Charleston Gazette-Mail story examines how opiate addiction came to infest Appalachia

Addiction to opiates and drug overdoses have become an epidemic in Appalachia. It hasn't always been like that. A perfect storm consisting of the introduction of OxyContin, coupled with the region's high rate of unemployment, job-related injuries and low-education levels have made Appalachian a perfect spot for opiates to thrive, David Gutman reports for the Charleston Gazette-Mail.

"The statistics are numbing," Gutman writes. "West Virginia leads the nation in overdose deaths. We take more prescription drugs, per capita, than any state except Kentucky. Wholesale drug distributors—not even including the two largest distributors—shipped 200 million pain pills to West Virginia over a recent five-year period. That’s about 111 pills for every man, woman and child."

Dr. Carl “Rolly” Sullivan, who has run the Addiction Program at West Virginia University Hospitals since 1985, said during the 1990s about 90 percent of patients were treated for alcoholism, Gutman writes. Sullivan, who said he only treated three patients for heroin addiction in the entire 1990s, said that by 2002 the number of patients being treated for prescription painkillers was 90 to 95 percent and the waiting list for the clinic is now more than one year. (National Prescription Audit map of 2012)

"In late 1996, Purdue Pharma introduced a new drug—OxyContin, a controlled-release version of the pain killer oxycodone," Gutman writes. "It’s designed to slowly release its active ingredient over the course of a day, so a patient in chronic pain needs to take only one or two pills a day, instead of five or six, as was the case for other types of oxycodone medications. That also meant, though, that each OxyContin tablet had much more of its potent active ingredient than other painkillers available at the time. OxyContin also came with two quirks on its FDA-approved label, one that made it ripe for abuse and one that made it easy to prescribe." The label read: “Swallowing broken, chewed or crushed OxyContin tablets could lead to the rapid release and absorption of a potentially toxic dose of oxycodone.”

"Of the six states hit hardest and earliest by OxyContin abuse—West Virginia, Kentucky, Virginia, Pennsylvania, Ohio and Maine—five are Appalachian," Gutman writes. Sullivan told Gutman, “West Virginia was ripe for the picking. We had a lot of blue-collar workers who were in farming and timbering and coal mining and things that were likely to produce injuries.”

The epidemic has since expanded to all corners of the U.S., Gutman writes. "In 1992, about 30,000 people nationwide were admitted to hospitals for overdoses or other problems related to prescription opioids, according to data from the U.S. Food and Drug Administration. By 1997, it was about 35,000—a slight increase, but nothing major. But then, hospital visits for opioid problems took off. By 2002, there were about 80,000 admissions a year. In 2006, it was 130,000." (Read more)