Photograph courtesy Philip Eil
On Valentine’s Day 2012 in a federal courtroom in Cincinnati, a medical doctor was sentenced to four consecutive life terms in prison. Paul Volkman, then 65, had committed his crimes working at cash-only pain clinics in Portsmouth and Chillicothe between 2003 and 2006.
Prosecutors alleged that Volkman had unleashed a torrent of controlled substances (opiates, tranquilizers, and muscle relaxers) in a region already struggling with addiction and that this activity led to the overdose deaths of more than a dozen patients. After an eight-week trial in 2011, jurors—who convicted Volkman on nearly all of the drug-dealing charges he faced—held him directly responsible for four of those deaths. Hence the four life sentences.
It was a major moment for the Buckeye State, and it also had national significance. Although there have been dozens of doctors convicted of illegal activity related to opiates in recent decades, no sentence matches or exceeds Volkman’s.
His sentencing was also a noteworthy moment for me personally. Back in the 1960s and ’70s, he’d gone to both college and medical school with my father. And Charles Eil, M.D.—a nerdy, soft-spoken endocrinologist—is one of the last people you’d expect to know a guy convicted of such horrific crimes. When I learned about this connection, I was shocked and fascinated. My dad, who had mostly lost touch with Volkman, couldn’t account for how his old classmate had “broken bad.” And, as a young journalist, I found the mystery irresistible. What on Earth happened to this guy?
Photograph by Grant Moxley
By 2012, I had interviewed Volkman extensively, traveled to southern Ohio repeatedly, and generally tried to make sense of a bewildering story. How does a high school valedictorian become, in the words of a Drug Enforcement Administration agent who worked on the case, a “murderous drug dealer?”
In 2017, I wrote a feature story for this magazine about Volkman’s case. And I expanded on the story further with a book, Prescription for Pain: How a Once-Promising Doctor Became the “Pill Mill Killer,” published by Steerforth Press in April. When I returned to Cincinnati in May for an author event at Joseph-Beth Booksellers, the audience included a prosecutor who worked on the trial and DEA agents who’d handled the investigation.
Prescription for Pain is my attempt to place Volkman’s story in its full context. Because I interviewed him over more than a decade, I draw heavily on his version of his own life story, including his account of what happened in southern Ohio. (Now 77, he’s doing his time at a federal prison in Tucson, Arizona.)
Unfortunately the doctor is, to put it mildly, an unreliable narrator. And throughout the book, I offer a detailed and exhaustive fact-check of his tale, based on documents, on-scene reporting, and interviews with more than 100 people.
I also spend a lot of time discussing Portsmouth, where most of Volkman’s crimes occurred. By now, the city’s overdose crisis has been featured in The New York Times, Men’s Health, the Canadian Broadcasting Corporation, and Al Jazeera. In 2015, Sam Quinones made the region a focal point of his book, Dreamland: The True Tale of America’s Opiate Epidemic. In 2017, one Guardian headline read “The Pill Mill of America: Where Drugs Mean There Are No Good Choices, Only Less Awful Ones.” The town of fewer than 20,000 had become ground zero in the opiate epidemic.
I don’t shy away from this history in my book. It was, after all, a corrupt doctor who brought me to Portsmouth in the first place. And, as I note in the book, Volkman wasn’t the first doctor in the region to get hauled off to prison for drug-dealing, nor was he the last.
But, just as I didn’t want Volkman’s deceased patients to be defined by their deaths—they were people with careers, hobbies, and family members who loved them—I didn’t want Portsmouth to be defined by its darkest hour. And so I kept going back over the years. In all, I traveled to Portsmouth 10 times and spoke with dozens of people there.
The following text is excerpted from the last chapter of my book. Twelve years after my first visit, I returned to Portsmouth one last time, in 2022. Telling this story has been the honor and responsibility of a lifetime. And I hope my words convey my love for the place and my gratitude for the trust its residents placed in me.
In August 2018, more than 1,400 people gathered in downtown Portsmouth, Ohio, to break the Guinness World Record for simultaneous plant-potting. A few months later, more than 1,850 assembled nearby to break the record for most people singing Christmas carols at one place and time, snatching the record from its previous holder, Waukesha, Wisconsin. A year later, in December 2019, Portsmouth claimed yet another Christmas-themed record when 1,482 people gathered in to wrap gifts simultaneously.
Each of these events was accompanied by a blast of press releases, which often led to coverage from local news outlets. “Portsmouth, Ohio, has been in the national spotlight for over a decade due to the devastating effects from the rise and fall of its ‘pill mills,’ ” read a release promoting the plant-potting record attempt. “Our hope is that an epic one-day downtown transformation and setting a Guinness World Records title will encourage outsiders, including businesses, to plant Portsmouth as a destination for business relocation, tourism, and raising a family.”
Photograph by Grant Moxley
At the bottom of the release was the name and e-mail address of a local attorney, Jeremy Burnside, who had started an organization called Friends of Portsmouth. And because I had written an article about Paul Volkman and his pain clinics in Cincinnati Magazine in 2017, I later received a personal e-mail from Burnside.
“As you can imagine, you are not the only national reporter to write about our problem,” he wrote. “As you also can imagine, there had to be a breaking point—a rally cry where the whole community got together to say, ‘enough.’ ”
He was writing to inquire if I would consider writing a follow-up story about how, in his words, “the opioid epicenter is now…rising from the addiction ashes to rebuild through restoring community pride.”
Burnside wasn’t the only one who was eager to shift the narrative about Portsmouth. In a Cincinnati Enquirer op-ed in 2019, Ryan Ottney, a former Portsmouth Daily Times reporter who had become a councilman in the nearby village of New Boston, said that he appreciated the need to tell stories about Portsmouth’s opiate-related struggles. “But there’s another side to Scioto County that doesn’t often make the news,” he said. “It’s the people who have stayed in town and are working together to help rebuild our community.” In the essay, he touted the achievements of local advocates for the homeless, as well as community programs focused on mental health, job training, and GED courses. In a separate Enquirer essay from 2019, Brad Wenstrup, the U.S. Representative for Ohio’s 2nd District, echoed Ottney’s message: “For every negative statistic and damaging headline, there are stories of dedicated Portsmouth citizens pouring their hearts and souls into making a positive difference in their city.”
Photograph by Grant Moxley
In May 2019, community members in Portsmouth held a pep-rally-style press conference at the city’s riverfront to call attention to various projects taking place in and around the city. On hand were the mayor, the county commissioner, the president of Shawnee State University, and a squad of pom-pom-waving cheerleaders. Among the developments mentioned were a new series of mountain-biking trails in the nearby hills, the return of powerboat racing to a local stretch of the Ohio River, and plans to build a new hotel downtown, which would mark the first multi-story construction project in the neighborhood in decades.
The momentum continued the following year, when the National Civic League named Portsmouth one of its 10 “All-America Cities” for 2020. The distinction, bestowed by the Colorado-based nonprofit to cities and towns annually since the late 1940s, carried no formal reward. But it did offer a morale boost, and, as the league noted, recently named All-America Cities often saw a surge in tourism and interest from businesses and prospective residents.
In its application, Portsmouth had mentioned that, at one point, there were as many as 11 rogue pain clinics in Scioto County that “operated almost exclusively to push opioid painkillers on people who were not aware of how addictive such medication could be.” Over time, the application said, “routine and repetitive” negative press coverage had helped to cement the town’s reputation as one of the nation’s worst-hit places of the opiate epidemic.
The application argued that an All-America City distinction would help to change the city’s image. And it would fit nicely alongside the city’s beautification and restoration initiatives.
Photograph by Grant Moxley
In late October 2022, I made one last reporting trip to Portsmouth. It marked my 10th time visiting the city, though it was my first time back since shortly after Volkman’s sentencing in February 2012. Due to a fortunate bit of timing, I happened to arrive during a photogenic week in mid-autumn, when the hills surrounding the city were splashed with vibrant yellows, oranges, and reds.
At first glance, the city itself didn’t look much different from previous visits. I saw plenty of empty storefronts, hollowed-out houses, and abandoned buildings with boarded-up windows. But on closer inspection, there were in fact several new sights. On the drive downtown, I passed a new, three-story, $10 million facility recently built by the local hospital, Southern Ohio Medical Center. Not far away was an upscale coffee shop called Lofts Coffee Company & Roastery and a gastropub called Patties & Pints. Next to city hall was a new dog park; on the other side of town, the city had built a skate park with the help of funding from the foundation of legendary skateboarder Tony Hawk.
Meanwhile, downtown, new banners hung from lamp poles touting notable people who once lived in the area. One was dedicated to Theodore Wilburn Jr., a Navy veteran who was the city’s first Black police chief in the early 1960s. Another featured the teacher and abolitionist Betsy Mix Cowles, who had served as the president of the first Ohio Women’s Convention in 1850.
The city wasn’t transformed, by any means. But it did seem to be moving in a good direction.
Photograph by Grant Moxley
In late 2022, Scioto County was still one of the poorest counties in Ohio, with higher poverty and unemployment rates than the state and country. And it remained the lowest-ranked county in the state for health indicators like length of life and quality of life.
Opiate-related problems persisted. Between 2015 and 2020, Scioto County was, by far, the Ohio county with the highest rate of unintentional drug overdose deaths. In 2019, the county recorded 79 overdose deaths, which meant that, on average, the epidemic was still claiming at least one life per week. These totals long surpassed the numbers that had prompted County Health Commissioner Aaron Adams to declare a state of emergency in 2010. But here, as in many places around the country, the state of emergency had simply become the status quo.
At the same time, though, rehab facilities had proliferated. The list of Portsmouth-based treatment centers now included Shawnee Counseling Center, BrightView, HopeSource, Sunrise Treatment Center, and ASCEND Counseling and Recovery Services. Rehab or residential facilities had also popped up in the nearby towns of West Portsmouth, Franklin Furnace, and Wheelersburg.
One of these organizations, Pinnacle Treatment Centers, made news when it purchased the sprawling South Shore, Kentucky, mansion that had once belonged to the region’s pill mill “godfather,” David Procter, M.D. After renovation, the house was repurposed as a 32-bed residential facility. When the center opened in 2016, The Enquirer announced: “Karma: Pill Mill Doc’s Home Gets New Use.” The report noted that, while Procter had pleaded guilty to illegal distribution of pills in 2003 and served 11 years in federal prison, “his former home on 37 acres, complete with pool and 10-acre lake set against the rolling hills of Appalachia, will now help addicts get sober and stay clean.”
Photograph by Grant Moxley
The largest of all these local rehab facilities was The Counseling Center, which had expanded dramatically in recent years. I had interviewed its CEO Ed Hughes during one of my first visits to town in 2010, and he’d told me that the local rehab system couldn’t keep up with the demand for services.
But in 2022, the center had a zero-waitlist, zero-wait-time policy for most of its programs. It was serving between 600 and 700 people at a given time, and around 3,000 clients per year. The facility boasted more beds than the largest local hospital, and it offered an array of services, including a 24-hour crisis hotline, an opiate-withdrawal treatment program, a program through which mothers could receive treatment without being separated from their children, and a career-oriented “Success Center” that offered classes on money management and workplace etiquette. “We are the Cleveland Clinic of treatment agencies,” Hughes told me. “People come from everywhere to get to us for treatment, because we offer things that nobody else offers.”
In 2021, the center announced plans to move most of its operations into a former shoe factory on the city’s East End. The long-abandoned building would be refurbished and repurposed as a state-of-the-art recovery hub that, overall, would allow the center to add 100 new jobs and dramatically increase its treatment capacity. A video about the project called it “the largest redevelopment project in southern Ohio in a lifetime.” The Counseling Center’s CEO said in a press release, “What has previously been viewed as a beacon of despair will now grow to be a beacon of hope for the neighborhood, the city, the region, and beyond.”
Photograph by Grant Moxley
I spent some of this trip going about now-familiar routines. I drove past Volkman’s house on Center Street and the now-empty former clinic on Findlay Street. I visited the public library’s local history room to comb through a thick manila folder of news clippings labeled “Drug Busts – Scioto County” one last time. And one morning I drove to the city health department for a final interview with Lisa Roberts.
Roberts was the person I had spoken with most frequently during my trips to Portsmouth. In the years since we first met, as Portsmouth’s profile rose, I had watched her become a kind of minor celebrity. She had appeared on national television, testified before Congress, and traveled to conferences near and far—in Michigan, South Carolina, Puerto Rico, Las Vegas—to tell the story of what had happened in Scioto County. But in conversation, she was still the same person: earnest, easygoing, generous with her time, and surprisingly cheery for someone who had spent years on the front lines of an overdose epidemic.
Roberts, who retired a few months after this final interview, told me that the region had seen some improvement in the decade after Volkman’s sentencing. Thanks to new laws on the city and state level and a concerted campaign of law enforcement, the local pain clinics had all permanently closed. The region also now offered what she described as “the full spectrum” of rehab and recovery services.
But the city’s problems were by no means solved. There was still a lot of addiction in Scioto County, she explained, and the lethality of the drugs in circulation had gotten worse. Most recently, the region had, like many others around the country, been flooded with the hyper-potent opioid painkiller fentanyl, which had caused local overdose rates to soar even higher. “These people die really fast, like within minutes,” she said. “It’s not like back when we had the opioid pain pills and they tended to be a little bit alive when paramedics got there.”
Roberts was still incredulous that the opiate crisis had gone under-addressed for so long. She said that if thousands of people had been dying in motorcycle wrecks or skydiving accidents, there would have been a major outcry. She felt the muted response had to do at least in part with the fact that the crisis was initially limited to Appalachia. For whatever reason, decision makers in state and national seats of power weren’t as concerned about the people who lived there.
Photograph by Grant Moxley
She was also still angry about how the crisis had originated: from pharmaceutical companies, doctors, and others in the medical field. Healthcare isn’t supposed to harm or addict or kill you, she said, but that’s what happened in Scioto County. “That’s what made me the maddest,” she said.
One morning, toward the end of my visit, I drove to the Scioto County Welcome Center. It’s located downtown in a low brick building next to the floodwall murals. Inside, near a large banquet hall that hosts regular bingo games, are offices for the Portsmouth & Scioto County Visitors Bureau and the Portsmouth Area Chamber of Commerce.
When I entered the building, I passed through a hallway lined with glass display cases featuring Portsmouth-themed mini-exhibits. One case was dedicated to Portsmouth’s bygone shoe industry. Another featured VHS tapes of Roy Rogers films, a smattering of Rogers-themed memorabilia (books, mugs, lunchboxes, a wristwatch), and a framed photograph with a handwritten message from Roy that reads “Happy Trails to all the folks in Portsmouth, Ohio.”
I visited the center because I wanted to buy some souvenirs at the gift shop. (And I did, indeed, walk away with a Roy Rogers mug.) But I also wanted to see if Lisa Carver was still working.
Carver had been executive director of the Portsmouth Area Chamber of Commerce during my first trip in 2010. During my interview with her then, when I asked if there was a problem with prescription drugs in the area, she quickly replied that there was.
Pain clinics were a local nuisance, she had said. “I mean, what doctor has people lined up outside their doors?”
As it turned out, in late 2022, Carver was still in the same job, and she agreed to an impromptu interview on the morning I visited.
Carver, like so many people in Scioto County, had a personal connection to the opiate epidemic. She had adopted and spent years raising the daughter of a cousin due to that cousin’s struggles with addiction and accompanying legal troubles. And in 2001, her husband died from an overdose of pain medication prescribed by his family practitioner.
Photograph by Grant Moxley
During our interview, she acknowledged that Portsmouth had faced its share of suffering. After most local manufacturing dried up or moved away, the pain clinics had made a bad situation worse. That, in turn, had made it hard to recruit good doctors to the area. Due to Portsmouth’s bad press, Shawnee State University had faced hurdles when attracting students.
But these days she was feeling genuinely optimistic. Carver mentioned some thriving smaller-scale industries in the region, including a shoelace manufacturer and a plastics-recycling facility. And she reported that the town was seeing a surge in historic preservation.
She also pointed to the natural beauty of the place, which she saw every morning as she drove from her home in Kentucky across the river into Portsmouth. By this time I, too, was familiar with this view: a panorama of buildings and church spires set against a backdrop of gently sloping green hills.
She was feeling better about Portsmouth than she had in years. They had faced some hard knocks, Carver said, “but we knew we were more than that.”
Excerpted from Prescription for Pain: How a Once-Promising Doctor Became the “Pill Mill Killer,” published by Steerforth Press in April. Copyright 2024 by Philip Eil. Reprinted with permission.
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