John Temple’s American Pain goes inside the operation that flooded the southeastern United States with prescription opiates

americanpainBut John couldn’t figure out just what had happened, where this crisis had come from. Then he saw an article about Chris and Jeff George and Derik Nolan, who were on trial in Florida for running pain clinics that had handed out 20 million opiate pills between 2008 and 2010. His journalistic instinct kicked in, and he started to delve into the story. Even in his wildest dreams, he couldn’t have imagined what he’d find.

The book that emerged from his research, American Pain, takes us right inside an operation that flooded Florida and the southeastern United States with prescription opiates. At the center of the story is Chris George, a construction worker and convicted felon in his late twenties, who, along with his brother Jeff, had been selling steroids illegally in Florida for years when a doctor told him the real money was in prescription painkillers.

They were dubious at first, but Chris decided to give it a try, and brought his pal Derik onboard, too. (Jeff would later open his own clinic.) Derik had met Chris through the construction industry; he was three years older than Chris and a keen user of steroids, and he’d also spent time in jail. Chris opened a small pain clinic and made Derik manager: it was nothing more than a couple of doctors who were willing to write prescriptions for large quantities and a safe full of drugs bought from a wholesaler. Soon enough, they were taking in so much money that cash registers were useless: they had cashiers simply dump money into trash bags, filling many every day. They were catapulted into the kind of lifestyle they’d always dreamed of, buying expensive cars and blowing thousands of dollars at strip bars. By the time they were arrested two years later, the business had brought in $40 million.

And while they enjoyed their cars and their cash, they were saturating whole swathes of America with Oxycontin and other opiates. The clinic’s fame spread, and people began traveling from states with more stringent drug laws to get their hands on the pills. Most commonly, they came from Kentucky or Tennessee. Hundreds of copycat clinics popped up in Florida when people saw how much money there was to be made, but Chris and Derik’s operation was always the largest by many scales of magnitude. The street price of prescription opioids plummeted in the southeastern United States, and thousands of people were plunged into the misery of addiction. Families and whole communities were devastated, particularly in previously sleepy Appalachian areas.

As hundreds of customers started arriving every day, desperate to hand over huge wads of cash, and sometimes shooting up there and then in the parking lot, it seemed impossible to Chris and Derik that the substances they were dealing with were legal. And yet they were—so long as they were prescribed by a qualified doctor who had reason to believe that the patient was truly in pain. That’s a very difficult thing to judge, and that difficulty leaves a lot of room for manipulation. There are all kinds of best practices in place to avoid abuse of these drugs, but as Chris and Derik discovered, for every procedure, there was someone willing to flout it. For a start, there were the doctors: a simple ad on Craigslist would bring them numerous doctors prepared to write high prescriptions on the flimsiest of evidence.