LEBANON, Ohio - As he sat in the doctor's office, ex-boxer and weightlifter Gerald Dixon explained that years of sports had left him in pain, especially his hands, and he was looking for relief.
After a cursory examination at the clinic in West Palm Beach, Fla., Dixon left with a prescription for 180 doses of OxyContin - and a plan to return to his Ohio home and sell them on the street.
The trips made by Dixon and others like him - authorities dub them "prescription" or "drug" tourists - have complicated the challenges investigators face trying to stem the flow of painkillers, whose prevalence have made drug overdoses the leading cause of accidental death in dozens of states including Ohio, Florida, Kentucky and Utah, surpassing car crashes.
Dixon, 52, a drug dealer for most of his adult life, had recently discovered a new angle on an old profession. By driving to Florida just once a month and acquiring a bagful of pain pills - legally and illegally - he could earn tens of thousands of dollars.
The only thing the medical clinics that Dixon visited in Florida cared about was the money, he said. A diagnosis for severe pain was easy to obtain.
"It's all about cash, cash, cash," Dixon said during a prison interview in April with The Associated Press. "You go, you pay the money, and they're going to come back and say, 'Yeah, you're right, you was hurt.'"
Prescription tourists thwart local efforts to combat the illegal sale of painkillers and to treat addicts by bringing huge volumes of drugs in from outside. Cracking down on the trade also requires complicated prosecutions crossing multiple state lines.
These tourists are based in a variety of states, but investigators in Kentucky, Ohio and West Virginia - where authorities have already cracked down on local pill mills - are among the busiest trying to track trips to Florida, Georgia and elsewhere.
The lucrative business involves drug dealers dispatching underlings like Dixon to states with numerous pill mills where they load up on painkillers, then return to sell the drugs to addicts willing to pay as much as $100 a pill, or as much as 10 times the drugstore price.
Florida for years was a popular destination because of its virtually unregulated pain clinic industry, which provided easy access to thousands of painkillers marketed under names like OxyContin, Vicodin and Percocet.
As Florida cracks down on its pill mills, the clinics have migrated to states like Georgia, which had practically none three years ago and now has as many as 150, said Richard Allen, director of the Georgia Drugs and Narcotics Agency.
Runners - another term for people like Dixon or addicts sent to buy pills and take them home - are coming from as close as Kentucky and Tennessee and as far away as Arizona and Nebraska, Allen said.
"They're like a swarm of locusts," he said. "Once they have a scrip, they'll hit every pharmacy in the state trying to get them filled."