AMERICAN PAIN (48 page)

Cadet is free, for the moment. Derik follows her case through prison-system e-mails from his sister. After the trial last summer, Cadet and Castronuovo were acquitted of the death charges and drug charges. The jury found them guilty only of money laundering. The
Palm Beach Post
called the verdicts a “stunning defeat” for the prosecutors.

Five months later, the defendants who’d testified or otherwise cooperated in the case against the doctors began to receive their sentence reductions. Paul Schwartz recommended that US District Court judge Kenneth Marra slash sentences by one-third. The defendants asked for more, and the judge cut the sentences roughly in half.

Except for those of two defendants. Chris George got three and a half years off of his seventeen-and-a-half-year sentence, nowhere near half and even less than the one-third that the prosecutors had requested.

And Derik Nolan got nothing. The US Attorney’s Office never requested a reduction for Derik, and Judge Marra didn’t give him one. Derik’s lawyer and sister tried to find out why, but got no answers. Derik figured Paul Schwartz was blaming Cadet’s acquittals on his conflicted performance in the witness box. Schwartz, understandably, will not comment. Derik alternated between rage and depression for a while, then gave up hope and settled in for the long haul. If he can stay out of fights and earn his full allotment of twenty-two months off for good behavior, he could be eligible for release in 2024, two years after Chris’s earliest possible release date.

In April, Judge Marra dropped another surprise when he sentenced Cadet and Castronuovo. The doctors did not expect lengthy prison sentences on the money-laundering convictions, but Castronuovo got eighteen months and Cadet got six and a half years. Marra didn’t buy Cadet’s defense that she had been fooled, and he specifically pointed to the undercover video of Derik yelling at the patients to not shoot up in the parking lot.

“All you have to do is look at (that) and see the chaos, the madness that was going on in that facility,” Marra said. “It’s just not possible to not have known that those people were all drug addicts.”

The doctors’ lawyers appealed. If Cadet wasn’t guilty on the drug charges, her lawyer said, then the money she made was clean. And if the money was clean, how could she have laundered it? The doctors remain free while they pursue appeals, which could take years.

At the FBI, Jennifer Turner and Kurt McKenzie have moved on to other investigations, and neither expects to encounter another case as rewarding or as demanding as American Pain. McKenzie, who led the death probe, says he’s worked only one other investigation that took the same toll on him, and that was the terrorist attacks of September 11, 2001.

Larry Golbom ended the Prescription Addiction Radio show in March 2014. He is proud of his seven-and-a-half-year run and believes the show had a positive impact, but it never took off the way he originally hoped. He continues to work for the same major pharmacy, and notes that many Florida pharmacists now refuse to fill opioid narcotic prescriptions. Golbom fills them when he believes the prescription is legitimate and comes from a qualified doctor. He’s not anti-opioid; he just wants people to understand the drugs.

Meanwhile, many in the medical profession are beginning to recognize that rampant prescribing of addictive narcotics for chronic pain has proven to be a devastating mistake in many cases. Short-term, the drugs make you feel great. Long-term, many legitimate pain patients are taking the drugs as prescribed and finding it harder and harder to get out of bed in the morning. Take these drugs too long and not under the watchful eye of a doctor who understands the subtleties of opioid pain management, and it may be difficult to regain a normal life. Studies have demonstrated that opioids may actually
increase
pain over the long run and that non-drug treatments are much more effective than opioid therapy. The federal Centers for Disease Control and Prevention has declared that painkiller overdose deaths are an official epidemic.

At the same time, Florida is celebrating having beaten back the pill mill scourge through arrests and legislation. In 2010, ninety of the top one hundred oxycodone-purchasing doctors in the country lived in Florida. By 2014, the DEA said, the state contained only one. The number of oxycodone pills shipped to Florida dropped from 650 million in 2010 to 313 million in 2013. The number of pain clinics dropped from more than one thousand to less than four hundred. Some of the pill mills moved to other states, notably Missouri, home of Mallinckrodt’s US headquarters and the last state in the country that lacks a prescription database. Meanwhile, pills grew more scarce and expensive in Kentucky, and hill-country sheriffs began seeing heroin for the first time ever. The same fix, now cheaper.

So the pill mills left Florida, to great fanfare . . . but, unabated and under the radar, the country’s appetite for pills has only continued to grow. That much is clear because the manufacturing companies keep asking the DEA for permission to make more pills, and the DEA keeps granting it. All those pills are going
somewhere
. In 2014, even as supplies shipped to Florida were shrinking, the total number of kilograms of oxycodone manufactured took another big leap, from 131,500 to 149,375—almost three times the amount produced a decade earlier, and forty-two times the amount made in 1993.

Any narco cop will tell you, when you kill off one secondary source of narcotics, two more tend to pop up elsewhere. You have to choke off the source, strangulate the fountainhead.

Or, as Derik puts it, junkies gonna get them pills, somehow, someway.

Derik doesn’t know what he’ll do if he makes it out of prison. Chris’s mom sent him magazines not long ago, and the pictures of Ireland made him want to go there. When old friends e-mail him, which is infrequently, he thinks about returning to South Florida. When he hears it’s snowing up north, he remembers growing up on the farm near Binghamton, New York, and he longs to go back home.

I’ve been communicating with Derik almost daily over the phone and e-mail for months, and he shows little remorse about his role in supplying millions of pills and fueling a gigantic wave of addictions up and down the East Coast. He mainly feels sorry for himself.

But he does feel bad about certain things. He feels bad when he thinks about the kids he saw at American Pain. He feels bad when he thinks about how he fired the homeless guy who watched over the parking lot. He feels bad about testifying against Cadet, though he believes she knew what she was doing.

And that’s the thing. He wasn’t alone. For a few years, in plain view, hard drugs were for sale in Florida, and it seemed to Derik that almost everyone was on the take. He and Chris turned doctors into drug dealers. They turned an ex-cop into a bag man. They turned pharmaceutical wholesalers into accomplices. Politicians and realtors and lawyers and landlords and medical associations and the
New Times
weekly newspaper helped them pull off the scam. And in the end, it was the big boys—Actavis and Mallinckrodt—who made the big money in Florida.

He and Chris were bad guys, no doubt about it. Felons. Violent men. So why did everyone make it so easy for them?

No doubt, this line of thinking is a way for Derik to blame the whole thing on somebody else.

But that doesn’t mean it’s not true.

“The fucked-up thing isn’t that we did this,” Derik says. “Of
course
we did it. The fucked-up thing is that we were
allowed
to do it. That they let us do it. Why were two guys like me and Chris allowed to set up a business like this? When we said we wanted to set up a pain clinic, they shoulda been like, ‘Umm . . .
No
.’ Or, ‘Let’s see your criminal record.’ When we said we wanted to order $100,000 worth of pain medication, they shoulda said no.”

He pauses, raising his eyebrows high to emphasize his point.

“They shoulda said, ‘
Fuck
, no.’ ”

S
OURCES

This book is a work of reported nonfiction. I changed no names or details. All information in the book was either told to me, observed by me, or found in public records or in journalistic and academic venues.

To report the book, I traveled to Kentucky and Florida numerous times and conducted hundreds of interviews. I researched and visited most of the sites described in the book. I also read numerous books and hundreds of newspaper and magazine articles, as well as dozens upon dozens of scholarly articles and government reports. I attended the 2013 National RX Drug Abuse Summit in Orlando, Florida, where I met many people on the front lines of the prescription opioid epidemic and heard numerous experts speak. I spent two weeks in West Palm Beach observing the federal trial of Dr. Cynthia Cadet. I also reviewed hundreds of court transcripts, pleadings, and investigative documents.

While I did not use a great deal of specific data from the following books and articles, they were key sources nonetheless:

•    Barry Meier’s books—
Pain Killer: A “Wonder” Drug’s Trail of Addiction and Death
from 2003 and
A World of Hurt: Fixing Pain Medicine’s Biggest Mistake
from 2013—and his years of coverage in the
New York Times
provided a foundational understanding of the resurgence of opioid narcotics.

•    The article “How Florida Brothers’ ‘Pill Mill’ Operation Fueled Painkiller Abuse Epidemic,” by Thomas Francis, published on
msnbc.com
on May 7, 2012, introduced me to the story of American Pain.

•    The article “American Pain: The Largest U.S. Pill Mill’s Rise and Fall,” by Felix Gillette, published in
Businessweek
in June 2012, helped me understand the pharmaceutical opioid manufacturing and sales process.

I read numerous academic journal articles about the opioid epidemic. The following were particularly useful to me:

•    “The Prescription Drug Epidemic in the United States: A Perfect Storm,” by J. C. Maxwell,
Drug and Alcohol Review
, 2011.

•    “Black Beauties, Gorilla Pills, Footballs, and Hillbilly Heroin: Some Reflections on Prescription Drug Abuse and Diversion Research Over the Past 40 Years,” by James A. Inciardi and Theodore J. Cicero,
Journal of Drug Issues
, 2009.

•    “The OxyContin Epidemic and Crime Panic in Rural Kentucky,” by Kenneth D. Tunnell,
Contemporary Drug Problems
, Summer 2005.

I tried, usually more than once, to communicate with every defendant who was affiliated with American Pain. Many chose not to speak to me, including Dr. Cynthia Cadet. Others communicated with me briefly, then cut off contact. Chris George answered many questions over prison e-mail but did not agree to an in-person visit or a phone call. He was concerned that helping with the book would make it look as though he was proud of what he did. However, he said he wanted to tell his story so others would avoid his mistakes, and he asked me to put a note to that effect in the book. Derik Nolan and I communicated for many months, exchanging hundreds of e-mails, speaking on the phone more than a dozen times, and talking for two days in person. Derik paid for many hours of time on the prison computers and phones, and I voluntarily sent him small amounts of money several times (about $100 total) to defray those costs. I also tried repeatedly to contact Dr. Rachael Gittens and Dr. Enock Joseph via e-mail, phone, and letter, and neither responded. Other key interviewees described in the book included Jennifer Turner, Kurt McKenzie, Paul Schwartz, Larry Golbom, Dr. Michael Aruta, Alice Mason, Kevin Mason, and Shelby Durham.

Other people I spoke to did not appear in the book but provided enlightening background information. Pete Jackson of Advocates for the Reform of Prescription Opioids and Karen Perry of the NOPE Task Force shared information about their organizations and their personal losses. Florida Board of Medicine member Dr. Steven Rosenberg shared information about the height of the Florida pill mill crisis. Mike Fulton of the Asher Agency and Michael Barnes of the Center for Lawful Access and Abuse Deterrence provided useful perspectives on the national opioid crisis. J. E. “Ned” Crisp, director of Fiveco Area Drug Enforcement Task Force in Russell, Kentucky, and Dan Smoot of Operation UNITE provided background about Kentucky’s fight against prescription painkillers. Dr. Gary Potter, a criminal justice professor at Eastern Kentucky University, shed light on the current and past drug scene in eastern Kentucky. Dr. Hilary Surratt, director of the Center for Applied Research on Substance Abuse and Health Disparities at Nova Southeastern University in Miami, Florida, provided insight into opioid addiction research. My friend Don Robinson, executive vice president and chief operating officer of MVB Financial Corp., answered my questions about banking and money laundering.

To recreate events, I used a combination of sources, including interviews, personal observation, photographs, videos, wiretap tran scripts, court transcripts, and investigative documents. The website
www.wunderground.com
detailed weather on specific days. When I came across conflicting information, I either left it out or used the version of events I believed was most likely to be accurate. Occasionally, I made minor edits to improve a quote’s clarity or brevity, and I took pains to never alter the meaning of the dialogue.