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In Tennessee, strict laws governing pain clinics force drug dealers out of state for supplies, using Interstate 75 to bring pills back from Florida or move them farther north, said Kristin Helm, spokeswoman for the Tennessee Bureau of Investigation.

Ohio has prosecuted several prescription tourists in recent months, with a federal judge in December sentencing Christopher Thompson of suburban Columbus to 15 years in prison for leading a scheme involving more than a dozen other people who traveled from Ohio to Florida, obtained and filled prescriptions for oxycodone and other drugs, and mailed the pills back to central Ohio for illegal distribution.

“The effect is the same effect as if they were coming out of our own pain clinics,” said Aaron Haslam, who directs Ohio’s anti-painkiller abuse efforts in the state’s attorney general’s office. “We have overdoses all over the state of Ohio because of it.”

Defendants in one southern Ohio case brought back drugs worth $50,000 on the street in one trip, Haslam said.

Authorities have fought back with extensive crackdowns in Florida against pill mills and with prosecutions in states like Kentucky, Ohio and West Virginia of both drug tourists and the Florida doctors who wrote prescriptions. State medical boards also regularly discipline or revoke the licenses of doctors who overprescribe painkillers.

Florida is finally seeing a drop in pill mills and doctors prescribing painkillers after enacting a 2011 law toughening penalties against doctors and clinics engaged in prescription drug trafficking.

Still, such a stance has consequences. A group sued the state in 2010 over the pill mill crackdown. One of the doctors, Paul Sloan, owner of Florida pain management clinics in Fort Myers and Sarasota, says that there’s no question that some doctors and clinic owners were doing bad things, but that the state has overreacted.

“We’re dealing with a war on legitimate medications that’s being dealt with like we’re all cartels and drug lords,” he said.

Doctors in that lawsuit defended disbursing prescriptions to patients who paid cash, saying uninsured patients with chronic pain relied on pain pills for relief because they often couldn’t afford more expensive procedures or services.

Posing as such a patient can serve a prescription tourist well.

Dixon said he traveled to West Palm Beach for about seven months in 2008, visiting clinics and picking up prescriptions and pills over a two or three-day period. Dixon never visited more than one doctor, but soon was also buying pills from people he met on the streets in deals arranged in motels.

“Once you get to motels down there, it’s just like a Wal-Mart or Kmart or Kroger store for drugs, pills, whatever,” Dixon said. “Once you get in that clique, they will find you.”

He said it was not uncommon to see pills offered from bulging 50-pound dog food bags filled with the prescriptions.

Dixon was arrested in 2008 returning from what would turn out to be his last trip, set up, he says, by a fellow drug dealer. He had 6,000 pills hidden in a false exhaust system he’d installed beneath the car. He is serving a four-year sentence for drug trafficking charges. Although painkillers are a legal drug, it’s against the law for anyone but a doctor or pharmacist to dispense them.

Crackdowns like Florida’s may be driving prescription tourists to states like Georgia, Haslam said.

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