The line of people clamoring for painkillers snaked out the front door.
Jason Stidham of Clearwater was among those in the queue last month. When he finally reached the pain clinic's waiting room, it was so packed that there was no place to sit, he said.
Many customers were there from other states, said Stidham, 36. Some lost patience. Others looked high or strung out. All of them waited for hours.
"One guy was raising all kinds of hell," Stidham said. "One guy was in the corner nodding off. He was already tore up and out of his mind."
Investigators say the storefront pain-management clinic at 2316 N. Dale Mabry Highway was one of an increasing number of "pill mills." Police raided the property and shut it down July 27.
The Tampa Bay area has supplanted South Florida as the epicenter of a statewide cottage industry that dispenses prescriptions and pills in multitudes, according to a federal agency that inspects pain-management clinics. As a result, people are dying, state and local officials say.
"We have a crisis in this state," said Sen. Mike Fasano, R-New Port Richey. "We have to make sure these pill mills are not dishing out narcotics like candy."
Dispensing 240 tablets of oxycodone and 100 Xanax per person is typical at some Tampa clinics, detectives say. Law enforcement officials call it a drug epidemic.
"It's just as bad as the crack cocaine problem we had in the 1990s," said Chris Rule, a Hillsborough County sheriff's narcotics detective.
Opiate-based painkillers such as oxycodone, hydrocodone and methadone are "the easiest drugs on the street to buy right now," he said.
In 2005, there were 179 drug overdose deaths, with 76 caused by oxycodone or a mix of painkillers and other drugs, Hillsborough County Medical Examiner's Office records show. In 2009, the number of drug deaths rose to 277, with 199 caused by oxycodone overdoses or cocktails of opiate-based pills, alcohol and other drugs.
"You could say Tampa is ground zero for pain clinics and prescription drug diversion," said Ryan Lynch, special agent in charge of the U.S. Department of Health and Human Services' Office of the Inspector General.
All it takes is a nominal medical screening - such as a blood pressure reading or an MRI - for people to get pills at storefront clinics, Rule said.
Investigators estimate there are about 70 pain clinics in the county and 35 in Tampa.
"Some are by the books," Rule said. "Some are shady."
Payments in cash
Stidham, who has chronic back pain from motorcycle crashes, said word of mouth led him to the Tampa clinic.
Police said neighbors complained about the clinic and that at times the lines outside were so long that chairs were brought out for the crowd.
"I thought they were pretty legit," he said.
Stidham paid $300 for his only visit and was told a follow-up would cost $150 - in cash.
Stidham said he arrived about 11:30 a.m. for an appointment and to pick up 90 oxycodone pills. Workers suggested he leave and said they would call when the prescription was ready.
Stidham said he drove around until he was able to pick up his pills seven hours later.
To avoid large crowds that would raise suspicion, customers often are told to go elsewhere until the prescription is filled, Tampa police Lt. Kenneth Morman said. A spate of minor crimes in the vicinity of a clinic may prompt detectives to investigate the business, Morman said.
Not all customers are junkies; there are customers suffering real, debilitating pain, Rule said.
"The majority of them are hooked on oxycodone, but don't think 100 percent of them are bad patients," he said.
Stidham said he's not an abuser and often has dozens of pills left over when it's time to refill his prescription.
The wait takes hours because clinics try to book up to 60 appointments a day, including Saturdays, Lynch said. Family physicians typically see up to 20 patients a day, he said.
The attorney for clinic owner Jorge Bentancourt-Gonzalez said his client was running a legitimate business. Bentancourt-Gonzalez, who is not a doctor, was arrested on one count of money laundering when police shut down the business.
"The clinic complied with all the laws," attorney Dale Sysco said. "We're in the process of contesting the search and forfeiture."
More than $225,000 was seized during the raid. Police say the money came from writing prescriptions and from workers distributing the drug "outside the scope of a professional practice."
Sysco said that although his client has been accused of running a pill mill, "he wasn't charged in an offense related to any such thing."
Some pain clinics are "classic money-laundering schemes," Morman said. Workers at other clinics that were shut down have been charged with insurance and Medicaid fraud, in addition to money laundering, Lynch said.
Weeks after it was raided and closed, people continued to show up, rattling the locked doors and peeking through the tinted windows, Lynch said.
So why has Tampa become a hotbed for storefront pain clinics?
There are several factors, authorities said. A major reason is that pills are cheap in Florida.
"People come from all the other states because the street value here is about $9 to $12 a pill, depending on how many you buy," Rule said. "Then you can take them somewhere else and sell them for $30 to $35 a pill."
Customers have come from Kentucky, Tennessee, Ohio and as far away as Washington, Lynch said.
Billboards at the state line display more ads for pain clinics than Walt Disney World, Morman said.
Also contributing to the problem was Tampa's and Hillsborough County's lax regulations regarding pain-management clinics. The state considers pain management a legitimate medical practice and specialty, according to the Department of Health.
"You and I can start a pharmacy right now," Rule said. "We'll just buy a building and hire out a doctor to come in and write prescriptions."
There are no restrictions on who can manage or own clinics as long as a licensed doctor is writing prescriptions, Lynch said.
Some clinics have doctors who are never on-site, Lynch said. The doctors have been hired as directors of the clinic and have signed a stack of blank prescriptions.
"These are 75- and 80-year-old doctors who haven't practiced in years," Lynch said. "What's their level of knowledge about the clinic? That's something we look at in every case."
Steven Rosenberg, a Palm Beach doctor and member of the Florida Board of Medicine, said disciplinary hearings are held six times a year. At least two pain clinic doctors turn in their licenses at every meeting, he said.
Among those was Tampa doctor Gerard Romain, who gave up his medical license in April after the state health department filed a complaint charging him with inappropriately prescribing drugs. Romain was a pain clinic doctor who provided prescriptions to a man who died of an overdose.
"It's certainly an embarrassment to the medical profession," Rosenberg said. "When they come to the board, there's no mercy. It's very hard for these individuals to defend what they've done."
Enforcement can be difficult because Florida doesn't have a prescription drug monitoring program, a statewide electronic database that would track where prescriptions are filled and how many times patients fill them with other doctors or pharmacies. Thirty-four states do.
The Legislature approved a tracking system in July 2009 but had no money to pay for it. The state is mostly relying on private donations to fund the $1.2 million program. Sen. Fasano said he expects work to begin on the program by December.
Tougher city and county ordinances are now in place, requiring all pain-management clinics to obtain permits, register with the state health department, and provide a list of owners and employers along with their addresses, dates of birth, copies of photo identification and fingerprints.
"We're going to start treating it like an open-air drug market," Morman said.
On Oct. 1, a similar law goes into effect across the state. Florida's stricter regulations will prevent pain clinics from dispensing more than three days worth of medication if the patient pays in cash and deny any person with a felony criminal record from owning or managing a clinic.
Authorities have a limited ability to prosecute doctors who excessively prescribe narcotic-grade pills until the new regulations kick in, Rosenberg said.
"This is definitely going to clamp down on these clinics," Fasano said. "When you become nationally known as the 'Pill Mill State,' you know something is wrong."
Stidham said he doubts the new laws would be the end of pill mills or Tampa's prescription drug problem.
"They'll find another way to do it," he said. "Just like with pot, cocaine and everything else."