As a professor at West Virginia University, John Temple saw firsthand how opioids were decimating his state. Curious as to how prescription pain medications had become so pervasive, he traveled south to the source of so many.
In “American Pain: How a Young Felon and His Ring of Doctors Unleashed America’s Deadliest Drug Epidemic,” Temple chronicles the exploits of a massive Florida pain clinic that distributed staggering amounts of opioids to hundreds of clients each day. Temple says his reporting was an eye-opening experience.
He’s back in Florida again, now investigating how former unscrupulous operators in the space have seamlessly shifted into running treatment centers and sober living facilities. At the upcoming Rx Drug Abuse & Heroin Summit, Temple hopes to share his observations from what he learned while reporting for “American Pain,” as well as what he is seeing now while working on his new project.
Recently, he spoke with Addiction Professional.
Editor’s note: This interview has been edited for length and clarity.
How did the American Pain facility appear on your radar, and how did this book come together?
I have been a professor at West Virginia University since 2002. As you know, West Virginia was hit hard and hit early by the opioid epidemic. I saw a lot of that fallout in my life and work, but I didn’t know much about it. Around 2012, I happened to read a story about this gigantic pain clinic operated by these guys with no education in medicine, no experience in it. They were young guys who got doctors to fill prescriptions for people who were mostly traveling down from Appalachia to go to the doctor and get opioids. They were either addicted themselves or selling them to people in their communities. There was a big pipeline from Florida. This particular pill mill, which was called American Pain, was the biggest one, but it was one of about a thousand operating in Florida at that time. I found it hard to believe. In 2012, there weren’t nearly as many headlines about the opioid epidemic as there are now. I wanted to find out more about how they operated so brazenly.
How much of what you learned while reporting on this project confirmed what you suspected going in, and what new information did you learn?
It wasn’t really particularly early in the opioid epidemic, but the amount of coverage and awareness was so small compared to how it is now. I kept thinking how is this not on the front page of the newspaper every day? It seems so massive and outrageous that I couldn’t believe some of what I was learning, and I almost questioned myself. Am I getting this story right? As we’ve become aware since then, it has become a juggernaut and is happening all over the country. The Florida pill mill years were from 2008-ish to 2012, 2013 before they got a handle on it. It’s not like they ended the pill mills and everything was fine. People with addictions would have to deal with them the rest of their lives.
One other thing I wanted to mention is that I’m down here in Florida again. I’m sort of reliving my experience from when I was writing “American Pain.” I’m working on a new book and possible podcast about the subsequent events that have happened down here since the pill mills were closed. Again, it’s been sort of unbelievable that a lot of those operators just shifted gears and went into the sober home and treatment arenas. It has been really tough for Florida to get a handle on this, although they’ve made some progress in recent years. A lot of those people saw a gold rush—another opportunity to attract young people down to Florida to pursue “treatment” or live in a sober home where the operators were engaged in shady insurance billing and making as much money—if not more—as the pill mill owners did.
And as we’ve seen recently, those types of activities aren’t just happening in Florida.
It’s so reminiscent of the pill mill stuff. Once they clamped down on it here, they could go elsewhere, but Florida just seems to be this early warning signal for the rest of the country.
I’m hoping that by the time I go to the Rx Summit, I’ll be able to have a presentation that integrates both subjects and explores what Florida has done with both of these problems.
Speaking of which, you’ll be speaking with a wide range of stakeholders—clinicians, treatment center owners and operators, public health officials, legislators. Do you have a message you want to convey in that room?
It’s always a little daunting to address people who really know what they’re talking about. These folks know what the deal is. … I do want to focus on what has happened here with the recovery industry and have a solid understanding of what has worked and hasn’t worked here in Florida. Certain numbers show a lot of improvement. In Palm Beach County, which is sort of the epicenter of things here, they have seen a pretty dramatic drop in overdose deaths, but that’s just one part of the equation. There has not been a corresponding drop in other things. They have chased out a lot of the most obvious offenders, but the crazy thing I’m realizing is they’re starting to see doctors who were involved with the pill mills but somehow escaped prosecution and flew under the radar and they’re now getting into other arenas. I’m not criticizing medication-assisted treatment, but some of the practitioners of it, you can tell from their history that they’re probably not in it for the right reasons. There is a lot to cover here.