Dreamland (26 page)

At first, Jeremy didn’t use the drugs he sold. But one night at a party he broke down and snorted an Oxy. That was it. Soon he was selling to support his habit. Then, in Cincinnati one day, he couldn’t find Oxys. A neighbor of his Cincinnati connection could get something else: black tar heroin. Jeremy balked. He wanted no part of heroin. But the next day, he couldn’t take the dope sick anymore. The guy phoned a Mexican, who brought over small balloons of black tar heroin. Jeremy never took the pills again.

For the next two years, he barely existed. He drove daily to Cincinnati to buy pills from a woman and his tar from the Mexicans. He sold the pills to pay for the heroin he used. For a while each balloon he bought from the Mexicans came with a paper attached and a phone number. Call anytime. He never forgot that. He guessed they were just starting out. He was new to heroin and wondered if all traffickers marketed like that, but figured they did not.

In late 1998, Jeremy Wilder, from the town of Aberdeen in rural Brown County, was among the first in southern Ohio to make the transition from OxyContin to heroin.

He was not the last.

About that year, reports from the Kentucky Board of Medical Licensure’s second investigation into David Procter began telling strange tales. He was losing all control, manipulating damaged and addicted women for sex.

One upset Kentucky medical inspector, who reviewed dozens of Procter patient records during the late 1990s, used terms like “gross incompetence,” “negligence,” and “malpractice.” Procter, the inspector wrote, didn’t even record a patient’s height, weight, pulse, or temperature. “Dr. Procter’s records are extremely poor and I am unable to tell what exactly was prescribed in each visit from his notes,” he wrote.

Of a second Procter patient: “There is significant lack of evidence of evaluation and alternative treatment to this patient except for the use of controlled substances.”

And a third: “There did not appear to be any type of practice of medicine involved except the description of symptoms by the patient and the doctor writing for controlled substances. I do not believe this constitutes the practice of medicine.”

Patient complaints prompted the investigation. Among them three women reported they repeatedly had sex with Procter in his office at his insistence in exchange for prescriptions. One said Procter pushed her to have sex with him, threatening not to give her an office job or help with her husband’s workers’ compensation claim if she did not allow him to lick her vagina, though her toddler son was in the room when he did it. Another went to Procter for depression that grew from an abortion she had had at eighteen. On the first visit, she said, Procter told her to write a letter outlining all her problems, which they would review. With each visit, she would write a letter about her emotional problems, which he would review, and then have sex with her. After a few such visits, the letter reading was dispensed with and Procter got straight to the sex. On the last of twenty visits, she took a drug overdose in his office and he had a nurse drive her home. After that, she told investigators, she entered drug rehab.

In November 1998, Procter had a car accident. He claimed it left him with short-term memory loss, unable to practice medicine. People were skeptical. Some suggested Procter used the injuries as a ruse, saying he could no longer remember where certain patients’ records were, or how he had treated them. Either way, he relinquished his medical license to the state of Kentucky, but kept his pain clinic open. He hired doctors from across the country to staff it—docs for whom the job of wantonly prescribing opiates was the only one available.

In the hollowing out of small-town America, the pill mill doc was a kind of a coup de grâce. In so many towns, locally owned businesses had expired. Family diners were replaced by Applebee’s and town hardware stores by Home Depot. Then ersatz pain physicians replaced family docs and became about the only health care some towns had. Around northern Kentucky and southern Ohio, Procter’s docs were initially hailed for coming to the area. In truth, they were vinegar in the mouth of a crucified region.

In the three years following his car accident, Procter hired fifteen doctors. They arrived with histories of drug use, previously suspended licenses, and mental problems, ready to prescribe while working for Procter for twenty-five hundred dollars a week. Some of these doctors stayed. They learned the business. Then they left to set up their own pain clinics in nearby small towns, taking with them office staff trained by Procter. One Kentucky lawman dubbed him “Ray Kroc,” for the man who spread McDonald’s restaurants nationwide. Procter’s business model spread like a virus, unleashing unstable doctors on a vulnerable region.

Dr. Frederick Cohn worked for Procter before relocating to an abandoned supermarket in the town of Paintsville (pop. 3,400) in eastern Kentucky, where he saw as many as 146 patients a day, three minutes each, while lines formed outside. Cohn had preprinted prescriptions for various narcotics, including OxyContin, Lortab, Soma, and Xanax. He prescribed the same pills in the same amounts over and over throughout the day, no matter the patient’s complaint—2.7 million pills in one year.

Dr. Steven Snyder worked for Procter for several months in 1999 before leaving to start his own pain clinic. Snyder once had his medical license suspended in Indiana and Florida for drug use. He was a longtime drug user. But in 1997, apparently unaware of his past, the state of Kentucky granted him an osteopath’s license. While working for Procter, Snyder was addicted to Lorcet and was injecting OxyContin while writing narcotics prescriptions ten and twelve hours a day. He told a DEA investigator that he often split prescriptions with patients, supplying his habit and that of his wife.

Dr. Fortune Williams worked for Procter before moving to Garrison, Kentucky, where he worked in a clinic owned by Nancy Sadler, a former Procter employee. On some days, he saw patients for ninety seconds at a time, and issued forty-six thousand controlled-substance prescriptions—for a total of 2.3 million pills—in nine months.

Dr. Rodolfo Santos worked in Procter’s clinic for a while, during which time at least one of his patients died. An investigator wrote that Santos displayed “gross ignorance, gross negligence, gross incompetence” and “a level of care that I would not find acceptable in a first year medical student.” Santos said he knew he was dealing with addicted patients who lied, and scammed drugs from him, but that he was trying to educate them. “Who will help them?” he told an investigator.

As the pain revolution spread across the country, so, too, did pain clinics—places where people in pain went for treatment, most often in the form of the opiate painkillers that were now accepted in modern medicine. The pain clinic became a business model, repeated over and over, and many were legitimate. But the business also attracted doctors who were unethical or compromised from the start. Even doctors whose intentions were honorable occasionally had their scruples worn out and warped by the temptation and constant pressure from pain patients and drug-seeking addicts. In either case, many clinics became places where doctors dispensed prescriptions like candy for cash, and became known as pill mills.

Once these businesses got going, they didn’t just prescribe opiate painkillers, such as Vicodin or OxyContin. There also emerged in the wake of David Procter a taste in the Rust Belt and Appalachia for the class of psychoactive drugs known as benzodiazepines. Valium was the first benzo, but Xanax bars were the most popular. As Procter showed his clients, benzodiazepines combined with opiates were especially potent and addictive. Both were depressants and very dangerous when taken together. But addicts grew to love the two together as benzos seemed to enhance the euphoria of the opiates. The combined prescription of opiates and benzos was a hot ticket at pill mills in Portsmouth and elsewhere.

I asked a detective, seasoned by investigations into many of these clinics, to describe the difference between a pill mill and a legitimate pain clinic. Look at the parking lot, he said. If you see lines of people standing around outside, smoking, people getting pizza delivered, fistfights, and traffic jams—if you see people in pajamas who don’t care what they look like in public—that’s a pill mill. And that’s what popped up all over Portsmouth, growing from David Procter’s first clinic.

Procter, meanwhile, gained the DEA’s attention. The agency launched an investigation into Plaza Healthcare. Procter pleaded guilty to conspiring to distribute prescription medication; then he fled to Canada with a Cincinnati bail bondswoman who was neither his wife nor his mistress, a few days before he was to be sentenced. They were captured at the Canadian border with forty thousand dollars and plane tickets to the Cayman Islands. His lawyer, Gary “Rocky” Billiter, aided the escape.

Procter was returned to Kentucky, where he had already testified against Drs. Williams and Santos in court in return for a lighter sentence in his own case. He eventually served eleven years in prison. Santos and Williams also went off to prison, as did Cohn and Snyder and Billiter.

With that, the era of the pill mill owned by doctors from out of town drew to a close in Portsmouth, Ohio.

David Procter ended up at the federal prison and hospital in Lexington, Kentucky, that once was the Narcotic Farm. I wrote to him there, toward the end of his sentence, asking to hear what he had to say about Portsmouth, pills, pain clinics, and his legacy. He declined and a year later was released.

As the pain revolution was taking hold across the country, however, Procter and his physician progeny showed a beat-down region a brand-new business model. Before long some of the first locally owned businesses in years opened in Portsmouth, known to folks in town as the “pain managements.”

The Man in the Heartland

Columbus, Ohio

The city of Columbus, Ohio, in many ways is a fine replica of the United States.

Its income and age distribution, its racial demographics and diversity of opinion, make Columbus a microcosm of America, and one that marketers especially prize. There’s a large white population, and moderate numbers of blacks. Unlike other parts of Ohio, Columbus has sizable immigrant groups—from Mexico, Somalia, Nepal, and other parts of Asia—who flocked to town to fill the low-end service jobs. A large college-student population at Ohio State and other schools has kept it vibrant and edgy.

No place, apparently, represents the country more faithfully and for that reason Columbus, Ohio, has been known as “the test-market capital of the United States” for several years now.

These days it’s no longer Peoria but Columbus that marketers use as a barometer of America. White Castle and Wendy’s and more than a dozen other fast-food chains headquarter there. Many companies have used the town to gauge interest in new product offerings, placing them in stores in Columbus first before rolling out those products nationally. McDonald’s tested its McRib in Columbus, and Wendy’s and Panera have tested prototype stores there as well. Taco Bell’s BLT Tacos were tested in the Columbus market. R. J. Reynolds tried tobacco in the form of a mint that did away with secondhand smoke. Giant Eagle’s massive Market District supermarket in Columbus tests a variety of concepts, among them the sale of wine by the glass.

“If you raked America together, in the center you’d find Columbus. And I think that’s really what makes us a unique test bed, as opposed to being average,” a spokesman for the Columbus Partnership told CBS News in a story in which the reporter concluded, “What they choose in Columbus today may very well determine what you will buy tomorrow.”

By the end of 1998, the Man was proving that true of black tar heroin as well. For the bounties of Columbus, he discovered, were indeed ample.

A metro area of close to two million, Columbus wasn’t Youngstown or Cleveland; it had no organized mafias or armed gangs controlling the drug underworld. It was connected by freeways to regional markets as far east as Wheeling, West Virginia, and south to Lexington and eastern Kentucky. There was Cincinnati to the southwest. Plus all around it were suburbs and farm towns with money. Columbus always was a highly educated community, with a service, not industrial, economy. As parts of the state went into something like permanent recession, in Columbus the suburbs spread and the malls stayed busy.

All this the Man saw upon arriving in the summer of 1998, which seems to be the first time Mexican black tar heroin made a large and sustained appearance east of the Mississippi River.

Up to then, the Colombian powder was all Columbus dealers could get, usually by driving to New York City—then diluting it before sale. “They were stepping on it five or six times,” the Man said. “Addicts would buy a hundred-dollar bag twice a day just to get well. They’d buy a forty-dollar bag of mine and stay well all day.”

Mexico’s proximity and his connection to the Nayarit poppy supply and Xalisco cookers meant he got the heroin quickly, cheaply, and unadulterated. Enormously potent dope could be sold at scarily low prices. This gave black tar a competitive advantage over heroin from Colombia, Mexico’s main heroin competition, and, of course, what little arrived from Asia.

He immediately sent for two more kids from Xalisco—so now he had three. He brought out a woman from California who rented two apartments in her name: one for the workers and one for him.

He found a car lot with an amenable owner. Every two months he switched cars. He exchanged an old Honda Accord for a Prelude and that for a Civic and then for a Camry—white, beige, gray. He ran two shifts of drivers: eight
A.M.
to three
P.M.
and three
P.M.
to nine
P.M
. They devised codes for places to meet the addicts: 1 was a Burger King, 2 a Kmart parking lot.