American Pain: The Largest U.S. Pill Mill's Rise and Fall ~ Business And Insurance

In West Palm Beach, a George brothers clinic

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. Chris paid doctors up to $100 a prescription 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.

“The significance of today’s takedown is that we have dismantled the nation’s largest criminal organization involved in the illegal distribution of painkillers,” said John Gillies, special agent in charge for FBI Miami. “Up until today, efforts focused on the demand by targeting individual users. Today, we attacked the source and choked off the supply.”