In the public housing complex where he lived in Celina, about 75 miles northeast of Nashville, "there were about eight or 10 people there on TennCare and they all had prescription drugs," Carmack said. "People who came there, who did not live there, came there to buy drugs."
Nationwide, the amount of five major painkillers sold at retail stores rose 90 percent between 1997 and 2005, but the biggest increase of any state was in Tennessee.
A study by The Associated Press shows painkiller prescriptions in Tennessee for oxycodone, codeine, hydrocodone, morphine and meperdine went up by 206 percent during those nine years.
The AP found there were several reasons for the nationwide increase: an aging population, marketing campaigns by drugmakers, and a greater acceptance of pain management by doctors. But the sharp increase in Tennessee was due in large part to the generous drug benefits from TennCare.
Patients enrolled in TennCare paid just 1.6 percent of the cost of their prescriptions, and that contributed to the state's high use of the drugs, according to a 2003 report by the state's leading private insurer, Blue Cross Blue Shield of Tennessee.
On top of that, an agreement the state made with legal advocates for TennCare patients in 1999 virtually assured all prescriptions would be filled.
The consent decree "did not allow us to prevent someone from getting additional narcotics, even if a pharmacist could see they had just picked some up somewhere else," TennCare spokeswoman Marilyn Wilson said.
"We have a point-of-sale system where a pharmacist is alerted that there is a problem when someone tries to refill a prescription," she said. But with TennCare patients, the pharmacist was required to push a button and override the alert.
Carmack got busted for selling prescription drugs in 2005, went to treatment and got clean, but prescription drug addiction still is a huge problem in his small town.
"You see a lot of people my age walking around with canes and walkers or carrying oxygen," the 37-year-old said. "If you know how to talk to a doctor and have any small health issue you can manufacture a chronic health problem."
Carmack says he knew a man who cut off his own finger to get a narcotics prescription.
"I really feel lucky to be alive," he said, "because a lot of people I used with are dead."
At the same time painkiller use was on the rise, the accidental poisoning rate for prescription drugs in Tennessee was found to be 26 percent above the national average, according to a Blue Cross Blue Shield of Tennessee study released earlier this year.
The death rate from accidental drug poisoning in the state doubled in the four years from 1999 to 2003.
There is reason to believe things have begun to change. The state created an agency to investigate TennCare abuse in 2005. Since then Inspector General Deborah Faulkner said her office has arrested 481 people, and 327 were for drug diversion.
In 2005, the state cut thousands of people from TennCare and reduced benefits to thousands more in an effort to save costs. And in 2006, the state won some relief from the consent decree and was able to put restrictions on the number of drugs it would pay for.
TennCare's chief pharmacy officer Dave Beshara said claims for chronic analgesics dropped from 2.6 million in 2005, to 1.6 million in 2006, when the new rules went into effect.
Beshara and others also said they expect a new law to cut down on the overprescription of painkillers. Although it had been illegal in Tennessee to sell prescription drugs or fraudulently obtain them, it was completely legal for someone to obtain multiple prescriptions for the same or similar drugs from several doctors.
Rep. Gary Odom, D-Nashville, sponsored a bill that made so-called "doctor shopping" a felony for TennCare patients beginning this June. He plans to introduce another bill next year that would extend the prohibition to all patients.
"When someone picks up 10 prescriptions for OxyContin, and it's 10 prescriptions for a one month's supply, in 15 days, there's no doubt about what that is," he said.