if you paid me. What value does a human life carry? Happiness? Nothing, in comparison to MONEY.

    The purest, coldest and ugliest form of capatlism.

    Yuk.

  • goto100

    9 June 2011 9:01PM

    You missed a detail about Rick Scott. Before taking up teabaggery full time, he was CEO of a medical company later convicted of, I believe approximately $1bn medicare fraud. Maybe it was even more. As a member of the American plutocracy, and in light of Bambi's "look forwards" justice policy (for rich people only of course) none of this had any real consequences for our Floridian wingnut. Hence, it should be no surprise to see him now unwilling to shut down pill shops. He probably regards this a legitimate commercial exercise.

  • pyq6

    9 June 2011 9:05PM

    In hospitals, they call them "frequent fliers": patients who regularly check in for what amount to insurance-subsidized drug vacations. Ask any nurse about the problems it causes. Of course it begins innocently enough, but there appears to be no way to wean these people off their drugs of choice. Pain is bad, but pain management is getting out of control.

  • thekingofengland

    9 June 2011 9:08PM


    oosdadaddy
    9 June 2011 8:47PM

    Perhaps so but I know very many for who smoking joints has literally sent them mad, irretrievably so.

    Twaddle. There is no proved causal link between smoking a joint and dementia.

  • brengunn

    9 June 2011 9:08PM

    Why do people take drugs?
    Because they feel good. Thats the initial reason, with addicts its more complicated but if they didnt feel good no one would bother.
    Its got absolutley nothing to do with the modern world, people were getting high even before homo sapiens evolved.

  • chiquita23

    9 June 2011 9:11PM

    It is no accident that the US is the world's biggest consumer of pharmaceuticals. It suits the corporate plutocracy very well to have the masses doped up and placid.

  • TheCorporal

    9 June 2011 9:16PM

    Since emigrating to North America I have been shocked by the overwhelming number of adverts on prime time television dedicated to prescription drugs; primarly anti-depressants and anti-anxiety.Sugar coated commercials showing 'happy' people walking along beaches blissfully oblivious to life's problems.

    It all seems too good to be true until you hear the mandatory disclaimer warning the user of side effects that include death, paranoia and thoughts of suicide.

  • oosdadaddy

    9 June 2011 9:19PM

    thekingofengland
    9 June 2011 9:08PM

    oosdadaddy
    9 June 2011 8:47PM

    Perhaps so but I know very many for who smoking joints has literally sent them mad, irretrievably so.

    Twaddle. There is no proved causal link between smoking a joint and dementia

    .
    .
    .
    Is that so your highness?

  • finality

    9 June 2011 9:24PM

    I went to a doctor recently here who asked if I had seasonal allergies I said no, she still prescribed morning and night nasal sprays. I never took the scripts to the pharmacy as I know I don't need them. But this is typical in the US.

    The American healthcare system is utterly bewildering, Doctors do procedures without telling you how much it might cost you and then a bill turns up and this is even when you have good insurance.

    For a lot of things that back in the UK would have been ignored as trivial here they will spend $1000s testing and trying to look for root causes. This isn't because they really think you need the treatment but just because it makes everyone money. I was always a fan of the NHS for all of it's faults but moving here has made me even more of a fan. In the UK you do have choice, you have free healthcare of a decent standard (ok you pay tax but no more than you pay in most places in the US on top of which you pay insurance) or you can pay for private healthcare which is cheaper and better than US private healthcare. Here in the US the choice is all an illusion, the Doctor has to be in your insurance network for a start and there are a lot of other limitations.

    I've never seen so much recreational use of prescription drugs. People who would be shocked at someone doing a line of coke think nothing of taking a couple of Adderall recreationally.

  • mangohead

    9 June 2011 9:26PM

    I think they need this shit to ease the come down from all the crystal meth they make in thier trailer parks...

    The solution? Legalise the growing of marijuana for personal use and regulate the import and sale of cocaine in the same way alcohol and tobacco is controlled. Kill two birds with one stone(r).

  • andywebsdale

    9 June 2011 9:27PM

    You don't get the variety of crazily potent opiates prescribed here (not any more anyway). Perhaps some private doctors still, but its not like the 70's & 80's when drugs like Diconal (remember them?) were a scourge. People injected the pills & silted up their veins - horrible. In the States there seems to be a huge black market in prescription opiates, which seems to lead to more "straight" (for want of a better word) addicts, perhaps because pills seem less sordid than powder heroin, whereas in fact, they're probably far worse.
    Strangely, often the media talk about "painkiller addiction" where these drugs are concerned(especially when taken by slebs), though they're quick to call heroin users "junkies" & "drug fiends", even though there is zero difference. Judging by the posts on here by people who've been prescribed them, they sound a lot more addictive.

  • rulnacco

    9 June 2011 9:28PM

    I dunno, with 6 billion people currently on Earth, a little population reduction is in order. Maybe this is a little Darwinian self-selection taking place here--possibly not a bad thing, so long as one of those who offs themselves isn't one of your family members or a significant other, I suppose.

    I really don't want to advocate killing anyone to get the population under control. But if folks want to do it to themselves, well...

  • BirneyCar

    9 June 2011 9:37PM

    @TheCorporal

    Since emigrating to North America I have been shocked by the overwhelming number of adverts on prime time television dedicated to prescription drugs; primarly anti-depressants and anti-anxiety.

    And these ads have to been seen to be believed, always advising at the end in voice over that the viewer "Ask your Doctor about [fill in the drug]". This may explain in great part the astonishing number of folks I know who smooth out life's ups and downs by swallowing a daily MD prescribed sumpin sumpin to dull themselves from the reality asylum.

    This is a spoof commercial, but I think anyone who has seen the real ones will agree that it's spot bollock on:
    https://www.youtube.com/watch?v=4ShdqCaClqY

  • andywebsdale

    9 June 2011 9:45PM

    Perhaps so but I know very many for who smoking joints has literally sent them mad, irretrievably so.

    Rubbish.
    i have a theory that this idea comes from gullible researchers/parents etc.. When a young person becomes psychotic apararently from drug use, someone (probably an authority figure or parent) will ask them what they've been taking. They' ll admit to puffing, but will probably lie about other drugs. The only proof I'll accept of weed causing psychosis is when the psychotics in question can be proved to have taken no other drug. Ever. Because one dose of LSD or E will make all the difference in the world. Also you have to rule out those who would have symptoms no matter whether thay took any drugs or not, e.g schizophrenics. Every other drug that causes psychosis is a stimulant, mostly amphetamine-related in some way, cocaine or a psychedelic like LSD, that keeps you awake, which of course conrtributes in a big way to the onset of psychosis.
    If someone is already psychotic, of course having a few strong bongs will make it flare up, but that's not the same thing at all is it?

  • MuchPreferWinter

    9 June 2011 9:48PM

    superbarnsley

    'Had 40 prescribed when I had my wisdom teeth out. 40, for Christ's sake. I needed 3 of them'

    Can you provide the details of this magical dentist / doctor please?!

  • northsylvania

    9 June 2011 9:53PM

    zoob1 says
    "Wouldn't live in USA if you paid me. What value does a human life carry? Happiness? Nothing, in comparison to MONEY."
    I wouldn't either and I am an American. The reason these pill mills are rife in Florida is that they have a crook for a governor and also a lot of old people, old people in some pain, who cost a fair amount in Medicaid dollars to maintain. The easiest way to get them off the rolls is to let them self-medicate themselves to death. The hillbilly heroin dealers are just a side effect.

  • cbarr

    9 June 2011 10:02PM

    Its simple its a legal fix people sometimes need to absent themselves from reality it is the self medication of a sick society these are not party drugs or social drugs like alcohol it is a hidden and secret attempt to blot out the pressure and suppress the very real pain. Don't think this is just a US problem though high functioning drug addicts amongst the middle class here in the UK can go abroad to other EU nations on their holidays go to a private doctor in Germany or Spain (two nations where this is easier then it should be) and get a prescription for anything up to and including diamorphine and legally acquire it here in the UK. It is a class issue as much as anything the middle class take clean, safe and legal drugs to absent themselves and to cope and the working class have 30 police officers burst through their doors for drugs that are illegal and potentially dangerously made because they can't afford the comfort of control capital offers.

  • DemocratDave

    9 June 2011 10:02PM

    Governor Scott, on June 4, signed a bill from the Florida legislature to crack down on drug mills and even implement a database, as reported by the St. Petersburg Times, probably the best source of news on the state's politics.
    http://www.tampabay.com/blogs/the-buzz-florida-politics/category/buzz-tags/prescription-drug-monitoring-database

    Scott was supposedly concerned about privacy. I suppose that if American conservatives don't like databases on firearms, at least some of them would object to prescription databases.

    The federal Centers for Disease Control and Prevention (CDC) is concerned that unintentional drug overdoses, a large portion of them subscription, have become a leading cause of accidental death, apparently exceeding car crashes. Unfortunately, not all states keep good records, and it takes a long time for the data to reach the CDC. They're working a few years in the past.

    Prescription opiates, including the ones prescribed in Florida, constitute a particularly severe problem.

  • sammantha

    9 June 2011 10:06PM

    Even the judges are pill poppers in TN!
    http://www.knoxnews.com/news/2011/mar/10/drug-habit-topples-judge-baumgartner/

    @finality - Agreed. Everyone in the UK needs to stand up and fight to keep the NHS - and improve it. US doctors are in it for profit and are all in bed with the pharm. co.s. And like you say, even though you pay your medical insurance premiums every month, you still get stung with extortionate bills or worse, they refuse to pay altogether! Save the NHS.

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