“You don’t take anything??” My old using buddy, Matt, asks me incredulously. “You don’t even drink?”
“Nope, I’m clean and sober,” I tell him.
“What’s that like?” He laughs a little.
It’s good to hear him laugh. When we first got on the phone, he sounded completely hopeless.
“I’m miserable,” he tells me at the beginning of the call. “I’m off the roxys. I’m getting subs now, but I’m still miserable.”
“Roxys” refers to Roxicodone (generic name oxycodone) which was my (and his) drug of choice. “Subs” means Suboxone (generic name: buprenorphine), a drug similar to methadone. It was originally developed for short-term use to ease the pain of withdrawal for people coming off opiates like prescription painkillers and heroin. Now more and more doctors and treatment centers are using it for long-term treatment. Proponents view long-term buprenorphine treatment as the best available solution not only to the life of crime, unemployment, poverty and cravings led by many addicts, but also to the chronic depression that can follow detox.
“It’s funny,” he says to me. “I go to the same doctor that gave me the roxys. He closed his pain management clinic, and opened a Suboxone clinic across town.”
“Jesus.” I say.
This is not the first time I’ve heard this. When Florida started cracking down on so-called “pill-mills,” many of the doctors closed up shop and/or switched to prescribing Suboxone. The same patients that they had been treating for “pain” now come to them to get treatment for their addiction to pills.
My Introduction to the “Pill Mill”
It was actually a friend of Matt’s that introduced me to pain management pill mills for the first time. I’d been seeing a “normal” doctor for a while. He took insurance, and had a tightly regulated practice. He’d been prescribing me pain medication for the past six months, but he wouldn’t give me anything stronger than Percocet. My addiction was in full swing at that point. I’d usually finish my month’s prescription within the first week or two after my visit and then buy pills on the street to get me through the rest of the month. It was getting expensive.
Matt’s friend, let’s call him Chris, had been selling us 30 mg roxys at $15-$20 a pop, depending on how many we bought. One day when I was completely broke, begging him to front me a couple, he presented a different solution.
Chris asked me if I wanted to be his “proxy” at a pain management clinic.
He said he’d pay for the visit, the MRI, and the prescription if I gave him most of the pills out of the first prescription.
“They’ll probably give you 180 of them on your first visit”, he told me. “So you give me 120, keep 60, and then you can go back every month for more and keep them all.”
“They’re going to give me one hundred and eighty pills on my first visit??” I asked him incredulously.
“Yep.” He said. “And by the second or third month, you’ll probably get 240, plus 90 Valium or Xanax.”
At this point I was prescribed four 10mg Percocet a day at my “legit” doctor. He was telling me I would now get six 30 mg Roxiodone pills a day, with potential to get more. I was sold.
I made an appointment the next day. The place wasn’t like any doctor’s office I’d ever seen. In fact, it wasn’t even an office, it was a house, set way back into the trees in a residential neighborhood. There were cheap metal folding chairs in the living-room-slash-waiting-room, and the receptionist sat behind a sheet of bullet-proof glass.
The place was packed, and many of the patients seemed to know each other. Whole families were there together, and one couple told me they drove down every month from Georgia to see the doctor.
I immediately felt out of place. I’d come on my lunch break from the law office where I worked, and I was dressed in a skirt and twinset. The other patients were comparing tattoos, catching up, and sharing cigarettes. One girl kept nodding out. I sat in a corner and tried not to make eye contact with anyone.
After 2 hours, my name was finally called and I went up to pay. A visit cost $240. They only took cash and there was no refund under any circumstances.
I was ushered into a little room off to the side. The doctor’s assistant asked if I’d had my MRI results. Luckily, I had known to get the MRI before going in. Everyone had to have one, and if you didn’t, they’d send you out to another place (a cash-only diagnostic facility that was down the street from the clinic) and you’d have to wait in line over there for another few hours.
She took the MRI report and stuck it in my chart without even glancing at it, and then turned to me and asked “What do you want?”
I’d been prepped for this part too and I told her I wanted 180 30mg oxycodone and 90 10mg Valium. She wrote the scripts and then disappeared. A few minutes later she came back with them signed, gave them to me, and told me to come back in a month. I never saw the doctor.
From Roxys to Subs
A couple of years later, after hitting an emotional, financial, and spiritual bottom due to my Roxicodone addiction, I decided to try Suboxone maintenance program. My first visit at the Suboxone clinic was eerily similar to that first experience at a pill mill.
The office only took cash. I never saw the doctor, and there were at least 50 people in that waiting room, one of them nodding out. Most of the patients waited in front, chain smoking and joking with each other.
When I went in the back, they asked me two questions:
1. What were you on?
2. How long has it been since you’ve used?
I told them how many pills I’d been taking, and that I’d just used before coming in. The assistant wrote a script for the highest dose, and told me not to take the first for 24 hours. (Taking Suboxone too soon after using heroin or painkillers can cause you to go into immediate, intense withdrawal.)
She gave me my prescriptions and told me to come back in a month.
“Pill Mill” or Detox Clinic?
A pill mill masquerading as a detox clinic isn’t exactly new. Back in the height of Florida’s pill mill epidemic, many pill mills would claim they could help you get off the pills. Their ads would proclaim “Addicted? We can help!”
Those “in the know” realized that these were just pill mills looking to fool law enforcement agencies, but I imagine more than one addict went there looking for help and was told they must “wean off slowly” before being handed a prescription for enough pills to kill a small horse.
Now that the ruse has been discovered, it seems as if at least a few of these same doctors have decided to stop prescribing painkillers altogether and have switched completely to Suboxone. They’ve found a way to make more money off the same poor souls that they got addicted in the first place.
Suboxone is more regulated than pain management, and I suppose that’s the only good news. These doctors must get special licensing and are only allowed to treat up to 100 patients at a time.
However, visits cost between $200-$300 cash, and with 100 patients, that’s still $20,000 to $30,000 a month; a nice little profit with virtually none of the risk associated with shady pain management.
Many of the doctors who didn’t get out of the pain management game before the crackdown have had their medical licenses revoked, and a few are even doing jail time.
I tell Matt about my experience. How abstinence and the twelve steps saved my life, and my sanity.
“I can’t keep doing this.” He says. “I want to punch that doctor every time I see him. I’m so angry that he got me hooked on pills.”
He sighs in defeat. “But I can’t. I still need him to give me Suboxone.”
If you or someone you know is in need of painkiller or Suboxone addiction treatment, please give us a call at 800-951-6135.