‘Hillbilly Heroin’ Holds Appalachia in Its Grip of Death and Addiction

Kristen Rutledge had watched friends slowly kill themselves with OxyContin. Her own cousin, just 18, shot herself in the head when she couldn’t get more of the drug. Girlfriends were prostituting themselves for another fix.

Still, when someone offered her a yellowish 40-milligram pill, she took it, chopped it up and snorted it. It was the start of a three-day binge, and she was hooked.

“It’s not like any other drug I’ve ever done,” the 20-year-old says as she takes a drag off her umpteenth cigarette.

Over the next year, her habit grew until she was taking up to eight “40s” a day, she says. When her dad, a county school board member and former mayor, found out, she tricked him into giving her more money by saying she was being threatened by drug dealers.

The cash drain contributed to Tim Rutledge’s loss of his grocery franchise. But Kristen didn’t care.

“When I got down to two, I started panicking,” she says. “I had to get out and buy some more.”

Many in Appalachia call OxyContin “hillbilly heroin.” Its abuse may not have started in the mountains, but it exploded here.

Across the region, people have overdosed on the powerful prescription painkiller and robbed pharmacies and family members to feed their habits.

“If this was an infectious disease, the Centers for Disease Control would be in here in white vans,” Tim Rutledge says. “There’s no doubt it’s very much a plague.” To cancer patients and chronic pain sufferers, OxyContin is a wonder drug that can return them to a semblance of normal life.

Dr. Michael Levy, director of pain management at the Fox Chase Cancer Center in Philadelphia, calls Oxy “close to an ideal opiate.” While most strong pain medicines last only about four hours and take an hour or so to work, patients on Oxy get a steady 12-hour release of pain medicine with fewer side effects and less risk of liver damage.

“This product is better than any one thought it would be when it was released five years ago,” he says. “This is a drug we need to protect because it really helps patients.”

But to addicts who chew the pill or crush it to snort or inject, Oxy produces a one-shot, heroin-like high that can kill.

Purdue Pharma, the drug’s maker, is willing to concede that Oxy abuse has led to “somewhere between dozens and hundreds” of deaths in the past two years, says David Haddox, the company’s medical director.

“I am sure it has caused some deaths,” he says, “but my feeling is there is a magnification of this in the media.”

Last Monday the state of West Virginia sued the drug’s makers, accusing them of pressuring and enticing doctors to overprescribe Oxy and of failing to adequately warn of potential abuse. Purdue Pharma called the suit’s claims “completely baseless.”

Purdue Pharma has taken steps to limit the damage. The company has stopped shipping its 160-milligram pills and has suspended shipment of 40s to Mexico because too many were finding their way back across the border. The firm has offered tamper-resistant prescription pads in Maine and other states, and it expects to help pay for a federal pilot program to track narcotics prescriptions in Florida, Mississippi, Ohio, Virginia and West Virginia. Purdue Pharma sent a representative to Gilbert in January to address concerns, and it is running public service announcements on local radio to warn against abuse.

Law enforcement officials insist the problems have not been overblown. At least one dealer in Virginia has been charged with murder, and manslaughter charges were filed in a Florida Oxy death. Several Virginia doctors have been convicted of illegally dispensing the drug. Breaking and entering and armed robbery charges related to Oxy have been filed from Maine to Mississippi.

Michael Pratt, a prosecutor focusing on drug crimes in Kentucky, Tennessee and West Virginia, sees reasons why OxyContin hit Appalachia especially hard.

The Appalachian economy has long been dependent on coal and timber. Those are industries that produce serious injuries, so there are large numbers of people on painkillers.

“A lot of places, you got a headache, you’ll tough it out,” Pratt says. “Down here it’s like, ‘Well, my grandfather’s got some drugs. I’ll take that and it’ll go away.’ And it just escalates.”

In addition, OxyContin sells on the street for $1 a milligram--up to $160 for the highest-dosage pill. In an area with chronic unemployment, that kind of money is hard to turn down.

Prescription fraud for Valium and other drugs has been a problem for years. “But we’ve never come upon something that kills people so much,” Pratt says. “I mean, if it killed them, they really had to work at it.

“Oxy rolls in. It’s so powerful, it just lays waste.”

“This is a nuclear bomb,” adds Gregory Wood, a health fraud investigator with the U.S. attorney’s office in Roanoke, Va. “I was a cop in Detroit and saw crack come through the ghettos, and I’ve never seen anything like this.”

Neither had the tiny town of Gilbert.

A Tiny Town Hit Hard Like many coal towns, Gilbert, pop. 417, winds like a centipede along the riverbank, pushing leg-like hollows out into the surrounding hills near the Kentucky line.

OxyContin found its way here about five years ago. What started as a gentle rain soon turned into a flash flood.

Police Chief Greg Cline blames the drug for at least four deaths in town, and state police Sgt. J.J. Miller estimates the number at a dozen for the entire county. But that statistic includes people who may also have been abusing other drugs.

A mental health counselor tells of a man who was having his teeth pulled two at a time because each visit meant a new Oxy prescription. Kristen Rutledge has known people to shoot themselves for a prescription. Cline has talked to cancer patients who were selling some of their pills.

“It seems like if you’re around people who are doing it, you catch it,” says Judy Compton, manager of the Compton Inn. “It’s contagious.”

She knows all too well. Her sister caught it too.

Jeanie Compton was spoiled. Her mother gave her a red convertible BMW before she could even drive, and a trailer home to live in. When she wanted to get married at age 15, her mother drove her across the Tug River.

Now it’s all gone. The BMW? Traded for OxyContin. The trailer? Sold for a few thousand dollars’ worth of pills. The husband? Found slumped over in the bathroom with a needle nearby, dead of a suspected Oxy overdose.

Jeanie’s troubles began around 1991, when her adoring father died suddenly at age 50. She started experimenting with drugs. Along came Oxy.

At one point, Joyce Compton says her daughter was raiding the family’s motel for televisions, microwaves, mattresses to supply her habit. Judy Compton stopped letting her come to her house.

“She’d get up to leave and my stuff would fall out of her pantlegs,” she says.

On more than one occasion, Judy has found her little sister slumped in a chair, her head lolled over.

Last Sunday was Jeanie Compton’s 23rd birthday. She spent it in a jail cell, where she was serving time for violating home confine

ment to seek Oxy. Back home Wednesday, wearing a monitoring anklet, she says she’s ready to get serious about kicking Oxy.

“I’ve said I’m either going to end up in jail or dead,” she says. “Well, I made it to the jail. I can’t come back from the grave.”

A Hamlet Plagued by Big-City Problems Locals have a nickname for the road: Pill Hollow.

“On one occasion I timed them, and in 30 minutes we had 45 cars coming to one house,” says Clyde Lester, a local school board member. Of the 20 or so homes wedged into the mountains around him, he says four were occupied by dealers.

People are starting to lock their doors, and establishing community watches. Isolation, long an obstacle for Appalachia, has become something people miss.

“A lot of those troubles that used to be in the cities have really come home to plague this community,” says the Rev. Denny May, whose 19-year-old daughter, Shanda, killed herself in 1999 shortly after getting involved with Oxy.

When Pastor Clayton Cline asked his Baisden Community Church congregation who had been affected by OxyContin, he says, “Almost everyone raised their hands.”

One hand was his own.

About a year and a half ago, his daughter became addicted to OxyContin after her husband received a prescription for an accidental gunshot. For the past six months, Cline’s daughter and son-in-law have been attending a church-based methadone program in Georgia.

Cline is a coal operator and has the means to get his daughter treatment. He has paid for some others to receive methadone at a clinic in Charleston, the only one in the state.

“It’s no disgrace to have a problem. What’s the disgrace is when you try to hide it,” he says. “You can’t hide this OxyContin. I’ve found that out.”

An Urgent Call for Volunteers Debbie Trent sits in a middle school auditorium in Bluefield, Va., and listens. She is a mental health counselor from Gilbert, where she is a member of a new drug-awareness group called STOP--Strong Through Our Plan. She has driven two hours along mountain roads to see what folks in southwestern Virginia are doing to battle OxyContin.

A self-described OxyContin abuser named Mary tells the group: “Addiction stands on a mountaintop and throws down commandments: ‘Thou shalt not abandon me. Thou shalt put no one or nothing before me.”’ She says she lost her job and committed prescription fraud because of OxyContin.

Another recovering addict, a 38-year-old mother of two identified only as Cindy, shuffles from one foot to the other as she explains how she took 320 milligrams of Oxy in the morning before she had the strength to take her boys to school. Friends thought she had cancer.

For two hours, people talk about the problem. Dennis Lee, Tazewell County’s top prosecutor, says 80% of the crime in his jurisdiction is now related to OxyContin.

Sheriff H.S. Caudill says efforts to get a statewide prescription tracking system failed in the legislature this past year. Just as local firefighting is done by volunteers, Caudill tells the crowd, much of the burden of stopping Oxy abuse will fall on them.

“I look at OxyContin as a huge forest fire,” he says. “It’s burning everywhere in Tazewell County. ... There’s not enough of us, ladies and gentlemen. We need you.”

A Hellish Time Going Cold Turkey Kristen Rutledge has three tattoos she doesn’t remember getting. She went through physical problems--not menstruating for months, constipated for weeks. She stopped writing in her journal.

When she finally decided to quit Oxy, she did it cold turkey. The withdrawal lasted three days, the same as her first Oxy binge.

“I’d rather have died,” she says, drawing her knees up to her chest. “I was vomiting. I could hear things and see things. I had pain all over my body, all over me--my head all the way down to my calf.”

Her habit cost her father tens of thousands of dollars. OxyContin is still costing Tim Rutledge: Now he’s giving the cash-strapped police department money for undercover drug buys and taking out full-page newspaper ads warning others about drugs.

Kristen says she’s been clean for a month. But she’s not kidding herself.

“I’m still addicted,” she says. “I’m just not using.”