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Missouri Is a Pill Lover's Paradise

Missouri is now the only state without a prescription drug monitoring program, meaning it's the best place to get hooked on oxycodone, or start your own pill trafficking operation.

Photo via Flickr user D.C. Atty

The CDC has called prescription pill abuse “an epidemic,” and Missouri is the new epicenter of pill mills.

Opiates are the most heavily abused, mostly because of the floaty, heroin-like high they give users. This family of drugs is responsible for killing about 50 people a day, and they make up 75 percent of all overdoses (which Missouri has one of the highest rates of), rivaling even car accidents as a cause of death nationwide.


The reason there’s such a bad pain pill problem in the former meth capital of the U.S. is its lack of a prescription drug monitoring program, a statewide database that would track when patients fill their scripts and prevent the main culprit behind our country’s pain pill problem: doctor shopping.

Once you know you've found a pill mill, the typical procedure is to pay a few hundred dollars for the initial exam, MRI and script. After you get the pill popper’s golden ticket, you visit various pharmacies around the state and fill your script as many times as your wallet allows. At about $6 a pill and anywhere between 30 to 120 pills per prescription, bottles cost between $180 and $720 and generate huge profits. The Tampa Bay Times reported that even small doctors, only seeing up to 80 patients a day, can put 20,000 pills in the hands of abusers and traffickers in one day. That’s a fuck ton of pills.

The revolutionary concept of a Prescription Drug Monitoring Program (PDMP) would tone down some of the more Machiavellian business strategies in the prescription world, both for doctors, and traffickers. When users or drug dealers in other states try to get their prescription filled more than once, an alert is sent to doctors and law enforcement. Not being able to double-dip on your prescription forces you to be imaginative when figuring out how to run your pill trafficking operation. Large swaths of abusers are slowed by this simple step, but somehow, Missouri is the only state that doesn’t have a PDMP. This can largely be blamed on their state leader, Sen. Rob Schaaf, R-St. Joseph.


"If they overdose and kill themselves, it just removes them from the gene pool,” Sen. Schaaf said during an eight-hour filibuster he led against a pill monitoring program bill in 2012. Suddenly, pill dealers from Tennessee to Illinois rejoiced knowing their businesses would not be threatened, and that finally, someone in government was looking out for them.

A new bill has recently passed in Missouri’s House, but as it moves to the Senate, Schaaf is still holding onto his argument that the program is a privacy concern and he is “protecting other people’s liberty.”

Missouri is following in the footsteps of Florida. Until about 2011, Florida prescribed 10 times more oxycodone than any other state in the country. Florida housed 90 of the top 100 pharmacies buying oxycodone and became a notorious destination for doctor shoppers across the country. In 2010 there were 29 pain clinics just on Commercial Boulevard, a main road in Ft. Lauderdale. Today, there is only one.

In this one instance, Florida, a state notorious for its swamp people and overall weirdness, actually cleaned up its act and became a model for states plagued with opiate abuse like Missouri. Florida lawmakers started noticing the record number of overdoses, the kids that barely graduated high school, and the piles of bloody syringes in pharmacy parking lots. As I was writing this, the New York Times published a front-page story on Missouri’s refusal to employ a PDMP program. But their piece opted not to connect the trend to the growing heroin problem in cities and towns across the country, particularly St. Louis' heroin epidemic.


Even though the portable MRI busses in strip club parking lots, the lines of scratching junkies exchanging clean piss outside of clinics, and the rich doctors that used to burn dollar bills to save space are a thing of the past for Florida, it hardly matters because Missouri is now feeding the appetite of all the states Florida let starve. Scott Collier from the Missouri DEA’s office said once a state becomes regulated, the businesses don’t just disappear.

“These folks don’t stop, they simply move beyond the border.”

Take, for example, Advanced Pain Center ("Where Life Just Gets Better"). Accused of being a junkie hotspot on forums across the Web, the clinic has six locations across, most of them conveniently within an hour from the next. Not only that, but they all happen to fall close to their neighboring states. Check out this nifty map I made:

These six clinics are all on Missouri’s eastern edge and nearly border Illinois, Kentucky, Tennessee and Arkansas. Their Cape Girardeau location is nine minutes west of the Illinois border and about an hour west of the Kentucky border. About a half an hour north, their Farmington location is about 40 minutes east of Illinois. Another 30 minutes north is their Festus location, which is about 25 miles from a more northern Illinois border. A bit more down state, their Kennett location is about 13 minutes east of Arkansas and 25 minutes west of Tennessee. There nearby Popular Bluff location is about a half an hour north of Arkansas and about an hour and a half north west of Tennessee. As the Times reported, ExpressScripts, which processes medications for 90 million Americans, found that residents of Missouri’s neighboring states fill more scripts in Missouri than Missourians do elsewhere.


When speaking to Collier about it, I mentioned how oddly close the clinics were to each other and how strategically located they were to other states. “That is interesting, isn’t it?” he said.

Advanced Pain Center was raided in June of last year, and while no charges have been filed according to the U.S. Attorney Eastern District of Missouri, Collier confirmed that the investigation is ongoing against the clinic.

I called counties across Missouri and spoke to medical examiners, advocates and health officials. They all recognize the problem as an epidemic, they see it growing in their hospitals and on their streets, and they can’t wrap their head around why a monitoring program hasn’t been established yet.

“It’s bad, it really is," Collier told me. "The reported usage is going way up, the death rates are going way up, this is a huge problem and it’s been a decade in the making. The unfortunate part of that is it’s going to take many years to dig ourselves out of this trench and get back to at least where we were 10 years ago.”

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