Chapter 13
Sanford, Florida, 2011
The phone calls haunted Joe Rannazzisi. Mothers and fathers sobbing, barely able to breathe as they told him that they had just lost a son or daughter to an opioid overdose. They pleaded with Joe to make sense of it all. What was the DEA doing? How could so many lives be destroyed so easily? Who’s to blame? Sometimes Joe cried, too. As a parent, he understood. But he still had his two daughters at home and three grown sons; the grieving parents on the other end of the line no longer did.
Over the years, Joe had met hundreds of parents at meetings the DEA had set up in communities torn apart by opioids. He always handed out his business card at the end of each gathering, dozens at a time. Still, he dreaded the days when his office phone would ring with an unrecognizable out-of-state number. “Hi,” they told him, “I met you at a town hall,” and then the story of another death would unfold, the body found on the street, or in a stairwell. And the parents invariably blamed themselves. Joe felt like a priest hearing confession, but without the gift of absolution.
Despite all the warnings to the drug companies—the briefings, the PowerPoint presentations, the phone calls, the civil cases, and the fines—he could not stop the carnage. As soon as he shut down the internet pharmacies, the pill mills sprouted up, seemingly overnight. Rapacious doctors kept writing prescriptions. Unprincipled pharmacists kept filling them. The drug companies kept supplying them.
It was so bad, the Florida surgeon general declared a public health emergency on July 1, 2011. Dr. Frank Farmer reported that ninety-eight of the top hundred physicians writing prescriptions for oxycodone in the nation were based in his state. In 2010, 100 pharmacies in the state filled prescriptions for 126 million pills. “More oxycodone is dispensed in the state of Florida than in the remaining states combined,” Farmer said as he announced the emergency.
Joe dispatched one of his best investigators to Florida, Ruth Carter, a twenty-three-year veteran of the DEA with shoulder-length blonde hair and hazel eyes who spoke with a soft Texas twang. Joe admired her tenacity and ability to close cases. He could give her an assignment and know that she would find something—or nothing—and not waste anyone’s time. If the case wasn’t there, Carter would tell Joe, and they would move on. If he didn’t hear back, he knew she was making progress and soon would be asking for permission to secure a search warrant and start taking witness statements.
Joe had one drug company fixed firmly in his sights: Cardinal Health. The numbers kept by his data team enumerated how Cardinal had saturated Florida with narcotics, and which pharmacies had purchased them from the distributor and doled them out by the tens of millions. The numbers revealed that Cardinal’s warehouse in Lakeland, Florida, by the Malfunction Junction near Tampa, was distributing 22 percent of all oxycodone in Florida—132 million doses in 2010 alone. It was the same warehouse the DEA had shuttered three years earlier for supplying the internet pharmacies. But it was now shipping monstrous amounts of opioids to brick-and-mortar pharmacies.
Joe had had it with Cardinal and its executives. “They either don’t want to understand, or they just don’t give a shit,” he told Carter. “We’re just going to have to hit them harder.”
Cardinal had a banner year in 2011. The company posted revenues of $102.6 billion, up 4 percent. The company paid its chairman and chief executive, George S. Barrett, $10.2 million, which included a $2 million bonus.
The numbers in the DEA’s ARCOS database led Carter to Sanford, Florida, a historic town about twenty miles north of Orlando on the banks of Lake Monroe. The town served as a U.S. Army outpost during the Seminole Wars of the 1830s before becoming the gateway between South Florida and the rest of the booming state. By the time Carter arrived in Sanford, the town had become a conduit for something else: the Blue Highway. After obtaining prescriptions from the pill mills, drug users and dealers stopped at pharmacies in Sanford to fill them on their way home. The pharmacies were perfectly situated, just off Interstate 4, with easy access to Orlando International Airport and Interstates 75 and 95. They were also at the start of Amtrak’s auto train to points north.
Two CVS pharmacies in Sanford, along with two independent pharmacies on the west coast of Florida, stood out for the eye-popping amounts of oxycodone they were dispensing. Carter swung by the CVS stores. How could pharmacies in one of America’s biggest chains be running up street gang numbers? What she saw stunned the seasoned investigator. Parking lots filled with cars and trucks bearing out-of-state license plates. Long lines of customers spilled out the door. Many customers paid cash for their pills. Queues at the drive-through windows curled around the stores. Most prescriptions were written for 30mg oxycodone tablets, the “blues” manufactured by Mallinckrodt.
Carter studied the distribution numbers and discovered that Cardinal sent 3.1 million tablets of oxycodone to six of the sixteen pharmacies within the Sanford city limits in 2011. That was enough to supply every man, woman, and child in the city, population 53,570, with 58 doses of the drug.
“I knew it was bad,” Carter told Joe. “But it’s a lot worse than I thought.”
On October 18, 2011, she executed search warrants on the two CVS stores and the two independent pharmacies. Eight days later, on October 26, Carter served the Cardinal warehouse in Lakeland with a similar warrant. Squads of agents and investigators, clad in windbreakers with “DEA” in yellow emblazoned on their backs, swarmed the warehouse and the stores. CVS store no. 219 in Sanford, Carter discovered, was Cardinal’s biggest customer in Florida. Between 2008 and 2011, the company sold more than 5 million pills to that one CVS. The store, in turn, accepted cash payments for 42 percent of the oxycodone pills it sold, a tell that the pills were destined for the black market.
Material turned up in the search showed how Cardinal kept raising the ceiling on how many oxycodone pills its customers could purchase—without ever asking for an explanation as to why sales were skyrocketing. Between 2009 and 2010, Cardinal increased its monthly oxycodone distribution to the top-selling CVS by 63 percent—from 1.2 million to 2 million pills. Carter noted that the average yearly sales of oxycodone for pharmacies in Florida was 112,000 tablets.
Ten days after serving the warrants on the CVS pharmacies, Carter interviewed the pharmacist-in-charge of CVS store no. 219, Paras Priyadarshi. He acknowledged that most of his customers were requesting “blues” or “M’s” when they were filling their prescriptions. He also knew that his store was filling more prescriptions for oxycodone than any other store in the region. But he said “no one from CVS corporate had said anything to him about the high volume,” Carter later noted in a DEA document, and he didn’t find the conduct of his customers suspicious. He told Carter, “If a customer asked for a particular brand name, he would fill the prescription with that brand name if the pharmacy had that brand in stock.”
Carter then traveled to Cardinal’s second-biggest customer, CVS store no. 5195, also in Sanford. Cardinal had sold that store 2.2 million oxycodone tablets between 2008 and 2011. Carter discovered that 58 percent of the pills were purchased by cash-carrying customers between 2010 and 2011. The DEA database revealed that Cardinal had increased its monthly oxycodone sales to that store by 748 percent between 2009 and 2010.
Carter interviewed the pharmacist-in-charge, Jessica Merrill. She was surprisingly candid. Merrill was so forthcoming that Carter called one of her supervisors over. She wanted a witness because she thought no one would believe what Merrill was telling her.
Merrill said she could fill oxycodone prescriptions “all day long,” but she decided to set a limit. Once that limit was reached, customers were told the store was out of stock. Glassy-eyed customers would begin staggering to the pharmacy the next morning to stand in line for their doses of oxycodone.
Merrill told Carter she was “between a rock and a hard place” because she believed she had to fill prescriptions written by doctors—even though pharmacists are required to turn away customers if they suspect laws are being broken. “It’s very time consuming,” she told Carter, “to call the doctors’ offices and verify each prescription.”
Merrill then said something Carter would always remember: Once the pharmacy reached its self-imposed limit of oxycodone sales, Merrill disclosed that she always kept a reserve supply on hand.
Why? Carter asked.
For my “real pain patients,” Merrill told her.
When Joe read Carter’s report, he was livid. He directed his team to prepare Immediate Suspension Orders against the Cardinal warehouse, the CVS stores, and the two independent pharmacies.
Time to shut these motherfuckers down, Joe said to himself.