CELINA, Tenn. — It was about 1 a.m. on April 19, 2016, when a housebreaking alarm sounded at Dale Hole Pharmacy in Celina, a tiny city within the rolling, wooded hills close to the Kentucky border.

Two cops responded. As their flashlights bobbed within the darkness, shining by the pharmacy home windows, they noticed a signal of a break-in: capsule bottles scattered on the ground.

The cops known as the co-owner, Thomas Weir, who arrived inside minutes and allow them to in. However as shortly as their flashlights beamed behind the counter, Weir demanded the cops go away. He mentioned he’d somewhat somebody “steal every part” than allow them to end their search, in keeping with a police report and physique digital camera footage from the scene.

“Get out of there proper now!” Weir shouted, as if shooing off a mischievous canine. “Get out of there!”

The cops argued with Weir as he escorted them out. They left the pharmacy extra suspicious than after they’d arrived, triggering a probe in a small city engulfed in a single of probably the most outsize concentrations of opioids in a pill-ravaged nation.

Almost six years later, federal prosecutors have unveiled a uncommon prison case alleging that Celina pharmacy house owners deliberately courted opioid seekers by filling harmful prescriptions that might have been rejected elsewhere. The pharmacies are accused of giving money handouts to maintain clients coming again, and one allegedly distributed its personal foreign money, “monkey bucks,” impressed by a pet monkey that was as soon as a frequent sight behind the counter. Two pharmacists admitted in plea agreements they attracted giant numbers of sufferers from “lengthy distances” by ignoring pink flags indicating tablets had been being misused or resold. Of their wake, prosecutors say, these Celina pharmacies left a rash of dependancy, overdoses, deaths, and hundreds of thousands in wasted tax {dollars}.

“I hate that that is what put us on the map,” mentioned Tifinee Roach, 38, a lifelong Celina resident who works in a salon not removed from the pharmacies and recounted years of unfamiliar automobiles and unfamiliar folks filling the parking tons. “I hate that that is what we’re going to be identified for.”

Celina, an previous logging city of 1,900 folks about two hours northeast of Nashville, was primed for this drug commerce: Within the shadow of a dying hospital, 4 pharmacies sat inside 1,000 ft of one another, on the crux of two highways, allotting hundreds of thousands of opioid tablets. Earlier than lengthy, that intersection had single-handedly turned Tennessee’s Clay County into one of the nation’s pound-for-pound leaders of opioid distribution. In 2017, Celina pharmacies stuffed practically two opioid prescriptions for each Clay County resident — greater than thrice the nationwide fee — in keeping with the Facilities for Illness Management and Prevention.

Guests as soon as got here to Celina to tour its historic courthouse or drop their traces for smallmouth bass within the famed fishing lake close by. Now they got here for tablets.

Quickly after Weir’s police encounter in 2016, the Drug Enforcement Administration set its sights on his two Celina pharmacies, three doorways aside — Dale Hole Pharmacy and Xpress Pharmacy. Individually, investigators examined the clinic of Dr. Gilbert Ghearing, which sat immediately between Dale Hole and Xpress and leased workplace house to a third pharmacy in the identical constructing, Anderson Hometown Pharmacy. Its house owners and operators haven’t been charged with any crime.

In December, a federal choose unsealed indictments in opposition to Weir and the opposite house owners of Dale Hole and Xpress pharmacies, Charles “Bobby” Oakley and Pamela Spivey, alleging they profited from attracting and filling harmful and unjustifiable opioid prescriptions. Expenses had been additionally filed in opposition to William Donaldson, the previous pharmacist and proprietor of Dale Hole, beforehand convicted of drug dealing, who allegedly recruited most of the shoppers for the scheme.

The pharmacists at Dale Hole and Xpress, John Polston and Michael Griffith, pleaded responsible to drug conspiracy and well being care fraud prices and agreed to cooperate with legislation enforcement in opposition to the opposite suspects.

Ghearing was indicted on drug distribution prices for allegedly writing unjustifiable opioid prescriptions in a separate case in 2019. He pleaded not responsible, and his case is anticipated to go to trial in September.

‘An American Tragedy’

The Celina indictment comes as pharmacies enter an period of new accountability for the opioid disaster. In November, a federal jury in Cleveland dominated pharmacies at CVS, Walgreens, and Walmart could possibly be held financially liable for fueling the opioid disaster by recklessly distributing huge quantities of ache tablets in two Ohio counties. The ruling — a first of its type — is anticipated to reverberate by hundreds of comparable lawsuits filed nationwide.

Legal prosecutions for such actions stay exceedingly uncommon. The Division of Justice lately elevated prosecutions of docs and ache clinic staffers who overprescribed opioids however information far fewer prices in opposition to pharmacists, and barely any in opposition to pharmacy house owners, who’re usually more durable to carry immediately liable for prescriptions stuffed at their institutions.

In a evaluation of about 1,000 information releases about authorized enforcement actions taken by the Division of Well being and Human Providers since 2019, KHN recognized fewer than 10 comparable circumstances involving pharmacists or pharmacy house owners being criminally charged for filling opioid prescriptions. Amongst these few comparable circumstances, none concerned allegations of so many opioids flowing readily by such a small place.

The Celina case can also be the primary time the Division of Justice sought a restraining order and preliminary injunction in opposition to pharmacies beneath the Managed Substances Act, mentioned David Boling, a spokesperson for the U.S. Legal professional’s Workplace for the Center District of Tennessee. DOJ used the civil submitting to close down Dale Hole and Xpress pharmacies shortly in 2019, permitting prosecutors extra time to construct a prison case in opposition to the pharmacy house owners.

Former U.S. Legal professional Don Cochran, who oversaw a lot of the investigation, mentioned the disaster in Celina was so extreme it warranted a swift and distinctive response.

Cochran mentioned it as soon as made sense for small pharmacies to be clustered in Celina, the place a rural hospital served the encompassing space. However because the hospital shriveled towards closure, as have a dozen others in Tennessee, the competing pharmacies turned to opioids to maintain themselves and acquired hooked on the earnings, he mentioned.

“It’s an American tragedy, and I feel the city was a sufferer on this,” Cochran mentioned. “The salt-of-the-earth, blue-collar of us that lived there have been victimized by these folks in these pharmacies. I feel they knew full nicely this was not a medical necessity. It was simply a money-making money machine for them.”

And far of that cash got here from taxpayers. In its courtroom filings, DOJ argues the pharmacies sought out clients with Medicaid or Medicare protection — or signed them up in the event that they didn’t have it. To maintain these clients coming again, the pharmacies lined their copays or paid money kickbacks every time they stuffed a prescription, prosecutors allege. The pharmacies collected greater than $2.4 million from Medicare for opioids and different managed substances from 2012 to 2018, in keeping with the courtroom filings.

Prosecutors say the pharmacies additionally paid kickbacks to retain worthwhile clients with non-opioid prescriptions. In a single case, Dale Hole gave $100 “payouts” to a affected person every time they stuffed his prescription for mysoline, an anti-seizure drug, then used these prescriptions to gather greater than $237,000 from Medicare, in keeping with Polston’s plea settlement.

Attorneys for Weir, Oakley, Donaldson, Spivey, Polston, and Griffith both declined to remark for this text or didn’t reply to requests for remark.

Ronald Chapman, an legal professional for Ghearing, defended the physician’s prescriptions, saying he’d accomplished “one of the best he [could] with what was out there” in a rural setting with no assets or experience in ache administration.

Chapman added that, whereas he doesn’t symbolize the opposite Celina suspects, he had a principle as to why they drew the eye of federal legislation enforcement. As giant company pharmacies made agreements with the federal authorities to be extra stringent about opioid prescriptions, they stuffed fewer of them. Prospects then turned to smaller pharmacies in rural areas to get their medication, he mentioned.

“I’m undecided if that’s what occurred on this case, however I’ve seen it occur in lots of small cities in America. The one CVS down the road, or the one Ceremony Assist down the road, is reducing off each supplier who prescribes opioids, leaving it to smaller pharmacies to do the work,” Chapman mentioned.

Donaldson, reached briefly at his residence in Celina on March 9, insisted the allegations levied in opposition to Dale Hole and Xpress may apply to many pharmacies within the area.

“It wasn’t simply them,” Donaldson mentioned.

The Monkey and the Monkey Bucks

Lengthy earlier than it was known as Dale Hole Pharmacy, the blue-and-white constructing that moved hundreds of thousands of tablets by Celina was Donaldson Pharmacy, and Donaldson was behind the counter doling out tablets.

Donaldson owned and operated the pharmacy for many years because the eccentric son of one of probably the most distinguished households in Celina, the place a avenue, a park, and many companies bear his surname. Even now, regardless of Donaldson’s prior conviction for opioid crimes and his new indictment, an commercial for “Donaldson Pharmacy” hangs on the entrance of a close by highschool.

“Invoice has at all times had a coronary heart of gold, and he would assist anybody he may. I simply assume he let that, nicely …” mentioned Pam Goad, a neighbor, trailing off. “He’s at all times had a coronary heart of gold.”

In line with interviews with about 20 Celina residents, together with Clay County Sheriff Brandon Boone, Donaldson can also be identified to maintain a menagerie of unique animals, at one level together with at the least two giraffes, and a monkey companion, “Carlos,” whom he wearing clothes.

A paper signal on the door of Dale Hole Pharmacy bars animals from the property. A former proprietor of the property, William Donaldson, as soon as let his monkey frequent the pharmacy. The pharmacy is accused of later introducing “monkey bucks” to entice opioid-seeking clients.(Brett Kelman / KHN)

The monkey — a mainstay at Donaldson Pharmacy for years — each attracted and deterred clients. Linda Nelson, who owns a close by enterprise, mentioned Carlos as soon as escaped the pharmacy and, throughout a scrap with a neighbor’s canines, tore down her mailbox by snapping its wood submit in half.

However the monkey wasn’t the one purpose Donaldson Pharmacy stood out.

In line with a DEA opioid database printed by The Washington Submit, Donaldson Pharmacy distributed practically 3 million oxycodone and hydrocodone tablets from 2006 to 2014, making it the nation’s Twentieth-highest per capita distributor throughout that interval. It retained its rating although the pharmacy closed in 2011, when Donaldson was indicted for allotting hydrocodone with out a legitimate prescription.

Donaldson confessed to drug distribution and was sentenced to fifteen months in jail. The pharmacy’s title was modified to Dale Hole and ended up with Donaldson’s brother-in-law, Oakley. In 2014, Oakley offered 51% of the enterprise to Weir, who additionally purchased a majority stake of Xpress Pharmacy, three doorways away, in keeping with the DOJ’s civil criticism.

Beneath Weir’s management, these two pharmacies turned an opioid hub with few equals, prosecutors say. From 2015 to 2018, Dale Hole and Xpress pharmacies had been the fourth-and Eleventh-highest per capita opioid purchasers within the nation, in keeping with the DOJ, citing inside DEA information.

Many of these prescriptions had been for Subutex, an opioid that can be utilized to deal with dependancy however is itself susceptible to abuse. Until the affected person is pregnant or nursing or has a documented allergy, Tennessee legislation requires docs as a substitute to prescribe Suboxone, another that’s a lot more durable to abuse.

However on the Celina pharmacies, prescriptions for Subutex outnumbered these for Suboxone by at the least 4-to-1, prosecutors say. Of their plea agreements, pharmacists from Dale Hole and Xpress described shops that thrived on the commerce in Subutex, and mentioned Weir set “mandates” for what number of Subutex prescriptions to fill and instructed them to “by no means run out.”

Griffith, the top pharmacist at Xpress, mentioned the pharmacy in 2015 created flyers particularly promoting Subutex, then delivered them on trays of cookies to practices all through Tennessee, together with some hours away. Within the following two years, the quantity of Subutex distributed by Xpress elevated by about eightyfold, in keeping with his plea settlement.

Dale Hole didn’t want flyers or cookies. It had Donaldson.

After getting out of jail in 2014, Donaldson was employed by the pharmacy he as soon as owned, the place he “recruited and managed” about 50% to 90% of clients, in keeping with the indictment filed in opposition to him. The pharmacy additionally enticed clients by distributing a Monopoly-like foreign money known as “monkey bucks” — an obvious callback to Carlos — that could possibly be spent on the pharmacy like money, the indictment states.

Prosecutors additionally allege that, from a desk inside Dale Hole, Donaldson would signal clients up for Medicare or Medicaid, then use a car offered by the pharmacy to drive them to a physician’s workplace to get opioid prescriptions, then again to Dale Hole the place he’d provide to cowl their copays himself in the event that they stored their enterprise on the pharmacy. Generally, he would textual content the Dale Hole pharmacist with directions to fill particular prescriptions, or simply to fill extra of them, in keeping with federal courtroom information.

“Y’all have gotten to get your numbers up. Fill fill,” Donaldson texted Polston in 2018, in keeping with his plea settlement.

By then, nonetheless, all these prescriptions had drawn undesirable consideration.

In August 2018, Dale Hole and Xpress pharmacies had been raided by DEA brokers, who introduced with them Fox Information’ Geraldo Rivera and a tv crew. Six months later, DOJ filed its civil criticism, persuading a federal choose to right away shut each pharmacies.

Immediately, Dale Hole Pharmacy sits shuttered, because it has been for the previous three years, and a paper signal taped to the door says animals aren’t allowed inside by order of the DEA. The constructing that was as soon as Xpress Pharmacy reopened this yr as an unrelated pharmacy with a contemporary coat of paint. Ghearing’s clinic and Anderson Hometown Pharmacy are closed.

Most of Celina’s opioid prescriptions are gone, too. In line with the newest out there CDC information, Clay County reported about 32 opioid prescriptions per 100 residents in 2020 — one-sixth the speed of 2017’s.