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A World of Hillbilly Heroin: The Hollowing Out of America, Up Close and Personal

In a new book Chris Hedges and Joe Sacco explore the poorest pockets of the United States. In West Virginia they found communities ravaged by drugs.

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Obtaining the monthly “handout” became an art form. People were reduced to what Caudill called “the tragic status of ‘symptom hunters.’ If they could find enough symptoms of illness, they might convince the physicians they were ‘sick enough to draw’... to indicate such a disability as incapacitating the men from working. Then his children, as public charges, could draw enough money to feed the family.”

Joe and I are sitting in the Tug River Health Clinic in Gary with a registered nurse who does not want her name used. The clinic handles federal and state black lung applications. It runs a program for those addicted to prescription pills. It also handles what in the local vernacular is known as “the crazy check” -- payments obtained for mental illness from Medicaid or SSI -- a vital source of income for those whose five years of welfare payments have run out. Doctors willing to diagnose a patient as mentally ill are important to economic survival.

“They come in and want to be diagnosed as soon as they can for the crazy check,” the nurse says. “They will insist to us they are crazy. They will tell us, ‘I know I’m not right.’ People here are very resigned. They will avoid working by being diagnosed as crazy.”

The reliance on government checks, and a vast array of painkillers and opiates, has turned towns like Gary into modern opium dens. The painkillers OxyContin, fentanyl -- 80 times stronger than morphine -- Lortab, as well as a wide variety of anti-anxiety medications such as Xanax, are widely abused. Many top off their daily cocktail of painkillers at night with sleeping pills and muscle relaxants. And for fun, addicts, especially the young, hold “pharm parties,” in which they combine their pills in a bowl, scoop out handfuls of medication, swallow them, and wait to feel the result.

A decade ago only about 5% of those seeking treatment in West Virginia needed help with opiate addiction. Today that number has ballooned to 26%. It recorded 91 overdose deaths in 2001. By 2008 that number had risen to 390.

Drug overdoses are the leading cause of accidental death in West Virginia, and the state leads the country in fatal drug overdoses. OxyContin -- nicknamed “hillbilly heroin” -- is king. At a drug market like the Pines it costs a dollar a milligram. And a couple of 60- or 80-milligram pills sold at the Pines is a significant boost to a family’s income. Not far behind OxyContin is Suboxone, the brand name for a drug whose primary ingredient is buprenorphine, a semisynthetic opioid. Dealers, many of whom are based in Detroit, travel from clinic to clinic in Florida to stock up on the opiates and then sell them out of the backs of gleaming SUVs in West Virginia, usually around the first of the month, when the government checks arrive. Those who have legal prescriptions also sell the drugs for a profit. Pushers are often retirees. They can make a few hundred extra dollars a month on the sale of their medications. The temptation to peddle pills is hard to resist.

We meet Vance Leach, 42, with his housemates, Wayne Hovack, 40, and Neil Heizer, 31, in Gary. The men scratch out a meager existence, mostly from disability checks. They pool their resources to pay for food, electricity, water, and heat. In towns like Gary, communal living is common.


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When he graduated from the consolidated high school in Welch in 1987, Leach drifted. He went to Florida and worked for the railroad. He returned home and worked in convenience stores. He held a job for 11 years for Turner Vision, a company that took orders for satellite dishes. He lost the job when the company was sold. He worked at Welch Community Hospital for six months and then as an assistant manager of the McDowell 3, the Welch movie theater. His struggle with drugs, which he acknowledges but does not want to discuss in detail, led to his losing his position at the theater. He is preparing to start a course to become licensed as a Methodist minister and serves the two local United Methodist churches, neither of which muster more than about a half dozen congregants on a Sunday. The 20 theology classes, which cost $300 a class, are held on weekends in Ripley, about four hours from Gary.

 
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