Source: CNN

In September 2022, a 15-year-old girl was found dead of an overdose in the bathroom of Helen Bernstein High School, which sits in the shadow of Netflix’s shiny headquarters in Hollywood and a couple of miles from my home.

After more than a decade covering the opioid epidemic, I’m admittedly a bit emotionally calloused when hearing about overdoses, but the story of Melanie Ramos got to me.

About a week after her death, the Los Angeles Times reported that Ramos was one of at least seven teenagers in the Los Angeles Unified School District who had overdosed from possible fentanyl-laced pills that month. Across the nation, there has recently been an alarming increase in the overdose mortality rate among teens, a shameful sign that we’re failing yet another generation as the opioid crisis enters its third decade.

A further reminder of just how poorly we’ve managed the crisis can be found in the details of the drugs found when they arrested the boy they allege sold the pill that resulted in Ramos’ death. The Los Angeles Police Department chief described finding what were believed to be counterfeit “crude blue M30 pills” containing fentanyl.

In recent years, these counterfeit pills have been flooding across the southwest border by the millions, according to the Drug Enforcement Administration, and fentanyl is the primary force behind an increase in overdose deaths.

For those who have witnessed the evolution of the opioid crisis, the cartels’ latest marketing scheme feels either like a cruel joke or some twisted homage to the players who gave birth to the market they now seem to control.

According to the DEA, the counterfeit M30s are fashioned after a generic 30-milligram oxycodone pill manufactured by Mallinckrodt Pharmaceuticals.

Mallinckrodt may not be a household name like Purdue Pharma, which patented and marketed OxyContin, but it produced nearly 30 times more pills than Purdue in 2006, according to DEA data obtained by The Washington Post.

I first came to know the M30 in 2008. I had no idea then that it would be the beginning of more than a decade of reporting on every dark turn of the opioid crisis. At that time, genuine blue M30 pills started flooding out of cash-only pain management clinics in South Florida and became arguably the most ubiquitous and popular pill on the streets of America.

As “American Pain” details, the most notorious of these pain clinics were operated by twin brothers Chris and Jeff George, who parlayed a Biogenesis-style hormone replacement business into a pill mill empire. Chris was convicted in 2002 for possession after he was caught selling anabolic steroids. The brothers opened their first pain clinic in 2008.

They stumbled into prescription painkillers at what turned out to be a critical juncture in the opioid crisis. In 2004, a trial judge invalidated Purdue’s patents on OxyContin, saying it misrepresented evidence behind the drug’s effectiveness to the US Patent and Trademark Office. In 2006, a federal appeals court vacated that ruling, and the trial court then found that Purdue did not intend to deceive the PTO and the patents were valid.

Generic manufacturers such as Mallinckrodt quickly pounced on the market that Purdue’s billion-dollar blockbuster had already proven was extremely profitable.

They offered essentially the same drug but at a cheaper price. And while Purdue was increasingly drawing heat for OxyContin — including pleading guilty in 2007 to criminal charges that it misrepresented how addictive and easily abused the drug was — the generics flew under the radar, at least for much of the American public.

“The generic medication was pretty much the lifeblood of our business,” Jeff George explained to me from the prison where he’s now serving a 20-year sentence. “People that didn’t have insurance could now afford it. This was the real game changer that created this opportunity.”

In the George brothers, generic manufacturers found a couple of pioneers who built an assembly line of doctors to stamp out prescription after prescription for super-size doses of oxycodone. “Handwriting took too much time,” Chris George said.

The M30 dominated the market, and an underground network of users and dealers drove the demand. The George brothers’ clinics became the hub for a whole cottage industry of drug runners, or “sponsors,” who would pay for van loads of “patients” to travel from Kentucky, Ohio, West Virginia and beyond to get pills that would be resold on the streets back home.

An M30 pill that cost about $5 at a pain clinic in Florida could be sold for up to $30 per pill on the streets of Appalachia or New England. And with those kinds of margins, the greatest drug racket to hit the Sunshine State since the “cocaine cowboys” in the 1980s was born.

Following the George brothers’ blueprint, more clinics popped up in Florida and, like the Georges, many of the owners didn’t have much prior experience with pain management.

There was Vincent Colangelo, aka Pill Mill Vinny, who had already been to prison for cocaine and heroin offenses. And there was Zachary Rose, who built a pill mill empire of his own.

“It was just a drug-dealing game times 10, times a thousand,” Rose told me. “You get 150,000 pills fronted to you, and by the time you’d mail [the wholesaler] the check, you sold all them pills.”

By 2009, so many little blue M30s were being trafficked between states that the routes became known as the “Blue Highway” and the “Oxy Express.”

Pharmaceutical companies are required to report suspicious orders for controlled substances to the DEA. But remarkably they overlooked or ignored glaring red flags, such as the fact that nearly 90% of all the oxycodone sold to US practitioners in the first six months of 2010 was suddenly going to doctors in Florida, according to The New York Times.

“The individuals who manufactured, distributed, supplied these medications had to have known exactly what was going on in South Florida,” said FBI Special Agent Jennifer Turner, who would lead the first major federal investigation into Florida’s pill mills.

“They’re following the life cycle of this pill from the day it’s manufactured to the end user. They were having to continuously up the supply to meet the demand. And the demand was very clear as to where it was coming from.”

In fact, according to Chris George, one pharma salesperson even advised him to find a straw owner and change the name and location of his clinic when it began drawing too much attention from local law enforcement and reporters.

Chris George says he took the advice and changed the name to American Pain, which became the biggest pill mill in the country, with five of the top oxycodone-prescribing doctors in the nation working under the same roof, reportedly seeing 500 patients a day.

When I asked Chris George how he came up with the name of his flagship clinic, he said: “It just sounded like a good name to me.”

But it turned out to be strangely prescient. American Pain and the pharmaceutical companies that kept their shelves stocked with addictive pills helped seed an overdose epidemic that has claimed hundreds of thousands of lives, including nearly 108,000 overdose deaths in 2021, according to provisional data from the US Centers for Disease Control and Prevention. About two-thirds of those deaths involved fentanyl or another synthetic opioid.

The difference between the drug companies and the pain clinics they supplied is that the clinic owners, such as the Georges, paid a heavy price for their role. They were targets of criminal cases that landed them in prison for years.

The drug companies, on the other hand, were largely given a pass. It wasn’t until a spate of civil lawsuits from communities around the country that drug companies finally came under public scrutiny and the true depths of their knowledge about what was happening in Florida began to emerge. They’ve since offered billions of dollars in settlements. In exchange, they admit no wrongdoing.

But every counterfeit M30 that comes across the border is a clear reminder of their role in spawning this epidemic. And the tragic death of a 15-year-old girl is more proof that whatever price these drug companies – and those who counterfeit their products – wind up paying, it isn’t nearly enough.

Note: This piece was updated to clarify a judge’s 2004 ruling on Purdue’s OxyContin patents and subsequent litigation.

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