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American Pain: John Temple

By David Butler What are you reading? 08 Feb 2016
american pain

I have just read American Pain by John Temple (2015) Lyons Press. This is the true story of the Florida “Pill Mills.” In one six month period, Florida doctors bought 41.2 million doses of oxycodone while every other physician in the country collectively purchased 4.8 million doses. Much of this was bought and distributed to addicts and profiteers, many of them out of state, by doctors working for a massive clinic known as American Pain, making 100,000 dollars a day.

I couldn’t find the humour

For me it is was a depressing but fascinating read. I think it an essential book for anyone with an interest in treating pain – it just exposes the problem in a very novel way, though I can’t find the humour in the book as was suggested on the jacket. For some years now, prescription drugs, much of them Opioids, have been responsible for more overdose deaths than non prescription drugs.  And its saddening, because the pill mills still continue in small ways, all over the country. And perhaps even more saddening, there is now rational, nonsynthetic ways to treat pain – it’s only slowly getting  out there.

Anyone else read it and feel angered?

Great journalism by Temple – I read it with numerous cups of tea.

-David Butler


Here’s a small taste of what the book is about, from the author’s website:

The king of the Florida pill mills was American Pain, a mega-clinic expressly created to serve addicts posing as patients. From a fortress-like former bank building, American Pain’s five doctors distributed massive quantities of oxycodone to hundreds of customers a day, mostly traffickers and addicts who came by the vanload.  Inked muscle-heads ran the clinic’s security.  Former strippers operated the pharmacy, counting out pills and stashing cash in garbage bags.  Under their lab coats, the doctors carried guns—and it was all legal… sort of.

American Pain was the brainchild of Chris George, a 27-year-old convicted drug felon.  The son of a South Florida home builder, Chris George grew up in ultra-rich Wellington, where Bill Gates, Springsteen, and Madonna kept houses.  Thick-necked from weightlifting, he and his twin brother hung out with mobsters, invested in strip clubs, brawled with cops, and grinned for their mug shots.  After the housing market stalled, a local doctor clued the brothers into the burgeoning underground market for lightly regulated prescription painkillers.  In Florida, pain clinics could dispense the meds, and no one tracked the patients.  Seizing the opportunity, Chris George teamed up with the doctor, and word got out.  Just two years later Chris had raked in $40 million, and 90 percent of the pills his doctors prescribed flowed north to feed the rest of the country’s insatiable narcotics addiction. Meanwhile, hundreds more pain clinics in the mold of American Pain had popped up in the Sunshine State, creating a gigantic new drug industry.

American Pain chronicles the rise and fall of this game-changing pill mill, and how it helped tip the nation into its current opioid crisis, the deadliest drug epidemic in American history.  The narrative swings back and forth between Florida and Kentucky, and is populated by a gaudy and diverse cast of characters.  This includes the incongruous band of wealthy bad boys, thugs and esteemed physicians who built American Pain, as well as penniless Kentucky clans who transformed themselves into painkiller trafficking rings.  It includes addicts whose lives were devastated by American Pain’s drugs, and the federal agents and grieving mothers who labored for years to bring the clinic’s crew to justice.



  1. “there is now rational, nonsynthetic ways to treat pain”.

    I agree with this, but many who use opiates would be doing so to relieve emotional pain. Proper treatment for emotional pain is ridiculously expensive. It’s also a lengthy process requiring the therapist to have both a strong intellect and emotional maturity – these qualities are so rare it’s frightening. This being the case, opiates and other drugs actually prevent society from imploding.

    It’s a tough one. All I can say is, the psychological therapies will be a huge growth industry this century. And drugs… well, they’ve always been big and will probably continue to grow exponentially.

    Glad to see you’ve swapped the Pinot for tea David. 🙂

  2. David, this is a timely reminder that we do not treat a “thing” called “pain”. But those who have been lobbying hard for chronic pain (without a discernible cause or lesion) to be recognised as a disease in its own right, have yet to come to terms with this important point.

  3. davidbutler0noi

    Thanks for the responses. I think I will be angry with the story of “American Pain” for some time yet. It really is an overt story about the overall current management of pain which in some parts, includes pain as a normal brain homeostatic output being branded a disease. Also, the “patients” going to American Pain and other pill mills all had to have MRIs. The imaging industry must have loved it. The inevitable MRI findings which are more a summary of normal variations and a life lived were never truthfully explained, thus enhancing fear and in some, a reason for addiction.


    1. jqu33431quintner

      David, I share your anger. But I am bemused by your phrase “pain as a normal brain homeostatic output”. In its place, would you accept something like “pain as an inescapable part of our being human”?

  4. davidbutler0noi

    Ah John,

    Bemusement and curiosity must surely be cornerstones of healthy retirement!. I would accept pain as “an inescapable part of our being human” as well as “a normal brain homeostatic output”. Pain is a normal inescapable part of being human. For me, what is not normal (normal is never a good word) are the contexts imposed on the experience and in some states, significant damage or change to the structural apparatus behind pain and other outputs


    1. jqu33431quintner

      David, I will need your assistance to help me understand precisely what you mean by “a normal brain homeostatic output.” For some reason, perhaps the result of my rapidly advancing decrepitude, I seem to be missing the point.

  5. davidbutler0noi

    Try other outputs (such as movement, respiration, sympathetic responses, cognitions etc) in the place of “pain” as a normal brain homeostatic output. Works for me with a wider view of homeostasis. But we have gone off the point and topic here and this may be worth a blog post elsewhere.

    Temple’s “American Pain” offers a novel framework to discuss pain treatment, but it will probably soon be forgotten and I suspect many health care providers may think it is fiction. I hope the movie proposal comes though. There is a telling section for those reading it (page 240) where Derik, the felon (and a nonmedical person) convicted of setting up “American Pain” and waiting for jail takes his Aunt to a doctor’s appointment. He has a revelation when he realises that the doctor’s office is also a pill mill, a fraction of the size of American Pain. Suddenly his aunts’ addiction symptoms make sense. She had been on oxycontin for years and he thought it had been OK simply because a doctor prescribed it. He wonders how many of these small pill mills exist across the country. I guess being a crim makes it easier to recognise criminal activity. The doctors involved in American Pain got off lightly – just a few years in jail. A major prescriber is still free despite multiple lives taken, lost and communities destroyed. This is a story for all health care providers.

    1. jqu33431quintner

      Oh dear, David! It still does not work for me. But I agree that our contretemps is off topic.

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