Jackson and the 'Pill Mills'

Kevork Djansezian / AP Photo Authorities investigating Michael Jackson's death have extended their probe into Miami, reports The Daily Beast's Gerald Posner, and a specific doctor practicing in the world's prescription-drug capital.

The probe into Michael Jackson's death has now crossed the country and reached Miami. Documents seized in 2003 from Neverland as part of the investigation into allegations of child abuse connected Jackson to Dr. Alimorad "Alex" Farshchian, the medical director of Miami Beach's Center for Regenerative Medicine. The Daily Beast has confirmed that Los Angeles authorities examining the superstar's death are now looking to see whether Farshchian and Jackson have had more recent contact than the 2002 broken foot for which Jackson initially sought treatment.

This is the state that has the decades long, well-deserved reputation as being the last refuge where ordinary, everyday people, not just celebrities and pop stars, can easily fill multiple prescriptions for opiates and other addictive pills.

In a July 21,2002, handwritten note, Dr. Farshchian writes to Jackson that he has sent a 'package it's a 5-7 day program that offers you the solution. Buprinex is the potent narcotic I told you about last week, it is just like the D but better.? Buprinex is an injectable narcotic analgesic. Los Angeles investigators believe the 'D' refers to Demerol, another narcotic that was found in Jackson's house after his death. Chris Carter, Jackson's then-head of security who went on to be arrested for bank robberies in Nevada,'told investigators in 2004 that Farshchian tried to wean Jackson off his heavy Demerol use. Although the 'D' could refer to Diprivan, the powerful anesthetic that might have played a fatal role in Jackson's dosing, investigators have no link between Farshchian and that anesthetic.

Farshchian, a Caribbean-trained physician (he got his degree from St. Lucia's Spartan Health Sciences University), describes himself on his Web site as limiting his practice to 'non-surgical orthopedics and sports medicine.' One of his self-described specialties, as described on his Web site, is cell therapy, using the patient's own cells in injections that accelerate the healing process, and which helps relieve pain from arthritis or injuries. He also works with human growth hormone.

In his 2002 note to Jackson, Farshchian said about the performer, 'You're the best, you're an ICON, and you belong to the tops.? A Los Angeles County Sherriff's deputy believes that Farshchian was 'awestruck' by Jackson. A former Jackson employee told The Daily Beast that Jackson also met Farshchian at his house and the two became so friendly that they even talked about opening a children's hospital in Miami's Little Havana. They went so far as to come up with a name The International Childrens Hospital and to shop for a building before Jackson returned to California and abandoned the idea. According to what Carter told the investigators about their visits to Farshchian's office, Jackson seemed alert on arrival but was visibly sedated when they left.

Dr. Farshchian, who lives in a $1.5 million waterfront home on Bay Harbor, did not return a call to his office, and a letter to his Facebook account, seeking a comment. Florida records show no prior discipline by state medical authorities and an electronic search of Miami-Dade, Broward, and Palm Beach counties show no malpractice suits against him. But the Miami tie-in isn't surprising. Being a Miami-based reporter, I felt it was only a matter of time until there was a South Florida medical connection to the Michael Jackson death probe. This is the state that has the decades long, well-deserved reputation as being the last refuge where ordinary, everyday people, not just celebrities and pop stars, can easily fill multiple prescriptions for opiates and other addictive pills.

The Farshchian-Jackson connection doesn't involve these dispensing clinics, or 'pill mills.' A celebrity like Jackson doesn't need to stand in line to get his addictive drugs. There are all too many doctors willing to prescribe for him, thereby gaining access to his celebrity entourage. But it's emblematic of a culture. Until Quaaludes (a powerful sedative that became a party drug in the late 70s) were made illegal in 1984, South Florida had more Quaalude clinics that the rest of the country combined.

Now the state has become the unofficial national headquarters for a thriving black market in addictive prescription drugs, especially oxycodone, one of the drugs found in the sweep of Jackson's house after his arrest.

Florida allows pill mills to operate so long as a licensed doctor is on the premises to write a prescription, and the patient shows up for each prescription renewal. Today's clinics, often in ramshackle buildings in strip malls of borderline neighborhoods, aggressively advertise 'Pain Management' on billboards and bus benches.There, patients complaining of chronic pain get prescriptions for the entire range of legal opiates. The initial consultation is $200, and each prescription is for a one month supply. Each follow-up visit for a new prescription takes only a few minutes and costs $100. Word has spread beyond South Florida to West Virginia, Kentucky, Ohio, Georgia, and other states about how easy it is to get a narcotic fix in South Florida.

Because of lax Florida laws, each pill mill employs only a single doctor who prescribes opiates for up to 70 walk-in patients daily. Crimes around the clinics, from robberies of patients with freshly filled prescriptions, to attempted break-ins at the clinics themselves, are a growing problem. But the demand for the pills has caused the trade to boom in the last year, the number of pill mills in Dade and Broward counties zoomed from 60 to more than 150. Only 45 South Florida doctors are responsible for prescribing nearly nine million oxycodone pills in the last six months of 2008. Thirty-three of the top 50 oxycodone-dispensing doctors in the United States practice in Broward County.

And Florida has no law to track the prescriptions. So someone can walk into 20 clinics a day and walk out with 20 prescriptions. Following the April arrest of 25 Kentucky drug dealers, who got their supply from the Florida pill mills, and an investigation by The Miami Herald, the state legislature passed a law that will start tracking the prescriptions next year. But for the next six months, it's still a paradise for drug addicts and dealers and anyone can start to get hooked at Florida's pill mills for a fraction of what it cost Michael Jackson with his celebrity doctors.