(CNN) — Today’s headlines are about heroin and fentanyl, but there’s an extraordinary new documentary on CNN reminding us all that the opioid crisis has its roots in America’s pharmaceutical industry.
“American Pain” documents a very specific time period when a group of young people opened pain clinics in South Florida and, with the help of doctors and pharmaceutical companies, flooded the country with addictive pain relievers and became rich in the process.
The documentary is bizarre and will leave you wondering how, exactly, this could have happened. It charts the rise and fall, in particular, of Chris and Jeff George, bodybuilding-obsessed twin brothers who somehow became prescription drug kingpins.
The film also documents how authorities eventually built legal cases against pain clinic owners with undercover work and the help of informants who wanted to stop the pain clinics.
I spoke to the director, Darren Foster, about how he came to tell this ridiculous story.
The film took many years to make. Foster first met the George brothers in 2009. He had been investigating the opioid crisis in Kentucky, where a sheriff showed him pill bottles from Florida. That led him to the South Florida Pain Clinic.
At first, the brothers literally chased him away from the clinic. Within six months, they would be the subject of the largest prescription drug investigation in American history.
After his trial, Foster convinced the brothers and a surprising number of other people to be in the film. Excerpts from our telephone conversation are below.
This story is amazing. How did you get these people to open up?
WOLF: How did you go from a moment of confrontation, with the brothers chasing you down the road, to interviewing them in prison?
FOSTER: I basically told them that I thought their story was interesting because I thought that, on some level, it was an indictment of the pharmaceutical industry.
The George brothers were not an anomaly. There were other clinic owners. “Pill Mill Vinny” – Vincent Colangelo – who was still on probation for heroin trafficking when he opened a clinic. Zach Rose, who was 23 at the time, was operating a grow house growing marijuana and dealing cocaine when he opened his first clinic.
These are the guys the pharmaceutical industry thought it was good to partner with to distribute pills. I thought by telling their story, it would show on some level that while these guys went to prison, the pharmaceutical industry, on some level, got away with it.
Doctors and pharmaceutical companies did not participate
WOLF: There are certainly no interviews with people from the pharmaceutical industry in the film. You don’t talk on camera with the doctors who were involved. Was it intentional, or were these people just not going to talk to you?
FOSTER: Yes, exactly that. When you make a movie, you have to figure out what its limitations are. And the restriction of this film, in my mind, was always that I wanted it to be first-person for those who perpetrated this conspiracy or the people who were on the front lines investigating how to take it down.
That obviously included the George brothers and other clinic owners and people who worked at the clinics, and then local law enforcement and federal law enforcement agencies that were there to put together the case.
Of course, I definitely wanted to interview the doctors and I contacted everyone involved in “American Pain”. They all just decided that they did not want to participate in this at all.
And the same with the pharmaceutical industry, especially with the pharmaceutical representatives that supply them. I contacted several of those people that I could identify, and none of them wanted anything to do with the documentary.
We had the advantage that I was able to obtain, through a freedom of information request, all the wiretaps in the case, the undercover video and many documents, and I think that helps to illustrate the whole ecosystem that allowed these clinics to operate.
The George brothers did not have medical degrees. They weren’t writing recipes. They had a bunch of doctors who were willing to do that for them. They did not give any individualization of care. They basically broke the same script for everyone who came through the door.
An absurd true story that seems like a farce
WOLF: The tone of the film is almost ridiculous. It’s fun sometimes. Before he kicks you in the stomach, he veers more into the ridiculousness of what was happening than the sadness. What made you decide to go in that direction?
FOSTER: The tone of the film was something that I knew was going to be a good balance. What I really want to capture is the absurd.
Looking back a decade later, it’s obviously absurd. Even at that time, it was absurd. Everyone who was there at the time, including me, knew that this was crazy, what was happening.
From local citizens who saw people lining up outside clinics, who were collecting needles in their front yard, who were seeing people fighting in parking lots, supposedly medical establishments. To law enforcement who were rounding people up, responding to overdoses at local motels all the time. Everyone knew that this was absurd.
The only people who didn’t seem to want to raise a red flag about it were the pharmaceutical industry. In fact, they are legally required to report to the DEA when they suspect something suspicious is going on with their controlled substances. But at no point did any of them raise a red flag.
Instead, they continued to supply people like the George Brothers and a bunch of other clinics. At one point, hundreds of clinics sprang up between Broward and Palm Beach County. He wanted to capture the tone of how absurd he was.
The people who ran the clinics were 20 years old, they were having a good time, they were making a lot of money. He wanted to put people on that journey.
I wanted people to understand how you can get carried away with this when you realize you’ve gotten into the biggest drug business since the “Cocaine Cowboys”, with all the money that implies. You let yourself be carried away by him.
At some point in the movie, he was going to pull the rug and you will understand the consequences of this. That people along the way were becoming addicted and a great tragedy was unfolding.
Zach Rose says in the movie that he was blinded to what was happening. The money blinded him to how bad things were. He knew that people were dying. He knew that the people who went to his clinic were dying. But the money blinded him.
I think that’s what happened to a lot of people. They were just blinded by money. And ultimately, they just didn’t care about the consequences.
How the opioid crisis has evolved
WOLF: I also wrote that when Zach Rose said it. He said: “The doctors turned a blind eye, the owners turned a blind eye, the pharmacists, the distributors and everyone lined their pockets.”
The pain clinics were closed, right? How has this evolved in the years since the events of the film?
FOSTER: The movie doesn’t actually end on a hopeful note. There’s not a little loop at the end that says we close the clinics and then everything goes back to normal, because unfortunately that’s the tragedy of the opioid crisis.
Once the pain clinics closed, unfortunately, there was a large population of people who were already addicted to opioids. When they couldn’t find the pills, they had to find another source to support their habit, and that’s when heroin came along. There were people who were transitioning from pills to heroin, which was cheaper and even more potent.
And now you have the next evolution, this kind of third wave attack, which is fentanyl, which has been devastating in recent years, especially since the pandemic, with overdose rates going through the roof.
Why was Florida the key to this?
WOLF: Your reporting in Appalachia took you to Florida. How did it all spread from Florida?
FOSTER: The opioid crisis first took hold in Appalachia and in some pockets of the Northeast, but then with Florida, it basically became a national issue, because there was this pipeline that ran between Florida and Appalachia, and then between Florida and the northeast and then everywhere in between.
These pills were so ubiquitous that law enforcement called I-95 and I-75 the Blue Highway or the Oxy Express, because there were so many pills leaving Florida, up and down the East Coast, with people who came from even farther away than that.
Was there accountability?
WOLF: One of the things that I found surprising is that all but one character has been to jail and been released. These are big drug dealers, essentially, but most of what they were doing was, literally, legal. It almost feels like a slap on the wrist even though these guys spent years in jail.
FOSTER: Chris George, Jeff George and many of the other players were some of the first people to be prosecuted for prescription drug trafficking at this level. The prosecutors on the case and the FBI really had to figure it out. How is a case like this prosecuted when it involves something that is technically a “legal” drug?
Unlike heroin or cocaine, which are illegal across the board, it’s not that easy to bring a case against people, doctors, clinic owners, when the drug they distribute is a legal pharmaceutical.
These guys are spending quite a bit of time in prison. I don’t think any of them are happy with the fact that they spent most of their adult lives behind bars.
But when you look at some of the others, the doctors got off. The pharmaceutical companies: No one has been criminally charged for what happened in Florida.
I would say these guys kept the bag. They definitely deserved what they got, but they were more or less the ones held to account.
Local reporters deserve a lot of credit
WOLF: What am I missing?
FOSTER: Things would not have changed in Florida without the attention of local reporters like Carmel Cafiero and Anthony Pineda, who were actually working on this story and are in the movie. I think it’s a testament to the importance of local journalism, local reporting, because they were the ones who identified the madness and started doing big investigations before anyone else.
I think it was because of his persistence that people realized they had to start taking this seriously and eventually forced changes in Florida to close the pain clinics.
