12 million pills and 700 deaths: How a few pill mills helped fan the U.S. opioid inferno
KNOXVILLE, Tenn. — Soon after he took over as medical director of the Urgent Care & Surgery Center in eastern Tennessee in 2012, Dr. Marc Valley realized he was supervising illegal drug dealers in lab coats.
Platoons of patients socialized in the parking lot, none seemingly afflicted by injuries. The packed waiting room echoed with chatter about how and where to score painkillers known as opioids.
Valley discovered that clinic staff were barely vetting patients. Some charts didn’t even include a diagnosis or pain level, yet patients all seemed to receive the same dosage of powerful opioids.
He worried that dozens risked dying from overdoses. He complained to management and tried to rein in the malpractice. But the operators ignored him. Their only concern, he said, was the money pouring in.
He quit after three months, convinced he was running an illicit pill mill, not a legitimate clinic.
“It was so very sad,” recalled Valley, now 60. “I knew it was wrong, and I walked away. But I can empathize with those who didn’t. It was tempting. There was just so much money.”
After he quit, the pill mill — located in a one-story office beside a state highway in Lenoir City, Tenn., in the shadow of the Great Smoky Mountains — was targeted by federal agents in a three-year investigation of local pain clinics.
The ensuing raids, telephone wiretaps and criminal charges against 140 people provide an unparalleled autopsy of how a handful of pill mills exacerbated the nation’s opioid epidemic during a critical early period in its history.
By the time they were shut down in 2015, four freewheeling clinics had churned out prescriptions for more than 12 million opioid pills and had generated at least $21 million, court records show.
In a rare step, federal authorities combed through medical files and death records, seeking the toll of lives lost — from three of the clinics in the Knoxville area and a predecessor in southern Florida.
They were stunned to discover that more than 700 patients had died, not including those who bought the pills on the secondary black market.
“A significant percentage of those deaths, directly or indirectly,” prosecutors wrote, “were the result of overdosing on narcotics prescribed” by the clinics.
“The opioid crisis wouldn’t be nearly as bad, where it is today, if it weren’t for pill mills like these,” said David Rausch, director of the Tennessee Bureau of Investigation and former police chief in Knoxville whose officers helped investigate the clinics.
“Some doctors started to see money could be made from prescribing these pills, and they forgot or ignored their responsibility to do no harm,” he added. “They literally devastated communities. To understand the crisis, you have to understand the role these clinics played.”
Like many tragedies involving prescription pain pills, this one began in Florida, during what authorities describe as the Wild West era of prescription opioid fraud.
In the mid-1990s, Purdue Pharma introduced a painkiller called OxyContin, which it billed as a safer and less addictive version of oxycodone, then in widespread use. At the same time, doctors were encouraged by professional groups to aggressively treat pain, and restrictions on prescribing opioids were loosened.
Pain clinics popped up to meet surging demand, and in 2009 the first Urgent Care & Surgery Center opened its doors in Hollywood, Fla., about 20 miles north of Miami. It was owned and operated, court records show, by three South Florida residents, Benjamin Rodriguez, 44, and two men with both U.S. and Italian citizenship — Luca P. Sartini, 59, and Luigi Palma, 53.
The clinic, in a squat building flanked by palm trees, was soon churning through hundreds of patients each month. It charged about $300 per appointment and didn’t take medical insurance, according to court records. Its dispensary charged $700 to fill a typical prescription.
The clinic raked in cash as word spread that it was pumping out pain pills.
Patients arrived in cars and vans from up the East Coast. Many were led by a “sponsor,” a drug dealer who paid for the trip, the clinic visit and the prescriptions in exchange for half the patient’s haul of pills.