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"
PHILIP EIL
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.

I RECEIVED A DRC FROM THE PUBLISHER VIA EDELWEISS+. THANK YOU.

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."

NORTHWOODS, deeper than I expected by the end of the read

NORTHWOODS
AMY PEASE
Atria/Emily Bestler Books
$27.00 hardcover, available now

Rating: 4* of five

The Publisher Says: The dark underbelly of an idyllic Midwestern resort town is revealed in the aftermath of a murder with ties to America’s opioid epidemic in this unputdownable and thrilling debut that is perfect for fans of James Lee Burke, William Kent Krueger, and Mindy Mejia.

Eli North is not okay.

His drinking is getting worse by the day, his emotional wounds after a deployment to Afghanistan are as raw as ever, his marriage and career are over, and the only job he can hold down is with the local sheriff’s department. And that’s only because the sheriff is his mother—and she’s overwhelmed with small town Shaky Lake’s dwindling budget and the fallout from the opioid epidemic. The Northwoods of Wisconsin may be a vacationer’s paradise, but amidst the fishing trips and campfires and Paul Bunyan festivals, something sinister is taking shape.

When the body of a teenage boy is found in the lake, it sets in motion an investigation that leads Eli to a wealthy enclave with a violent past, a pharmaceutical salesman, and a missing teenage girl. Soon, Eli and his mother, along with a young FBI agent, are on the hunt for more than just a killer.

If Eli solves the case, could he finally get the shot at redemption he so desperately needs? Or will answers to this dark case elude him and continue to bring destruction to the Northwoods?

I RECEIVED A DRC FROM THE PUBLISHER VIA NETGALLEY. THANK YOU.

My Review: The steady erosion of the workforce in rural areas is pushing a major crisis in substance abuse to epidemic proportions. This is what underpins the story that debut mystery writer Amy Pease chooses to tell us.

Eli, our main character, is self-medicating with alcohol (the legal drug) his PTSD, his marriage ending, and the loss of his career in the US Fish and Wildlife job he's done since leaving Afghanistan. His mother Marge does what any good parent would do, scrapes him up and gives him a purpose: As sheriff in a drastically underfunded department, she hires him to be a deputy. No one can say it's only nepotism, since he was a soldier, then a game warden, and so what if he's her son? Should she overlook his attendance problems and his increasingly frequent panic attacks from his entirely self-"managed" PTSD? In reality, no. In the book, she does, and it goes pretty much unexamined. As does a lot of the painfully obvious skulduggery rampant in the town...in the name of "going along to get along."

No good deed goes unpunished.

Eli comes across a murder that will make the entire town take stock of what they all know but won't discuss. In this way it resembles "The Ones Who Walk Away from Omelas" in its exposé of complicity by silence. The silences run deep. The town's got many dirty little secrets, and Eli has the end of the thread that unravels the curtain hiding them in the murder of a teenaged boy. That it involves a local drug rehab center...for rich people...is the meat of the sandwich. There is a LOT of drug use in Shaky Lake, Wisconsin, and no one from the town gets help at that rehab...nicely done, Author Pease. There's a lot to unpick in the way this story attacks many facets of the status quo. This is, in fact, the reason I gave it four stars. If I was going solely on its literary merits, maybe three would be more like it. The pacing is slow, the way the author uses descriptions is odd...though it was the way I stumbled upon my fourth star...and the completely unprofessional behavior of Sheriff Marge towards her deputy Eli wouldn't pass the most casual law-enforcement scrutiny.

The action in the book, as in direct conflict, takes place in the last quarter or so; until then, one's got to be kept reading by the investment made in the characters. The frequency of Eli's panic attacks as he responds to the initial call for a disturbance of peace and thus discovers the dead boy became a cause of problems for me. I got jittery every time I was forewarned of another social situation that would trigger Eli. It's a state of negative arousal, so I wasn't at all sure I wanted to keep reading. His lack of proper help, at apparently any turn in his post-service life, turned out to be my dark little clue of what the author was doing. The lights came on for me when I realized the only places she was using descriptive words that were more than merely functional was when Eli was in the woods, or among the wealthy people in his resort-ridden town. The safest and most unsafe places in Eli's world were heightened, thus counterpointed.

Clever. Subtle. Make the contrast unmissable, once you've seen it. The plot's main driver becomes less the murder of that poor kid, and more the hideous disfiguring sense of entitlement that Eli smacks into as he shakily grasps the threads of motive behind the murder. After the dead kid's girlfriend disappears and the FBI gets involved...why that would occur remains hazy in my mind...even then, Eli and Marge are just kept in their place. That the resolution of the case comes at the cost of Eli's illusions about his world, and his mother, is down to the outsiders. Yet nothing is going to change, it feels like to me; the perpetrators are not let off scot-free but there's no sign of some wider awakening....

Honestly, I was in two minds about how to rate and focus on the review until I thought back on the larger exposé aspects of the story as told. Eli is a suffering everyman, a person used and discarded by the very world he's served and is still serving as being broken therefore useless. What I felt the author was doing in making Eli's panic attacks so frequent yet so pointedly timed, was a kind of human kintsugi. Much like the narrative device in A Man and a Woman, it's something that must be allowed to pervade one's sense of the story. To bring it into sharp relief would've made the author's deeper purpose, the one I perceived anyway, too on-the-nose. No exaggeration intended, it truly changed my perfectly okay read of a first mystery, possibly a series-starter, into a very pleasant read of a solidly crafted, well-aimed novel.

Good one, Author Pease.