Pain in Paradise: Florida, OxyContin, and the Complexity of Healing

Although manifesting differently for each of us, pain represents a critical checkpoint in the timeline of our lived experience. One can recollect the exact moments where their most profound suffering occurred, and in this way, we share a common reverence for pain. Juxtaposed next to exhilaration and accomplishment, they collectively serve as the slide show we often play ourselves as a personal reminder that we have existed. That we continue to exist. 

Healing is a messy son of a bitch. Abstract and arduous, it is the gook that slowly fills the crevasses between pain and triumph. Pain requires rehabilitation, and achievement is proceeded by basking- both, at the very least, keep us in perpetual motion. There is, therefore, a lie we tell ourselves about pain- the goal is not to eliminate it but rather to expedite the time between pain and our ultimate glory. To fulfill this process, we have substituted healing for coping. To cope is to be made whole again, even if only for a partial moment in time. For an addict, the hook of a pill. For their family or an embarrassed citizenry who sat idle, a sensible and succinct explanation for why. 

The full reckoning of the opioid prescription epidemic that killed 100,000 Americans between 2000 and 2010 has morphed into a national exemplar for how to cope rather than heal. The narrative set in stone is that of the laborer in coal mine country, prone to injury and suckered into a devasting addiction to a drug founded by the pharmaceutical giant Purdue. An often neglected piece also feels like a rather important one. Florida served as the epicenter of the Oxycotin explosion during the 2000s. Yet, her story- victim, bystander, and perpetrator alike- has taken on an identity eerily similar to that of the state itself- incoherent, void of any semblance of responsibility, and desiring, ultimately, to be forgotten and left alone. 

Chronicling the prescription drug’s eventual suffocation of Florida requires a perverted form of one-upmanship; each sentence and corresponding year competing against the previous for outrageousness and absurdity. As of 2000, Florida was one of only a handful of states allowing “dispensing practitioners”– doctors who, through a simple application process, could be approved to sell prescription drugs directly from their office, cutting loose the third-party pharmacy. By 2006, these Florida practitioners handed out 85 percent of all Oxycotin distributed in the entire country. As the drug became increasingly accessible and the process remarkably expedient, overdose deaths caused by OxyCotin rose in Florida from 340 in 2005 to 705 in 2007. A new pain clinic opened in Broward and Palm Beach counties nearly every three days from 2007 to 2008. By 2010, 90 of the nation’s top 100 opioid prescribers were Florida doctors. Forty-nine of the country’s top 50 oxycodone-dispensing clinics were also in the state. There were now more pain clinics in Broward County than McDonald’s fast-food chains. Ultimately, the number of people who died in Florida from opioid pills would reach 2,000 by 2010, representing a four-fold increase since 2000. 9,257 people would surrender to prescription pain pills by the end of the decade. 

Logic would suggest that the founding drug company should bear the weight of justice, but what weight of culpability should we place on the structure of justice itself? Purdue Pharma, after all, is not Al Capone. This was not hooch illegally produced in bathtubs, and secret knocks at speakeasies. It was a byproduct of collaboration between a powerful drug company and a government that was incompetent and distracted at best or an active agent of collusion at worst. Florida, in particular, embraced laws and practices that encouraged abuse and profiteering while remaining steadfast in their unwillingness to capitulate despite the carnage of the decade. One would expect pain clinics dolling out potent opioids to be run by highly esteemed medical experts supported and managed by a competent agency on the lookout for transgressions. Florida’s Agency for Health Care Administration was monitoring pain clinics. Still, it could only do so for those that accepted insurance- a nonsensical practice for what was always a cash-for-pills business. Exacerbating Florida’s issues were pain clinics owned by private investors rather than medically trained doctors. Prior convictions and ongoing investigations were no barrier for private investors or dispensing doctors alike. Owners of clinics with rap sheets that included racketeering, fraud, and auto theft were allowed to keep their doors open. Doctors continued to prescribe Oxycontin despite ongoing criminal investigations and prior convictions for selling fraudulent prescriptions to undercover officers. When confronted with the crisis at a policy level, Florida’s legislature balked at even the most primal of interventions. While 38 states enacted a prescription drug database to keep tabs on prescriptions to eradicate pill shopping by patients and doctors over-indulging, Florida refused. Citing both budget and patient privacy concerns, the bill to enact the database stalled for almost nine years, allowing addicts to hop from doctor to doctor without a trace left behind. Lost in this argument for the public was the money trickling in. Between 2006 and 2015, opioid producers gave upwards of $4 million in campaign contributions to Florida politicians.  

We believe that those who do not learn from history are doomed to repeat it, but what we learn from history directly results from what we are taught about pain and healing. Florida’s history with its opioid epidemic reminds us that a narrative is never linear, nor can it ever be filed down to the cliff notes. If we are to change the future, the past itself requires a constant and ever-present revision. Our willingness to actively rewrite history as it reveals more and more of itself to us is both our most treacherous pain and worthy accomplishment. Only in this process do we genuinely heal.

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