Special Episode: Philip Eil & Prescription for Pain

In February 2012, Paul Volkman was sentenced to four consecutive terms of life imprisonment for his role in illegally prescribing and dispensing pain medications that resulted in the deaths of several individuals in his care. This was a remarkable case, both in terms of the lengthy sentence as well as the perpetrator. Paul Volkman was a highly-educated physician researcher, who earned both his MD and PhD and had decades of experience practicing medicine. How did he end up in a cash-only pain clinic in southern Ohio? In this TPWKY book club episode, journalist Philip Eil joins me to trace Volkman’s journey as outlined in Eil’s book Prescription for Pain: How a Once-Promising Doctor Became the “Pill Mill Killer”. Eil places Volkman’s actions in the broader context of the opioid epidemic and reflects on the lasting impact Volkman’s case has had on painkiller regulation and the communities most impacted by his crimes. Tune in for a fascinating conversation about what happens when a doctor decides he is above the law.

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Episode Transcript

Speaker 1 (00:44):
Hi, I'm Aaron Welsh and this is this podcast Will
Kill You. You're listening to the latest episode in the tp
w k Y book Club series. This season our ongoing
miniseries where we bring authors onto the podcast to chat
about their fascinating books in science and medicine. So far
this season, we've explored topics all across the realm of science,

(01:08):
from how roads affect our lives and the lives of wildlife,
to how our brain picks and chooses what's important to remember.
From why fungi rule the world to how unsung heroes
at a hospital on Staten Island helped to bring about
a cure for tuberculosis. And we've got more topics to
venture into this season, but just a couple. That's right,

(01:31):
We've got just two more book Club episodes left after
this one for the season, but don't worry, we'll be
back next season with more book Club episodes. And you
can always check out our website This Podcast Will Kill
You dot com, where you can find a link to
our bookshop dot Org affiliate page. Under the extras tab.
On that page, you can find the TPWKY book Club List,

(01:54):
which includes all of the books we've covered so far,
as well as the ones that will be coming out
later season. And a hint for anyone who's doing some
last minute holiday shopping, our book club lists are a
great place to pick out some fascinating books for the
readers in your life. Speaking of fascinating books, this week
will be delving into a story that is part public

(02:16):
health crisis, part true crime, and part tragedy whose impact
is still felt by so many to this day. Journalist
Philip Isle joins me to discuss his book Prescription for
Pain How a once promising doctor became the pill mill killer.
That once promising doctor refers to Paul Volkman, an American

(02:37):
doctor who is currently serving four consecutive life sentences in
an Arizona prison for unlawful distribution of a controlled substance
resulting in death. Looking at Volkman's early life and career,
which included an MD and a PhD, this seemed like
a guy destined for greatness for a Nobel prize, even
as one of his former colleagues suggested, how did Volkman

(03:01):
go from being one of the most accomplished physician researchers
in the United States to working at a cash only
pain clinic in southern Ohio to then spending the rest
of his life in prison. That's the question at the
center of Isle's prescription for Pain. In the course of
tracing Volkman's downfall, Isle also exposes the systemic failures and

(03:24):
lack of oversight that permitted Volkman to remain in a
position of power for so long, a position he exploited
to harm those who sought his help. In general, I
think that most of us trust physicians to do the
right thing. Of course, we know physicians are flawed, they
make mistakes, They're human after all, But when it comes
to helping versus harming, we expect them to abide by

(03:47):
a moral code, the bottom line of which is do
no harm. Volkman's complete violation of this code begs the
question why why did he continued down this path knowing
that he was causing irreparable harm to individuals, to families,
to an entire community. Through extensive research, including conversations with

(04:12):
Volkman himself, Ile reveals the disturbing answer to this question,
which is simply that Volkman sees himself differently than the
rest of the world sees him. Ele also puts Volkman's
actions in the broader context of the opioid epidemic and
how it has changed shape over the past twenty years.
But importantly, throughout his book, Ile doesn't lose sight of

(04:34):
those who were harmed by Volkman, drawing attention to their
lives and honoring their memory. Prescription for Pain is a
gripping account of a physician who abused his power and
status and betrayed those who came to him for help.
But more than that, it's a story of how he
was able to carry out his crimes in this country

(04:54):
in the early two thousands, enabled by a broken system
and supported by corrupt officials. What is Volkman's true legacy
and how can we prevent someone like him from going
down a similar path. Let's turn to the interview to
find out. Right after this break, Phil, thanks so much

(05:38):
for joining me today. Happy to have you here.

Speaker 2 (05:40):
Thanks so much for having me arin your book.

Speaker 1 (05:43):
Prescription for Pain is a meticulously researched account of the
truly chilling life of Paul Volckman, a doctor, a doctor
doctor mdphd specifically, who is currently serving four life sentences
in prison for illegal prescriptions. As you discs us in
the book. Your reasons for writing this are in part personal.

(06:03):
How did you first hear about this story and what
about it made you think to yourself, Okay, I've got
to write a book about this.

Speaker 2 (06:10):
To answer that question, we have to go all the
way back to two thousand and nine, when I was
twenty three years old. I was less than two years
out of college, and I had just started my journalism career,
and one of the books that had inspired me to
pursue writing, to pursue nonfiction writing was Truman Capote's In
Cold Blood. So young Phil has just started out on

(06:33):
his journalism career. I've written maybe ten or so small,
lighthearted articles for local publications in my home state of
Rhode Island, and In Cold Blood had been one of
the things that kind of got me on this path.
And I'm talking to my dad and he mentions that
he brings up this case, the situation of this old

(06:54):
classmate of his from the University of Chicago mdphd program,
and this old classmate, Paul Volkman, at that time, was
facing a federal indictment. The indictment alleged that Volkman had
participated in a multi year drug dealing scheme. Basically, federal
prosecutors said that Volkman was working out of cash only

(07:18):
pain clinics in southern Ohio, that these clinics were patrolled
by armed guards, that local pharmacies refused to fill the
prescriptions written there, that he was prescribing prodigious amounts of
opiate painkillers as well as sedatives and muscle relaxers, and
most awfully, that a number of his patients had died

(07:41):
over the course of this conduct from apparent overdoses after
taking the medications that Vulkman prescribed them. So, as I
described in the book, my dad is a mild mannered,
nerdy guy who wears glasses and plays golf and sings
in civic corrals, and I'm not sure he's ever even

(08:01):
gotten a speeding ticket. He's not the kind of guy
you would expect to know someone who's accused of essentially
being this kind of prescription drug dealing kingpin. So it
was immediately struck by that kind of familiarity that these
two guys had gone not just actually to medical school together,
but college as well, but also the foreignness of it

(08:22):
that this guy who my dad knew was accused of
these horrifying crimes. And another factor was that my dad
had fallen out of touch with Paul Volkman in the
years between their graduation from the University of Chicago in
the mid seventies and Volkman's indictment, so he couldn't account
for what had happened in between those two dates, so

(08:45):
it was also a mystery. So throw all these things together,
and you've got me the energetic and ambitious and also
pretty naive young journalist who has big dreams of writing
a true crime book like Truman Capodi, and I was
immediately hooked. I was about to enter a graduate writing program,

(09:05):
and I had already gotten in with a portfolio that
was based on some other stuff. But I immediately pushed
that stuff to the side and said, this is the
story I want to pursue. This just seemed so fascinating
and rich. It immediately struck me as a big story,
even though I didn't really know what was between those
years of their graduation in Volkman's indictment. And one other

(09:27):
thing I'll just add is that Volkman was not a
guy who was a regular at my house growing up.
It's not like he came over for dinner or hung
out of family barbecues. I'd never met him, I'd never
even heard of him. He was this long lost guy
from my dad's past. So I was coming to the
story with a personal entry point, but without any history
with this guy. And I was off to the races

(09:49):
from that point.

Speaker 1 (09:50):
And fifteen years later, you say you started this fifteen
years ago, and then here now you have this book.
Did this book change shape as you worked on it,
or as the broader narrative surrounding opioids in the US change?

Speaker 2 (10:06):
Yes? I mean, i'd say for the first couple years,
I was just a graduate student who was in an
MFA Masters of Fine Arts writing program who needed a
big project. Not a finished book, but like a thesis project.
And I use that term lightly because your audience is
probably used to much more serious and rigorous thesis than
the one I had to produce for my MFA program.

(10:28):
Is just kind of like an exhibition of my work.
So initially I didn't know that this would be a book.
I just knew it was a big story. I mean,
in a technical sense. I didn't have confirmation it was
a book until twenty twenty one, when I landed a
book deal. I always, from a pretty early stage in
my mind, thought there was enough for a book here.

(10:51):
The journalist to me, who wants to just point to
facts is like, no, I didn't actually have a contract
until twenty twenty one. I mean, so that's a kind
of a literal answer to your question. The other answer
is to start this in two thousand and nine. There
hadn't been that many books at that point written about
the opiate epidemic. You know, we're in this phase of

(11:15):
we're so far into this epidemic. It's progressed from prescription
drugs to heroin to fentanyl, and we're also in this
stage I think of slowly understanding how this all happened
with the help of remarkable books, I mean, Patrick brand
and Keith's Empire of Pain, Sam Canone's Streamland, Beth Macy's
Dope Sic, Anna Lempke's Drug Dealer, MV. My book, by

(11:39):
the time it came out, joined this kind of sub
field of nonfiction literature about the opiate epidemic, whereas when
I started, there were a few of those books, but
not too many of them out there. And one thing
that allowed me to do, you know, this book didn't
wind up being short, it's four hundred pages on its own,
because I knew there's other books were out there to

(12:01):
really just focus on this one doctor's extraordinary life.

Speaker 1 (12:07):
Let's take a quick break, and when we get back,
there's still so much to discuss. Welcome back everyone. I've

(12:29):
been chatting with Phil Isle about his book Prescription for Pain.
How a once promising doctor became the pill mill killer.
Let's get back into things. Speaking of Volkman, let's get
a bit into his story. So here we have this
highly educated, highly driven guy who starts out with this
promising career. He's got his MD, he's got his PhD.

(12:51):
But then things begin to go downhill for Volkman. He's
involved in medical malpractice suits. He's having a hard time
finding and keeping a job. No one will ensure him.
How did Wolkman eventually find himself working at a cash
only pain clinic in southern Ohio? Like what was the
turning point? Or were there several turning points?

Speaker 2 (13:12):
So that I mean I talk at the beginning of
the book, how it was really that question Aaron that
drew me in of like what happened to this guy?
On paper? He was a high school valedictorian. He got
a partial scholarship to his undergraduate studies at the University
of Rochester. He and my dad both got federally funded

(13:34):
scholarships to get mdphds at the University of Chicago, the
MSTP Medical Scientist Training Program. That was fascinating to me.
You would think that a guy like that would emerge
with no debt, with two degrees, really the highest qualification
we have in our culture, double doctor. As you said
at the start, you would think a guy like that

(13:56):
would just have endless possibilities in front of him, endless
option And how was it that he wound up in
such sedy and ultimately criminal situation. That's a question that
after many, many years of research and reporting, I wind
up answering in the first part of my book, before
the crime start, because actually Volkman's crimes don't start until

(14:19):
he's well into his fifties. He's had kind of a
full adult life. He's had a career, and as you say,
it was an odd career. He and my dad were
really trained to be researchers. They weren't really trained to
see patients. Volkman flamed out of research fairly early on,
and the reasons are there's kind of a theme that

(14:40):
would emerge in his life where he said it was
one thing, and the facts, as determined by interviews with
other people or documentations say another. Volkman says, basically, he
had produced this brilliant work of research about a new
treatment for strokes at a laboratory in Chicago, and that
his lab director was away and came back and didn't
understand it and wouldn't sign off on it. And so

(15:04):
Volkman's according to him, you know, paradigm shifting research was
ultimately spiked for reasons that he says, we're due to
his lab director. The lab director, who I tracked down
said a very different story that Volkman was not a
particularly promising or bright researcher, that he didn't produce a
lot in the way of funding or research, that he

(15:28):
seemed distracted and was working a lot on nights in
emergency rooms, and that they ultimately decided that this wasn't
a good fit. So again, this is the start of
Olkman's career, and for me as his biographer, we have
a trend emerging that would continue to emerge of him
saying one thing, often a self glorifying narrative and another

(15:48):
person saying another. So from there he has stints in pediatrics.
His decision to go into pediatrics kind of befuddles his classmates.
It didn't make economic sense, didn't make sense with his
personality that ultimately wasn't earning the kind of money he
hoped it would for his now growing family. He's married,

(16:08):
he has two kids. He's living in Chicago. Starts moonlighting
in emergency rooms on nights and weekends, first in Chicago.
Then he discovers that he can actually earn more money
taking these kind of temporary what are called locum tenens
gigs across the Midwest. So ultimately these last for days
or weeks at a time. Over the years, he works

(16:30):
in dozens of hospitals in Indiana, in Ohio and Iowa,
in Wisconsin, he's kind of a traveling doctor, and over
the course of about twenty years, as you say, he's
sued for malpractice, all cases which he says were without
any basis. He says he was a victim of an
out of control malpractice lawsuit system and predatory lawyers and

(16:55):
patients who were looking for a quick payout. And I
include that version of the story in the book, of course,
But as I always do because I'm a journalist, I
tracked down these cases and the people involved in them
when I could to see what they said, and once
again they told a very different story. In one tragic case,
a young pediatrics patient who was about a year old

(17:17):
died from what a jury agreed were Volkman's actions, which
I can talk more about that. In another case, a
woman's arm was amputated from the below the elbow. In
another case, a young guy was left with permanent brain
damage from what was argued to be kind of negligence
on Volkman's part. So these were really serious cases where

(17:41):
people had really serious injuries, and the facts, as I
determined them, were much more incriminating than Volkman let on.
So all of this happens, and by two thousand and
three the lawsuits add up enough where malpractice insurers notify
him at some point, and it's unclear he gave me
differing acc whether his rates became too high that he

(18:03):
couldn't afford them, or he was actually like kicked out
of malpractice insurance entirely, it wasn't clear, but the result
was he couldn't get malpractice insurance. And so he's in
his mid fifties, he's living on Lake Shore Drive in
Chicago with a rent of four five hundred dollars a month.
He has a lot of expenses, and he's virtually unemployable

(18:25):
in most medical settings. And after kind of some desperate scrambling,
he finds an ad online for a cash only pain
clinic in the Appalachian part of southern Ohio on the
on the Ohio River, and malpractice insurance isn't required, and
that's how he winds up in southern Ohio.

Speaker 1 (18:46):
And this clinic that Volkman ends up joining already existed
at this point. What can you tell me about the
beginnings of tri State Healthcare and Denise Huffman? Like, how
was Denise, with someone without any any medical credentials whatsoever,
able to open a cash only pain clinic.

Speaker 2 (19:06):
Yeah. So, well, preface is by saying, you know, there
were a lot of things that kept me motivated on
this story for more than ten years. One. The facts
were just astonishing. They remained astonishing to me even after
the book is out and I've processed this all, Like,
this is why I write nonfiction, not fiction, because if
you read this in a novel you might not believe it.

(19:26):
Denise Huffman, who started the clinic that would ultimately hire Volkman,
was a native of eastern Kentucky. She had dropped out
of high school knock gone to college. I had no
medical training. She had worked in fast food restaurants and factories,
although her employment history is a bit murky, as are
a lot of things about her life. She was a

(19:47):
contrast to Voltman spoke to me virtually endlessly for the book,
first in person before his trial, then via email and
letters after his trial. Denise Huffman did not really speak
to me at all. I had to kind of cobble
together her story from legal documents. But according to Denise,
she's started this non hospital affiliated pain clinic. Again, she

(20:11):
has no medical background because it was a business that
she felt the area needed. The area is this region.
First she was in Kentucky, but it's kind of where
the rust Belt and Appalachia overlap. Used to be industry
around here. Most of that is long gone, and by
this time, in the early two thousands, it's a really
poor place and has been for quite a while. If

(20:33):
you talk to people around here as to why Denise
here being southern Ohio eastern Kentucky. Why Denise founded this clinic,
It's because there was an existing model for how to
run this kind of business that was up and running.
This kind of high volume, prescribing cash only pain clinic,

(20:55):
you know, the so called pill mill that a few
people had and was kind of shown to work. Even
if the doctors and other people wound up going to prison.
There was money to be made there. And she seems
to have had some kind of connection personal professional with
one of the most infamous doctors who ran this kind

(21:16):
of clinic in the region. So she says it was
a good clinic that the people who were in pain
in the area needed. Other folks say no, if she
saw the writing on the wall, she was kind of
an understudy of this crooked doctor and started her own operation.
But that's who Denise Huffman was. She turned it into
a kind of a family business. Her daughter went to
work for her, managing the day to day operations. Some

(21:38):
of her nieces worked there as medical assistants and nurses.
The first few doctors she hired, more than one of
them ran into issues with the Kentucky Board of Medical Licensure.
I tell those stories in the book. At a certain point,
she hops over the river to Portsmouth, Ohio and finds
doctor Voltman online. And so this odd couple, big doctor

(22:00):
with an impeccable resume, at least on paper, and this
woman who's a native of Appalachia, who's you know, doesn't
have any kind of training or much education. They wind
up partnering up in a sense. She's the clinic owner,
he's the doctor, and that partnership would last for more
than two years.

Speaker 1 (22:18):
This ultimate success of the Tri State Healthcare clinic. It's
not unique in itself, and it really does fit into
this larger context of painkillers in the early two thousands.
Can you talk a little bit about that and where
these pill mills, including Tri State Healthcare sort of fits
into the growing awareness of pain during this time. As

(22:40):
the quote unquote fifth vital.

Speaker 2 (22:42):
Sign, Volkman's crimes took place between two thousand and three
and two thousand and six, and that places them squarely
and kind of the early years of the opiate epidemic.
I mean literally, if you look at grafts from the
CDC about death student opiates, they break it down into
three eras, the prescription era, the heroin era, which is

(23:03):
largely seen as a result of the crackdown on prescribing,
and now we're in this ventanyl era, So these are
pretty early years. This is less than a decade after
the arrival of OxyContin, and the story of what happened
around OxyContin, which I describe as kind of the big
bang of the opiate epidemic, the wildly inappropriate and cynical

(23:28):
ways that those drugs were marketed, and the kind of
misinformation as marketing that was spread about the supposedly low
risk for addiction, and the much wider uses for these
really strong opiate medications than anybody previously thought. That is
well documented in books by Barry Meyer and Sam Canones
and Patrick brad and Kief and the excellent documentary Crime

(23:52):
of the Century by Alex Gibney on HBO. As a
side note, Vokeman, for kind of unclear reasons, preferred to
prescribe eric oxycodone, so he really didn't prescribe the brand
name OxyContin. So this actually isn't an OxyContin story per se,
but any story involving opiates and over prescribing in this

(24:12):
era as an OxyContin story, because they're the ones Purdue
Pharma who really got this whole mess rolling. So Volkman,
as a guy who even to this day from federal prison,
having been convicted of drug dealing, maintains he was treating
pain and being compassionate and being professional and helping people,

(24:34):
is really a man of his era. In that the
era you described to the fifth vital sign, this was
a moment when the winds of change were really blowing
in the direction of let's treat pain more aggressively. The
fifth vital sign, for folks who don't know, is this
campaign to treat or assess pain upon a patient's arrival

(24:55):
in a healthcare setting like you would their pulse or
their blood pressure, their temperature, even though critically pain is
not measurable independently like those other things, which makes it
more complicated. But it was a time when the medical
world was trying to shift, and culture generally was shifting.

(25:16):
A piece of kind of trivia that I found in
my research was that Congress actually included in a bill,
an unrelated bill, the distinction that the decade from two
thousand to twenty ten would be dubbed the Decade of
Pain Control and Research. This was and state legislatures were
passing laws protecting doctors who wanted to prescribe opiates. This

(25:39):
is all the context in which this case unfolds, and
we now know that it was an era when a
lot of actors, be they corporations, be they doctors, distributors,
even McKenzie the consulting company, kind of used this cloak
of treating pain, of relieving to make a lot of

(26:01):
money and to cut corners and ultimately to cause a
lot of damage in the process. It's this unimpeachable idea. Right,
I'm not against treating pain, right, who is against relieving suffering?
But that cause, which had this new momentum at the time,
gave cover for a lot of bad actors, and Paul
Holtman was one of them.

Speaker 1 (26:22):
Let's take a quick break here. We'll be back before
you know it. Welcome back, everyone, I'm here chatting with
Phil ele about his book Prescription for Pain. Let's get

(26:45):
into some more questions. After Volkman moved to Ohio, he
didn't fly under the radar for too long. What were
some of the immediate red flags that popped up when
he started working at tri State that very clearly showed
that he was involved and at drugs for money scheme.

Speaker 2 (27:02):
First off, he continues to live in Chicago. Another you know,
the odd couple nature of his relationship with Denise fascinated me.
And the fact that he lived in Chicago and was
commuting on a weekly basis, went down on Monday, return
Friday to a town four hundred miles away in southern Ohio.

(27:22):
So that's a key part of this story, right, just
the distance. And I think he was used to traveling
from his years as a local tenants doctor. But there
were people who were so upset with him during his
time in Ohio, one of whom told me, she said
to him, you need to go back and start this
clinic in your neighborhood in Chicago. That was the kind
of vibe it was, anyway. So he gets down there

(27:45):
and almost immediately pharmacists are which the clinic needed at
that time to fill their prescriptions, are alarmed by the
prescriptions he's writing. They strike the pharmacists, many of whom
would later testify a Volkman's trial as excessive, as dangerous
as it was sketchy the number of patients who would

(28:05):
kind of arrive at pharmacies and waves, or their willingness
to pay cash, or the fact that many of them
seemed young and pretty able bodied for people who were
filling prescriptions for opiate painkillers and sedatives like Valley and
the muscle relaxers. So kind of one by one the
local pharmacists say we don't want any part of this.
We're not going to fill these scripts. This is within

(28:25):
months of Vulkman arriving. Volkman, you may get a sense
of his personality, says this is a result of their ignorance,
or their corruption, or some collusion on their part against him. Certainly,
isn't his prescriptions which according to him or by the
book and completely appropriate. So he's not, you know, thrown
off course, and he and Denise do something that at

(28:48):
the time was legal. They submit an application to the
Ohio Board of Pharmacy to establish an on site dispensary
at their clinic. I think this is designed. The law
was designed for rural doctors who maybe had to write
an occasional script every now and then, and it was
convenient for them to just be able to give it

(29:10):
to patients on site. I don't think these laws were
designed to open up a kind of massive in terms
of the amount of pills moving through dispensary on site.
But that's what this became. The Ohio Border Pharmacy gave
this clinic the green light, and that's kind of when
the floodgates opened. This turned their clinic. This was within

(29:31):
months of Volkman arriving down there, into a one stop
shop again all cash, where patients could see the doctor,
receive their prescriptions, literally walk down a hall and get
those scripts filled. That this kind of ad hoc tossed
together pharmacy which was dispensing enormous amounts of medication. Volkman,

(29:53):
from this small clinic in a small town in rural
Ohio became the single largest per to serve oxycodone in
the country for the year two thousand and four. That
was the kind of volume he was writing and dispensing,
and the clinic operated like this as a one stop
shop for again a couple of years. Pretty soon the

(30:14):
DEA got wind of it through various ways, complaints by
pharmacists by other people, and they start an investigation within
a few months, but it would take quite a while
for that investigation to I guess acquire enough momentum where
they felt they could shut them down.

Speaker 1 (30:29):
Part of that momentum was when some of Volkman's patients
began to die from what appeared to be drug overdoses
happening on a regular basis. Really, and what finally then
led to this dea raid on the clinic in two
thousand and five, And what did they find that was
quote unquote highly unusual, I guess to put it mildly.

Speaker 2 (30:53):
I don't know if I ever learned what the exact
inciting incident was for that raid in two thousand and five,
but they had been collecting enough information at that point.
So there were complaints from local pharmacists before Volkman and
Denise started the dispensary. Then when the dispensary got up
and running, there were complaints or at least red flags

(31:14):
thrown by medical distributors who were filling their orders and
saying we've never seen orders of the size for ox codo.
And then of course there were the deaths, as you mentioned,
I never got an exact number of how many deaths
investigators looked into. I was told it was over thirty
deaths that they at least explored, and they ultimately found

(31:37):
enough of a connection where they mentioned fourteen patient deaths
in Voltman's indictment. And this is in a place, by
the way, I should note that at the time of
Volkman's arrival already had an established problem with addiction overdoses opiates.
I found a clipping from a local newspaper from two

(31:58):
thousand and three, the year here arrived, where mayoral candidates
in Portsmouth were debating whether the city deserved the nickname
the OxyContin capital of the world. So that's the place
he arrived in. And so he's at this clinic and
the Dea swoops in for the first of more than
one raid in the summer two thousand and five, and

(32:20):
a lot of people show up and they videotape it,
and that tape is shown at Bolkman's trial, and I
ultimately get my hands on it, and they find well,
they find guns. There's a number of guns at the clinic.
There are guns upstairs in an office, a rifle on
a floor. There's another gun leaning against the wall. This
is all visible in the video. There's a handgun behind

(32:41):
the counter at the dispensary. Inside the dispensary there are
stacks of pre filled and labeled bottles that kind of
like an assembly line operation. These are just kind of
ready to go. It doesn't really seem like the kind
of place that would be offering specific, highly tailored medical care.
If you know, these bottles of ninety oxycodone or valium

(33:05):
are just kind of ready to go. According to some testimony,
there you'urine sample cops that are visible kind of lying around.
It's a mess and a really sketchy operation, to put
it mildly. I mean, I've seen the video and it's
just kind of mind boggling. And yet after that day

(33:26):
in the summer two thousand and five, Volkman is not
shut down. He continues to practice. He is again undaunted
by the fact that the Feds have come in and
you know, taken a whole bunch of paperwork and you know,
rated the clinic essentially, and he goes back to work,
back to what he's doing. The show continues, and the

(33:47):
money keeps pouring in, and more people continue to die
after that point.

Speaker 1 (33:51):
Yeah, and so then he's still there despite this, like
you said, just kind of unbothered in a sense. How
did he eventually get arrested? Like what ends up happening
where it's like, okay, this is it now, Like we
had this raid, we have more evidence, enough is enough,
and then he you know, gets finally arrested for his crimes.

Speaker 2 (34:12):
In one sense, I don't really have an answer to
what the tipping point was, because I think it's an
open question and a good question to ask. Why did
it take the DEA nearly three years to shut this
guy down? He starts in April two thousand and three,
red flags are there from the start, and he isn't
shut down. And by shut down I mean the DEA

(34:34):
formally suspends his registration to prescribe controlled substances until February
two thousand and six, nearly three years after he started.
So I think people should ask, even though I think
Volkman deserved to be taken down by the DEA, and
I think overall it was good that they took him
off the streets. You know. One of the first articles

(34:55):
about this case was in the Columbus Dispatch, and they
kind of asked what took so long? The headline was
more dyed as three year probe unfolded. So I don't
really have an answer to why it took that amount
of time, but I can say that Volkman was not
chastened by this rate of his office in two thousand
and five. In fact, his behavior became even more outrageous.

(35:17):
Within a couple months, his relationship with Denise sours and
they part ways, and Volkman decides, while he's looking for
a new office, to try to run a pain clinic
out of his house that he was renting in Portsmouth,
you know, a quiet, out of the way residential street

(35:37):
in a quiet town. He opens up or attempts to
open up a really high volume, both in terms of
the number of people coming in, the number of scripts
going out pain clinic, and it just wreeks havoc on
this neighborhood. You know, the street clogs up with cars.
People are milling around on the front yard, on the

(35:59):
backyard because there's no sign on the house. They're knocking
on the neighbor's door asking for the doctor at odd
hours of the day. There's a guy with a gun
who's a security guard wandering around. It's total chaos. Even
Volkman's defense lawyers at his trial use the term chaotic
to describe it, which you know, it's chaotic if your

(36:20):
defense lawyers are going to say, yeah, those couple of
weeks were chaotic. Oh. Another extraordinary moment is when the mother,
the desperate mother of a patient of his, the patient
who was in recovery from addiction before going to Volkman's clinic.
She's literally fearing for his life knowing about this doctor.
She's a guard at the local prison, barges into the clinic,

(36:44):
kind of elbows her way into a room where this
is a clinic in the house where Volkman seeing a
patient and threatens him says, basically, I have a gun
in my car. If you don't stop prescribing to my son,
you know I will use it. This is the kind
of environment of Volkman's operating in. Would testify at his
trial and tell that story, but again that gets shut

(37:05):
down by the local police. He's still not ready to stop.
He finds a new office space about an hour north
in a town called Chilicothee, and for four or five
more months continues to operate until again I don't know
what the exact calculus was, except the DEA finally decided
it had what it needed to initially suspend his registration.

(37:27):
And look, there are good reasons why the DEA needs
to present evidence before they can just yank a doctor's
drug registration. You know, that's a person's livelihood. But it
certainly does beg the question of what took so long?
But by February two thousand and six, they had what
they needed and they raid his office for the last time,

(37:47):
suspend his license to prescribe controlled substances, and then a
little over a year later, a federal indictment follows in
two thousand and seven.

Speaker 1 (37:55):
While researching for this book, and you've mentioned this throughout
our conversation, you were able to spend a lot of
time communicating directly with Volkman through you know, in person chats,
through email, through letters, and you talked about how his
version of events often appears very different than the version
of events that other people tell or that is just

(38:17):
as laid out in the facts. What patterns did you
see in his telling, Like, do you think that he
truly does see himself as a victim?

Speaker 2 (38:26):
Yes, oh absolutely. He says as much in an open
letter that he wrote from prison in twenty eighteen that
was published on a blog that's sympathetic to the plight
of doctors convicted for prescription drug dealing. He literally says,
I'm a victim in this story. And that's kind of
a distillation of his view of his entire life story.

(38:49):
The most prominent trend in his telling is he's a victim.
Not only is he a victim, but you know, he
was a good guy doing helping people. According to him,
these were people in chronic, severe pain for whom other
treatments had failed, who were kind of at their wits end,

(39:11):
whose lives had been severely harmed by these injuries or illnesses,
and that he was the only doctor with the brains
to know how to treat them and the guts to
prescribe these stigmatized medications of opiate painkillers, and as he says,
basically give them their lives back. That is his version,

(39:32):
and so in his telling, he's been railroaded by the
federal government. The DEA is a corrupt, out of control
agency that, in its zeal to prosecute the war on drugs,
found doctors to be a more appealing target than traditional
street corner drug dealers and started going after innocent doctors.

(39:53):
And he was one of them. If for him, it's
a story of a grave injustice that he is that
he was charged in the first place, and that he
was convicted and sentenced to life in prison. I found
that stance to be unwavering in my years literally of
communicating with him. He's not a guy who's prone to

(40:14):
admitting really any kind of fault. He has an extremely
high view of himself in terms of his intelligence, in
terms of his morality, and an extremely low opinion of
a lot of other people who he seeses his antagonists,
and that list came to ultimately include me, you know,
the son of his former classmate, who showed up with

(40:36):
a tape recorder in a notebook, and who wound up
publishing first a magazine article that wasn't to his liking.
And I haven't heard from him since I published the book,
but I know he didn't approve of a much shorter
magazine article that told what I thought was the accurate story.
So in a lot of ways, the book became a
character study of an exceedingly bright guy who just sees

(41:00):
the world fundamentally differently from virtually everyone around him. At
his sentencing in twenty twelve, said I have no apologies
to make and called the judge a heinous criminal. At
that point, Volkman's lawyers had backed off the case, as
a number of lawyers for him had done previously, and

(41:22):
he was representing himself, and he told the judge that
she was the criminal, not him. And some folks have
understandably asked in my book events, you know, was he
using the drugs himself, or did he have a gambling addiction?
Or was he trading pills for sex? You know, there
have been a lot of doctors convicted of prescription drug

(41:42):
dealing during the opiate epidemic, and you when you look
at some of these cases as I have, you see
those things. You see the tales of the doctors who
were using drugs themselves, or who were, you know, trading
pills for sex, or who were gambling whatever. I say that,
I think this book would have been a lot thinner

(42:04):
if when I scratched the surface, I found that it
was a fairly kind of traditional vice that explained Voltman's behavior,
but there was no real evidence of that. Instead, it
became a story, a much more complex story of a
guy who, more or less in his right mind, or
at least not under the influence of anything I could tell,

(42:26):
did this and did this for nearly three years. I mean,
this is the very opposite of hot blooded crime that
happened in an instant. Not only did this guy do
this conduct for three years. He was commuting for hours
each way every week and had plenty of time to
think about what he was doing. So that is really

(42:47):
what interested or that's one of the things that interested me,
is how does that happen? What does it look like
when a person thinks that way.

Speaker 1 (42:56):
Another thing that makes Volkman stand out among these other
physicians who have been convicted of illegally prescribing opioids is
his sentence.

Speaker 2 (43:08):
Yeah, out of all of the doctors, and I've seen
estimates as high as there have been a few hundred
convicted over the course of the opiate epidemic, and virtually
every state has at least one case of a doctor
who broke bad and was convicted of crimes during the
opiate epidemic. I looked really hard to see if there

(43:30):
were any sentences that matched or exceeded his sentence of
four consecutive life terms, and I did not find any.
It's a high water mark. And you know, there are
reasons for that that I can get into a little bit,
but just to start, it's one of the many things
that makes this case stand out. I would also say
that I didn't really find many, if any other cases

(43:51):
involving an mdphd. And I should add that Vulcan's PhD
was in pharmacology and toxicology, so it wasn't in some
unrelated field. It was literally in the discipline of drugs
and how they affect the body.

Speaker 1 (44:06):
Ultimately, both Volkman story and this larger story of the
opioid epidemic, they're true crime stories with villains like Volkman
and with victims. In your process of writing the book,
how did you go about making sure that the experiences
of those harmed and exploited by Volkman were represented or honored.

Speaker 2 (44:28):
Here's another you know my book events, I'm always saying,
and that's another reason why this took me over ten years.
This was a thing that I really didn't want to
rush again. Like we said at the beginning, I was
twenty three years old when I started this. I hadn't
published a book. I hadn't even published any of the
in depth reporting on serious subjects that I would do

(44:50):
later on in my career. And I knew that this
was an exciting story one, but I also knew that
it was a really serious story. To me, as a
jar lists, there is no bigger responsibility than telling a
story of somebody who's no longer here to tell their
own story, and or somebody who's been the victim of

(45:12):
a serious crime. And in this case, there were many
of those people. There were fourteen of those people, And
we could go on a whole long detour about true
crime stories. I got really obsessed with true crime as
a genre as one of the ways of kind of
working through my anxiety about how I would try to
pull off this story. You know, I would read a

(45:34):
lot of books, and watch a lot of documentaries and
listen to a lot of podcasts. And the good ones
inspired me and helped steer me in the right direction.
And the bad ones, and there are many of bad ones,
or at least flawed ones, gave me a long list
of things I didn't want to do. And one of
the things I didn't want to do was flatten the
lives of the people who died in this story, or

(45:58):
sensationalized the story, or you know, stigmatize these people or
you know, demean to them in any way. And there
was actually a helpful reminder within the story itself of
how not to do it, because Volkman himself clearly did
not see these people as three dimensional people. I mean

(46:19):
there was an email that was presented during his trial
that he wrote at the time he was doing this work,
in which he said most of his patients were hillbillies.
You know, that's the word I would never ever use
to describe these people, and certainly don't in the book.
So telling the story right, and by right, I mean
in a way where the loved ones of these people

(46:41):
didn't feel disrespected, where the community itself of Portsmouth and
southern Ohio and Appalachia in general didn't feel disrespected. This
is a region that's been maligned so many times in
popular culture and in the press, and I was well
aware that I was the caricature of the East Coast
journalists driving in from out of town. You know. I

(47:04):
didn't want to be one of those people who just
looked down his nose at this place and maybe went
once or twice and then went home to write a
story that fell into some of the worst tropes. So yes,
I took the responsibility the task of writing about these
victims really seriously, and I tried to speak with as

(47:25):
many of their loved ones as I could and get
as much detail about their lives as they could. Not
just their tragic final moments, but also who they were
as happy, healthy people, because that's an important part of
their story too, So yes, that was really important to me.

Speaker 1 (47:43):
One of the key aspects of this story, and it's
something that we've kind of touched on already, is that
it's not just one rogue doctor taking advantage of a
broken system. Along Volkman's journey, are so many individuals and
organizations that are complicit in this, enabling him, like the
pharmacist Fletcher that you mentioned who filled Volkman's suspect prescriptions,

(48:07):
Like the manufacturers of the meds who lied about their
addictive potential, Like corrupt officials who turned a blind eye
to the pain clinic, like the system that allowed an
unqualified person to operate a cash only pain clinic in
the first place. And we already asked this kind of
unanswerable question of why did it take so long? And
I suspect that this is part of it, is that

(48:27):
there were so many moving parts for Volkman's crimes to
eventually not just come to light, but be actually dealt with.
But the question that I want to ask is is
what measures have been put into place to prevent this
or at least reduce the chances of this happening again.
And where is their oversight potentially still lacking.

Speaker 2 (48:49):
I'm speaking to you from Portsmouth, Ohio now where I'm
here for a book tour, and at both the city level,
the Portsmoth is where most of the events of the
book took place, and the state level, they passed laws
to close loopholes that clinics like this exploited. There are

(49:10):
laws on the books now where I think it's according
to the city ordinance. Owners of the clinic have to
be doctors, are involved in the medical field. Clinics need
to be affiliated with a local hospital or educational institution.
Just those two things right there would have made a
clinic like this impossible, I believe. At the state level,

(49:30):
Ohio was one of a few states that passed a
so called pillmill bill. Florida was another. I think Tennessee
was another. Coincidentally, this law was signed a couple weeks
after Volkman's trial ended. That just happened that way, so
the state was well aware of issues around pain clinics,
and the Ohio Sate legislator voted unanimously, which is not

(49:54):
super common, to pass this bill. Putting a lot more
oversight clinics like this. What's interesting is that was in
twenty eleven, But if you go back to the nineties,
a lot of state legislators passed the laws making it
easier for doctors to write opiate scripts. And whether these
were genuine responses to the kind of cultural shifts we

(50:18):
talked about earlier, or whether there was like Purdue pharm
A lobbying behind the scenes for such a law, I
don't know. But Ohio was one of those states. And
I know this because Voltmann is part of his story
of what he tells was that he was following the
Ohio Intractable Pain Act to a tee and he felt
because he was following this stay law, which by the way,

(50:39):
I don't think he was actually following. You know, the
DEA should have never come in and did what they did.
So there are laws on the books in Ohio and
elsewhere that prevent clinics like this from happening. That's in
some sense the good news, I mean they're not so
good news is that we now know cracking down on
the flow of prescription medications did not end the opium epidemic.

(51:01):
It just prompted a shift in the opiate epidemic initially
to heroin and out to the horribly dangerous fentanyl, and
we saw deaths. I mean, recently, thankfully, there's been a
leveling off and a dropping of fatal overdose numbers at
the state level and nationally. But for many years, including
through to the pandemic, those numbers of fatal overdosees just

(51:24):
kept climbing up and up and up. So that is
one thing I would say in terms of areas for oversight.
There were whole sections of the book about the DEA
that wound up on the cutting room floor. The Washington
Post in sixty minutes have done some great reporting on
ways the DEA could have done better with the opiate epidemic,

(51:46):
the culture of kind of revolving door between officials at
the DEA and the pharmaceutical industry, and the negative effects
that that has. The refusal of the DEA to lower
the national quotas for opiate manufacturing. Scathing report by a
Republican Attorney general in West Virginia pointing at the DEA's
refusal to the DEA, among its other responsibilities, basically decides

(52:10):
how much of a given controlled substance the entire country
needs via these kind of manufacturing quotas. And even when
alarm bells were going off well into the opiate epidemic
and people were pleading with them to lower the quotas,
knowing that simply, you know, the downstream effects of more
opiates would be bad on the ground level, they didn't

(52:31):
do that. And if folks want some interesting reading, the
West Virginia Attorney General's report is remarkable. He says, again
a guy in a red state, a law enforcement official,
that people died as a result of that. But the
DA is just one area. I mean, the FDA fell
asleep on the job. That's portrayed in stories about OxyContin.

(52:52):
Academic medicine has a lot to answer for. The causes
of this man made crisis are numerous. One thing I
often mentioned is that I focus on a doctor who
was convicted, and I'm not here to say Volkman didn't
deserve to be convicted. I think he did. But if
you zoom out, you see that dozens hundreds of doctors

(53:13):
were convicted of criminal activity, but very very few drug
distributors or pharmaceutical companies faced criminal charges. Of course, they've
been sued to the ends of the earth. And back,
and they've paid out enormous amounts, but again, very few
of them faced real criminal charges. So I think the

(53:36):
opiate epidemic is a story. I mean, yes, doctors are
white collar crime, but there's kind of white collar crime
above them that really didn't get prosecuted. And it makes
me think of the financial crisis, where virtually no one
faced criminal charges for this massive man made crisis. So
I think one of the lessons of the opiate epidemic

(53:56):
is I came away thinking we really don't take white
dollar crime all that seriously in this country, and there
were people and organizations higher up in the chain than
doctors who probably deserve some of that.

Speaker 1 (54:12):
Going back to Volkman specifically, what lasting impact do you
think that he has had on medicine, on Portsmouth, on
how prescriptions are regulated, like how much did he impact
those things? Or maybe just a broader question of what
can we learn from volkman story.

Speaker 2 (54:31):
In some ways, this case stands out for reasons I
described because it took place in one of the worst
hit areas of the country for the opiate epidemic, because
of Volkman's level of high education, the MD, THEPHD, because
of the sentence. But in many ways he was just
one of many doctors, and that was what interested me
about this story. As a reader and as a writer,

(54:52):
I am drawn to stories that tell a bigger story
through the individual particulars of one case. And another thing
that I'm not sure i've is that Volkman, as part
of his staunch insistence on his innocence, refused to take
a plea deal, which was unlike most of the other
charge doctors. Some of them went to trial, but most
of them did not, but he did. And so there

(55:13):
were seventy prosecution witnesses called and ten defense witnesses in
this trial took place in federal court over eight weeks
in Cincinnati in twenty eleven, and as a result, there
was a four thousand page transcript that I ultimately got
my hands on that was just invaluable to me in
writing this story. So again, one of the reasons this
case stands out is because we can see it all

(55:35):
the more clearly because of that testimony that took place
in open court, all of which, by the way, as
a result of Volkman's arrogance and insistence that he's right. Like,
there were so many ways where I as a storyteller
benefited from his arrogance because he was willing to speak
to me at length because he refused a plea deal.
It's kind of ironic or something that his story got

(55:57):
told in so much more granular detail because of his
own kind of belligerence. Not to be too cute about it,
but maybe this is old news to your listeners. But
I learned, or at least on a gut level, I
will never forget that Volkman's brilliant test scores and intelligence
and educational pedigree did not prevent him from doing heinous things.

(56:23):
And if anyone needs a reminder of that that mdphds
from University of Chicago and high school valedictorians can commit
awful crimes, well, my book is an example of that.
It's a lesson also in how a certain kind of
psychology or a person with a certain kind of psychology
can move through the world and the damage that that

(56:45):
person can do. I mean, one of the most couple
of the most memorable conversations I had for this book
with Volkman's two adult children, both of them wound up
being estranged from him because he's kind of an impossible
person to interact with. Having said all that, one of
the reasons I'm so excited to be on your podcast

(57:06):
is because I didn't necessarily write the book because I
knew what all the lessons would be to take away
from it. I'm not an MD, I'm not a PhD,
I'm not a pharmacist. I'm not a researcher. I told
the story, but I'm so eager for folks in those
worlds to read the book, not just because I want
people to read the book, but like and to apply

(57:30):
their own experiences and their own knowledge and hear what
they take away from it. So yeah, I have my
own lessons that I learned from it, but I want
to hear what people in med school say about it,
and people on state medical boards say about it, and
pharmacists because I think that again, that was one of
the things that interested me about the story. It wove

(57:51):
through malpractice and bankruptcy law and criminal law and pharmacies
and medicine, and there was just so much there that
I could say my teeth into, but I want to
hear what other people think about it.

Speaker 1 (58:22):
Phil Thank you so much for such an enthralling conversation,
and to our listeners, if you find yourself. Wanting to
know more about Volkman and his role in the opioid epidemic,
check out our website this podcast will kill You dot com,
or I'll post a link to where you can find
prescription for pain how a once promising doctor became the
pill mill Killer, as well as Phil's website, and don't

(58:45):
forget you can check out our website for all sorts
of other cool things, including but not limited to, transcripts
Quarantini and placy Berita recipes, show notes and references for
all of our episodes, links to merch our bookshop dot org,
affiliate account, our goods list, a first hand account form,
and music by Bloodmobile. Speaking of which, thank you to

(59:05):
Bloodmobile for providing the music for this episode and all
of our episodes. Thank you to Leanna Scuilacci and Tom
Bryfocal for our audio mixing, and thanks to you listeners
for listening. I hope you liked this bonus episode and
our loving being part of the TPWKY book Club. A
special thank you, as always to our fantastic patrons. We

(59:26):
appreciate your support so very much. Well, until next time,
keep washing those hands