When in 2017 the police of the police entered his small medical practice in Martinsville, Virginia, Dr. Joel Smithers had prescribed about half a million doses of opiates that are addictive in two years.
Interested in Opioid epidemic?
Add Opioid Epidemic as an interest to stay updated on the latest news, videos and analysis on Opioid Epidemic from ABC News.
Patients from five states have driven hundreds of miles to see it, spending up to 16 hours on the road to get prescriptions for oxycodone and other powerful painkillers.
"It has done great damage and contributed … to the general problem in the heart of the opioid crisis," said Christopher Dziedzic, a special supervisory agent for the Drug Enforcement Administration who oversaw the investigation of Smithers.
Over the past two decades, opioids have killed around 400,000 Americans, torn families apart and left communities – many in Appalachia – struggling with ballooning social services like the forces of order, foster care and drug rehabilitation.
Smithers, a 36-year-old married father of five children, is facing the possibility of living in prison after being sentenced in May for over 800 counts of illegally prescribed drugs, including oxycodone and oxymorphone which they have caused the death of a West Virginia woman. When sentenced on Wednesday, the best Smithers can hope for is a mandatory minimum of 20 years.
Authorities claim that, instead of performing a legitimate medical practice, Smithers ran an interstate distribution ring of drugs that contributed to the opioid abuse epidemic in West Virginia, Kentucky, Ohio, Tennessee, and Virginia.
In court and at the trial, they described an office lacking basic medical supplies, a receptionist who lived outside a back room during the work week, and patients who slept outside and urinated in the parking lot.
At the trial, a woman who described herself as a drug addict compared the practice of Smithers to the mills she attended in Florida.
"I went to get the medicines without – I mean, without any kind of physical examination or carrying medical records, nothing of the sort," the woman testified.
A receptionist testified that the patients would wait up to 12 hours to see Smithers, who sometimes kept his office open after midnight. Smithers did not accept the insurance and received almost $ 700,000 in cash and credit card payments for two years.
"People went there just for a reason, and this was just to get painkillers that they could (abuse) themselves or sell them for profit," said Dziedzic.
The opiate crisis has been in place for decades and has been fueled by a mix of prescription and street drugs.
From 2000 to 2010, annual deaths related to prescription opioids increased nearly fourfold. By 2010, with more repression on pill mills and more restrictive guidelines on prescriptions, the number of prescriptions has decreased. So people with addictions have turned to even more deadly opioids. But the number of deaths linked to prescription opioids did not begin to decline until last year, according to data from the US Centers for Disease Control and Prevention.
Martinsville, where Smithers opened a shop, was particularly impressed.
A city of about 14,000 inhabitants near the southern border of Virginia, Martinsville was once a thriving center for the production of furniture and textiles that proclaimed itself "Capital of sweatshirt of the world". But when the factories began to close in the 90's, thousands of jobs were lost. Between 2006 and 2012, the city received the third highest number of opiate pills per inhabitant, according to an analysis of the Associated Press on federal data.
Andrew Kolodny, a physician at Brandeis University who has long been critical of opioids, said that in recent years, doctors have felt less comfortable writing many opiate prescriptions and many major prescribers they are withdrawn. This has opened up an opportunity for others.
"If you're one of the guys still doing it," he said, "you'll have tons of patients knocking on your door."
During his trial, Smithers testified that after moving to Virginia, he found himself inundated with patients from other states who claimed that many nearby pain clinics had been closed. Smithers said he reluctantly started treating these patients with the goal of eliminating them at high doses of immediate-release drugs.
He acknowledged during the testimony that he sometimes wrote and mailed prescriptions for patients he had not examined, but insisted he had spoken to them on the phone.
He once met a woman in the parking lot of a Starbucks, gave him $ 300 and gave her a prescription for fentanyl, an opioid painkiller that is 50-100 times more powerful than morphine.
When area pharmacists began to refuse to complete the prescriptions written by Smithers, he referred patients to distant pharmacies, including two in western Virginia. Prosecutors say that Smithers also used some patients to distribute drugs to other patients. Four people were indicted in Kentucky with the conspiracy charge.
At his trial, Smithers portrayed himself as a caring doctor who was deceived by some patients.
"I learned several lessons the hard way about trusting people I shouldn't have trusted," he said.
Smithers' attorney told the judge that he had been diagnosed with depression and anxiety. Family members said through a spokesman that they believe his decisions were influenced by personal stress and emotional and mental tension.
Even before opening his practice in Martinsville in August 2015, Smithers had raised suspicions. The West Virginia authorities contacted him in June 2015 about a complaint with his file there, but when they returned the next day with a summons, they found his office cleaned up and a dumpster full of shredded papers and samples of urine not tested.
Some of Smithers' patients remained very faithful to him, insisting that their severe chronic pain was relieved by the powerful painkillers he prescribed.
Lennie Hartshorn Jr., the father of the West Virginia woman who died two days after taking the medicines prescribed by Smithers, testified of the defense.
Hartshorn said his daughter, Heather Hartshorn, told someone "she'd rather be dead than suffer all the time". According to a form compiled by Heather Hartshorn when she went to visit Smithers, she suffered from chronic pain in her lower back, legs, hips and neck due to a serious car accident and a fall.
When asked by Smithers' attorney to blame Smithers for something, Lennie Hartshorn said no.
Smithers was denied the bond while awaiting sentencing. His lawyer did not answer the questions of the AP. Smithers stated that he intends to appeal.
Associated Press journalists Geoff Mulvihill and Riin Aljas contributed to this story.
.. (t) Synthetic drugs (t) Virginia (t) United States (t) North America (t) health news (t) medical news (t) medical articles