Before the lid got blown off Tampa Bay's pain-pill epidemic — before the TV exposés and high-profile raids, before the moratoriums on new facilities and emergency city hall ordinances — Creative Loafing received a letter from Bernie McCabe, state attorney for Pinellas and Pasco Counties, asking for the paper to reconsider running ads for pain clinics on the back page.
"We believe the physicians who prescribe these medications play a role in the prescription drug abuse and overdose epidemic that faces our community today," the letter, dated March 2, said in part. "While we understand the right to freedom of the press, we feel this type of advertisement is a blatant invitation to easy access to powerful narcotics by persons who are drug seeking."
CL's initial response was: OK, there's reason for concern. The paper can deny advertising if there is indication a business is operating illegally.
But McCabe's letter had not said that any of the pain clinics on the back page were illegal. And editor David Warner didn't want to tar advertisers as unscrupulous pill mills without cause. So he decided CL needed to do some investigating on its own. That's when he called me, a former CL staffer.
The approach was simple: Contact some of the pain clinics, set up appointments and find out just how easy it is to score prescriptions for Oxycodone, Vicodin or other opiate pain meds. I have my share of pain — low back, knees, right shoulder, Achilles tendons — so it was reasonable that I would look into the clinics' services. We agreed that I would not tell the facilities I was a reporter, but if asked I would divulge my identity and intent.
We wanted to find out if our advertisers were indeed scofflaw pill pushers — places where all you had to do was limp or cringe a little and walk out with a sheaf of prescriptions — or if the establishments vetted patients and required them to make a persuasive case that they needed opiates for legitimate pain therapy.
Honestly, we expected a free-for-all, pills for the asking. That's not what we got.
First we wanted to talk to McCabe. I called his office and asked to speak to him by phone. A couple of days later, an assistant called me back with an appointment time to visit him the following week. When I met the State Attorney and Public Defender Bob Dillinger in a nondescript conference room in the Criminal Justice Center on 49th Street in Clearwater, McCabe said he was pleasantly surprised that Creative Loafing had responded to his letter. He eyed me warily for the first 10 minutes of our meeting. I told him the paper's plan.
McCabe, who wore a yellow golf shirt with his office's seal imprinted on the breast, did not use his blustery personality to pressure me to drop the ads. Instead, he handed me a sheaf of papers filled with statistics, press releases and newspaper stories about the pain pill epidemic.
• Prescription drug abuse has risen 500 percent since 2005.
• In 2008, 15.7 percent of Pinellas County high school students and 3.4 percent of middle school students reported using prescription pain relievers at least once in their lifetime.
• That same year, Florida's Sixth Judicial Circuit — Pinellas and Pasco Counties — had the highest number of reported deaths in the state involving Oxycodone at 308, more than Xanax (250), Valium (145) and Methadone (108).
• Also in Circuit 6: From 2001-2008, reported deaths that involved Oxycodone rose from 61 to 308, or 404.9 percent.
McCabe went on to discuss the scourge of the clinics in general terms, without singling out any particular facilities. He said that the doctors working at the clinics should "rot in hell. They are taking advantage of addicts. They are killing people. It's despicable."
For his part, PD Dillinger said his office was deluged with drug cases and supported the overall effort to strike at one of the problem's sources: pill mills.
The only insight the two offered regarding my investigation was that the clinics required prospective patients to present an MRI. They wished me luck, and said they were eager to hear my findings.
Then a bit of bad timing. Before I was able to visit my first facility as a supposed patient, the Pinellas County Commission issued a moratorium on new pain clinics, which suggested to me that clinics would likely circle the wagons, vet new patients more strictly.
Yet off I went a couple of days later to visit St. Petersburg Pain Management at 4900 33rd Ave. N. in St. Petersburg, which advertises "Chronic Pain Relief" in big yellow letters against a green background. Why this place? In part, because the ad said "FREE initial visit." It's an unfortunate reality that CL simply does not have the resources to fund an investigation that would require multiple office visits ranging from $150 to $300 a visit. Plus, St. Petersburg Pain also had what we considered the most blatant come-on, including "Dispenser Onsite!"
The facility is a converted one-story house on 49th Street with a circular driveway, where only a couple of cars were parked on the sunny late morning I visited. In the compact waiting room, I signed in and was quickly handed a stack of papers to fill out that was more extensive than any other doctor's office I'd ever visited. I wrote down symptoms, medical history, signed waivers — all of it truthfully.
I asked when I could see a doctor. The woman behind the counter asked if I had a report from an MRI that was taken within the last six months. It just so happened I had an MRI on my right knee some weeks earlier, but it certainly was no ticket to Oxy Land. It said that I had a loose body in my knee but other than that was negative for damage to cartilage or ligaments. Still, I claimed pain in my knee and low back (both true).
The woman then asked me for a pharmacist's report. I told her I didn't have one, that a doctor had given me Vicodin samples and they really worked, they were the only thing that effectively eased the pain. That doc would not give me a prescription, I said. (This part was fabricated.) Would this doctor write me a script?
She gave me a quizzical look and said someone would call me.
I left. The call never came. I phoned a couple of days later asking when I could get my prescription and was told that someone would call me back. That call never came either.
At this point, it seemed apparent that the place advertising itself for "Chronic Pain Relief," whose actual name is St. Petersburg Pain Management and Urgent Care, was not eager to have me as a patient. I figured my investigation had reached a dead end. No dispensers spitting out pills like slot machines for me. With a less-than-convincing MRI and no pharmacy record showing pain pill usage, it seemed untenable to continue our CL report.
After conferring with editor Warner, though, we decided to complete the project as best we could. I was to call all the pain-clinic advertisers on the back page of the CL Summer Guide (May 13-19) and finish what I started with St. Petersburg Pain Management and Urgent Care.
The seven clinics I telephoned all had essentially the same story:
I would need an MRI — if I didn't have one, they could direct me to a facility where I could get one at a reasonable price. "We have to have some medical correlation to why you're having pain," said a woman from Quality Care Medical Group with offices in Brandon and Bradenton. "You say you're having pain, but there has to be some issue going on with the body that explains why you're having pain."
The clinics I called also said I would need a pharmacy report documenting my prescriptions. Some required a urinalysis.
Initial office visits ranged from $125 to $300. If I qualified, I would need to return every 28 days, which cost from $110 to $125. Then there was the cost of the meds.
I couldn't help but think: Kinda pricey to be a pillhead these days.
With one clinic, Medical Pain Management at 1010 E. Busch Blvd. in Tampa, a woman pitched me on injections that could get a person off alcohol and narcotics. She was adamant that the clinic should not be lumped in with pill mills. "They're cracking down on clinics, but our doctors have never had problems," she said. "We're above board and clean. We're the best. We've been here 17 years."
I tried a bit of cajoling with the clinic staffers, whined about my chronic pain: Was there anything I could do to get around some of these restrictions? I was desperate.
I was shut down, politely, at every turn.
When I parked outside St. Petersburg Pain Management and Urgent Care for my second visit, a security car was in the lot. The clinic had recently been robbed at gunpoint at 3:35 p.m., with thieves stealing an undetermined amount of Oxycodone. An armed guard stood at the hallway leading from the lobby to the exam rooms.
During my two-hour wait, a small parade of obviously suffering people came through with varying tales of woe, most related to their inability to obtain pain pills. Some were there for monthly visits and left with prescriptions.
It took the staff a while to find my paperwork. A man dressed in scrubs said he would have to call the physician who authorized the MRI. After several attempts, he got through.
A doctor walked into the office area a few times — a slightly built, elderly man with thinning hair and a gaunt face. He made no attempt to interact with patients in the waiting area.
I waited a while longer, enduring the cigarette reek from bodies, reading the sign on the walls that said "All Patients Subject to Random Urinalysis," thumbing through a Health magazine that was among a bunch in a plastic container on the wall.
Finally, the man in scrubs called me over. Said he had consulted with the pain doctor. "He says you should see an orthopedic doc first, who'll determine whether you need pain management care," the man said with such finality that I didn't even put up an argument.
I walked out the door and into the sunlight, pill-less.
Editor's Note: Subsequent to Eric's visit to St. Petersburg Pain Management, we spoke with the clinic's office manager, who made a forceful argument for the legitimacy of the business. "Whenever we have a new patient come in, we contact all the doctors that are in their pharmacy history," she said. "We have an 18-page contract that they sign that says that they will not go anywhere else. And any doctors that they've seen previously we notify them by fax that the patient is here. So if the doctor has anything to say they will and do contact us. We are very cautious — we check everything out."
Asked how she felt about the crackdown on clinics by law enforcement, she said, "It needs to be cracked down on. They should be strict. We're strict."
This article appears in Jun 3-9, 2010.