Ordinarily you would not think that a convicted felon in his mid-twenties, whose main experience is house construction, would be able to get involved in anything resembling the medical field. Chris George got his start by selling diet pills and steroids, but a doctor got him started in the field of opioid painkillers. George merely had to rent a location, and provide the start-up money to produce something resembling a walk-in clinic. The doctor would provide their DEA license which enabled George to make purchases of oxycodone and other drugs from wholesalers and the doctor would write the prescriptions. The pain clinic could then fill the purchases in-house under the ''supervision'' of the physician. George wasn't certain that the idea would really take off, but was willing to give it a try. As patients continued coming in, packing the waiting room and stretching the line outside into the tiny parking lot, George realized they were onto something. From there the business grew by leaps and bounds until George's clinic was processing hundreds of patients in a single day, and bringing in hundreds of thousands of dollars in revenue each day as well.
Why this happened is because of a multitude of reasons, which created a perfect storm situation that allowed George and his cadre to grow absurdly wealthy on something that was (technically) legal. The first was the increase in the availability of opioids starting in the late 1990s. Prior to that period opioids were largely restricted to patients who most likely weren't going to live long enough for addiction to become an issue. However, starting in the 1990s drug manufacturers began aggressively campaigning for increased sales of opioid painkillers through a variety of methods. This included advertising campaigns with fallacious information about how new opioids were safe and non-addictive if taken ''as prescribed'', dubious or downright illegal efforts by drug representatives to encourage physicians to prescribe opioids, and lobbying of the DEA to increase annual quotas of controlled substances. (Go ahead and put a pin in that last part. We're going to come back to it later.)
In addition, Florida had fairly lax regulations regarding pain clinics and opioid prescriptions. Basically anybody who could fill out a business registration form could start up a pain clinic, regardless of their background. And any doctor, so long as they had a valid DEA license, could order and prescribe opioid painkillers. The doctors did not even have to be pain specialists, they just had to have a valid license. There were various ways that doctors could trip automatic alerts and cause increased scrutiny from the DEA and other police agencies, but generally as long as a doctor didn't prescribe more than 240 30mg doses per patient per 28 day period, they could fly under the radar.
George even went to the effort of making it appear they were a legitimate medical facility. MRI reports were required before treatment, mounds of paperwork including a pain management contract were created, and patients with obvious track marks or forged paperwork were turned away, just to give the organization a veneer of legitimacy. But it was at most a paper shield to cover everyone's ass. People could tell that this was drug-dealing, plain and simple. The fact that patients would start shooting ground-up pills in the parking lot was proof enough of that. Eventually the police did end George's operation and new legislation made setting up a pill mill more difficult, but the fact that they operated for two years in the wide open, with multiple imitators and competitors, shows how dangerously lax the regulatory environment was.
Okay, so to return to the issue of the DEA and quotas, this was my biggest takeaway from the book. Every year the various drug manufacturers submit requests to the DEA for quotas on how much of controlled substances, such as amphetamines, opioids, and other drugs, they can produce in a year. Now, the public doesn't know how much opioids a specific manufacturer is allowed to produce in a year, but the DEA does release its total for the industry as a whole. In the past 25 years, the total quota for opioids has increased dramatically. In the past ten years it's at least doubled. In the past 25, it's increased by a factor of 42. Yes. 42. For every kilogram of opioids produced in 1993, there are 42 being produced today. The question isn't how we ended up with an opioid epidemic in the United States. We're so awash in pills nowadays that the more apt question is how couldn't we?
And yet, there's something the DEA could have done. Back in the 1970s when there was concern that amphetamines were being abused, the DEA drastically cut national quotas for the drugs and severely curtailing supply. When the supply dried up, the market for amphetamines dried up as well. At any point in the past decade when people started expressing concerns about the abuse of prescription painkillers the DEA could have drastically curtailed the quotas and dried up the supply of opioids. Instead, year after year, the DEA has obligingly raised the quotas meaning, year after year, we end up with an even greater supply of opioids. If we were serious about ending the opioid epidemic in the United States we could cut the supply off at the source, and it wouldn't cost us anything we weren't already spending.
I think this book is definitely worth reading. If nothing else it reveals the core problems surrounding our current opioid crisis, an overly plentiful supply of drugs and lax regulations regarding them. I definitely recommend giving this book a read for that, as well as the true crime aspects of the story involving the American Pain clinic.
- Kalpar
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