In tiny Bath County, nine people have died since August from overdoses of powerful pain pills that were prescribed by Florida doctors, including a mother and son who died just five months apart.
"They were all that I had. I tried to watch them as close as I could," said Floyd Chapman, referring to his mother, Barbara Robertson, dead at 53, and his brother, James Chapman, who died at age 35.
Floyd Chapman said he attempted to dissuade the pair from joining thousands of Kentuckians who travel in cars, vans and airplanes to South Florida's pain clinics. Once there, people get monthly prescriptions for hundreds of painkillers like oxycodone. Increasing numbers of Kentuckians are dying as a result.
Drug policy officials in Florida and Kentucky have not tracked the number of overdose deaths along the Interstate 75 pill pipeline. But coroners, physicians and law enforcement officers who are starting to tally the numbers say they are alarmed.
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"It's epidemic. I don't know what the answer is. But it's got to stop," said Robert J. Powell, Bath County's coroner.
A combination of factors has led to the much-travelled Kentucky-Florida pipeline. Kentucky and 37 other states electronically monitor the number of narcotics prescriptions a person obtains from physicians. The Sunshine State has no such system. That has led to a proliferation of storefront medical clinics in Florida whose parking lots are filled with cars from Appalachian states and where doctors prescribe and dispense the often-abused drugs for cash.
A Herald-Leader survey of coroners in just three Kentucky counties — Montgomery, Rowan and Floyd — found that 14 people had overdosed on pain pills they obtained from Florida physicians in 2008.
Powell said that, in the past, he investigated about one fatal drug overdose a year in Bath County, where the population is just more than 11,000. Recently, he's seen about one a month.
Van Ingram, director of the Kentucky Office of Drug Control, said he is surprised at how quickly the problem has grown.
"I never dreamed that it would be as big as it turned out to be," said Ingram, who said the problem has intensified in the last eight months. "We are hearing of thousands of Kentuckians going to Florida to get prescriptions and ... people going in droves to pharmacies in states along I-75 to get the prescriptions filled."
Death on the road
Not all the deaths connected to the Florida pain-pill phenomenon are overdoses.
In January, a Morehead man and his fiancée were found dead in their car at a Florida rest stop. The cause was carbon monoxide poisoning.
Sgt. Chuck Mulligan, a St. Johns County, Fla., sheriff's spokesman, said he has no evidence that Kenneth Oldham, 23, and Kayla Hinton, 22, had drugs or alcohol in their systems. But in their black Volkswagen Jetta was a bottle of pain pills prescribed by a South Florida physician and filled by a pharmacy there just before they died.
Mulligan said he did not know whom the prescription was for, but the information about the pills has been turned over to police in South Florida.
Denise Hamrick, Oldham's mother, said she did not know her son was in Florida until police came to tell her that he had died.
Hamrick says she hopes Florida passes a law that would require a prescription monitoring system.
"I think all states should pass the laws," Hamrick said.
At least one murder has been linked to the interstate pipeline. Brent Conn of Rowan County died of an overdose in a Florida motel room in 2007 after traveling to Florida in a car with Timothy Riggs of Bath County.
Conn's father, James Kent Conn, blamed Riggs for his son's death. He hunted Riggs down and shot him to death. In September, Conn was sentenced to 45 years to life in prison.
John Riggs, Timothy's father, said his son was addicted to drugs. "Every time I turned around, he was going to Florida," Riggs said.
Now, two families have been damaged irreversibly by the pill pipeline.
"It's ruined my life. It ruined Mr. Conn's life, too," Riggs said. "Everybody's paying, paying for something they are doing in Florida to make the almighty dollar."
'A beautiful future'
Kentucky has a long and troubled history of prescription drug abuse. People seeking pain pills to use themselves or sell to others illegally know that the Kentucky All Schedule Prescription Electronic Reporting system, known as KASPER, will track those prescriptions. So many of them travel out of state to avoid that scrutiny.
Because Florida is one of 12 states that don't have a tracking system, it's a popular destination for importing pain pills. In some cases, drug dealers provide cash for addicts to pay for the pills in Florida. The couriers buy pills for themselves, and the dealers sell the rest when they return to Kentucky. Patients report that most South Florida clinics and physicians' offices accept only cash.
Doctors charge a few hundred dollars for an MRI that justifies the prescription and, in many cases, the drug seekers get monthly prescriptions for as many as 300 pills filled at the clinics without ever having to go to a pharmacy.
The Miami Herald reported that in the last six months of 2008, doctors at Broward County's pain clinics handed out more than 6.5 million pills of the potent painkiller oxycodone. There is little regulation of the Florida clinics. And the newspaper found more than a dozen South Florida doctors with criminal or disciplinary records dispensing pills.
"Florida needs a law tracing when people get medicine," said John Copher.
Copher has a reason to believe that. His son Roger Dean Crouch, 27, of Salt Lick died Feb. 26 of an overdose of pills he received from a Florida doctor 10 days before.
"He had a nice home, a beautiful wife and a little girl," Copher said of his son, who lost his job because of his addiction. "He could have had a beautiful future.
"I think the Florida doctors should be held responsible for the deaths."
Copher suspects that Crouch split the pills with a dealer who subsidized the trip.
'A lot of pain'
Many pill seekers become addicted to drugs after they are prescribed for legitimate pain needs.
Chapman, whose mother and brother died from overdoses, said his mother at first sought prescriptions because she had pain from a degenerative spine condition and carpal tunnel syndrome.
"She had a lot of pain," he said. "I guess she just became immune to the medication."
Relatives of those who have died of overdoses are hoping that lawmakers will come up with a system that will make it more difficult to go out of state to get the drugs.
A law creating an electronic monitoring system is working its way through the Florida legislature, where similar legislation has failed for the past seven years. Kentucky Lt. Gov. Daniel Mongiardo, a physician from southeastern Kentucky where the problem is especially pronounced, plans to go to Florida to testify before the General Assembly.
Mongiardo said it's imperative that all states have electronic tracking systems.
"If you stop doctor shopping in one state, they find another source," Mongiardo said. Narcotics obtained in Florida, he said, "are killing people and driving up costs in emergency rooms."
Cindy Estep, a teacher at Rowan County High School in Morehead and the mother of Brent Conn, an overdose victim, has started a Web site to educate others about the prescription drug pipeline.
"The drug dealers are running organized crime syndicates, and the sentences aren't tough enough," said Estep. "Passing a law in Florida for a tracking system is a start."
Federal and state authorities in both states began launching criminal investigations into drug syndicates involving patients and doctors a few years ago. Last month, nine Kentuckians and a former Florida doctor were sentenced in U.S. District Court for taking part in a conspiracy to distribute oxycodone pills.
Several of the Kentucky defendants went to Florida numerous times from January 2007 to January 2008 to get prescriptions from Roger Browne, 52, a former doctor in Coral Springs, Fla., according to court documents.
Police found files on 500 patients from Kentucky in Browne's office.
Pills in their pockets
The travel between the two states is one reason that Kentucky officials say tracking the deaths is difficult.
Floyd County Deputy Coroner Roger Nelson, who investigated five overdoses of prescription pills from Florida in 2008, said one man from the county died in Georgia as he traveled back to Kentucky.
"I don't see how a bona fide doctor can give somebody all those pills with refills," said Nelson. "It doesn't take an Einstein to figure out what's going on."
Laurel County Coroner Doug Bowling said he investigated a case recently in which a Madison County man died of an overdose in a car in Laurel County after filling a prescription from Florida.
Florida, meanwhile, has seen a 107 percent jump in oxycodone deaths in two years, the Miami Herald reported last week. Florida officials didn't know how many of the dead were Kentuckians. But the newspaper has reported two Kentucky deaths recently.
Dr. John Robert Morgan, an emergency room physician at St. Claire Regional Medical Center in Morehead, told the Herald-Leader he sees at least one overdose case — sometimes two — each week involving patients who have made a trip south. Some survivors overdose again, he said.
"We are pulling prescriptions and pill bottles from Florida out of their pockets," Morgan said. "If this many people from Kentucky were going to Colombia bringing back drugs that were killing people all over the state, there would be an outcry. But not enough people see this problem as an issue."