Dark Heart

A new book by WVU Associate Professor John Temple traces the tangled roots of rising prescription drug abuse.

It’s hardly an unassuming flower, the poppy. A patch can yield a riot of leggy stalks and colorful silken petals, each flower’s dark heart a hypnotizing mix of bloody burgundy and bright orange, oily black and pale purple, radiation green and cerulean blue. It’s an arresting addition to any garden. It’s also dangerous in the right hands. From poppy sap a scientist can create some of the most potent and addictive drugs known—opium and heroin. Yet along the poppy’s family tree you will also find morphine, administered in hospitals for acute pain; codeine, a drug often paired with Tylenol for mundane things like a sprained ankle or the flu; and oxycodone, a potent pain killer now increasingly manufactured and widely prescribed for a range of painful ailments.

But while opium and heroin are illegal and have been blamed for addictions and deaths throughout history, more socially accepted medications like oxycodone are now linked to the same problems, even among the most unlikely of users—middle class Americans. “The number that shocks me the most with oxycodone is the fact that we make 42 times the amount of this narcotic painkiller we did in 1993,” says John Temple, associate professor of journalism at WVU and author of the new book American Pain: How a Young Felon and His Ring of Doctors Unleashed America’s Deadliest Drug Epidemic. “This is a drug that’s very similar to heroin. It’s made from the same plant. It produces the same high. And the addiction is the same addiction. There are all sorts of problems with this drug, and we are now legally selling that much more of it and prescribing that much more than we used to.”

In part that is the issue John decided to tackle when, in spring 2012, he read a news article about Chris and Jeff George, twin brothers arrested for running an illegal pain clinic in Florida that doled out thousands of prescription pills. The brothers made nearly $40 million in just two years, and they did it with seeming ease. The story hooked him. “I thought, here is a perfect way to delve into the subject. I wanted to talk about why these drugs have become so prevalent and why so many people are becoming addicted,” John says. “But I wanted to tell a good story along with it, and this story about these brothers and their buddies who, with no medical background, figured out how to hire doctors and sell drugs was perfect. The fact that these Florida pain clinics were able to sell millions of these pills shows how the mentality toward these drugs has changed.”

John’s book, now optioned by Warner Bros. for a potential film, pulls back the curtain on a billion-dollar industry. While the brothers-turned-drug traffickers did help fuel a tide of opioid abuse and overdose—one that has swept through Appalachian states to devastating effect—the medical system allowing such abuse is perhaps at greater fault. And for John the issue hits close to home.

In 2014 West Virginia ranked number one in prescription drug overdoses. From 1999 to 2004 the state had a 550 percent increase in such deaths, according to a study published in The Journal of the American Medical Association. What’s worse, John says, with pharmaceutical prices on the rise, many prescription drug addicts later turn to cheaper, dangerously unregulated heroin. “It’s something I’ve been noticing for a long time. More and more people I’m acquainted with in the state have friends or family members who struggle with addiction, or are themselves having issues with prescription drugs,” he says. “I never really understood until now what changed in the past 20 years to create these conditions.”

Through sharp, witty prose, vivid language, and cinematic storytelling following the George brothers, law enforcement, and victims, John’s book slices into the dark heart of America’s prescription drug habit, revealing a nation addicted to money and power as much as the poppy plant. “I’m not a cynical person, but there’s a lot of money to be made off these drugs,” John says. “The gatekeepers are doctors. They control the prescription pads.” In recent decades, he adds, there has been a concerted effort to convince doctors that these drugs are not as dangerous as they were once believed.

Despite the terrifying statistics he uncovered while writing the book—statistics surrounding the companies and individuals making billions selling prescription opioids both legally and illegally—John says he’s hopeful American Pain will help shake things up. “I’m not a doctor or a policy maker. I can’t tell you how we should handle this drug. But we should be aware of what’s happening every day.”

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