On the morning of March 3, 2011, teams of gun-toting DEA agents in black jumpsuits raided Salerian’s home. They handcuffed Salerian’s wife and the two adult children at home. (His wife told me she was so traumatized that she soiled herself.) Salerian arrived at his practice to find it commandeered by agents, who spent the day searching his computers, files, and financial records. Under civil-forfeiture laws, which don’t require criminal charges, the agents also seized three cars and the cash in three bank accounts.
Salerian responded by appointing himself leader of a global movement to end discrimination against pain sufferers. The curtain raiser was to be a giant civil-rights-style demonstration—Festival Pain Brain—in the fall of 2011 at the Lincoln Memorial. Salerian hired an advertising firm to mount a publicity campaign and to e-mail invitations to 40,000 medical students. He promised a guest appearance by country star Blake Shelton, an onslaught of 20,000 protesters, and the freeing of thousands of butterflies. Actual turnout: perhaps two to three dozen. There was no Shelton (who’d never agreed to come). There weren’t even butterflies.
Convinced of sabotage, Salerian made a defiant trip three months later to southwestern Virginia, where he’d heard that his long-distance patients were being harassed by police. He had persuaded a Buchanan County newspaper, the Voice, to host a public forum to take on critics. The paper’s publisher, Earl Cole, told me the issue was personal: His painkiller-addicted son had committed suicide in 2007, and his 21-year-old grandson was high on pills a year later when he lost control of his car and died in a head-on crash with a tractor-trailer.
“I said, ‘You have a lot to do to convince me that you’re not a drug dealer,’ ” Cole recalls. “But he did convince me. When he showed me a picture of the brain and how it all worked, I began getting an open mind about it.”
Cole remembers Salerian telling him, “I’m going to win a Nobel Prize for this.”
As the months passed, Salerian’s waiting room saw fewer patients in Rolexes and designer suits and more who looked like extras in some modern Grapes of Wrath: coal dust under fingernails, hats bearing Confederate flags. According to court papers, other tenants were soon complaining to the landlord about “the traffic of dirty unkempt people.”
Veteran staff bolted, and his office became a kind of hall of mirrors. Salerian hired one of his sons as a clinical director and another as a medical technician. He rated patients on a Salerian Pain Score, Salerian Mood Score, and Salerian Attention Measure. Though people came to him for physical pain as well as emotional distress, “there wasn’t a blood-pressure cuff or a stethoscope in the entire office,” a former employee says.
Salerian hired a bodyguard and, according to court records, ordered a strip search of a patient he thought was a police informant. By 2012, his fee for an initial “pain management” consultation had risen to $1,200, from $350 in 2010.
The front-desk staff soon asked patients to sign a new form. “I am not an undercover agent,” it began, before warning that anyone who tattled to authorities risked “serious consequences to [their] health.”
• • •
Seven hours to the south and west, Sheriff C. Ray Foster and Buchanan County’s chief prosecutor, Tamara Neo—along with state and federal law-enforcement officials—were building what they hoped would be a bulletproof criminal case.
A police informant showed up at Salerian’s office with a healthy MRI and records from a previous doctor who thought he needed nothing more than over-the-counter painkillers and exercise; the informant walked out with a prescription for 210 tablets of oxycodone, 90 of methadone, and 90 of Adderall, a stimulant, according to court records. The next month, when he wanted refills, the informant didn’t even have to come in. A request was phoned in to the office, and two days later UPS delivered the prescriptions to the informant’s doorstep in southwestern Virginia, in an envelope bearing the slogan “The Art and Science of Healing.”
The DEA, meanwhile, heard from a Rockville pharmacist who’d stopped filling Salerian’s prescriptions. The final straw for the pharmacist was the parade of patients with Tennessee ID cards who visited five minutes apart, each bearing a Salerian script written the same day.
Investigators discovered that Salerian had been prescribing more than 800 pills a month to four members of a major western Virginia drug-trafficking ring, according to court records. There was also a Buchanan County man, Brian Justice, who “was working with his mother, apparently, and his sister,” a prosecutor said at a hearing. “Other people were engaged to go as girlfriends down to see the doctor, and they were actively recruiting—this was a thriving business, sort of like Mary Kay.”
Last April, a federal grand jury in southwestern Virginia indicted Salerian on 36 felony drug counts. Two months later, it added over 100 more. The doctor now faces one count of conspiring to unlawfully distribute controlled substances and 143 for unlawful distribution—in many instances, to people in and around Buchanan County. If convicted at a trial set to begin February 10, Salerian could spend the rest of his life in prison.
The end can’t come soon enough for police in southwestern Virginia. In Sheriff Foster’s office last summer, I asked two of his plainclothes drug investigators where Salerian had ranked among doctors writing scripts to county residents. “Number one,” came the reply. “The majority of the medication coming into this county was written by him.”
Salerian denies any wrongdoing. His lawyers paint him as a pioneering pharmacologist whose clinic bore no signs of a profiteering pill mill. “Unlike other doctors actually convicted of similar charges,” they wrote in a statement, “Dr. Salerian established a doctor-patient relationship with each of his patients. He did not receive kickbacks in exchange for prescribing medication. He never led an extravagant lifestyle. He never treated phantom patients.”
For Salerian, though, the ultimate indignity came in June of last year, when the DC medical board finally acted. The board, composed mostly of fellow doctors, voted unanimously to revoke Salerian’s medical license. Salerian, trailed by his family, stormed out of the hearing room. One of his sons wiped away tears.
I walked out with Paddy’s father, Steven Kennedy. On the plaza outside the health department, Salerian, shaking with rage, pointed at Kennedy. “Child molester!” he bellowed. “Child molester!”
As bystanders looked on stunned, Salerian’s family tried to move him away. But he wouldn’t back down. “Child molester is here!” Salerian sputtered. Finally, one of his sons managed to lead him up the steps to North Capitol Street.
I caught up and asked Salerian for a response to his professional defrocking. “The Vatican was unanimous when they said the world was flat,” Salerian said. “Remember Galileo.”
• • •
Alen Salerian lives with his wife on a wooded lot in Bethesda. I visited a week before he lost his license, and he answered the door unsmilingly, with the darting eyes of a hunted man.
He’s free on $100,000 bond until his trial. But a judge confiscated his passport and restricted his travel to Maryland and DC. Salerian has filed for personal bankruptcy and owes his twin brother at least $1.9 million, much of it for legal fees. In addition to preparing his defense, his lawyers are fighting to reinstate his medical license. Experts they’ve hired will argue that something other than methadone killed Paddy Kennedy.
In the first minutes of our four-hour interview, I felt as if I were listening to the raw neural firings of a persecuted man, the ravings that jangle in our brains but that we dare not give voice for fear of being seen as unhinged. There were disjointed references to “the laws of the universe and the jungle,” “computers and nuclear bombs,” and “devastation with trickery.” The shelves of a sunroom that had become his makeshift office were lined with conspiracy books: Plausible Denial, Rush to Judgment, Lessons in Disaster.
Salerian told me that a former employee whose depression he’d treated with narcotics had family in Buchanan County, and that’s how people there discovered his practice. Prosecutors, he said, were reading too much into the distance patients had traveled and the spike in his fees. He charged many people on a sliding scale. There was no mystery to his popularity: Southwestern Virginia is home to many “poor, uneducated” people in injury-prone jobs like mining and trucking. Overzealous DEA crackdowns, Salerian said, had deterred all but the noblest doctors from prescribing the painkillers patients desperately needed.
Some of Salerian’s friends and longtime patients told me they worried Salerian had himself succumbed to dangerously “narcissistic” and “grandiose” delusions. The doctor needed professional help, they said, not prison.
When he and I spoke again last fall, I asked if it was possible he was ill.
Salerian told me he’d been diagnosed in the 1980s with anxiety and ADHD, for which his psychiatrist still prescribes Prozac and Adderall. But he rejects the idea, proposed to him by colleagues over the years, that he also suffers from bipolar disorder, a more serious condition in which people sometimes feel possessed of a kind of superhuman invincibility. He said his colleagues, forgivably, had mistaken his prodigious work habits, theatrical personality, and wide-ranging artistic pursuits for a disorder.
“Show me another psychiatrist who has had the record I have,” he said.
Contributing editor Ariel Sabar’s new book is a Kindle Single, The Outsider, about a maverick psychology professor who turned the town of Oskaloosa, Kansas, into an observatory of human behavior. This article appears in the February 2014 issue of Washingtonian.