Jaclyn Kinkade, a 23-year-old doctor's-office receptionist and

occasional model, was a casualty of America's No. 1 drug menace when she

overdosed and died, alone, in a tumbledown clapboard house in

Dunnellon, Fla.

The drugs that killed her didn't come

from the Colombian jungles or an Afghan poppy field. Two of the three

drugs found in her system were sold to Ms. Kinkade, legally, at Walgreen Co. and CVS Caremark

shops, the two biggest U.S. pharmacies. Both prescription drugs found

in her body were made in the U.S.—the oxycodone in Elizabeth, N.J., by a

company being acquired by generic-drug giant Watson Pharmaceuticals Inc., and the methadone in Hobart, N.Y., by Covidien Ltd., another major manufacturer. Every stage of their distribution was

government-regulated. In addition, Ms. Kinkade had small amounts of

methamphetamine in her system when she died.

The U.S. spends about

$15 billion a year fighting illegal drugs, often on foreign soil. But

America's deadliest drug epidemic begins and ends at home. More than

15,000 Americans now die annually after overdosing on prescription

painkillers called opioids, according to the Centers for Disease Control

and Prevention—more than from heroin, cocaine and all other illegal

drugs combined.

Rising opioid abuse means that drug

overdoses are now the single largest cause of accidental death in

America. They surpassed traffic accidents in 2009, the most recent CDC

data available.

Paradoxically, the legality of

prescription painkillers makes their abuse harder to tackle. There is no

Pablo Escobar to capture or kill. Authorities must contend with an

influential lobby of industry representatives and doctors who argue

against more restrictions, saying they would harm legitimate patients.

And lawmakers have been reluctant to have the federal government track

Americans' prescriptions, leaving states to piece together a patchy,

fragmented response.

Ms. Kinkade's final days, and the path of the drugs that killed her,

were reconstructed from medical and prescription records, police files

and interviews. Many records were assembled by Ms. Kinkade's father and

stepmother.

Shuffling through the documents at their living-room table, Bruce

Kinkade, a garage-door salesman, and his wife, Ann, said they don't wish

to absolve their daughter of responsibility. "We're not naive and want

to say she was a perfect angel," said Ann Kinkade, Jaclyn's stepmother.

Tracing the Path of Prescription Painkillers

Jaclyn Kinkade

A family photo of Jaclyn Kinkade as a child with a composite of the prescription records.

But the Kinkades say the companies and

licensed professionals that supplied her with the drugs must also bear

some responsibility. "Jackie didn't wake up one day and say, 'Hey, I'm

going to be a drug addict today,'" Ann Kinkade said. "Jackie pretty much

got sent there by a doctor, got hooked and continued to go back."

There are few easy villains in

prescription drug abuse. Companies, physicians and addicts alike are all

pieces in a complex puzzle. For some time, regulators have been

cracking down on doctors who prescribe to addicts for profit. Now,

federal and state officials are starting to move up the supply chain to

pursue pharmacies and distributors.

On Sept. 12,

the Drug Enforcement Administration revoked the licenses of two Florida

CVS stores, which it claims sold excessive amounts of oxycodone without

ensuring the pills weren't diverted to the black market. CVS is fighting

the DEA's order in administrative and federal courts.

Two days later, the agency served

Walgreen with a suspension order halting sales of controlled substances

from its Jupiter, Fla., distribution center, calling it an "imminent

threat to public safety." The DEA's regulatory action alleges that the

facility—the state's largest oxycodone distributor—"failed to maintain

effective controls'' of its narcotic painkillers.

Walgreen said it is working with

regulators and has tightened its procedures. CVS said it was committed

to working with regulators "to reduce prescription drug abuse and

diversion while ensuring access to appropriate, effective pain

medication for our patients who need them."

Participants in the drug-supply chain

acknowledge the problems but point to others as the weak link. Doctors

involved say pharmacies should be able to tell if patients are secretly

using several physicians to obtain more drugs. Druggists say they can't

second-guess a valid prescription. Manufacturers and distributors say

they are simply delivering products ordered by health-care

professionals.

from previous ones, such as heroin in the 1970s and cocaine in the

1980s, is that everyone in the distribution chain is identifiable. The

DEA itself controls the supply spigot by setting drug companies'

production quotas for opioids like oxycodone and hydrocodone.

For

years, opioids were reserved mainly for cancer or terminally ill

patients because of fears over their safety and addictiveness. But over

the past 15 years, many doctors have come to view them as an essential

tool to manage chronic pain. Around the same time, drug makers began

marketing patented, time-release formulations of the drugs, making it a

lucrative category.

Today, a growing number of doctors say

the pendulum has swung too far, with powerful narcotics being dispensed

for even relatively minor complaints. Last year, pharmacies dispensed

more than $9 billion in prescription opioid painkillers, more than twice

the amount a decade earlier, according to IMS Health, a research firm.

The number of prescriptions has risen fourfold. The generic version of

Vicodin, a blend of hydrocodone and acetaminophen, is now the most

prescribed drug in the country.

as heroin and can produce similar addictions, researchers say. "We're

basically talking about heroin pills," said Andrew Kolodny, chairman of

the psychiatry department at Maimonides Medical Center in New York.

Studies show that opioid addicts come

from a surprisingly broad swath of the population: the middle-age, the

elderly and, increasingly, young adults. Many U.S. veterans returning

from Iraq and Afghanistan with physical and mental injuries are also

becoming dependent on prescription painkillers, researchers say.

In recent decades, researchers have

come to view addiction as a disease, rather than just a personal

failing. Some people are more predisposed to becoming addicted because

of heredity, experience and other factors that have yet to be fully

understood. But some drugs are simply more addictive than others.

Jaclyn Kinkade Before She Began Taking Drugs.

research suggests that drugs like opioids cause long-lasting changes to

the brain, rewiring some areas to crave more drugs while simultaneously

damaging the parts that can control those cravings. The drugs can damage

the brain's ability to feel pleasure, so regular users eventually need

to take them not to get high or help with pain, but just to feel normal.

Avoiding unpleasant withdrawal symptoms end up conditioning many drug

users' daily lives.

One of the most confounding aspects of this latest epidemic is that

it blurs the lines between legal and illegal drug use. Some people first

take drugs from their family medicine cabinets to get high, then go to

doctors to get more. Others are originally prescribed the pills for

legitimate reasons, then buy them on the street once they're hooked.

Many, such as Ms. Kinkade, end up mixing legal and illegal drugs in ways that can prove lethal.

Ms. Kinkade was a lively, talkative

woman with blond hair, a fear of caterpillars and a pit-bull terrier,

Bentley, that traveled everywhere with her.

She was first prescribed an opioid on

Oct. 27, 2006, by the doctor who employed her as a receptionist,

prescription records show. According to medical records and an entry

from her diary, she had been suffering back and neck pain. Thomas Suits,

her employer, prescribed 20 pills of Endocet, a drug containing

oxycodone. "I'd never taken opioids before," Ms. Kinkade wrote in a

diary entry. "But I started the med routine and OMG I felt no pain."

Jaclyn Kinkade on vacation when she was 21 years old. She died of an accidental drug overdose about two years later, at age 23.

Dr. Suits

didn't recall prescribing the medication, said his wife, Irene Machel, a

doctor who also works at the clinic. She declined to discuss the matter

further.

Endo Health Solutions,

which made the pills, declined to comment on Ms. Kinkade. "These types

of stories are tragic and we obviously take them seriously," said Endo

spokesman Blaine Davis. "Our responsibility, as a company that is very

dedicated to the field of pain management, is to educate both physicians

and patients about appropriate use."

Soon

Ms. Kinkade was seeking more drugs. On Jan. 5, 2007, she saw Bruce

Kammerman, a family practitioner at a clinic in Stuart, Fla., and came

away with a generic blend of oxycodone and acetaminophen. A scan taken a

month later showed no problems with her spine, according to the medical

report. Through his lawyer, Dr. Kammerman declined to say why he wrote

the prescription. "That's a sad case," said his attorney, Lance Richard.

"Maybe she didn't have justifiable pain but she certainly came in and

made complaints about it. At some point the doctor just has to go on the

patient's word."

pain clinic in Vero Beach, Fla., charged with drug trafficking,

racketeering and illegally selling controlled substances. The DEA said

in a news conference he was prescribing an average of 1,700 oxycodone

tablets a day. Dr. Kammerman's lawyer said his client has done nothing

wrong and pleaded not guilty.

Jaclyn Kinkade In a Mug Shot on May 10, 2010, Two Months Before Her Death.

Ms. Kinkade broke up with her

boyfriend. She began missing work. One day she was found curled up under

her desk, crying. "She always used to be clean-cut, nice makeup," said

Susan Cochran, a former colleague. Then "she would come in in sweatpants

and it was like: 'Who is this person?'"

Ms. Kinkade changed jobs to work at a radiologist's office. There,

she had two other scans, in April and July 2008. Neither showed

significant spine problems, according to the medical reports. Ms.

Kinkade started seeking clinics that asked fewer questions. "Family

practitioners hate writing narcotics," she wrote in her diary.

"Nowadays—I'll just go str8 to pain docs."

During that period, she was prescribed

large amounts of oxycodone, her records show, combined with antianxiety

drugs and powerful muscle relaxants. Her parents grew increasingly

alarmed. "Sometimes you'd be having a conversation with her and her head

would just drop," Mr. Kinkade said. "And she'd say: 'Oh, I'm just

tired; I was out late.'"

After reviewing her records, he said, "We estimated that at one point

she was taking 13.4 pills per day, for nothing wrong with her."

In May 2009, Mr. Kinkade and his wife asked a judge to have their

daughter forcibly admitted to drug treatment under a Florida law. Their

request was initially denied because she wasn't a minor. Angered by

their efforts, Ms. Kinkade moved out of their home and drove across the

state to her biological mother's house. She crashed her car and was

found wandering along the highway in a drug-induced daze, her parents

said, searching for her pills.

Legal records show she was arrested

several times for minor crimes such as possessing controlled drugs

without a prescription and shoplifting small items, including makeup and

cake topping. In each case, she was released and the charges dropped.

She

started visiting a pain clinic in Tampa called Doctors Rx Us, where she

was prescribed oxycodone, methadone, alprazolam and gabapentin, an

antiseizure medication, according to records her parents collected.

Housed in a rundown strip mall, the clinic today is called Palm Medical

Group after a name change in 2011, according to its state records.

Ms. Kinkade was prescribed the drugs by two physicians at Doctors Rx

Us: Richard Smith and William Crumbley. Dr. Crumbley was arrested in

December and charged with operating a nonregistered pain clinic at

another location. He has pleaded not guilty.

Dr. Smith and the clinic declined repeated interview requests. A

lawyer for Dr. Crumbley said he was innocent of any wrongdoing.

On May 3, 2010, Ms. Kinkade stopped at a

CVS in Crystal River, Fla., and picked up a prescription written by Dr.

Smith for 90 tablets of 10mg methadone, along with 90 tablets of

alprazolam, an antianxiety drug.

"Jaclyn Kinkade's death is a terrible

tragedy that highlights the need for a comprehensive national effort to

prevent prescription drug abuse," CVS said in a statement.

Information provided by the manufacturer suggests that the methadone dispensed to Ms. Kinkade was likely supplied to CVS by Cardinal Health Inc.

Cardinal was the only distributor to have sold that particular drug to

that CVS branch during that period, according to the manufacturer's

records. CVS and Cardinal declined to comment.

Last

year, the DEA launched a probe of the Florida-based operations of

Cardinal Health and CVS Caremark. The agency alleged they dispensed

"extremely large amounts" of oxycodone with signs that the drugs were

"diverted from legitimate channels."

CVS said it has "responded to the DEA's

concerns, including implementing enhancements to our policies and

procedures for filling controlled substance prescriptions." Cardinal

settled with the DEA in May, agreeing to suspend sales for two years at

one of its key distribution facilities in Lakeland, Fla.

The methadone Ms. Kinkade picked up at

the end of her life was made in Hobart, N.Y., by Mallinckrodt, a unit of

health-care giant Covidien. "Any death from abuse or misuse of

prescription drugs is tragic," Covidien said. "That's why we believe

that, as a nation, ending the abuse, diversion and misuse of powerful

pain medications is necessary to ensure adequate treatment of pain and

access to that treatment for legitimate pain patients."

On May 10, 2010, Ms. Kinkade was

stopped by police in Levy County, Fla., for having an expired

registration. A drug-sniffing dog reacted to her car and she was

arrested for possessing a generic form of Xanax without the correct

prescription. This time, her parents let her sit in jail for a couple of

weeks while they organized a place for her in a rehabilitation program.

They bailed her out May 25 and enrolled her in drug treatment.

Over the next month, Ms. Kinkade went

to the treatment program during the day and seemed to improve, her

parents said. Then, the evening of June 24, she climbed out the window

at her parents' house.

A few days later, on the other side of

Florida, she met up with a boyfriend, according to a statement he later

gave police. She returned to Doctors Rx Us, where Dr. Smith wrote a

prescription for 90 tablets of 30mg oxycodone, according to prescription

records. It would be her last.

The next day, Ms. Kinkade filled the

prescription at a Walgreens in Beverly Hills, Fla. The oxycodone would

have come from Walgreen's Jupiter, Fla., distribution center, a company

spokesman said. On Sept. 14, the DEA barred that facility from selling

controlled substances, alleging that it failed to maintain effective

controls to stop large amounts of oxycodone from reaching the black

market. "When [companies] choose to look the other way, patients suffer

and drug dealers prosper," Mark Trouville, the DEA special agent in

charge, said at the time. Walgreen said in a statement it is cooperating

with the DEA.

The oxycodone came from the New Jersey

plant of Actavis, a Swiss pharmaceutical company. In April, Actavis was

bought by Watson Pharmaceutical in a $5.8 billion deal awaiting

regulatory approval. An Actavis spokesman described Ms. Kinkade's

situation as a "tragic occurrence" and called for discussion on "how to

prevent such cases in the future." A Watson spokesman cautioned against

action that would make it harder to treat legitimate patients. He said

the company supported educating patients about the drugs' proper use.

The morning of July 4, Ms. Kinkade's

boyfriend found her sitting cross-legged and slumped in his room at a

white, low-slung house tucked behind a trailer park. The medical

examiner said she died from a drug cocktail including oxycodone,

methadone and methamphetamine.

Ms. Kinkade's physical decline made

such an impression on the detective who investigated the case that, two

years later, he still recalls the scene. In the living room, he noticed a

poster of Ms. Kinkade modeling for a biker magazine.

"Wow, she's a beautiful young lady," Detective Matthew Taylor

remembered thinking. "When I actually saw her, it was as different as

night and day."

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