ERWIN, TENN. — Cpl. Stacy Wigand of the Unicoi County Sheriff's Department has long been accustomed to the prescription drug problem that plagues his mountain community in eastern Tennessee.
But his discovery on a recent Friday night was indicative of the new wave of trouble sweeping through the hills and hollows of Appalachia -- trouble that is increasingly coming from sunny South Florida.
The manager of the local Wal-Mart had called to report an SUV in the parking lot, with Kentucky plates and a driver who appeared to be asleep. Wigand discovered a clutch of little pills in the man's pocket.
Two of his friends were found wandering inside the store, too blitzed to pass a field sobriety test.
"They couldn't even count to four," Wigand said.
Wigand searched the car and found six bottles of the prescription painkiller oxycodone in the engine compartment -- 1,168 pills in all. From the bottles, it appeared the trio of Kentuckians had obtained the drugs two days earlier with prescriptions written by two doctors from Broward County, Fla.
In counties like this one, Florida opiates are giving oranges a run for their money as the Sunshine State's best-known export.
With most Appalachian states now closely monitoring narcotics prescriptions with the aid of statewide computer databases, officials in these states now say their drug addicts and dealers are taking their business to South Florida, where they often use fraud and deceit to purchase pills that are legally dispensed by doctors at storefront "pain clinics."
The poorly regulated clinics often advertise on the Internet, making specific pitches to non-Floridians. A Web page for the Broward Pain Clinic says it accepts "patients from all states," and requires that patients bring proof of their pain. An unidentified employee who answered the phone at the clinic recently said that it was a cash-only business and did not accept insurance.
Anti-drug advocates say Florida has become a magnet for pill buyers in part because it is the largest state in the nation without a prescription-monitoring program. Thirty-two other states, including California, operate such systems, which typically allow doctors and pharmacists to access a patient's prescription history, limiting prescription forgery and "doctor shopping," in which patients seek pain drugs from numerous physicians.
Many states adopted their monitoring programs in the last three years, as the systems became eligible for new federal anti-drug grants, said Aaron Gilson, director of the U.S. program at the Pain and Policy Studies Group at the University of Wisconsin.
And as more states did so, Florida, usually a pleasant vacation spot, also became one of the easiest places to score.
"It's the classic balloon squeeze," Gilson said. "You cut off the supply in one area and it will leak out somewhere else."
The trade can be lucrative. Sgt. Richard Pisanti of the Broward County Sheriff's Office said that an 80-milligram dose of oxycodone -- a popular and addictive opiate partly responsible for the death of actor Heath Ledger -- could be purchased for about $4.50 in a Florida clinic. The same pill sells for $80 on the streets of Unicoi County, according to the county sheriff.
The problem has recently taken center stage in South Florida: The United Way of Broward County Commission on Substance Abuse released a report showing that the state's physicians give out five times more oxycodone than their colleagues in other states. In the second half of 2008, all of the top 50 oxycodone-dispensing doctors in the nation were Floridians, according to federal figures compiled in the report.
The Miami Herald detailed many of these facts this month in a series of articles that noted that some of the clinics were owned by ex-convicts. The newspaper's editorial page singled out Broward County, which reportedly has 89 pain clinics, as "the painkiller capital of the United States."
Officials across the Southeast have taken notice. On March 16, the North Carolina pharmacy board warned drugstores to be wary of a wave of drug users from Tennessee, West Virginia, Ohio and Kentucky trying to fill Florida prescriptions for painkillers. Pharmacy board officials said many of these prescriptions were pre-printed with the name of the drug, making them illegal under North Carolina law.
On March 20, Kentucky Lt. Gov. Daniel Mongiardo sent a letter to Florida House Speaker Larry Cretul urging him to support bills pending in the Florida Legislature that would tighten the regulation of the clinics and create a monitoring system.
"Are there legitimate pain clinics in Florida? Absolutely," said Mongiardo, a physician from the small mountain city of Hazard. "But when you have pill factories like this, it gives every doctor a bad reputation."