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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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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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