Thursday, April 11, 2024

PRESCRIPTION FOR PAIN: How a Once-Promising Doctor Became the "Pill Mill Killer", be extremely alert to the dangers of "doctor knows best"

PRESCRIPTION FOR PAIN: How a Once-Promising Doctor Became the "Pill Mill Killer"

Steerforth Press
$29.95 hardcover, available now

Rating: 4.5* of five

The Publisher Says: An obsessive true crime investigation of a bizarre and unlikely perpetrator, who’s serving the opioid epidemic’s longest term for illegal prescriptions — four life sentences

Written in the tradition of I'll Be Gone in the Dark and True Crime Addict, combining Dopesick's heart rending portrayal of the epidemic's victims with Empire of Pain's examination of its perpetrators.

This haunting and propulsive debut follows a journalist’s years-long investigation into his father's old former high school valedictorian Paul Volkman, who once seemed destined for greatness after earning his MD and his PhD from the prestigious University of Chicago, but is now serving four consecutive life sentences at a federal prison in Arizona.

Volkman was the central figure in a massive “pill mill” scheme in southern Ohio. His pain clinics accepted only cash, employed armed guards, and dispensed a torrent of opioid painkillers and other controlled substances. For nearly three years, Volkman remained in business despite raids by law enforcement and complaints from patients’ family members. Prosecutors would ultimately link him to the overdose deaths of 13 patients, though investigators explored his ties to at least 20 other deaths.

This groundbreaking book is based on 12 years of correspondence and interviews with Volkman. Eil also traveled to 19 states, interviewed more than 150 people, and filed a Freedom of Information Act lawsuit against the Drug Enforcement Administration that led to the release of nearly 20,000 pages of trial evidence.

The American opioid epidemic is, like this book, a true crime story. Through this one doctor’s story, an era of unfathomable tragedy is brought down to a tangible, and devastating, human scale.


My Review
: Greed, selfishness, and vanity are unholy siblings in this unnerving true-crime book.

The fact that I am treated for a very painful chronic condition, gratefully enough not by a pill-mill doctor!, meant I very much had a dog in this fight. Doctors who prescribe regular doses of strong pain meds are subject to a lot of scrutiny. After reading this horror story, I understand why.

I have a really hard time thinking about the kind of sociopathic ideation that goes into knowingly ruining people's lives on an industrial scale. A person with medical-school training who prescribes the cocktail of opioids, depressants, relaxants, that this man fed patients is well aware that the probability of disaster is very high. Anyone on these drugs, still less all these drugs in a cocktail, needs to be under close medical scrutiny. I'll mention here that, unlike many of the patients in this story, I am physically seen and extensively interacted with by my doctor every time I renew my pain medication. He interacts with me on multiple levels, conversationally determining if I am more or less impaired each visit; checking all vital signs, quizzing me on what I am doing with my medications; in short testing my level of cognitive ability to manage the use of all my meds. It makes my visits longer than most people's visits but that is what I need so it's what he does.

None of that happened for the pain patients caught in this doctor's pill mills.

When people seek pain relief, as a result of this doctor's and the many doctors like him prescribing pain drugs solely for their earning capacity, they often do not get it. People who need it are denied it because the possibility of abuse is so very present in our cultural consciousness due to the horrible, greedy, often fatal and always destructive issues caused by doctors turned drug entrepreneurs.

I wanted to read this book because I thought I'd read some overzealous puritan's exaggerated rage-filled hatchet job on a particular bad doctor. I assumed I'd come out of it like I did from Dopesick, thinking that I wanted a less judgmental and overemotional tone that would help me see the problem with greater clarity but not expecting to find it. This is, after all, the time of who shouts loudest sells best and controls the conversation...however briefly.

That made my surprise on finding exactly what I had hoped to find all the sharper. Eil's journalistic approach is to do the research and present the evidence, then go into an analysis of it that includes consulting with experts as well as speaking with the affected people. The emotional and judgmental stance I was expecting and dreading was vitiated by the careful framing of it inside contexts of the times and places, and most importantly people, involved.

Perhaps the most important context was that of the doctor himself. Only he knows why he did what he did. The people consulted by Eil give us the impression he left on those who knew him personally and professionally. That left me, as a reader who never met him, with the impression that psychological screening should be mandatory for anyone seeking a medical degree. It would help to identify narcissists and get them, as a condition of their future licensing, into counseling. It could also keep sociopaths out of the field entirely because, unlike narcissists, they lack empathy entirely instead of misplacing it in relationships, and can not be trusted to give actual help to patients in their uncaring care.

The entire grim saga of the pain mills run by this doctor, and yes I am not using his name because it is a bad idea to spend time in this hyperconnected era saying unkind things about narcissists in public, is one of societal subversion, too. The expectation that consumers of medical services have of their use is that a licensed professional will be trustworthy because the issuers of the license have done their research into the person and deem them credible and qualified. The system in his area let the people it's meant to serve down in pursuit of money. A hypercapitalist system is not going to result in good care for the ill and the needy. This book never smacks the reader with this conclusion; it presents a case that, unless one is dimwittwed or a sociopath, this is the only conclusion one can draw.

That's all I feel I need to say about that. That is, in fact, all I really want you to know that I got from the read. Was it fun? No it was not. Did I enjoy it? Not in any healthy way. My hope is that you will read this terrible tragic tale of dishonesty, greed, and cruelty, not because I dislike you but because I want you to be extremely alert to the real dangers of casually accepting "doctor knows best."

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