Hillbilly heroin: the painkiller abuse wrecking lives in West Virginia

Just as the service at the New Hope Victory Centre church was coming to a close, Sam Cox rose to his feet and announced that he was still "clean". He had a job and had already been given a rise. The congregation applauded and fell to its knees. The pastor and his assistant laid their hands on his head and began to talk in tongues.

It sounded like the sort of nonsense language children would share, but Mr Cox listened intently as the relentless rhythm of seemingly random syllables drowned out the sound of the coal trucks grinding their gears outside. Faith had saved him, the 33-year-old labourer said, by showing him his problem lay deeper than simple addiction.

"I always thought I had a drug problem, but now I know the pills are straight from the devil," he explained matter-of-factly. "The devil comes to steal your soul. That's his job every day. The drug is the demon spirit."

If so, the demon spirit remained triumphant outside the church walls, running rampage along the Appalachian valleys where Mr Cox was raised. In his tiny home town, Justice, and in Gilbert, a few miles further down the Tug Fork river, four out of 10 young adults are hooked on a potent prescription painkiller called OxyContin.

In this part of West Virginia, and the neighbouring hill counties of Virginia and Kentucky, they call it "hillbilly heroin" or "poor man's heroin". They also call it a plague. In the past two years it has caused scores of deaths in the region in the form of overdoses, suicides and car wrecks. In the words of Michael Pratt, a Kentucky prosecutor trying in vain to combat its influence: "The bodies are stacking up like cordwood".

Crime wave

The OxyContin epidemic has meanwhile generated an exponential rise in the crime rate, as addicts become ever more desperate to finance their craving. The Gilbert police chief, Greg Cline, is trying to do his best to combat the dealers, who are often families on welfare trying to earn extra money, but money for sting operations is in short supply. And he has his hands full enough with the OxyContin crime wave.

"Its serious," he said. "You see a lot more shoplifting, petty theft and prescription fraud. Our thefts went up a lot. We're a real small town and our thefts tripled in the last summer."

In some of the hardest-hit towns up the valley, the police believe that up to 80% of crime is OxyContin-related.

It is no accident the epidemic took root in the Appalachians, traditionally the poorest region in the country. With a doctor's prescription and Medicaid assistance, OxyContin - a brand name for the synthetic opiate oxycodone - can cost virtually nothing at a chemist's but sells on the streets for a dollar a milligram. A prescription is often worth over $1,000 (£700).

The high rate of injuries and chronic pain among workers in the local mining and logging industries means that it found its way into a lot of bathroom cupboards. Mr Cox first encountered its overwhelming powers after he fell from a bulldozer in a 1999 logging accident.

Now OxyContin abuse is spreading from its heartland. It already has a grip in Maine, it is a significant problem in Ohio. It has reached epidemic proportions in New Orleans, there are reports of trouble in Florida and the west coast, and it is steadily eating its way through Virginia and Maryland towards Washington DC.

"It's likely to go national," said Robert DuPont, a former White House drug tsar who now runs a thinktank on drug abuse policy. "The tinder is there. The spark hasn't set it off yet, but it will."

Four million Americans take prescription drugs for recreational reasons, according to a study by the National Institute on Drug Abuse, including opiates like oxycodone as well as stimulants ("uppers") and sedatives ("downers").

OxyContin represents the worst single-drug outbreak the US has seen since the 19th century, when opiates were the most prescribed medicine in the country, and morphine or opium addiction was rampant. That changed when legal restrictions were placed on the medical use of opiates, but now, Mr Dupont said, the pendulum is swinging back the other way.

He said: "In the pain management field, there is a strong feeling that pain is being undertreated and that it would be better dealt with with higher doses, and that view has got up a tremendous head of steam."

The shift back to powerful opiates is far less pronounced in Britain, where OxyContin has been available since 1999 but under far more rigorous supervision. Cases of addiction are so far rare.

In the US, OxyContin is manufactured by Purdue Pharma of Connecticut. Whereas previous oxycodone drugs contained only 5mg of the active ingredient, OxyContin offered 20mg, 40mg, 80mg and, until recently, 160mg. It is coated in such a way to release the drug over a 12-hour period, and it has undoubtedly helped restore a semblance of normal life to thousands of cancer patients and hundreds of thousands of others in chronic pain. But addicts soon found that by scraping or sucking off the outer layer, they could experience all 12 hours-worth at once. It was, the addicts said, a rush like heroin, and every bit as miserably addictive.

"I took them by mouth. Then I snorted it and then in the last few months I took it by needle," Mr Cox said. "I woke up in the morning and every part of my body hurt. It's called 'pill-sick'. You start needing it just to get out of bed. You think if you do one more pill the pain will go away. You never get enough. That's the way the devil works."

After chemists shops in Appalachian valleys began to be robbed of their OxyContin stocks at gunpoint, most stopped stocking the drug and put up signs to say so. But it is freely available elsewhere in the state, and many addicts spend their day "doctor-shopping" for it. One local doctor was so free with his prescriptions that there were traffic jams on the road outside his office.

Class action

Purdue sells $1bn-worth of OxyContin a year, but is under pressure to tone down its marketing. West Virginia, Ohio and Kentucky are pursuing class action lawsuits against the pharmaceutical company for the costs incurred by addiction. The firm is also being privately sued by addicts in Virginia.

The West Virginia lawsuit accuses the manufacturers of "highly coercive and inappropriate tactics" in persuading doctors and chemists to prescribe the drug "often when it was not called for".

Purdue has acknowledged that OxyContin abuse is a problem, and has taken steps to curb illegal use, such as tamper-proof prescription pads, but it rejects the allegations of improper marketing.

"We will vigorously defend ourselves and fully expect to prevail," the firm said earlier this month. "We want the many thousands of patients in West Virginia receiving pain relief from OxyContin tablets to rest assured that nothing in this case or any other case will cause us to abandon them or deter us from making sure that our drug is available to them."

That reassurance provides little comfort in the Appalachians, where Mr Cox is a rare exception. OxyContin addicts hardly ever break free entirely. Hundreds make their way up to a methadone clinic in Charleston every day but it is a long and usually vain struggle.

On the same evening Mr Cox was having hands laid on him, a town meeting was being held on how to deal with OxyContin in Gilbert's community centre. Towards the end of the session an elderly man got up and pleaded with his fellow townspeople to tell him how his son, an OxyContin addict, had died.

He was a retired miner called Danny Layne. One October morning in 1999, he had found his son Brian, 27, sitting on his bed motionless with his arms and legs crossed. "I said: You got to go to work, and he didn't say anything. I felt his neck and he was cold," Mr Layne said.

The autopsy said he had died of OxyContin overdose and needle marks were found in his shoulder, but there was no sign of drug paraphernalia. He had been partying with friends but they had all cleaned up and disappeared. Someone had used Brian's phone two hours after he had died. No one had called his parents.

"Who was partying with my son? Why in the world didn't they just call us and say something's wrong? God, we just want to know what happened. We want to stop hurting," Mr Layne pleaded, in a voice that was roughened to near-inaudibility with pain and 30 years breathing coal dust down a pit.

His neighbours were silent. Almost everyone in the hall had a child in jail, in rehab, or shuttling between the two. The town's drug counsellor, Deborah Trent, offered words of consolation, but no answers. "It's hard to compare this with anything we've seen," she said. "This thing knows no boundaries. It took some of the best and the brightest from this town and destroyed them."

To any other town facing the same demons she had some blunt advice: "Don't ignore it. It won't go away. It's deadly and it's legal."

Prescriptions selling at a premium

The following are the most commonly abused prescription drugs in the US. Their brand names are in brackets:

Opiates ("Narcotics")

Oxycodone (OxyContin, Percodan, Percocet, Tylox)

Hydrocodone (Vicodin, Lortab, Lorcet)

Morphine (MS-Contin)

Methadone (Dolophine)

Meperidine (Demerol, Mepergan)

Stimulants ("Uppers")

Methylphenidate (Ritalin)

Amphetamine (Dexedrine, Adderall)

Sedative-hypnotics ("Downers")

Diazepam (Valium)

Alprazolam (Xanax)

Lorazepam (Activan)

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