The illegal sale of prescription drugs has surged recently, especially pain medications like Vicodin, Percocet and OxyContin. The demand for pain medication for recreational, rather than valid medical purposes, has led to a corresponding increase in unlicensed, illegal sales of prescription drugs. Bogus “pain management clinics” have sprung up in cities nationwide, run by licensed health care professionals who write and sometimes fill unnecessary prescriptions.
A recent National Drug Assessment study shows that prescription narcotics are the second most abused drug, behind marijuana and surpassing cocaine, heroin, meth and crack. Federal law makes it illegal for any person who does not have a license to write prescriptions to sell or give prescription drugs to another person (21 USC 841 <a>). But with the demand, sales are booming on the street, and due to the absence of a widely used prescription drug monitoring system and lax state regulations, federals officials have stepped in to stop the so called “Oxy Express.”
Oxycodone and hydrocodone are opioids and controlled substances, their active ingredients are derived from the opium poppy. Each year in December, the Drug Enforcement Administration (DEA) announces how much of such controlled substances may be produced in the country the following year. For 2012 the DEA set the quota for oxycodone at 98 million grams or about 108 tons, and for hydrocodone at 59 million grams, or 65 tons.
Thousands of businesses participate in the multi-step process by which opium derivatives are harvested in India, Turkey and Australia, and turned into dozens of different generic and brand name narcotic medication, distributed throughout the US, and resold to individuals via prescriptions. There’s lots of money to be made along the way. In 2011, US sales of prescription painkillers amounted to $9 billion, according to IMS Health.
Opioids are not only profitable, they’re addictive and dangerous. They can depress respiration and if someone takes too many or mixes them with other drugs such as alcohol, a person can stop breathing altogether. According to the Centers for Disease Control and Prevention, 14,800 Americans died from overdosing on opioids in 2008, the most recent year data is available, more than the number of deaths from heroin and cocaine combined.
The nationwide surge in deaths now places prescription drugs as the second leading cause of accidental death behind traffic crashes, and painkillers are now the top narcotic contributing to death. With a lack of awareness concerning the dangers of prescription drugs officials have now acknowledged that the program is alarming. Oxycodone, which when abused has an effect similar to heroin, is the most lethal.
Most opioids are Schedule II drugs, subject to regulatory restrictions from state and federal agencies. But the regulations are not always clear. Sell too many, too fast, with too much marketing or too little discretion, and suddenly the veil of social acceptability is yanked away. The resulting exposure can be perilous.
Those who cross the over sometimes hazy line separating legal from illegal handling of pills often watch as federal agents suspend their licenses, seize their products and arrest them in high profile busts with gothic code names like Operation Snake Oil, Operation Pill Nation or Operation Juice Doctor 2.
As prescription narcotics have become more popular, pill mills, businesses that distribute the drugs under the guise of pharmacies, have become as commonplace as McDonald’s. Pill mills come in all shapes and sizes but investigators say more and more are being disguised as independent pain management centers. As states have begun to crack down they tend to open and shut down quickly in order to evade law enforcement scrutiny.
Pill mill is a term used by local, state and federal investigators to describe a doctor, clinic or pharmacy that is prescribing or dispensing powerful narcotics inappropriately or for non-medical reasons. They are places where bad doctors hand out prescription drugs like candy.
“The medical clinic is usually located between the tattoo parlor and the pawn shop,” a law enforcement official said. Pill mills have been linked to the rise in prescription drug abuse over the last decade and their existence has become a national scandal that wastes valuable law enforcement resources and contribute to the destruction of thousands of American lives, the DEA reported.
Due to the lack of legislation or laws governing pain clinics almost anyone can operate one. With many people looking for an escape to their discomfort it’s a good time to be in the business of servicing people in pain. Pain clinics often accept cash only, give no physical exams, don’t require medical records, have no medical equipment in the office, don’t schedule appointments, and work on a walk in basis.
They do service legitimate patients, but more and more addicts seeking drugs and dealers who buy pills to resell on the street, sometimes sending in numerous customers to get multiple pill prescriptions, are their main business. Pain is treated by pills alone and a pharmacy that dispenses them is on site.
A pain clinic can consist of a couple of rooms, two doctors, one computer, a filing cabinet and some basic examination equipment. They can charge up to $200 for the first visit and $150 for a visit thereafter. Few patients have insurance and doctors can see an average of 30 patients a day, handing out month long supplies of powerful opioids.
To move large amounts of prescription painkillers in America, somebody needs to write the prescriptions, and there are plenty of willing doctors. Hiring doctors to sell drugs is easy, you just look on Craigslist. What the jobs lack in prestige, they make up in wages. Doctors are paid a flat fee of around $75 for each opioid prescription they write.
Most patients come from out of state and operators do very little to screen out addicts or dealers. They just have everyone sign a waiver that reads, “The physician assumes no liability.” Laws requiring pain clinics to be owned by medical professionals are non-existent. Anyone can get in the game. State medical boards don’t even have the power to close shady operators or suspend the licenses of unscrupulous doctors.
The White House says prescription painkillers are the nation’s number one drug epidemic. More than 16,500 people die annually in the US from opioid painkillers. To combat abuse, drug and law enforcement officials are relying on a patchwork of state laws.
Only eight states restrict pain clinic ownership and while 42 states have prescription drug monitoring programs, they don’t all track the same information. Only 10 states are actively sharing data with other states. Others aren’t linked in part because of patient/privacy concerns and a lack of funding. The industry is ripe for corruption and criminals are taking advantage. The black market for painkillers is driven by a huge volume of purchases across state lines and state officials say they can’t overcome the epidemic without federal dollars. For its part, the DEA has focused on trying to stifle black market sales and the street trade of illegal sales. A waste on important resources.
As the clinics are coming under more fire than ever, legislation to combat the growing epidemic is in the pipeline. The feds are also making more arrests for prescription drug dealers. Hoping to reduce the prescription drug abuses and deaths caused by overdoses, lawmakers have approved increased monitoring to curb the proliferation of pill mills.
A national Prescription Drug Monitoring Program (PDMP) was announced by the White House’s Office of the National Drug Policy in an effort to combat prescription drug abuse. The prescription drug database will track prescriptions and patients and red flag people whose use signals illegal trade or abuse. Law enforcement agencies are also keeping a closer eye on the pharmacies and conducting more background checks on owners and employees. Violators of the monitoring system, including doctors and owners, will face stiffer and swifter penalties if they prescribe or distribute legal narcotic drugs to people who do not need them or without following the required steps.
Law enforcement has frequently pointed to pill mills as a major factor in the prescription drug street trade. Pills purchased for $1 at pain clinics can be resold for $10 a pop on the street. Tons of dealers and scammers rely upon pill mills to conduct their trade. As the business has flourished in the criminal underworld, federal, state and local law enforcement officials have worked closely to increase the number of arrests and major indictments.
They are dealing with pill mill operators and street dealers as they would large criminal enterprises. With the cases going federal, pill hustlers are getting real time as opposed to fines, rehab or a slap on the wrist. To get the real on this situation we got with a Philadelphia prescription writer and street hustler for a close and detailed look at the prescription drug trade, the profits available and the consequences he faced.
Mikhail Elam was charged in January 2009 with conspiracy and possession with intent to distribute oxycodone. The feds claimed from about January 2007 to October 2008, Elam provided approximately 2084 false and fraudulent prescriptions for a total of about 245,620 Percocet and OxyCotin pills, which were filled at a local pharmacy and subsequently sold on the street for a substantial profit.
His indictment labeled him one of the biggest illegal prescription writers in Eastern Pennsylvania. Elam, who was employed at a Medical Office in Philadelphia, stole and received blank prescription forms he used to forge false prescriptions. He provided the forged and false prescriptions to other individuals to use to obtain oxycodone from a pharmacy for resale on the street.
Elam eventually pled guilty to unlawful possession with intent to distribute oxycodone and was sentenced to 87 months for his role in the conspiracy. His coconspirators, Harvey Penn and John Kerzner, were sentenced to 60 and 70 months respectively.
One of the pharmacists they used, Thomas Fortunato, who ran Squire Pharmacy, was sentenced to 46 months in the feds. The case was investigated by the FBI, DEA and the Springfield Township Police Department. Elam, who is about done doing his time, has agreed to an interview to break down the ends and cuts of the legal and illegal ways prescription pills are distributed on the street. But don’t let us tell it, let him. This is the exclusive, a look into the illegal prescription narcotics pill trade from the man they call Dr. Philadelphia in the streets.
What are you convicted of and what is your sentence?
A federal drug trafficking crime, conspiracy to distribute OxyCotin and conspiracy to distribute Roxicodone, (both from Oxycodone), forgery and aiding and abetting. I got sentenced to 87 months.
Where are you from, born and raised?
I was born and raised in Philadelphia, Pennsylvania on 54th and Baltimore Avenue in West Philly.
Where did you work at and what did you do?
I worked at Sports Medical and Samson Medical Rehab. They were pain treatment clinics for people who had been in car accidents or got hurt playing sports. Full blown rehabilitation centers with doctors, acupuncture, chiropractors, massage therapist and physical therapists. I was a physical therapist. I worked directly with the patients as far as their rehab. The Russians own these spots in my city; you don’t have to be a doctor, as long as you got a doctor working for you.
What is the deal with the pain management clinics?
To most people it was a scam; they were coming for pain pills, 90 percent of them. They would stage accidents. Fifty percent of the claims were false, this is true at most of these places, but it generates money so they fill out whatever the customer wants with the patients that come in, they bill their insurance. Most people weren’t hurt and the doctors knew, but they wrote the prescriptions and billed them anyway to get the insurance money. Everyone was working toward that.
What made you start hustling pills?
I got paid a salary when I started off. I was legit for a couple of years until I saw that the doctors and patients weren’t. They were abusing the system. I even got some prescriptions for Percocet and other things people needed. People would ask me. I was doing favors. I would go in and ask the doctors, they would write the prescription in my name. I was a lab tech. I had no business working as a physical therapist, but me not being a licensed PT the doctor could pay me less, but bill the insurance company as having a PT on site.
How did you get into what you were doing?
A couple of months before I started a patient of mine saw me signing and writing on his medical chart and approached me when I was closing the office later that day. He asked me about writing scripts for him. I refused, but as times got a little harder and I needed extra money I took him up on his offer. It took me to be at my down point– new baby, new problems. I was approached and took somebody up on their offer. I studied how they were writing the scripts and I forged the doctors’ signature. Everything was a go, I was a natural.
How did you learn the prescription writing game?
At first, the doctors that worked there before had left some of their prescription forms, a couple of boxes full. I got them when I was told to throw them away. I kept them and started writing with them. It got to the point where I was ordering the pads for the doctors, I would order extra.
What exactly were you doing? Explain the process.
I started off just as the prescriber (the prescription writer), charging per script I wrote. I was selling my prescription writing services then I changed the deal. I got hip to how much I was missing out on. So me and my other partners reconstructed our deal. I started writing for free and receiving four out of every 12 bottles of OxyCotin and Roxicodone that they got. I also wrote daily prescriptions for Percocet 5 mg, 7.5 mg, 10 mg on this case. I would give it to my people and they would go to their pharmacist. By this time Roxy 130’s started coming in and Oxycotin 20’s, 40’s, 80’s. The Roxy’s started becoming popular. I was writing prescriptions for the 80s. These ain’t the normal drugs I was used to seeing or selling growing up. When I saw all the people taking these I was like, damn, the whole world is taking drugs. I got introduced to judges, baseball and football players, musicians, strippers, cheerleaders. It was crazy.
What is the market for prescription drugs?
I paid $15 per pill, then sold them wholesale for $25 per pill. They was taking them to the street and selling for one dollar per milligram. OxyCotin was 80 milligrams so that was $80 per pill. Depending on where you were selling at. As of now I don’t know what the street value is. For Roxicodone I paid $1 per pill and sold wholesale for $15 a pill, street value was about $35. I found out that the crowd that takes the pills were lawyers, athletes and doctors. We had connects with the upscale strip clubs in the city. We would sell them the to the strip club owners, he would get the girls to sell them to customers. People from all walks of life- politicians, police officers, college students- they were taking the pills with alcohol. Pills are drugs for people who don’t want to take drugs like a legit, safe high to enhance the affects of alcohol and get legit people out of their heads.
Is it very prevalent, what you were doing?
Selling pills was. You may find people addicted to other drugs selling their bottle of pharmacy pills for cash in the drug trade out there. They’re usually working with a script per month, from their doctor. Dealers or users may luck up with these people. But as far as getting it daily or weekly, nah, not for them. You’ll have to find a doctor that would write for you on that level. You could find one, it wasn’t impossible, but they don’t come and write for just anyone, and they are limited as to how many they can write because they still have their legal patient they have to write for, feel me? But to find a good writer that’s possible at any pharmacy or you have to have a pharmacy hook up, like me with both, so it’s possible but hard. I myself at fist didn’t know that until my codefendants sat me down with $30 grand in a bag, just for me to stop freelance writing and to start writing for just them. They let me know how valuable my writing skills were and with $30 grand upfront that confirmed it. At that time they had the pharmacist on their side, filling out however many prescriptions they brought him. I worked out of the medical office and had unlimited prescription pads.
Where do you sell the pills at and to who?
At first I was just a writer. And these types of pills, OxyCotin 80 mg and Roxicodone 30 mg, wasn’t the choice of drugs for African Americans in the urban parts of Philly. Their choice was crack, weed, Xariax, Percocet 10 mg back then. The high power pain meds was white folks stuff. Far as what going on now I don’t know. My second codefendant, the nephew, was first offing his load at the top strip clubs in South Philly and Delaware until he got his clients at the University in Philly and people in the suburban parts of Delaware County. He passed me the Italian owned strip clubs to deal at. He said they didn’t want to deal with him because he was Irish and the feeling was mutual. I took that off his hands and then I got a couple other serious buyers from South and North Philly on my own and I was cool with that. I used to go to the clubs and chill and observe all the people coming home from work and popping all the pills I had dropped off. It amazed me.
What type of money were you making?
From what this federal indictment says I was a part of a $5 million dollar illegal prescription pill distributing organization. The feds said I took in over $800,000 in 1 1/2 years. Now if I made $800,000 with them then somebody owes me some money. This money was better than street money. It was constant, safe, no danger or rip-offs or threats to me. The club owners treated me like royalty.
How did your case come about?
My codefendant picked up his phone and called the FBI and told them what we used to do. Thinking that me and his nephew was still in business without him.