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American Pain: The Largest U.S. Pill Mill’s Rise and Fall

By Felix Gillette on June 06, 2012
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Cardinal Health Inc
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Christopher George and his twin brother Jeffrey opened their first pain clinic in a strip mall on the outskirts of Fort Lauderdale in 2008. There were a couple of rooms and a handful of doctors. No appointment was necessary.

It was a good year to be in the business of servicing people in pain. The economy was tanking. The real estate market was in free fall. People were losing their homes, businesses, savings, and jobs, and looking for an escape from their discomfort. The George brothers ran an ecumenical clinic. Their doctors didn’t discriminate among the causes of human suffering—be it back pain, fibromyalgia, toothaches, cancer, depression, divorce, boredom, mental illness, unemployment, hip replacement, or withdrawal symptoms.

Just about everyone who came through their doors walked away with the same remedy: a prescription for a month-long supply of powerful opioids. More often than not, the pills were small and blue—generic, immediate-release oxycodone-hydrochloride, which everyone called “roxies.” The customers often left satisfied and frequently returned.

Palm Beach sheriff officeJeffrey helped run the nation’s largest pill mill operation

The George twins, now 31, grew up in Florida in an entrepreneurial family. Their father, John George, owned Majestic Custom Homes, a luxury development business that fell into bankruptcy during the recession. While their father’s company crumbled, the twins’ business flourished. Each of their four clinics—American Pain, Executive Pain, Hallandale Pain, and East Coast Pain—was bigger than the last. Christopher invested in two pharmacies. They charged patients $50 a referral to visit a mobile MRI business in a parking lot behind a strip club. Jeffrey bought a monster truck, a Lamborghini, and a bunch of boats. They advertised on billboards. They gave their mom a job.

Palm Beach sheriff officeChris paid doctors up to $100 a prescription

Oxycodone and hydrocodone are opioids and controlled substances; their active ingredients are derived from the opium poppy. Each year in December, the Drug Enforcement Administration (DEA) announces how much of such controlled substances may be produced in the country in the following year. For 2012, the DEA has set the quota for oxycodone at 98 million grams, or about 108 tons, and for hydrocodone at 59 million grams, or 65 tons. Thousands of businesses participate in the multi-step process by which the opium derivatives are harvested in India, Turkey, and Australia, turned into dozens of different generic and brand-name narcotic medications, distributed throughout the U.S., and resold to individuals via prescriptions. There’s lots of money to be made along the way. In 2011, U.S. sales of prescription painkillers amounted to $9 billion, according to IMS Health.

Opioids are not only profitable, they’re addictive and dangerous. They can depress respiration. Take too many or mix them with other drugs, such as alcohol, and a patient can stop breathing altogether. According to the Centers for Disease Control and Prevention, 14,800 Americans died from overdosing on opioids in 2008, the most recent year data is available—more than the number of deaths from heroin or cocaine.

Most opioids are Schedule II drugs, subject to regulatory restrictions from state and federal agencies. But the regulations are not always clear. Sell too many, too fast, with too much marketing or too little discretion, and suddenly the veil of social acceptability is yanked away. The resulting exposure can be perilous. Those who cross over the sometimes hazy line separating legal from illegal handling of the pills often watch as federal agents suspend their licenses, seize their products, and arrest them in high-profile busts with gothic code names. Recent crackdowns have included Operation Snake Oil, Operation Pill Nation, and Operation Juice Doctor 2.

In the spring of 2010, the George brothers were the target of Operation Oxy Alley. Local and federal cops raided their businesses, confiscated their opioids, and seized millions of dollars of assets, including safes full of cash stashed away in their mom’s attic, according to prosecutors. In August 2011 the Department of Justice unsealed a five-count indictment outlining a range of charges, from racketeering to possession with intent to distribute controlled substances, against 32 individuals, including 13 doctors and one wholesaler involved with the Georges’ clinics. From 2008 to 2010, according to the federal agents, the George twins were the largest illegal dispensers of oxycodone in the U.S.

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Workplace Insurers Spend More Than $1 Billion on Narcotic Painkillers

By Join Together Staff | June 4, 2012 | Leave a comment | Filed in Insurance & Prescription Drugs

Costs related to narcotic painkillers are growing for workplace insurers, which are currently spending an estimated $1.4 billion on the drugs, The New York Times reports. The companies are facing payouts to workers with injuries who are being treated with opioids, including many who do not return to work for months—or who don’t return at all.

Opioids can increase disability payouts and medical expenses by delaying employees’ return to work, if the drugs are used too often, too early in treatment, or for too long. A study by the California Workers Compensation Institute conducted in 2008 found workers taking high doses of opioids to treat injuries, such as back strain, were out of work three times longer, compared to those with similar injuries who took lower doses of medication.

A 2010 study by the insurer Accident Fund Holdings found that when disability payments and medical care are combined, the cost of a workplace injury is nine times higher when a strong painkiller such as OxyContin is used, compared to when an opioid is not used, the article notes.

“What we see is an association between the greater use of opioids and delayed recovery from workplace injuries,” Alex Swedlow, the head of research at the California Workers Compensation Institute, told the newspaper.

Although there is little evidence that opioids provide long-term benefits in treating common workplace injuries such as back pain, these drugs are widely prescribed for these problems.

Insurance industry data shows that between 2001 and 2008, opioid prescriptions as a percentage of all drugs used to treat workplace injuries rose 63 percent. Costs have also increased. To reverse this trend, some states have issued new pain treatment guidelines, or are expected to do so.

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Spending just $10 per person per year in proven community-based programs to increase physical activity, improve nutrition, and prevent smoking could eventually save more than $16 billion a year, according to Trust for America’s Health. That’s a nearly $6 return on investment for every dollar invested.

We Must Focus On Preventing Disease If We Want Our Nation To Thrive

By Risa Lavizzo-Mourey

The surest way to control costs in healthcare? Live well.

As a physician, I know how frustrating it is to look into the eyes of a young patient and tell her she has Type 2 diabetes and high blood pressure, knowing that these conditions could have been prevented or at least delayed. It’s a tragic waste; not only would she be healthier and happier, but her health care would not cost nearly as much.

Unfortunately, this scenario plays out all too often in American medicine. Preventing diseases before they start is one of the most common sense ways to keep people healthy, but this nation continues to focus too narrowly on treating medical conditions after they occur.

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Solving the nation’s most entrenched problems See full coverage

A disproportionate share of the $2.6 trillion we spend on health care each year goes toward treating the sickest people–covering mostly high-cost hospital care for preventable chronic conditions like heart disease, stroke, Type 2 diabetes, and cancer. Health care spending and lost productivity tied to smoking alone, for example, totals over $193 billion a year. It is estimated that obesity rates are responsible for $34.3 billion and $27.6 billion in additional spending in Medicare and Medicaid respectively, and $74.6 billion in higher spending by private health insurers.

In stark contrast, strategies that can prevent disease and promote health are chronically underfunded. For every dollar spent on health care, less than four cents goes toward public health and prevention–programs and policies that hold the most promise for lowering costs by keeping us from getting sick in the first place.

The solution is simple. With more than half of Americans living with at least one chronic disease, we should be investing more in community-based prevention. A recently released Institute of Medicine (IOM) report concluded that changes in how America invests in health will be critical for the nation to prevent illness and control costs at a level comparable with other rich nations. IOM called for “significant reforms” to refocus the U.S. health system on prevention of the chronic diseases burdening the nation’s health and economy.

We know these investments pay off. Spending just $10 per person per year in proven community-based programs to increase physical activity, improve nutrition, and prevent smoking could eventually save more than $16 billion a year, according to Trust for America’s Health. That’s a nearly $6 return on investment for every dollar invested. This doesn’t even count the indirect gains yielded through increased worker productivity, reduced absenteeism at work and school, and improved quality of life.

Health insurance, while critically important to making health care affordable, is only part of the solution. It will take a combination of expanding coverage, delivering better preventive and chronic care, and committing to policies that foster safer, healthier environments and healthier behaviors. Evidence shows that embracing these three strategies collectively are much more effective at both saving lives and money than implementing any one of them alone.

There are economic implications as well. State, city, and local leaders recognize that a community’s health affects its ability to attract and retain employers who create jobs. In Nashville, TN leaders are pursuing a range of prevention efforts to make it easier for city residents to make healthier choices. Minnesota is doing something similar. Four years ago, the state launched a Statewide Health Improvement Plan to help save health expenses for both the state and businesses by focusing on improving health and curbing the rise of preventable chronic disease.

And in Wyandotte, Kansas, Major Joe Reardon, seeing how unhealthy his community was–it hadn’t seen a new grocery store in 40 years–brought business, public health, education, transportation, and housing leaders together to support efforts to curb smoking, improve rates of physical activity, and promote healthier choices. Under Reardon’s leadership, all things relating to community improvement in Wyandotte, even resurfacing streets, now include a prevention inquiry: “How does this affect the health of our residents?” and “What is the economic impact on costs and productivity?”

The good news is that a growing number of policymakers and employers view prevention as critical to both improving worker health and productivity while also lowering soaring health care costs. In 2011, 67 percent of companies with at least three employees that provided health benefits also offered worksite wellness programs; almost all companies with at least 1,000 employees offered one. Companies are encouraging employees to be more physically active, quit smoking, lose weight, and eat healthier.

That’s real progress. But if employees and their families live in communities with poor air quality, unsafe areas that limit physical activity and poor access to healthy foods, workplace wellness programs will only get us part way to better health.

This article available online at:

http://www.theatlantic.com/health/archive/2012/05/we-must-focus-on-preventing-disease-if-we-want-our-nation-to-thrive/257759/

Copyright © 2012 by The Atlantic Monthly Group. All Rights Reserved.

Bath Salts Had Role in Face-Eating?

A doctor said on Tuesday that they are investigating whether the drug commonly known as bath salts played a role in the face-eating attack in Miami over the weekend. The attacker has been identified as Rudy Eugene, 31, and according to court filings, he had no income and his assets included $2 cash and a $50 cellphone. Eugene was shot and killed by a police officer after he was apparently caught, naked, trying to eat the face of another naked man on a busy Miami highway. The victim is recovering in the hospital, most of his skin gone, his eyes gouged and his nose bitten. Police originally theorized that “cocaine psychosis” could have played a role in the attack, but an emergency room doctor said the attack could have been caused by bath salts, an LSD-like drug popular in the South, especially Florida.

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May 29, 2012 1:46 PM

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U.S. Senate Approves Bill to Ban Sale of Synthetic Drugs

By Join Together Staff | May 29, 2012 | 4 Comments | Filed in Drugs, Legislation & Prevention

The U.S. Senate last week passed a bill that would prohibit the sale of synthetic drugs. The bill had been held up in the Senate for months by Kentucky Senator Rand Paul. New York Senator Charles Schumer was able to get the bill passed by attaching it to a larger Food and Drug Administration bill, the New York Daily News reports.

The bill passed 96-1, the article notes.

“Let this be a warning to those who make a profit manufacturing and selling killer chemical components to our teens and children: the jig is up,” Senator Schumer said in a statement. “This bill closes loopholes that have allowed manufacturers to circumvent local and state bans and ensures that you cannot simply cross state lines to find these deadly synthetic drugs.”

Often marketed as legal substances, synthetic drugs are sometimes labeled as “herbal incense” or “bath salts” and sold in small pouches or packets over the Internet, in tobacco and smoke shops, drug paraphernalia shops, gas stations, and convenience stores. In December, the National Institute on Drug Abuse released new information indicating that one in nine high school seniors had used “Spice” or “K2” over the past year, making synthetic marijuana the second most frequently used illicit drug, after marijuana, among high school seniors. Poison control centers operating across the nation have also reported sharp increases in the number of calls relating to synthetic drugs.

A similar bill passed the House last December. Senator Schumer said he expects the ban to be on President Obama’s desk by July 4. When it is signed into law, the bill will make it illegal to sell synthetic marijuana and bath salts anywhere in the United States, regardless of local laws. First-time offenders will receive up to 20 years in prison, and repeat sellers will receive up to 30 years

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We have been open over 100 days now .I am commited to my clients and am available 24/7.I am here to serve and get the students so much needed (not always wanted at first )recovery.We base our program on the spiritual consept -we must have a psychic change and obtain a new level of awareness so foreign to many alcoholics and addicts that we call of hopeless variety.We realize that most feel totaly cornered and out of light.And it is so sad to see people die from this disease it is completely absurd and crazy reality of our world to see no way out and run amok or aimlessly out into the darkness.
We do recover are not just words in our rehab we see our clients in action creating their new reality,by facing the mirror,going thru breakthroughs and acquiring positive mindset.Change in thinking and getting down to another side thru thorough and tedious and liberating work brings real results.Not temporary plug.
Our prayers go to Jame’s family.Amen.

U.S. Looks to Other Nations for Addiction Treatment Ideas: Kerlikowske

By Join Together Staff | May 23, 2012 | 1 Comment | Filed in Addiction, Drugs, Government & Treatment

The United States is looking to other nations for ideas on how to treat addiction as a disease, the U.S. Director of National Drug Control Policy said Tuesday. Gil Kerlikowske, who spoke during a visit to London, said the Obama Administration wants to speak to drug addiction experts in other countries to learn whether elements of their programs could work in the United States, according to Reuters.

Kerlikowske has visited Portugal, Italy, Mexico, Colombia and other South American countries to see different types of drug treatment programs, the article notes. He said the approach to drug addiction in Portugal was somewhat successful. Since 2001, authorities in that country have focused their efforts on prevention messages and treatment, and stopped arrests, trials and imprisonment of people who carry a personal supply of drugs.

He said the U.S. is taking a more balanced approach to substance use, with an emphasis on treatment instead of law enforcement. He urged the international community to work together on substance abuse prevention and treatment programs, to stop the cycle of drug use, criminal acts, imprisonment, release, and re-arrest.

Last week, the Office of National Drug Control Policy released a report that it said showed the importance of addressing the nation’s drug problem not just as a criminal justice issue, but as a public health issue.

The report showed a decline in cocaine use since 2003, which indicates that law enforcement efforts and public education campaigns may be having an effect. Illegal drug use overall has decreased about 30 percent since 1979.

An average of 71 percent of men arrested in 10 U.S. metropolitan areas in 2011 tested positive for an illegal substance when they were taken into custody, the study found. The rates ranged from 64 percent in Atlanta, to 81 percent in Sacramento, California. These rates were higher for almost half of the collection sites since 2007.

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NIH Chooses 11 Health Professional Schools as Centers of Excellence in Pain Education

By Join Together Staff | May 22, 2012 | Leave a comment | Filed in Government, Healthcare, Prescription Drugs & Prevention

Eleven health professional schools have been chosen by the National Institutes of Health Pain Consortium to be designated Centers of Excellence in Pain Education (CoEPE). These centers will enhance and improve how health professionals are taught about pain and its treatment.

The CoEPEs will be hubs for developing, evaluating and distributing pain management curriculum resources for dental, nursing and pharmacy schools. Approaches to treating pain are not taught extensively in many health professional schools. The curricula developed by the CoEPEs will include the assessment, diagnosis, and safe treatment of many pain conditions, while minimizing the abuse of opioid pain relievers.

“Virtually all health professionals are called upon to help patients suffering from pain,” NIH Director Francis S. Collins, MD, PhD, said in a news release. “These new centers will translate current research findings about pain management to fill what have been recognized as gaps in curricula so clinicians in all fields can work with their patients to make better and safer choices about pain treatment.”

The new Centers of Excellence in Pain Education are the University of Washington, Seattle; the University of Pennsylvania Perelman School of Medicine, Philadelphia; Southern Illinois University, Edwardsville; the University of Rochester, New York; the University of New Mexico, Albuquerque; the Harvard School of Dental Medicine, Boston; the University of Alabama at Birmingham; the Thomas Jefferson University School of Medicine, Philadelphia; the University of California, San Francisco; the University of Maryland, Baltimore; and the University of Pittsburgh.

“While opioid pain medications have improved the quality of life for millions who suffer from pain, they can also produce harmful consequences, including addiction,” said NIDA Director Nora D. Volkow, MD. “These new CoEPEs can help prevent negative outcomes by designing curricula that promote appropriate screening and management of chronic pain patients, along with education about the risks of prescription drug abuse