Appalachia Today: Part 6 – Systemic Drug Abuse in the Region – An Epidemic

Source: Brandon Giesbrecht

Prescription Pain Killers

The life of Bobby Vaughn, a 47-year-old man from Harlan County, KY, illustrates the drug crisis that Appalachia has faced in recent years. Vaughn began abusing painkillers at the age of 15, stealing pills from his coal miner father, who was taking them for a work-related injury. Over the next three decades, Vaughn experimented with numerous drugs as they gained popularity in the region: OxyContin, meth, cocaine and now, heroin.[i] Vaughn’s story is one that has been repeated thousands of times by many others throughout the coal mining area of Appalachia.

Drug abuse has plagued Appalachia for at least two decades. Starting in the 1990s, the use of “meth” spread throughout the region. By 2005, the simple “shake-and-bake” method of producing meth had gained popularity, making it easy for virtually anybody who had access to the necessary ingredients to “cook” the drug at home. Between 2007 and 2013, the number of meth labs in Kentucky more than tripled, with southeastern Kentucky particularly hard hit.[ii]

According to some, a major reason for the spread of meth and meth addiction was a lack of meaningful work available in the region and the boredom that resulted from the lack of “anything to do.” As one former addict put it, “…around here drugs are the main source for people’s entertainment here…’cause people sit around and say, “Oh there ain’t nothing to do.'”[iii] Yet people who were gainfully employed also fell victim to addiction. One man in Laurel County, KY, for example had a good job in construction and a stable family life with his wife and four children. However, as he said, “Everybody around me was using it.” So he, too, decided to try it, and soon after, he lost his job, his house, his wife and his children. Twice, he was attacked by other addicts: one time, he was stabbed with a knife and the other time, he was shot in the face. His wife, like him, also became addicted, and both ended up in jail, leaving their children with their grandparents.[iv]


Source: Center Disease Control and Prevention

After meth, prescription opioids came to Appalachia. Six states in the country were hardest hit by the abuse of OxyContin, a prescription opioid, and five of those states are in Appalachia: West Virginia, Kentucky, Virginia, Pennsylvania and Ohio.[v]

West Virginia has one of the highest prescription rates of opioids in the country and is among the top ten states with the most prescriptions for high-dose and extended-release opioids, both of which are highly likely to be abused.[vi] Further, as of 2015, West Virginia had the highest rate of overdose deaths in the U.S.,[vii] with deaths caused by hydrocodone and oxycodone overdoses increasing by 67% between 2007 and 2012.[viii] Over a period of two years, drug companies shipped nearly 9 million hydrocodone pills to a single pharmacy in Kermit, WV, a small town with a population of just 392. In West Virginia as a whole, over a period of six years, drug wholesalers sent a total of 780 million hydrocodone and oxycodone pills to the state, which equates to 433 pills for each person in West Virginia. 1,728 people in the state fatally overdosed on these two drugs.[ix]

The coal mining areas of West Virginia were the hardest hit by opioid abuse in the state. Various theories exist as to how the coal industry and its collapse have contributed to the drug abuse problem. The state’s coal counties (Wyoming, McDowell, Boone and Mingo counties) are the top four counties in the nation for fatal overdoses caused by painkillers.[x]

Opioid abuse in West Virginia had similar beginnings as in the rest of the country. Prescriptions for opioids began rising dramatically in the mid-1990s, when pharmaceutical companies began heavily marketing powerful new painkillers like OxyContin. However, in West Virginia and other parts of Appalachia, two factors combined to make the epidemic much worse than in the rest of the country: 1) the existence of a large number of jobs involving manual labor, such as coal mining, which can often lead to injuries; and 2) high unemployment rates.[xi]

In the 1990s, miners, encouraged by their doctors, were more likely to take painkillers and keep working in the event of an injury rather than staying home and recovering. As John Temple, a West Virginia University professor and author of the book American Pain, described it, “In a mining camp, there aren’t a lot of doctors. That doctor is going to be more likely to opt for the quick fix and give people pills to fix their pain and get them back into the mine, rather than give them rest or therapy or those things that can actually cure pain.”[xii] Furthermore, if the miners were to stop working because of an injury, they would then have to fight for disability compensation, which is barely enough to live on.[xiii]

Opioid abuse over the past 20 years was exacerbated by the state’s declining economy and rising unemployment rate. Unsurprisingly, the southern coalfields, where the coal industry collapsed and many jobs were lost, were the areas hardest hit by drug abuse. As a 2009 report from the Appalachian Regional Commission put it, “Low education levels, high rates of unemployment and job-related injuries are closely linked to abuse of alcohol, illicit drugs and prescription medications.”[xiv]


Photo:
Data overview of drug overdose. (Source: Center Disease Control and Prevention)

Recently, after some attempts at a crackdown on pill suppliers, pill prices went up and drug dealers promptly took advantage of the situation by supplying cheap heroin, which produces a similar high as prescription painkillers.[xv] In West Virginia, heroin costs $20 per bag, about half the price of a single OxyContin pill. As a result, heroin use and heroin overdose deaths in West Virginia have tripled from 2009 to 2014. While heroin is not more addictive than OxyContin, it can be more dangerous. Heroin can contain impurities and contaminants, increasing the chances of death from use.[xvi] Heroin addiction has also led to more diseases being contracted through dirty needles, such as HIV and hepatitis. Among the 220 counties nationwide that are at high risk for the spread of these diseases, 54 are in Kentucky.[xvii]

As with meth, the abuse of heroin is a sign of a broader issue in central Appalachia: the lack of work and entertainment options due to a declining economy. As a former addict from Moorefield, WV described it, “Back where I’m from, there is nothing for people to do. There are no jobs. No drive-ins. No youth centers. There is no economy. People are going to doctors, getting scripts, and selling them on the street to survive.”[xviii]

Neonatal Withdrawal Syndrome


Photo: An infant with withdrawal syndrome after birth as a result of in utero exposure to licit or illicit drugs, especially opiates. (Source: Aneta Meszko)

Of course, drug addicts are not the only ones who suffer the consequences of their addiction. The presence of meth labs virtually everywhere, from cars, to motel rooms, to apartment buildings, exposed those living nearby to toxic chemicals and the risk of explosions. Families were also torn apart. Many children have had to be taken away from their homes, which were being used as meth labs, and many others were neglected, abused or injured by addicted parents and had to be placed in foster care.[xix]  In 2014 in a single school, Southside K-8 School in War, McDowell County, WV, the principal said that on average, 43% of her students had lost a mother or father either from a drug overdose or because they were removed from their homes. In the fourth grade, about 40% of students were in a special education program because many of them were born addicted to drugs. In more than one case, the principal has even seen students removed from their homes because a parent sold them for sex in exchange for money to buy drugs.[xx]

 

[i] Laura Ungar, “Fears grow as heroin seeps into Appalachia,” The Courier-Journal, August 13, 2016. http://www.courier-journal.com/story/news/local/2016/08/13/fears-grow-heroin-seeps-into-appalachia/87950936/.

[ii] Jonah Engle, “Merchants of Meth: How Big Pharma Keeps the Cooks in Business,” Mother Jones, August 12, 2013. http://www.motherjones.com/politics/2013/08/meth-pseudoephedrine-big-pharma-lobby.

[iii] Ryan A. Brown, “Crystal methamphetamine use among American Indian and White youth in Appalachia: Social context, masculinity, and desistance,” National Institutes of Health, June 2010, p. 4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3104682/pdf/nihms249891.pdf.

[iv] Jonah Engle, “Merchants of Meth: How Big Pharma Keeps the Cooks in Business,” Mother Jones, August 12, 2013. http://www.motherjones.com/politics/2013/08/meth-pseudoephedrine-big-pharma-lobby.

[v] David Gutman, “How did WV come to lead the nation in overdoses?”, Charleston Gazette-Mail, October 17, 2015. http://www.wvgazettemail.com/apps/pbcs.dll/article?AID=/20151017/GZ01/151019539.

[vi] Harrison Jacobs, “Here’s why the opioid epidemic is so bad in West Virginia – the state with the highest overdose rate in the US,” Business Insider, May 1, 2016. http://www.businessinsider.com/why-the-opioid-epidemic-is-so-bad-in-west-virginia-2016-4.

[vii] David Gutman, “How did WV come to lead the nation in overdoses?”, Charleston Gazette-Mail, October 17, 2015. http://www.wvgazettemail.com/apps/pbcs.dll/article?AID=/20151017/GZ01/151019539.

[viii] Eric Eyre, “Drug firms poured 780M painkillers into WV amid rise of overdoses,” Charleston Gazette-Mail, December 17, 2016. http://www.wvgazettemail.com/news-health/20161217/drug-firms-poured-780m-painkillers-into-wv-amid-rise-of-overdoses.

[ix] Eric Eyre, “Drug firms poured 780M painkillers into WV amid rise of overdoses,” Charleston Gazette-Mail, December 17, 2016. http://www.wvgazettemail.com/news-health/20161217/drug-firms-poured-780m-painkillers-into-wv-amid-rise-of-overdoses.

[x] Eric Eyre, “Drug firms poured 780M painkillers into WV amid rise of overdoses,” Charleston Gazette-Mail, December 17, 2016. http://www.wvgazettemail.com/news-health/20161217/drug-firms-poured-780m-painkillers-into-wv-amid-rise-of-overdoses.

[xi] Harrison Jacobs, “Here’s why the opioid epidemic is so bad in West Virginia – the state with the highest overdose rate in the US,” Business Insider, May 1, 2016. http://www.businessinsider.com/why-the-opioid-epidemic-is-so-bad-in-west-virginia-2016-4.

[xii] Harrison Jacobs, “Here’s why the opioid epidemic is so bad in West Virginia – the state with the highest overdose rate in the US,” Business Insider, May 1, 2016. http://www.businessinsider.com/why-the-opioid-epidemic-is-so-bad-in-west-virginia-2016-4.

[xiii] Nick Mullins, “The pain pill epidemic isn’t going anywhere until we end coal’s dominance,” The Washington Post, January 3, 2017. https://www.washingtonpost.com/opinions/the-pain-pill-epidemic-isnt-going-anywhere-until-we-end-coals-dominance/2017/01/03/e7e87ee6-ceb3-11e6-a87f-b917067331bb_story.html?utm_term=.f00c7e973e06.

[xiv] Harrison Jacobs, “Here’s why the opioid epidemic is so bad in West Virginia – the state with the highest overdose rate in the US,” Business Insider, May 1, 2016. http://www.businessinsider.com/why-the-opioid-epidemic-is-so-bad-in-west-virginia-2016-4.

[xv] Harrison Jacobs, “Here’s why the opioid epidemic is so bad in West Virginia – the state with the highest overdose rate in the US,” Business Insider, May 1, 2016. http://www.businessinsider.com/why-the-opioid-epidemic-is-so-bad-in-west-virginia-2016-4.

[xvi] Olga Khazan, “The New Heroin Epidemic,” The Atlantic, October 30, 2014. https://www.theatlantic.com/health/archive/2014/10/the-new-heroin-epidemic/382020/.

[xvii] Laura Ungar, “Fears grow as heroin seeps into Appalachia,” The Courier-Journal, August 13, 2016. http://www.courier-journal.com/story/news/local/2016/08/13/fears-grow-heroin-seeps-into-appalachia/87950936/.

[xviii] Olga Khazan, “The New Heroin Epidemic,” The Atlantic, October 30, 2014. https://www.theatlantic.com/health/archive/2014/10/the-new-heroin-epidemic/382020/.

[xix] Jonah Engle, “Merchants of Meth: How Big Pharma Keeps the Cooks in Business,” Mother Jones, August 12, 2013. http://www.motherjones.com/politics/2013/08/meth-pseudoephedrine-big-pharma-lobby.

[xx] Kimberly Johnson, “As coal fades in West Virginia, drugs fill void,” Al Jazeera America, March 26, 2014. http://america.aljazeera.com/features/2014/3/as-coal-fades-inwestvirginiadrugsfillthevoid.html#featureArticle-chapter–2.