How a Young Felon and His Ring of Doctors Unleashed America’s Deadliest Drug Epidemic

I started reading American Pain because I saw the episode about pain clinics on "American Greed".
I enjoyed this book because it didn't glamorize pain clinics/ opioids .It made the story raw & real but I didn't like the way the author described Appalachian people capitalizing on their heartache and grief .It was uncalled for....
I've lost friends,good people ( at one time) to drug mixtures that literally cost them their lives so in certain parts of the book the author seemed a little Frivolous in the way he described opioid use so if you like "fluff" reading this is the book for you....enjoy?

Great read on a great subject. I had already worked with Christian Valdes on his expose of this industry Pill Mill: My Years of Money, Madness, Sex and Drugs in the Florida Pill Mill, which gives a compelling view of this business from the inside out through the eyes of a pill mill manager - so I knew about a lot of what happened in Florida during this time period. This book lays out all the facts in a compelling documentary style and I would highly recommend.

This book is a wonderful read and helps explain the "nuts and bolts" of how this was allowed to happen. A very rich resource for those trying to understand the epidemic and beautifully written. Thank you John!!

This book does an excellent job of detailing the operation and taking down of Florida's Pain Clinics or "Pill Mills." It does this by telling the story of the folks who built and worked at the largest of these. We get to know the people. We laugh often and cry with the victims. The author spins a great yarn. One of the best books I've read in some time, which both informs and entertains.

Shocking read.... You can't make this stuff up. The AMA needs to do a better job of policing the medical community. The events in this well written and researched book should never of happened. In trusting a medical provider with the keys to the medicine cabinet should be come with a great deal of responsibility and oversight.

A quintessentially American story of entrepreneurial ambition, unrestrained amoral capitalism, destructive self-indulgence, and blinding malicious greed. A really great book, I burned through it in two days.

The title of John Temple’s work, "American Pain," is applicable in three ways. First, American Pain was the name of a now defunct Florida pill mill which Temple writes about with great insight. Secondly, American pain describes the experience of a collective group of Americans who seek help in addressing debilitating pain issues due to accidents or illness. Third, the term American pain highlights the angst many of our friends, neighbors and other citizens experience when their loved ones become addicted to pain-killers, sometimes to the point of dying of an overdose.

As other reviewers have written, the book reads like a good crime novel; it’s truly a gripping story. However, the big take-away from this sordid tale is not the abhorrent activity of the felonious owners of the clinic and their complacent, complicit and over-prescribing physicians. The big story is not the lax Florida state laws which allowed this clinic and others to thrive. No, the take away can be found early on page 51 of American Pain and involves the US government’s Drug Enforcement Agency (DEA).

“One of the DEA’s most important and least recognized duties is to decide how much of each controlled substance can be manufactures. If the DEA decides that the amount of oxycodone being made exceeds the ‘medical, scientific, research and industrial needs of the United States,’ it can reduce the drug’s production, simply cut it down by denying pharmaceutical companies’ annual requests to manufacture more of the drugs. Instead, year after year, the DEA had signed off on hikes in the manufacturing quotas of all popular prescription narcotics.”

So essentially, while Americans were dying at the hands of greedy pill mill owners and their doctors, our government was giving them the pharmaceutical ammunition for the job.

The Senate subcommittee on Crime and Terrorism (http://www.judiciary.senate.gov/about/subcommittees), under the auspices of the Senate Judiciary committee, provides oversight of the DEA and the Office of National Drug Control Policy. As Americans watching the pain of others, or maybe experiencing it first hand, we should be writing those sub-committee members demanding a review of issues raised in John Temple’s book.

This is an important book. It chronicles a "pill mill" in Florida that in the absence of oversight, was able to hire willing physicians and distribute vast quantities of opiates and benzodiazepams. As a physician who vividly remembers a conference sponsored by our state attorney general, to inform us that pain was a vital sign and vastly under-treated, and opiates were safer than we knew, and now sees the end result of the opiate epidemic, I never knew that the DEA allows the drug companies to produce massive quantities of opiates and could cut off the supply if they wanted, and that manufacturers of oxycontin were so successful at starting this epidemic, as they marketed their product. The felons who ran American Pain were told it was legal. The doctors who were employed there made a lot of money. As a central character said--someone should have said "no". The governor of Florida obstructed a prescription monitoring program, despite widespread abuse and patient deaths. If only this was remote history. Greed and lack of oversight started this, and the DEA keeps letting the companies manufacture the drugs. The story is both fascinating and horrifying and the problem is no where near to being solved.

I must be the anomaly here. American Pain had so much potential to be a great book, but it just fell flat. It's hard to read about how two roid-loving felons took advantage of addicts from Appalachia, and how they justified their actions by calling them "Mountain Dew-drinking zombies." Even more tragic are the lengths these heartless criminals went to ensure they stayed on top. But business was business, right?

Derik Nolan and Chris George were exploited Florida's loopholes to ride the wave of a national epidemic, and made a ton of cash doing it. This fact wasn't amiss to the FBI or the DEA, who had American Pain under their radars for months. Derik and Chris, two bobybuilding knuckleheads, were nothing more than legalized dope men. However, they weren't the only villains of American Pain. American Pain's cast of colorful doctors, hired through Craigslist, were slowly killing their patients by writing massive scripts, while making millions. The worst villain was Dr. Cynthia Cadet, who convinced herself she was perfectly within the realms of the law, even though she was the highest prescriber of Oxycontin in the state and the country.

American Pain had the potential to be a really good book, and it had a terrific story. Sadly, it just dragged on. Parts of book lingered over the pharmaceutical industry, which really wasn't worth writing a whole chapter about. The book lacked the substance to really make you want to keep reading it, and that's a shame because the material is there.

Suffice to say, I wasn't one of those who found American Pain a fantastic read.

This book tells a crazy, almost unbelievable story about drugs in American. If you lived through the Oxycontin epidemic and remember how many people were addicted to it and how prevalent it was, this book explains how that happened. It was the pill mills. It's a crazy story that I've never heard of before, all about how this legal drug was dispensed so widely by a borderline criminal crew, based largely in Florida. Temple does some great investigative journalism here, uncovering the identities of the main distributors: a couple of brothers and their partners. It has major reminders of Breaking Bad, only the drug was Oxy and prescribed by doctors. Oh, did I mention that the brothers were hopped up on steroids? Yeah, it's a crazy story.

Waves of drugs have come and gone in this country: Oxy came after cocaine and before "plant food" (and the other drugs of the present day). The wave of Oxy distribution that this book captures is different from some of the others, though, as we tend to think of drugs as coming from outside the U.S. and thus worthy of our long going drug wars. But Oxy was home grown (made in St. Louis) and not even illegal, though it was spread and used just like any other narcotic.

If you've read other books about the drug trade or liked Breaking Bad, I think you'll like this book. It follows the story of the pill mills and is not dry like some other accounts of drug culture. It's about how two brothers made this industry boom, and then how they were taken down by the DEA.

I just finished the book American Pain. Honestly I stumbled upon it
at the Eastport Library in Annapolis, MD. It was on a display. I saw the
cover read a little bit of the foreword saw the location of the clinics
were in Ft. Lauderdale ( I am originally from West Palm Beach). Then I
looked at the author and saw he is a professor at WVU ( from which I
am a 1985 graduate in Landscape Architecture)! Sadly I know people in
Annapolis who have died from heroin or have opiad drug addiction.
Between these three factors I knew I had to read this book.

I thought it was very well written. It is fact filled yet almost read
as a fiction book because it was so hard to believe and you did a great
job developing the characters. I will recommend it to my friends and
friends I know in book clubs. It really helped me understand the epidemic that
is striking the country. I will definitely help spread the word about
how addictive these legally prescribed drugs are and to stay away from
them as much as possible. When something is legal and approved by the
FDA etc. you think it must be alright to use. Now I know they are not to
be taken lightly.

I enjoyed the book so much I think I will look into the other two books
he has written. When I say I enjoyed I do not mean I loved hearing
about other people's misery but more like it had a balance of fact or
statistic, human character and heartfelt albeit heart breaking stories.

Opioid addiction. Learned a lot in last 48 hrs. reading Professor Temple’s book American Pain. If you live in Bervard County FL or in WV or Kty or anywhere that Oxycontin has robbed your neighbors or your children’s souls, you need to read his book. Or if you just care to understand the depth of legalized heroine we have unleashed through the pharma industry’s efforts to maximize profit or the neglect of eyes wide shut to examine what doctors did operating in bill board advertised pill mills created by felons and other uncaring operators. Greed and stupidity and accidental happenstance. Deaths and pain. The only wish I had were for more stories of the victims, hooked and distressed, waiting for the quick fix with deep pockets of cash yet poor as church mice. The few stories added greatly to this book’s grim reality. The crooks were painted in great detail. Very real. While the title is great, it is made greater because It is also the actual name of the clinic in Fl that this book is written about. First it was called So Florida Pain then American Pain when a competitor named their pain clinic East Coast Pain. But in fact about pain beyond measure for the most helpless and addicted—all through “good” doctors who “weren’t breaking the law”. The author is a journalism prof at WVU. His name is John Temple. He’s on his way to capturing America by continuing to write about our not so excellent selves. Watch him. He’s coming right at us with unvarnished truth about what we need to understand and address — in this book and others yet to be.

I have worked in the addiction field since 1972 and am currently in charge of certifying addiction professionals in my state, which has been slammed by the opioid epidemic. I am an avid reader, almost exclusively of nonfiction. This book is not only an incisive look inside the opioid epidemic, it reads like a whodunnit. For me it was a real page turner. I found it both detailed and accurate. John Temple is a gifted author who knows how to dig through a mountain of information and whittle it down to a terrifically interesting tale. If someone doesn’t make a movie out of this book I’ll be very surprised.

John Temple manages an extraordinary feat here: weaving the public health disaster of our current prescription opioid painkiller epidemic into an exciting page-turner that takes us from the hills of Kentucky where blue-collar workers are getting hooked on OxyContin and other opioids and overdosing on them to the strip malls of southern Florida, where the managers and doctors who ran the American Pain pill mill were getting rich off of this addiction epidemic. What I loved about this book, besides the writing, which absolutely sparkles, are the nuanced portraits Temple has given us of both the bad guys, particularly the go-for-broke young men who made American Pain into Florida's biggest pill mill and the so-called good guys, which include a Drug and Enforcement Administration (DEA) that even to this day won't cut back on the volume of opioid narcotics it allows to be sold in the United States. As Temple notes at the end of this gripping narrative, it doesn't help to just shut down a few pill mills here and there, because another one will just pop up to take its place. What we have to do is choke off the source, which are the pharmaceutical companies that originally mislead doctors about the addictive nature of these opioids and keep asking and getting permission from the DEA to sell more of them

I really enjoyed American Pain. As a physician, I found it very sad that these dishonorable physicians would betray their oath and actually harm patients simply to make unconscionable profits. I found it particularly interesting that what happened is that a segment of the opiate trade was essentially legalized, with the drugs supplied by legitimate pharmaceutical companies and prescribed by licensed physicians, allowing addicts relatively easy access to opiates without the involvement of cartels or street dealers (except for those drugs sold to the addicts which were ultimately diverted to street sales). This has resulted in a growing problem which has particularly affected certain regions of the country (Staten Island, where I live, has been severely affected). To me, this gives the lie to the idea that the solution to the drug problem is to declare the "war on drugs" a failure and legalize drugs of abuse. The experience with oxycontin and similar opiates suggests that this would only make the problem worse.
American Pain is well researched, well written and easy to read. Anyone who reads it will come away with a good understanding of the problem of prescription opiate abuse that has been a scourge in so many of our communities. Overall, a great book!

Great account of the worst pill mills to have hit Florida. Good to know that people are paying attention to the opioid addiction problem and that the US Government is doing something about. But a bit unclear from the book why DEA continues to approve the high distribution numbers of these controlled substances...is that really happening or do our lobbyists have something to do with that? Overall great book

John Temple gets behind the shocking headlines of the most insane chapter of American medical history, when drug dealing was legal and in-your-face in the state of Florida. While the pill mills were horrible enough, to finally learn what went on in the minds of the guys who ran the biggest pill mill was just wonderful. It's a gift to all of us who have watched in disbelief as the State of Florida fueled the East Coast with narcotics and spawned a heroin/fentanyl epidemic that we're still dealing with years later. Thanks John Temple for keeping it real. Without stories like this, it is still hard to believe this stuff actually happened.

Wow. I don't normally post reviews about books but felt compelled to write one for this story. American Pain traces the story back to the roots of the opioid addiction problem in the United States. Every state in the country has been affected by this issue and too many families have been torn apart because of it. This is a serious issue in this country that, unfortunately, is becoming worse every day. The information contained in this book needs to be out in the public so something can be done to start to fix this problem.

The story itself almost writes like a book of fiction; I felt there was no way that this story could possibly be true in such a great country like the U.S. Yet, it is completely true; and that is more scary than fiction. Do yourself a favor and read this book. Then do something to help fix this problem.

Captain Jan Rader of the Huntington,WV fire department recommended this book when she spoke at KidStrong Conference 2018. She understands the Appalachian opioid crisis better than most and is admired for her work and vision. She said this book would "piss you off" . She was right! It was too easy for these thugs to get rich quick and enable addiction to grow.

Before we can ever tackle the opioid epidemic in America and particularly Appalachia, we have to trace it's gnarly, twisted roots back to the source...and this book comes as close as possible to doing that. One may believe crooked doctors and careless pharmacies may be to blame for the rise in painkillers, but the answer is far more complex and the eventual culprit will disturb any American. It's little wonder this book is in the works to be turned into a movie, it is spellbinding from the opening lines, and I daresay will leave you addicted for more.

This book captures the beginnings of the opiate (now heroin) epidemic in Appalachia. As a native West Virginian and practicing emergency room physician in WV I have watched this epidemic grow and now work to halt it. Unfortunately greed continues to push some physicians to practice in this manner in present day. American Pain is the most accurate and well written book on the topic outside of the medical literature. I would recommend it to both the lay public and the medical community.

Christopher Goode, MD, FACEP
Emergency Physician

Note: This review was taken from my blog titled: “American Pain” a Fascinating True Tale of Greed, Addiction, and Pill Mills ~Daleen

If you don’t know anyone who’s been addicted to narcotic painkillers, you’re fortunate. Sadly, most of us do, or did, in the case of an addict whose addiction ended in death. It’s not a pretty topic—but it certainly is a crucial one.

Last fall I joined a local writer’s group made up largely of WVU professors. We email each other pages of our current project and meet once a month to provide feedback. It’s probably the best writer’s group I’ve ever been involved with, and I enjoy it immensely. One of the members, John Temple, was working on a nonfiction project he was under contract to finish. The early drafts of American Pain: How A Young Felon and His Ring of Doctors Unleashed America’s Deadliest Drug Epidemic really grabbed my attention. In part because I lost a sister to drug abuse, after she got hooked on those nasty painkillers, and also because I’ve had several surgeries myself and almost every single time I was sent home with a prescription for an opioid—which is a synthetic form of opium. Most of the time, I didn’t even need to fill the script. Other times, if I did, I rarely finished the pills, and flushed those that remained down the toilet.

Then, on Monday, August 31, 2015, I attended Temple’s book launch at the WVU Law School. There, a three-member panel composed of a psychologist, an attorney, and Temple, discussed the painkiller epidemic. I thought I knew how addiction worked, but I learned even more that night. For instance, the more painkillers you take, the more pain you have. That’s the word from Dr. Carl Sullivan, director of the West Virginia Addiction Training Institute for the last 25 years. Once the brain becomes accustomed to painkillers, any real or perceived pain seems even worse, which prompts the user to feel like he needs more pills at higher doses. It’s a vicious cycle that turns many people into addicts and eventually leads them to heroin.

Sullivan knows addicts. Prior to 1985, most of his patients were alcoholics. But in the 1990s, pharmaceutical companies began pushing drugs like OxyContin, saying that opioids were safe. They pushed them right into West Virginia, which has a large worker’s compensation population, due to such dangerous jobs as cutting timber and mining coal. At the same time, pain became the fifth vital sign doctors would check when examining patients. Because pain isn’t easy to quantify, and it’s impossible for doctors to confirm if a patient doesn’t have any, “doctors felt compelled to treat it,” Sullivan said. The result was a perfect storm here in Appalachia and elsewhere. “Opioids in West Virginia were just flowing like water,” he added.

We can thank Purdue Pharma for this change in the medical community. In the early 1990s, Purdue developed OxyContin, a controlled-release pill. It would replace MS Contin, one of their other drugs, used only to treat cancer patients. As Temple writes in American Pain, “Purdue wanted OxyContin to be prescribed to a much broader array of patients and for a longer period of time.” So Purdue began a major marketing campaign: first, they educated the American public about the problem of untreated pain. Then, they provided the solution—their new drug!

When West Virginia figured out what was going on with pill mills, Temple said, it became one of the first states to clamp down on the problem, which included patients who would doctor shop and buy far more painkillers than they needed. “The drugs may go away but not the addiction, so you go where the drugs are,” Temple said. Thus the reason West Virginia residents, like many people in southern states, began driving to Florida to get their fix.

The morning of the book launch, Sullivan treated 23 patients. All of them were addicted to opioids. These and other addicts have symptoms that include an intense craving for painkillers, being restless, sweating, vomiting, diarrhea, and thinking only about one thing: getting more drugs. “Without treatment, nothing good happens,” Sullivan said, “squalor, death.”

Not long ago he felt hopeless. Since then, new treatment programs are helping people addicted to painkillers. The clinical psychologist said he “feels more optimistic in 2015 than in a long time.”

Who would believe that this painkiller epidemic started, in large part, because of a construction worker–and felon–in Florida? The story of their American Pain clinics and the drug-dealing doctors who worked for them is amazing! Temple spent three years writing his book while on sabbatical from WVU, where he teaches journalism.

Not only is his writing crisp and clear, but Temple also cites fascinating numbers that help tell the story of this American epidemic. For instance, Temple says that during one period, Florida doctors bought nine times more oxycodone (the main ingredient in OxyContin and other painkillers) than doctors in other states. “That’s nine times more than the other forty-nine states combined,” he says. Records from the Drug Enforcement Agency show that in “one six-month period,” Temple says, “Florida doctors bought 41.2 million doses while every other physician in the country collectively purchased 4.8 million doses.” In fact, he says “four of [American Pain’s] clinic’s full-time doctors ranked among the top nine physician purchasers of oxycodone in the country.”

American Pain got its start, in part, from a health care industry that comprises 18-percent of the U.S. economy, according to Valerie Blake, a WVU associate law professor. That’s huge, and it’s climbing. When the pill mills were pumping out pills so fast almost no one could keep count, Florida then had virtually no laws regulating health care, Blake said. And the state certainly had no database to help track patients who were “doctor shopping.” Nor did it have any laws that stipulated who could or couldn’t own a medical clinic, she added.

Enter the George brothers, Chris and Jeff, and their construction worker buddy, Derik Nolan. Not even knowing what they were doing, they ran their little operation haphazardly, but over time they learned what the DEA looked for, when determining if a clinic could be busted for dispensing too many drugs. And they began implementing changes accordingly, until their company became a major player in the narcotic painkiller industry.
Astonishingly, though, when Chris George checked out the DEA’s own 2006 policy, he found that the federal agency would consider suspicious any doctor who “prescribes 1,600 [sixteen hundred] tablets per day of a schedule II opioid to a single patient,” Temple wrote. With numbers that high, it’s clear to see why the George brothers and Nolan thought they could get away with what they were doing.

American Pain is an important book about an epidemic that is far from over. Not only did Temple dig into the DEA’s own puzzling actions of allowing pharmaceutical firms to manufacture more pills than ever, but he did so while weaving together a powerful and sometimes even funny story about the three Florida construction workers who became so wealthy and powerful they were mafia bosses in their own right. Bosses the FBI brought down, when a female agent named Jennifer Turner took an interest in the construction workers’ clinics. Turner and her fellow agent, Kurt McKenzie, worked for more than a year to bring the case to trial. According to Temple, McKenzie says the only “other investigation that took the same toll on him . . . was the terrorist attacks of September 11, 2001.”

There is one other important thread Temple wove throughout his book: the victims of American Pain’s pill mill practices, many of whom died. Like the Racine, W.Va., man, who smashed his Camaro into a pickup truck while high on oxy. Or the Tennessee man who died in a Boca Raton motel, two days after being treated at one of American Pain’s clinic.

But Temple’s story about Stacy Mason, a young concrete worker from Kentucky who drove to Florida to get oxy so he could cope with back pain from a serious vehicle accident that made it impossible for him to work, will leave you longing for justice for all the victims of this terrible epidemic.
Many times, Temple got in his own car and drove up hollers in backwoods Kentucky to interview the Mason family for this book. Their story, like those of the other addicts Temple writes about, will make you angry that so many senseless deaths have occurred because of greedy pharmaceutical companies. Be prepared to settle in for a long read, because American Pain is an addictive read. And it will captivate you, making it almost impossible to put down.

Derek Nolan said it best in the final chapter when he asked why two twenty something shmoes, one a convicted felon, were allowed to open and operate a pain clinic. And what is wrong with the system that there were doctors lined up to participate? We have created a monster with pharmaceuticals and we had best tame it before it kills us all.

American Pain is a fascinating story. I prefer to read fiction but this true story caught my eye. As a healthcare provider and dealing with a chronic disease myself, I follow the the legal painkiller conundrum closely.
Living in the Midwest I shake my head at Florida. A state that allows this kind of lawlessness is disgusting. As the author points out, it's always about money in the end.

Great book.. Wonderful storytelling and a lot of insight into an oft-misunderstood problem. There's a ton of collateral damage the guys in this book left behind. This book is a great example of taking a hot-topic issue, putting a face (or two) onto it, and turning it into an interesting, insightful read.

Excellent book showing how drug abuse is multifactorial. Whose fault is it? DEA, drug companies, doctors, patients who become addicts? Our nation's drug problem is fed by all of these components creating a problem with no positive answer. While the story is very interesting and hard to put down, the truth of the book makes you continue to think after you turn the last page. It's hard to believe that people with no medical training could open and run a 'medical' office. I really enjoyed reading the book and appreciate all that I learned from it.

Temple told a very important and true story about this opioid epidemic. One has to wonder what it really takes for a change to take place. This is just one group of criminals. There are numerous more.

Exceptional book - excellent character development and outstanding journalism. I had to keep reminding myself that this is a real story, unfortunately! I really got a much improved understanding of how the pill mills flourished and why this became such a scourge in WV and southeastern Kentucky. The research for this book was very well done. John Temple masterfully wove the facts into a hard to put down book.

If anyone ever wanted a counterpoint to the mantra "get rid of all regulations," this book offers a textbook case of the hu,am disaster that follows when a state (Florida) refuses to regulate its pill economy.

Not only was the book truly engaging, the in depth stories regarding a few of the players was gripping. Regardless of the government's or the industry's role in the creation of the "pill mill", the bottom line is that there were also those individuals who found a way and method to profit. American Pain and its short lived blaze was, like it or not, the American way.

American Pain was a fascinating read. The events and story captured my attention from the first page and held it for the remainder of the book. The complicated web of personal stories, pharmaceutical companies, and the legal system were described in a way that was clear to follow, educational and very thought-provoking. I am going to recommend this book to my book club!

A gripping story of systematic failures and the exploitation of those failures that ultimately led to a prescription drug abuse epidemic. Continuously had to remind myself this was non-fiction. Thoroughly researched! Fantastic insight into how the prescription drug industry impacts the overall landscape of the American healthcare system ...