HENRY ZEBROWSKI
Hello, Last Podcast on the Left listeners. Welcome to the Patreon interview series. My god, today, it's very exciting. My name is Henry Zebrowski. I'm sitting here with Ed Larson.
ED LARSON
How you doing, buddy?
HENRY ZEBROWSKI
You're looking good.
ED LARSON
Feeling good. Feeling good.
HENRY ZEBROWSKI
Good, good, good. Hopefully not too good.
ED LARSON
No!
HENRY ZEBROWSKI
Because that might mean you're on something.
ED LARSON
I mean well I have to take medicine.
HENRY ZEBROWSKI
But a good prescribed medicine.
ED LARSON
Yes, yes.
HENRY ZEBROWSKI
That doesn't necessarily make you feel good, it makes you feel neutral.
ED LARSON
I don't even know I take it because it's for my cholesterol.
HENRY ZEBROWSKI
That's a very good thing. But today we're talking about-
ED LARSON
Keeps the ham strong.
HENRY ZEBROWSKI
As it should. Now this story I find... This is very interesting and it's very, very thick and it's sort of about... Obviously it's huge issues involving pharmaceutical, kind of like manipulation of these various systems but also destroyed up almost serial murder. Like this heads into true crime area. We have the author Philip Eil who wrote the book 'Prescription For Pain: How a Once Promising Doctor Became the Pill Mill Killer'. It's out there, you can get it on Amazon, you can get it in any other place, right?
PHILIP EIL
Anywhere you buy books.
HENRY ZEBROWSKI
I love it. And this is about the doctor, quote unquote "evil doctor" Paul Volkman who ran a essentially like a pill mill. Now I really want to know the exact... So first of all, thank you for being here.
PHILIP EIL
Thank you for having me. It's a pleasure to be here, guys.
HENRY ZEBROWSKI
Hopefully it will continue to be so. Now I have to ask the question.
PHILIP EIL
Right. It's a pleasure so far.
HENRY ZEBROWSKI
So far everything is painless. Much like Eddie's cholesterol medication. Now my question is I know, like my parents are from Florida. So my mom used to get like... Doctors used to toss oxys at her for headaches.
PHILIP EIL
Right.
HENRY ZEBROWSKI
You know what I mean? She literally had a walk-in closet of pharmaceuticals that just kind of fell out of her pocketbook at any given time. But what's the difference between a straight up, I'm gonna say too friendly doctor, and a pill mill?
PHILIP EIL
That's a good question. Years ago now I came across this article from I think it was the law enforcement magazine for law enforcement in Kentucky that defined a pill mill. And maybe after the pod finishes recording, I can track that down for you. But honestly the clinics I'm writing about in this book are a pretty good case study. I think what makes a pill mill is kind of a cluster of factors. You've got not necessarily affiliated with local hospitals or educational institutions; you've got cash only in this case, in this case you've got clinics that were patrolled by armed guards. In this case you've got clinics that don't really offer a wide variety of medical services, don't even prescribe necessarily a wide variety of prescription medications. Paul Volkman, the doctor I wrote this book about, was really prescribing three different medications: opiate painkillers, muscle relaxers, and sedatives like Valium. And he stuck to that combination pretty closely. And in this case and in the case of a few different clinics in the part of the country where these crimes took place, Southern Ohio, also across the border in Kentucky, this clinic was owned by somebody who wasn't a medical professional, didn't have any medical training whatsoever. This woman, Denise Huffman, had worked in fast food restaurants, she had worked in factories, hadn't gone to college. So you have this kind of cluster of characteristics that I think makes up a pill mill in this case and in other cases. Local pharmacies pretty quickly saw the kind of prescriptions that were coming out of this clinic and said no way, we're not gonna fill these, we don't want anything to do with it. So that was another characteristic of what made this a pill mill.
HENRY ZEBROWSKI
So when you go to a pill mill-
PHILIP EIL
Right.
HENRY ZEBROWSKI
This is not just for my own education. But if you go to a pill mill, like you still have to get a prescription and take it to a pharmacy to fill it? Or do you go and purchase it there like it's the weed store?
PHILIP EIL
Well I spoke to somebody who had gone to the... So one of the things that interested me about this story, I got interested in this case because my dad went to medical school with the guy at the heart of the story.
HENRY ZEBROWSKI
Yeah.
PHILIP EIL
So I was particularly interested in this one doctor and what on earth happened to him, where he-
HENRY ZEBROWSKI
And I liked your position of why does my dad go this way and why did he go this way?
PHILIP EIL
Totally. I was drawn in by this one doctor. But when I pulled the thread of this doctor's story, I learned that in this part of Appalachian Ohio and across the river in Kentucky, these clinics were pretty old news. They had been around, they had seen cycles of doctors go to prison for prescription drug dealing. And another doctor and another clinic owner would just kind of take up the torch. So folks down there were really familiar with this kind of operation. And one person told me that you go into these clinics, she said, and I'm paraphrasing, you would see your uncles, your cousins, your neighbors. You wouldn't necessarily talk to them. As she said it, everyone kind of knew what they were in for; what they were there for. And it was kind of this charade or kind of play acting at a legitimate medical scenario. Oftentimes the doctors would require things like MRI readouts. But before Volkman arrived on the scene, there was also a robust black market for fake MRI scans. So it was all kind of like pretending to be a medical clinic and it doesn't say 'pill mill' on the on the door.
HENRY ZEBROWSKI
No. Yeah, yeah, yeah.
ED LARSON
No.
PHILIP EIL
It'll have some generic name like such and such Health Services. Or the clinic I wrote about was Tri-State Healthcare. These kind of generic vaguely medical names. But if you talk to folks down there, everyone knows what's really going on. The people in the legitimate medical world know what's going on. The people who go to the clinic know what's going on. And it kind of keeps on going until law enforcement does something about it.
ED LARSON
Yeah. And you kind of see this thing happening now with marijuana prescriptions. That was how they used to do it in California before it became totally legal recreationally.
HENRY ZEBROWSKI
Oh yeah, the gray market.
ED LARSON
Yeah. And now in Florida, you're seeing a lot of this too. And I know that marijuana is obviously much different than Oxycontin but it's still something that's very prevalent.
PHILIP EIL
Yeah. I mean in both cases you've got... I mean one of the things that fascinated me about this story is the things that Volkman was prescribing are these so-called controlled substances, medications like oxycodone or Valium. And there are these really kind of weird, they exist in this kind of legal limbo when you think about it. If I have a prescription for oxycodone and I am stopped by a law enforcement officer and he finds my pills, then I have the prescription. That's completely legal. If I don't have a prescription and I've got oxycodone or Ritalin or another controlled substance in my pocket, that's a crime. So marijuana is somewhat similar in that depending on where you are in the country, we have these different laws. In some places it's legal with a medical card, in some places it's not. And when you have these situations like gray markets you described, people will go to great lengths to work their way around the system or to manipulate that system.
HENRY ZEBROWSKI
Now in the case of Paul Volkman, is it fair to say he sort of failed his way into this environment?
PHILIP EIL
I would say that's accurate, yes.
HENRY ZEBROWSKI
How does somebody like Paul Volkman get to this position where they just become a drug dealer? Because honestly, it sounds like he was doing real well.
ED LARSON
Yeah, people loved him. He had a buddy who said he thought he was gonna read about him getting the Nobel Prize.
HENRY ZEBROWSKI
Yeah, man. For good times, dude.
PHILIP EIL
Correct. Correct. And I should note, as I always do both for the purposes of the story and for fairness, Paul Volkman is sitting in a federal prison serving four consecutive life terms in Arizona right now and still maintains that he was a legitimate doctor, that he was never a drug dealer, that he was acting in his patient's best interest following his medical training and so on. Now a lot of people, myself included, don't buy that. Having looked into it, the jury didn't buy it, prosecutors didn't buy it. But he claims. So let me just, I just want to state that for the record.
HENRY ZEBROWSKI
Great.
PHILIP EIL
But the question that you posed at the beginning of how does a guy with such promise, this was a guy who was a high school valedictorian, who received a partial scholarship to go to college, who like my dad received a full scholarship paid for by the federal government to get an MD/PhD from the University of Chicago; what on earth happens to him for him to find his way to a cash only pain clinic in Southern Ohio, writing scripts all day long and having his patients die at remarkable rates in their 30s and 40s?
HENRY ZEBROWSKI
Because that's how he got the consecutive life sentences, right? Is that they connected these deaths to him.
PHILIP EIL
Correct. Prosecutors charged him with playing a role, it wasn't murder or manslaughter, it was drug dealing with death or injury resulting. That was the charge. 14 different patients were listed on the indictment.
ED LARSON
Damn.
PHILIP EIL
He was convicted of dealing drugs to the majority of them. And in four cases, the jury held him directly responsible for a patient's death. And so those four consecutive life sentences, one corresponded with each of those deaths. But to your point about failure, what initially drew me in is I didn't know what happened inbetween those two dates of graduating alongside my dad from the University of Chicago with an MD/PhD in 1975, to being indicted for prescription drug dealing by the federal government in 2007. And not just being indicted but being arrested at his kind of upscale Lakeshore Drive apartment in Chicago with a doorman, paid $4500 a month in rent. And it's really a kind of posh part of town. So I hear these two facts, and this was many years ago now, I'm 23 years old, just starting out in journalism. I had recently read 'In Cold Blood' and I'm filled with that energy.
HENRY ZEBROWSKI
Yeah, you're ready to go! Yeah.
PHILIP EIL
Exactly. I'm ready to go. And this wild story falls into my lap. And my dad, like virtually everyone else from Volkman's early life, had fallen out of touch with his old classmate and couldn't account for what happened in the interim three decades. So a 23 year old me decides this is a crazy story, I'm gonna pursue this. And it took me 15 years but I ultimately put it all together and that's the book that came out earlier this year.
HENRY ZEBROWSKI
I also really like that you spent the time with Volkman to talk to him, to get his perspective. Because I think that that's... As a person who loves true crime, my favorite is the criminal's perspective. Because I like to hear what they thought. Because there's something about the idea, no one thinks they're the villain.
PHILIP EIL
And Paul Volkman is Exhibit A of people who don't think they're the villains, literally. I mean another thing that fascinated me about this case was yes, in legal terms the trial was about guilty or not guilty but Paul Volkman doesn't just claim he's not guilty, he actually thinks we should be applauding him for what he was doing. He thinks he was helping vulnerable people who had treatment resistant pain conditions and that he was the only one, in his words, brave or sympathetic or educated enough to know that these people needed opiate medications. So yeah, your listeners might not be surprised that Paul Volkman is a bit of an arrogant guy. He has no shortage of self-confidence and there are many ways in the course of writing this book that I benefited from that arrogance and ego. And I think foremost was his agreement to speak to me at great length, including 15 hours of in-person recorded interviews before his trial took place.
HENRY ZEBROWSKI
Oh yeah.
PHILIP EIL
I often say that had he told his defense lawyers, hey, there's this graduate student who wants to talk to me for 15 hours with a tape recorder running, you think I should do it? They would have said no way.
ED LARSON
Yeah.
HENRY ZEBROWSKI
What in the living fuck are you doing? Yeah, yeah. Are you high now?
PHILIP EIL
But he did. And because he didn't listen to them and he continued to speak to me after his conviction with written letters, with emails depending on which jail or prison he was in. So the kind of backbone of this book is the story of Paul Volkman, about what happened in his life. But I'm a journalist, I'm not Paul Volkman's ghostwriter or somebody who's sympathetic to him. It was my job to listen to his kind of wildly implausible tale that he was just the victim of bad luck and other people's corruption or other people's bad intentions over the course of his life and to see whether there was any truth to that. And so the book, I've often described it is just kind of one long meticulous fact check of this guy's story. And perhaps no big surprise, I didn't find his story particularly reliable. But his story is in there because at every turn I wanted people to hear his explanation for why his clinics accepted only cash or why he was working with this woman who dropped out of high school owning his clinic or why his patients had died with such frequency, so on and so forth.
HENRY ZEBROWSKI
I mean at what level is it a crime? I mean I know it is a crime but I actually wonder what the distinct line is between just being bad at being a doctor and being a serial killer. They talk about this, like with Paul Volkman I think it's obvious, it seems that he was... Was he getting high on his own supply?
PHILIP EIL
It's funny, I think the book would have been a lot shorter if the explanation for Volkman's behavior was some sort of classic predictable vice, like he was a drug addict or he was an alcoholic or he had a gambling problem or he was trading pills for sex. But I didn't really find any of those things. What I really found was a guy-
HENRY ZEBROWSKI
Wait a second, you can trade pills for sex? That's incredible. All right, I'm sorry, continue.
PHILIP EIL
What I found instead was a guy who was just acting out of his own sober psychology, which was twisted in its own way. What this book became was a psychological profile. Not a profile of a guy in the throes of addiction or some other compulsion.
HENRY ZEBROWSKI
So he did all of this sober. So he did all of this legitimately like it wasn't just greed? Because what's the MO? Where's the why? What's the why? You know what I mean? Is it just money?
PHILIP EIL
So the cynical book promoter in me says well you gotta read the book.
HENRY ZEBROWSKI
Yeah, yeah, yeah. As you should! No please, no. Our audience loves the book, yeah.
PHILIP EIL
No, no, no. Well I wish there... Maybe I don't wish but I didn't find a simple answer right.
HENRY ZEBROWSKI
Sure.
PHILIP EIL
Because Volkman's life was this kind of domino effect, right. Like he doesn't go into pain management out of a cash only pain clinic in 2003 if he had not been sued for malpractice and lost his malpractice insurance prior and become desperate for any kind of medical employment. He doesn't lose his malpractice insurance if he hadn't had a number of malpractice cases over the course of 20 years, that kind of added up. Whether they were jury verdicts, there were some, others were insurance settlements against him in favor of plaintiffs. He doesn't even find his way into pediatrics or emergency medicine where he potentially faces these malpractice lawsuits if he doesn't wash out of medical research in the first place. He and my dad weren't really even trained to be the kind of doctors who see patients every day, they were MD/PhDs which means they were really training to be researchers.
HENRY ZEBROWSKI
Interesting.
PHILIP EIL
When you're a medical researcher, and I myself had to kind of do some reporting on what exactly is a medical researcher, I mean Anthony Fauci, he's been in in charge at a very high level of medical research in this country.
HENRY ZEBROWSKI
Yeah, he's like the Gandalf of medical research right now.
PHILIP EIL
Exactly. Medical research, you're not really seeing patients for the most part. You're doing research, you're studying new treatments, you're studying new medications. And you're publishing and you're based in an academic environment and you're helping kind of push the medical field of knowledge forward. And that's just the circumstances in Paul Volkman's life that I had to dig into.
HENRY ZEBROWSKI
Yeah.
PHILIP EIL
There are also circumstances which were equally fascinating to me of the historical context of this book. The crime takes place between 2003-2006, kind of in the heyday of the post Oxycontin years before the crackdown on pills and before the opiate epidemic changed over to heroin and subsequently fentanyl. And all of this or most of this took place in a town, Portsmouth, Ohio, which I had never heard of before this story. A kind of down on its locked town kind of in the little area where the Rust Belt and Appalachia overlap. And this was a place that even before Volkman arrived in 2003 had earned the nickname the Oxycontin capital of the world. So when I pulled the thread of what happened to this wayward former classmate of my dad, I found this incredibly complex entangled story that couldn't be neatly summarized. I mean if you were to maybe boil it down to one word, it might be psychology, Volkman's psychology, which is narcissistic tendencies, a lack of empathy, stubbornness to let's say not stop his clinic when the DEA raids it or when the local cops raid it.
HENRY ZEBROWSKI
This all sounds like persistence to me.
PHILIP EIL
Right.
HENRY ZEBROWSKI
You know what I mean? I mean I'm hearing a lot of negative words are being applied to this. It sounds like somebody who's really going for it.
PHILIP EIL
Exactly.
ED LARSON
What is the difference between Paul Volkman and someone like Conrad Murray?
PHILIP EIL
Well in one sense, Conrad Murray is more famous because the person who died is more famous. You think about these things when you write a book and when you market a book and try to sell a book. And it's like who knows about this? And Conrad Murray, you can say oh that was Michael Jackson's doctor. I mean that's not really the answer. So Conrad Murray, I mean the substances are different.
ED LARSON
Yeah.
PHILIP EIL
I didn't look particularly closely to that case but he was giving Michael Jackson, what was it propofol?
HENRY ZEBROWSKI
Yeah. He used to ask for his milk. He'd be like come give me some milk, I wanna go to sleep.
PHILIP EIL
Right, right. So actually it's interesting to compare and contrast the two because what you had there was a kind of concierge doctor to somebody who was unfathomably rich and couldn't say or was perhaps-
HENRY ZEBROWSKI
Felt compelled to not say no.
PHILIP EIL
Right.
ED LARSON
Yeah.
PHILIP EIL
And there, I dug into various detours along the way. And Elvis's doctor was charged with crimes after his death. He was actually acquitted. Howard Hughes had a doctor I think nearby. So that's like a whole trend in us history of like doctors who were close to famous people who died before their time. Volkman was a case of different substances. He was prescribing pills to these people. But people on the far other end of the socio-economic spectrum.
HENRY ZEBROWSKI
Yes.
PHILIP EIL
People who were poor, who were in a forgotten part of the country and even a forgotten part of the state of Ohio, a place that was perennially lowest on per capita income, on health outcomes, on life expectancy among Ohio's 88 counties. And some people have rightly asked why was it that alarm bells weren't going off for the opioid epidemic earlier on when people in places like Appalachia were dying? Why did it take for this to drift upward to people in the middle and upper class for us to really get serious about it? So one difference between this and Conrad Murray is like wealth and fame and the utter opposite of that.
ED LARSON
Yeah.
PHILIP EIL
And I think that perhaps led to... I mean I know that Volkman looks down on his patients to an extent because he referred to them as hillbillies in an email that was submitted at his trial. That's not a thing you say I don't think when you see the folks you're treating us as full human beings.
ED LARSON
Yeah.
HENRY ZEBROWSKI
Yeah, it was a full like depersonalization. He viewed them as just sort of they're a source of income and giving him his narcissistic supply of being a doctor.
ED LARSON
Was he providing drug dealers with pills?
HENRY ZEBROWSKI
Yeah, like what's the real... With something like a pill mill, to get employees for a pill mill, like for these type of people that are running these things or being like the armed guard, these people; is that the criminal element? Is that like a thing that he brings people in or are these just guys? Is everybody addicted to drugs that are sort of working there?
PHILIP EIL
Well I mean one remarkable moment in the trial testimony that I thought was deeply incriminating was I forget whether it was the mother of Denise who owned and ran the clinic or her daughter who was also indicted. But at one point the prosecutor asked one of them were you a patient of Dr. Volkman's when you were working there? And she said yes. And he then rang off like three or four or five other family members/employees, all of whom were patients of Volkman while working there. Super sketchy situation. Volkman would claim, whether you believe it or not, that he was entirely convinced that his actions were on the level and that the people whom he was prescribing to were paying patients in need of these medications. I think I find that very, very hard to believe for a number of reasons. One, the incentives for turning around and selling pills in a place like Portsmouth, Ohio in the early 2000s were overwhelming. This again was a really poor, burnt out, former industrial town that had been poor for decades. And these clinics were, you'll hear people say, an economic engine for just about everyone involved.
HENRY ZEBROWSKI
Yeah.
PHILIP EIL
They were money in the pocket of the doctor, they were money in the pocket of the owners, and they were money in the pocket of the patients, some of whom would take some pills, others of whom would just turn around and sell them all. You also heard about things in the trial testimony of people sponsoring other patients, paying for their visit fee to the doctor and then getting a cut of the pills that they were prescribed afterward. So you have this kind of... There was a lot of testimony during the trial about people who were selling pills.
HENRY ZEBROWSKI
I think, and this might sound shocking, but I think we need to take a second look at the healthcare industry. Because I feel like there's something off here. I feel like this might be... I mean maybe it's me as a comedian kind of just smelling something off.
ED LARSON
Do you notice a pattern?
HENRY ZEBROWSKI
Yeah. When I was reading about this, do you think that in this world, and while you were researching this, did you ever see any connection to the body part industry as well or the organ industry as well? Because there's also a whole world of open market body part and organ sales that have come up over the last couple of years. Like I remember, have you ever seen these cases of people washing off torsos in a parking lot and doing all these things because they're doing organ harvesting? But they're all like I'm just an employee. Meanwhile they're hitting an armless headless torso with a hose in a parking lot. Just like I'm just getting paid here, buddy.
ED LARSON
This is happening in America?
HENRY ZEBROWSKI
Yes, happening in America.
PHILIP EIL
I went down a lot of roads in my research, a lot of roads, and there's probably an entire whole book that I cut from this book. But I did not go down the organ harvesting road for whatever reason.
HENRY ZEBROWSKI
It just seems like it's a whole other like well that's very serious, very serious.
PHILIP EIL
I mean yeah. Mainly what I was struck by and what I think one of the most incriminating facts toward Volkman is if you sit with Paul Volkman in his apartment in Chicago and listen to his story of why he was under indictment, and I did this for many hours, he's so smart and he has so many answers and he's so highly qualified that you can almost find it plausible, as far fetched as it is. But if you go down to this part of Ohio, they will tell you that 3, 4, 5 doctors were convicted of similar crimes before this guy and 4, 5, 6, 7 doctors were convicted of similar crimes after Volkman. So really he is part of this kind of slow motion 20 year crime wave down there.
HENRY ZEBROWSKI
Wow.
PHILIP EIL
So even though I never heard necessarily about organ donation... Although I will say I heard people say that these pain clinics were kind of a spin off from the diet pill clinics in an earlier era, that this problem had like changed its complexion over the years. In the 80s or 90s it was sketchy diet pill clinics. And then later on it became these pain clinics. But really I remember distinctly talking to a TV news reporter when I first went to Portsmouth and asking him if he had heard of Volkman. And he said something to me like Volkman is just a name on a long list of names to me. I've seen this happen so many times.
HENRY ZEBROWSKI
Also I guess what you just said was so illuminating to me. I didn't even think about it like that, about how everybody's kind of getting a little piece of it too. Like the patients are getting some of the money. Like they are getting paid. Because I was looking at that, like how in the living hell would you live if you were taking 200-600 pills a month?
ED LARSON
Yeah.
HENRY ZEBROWSKI
Like how would you? Like that's death, right? I don't know what the extent-
ED LARSON
When it comes to Oxycontin, that's death.
HENRY ZEBROWSKI
Yeah. So they're selling them, they're moving them, they're selling them as well. So it is part of why it's perpetuating almost in a way because everybody's kind of making a little piece off of it.
PHILIP EIL
Yeah. And if you believe Volkman, which I don't necessarily, I mean some people say the law enforcement is taking a cut as well. I never saw evidence of that but certainly there was allegations of that left and right. There's a chapter in my book where I tell the stories of many of the folks who passed away, one of whom I spoke with his stepson who described the many reasons why his stepdad went to these pain clinics. He did have real pain and he could back it up with medical documentation. He also definitely liked to take the pills for recreational purposes. He also used the money to sell some of them. And there was even fourth reason, he said his stepdad liked the pills because he was a social guy and he brought his friends around, he could give pills away when he had them.
ED LARSON
Yeah.
PHILIP EIL
So in that one story was an example of the many, I say in that chapter, there were many reasons why a person might go to a pain clinic in Southern Ohio in 2003. And this guy basically checked off every one of them.
HENRY ZEBROWSKI
It feels like, this might sound kind of hacky, but it's not just physical pain. It's like a spiritual pain. It's almost like that idea of someone who's looking for that. Like something is extremely heartbreaking to me about the idea that one of the factors is that it brings me friends.
ED LARSON
Yeah. Well it's a party drug at some point. Now I wanna talk about something that happened to me in my own personal life and that I think you might have some insight to. Going back to the same time period, 2003-2004, a former vice principal of mine at Olympic Heights High School in Boca Raton, Florida, Kevin McKinney, was arrested with 500 Oxycontin by a federal agent outside the school and he was selling them. And when they got back to his house, there were hundreds of more pills there. And three students, four students from my school died of Oxycontin overdose during that time period. But like how does someone who's not a professional doctor get his hands on that many pills?
PHILIP EIL
Well what year was this?
ED LARSON
He was arrested in 2003 but he had been doing it for like five or six years.
PHILIP EIL
I mean if things were bad in Ohio and they certainly were, they were arguably worse for pill mills and pain clinics in South Florida.
HENRY ZEBROWSKI
Wow. Like right here, literally like talking, he picked right the spot.
PHILIP EIL
I mean there's a book about this by John Temple called 'American Pain' which was turned into a documentary. I remember visiting my great aunt and grandmother who lived in Pompano Beach not far from Boca Raton.
ED LARSON
Yeah, he actually lived in Deerfield, the guy who got arrested. McKinney.
PHILIP EIL
Yeah, yeah. But these clinics, I mean I'm sure you remember if you lived there around that time, they were just everywhere in South Florida. And you had people driving from states quite far away, sometimes Ohio down to Florida on these like pill mill tourism excursions and going back up. So how does a guy like that get his hands on that many pills? I don't know the specifics but I do know that there were lots and lots of sketchy pain clinics that had basically opened a spigot to just unleash enormous amounts of controlled substances into places like South Florida and Southern Ohio. And if he wasn't getting them from one clinic alone, which is likely or possible I mean, Volkman's patients' family members told me the size of the pill bottles that their family members walked away from were just enormous.
HENRY ZEBROWSKI
Yeah.
PHILIP EIL
These like 6"-8" inch things.
HENRY ZEBROWSKI
I know, my mom literally had pill bottles that were this big!
PHILIP EIL
Right.
HENRY ZEBROWSKI
They were like 7" long, yeah.
PHILIP EIL
It's also taken quite a while for states to catch up with their prescription drug monitoring things. So you hear about doctor shopping where for a time before these electronic monitoring systems were set up, people could hop from one clinic to another and just walk away with those kinds of pills. Or maybe they were going in as a group and these people were funneling pills back to this guy. I mean the common denominator is that these pills were just flowing so easily in places like Florida and Ohio during these years. It's horrifying to think about. And in that way, that is also why the fentanyl and the heroin crises we're dealing with, the ball started rolling on that with the pills. And we're dealing with downstream consequences still of things that were going on not long ago.
HENRY ZEBROWSKI
Aren't the consequences, a lot of these black markets too, like how in the living fuck do you maybe get the real stuff all the time? Right? Isn't it there a thing? Like isn't there any sort of like thing where like you're getting stuff that's not oxy, it's something else but it looks like an oxy and it's in a thing that says oxy. Like how often does that happen?
PHILIP EIL
I think the creepier thing to contemplate... I didn't hear anything in Volkmann case about counterfeit pills. The creepier and more unsettling thing to contemplate is when local pharmacies stopped filling his prescriptions which was a few months into his rival in Ohio, he and his clinic owner said submitted an application to the Pharmacy Board of Ohio and launched an onsite pharmacy, an onsite dispensary. And that continued for like two years. So this meant that patients could receive their scrip, the paper, and then have it filled under the same roof. And the reason that I bring this up is that place was getting supplied by pharmaceutical suppliers for years, who I know from the investigative documents did raise red flags about the size of some of the orders this clinic was putting in.
HENRY ZEBROWSKI
But it was like hi, hey, hey, sorry, something's happening.
PHILIP EIL
Apparently he continued to fill the orders. And here is where you see I think it's interesting to look at all of the different people and entities that have been sued in the civil litigation side of the opiate epidemic, to see where all of the places for accountability go. You see pharmacies like CVS and Walgreens, you see medical distributors like McKesson and Cardinal. You see pharmaceutical companies of course, you see pharmaceutical suppliers. Companies I didn't even know had anything to do with opiates like Johnson & Johnson-
ED LARSON
Yeah.
PHILIP EIL
Paying out enormous amounts of civil litigation fees because they were apparently providing raw materials. So a lot of people, putting aside even the counterfeit stuff, a lot of people and companies were making a lot of money for a long time; were benefiting from this flow of prescription pain medication.
ED LARSON
How much... I mean Volkman obviously was the guy who wrote the scripts but how much blame do you put on companies like Johnson & Johnson, Pfizer, and Eli Lilly?
PHILIP EIL
Well I started this book in 2009 and I wound up publishing it in 2024. I wasn't working on it nonstop the whole time, there were a lot of detours. And a lot along the way I saw a lot of books come out about the opiate epidemic that I think cast some of that blame around. Books like 'Painkiller' by Barry Meier or 'Empire of Pain' by Patrick Radden Keefe or 'Dreamland' by Sam Quinones, which point a finger at the Purdue Pharma and the Sackler Family. I think certainly they deserve a whole, whole lot of the responsibility. But it wasn't just them. There's another book called 'Drug Dealer, MD' by Anna Lembke out of Stanford, I believe. And her book is really interesting because she makes a convincing case of just how many different places bear some responsibility. The FDA fell down on the job, academic medicine fell down on the job, regulators, pain advocacy organizations, some of which were like astroturf organizations on behalf of Purdue Pharma, failed patients. So I mean the blame is just so wide, there are so many. I mean McKinsey we now know has issued kind of a vague apology for their work helping Purdue Pharma market and sell Oxycontin more effectively. It's kind of astonishing. I mean I'm based in Rhode Island, the state that's headquarters of CVS Pharmacy. And CVS has paid out for this. So it's pretty alarming to think of all of the different places that share some of the responsibility. And one thing I do remind people, it's maybe obvious but the opiate epidemic was not a natural disaster, it was not an earthquake, it was not a tornado, it was an entirely manmade crisis that we are still dealing with the fallout from. So when you have a manmade crisis, as a journalist I would say that deserves a lot of books and that deserves a really close look for who we can hold accountable and how we can hopefully learn from this to not have something like this happen again.
HENRY ZEBROWSKI
And all this happened because we made weed illegal. I do sort of believe it in some ways, where you're like there are ways to handle this. We're in this extremely toxic place with pain because the medical health industry is in shambles, people don't know what to do. I know. But how do we move on from this? What do we do now? How do we fix it, Phil? The floor is yours. Let's talk to Michael Keaton. Can Michael Keaton help?
ED LARSON
He's doing his best.
PHILIP EIL
Oh man. I don't know. I think I've done a lot of interviews about this book but I think you're the first ones to ask me what do we do now?
HENRY ZEBROWSKI
Yeah, you fix it now if you could, please. Thank you.
PHILIP EIL
So here's my... I always offer the disclaimer that I'm a journalist and not a doctor. That's not a cop out. That's just me.
HENRY ZEBROWSKI
It's just life. Yeah, yeah, yeah. If you ask me my prescription, I say take two shots of tequila and call me in the morning. Come on. But that's because I've got a problem.
PHILIP EIL
I would say if you're looking for the answer to the opiate epidemic, to solve it in this podcast, I wish we could do that. I know. But I will say that there are some exciting things happening in my home state. I'm often frustrated by the politics in my home state. But there are some things that Rhode Island is kind of leading the way on. We have launched a safe injection program, safe injection site where people who are IV drug users can use drugs in a safe environment. I think that whole kind of world of destigmatizing addiction, needle exchanges. We also have a program with things like Good Samaritan laws that provide legal cover for people who call 911 when somebody overdoses and make sure those people don't face, the people nearby, criminal prosecution. I think we still have a long ways to go in terms of destigmatizing addiction.
HENRY ZEBROWSKI
Yeah.
PHILIP EIL
And the things that come with it. Another thing that occurred to me recently, it's just like how, back to the things you said about the health system, how on earth can we expect to fix a problem of this magnitude, this opiate epidemic, and still require people to pay for rehab and medical services generally?
ED LARSON
Yeah.
PHILIP EIL
It seems like so self defeating. Like to me of course if we were serious about stopping the opiate epidemic, we'd make rehab free.
HENRY ZEBROWSKI
Yeah, sure.
ED LARSON
Yeah.
HENRY ZEBROWSKI
You'd make all the pills free, you figure out other ways to do it. You'd be like hey, let's not make it like this illegal black market. We wouldn't allow them to exist. We could just make it so that you get the stuff that you needed.
PHILIP EIL
Right. So I mean one, it's not even-
HENRY ZEBROWSKI
I used to have to fight tooth and nail to get my blood pressure medication. Like this is one of these things. People are buying hundreds of oxys at a time. Meanwhile I have to beg to get my olmesartan.
PHILIP EIL
Yeah.
HENRY ZEBROWSKI
And it's like I have to have this, I don't even want this.
PHILIP EIL
I mean maybe a baby step toward Medicare for all, which I do think is a pretty good idea, would be free rehabilitation for anybody who needs it. Like this is common sense stuff.
ED LARSON
Yeah.
PHILIP EIL
And yet I sound like some wild-eyed revolutionary by saying it.
HENRY ZEBROWSKI
Yeah.
PHILIP EIL
So I mean there's my best answer. Destigmatize drug use, continue to destigmatize drug use, and make rehabilitation free and easier to access. And stop, and this applies less to the perpetrators but drug users, stop criminalizing lower level nonviolent drug crimes. Not crimes like Volkman's, I'm not staying this guy belongs-
HENRY ZEBROWSKI
No, no, no.
ED LARSON
No, no, no.
HENRY ZEBROWSKI
No. We work for Last Prisoner Project, the whole goal is there was like 40,000 people still in jail for cannabis-based crimes, trying to get them out because if I can go to an Apple store and buy weed in Los Angeles, you shouldn't be in jail for it.
ED LARSON
Yeah.
HENRY ZEBROWSKI
That's how I feel.
ED LARSON
Yeah. Don't arrest the users, arrest the sellers.
HENRY ZEBROWSKI
Yes. Phil, thank you so much for talking to us today.
PHILIP EIL
Thank you so much for having me.
HENRY ZEBROWSKI
This is Philip Eil. You got the book 'Prescription For Pain: How a Once Promising Doctor Became the Pill Mill Killer'. It is out there wherever books are available. We always say go to your local, like going to your local. I actually really... What's awesome about this book is the fact that for our listeners, for me, I have a political block sometimes in my brain. When things get too political, I have a hard time understanding kind of the ins and outs. But when you put it in a true crime context I can understand. So this is one of those where I think this is a really good book for people to sort of understand this issue that you wouldn't normally read about something.
ED LARSON
Yeah.
HENRY ZEBROWSKI
You wouldn't read necessarily about the Oxycontin crisis otherwise and I think that this is awesome and it's a great way to explain what the hell's going on.
PHILIP EIL
Thank you so much. The amazing folks at my publisher, Steerforth, in putting together the jacket, they wrote this at the top of the back: "The opioid epidemic is a true crime story."
HENRY ZEBROWSKI
Yes.
ED LARSON
There you go.
PHILIP EIL
Well actually I mean that was part of my book proposal.
HENRY ZEBROWSKI
The pitch. Yeah, sure.
PHILIP EIL
Yeah, that's it right there. I am so pleased that you guys appreciated the book and it's such a pleasure and an honor to be here. Thank you so much for having me on.
HENRY ZEBROWSKI
Absolutely. Any other plugs you want to give?
PHILIP EIL
Oh I don't know. The first thing that popped into my head is I'm a cat guy. So like adopt cats.
HENRY ZEBROWSKI
Yeah. Adopt a cat.
ED LARSON
Adopt cats.
HENRY ZEBROWSKI
Adopt, don't shop.
ED LARSON
Yeah.
PHILIP EIL
Yes, exactly. That's the best I got. This is the one thing I have to sell right now. Other than that, it's just like save the cats.
HENRY ZEBROWSKI
You gotta pick up from Bob Barker and it's all about neutering.
PHILIP EIL
Right, right. Exactly.
HENRY ZEBROWSKI
God, I realize that now. That was a weird way to sign off every one of his shows.
ED LARSON
Yeah.
HENRY ZEBROWSKI
Make sure to neuter your animals.
PHILIP EIL
Go neuter your pets.
HENRY ZEBROWSKI
Yeah. Phil, thank you so much, man.
PHILIP EIL
Thanks for having me, guys.
ED LARSON
Good to meet you, buddy.
HENRY ZEBROWSKI
Yeah, good talking, man.
ED LARSON
Continue this kind of work, man. It's amazing.
HENRY ZEBROWSKI
Yeah, this is great.
PHILIP EIL
Thank you so much, I really appreciate it.
HENRY ZEBROWSKI
This is super important. Very interesting, very serious.
ED LARSON
Yes! I mean well it's killing lots of people.
HENRY ZEBROWSKI
It's not good.
ED LARSON
No!
HENRY ZEBROWSKI
It's not good. I think people should stretch more.
ED LARSON
Yeah, you think that'll help?
HENRY ZEBROWSKI
Yoga helped my back.
ED LARSON
It's a weird thing. I feel like everything's best in moderation. If you find yourself doing these type of drugs on a regular basis, you need to really look inside yourself. Unless you are in an incredible amount of pain and you need to manage that. But even then, these destroy your livers, you destroy your kidneys, your pancreas. Fucking smoke weed.
HENRY ZEBROWSKI
I agree. Get acupuncture.
ED LARSON
Yeah. And if you see someone in your family-
HENRY ZEBROWSKI
Ginseng.
ED LARSON
All of a sudden has like a bunch of Xanax, just check in with them.
HENRY ZEBROWSKI
Yeah.
ED LARSON
Just like make sure that they're not-
HENRY ZEBROWSKI
See how much you're selling per pill.
ED LARSON
Yeah.
HENRY ZEBROWSKI
I think we've learned a lot today. Yes. But please-
ED LARSON
Yeah.
HENRY ZEBROWSKI
Check on your others.
ED LARSON
Yeah, no. It was good to finally get a little bit of like closure and idea. I didn't realize that South Florida was so bad in that time period. Even though my friends would just show up with bottles of pills and stuff like that occasionally.
HENRY ZEBROWSKI
Oh no, my mom, the pills were just thrown around.
ED LARSON
And it kind of makes sense with all those old people. It might have been easier to get away with writing that any scripts and stuff like that.
HENRY ZEBROWSKI
Absolutely. Oh yes.
ED LARSON
And not raise some flags. But it was a very upsetting time. I remember we lost like twin brothers exactly one year apart from each other from Oxycontin.
HENRY ZEBROWSKI
Damn.
ED LARSON
I lost like the most popular kid in school passed away in college from Oxycontin.
HENRY ZEBROWSKI
This is very close to you.
ED LARSON
Yeah, yeah, yeah. And so I was very happy to do this interview and learn about this guy. And I can't wait to buy the book, not just read the copy they gave us.
HENRY ZEBROWSKI
Well good work. Thank you so much. Thank you for listening. And we'll see you soon.