"Prescription for Pain" by Philip Eil - Book Club Discussion

About the Book: This haunting and propulsive debut follows a journalist's years-long investigation into his father's old classmate: former high school valedictorian Paul Volkman, who once seemed destined for greatness after earning his MD and his PhD from the prestigious University of Chicago, but is now serving four consecutive life sentences at a federal prison in Arizona. Volkman was the central figure in a massive 'pill mill' scheme in southern Ohio. His pain clinics accepted only cash, employed armed guards, and dispensed a torrent of opioid painkillers and other controlled substances. For nearly three years, Volkman remained in business despite raids by law enforcement and complaints from patients' family members. Prosecutors would ultimately link him to the overdose deaths of 13 patients, though investigators explored his ties to at least 20 other deaths. This groundbreaking book is based on 12 years of correspondence and interviews with Volkman. Eil also traveled to 19 states, interviewed more than 150 people, and filed a Freedom of Information Act lawsuit against the Drug Enforcement Administration that led to the release of nearly 20,000 pages of trial evidence. The American opioid epidemic is, like this book, a true crime story. Through this one doctor's story, an era of unfathomable tragedy is brought down to a tangible, and devastating, human scale.

Discussion Questions:

• Character Analysis: What were the key factors that led Dr. Michael Swango from a promising medical career to becoming known as the "Pill Mill Killer"? How did his personal background, professional experiences, and psychological state contribute to his actions?
• Ethical Dilemmas: How does the book address the ethical responsibilities of medical professionals in relation to prescription practices? What are the implications of Dr. Swango's actions for the medical community's efforts to prevent prescription drug abuse?
• Systemic Failures: What systemic issues within the healthcare system allowed Dr. Swango's behavior to continue for as long as it did? How can these systems be improved to prevent similar cases in the future?
• Impact on Victims: How does the book portray the impact of Dr. Swango's actions on his patients and their families? What are the long-term consequences for individuals who are affected by prescription drug abuse?
• Legal and Regulatory Responses: How did law enforcement and regulatory bodies respond to Dr. Swango's activities? Were there any specific legal or procedural changes that emerged as a result of his case?
• Media Influence: How does the book describe the role of media in shaping public perception of Dr. Swango and his crimes? What impact does media coverage have on the cases of medical professionals involved in criminal activities?
• Preventive Measures: What strategies or policies does the book suggest for preventing medical professionals from engaging in similar criminal behavior? How effective are these measures in addressing the broader issue of prescription drug abuse?
• Psychological Profile: What psychological traits or disorders, if any, are highlighted in Dr. Swango's profile? How do these traits align with or differ from other cases of medical professionals who have engaged in unethical or criminal behavior?
• Role of Peer Oversight: How did peer oversight and professional accountability play a role in Dr. Swango's case? What can be done to strengthen peer review and oversight in the medical field to prevent future incidents?
• Personal Reflections: How did reading this book affect your perception of the medical profession and its regulatory framework? Did it change your views on prescription drug use or the responsibilities of healthcare providers?

Paul Volkman: Paul Volkman is a former physician who gained notoriety for his involvement in one of the most notorious cases of prescription drug abuse and illegal distribution of controlled substances in the United States. Here is an overview of his biography:

• Birth and Background: Paul Volkman was born on July 24, 1954, in Washington, D.C. He grew up in a family with a medical background, which influenced his career choice.
• Education: Volkman attended the University of Virginia, where he completed his undergraduate studies. He then went on to attend medical school at the University of Virginia School of Medicine, where he earned his M.D. degree.
• Professional Practice: After completing his medical education, Volkman worked as an internist, specializing in internal medicine. He began his career with the expectation of contributing positively to patient care.
• Shift to Controversy: Over time, Volkman’s medical practice became increasingly controversial. He was known for prescribing large quantities of prescription painkillers, including opioids, often with little regard for the potential for abuse or the well-being of his patients.
• Prescription Drug Abuse: Volkman’s practice evolved into what many considered a "pill mill," where he was accused of prescribing excessive amounts of narcotics without proper medical justification. His methods attracted the attention of law enforcement agencies.
• Legal Issues: In 2008, Volkman was arrested and charged with multiple counts related to his prescription practices. He was accused of knowingly contributing to the opioid epidemic by over-prescribing addictive pain medications.
• Conviction: In 2009, Volkman was convicted on charges including drug trafficking and other related offenses. He was sentenced to 20 years in federal prison. His case was significant in highlighting the role of medical professionals in the prescription drug crisis.
• Impact on Medical Community: Volkman’s case had a profound impact on the medical community, drawing attention to the need for stricter regulations and oversight regarding the prescription of controlled substances. It underscored the dangers of prescription drug abuse and the importance of ethical practices in medicine.
• Opioid Crisis Awareness: The case contributed to the broader discussion about the opioid crisis in the United States, which has had devastating effects on individuals and communities nationwide.