Dr. Roger Browne was once one of Kentucky's most popular pain doctors.
His office, however, was 850 miles away, in Broward County.
When federal agents raided Browne's Coral Springs clinic, Americare Health and Rehabilitation, last year, they found medical files on nearly 500 Kentucky residents who had received painkillers from the doctor.
Browne was just one part of a vast pill-trafficking industry stretching from Broward County through rural Kentucky, Tennessee, Ohio and West Virginia.
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Squads of traffickers dispatched from those states descend on the Fort Lauderdale area almost daily to buy oxycodone, methadone and other narcotics from doctors at local pain clinics and resell them in Appalachia, according to interviews with police and court records.
Cars from Kentucky loaded with passengers can be seen clogging the parking lots of some Broward clinics. One discount airline flying from West Virginia to Fort Lauderdale is so popular with drug dealers that police have dubbed it the "O.C. Express."
"We're inundated with it. Florida is killing us, " said Sheriff Bill Lewis of Lewis County, Ky., population 14,000. "There's a carload that leaves here so often -- hell, every week or so -- to go to Florida."
In February, Lewis' deputies arrested four people returning to Kentucky with almost 1,000 painkillers prescribed by Florida doctors. And last Thursday, they arrested a suspected oxycodone trafficker carrying the business card of a Hollywood pain doctor in his wallet.
The carloads are lured by Florida's growing number of storefront pain clinics, where doctors can dispense pills to walk-in patients from on-site pharmacies with little oversight -- exploiting lax state laws and health regulations.
Broward County is now the epicenter of a prescription-drug epidemic spreading across the eastern United States, with local doctors dispensing 6.5 million oxycodone pills in the second half of last year -- far outpacing the rest of the country -- according to federal data compiled by the Broward Sheriff's Office.
"Sometimes a doctor with a pen can be some of your biggest drug dealers. It's called legal until you can prove it different, " said Sheriff Kent Harris of Unicoi County, Tenn. Last week, his deputies arrested three men driving back from Florida with 1,000 pills stuffed into the motor of their car.
THE PILL TRAIL
Police in Appalachian states confiscate Florida pills almost daily, prompting the U.S. Drug Enforcement Administration to ask police in the region to track and log the Florida doctors whose prescriptions they find. The Miami Herald has documented more than a dozen such cases in rural parts of Kentucky, Ohio, West Virginia and Tennessee this year.
The Florida pill pipeline has carved a depressing path through Appalachia, already one of the poorest regions in the country. Kentucky police call painkiller abuse an epidemic -- a far bigger problem than cocaine, methamphetamine or other illegal drugs -- sparking burglaries and robberies, and ruining lives.
"We have families breaking up, and people dying and people losing their jobs, " said Sheriff Keith Cooper of Greenup County, Ky. "It's sad now that it's so routine."
Just as routine are overdose deaths. In West Virginia, accidental overdoses increased by 550 percent from 1999 to 2004 -- the biggest increase in the country -- a spike attributed to prescription painkillers, according to a recent report in the Journal of the American Medical Association.
Last August, 38-year-old Timothy Hardin died of an overdose in a Fort Lauderdale hotel room while "doctor-shopping" for pills with three friends from Kentucky, according to a medical examiner's report.
Also dead: John White, 42, who overdosed in February hours after flying back to Kentucky from Fort Lauderdale, according to police. His wife told police he had come down for a doctor's appointment.
Sheriff Steve Burns of Greene County, Tenn., said he is investigating the overdose of a teenager who died recently after returning from Broward on a pill-buying mission.
"The problem I'm having is, they're either coming back and dying, or they're coming back and selling them on the street, " Burns said. "It's a problem, even if they are getting them legally."
Once in South Florida, the traffickers are hardly subtle. While on a fact-finding tour last month with Broward sheriff's detectives, two local lawmakers say they found a traffic jam of cars with Kentucky license plates outside one clinic.
"We saw cars filled with families, " said Rep. Ari Porth of Coral Springs, who is also a prosecutor with the Broward state attorney's office. "I had to see it for myself to believe it."
More often, police say, pill carriers fly back and forth through Knoxville, Lexington, Blountville, Tenn., and Huntington, W.Va. Police say one airline's flight from Huntington to Fort Lauderdale -- with rates as low as $29 one way -- is particularly popular with the pill network.
"The flight is pretty much full of dopers, " said Sheriff Cooper, a former narcotics detective with the Kentucky State Police.
Many local clinics are aggressive in their advertising. "Out of State Patients Welcome, " blares a newspaper ad for A1 Pain, a new clinic on Oakland Park Boulevard in Fort Lauderdale. Other clinics offer coupons and discounts for patients who bring new referrals, or advertise their price per pill.
Whether by car or plane, Kentucky police say, the drug dealers typically send groups of four to eight people to South Florida to buy pills from unscrupulous or unwitting doctors -- a practice commonly known as "doctor shopping."
The buyers can visit several clinics, often using forged or bogus medical records or fake MRI results to justify the medications, according to investigators in Florida and other states.
An anonymous tipster described the Kentucky-Florida pipeline in a note left for the Lewis County sheriff in December at a dock along the Ohio River: A Fort Lauderdale clinic "is giving anyone medicine all you have to tell them is that you used to go to a pain doctor and your doctor has moved, " read the note, signed "Mr. X." "There is vehicles from Kentucky there every day."
Some clinics sell the pills directly to the patients; others provide prescriptions filled at pharmacies on the trip back north. Searching a suspect's home last year, Cooper said he found a road map tracing a route back from South Florida -- eight red circles marking stops in Florida, Georgia and North Carolina.
The trail is well-worn. Last month, North Carolina's Board of Pharmacy warned pharmacists to be wary of people from Kentucky, West Virginia, Ohio and Tennessee with oxycodone prescriptions from Florida doctors. "Many of the individual patients have been calling ahead, asking pharmacists if they have oxycodone or roxicodone in stock, " the alert said.
These traveling bands of buyers are often drug addicts who split the pills they collect with the main dealer, who typically covers the travel expenses and sells the remaining pills, according to police and court records. An oxycodone pill selling for $3 to $6 at a Broward pain clinic could sell for as much as $30 on the black market in Kentucky or Tennessee.
DOCTORS HELPING OUT
Sometimes, the local doctors are unwitting dupes in the scheme. Others, like Browne, are knowing conspirators.
Browne, 53, teamed with a group of Kentucky drug dealers to provide thousands of painkillers through phony prescriptions for at least a year, court records show. DEA agents arrested Browne after one of his Kentucky patients became an informant, secretly recording his meetings with the doctor.
"My son's girlfriend is telling everyone that I am coming to Florida to get pills, " the informant told Browne in one meeting.
"What you need to do is not tell anybody that you come here, " the doctor replied.
Browne, of Pembroke Pines, was indicted along with 13 others in the drug ring. The doctor -- who spent four years as a medic at Everglades Correctional Institution in South Miami-Dade County before going into pain management -- is now serving a 2½-year prison term after pleading guilty to conspiracy to distribute oxycodone.
Browne is the only South Florida doctor prosecuted as part of a Kentucky drug ring -- although police say they can name several doctors whose prescriptions routinely turn up in Kentucky investigations.
"We need to start getting some of those doctors down there arrested, " said Cooper, the Greenup County sheriff. When he interviews drug suspects, he said, "it's always the same story: It's just easier to get them down there."
Prosecuting the pill buyers can be difficult. A prescription from a doctor -- even a doctor in a far-away state -- creates an assumption of legitimacy that's hard for police to disprove, law enforcement agents say. Most successful prosecutions arise when a suspect is found with only a few pills left on a fresh prescription -- suggesting the missing pills were sold or traded -- or with pills prescribed to someone else.
Florida emerged as the prime supplier of black-market pills after most other states created computer monitoring systems, allowing police to track patients receiving pills from multiple doctors. Kentucky was one of the first states to pass such a law; Florida is one of 12 states without a comparable program.
"We are source-supplying many other states, " said Sgt. Lisa McElhaney of the Broward Sheriff's Office, who has spent years investigating prescription drug fraud. "This is literally embarrassing."
Last month, Kentucky's lieutenant governor wrote a letter to Florida House Speaker Larry Cretul, urging the passage of a new bill creating a monitoring program to help police track addicts and pill peddlers -- a proposal strangled in the Legislature for the past seven years.
Police in Appalachia say lawmakers must do something to stem the pipeline from Florida.
"Until Florida itself gets off the pot and does something about this problem -- they're just killing us all, " said Terry Keelin, sheriff of Boyd County, Ky. "They're killing our citizens. It's a mess."
Feeding the nation's pill habitSouth Florida pill mills are the supply pipeline for users and dealers in several of Eastern states. A recent sampler:
1 LEWIS COUNTY, KY. Feb. 11: Sheriff's deputies arrest fourpeople - among them an uncle, his nephew and niece - carrying nearly 1,000 painkillers and other pills prescribed one day earlier by doctors at Fort Lauderdale pain clinics.
2 UNICOI COUNTY, TENN. Feb. 21: Four men are arrested aftertrying to obtain pills with prescriptions obtained from a Fort Lauderdale doctor one day earlier.
3 LAWRENCE COUNTY, OHIOMarch 23: A grand jury indicts 12 people after an undercover investigation reveals a network traf?cking prescrip- tion drugs bought in South Florida.
4 HUNTINGTON, W. VA.March 26: Police arrest a Tennessee couple with hundreds of prescription pills worth an estimated $20,000. Police say the couple obtained the pills with prescriptions ?lled in Fort Lauderdale and St. Petersburg.