American Pain by John Temple. Painful.

American Pain

Read March 2016
Recommended for fans of 60 Minutes
 ★   ★   

Americans have a pain problem. As does healthcare. We might be at an impasse: patients and federal dollars both demand pain control, and yet narcotic deaths continue to exponentially rise, with most users reporting their gateway drug was a prescribed painkiller. Personally, I’m in the Dread Pirate Roberts school of philosophy: “Life is pain, Highness! Anyone who says differently is selling something.” I do believe we are in pain, but I think instead of attempting to interpret the signals, we’re trying to silence the noise. Narcotics are the physiological equivalent of telling someone to “shut up.” Don’t get me wrong; they absolutely have their use and as a cancer nurse, I see first hand why they are needed. But I also know that some people will experience pain no matter how many narcotics are pushed in them, and I’ve come to believe ‘pain’ is more than a reflection of a noxious nerve stimulus.

I picked up American Pain thinking I was going to get a medical/drug exposé along the lines of Martin Shkreli, the pharmaceutical-company C.E.O., who boosted a HIV drug over 5,000 percent, from $13.50 a tablet to $750. Alas, what it is about is two brothers, Chris and Jeff George, and their friend, Derik Nolan, opening a pain clinic in Florida in the late 2000 and making a ton of money selling oxycodone and Xanax. It reads like this:

Construction, tattoos, steroids, oxycodone, oxy, oxy, oxy, oxy, strippers, storefront clinic, doctors, oxy, oxy, oxy, oxy, oxy, oxy, oxy, oxy, cash, safes, bank, oxy, oxy, oxy, oxy, oxy, oxy, oxy, oxy, oxy, money in garbage bags, junkies, Mountain Dew, oxy, oxy, oxy, oxy, oxy, Kentucky, shooting up, bouncers, oxy, oxy, oxy, Range Rovers, partying, drug testing, oxy, oxy, oxy, oxy, zombies, junkies, clinics, oxy, oxy, oxy, oxy, oxy, oxy, houses, property, wiretaps, oxy, oxy, oxy, oxy, oxy oxy, oxy, oxy, oxy, oxy.

Still, there was about a twenty page section that panned some informational gold. Oxycontin is the long-acting form of an older drug, and an enterprising drug company was seeking to capitalize on their expiring patent. Heavy “educational” campaigns helped doctors and consumers how their pain was being under-treated. Strategic differentiation between ‘psychological addiction’ and ‘physical dependence’ was propagated. And, quite shockingly, the revelation that the DEA meets with drug companies to decide and approve the amount of narcotics allowed to be manufactured annually. The end result was overdose deaths quadrupling in eight years and killing more people than cocaine and heroin combined. All this is truly fascinating stuff, but it’s over quickly so that Temple can return to the drama of the American Pain Clinic.

I take issue with his approach, because though Temple relates a FBI agent is told to, “follow the money,” this journalism fails to do the same thing. Sure, these owners of the clinic were getting rich–Chris George had 4 million in cash stashed at his mom’s house when he was busted–but you know who else was getting rich? A lot of people. Strangely, the tale leaves that out. Manufacturers. The pharmaceutical company. Lawyers. Bankers. Corporations that rented space to the clinics. No doubt the lobbyists. Governments–these clinics were legal and paid taxes. The lawmakers that didn’t regulate clinics or create patient drug registries as their state dispensed more oxycodone than the rest of the nation combined. There’s a whole lot of people complicit in this racket, and I don’t think the Kentucky “hillbillies,” as Nolan and Temple so generously call them, are the ones making the real dough–though they are the ones paying the price for overdoses.

Still, this might have been an interesting tale. However, sentence construction is staccato-like, resulting in a narrative that jars. Sentences are mostly factual statements strung together, with insight only from Derik, and that limited–and I mean that in the psychological sense as well as all the commentary that comes from him only emphasizes his good-time attitude and willful ignorance. While I suppose it is technically a more honest journalism, the author then relies on prejudices of the reader to draw assumptions, courtesy of class prejudices. Anecdotes like Nolan’s father killing his mother and step mother, Florida construction boom, stripper-junkie girlfriends, homemade fireworks, etc. seek to drive the point home. Nuance is not Temple’s forte.

This is a topic worthy of some serious journalism, but instead it’s caught up in the tale of some young, canny dudes out to make serious bucks. Worse, instead of really investigating the true crime–a manufactured epidemic of pain and the addictive drugs to ‘cure’ it–it settles for self-righteous judgement and economic prejudices. I can’t honestly recommend it, as only the factual sections saved it from the DNF pile.


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4 Responses to American Pain by John Temple. Painful.

  1. Stephen Fisher says:

    The FX series “Justified” serialized this crisis beginning in 2010 using Elmore Leonard’s sheriff Raylan Givens from “Fire in the Hole” and Harlan County, KY as backdrop. Over the first three seasons the show painted a shocking portrait of how drug companies and politicians enabled clinics (pill mills) in Florida, Georgia and Alabama to supply drug runners and dealers across the South to addict large portions of the population to prescription pain meds. The crisis has since migrated to the Midwest and deaths caused by opioids are rising. According to the CDC more than 3 in 5 drug overdoses are from opioids like foxy, more than half occurring from prescriptions. 28,000 people died from opiod overdoses in 2014 ( Sad and criminal.

    I wondered how much of the show was factual vs sensationalized. Found the truth was scarier than what the show portrayed. “Justified” likely prompted NPR’s reporting on “The Oxo Express” in 2011 ( Sounds like both accounts are better than “American Pain.” The oxy crisis is a sad and criminal enterprise for which key perpetrators (politicians and drug companies) have as you say yet to and may never be prosecuted.

    • thebookgator says:

      Thank you for commenting. You know, the best entertainment shows us the truth. I’ve heard good things about “Justified,” but addiction is such an emotionally frustrating issue for me that I haven’t watched it. I suspect the truth is really quite serious–I know certain drugs are “controlled substances,” but I didn’t think about the idea that manufacturers seek to get permission for the amount produced. Rocks and hard places–i suppose if the government reduced manufactured drugs, they could charge more for them. In Wisconsin, narcotic overdoses are continuing to increase (double digits), to the ridiculous point where police officers carry Narcan to reverse the opiates. However, it’s hard enough to get the legal ones now, so users are turning to heroin. Then there’s plan old mixing or death by misadventure–a 70 some year old my dad was friends with was found in his car–they think he fell asleep after taking his pain pills. So it isn’t just “addicts” in the traditional sense of the word. Sigh. I’m sure your numbers are factual.

  2. neotiamat says:

    Pity about the uselessness of the Temple book. The current Opiod epidemic is the bit of the drug situation that I know least about, though from everything I’ve read, it’s an absolute devil’s brew of bad incentives — there was a Cracked article on it, of all things, when a crackdown on some pill-mill doctors caused all the other doctors in John Cheese’s area to stop prescribing out of fear of being arrested, causing a sudden drought in pain medication in an area about the size of a state.

    Speaking of drugs, this is a bit away from Oxy-et-al, but about a year ago I was working as a teaching assistant for a Latin American Labor historian who was teaching a course entitled Drug War, Drug Trade (got to read De Quincy’s Confessions of an English Opium-Eater, which was fascinating). Anyway, we used a number of clips and episodes from National Geographic’s “Drugs, Inc.” in the course, which were very good. We never touched upon Oxy in it, focusing more on the socio-economic consequences for Latin America and the general history of Cocaine, Marijuana, and Opium/Heroin, but I imagine NatGeo would have some good stuff there.

    For my part, I’ll have to take a look at NPR’s Oxy Express. I have, thank god, not had any personal or family experience with Oxy or other drugs (in the Russian community, we prefer drinking ourselves to death, thank you very much, none of your fancy bourgeois narcotics), but I do find it interesting.

    • thebookgator says:

      Well, you know–Americans definitely love drinking themselves silly as well. I’d say we see more detox’ers at my hospital than we do overdoses. Sounds like your Drug War class was interesting. I imagine that provided an excellent understanding–it is so hard to get a picture of the issues from piecemeal newspaper articles. Hm, an article on Cracked, hm? I’ll have to go look for it. They have a fascinating perspective on things.

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