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Inside the Growing Prescription Pill Epidemic That's Ravaging Communities

What started out as a situation in poor isolated areas of the country left to their own devices has taken root and spread, across Appalachia and beyond.
 
 
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Editor's Note: We're proud to announce that we've teamed with Salon to pursue the most important under-covered stories in the country. This story is the first product of our Salon-Alternet Investigative Fund.

KERMIT, W.Va. -- It takes less than a minute to drive past Kermit, five to tour the place entirely. An old coal mining town with barely 300 residents and one blinking light between the train tracks, Kermit has no supermarket, no clothing store, no main drag. Main Street is really a side street with rows of cottages, its biggest building, the Kermit community center, empty and boarded.

Yet in this tiny town, the Kermit Sav-Rite Pharmacy used to be as busy as a New York deli. Six employees worked the counter, lines at the drive-through window snaked around the square cinder-block building, and the parking lot was full day and night.

Of course, everyone in Kermit — just about everyone in the wooded hollows of Mingo County — knew the Sav-Rite was a pill mill. It handed out Xanax, Lortabs, Vicodin — all manner of the prescription painkillers and anti-anxiety drugs that are crippling Appalachia like a rogue disease — to anyone with an excuse. Kermit, which sits in the poorest, most remote corner of southwest West Virginia at the Kentucky border, was drawing pill addicts from all over the Eastern seaboard. People were throwing pill parties in the parking lot. Trading pills, buying, selling, injecting, snorting, the works.

This went on for years before the law could stop it. In February, more than two years after the DEA and FBI stormed the Sav-Rite, seizing cases of files, its owner, John T. Wooley, pleaded guilty to selling prescription pills by fraudulent means. Wooley, in cahoots with a pill mill “pain management” clinic that existed to sell scripts, was filling prescriptions as if the fate of mankind depended on it. The Kermit Sav-Rite, along with another one Wooley owned in a tiny hamlet about 10 miles from Kermit, together doled out enough hydrocodone, the main ingredient in Vicodin and Lortabs, for every man, woman and child in West Virginia (population: 1. 8 million). The Sav-Rites moved almost 3.2 million dosage units of hydrocodone in 2006, the year the U.S. attorney used to make a case, compared with the national average of 97,000. Wooley, who sold the Kermit store a few months ago (he lost the other to the feds’ raid), faces four years in prison and a $250,000 fine at his sentencing in May. At 76 years old, he could probably better afford the fine than the time. Agents who raided the Kermit store said cash drawers were so stuffed they couldn’t close.

But shutting down pill mills in these parts is like playing Whac-A-Mole: As soon as a lawless “pain management” clinic or pharmacy is smacked down, others spring up. Investigations take years before prosecutions can be secured.  And pill mills are only part of the problem. Most often, pill addicts get their drugs from friends or on the street. Drug gangs from cities like Detroit, Atlanta and Columbus, Ohio, have also moved in on the action, setting up drug “stores” in residences and other fronts. Almost fondly, people here recall when Oxycontin was jokingly called “hillbilly heroin ”and pill addicts were “pillbillies.” No one is joking now. What is happening in Appalachia, about 10 years into an explosion of prescription drug abuse, is so pervasive a problem that law enforcement officials say they cannot solve it alone.

The West Virginia newspapers offer daily examples of what the Mingo County sheriff, Lonnie Hannah, calls the “spinoffs of drug abuse”: Murders, assaults, robberies, burglaries, domestic violence, child abuse, child neglect, elder abuse, DUIs, overdose deaths. West Virginia, the ninth smallest state, has the highest rate of prescription drug overdose deaths in the nation.

Hannah estimates that two-thirds of the crimes and incidents his department handles are related to pill abuse. Chasing down pill dealing is more than enough work by itself. “It’s all over the county,” Hannah said, at his headquarters in the city of Williamson (nickname: Pill-iamson), the Mingo County seat. Authorities keep busting pill mills and dealers in the city of 3,000 residents, only to see them start up again. “Whenever we move in,” Hannah said, “they move around to someplace else.”

People in these parts have a word for pill abuse: "pilling."  So much of it goes on that everyone has a story. They know someone who has abused or is abusing pills. They know parents who have lost custody of their children or neighbors who have lost good jobs or friends who have died because of them. They are shocked to hear that in some places in the country, say, San Francisco, pilling is neither a word nor a fact of life.

But that could be changing.  As the Centers for Disease Control and Prevention keeps warning, prescription drug abuse is spreading. Pills, especially Xanax, the anti-anxiety drug manufactured by Pfizer, and Vicodin, Loracet and Lortabs, highly addictive opioid painkillers familiar to anyone who has had a wisdom tooth removed, are being abused more and more, all over. What started out as a situation in poor isolated areas of the country left to their own devices has taken root and spread, across Appalachia and beyond.

You can find pockets of pill abuse from Orange County, Calif., to Staten Island, NY (sometimes now called Pill Island). Nationally, the abuse of prescription pain relievers, as evidenced by treatment submissions, has gone up 430 percent in the last decade, according to a new report by the Substance Abuse and Mental Health Services Administration in Washington, D.C. The report says states with the highest rise in prescription painkiller abuse include Maine, Vermont, Delaware, Kentucky, Maryland, Arkansas, Rhode Island and West Virginia.

Last June, pill addiction on Long Island raged into the headlines when a 33-year-old Army veteran, David Laffer, shot and killed four people in a Medford pharmacy while he robbed the store for hydrocodone. A Vicodin addict, he had been getting the drug through doctor shopping — going from one doctor to another to sidestep the monthly limit for scripts — until he lost his job and his insurance.

“If there is a discussion of doctor shopping and prescription pill abuse,” Laffer said upon his sentencing to life without parole, “then perhaps some good can come from this.”
Laffer’s story lingered for barely more than a news cycle. But the spread of pilling may be the saving grace for Appalachia and the other mostly poor, mostly rural parts of the country where little white pills are leveling entire communities.

They offer the cautionary tale: Political leaders, health professionals and community groups in these parts who have been crying for help can show the rest of the country what can happen when pilling runs rampant.

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Once, maybe just a few years ago, domestic mayhem like the kind described in the March 28 Williamson Daily News would have been the talk of Mingo County for days on end.

A 911 call brought sheriff’s deputies to unincorporated Dingess, a cluster of houses off a gutted path that can only generously be called a road. A couple had been fighting over pills.

Officers found 32-year-old Charles Earnest Chapman bleeding from stab wounds over his left eye and his abdomen, blood all over the house, a small white pill and pill residue by a children’s play area, and two kids, barely toddlers, hanging out of wide-open windows. In the yard lay an empty bottle of Lortabs, 90 mg. April Dawn Vance, 24 years old, had stabbed Chapman and fled the house, she told officers, after Chapman had knocked her to the ground, beat her and choked her. The children became wards of the state, the couple wards of the county jail.

The story did not prompt a single comment in the local news. Nor did this home invasion, reported the same week: In Williamson, Mingo County’s big city, with 3,000 residents, a man arrested for robbing a house admitted to another robbery where he and a cohort stalked an 85-year-old man, busted into his house, beat him to the floor and stole $340 from his wallet. Police said the man admitted he used the money he stole from the elderly man to buy pills. The Williamson police chief advised residents to lock their doors and windows and be vigilant.

Shootings have become news briefs. On April 2, a 33-year-old Mingo County woman, an admitted pill addict, was sentenced to 40 years in prison for shooting her husband to death during an argument.

Too many pill stories have knocked the shock out of the populace. Southwest West Virginia in the age of pilling is like a country that has been living with war for so long, people could barely remember peace.

Ask people how pilling started and most blame coal mining and Oxycontin. Miners spend much of their time in backbreaking positions, crouched, bent and folded over, and men anxious to keep their jobs have long relied on strong painkillers to keep going. Oxycontin began making the rounds here in the late 1990s. Its maker, Purdue Pharma, touted it aggressively to doctors as a safer alternative to hydrocodone-based pills like Percocet or Vicodin because of its time-release formulation.

That proved a boon to Purdue Pharma, which sold over $1 billion worth of Oxycontin a year. It also proved a lie: In 2007, Purdue Pharma pleaded guilty in federal court in Virginia to misleading doctors and patients by making false claims about Oxycontin’s safety. It paid a $600 million fine, the only time that Big Pharma has been publicly implicated in the pill abuse epidemic.

These days, the coal mining industry in West Virginia is rife with pilling. In March, a lobbyist for the West Virginia Coal Association told state lawmakers that the association suspects that miners from Kentucky and Virginia who were suspended after failing mandatory drug tests are now working in West Virginia. West Virginia is considering mandatory drug testing as well, especially after several incidents. In one recent accident, the lobbyist said, a miner high on prescription drugs crashed a locomotive into a mine car, killing a co-worker.

Oxycontin, public health experts and addicts themselves will tell you, is not the most-abused prescription drug in West Virginia. In 2010, the drug was reformulated to make it harder for addicts to crush, snort and inject it.  But public health experts say that even before then, by the mid-2000s, hydrocodone-based pills like Vicodin and Lortabs, and Xanax (generically, alprazolam), a benzodiazepine used to treat anxiety and panic disorder, were the drugs of choice in the dirt-poor areas of Appalachia, along with methadone and Percocet. Research on why points to “social determinants” such as poverty, lack of education and lack of opportunities, said Robert Pack, a public health expert at the East Tennessee University College of Public Health who has been studying pill abuse since 2002.

Mingo County (population.: 27,000), which became famous for the Hatfield-McCoy feud of the late 19th  century and the Matewan union-busting massacre of 1920, is second only to its neighboring county, McDowell, for the highest rate of overdose deaths from pills in West Virginia. Both counties are poor, McDowell the poorest in the state.

But the women at Crossroads, a kind of halfway house for recovering addicts in the town of Gilbert, at the southern end of Mingo County, come from very mixed backgrounds. Some come from broken homes and awful childhoods, others from loving parents. Some never finished high school, others are college graduates.

They consider themselves lucky. They landed in jail or committed to mental wards and were forced to go clean.

Crossroads, run by the Mingo County STOP  (the Strong Through Our Plan Coalition, a nonprofit community organization focused on drug prevention and treatment), requires a 90-day commitment. But many of the women end up staying longer, some longer than a year, as they earn high school equivalency diplomas and, often, try to regain custody of children they lost to the state.

Crossroads is a white single-wide trailer with a big sign on it; the whole town knows what it is and why its residents are there. But that has not hurt their job prospects. Every woman at Crossroads has a job. Local employers like hiring them, they say, since they know the women are clean and routinely drug-tested.

On a recent visit, the women were buzzing over the break-in, the night before, of one of Gilbert’s four pharmacies. The thieves had sawed through concrete dividing the building’s cinder blocks, the same break-in technique used at the Kermit Sav-Rite some months ago.

Long discussions with six of the eight women, who ranged in age from 21 to 37, found few patterns. Several had started using pills after doing other drugs. Others were given a pill by a friend. One had become hooked after receiving a legitimate prescription.

Most ended up on the Oxy Express, driving 15 hours with others, every two weeks, to central Florida to obtain scripts from pill mills there. Until recent crackdowns in Florida, it was the go-to place for pill heads from Appalachia to get their drugs. They’d buy cheap prescriptions and come up and sell them for five times what they paid. The general price on the street for pills is $1 per milligram, so that a 30 mg. Lortab costs $30. But in rural southern West Virginia, because of the demand, the pills cost more: 30 milligrams for $40, 90 milligrams for $100.

Now, the women said, more pill users are heading to Georgia and other states.

Several of the women became criminals: thieves, armed robbers.  One of them had just found out that her best friend and pill partner, 21 years old, had been sentenced to 30 years in prison for armed robbery.

Christine, a 35-year-old recovering opioid addict from Charleston, S.C. — she did heroin, pills, “anything I could shoot up” — works as a bookkeeper at a local company.  She had done drugs all through college and for years on end afterward, supporting her habit by selling pills and manufacturing methamphetamine. She was saved, after two overdoses in a month, when her mother and brother had her committed to a hospital. Now, a year and a half after entering Crossroads, she is a sponsor to other women and to inmates at the county jail.

Gilbert, with 450 residents, is not exactly a haven from pilling. Its nickname is Pillbert. The former executive director of Crossroads was forced to quit when she confessed that she herself was in active addiction.  Her husband, a church pastor, was fired from the church after he was spotted at a methadone clinic, receiving treatment for his pill addiction.

But the women at Crossroads tend to come from other parts of the county, or outside it altogether. For them, Gilbert is safer than returning to their own towns.

Christine said she thinks Gilbert will be a great place to raise her son, now 3 years old. She is hoping to get him back from her sister in Columbus within a year.  “Of course," she said, “nowhere is completely safe.”
 

 

Evelyn Nieves, former staff writer and columnist for the New York Times, is working on a book.
 
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