Opioid settlement funds won't be enough for some of the country's hardest-hit regions to rebuild and recover

For many counties, the opioid settlement funds won't be
enough to address the losses. (Adobe Stock photo)

As the first $50 billion in opioid-related settlement funds gets distributed to states, counties and municipalities, a painful reality is setting in: It won't be enough for these places to rebuild or recover what has been lost, report Arian Campo-Flores and Jon Kamp of The Wall Street Journal. 

Community leaders are finding that "the funds only cover a fraction of their wish list. Some of their projects likely aren't even eligible because of confusion over restrictions on how the money can be used."

Whitley County, Kentucky, is an example of a region that received settlement funds, but county leaders quickly recognized that the money would only scratch the surface of what is needed to spur recovery, the Journal reports. Whitney Wynn, a Horizon Health outpatient facility director, "wants to establish the area's first detox facility. Ideally, she said, such a center could send patients to a residential treatment site. But the settlement money wouldn't cover both projects."

Other regions are using the settlement money paired other funding to create facilities and programs to support change. "In Dickenson County, Va., officials are allocating $250,000 of roughly $330,000 in settlement funds received thus far for the rural area's first residential treatment facility," Campo-Flores and Kamp write. "The project's price tag is $7.7 million, so the remainder is coming from sources including a loan from a regional economic development authority."

Kentucky is expected to receive about $900 million in settlement funds, with "half administered by the state and half going to local governments," the Journal reports. While that sounds like big money, it isn't when compared with what the crisis has cost. "In 2017, Kentucky's estimated cost from deaths and lives undermined by addiction exceeded $24 billion. Per-capita costs there were among the nation's highest."

Robbie Williams, a judge-executive in Floyd, Kentucky, told the Journal the $1 million the country has received so far is just "a drop in the bucket" compared with what the opioid crisis has cost the community. He added, "We have so many unmet needs; we really don't know where to start."

The Journal reports, "Meanwhile, the opioid crisis — which started with pain pills and is now fueled by fentanyl — continues killing at a record pace. "

OxyContin sales reps were told to downplay the threat of addiction as they sold the painkiller

Pharmaceutical sales representatives from health-care giant Abbott Laboratories sales reps "were instructed to downplay the threat of addiction with OxyContin and make other claims to doctors that had no scientific basis," David Armstrong reports for Stat, the health-and-medicine supplement to The Boston Globe, after reading internal documents in a lawsuit that were unsealed by a judge.

The documents revealed that offering sugary sweets was the secret to getting one surgeon to listen to sales pitches for OxyContin, and to buy the painkiller, according to internal documents obtained by  Using a tip from nurses that the surgeon liked junk food, the sales rep "showed up with a sheet cake box filled with doughnuts and snack cakes arranged to spell out the word 'OxyContin'," Armstrong reports. (Stat photo illustration)

"The doughnut ploy . . . shows the lengths to which Abbott went to hook in doctors and make OxyContin a billion-dollar blockbuster," Armstrong writes. "The sales force bought takeout dinners for doctors and met them at bookstores to pay for their purchases. In memos, the sales team referred to the marketing of the drug as a 'crusade,' and their boss called himself the 'King of Pain'.”

What Armstrong calls "a treasure trove of internal documents" became available a few months ago, when a Kentucky judge ordered their release in response to a motion by Stat, reported Kentucky Health News, published by the Institute for Rural Journalism and Community Issues, which also publishes The Rural Blog: "Documents were part of a state attorney general's lawsuit settled in December by payment of $24 million from Purdue Pharma, the maker of OxyContin."

Armstrong writes, "Abbott, a much larger company than Purdue, had a sales force entrenched in hospitals and surgical centers, and had existing relationships with anesthesiologists, emergency room doctors, surgeons, and pain management teams. Abbott devoted at least 300 sales reps to OxyContin sales—about the same number of people Purdue initially dedicated to the drug—as part of a co-promotional agreement with Purdue."

Abbott marketed OxyContin from 1996 through 2002 after it was approved by the U.S. Food and Drug Administration, Armstrong writes. "With Abbott’s help, sales of OxyContin went from a mere $49 million in its first full year on the market to $1.6 billion in 2002. Over the life of the partnership, Purdue paid Abbott nearly a half-billion dollars, according to court records." (Read more)

One-third of doctor shoppers travel out of state to purchase prescription drugs, study says

About one-third of all prescription drug abusers travel out of state to shop for a doctor, says a study funded by the National Institutes of Health published in Pharmacoepidemiology and Drug Safety. This is because "many states have drug monitoring programs in place to track prescriptions dispensed within their borders—but not across them," Jason Millman reports for The Washington Post.

Douglas McDonald of Abt Associates, who co-authored the study, told Millman, "Part of the problem is that state systems all vary—they're either home-grown or operated by different vendors, and they're not interoperable." As a result, smaller states like Rhode Island, New Hampshire and Delaware are having some of the highest rates of occurrences, with drug shoppers making the trek from neighboring states to buy prescription drugs.

Several states have begun combatting the problem by entering into agreements with each other, Millman writes. But only a small percentage of prescription drug users are doctor shoppers. According to 2008 data, only one out of every 143 prescription drug abusers shop for doctors—about 0.7 percent of all patients—but they purchase four percent of all prescription drugs. (Pharmacoepidemiology and Drug Safety map: County-level data from 2008 of doctor shoppers)

Ky. attorney general says Purdue Pharma faces nine-figure settlement for Oxycontin marketing

Kentucky Attorney General Jack Conway says he wants Purdue Pharma to settle for $100 million or more after it missed a deadline to respond to his arguments in his lawsuit over the marketing of Oxycontin, Nick Strom reports for cn|2, a news service of Time Warner Cable in Kentucky. After Purdue Pharma failed to respond to a court motion, "all the admissions the commonwealth sought in the case were deemed admitted" by the circuit judge hearing the case in Pike County, at the state's eastern tip.

"Judge Steven Combs ruled Monday that Purdue could not withdraw those admissions which include that the drug maker: misrepresented and/or concealed the addictive nature of OxyContin, knew OxyContin was being abused and wasn’t being used for its stated purpose, continued to market and promote OxyContin despite knowing that, and encouraged physicians to overprescribe the drug," Storm reports. Conway told him, "I expect that a jury would be very very harsh on Purdue Pharma. I’m not going to be really negotiating much less or below nine figures. I want to see something well into nine figures.” (Read more)

Purdue Pharma has been blamed for starting, in Central Appalachia, the national epidemic of prescription-painkiller abuse and deaths. More than 1,000 Kentuckians die each year from prescription overdoses, the sixth highest rate in the country. Forbes ranked the Kentucky as the fourth most medicated state, according to Conway's office. More Kentuckians die from overdoses than in traffic accidents. (Read more) Map by Kentucky Justice and Public Safety Cabinet:

W.Va. panel says documentary accurately depicts local drug culture and can lead addicts to seek help

Residents of Oceana, W. Va. have been battling for months to prove that a new documentary, "Oxyana," about the painkiller epidemic in the 1,400-population town in the southern part of the state is misleading in its depiction of the town and its people. However, a panel that viewed the film said Tuesday it is an accurate description of pill addiction in Wyoming County and the state, and can be helpful in leading users to seek help for drug addiction, Travis Crum reports for the Charleston Gazette. The film can be viewed online. (Photo: A still from the film)

The panel consisted of recovering drug addict Kelly Sizemore, who is now a social worker; state Chief Justice Brent Benjamin; and Kim Miller, director of development of the Prestera Center, a mental-health facility. Sizemore told Crum, "It really hit home. It hit on all parts of being an addict. The drug problem is everywhere today. It's not just in Oceana, it's in every small town in West Virginia."

"The panel members said the film opened a dialogue they hope will continue into activism," Crum writes. Miller told him, "You've seen the film. You can't hide anymore. We have to get these people help. We have to get them into recovery." Benjamin said 30 of the state's 55 counties have drug courts, with some having a recidivism rate as low as 14 percent. He said by 2017, all 55 counties will have drug courts.

Another documentary about the drug problem in West Virginia, "Hollow," focuses on neighboring McDowell County. (Read more)

W. Va. residents have different takes on films depicting drug problems in their communities

A pair of southern West Virginia counties sit adjacent to each other, and share a common bond -- county-wide painkiller epidemics that have ravaged their communities, and documentaries about their plight. One community has rallied in support of one film, while the other has come together to rally against the other, David Gutman reports for The Charleston Gazette. (Still from "Oxyana" shows James, whose last name is not given, describing how his father killed his mother, his brother and himself in a dispute, likely over prescription drugs)

"Oxyana," which will be released online July 1, "is told primarily through interviews with about a dozen drug addicts and recovering addicts in Oceana," in Wyoming County, Gutman reports. "Hollow," which was released online June 20, "shows McDowell County through the eyes of its residents, many of whom were given cameras to tell their own stories."

West Virginia has the nation's highest rate of death from drug poisoning, according to data from 2010 from the Centers for Disease Control, Gutman reports. McDowell County has gone from one of the country's richest counties, when coal was booming in the middle of the 20th century, to one of the country's poorest. It has lost nearly 100,000 residents since 1965, and has the nation's worst death rate for prescription-pill overdoses.

Elaine McMillon at a screening Saturday in Welch

Still, McDowell County residents are mostly happy with "Hollow," which was directed by Elaine McMillon, who grew up in nearby Logan County, and spent more than a year filming her movie, Gutman reports. Linda McKinney, who runs a food bank in Welch and is featured in the film, told Gutman, "Elaine allowed us to tell our story. I was born and raised in McDowell County and McDowell County has been good to us. Elaine came in and became part of our family, she didn't come in with an agenda."

McMillon told Bill Archer of the Bluefield Daily Telegraph that people in McDowell County tell their stories with heart. "I think West Virginians are natural storytellers," she said. "When someone starts telling you a story, they’ll tell nine stories before their through.” Despite now living in Boston, she said  “I’ll never disconnect from this community. I love these people. They’ve adopted me as one of their own. I have many friends here.” (Read more)

Residents of Oceana don't feel the same about "Oxyana" filmmaker Sean Dunne, who spent three weeks filming his movie, which depicts one person claiming half their high school class is dead from overdoses, or another saying 70-80 percent of residents have Hepatitis C.  D.J. Morgan, a local lawyer who organized a town meeting to fight the film, said "Mr. Dunne spent three weeks filming and he used those three weeks to try to define our town. Today, we start to define ourselves on our own terms."

Renee Bolden, who lives in Wyoming County but was born in McDowell County and founded the McDowell County Historical Society, told Gutman "As far as 'Oxyana,' Sean Dunne just set out to exploit the people that he interviewed in that movie. And 'Hollow' was the exact opposite of that. The stories were told by the people . . . it just showed how the people here have lived." (Read more)

Oceana, W.Va., residents admit town has a drug problem, but say documentary went overboard

OxyContin has created a nightmare of problems in Oceana, a town of 1,400 in southern West Virginia, but residents say a new documentary called "Oxyana" is misleading in its depiction of the town and its people, reports Dave Boucher for the Charleston Daily Mail. (Photo: A drug is heated in the film.)

Local resident D.J. Morgan told Boucher, "I think that throughout the history of West Virginia, outsiders have always came in and mis-characterized our residents for stories in newspapers that were sold across the country for nothing more than a dog and pony show, and I think that is exactly what [filmmaker Sean Dunne] has created."

Whatever the opinions, the fact is that drugs are a concern in Wyoming County, which has 41,000 residents and 65 drug-related deaths since 2011, 80 percent of them from overdoses, the Wyoming county sheriff's office told Boucher.

In response to the film, Oceana officials have organized a meeting to allow residents to voice their frustrations about it, and for the town "to be honest with ourselves and realize there is a drug problem here and we need to take our town back and our county back," Morgan told Boucher. (Read more)

FDA says it may require tamper-proof painkillers

The Food and Drug Administration will force generic manufacturers of powerful pain pills to switch to a tamper-resistant composition if it finds evidence the composition curbs prescription drug abuse and addiction, Alan Rappeport of The Financial Times reports. Public-health advocates worry that if generic versions of opiate pills are not made tamper-resistant, the prescription drug abuse epidemic may worsen.

If the agency finds tamper-resistance significantly deter abuse, it has legal authority to require generic drug makers to switch their opiate formulas. Just as manufacturers of some pain pills began switching formulas to make the pills harder to crush, easily crushable, generic forms of OxyContin and Opana were released. Purdue Pharma and Endo Pharmaceuticals, which make Opana, have hoped to extend patent life of their drugs by pushing the FDA to prevent generic makers from using old versions of their drugs. Generic makers argue this will keep patients from buying cheaper drugs.

The FDA said it will take a "flexible" approach to determining the effectiveness of tamper-resistant drugs because abusers are constantly finding new ways to avoid deterrents. (Read more)

Appalachian Ohio prescription drug trade worsens

Prescription drug abuse in Ohio is escalating, with most of the problem centered on the southeastern region of the state. In 2008, Ohio pharmacists filled 2.7 million prescriptions for narcotics that contain oxycodone and 4.8 million prescriptions for hydrocodone medications, Holly Zachariah of The Columbus Dispatch reports. The oxycodone prescriptions amounted to almost one for every four Ohio residents, while the hydrocodone prescriptions were enough for almost one of every two and one-half Ohioans.

The state's drug abuse is particularly bad in its Appalachian region for a number of reasons, including poverty, location and apathy, state officialsm say. US 23 "provides a pipeline to and from Columbus," Zachariah reports. "Bordering states of Kentucky and West Virginia have significant amounts of prescription-drug abuse." William Winsley, director of the Ohio State Board of Pharmacy, told Zachariah the area also has a track record of limited resources and uncooperative elected officials who have refused to help with drug investigations.

Scioto County in Southern Ohio was named to the federal Drug Enforcement Administration's watch list of the 10 most significant places in the country for trafficking in medications. While government officials brainstorm ways to tackle the problem, a grass-roots movement in Southern Ohio has risen up against the abuse, Zachariah reports. Activists in the region are considering pickets at the pain clinics and want to photograph the cars that come and go. (Read more)

Cops seek to close Florida-Appalachia pill pipeline

We reported here that prescription-drug seekers from Appalachia have found Florida an ideal location when looking for prescriptions. That state does not have an electronic monitoring system that keeps track of narcotic prescriptions. In an effort to stop the flow of these drugs to Kentucky, "24 alleged drug dealers in Montgomery and Bath counties have been arrested and accused of obtaining prescription drugs at Florida clinics and bringing them back to Kentucky to sell," Mount Sterling Police Capt. David Charles told the Lexington Herald-Leader.

Kentucky law enforcement is also working with Florida officials to investigate Florida physicians who prescribe the narcotics. "Doctors charge a few hundred dollars for an MRI that justifies the prescription and, in many cases, the drug seekers get monthly prescriptions filled at the clinics, for as many as 300 pills, without ever having to go to a pharmacy," reports Valarie Honeycutt Spears of the Herald-Leader. Kentucky law enforcement officials say that more arrests are likely to result from this investigation.

The effort has been dubbed Operation Pill Crusher, reflecting both the crackdown and users' practice of crushing painkiller pills for quicker effect. (Read more)

Painkiller abuse continues in southwest Virginia; black market in legal methadone spurs overdoses

"Rising coal prices have meant jobs and money for southwestern Virginia's mining towns. But a cloud hangs over those communities too: prescription painkiller abuse," The Washington Post reports in a 3,400-word story today, with multimedia interviews with miners.

Staff Writer Nick Miroff reports from Tazewell County, Virginia's easternmost coal county: "Nearly a decade after OxyContin slammed into southwestern Virginia and much of Appalachia, the abuse of prescription painkillers in the region is worse than ever, police and public health officials say. ... A record 248 people died of overdoses in Virginia's western region in 2006, more than those who died from homicides, house fires and alcohol-related car accidents combined. ... The problem is most acute in Virginia's poorest rural areas."

"In what is perhaps the most troubling sign of the problem's intractability, the single deadliest drug in the region in 2006" was methadone, which is given to addicts and has spawned a big black market, Miroff reports. "Methadone was linked to 78 deaths in western Virginia in 2006, and experts say that whatever ground was gained against the illegal use of OxyContin is being lost, engulfed in a widening circle of abuse that extends to painkillers, antidepressants and other prescription drugs."

Here's part of the story's coal angle: "Drug use by miners who snort or shoot up underground has been a growing cause for concern among state regulators, and a law approved last year in the General Assembly imposed stringent drug-testing policies. All newly hired miners must be screened, and random testing requirements have increased. Those who fail risk losing their miner's license. The impact of the new policies was immediate." Mine operator Noah Vandyke told Miroff, "I can't find nobody to work. The younger generation, you can't hardly find one that will pass a drug test." (Read more)

Giuliani and Oxycontin: How much influence?

Last month, we heard from columnist Don McNay that "The mainstream media [have] ignored how [Rudy] Giuliani made his living. Helping a company that sold addictive drugs is worse than being married a few times." McNay started writing about that in May. Today, The New York Times tells the story of the presidential candidate and Purdue Pharma, the manufacturer of the painkiller Oxycontin (in photo by Toby Talbot of The Associated Press).

"His work for Purdue, the company’s first and longest-running client, provides a window into how he used his standing as an eminent lawyer, a Republican insider and a national celebrity to aid a controversial client and build a business fortune," Barry Meier and Eric Lipton write of Giuliani Partners, the consulting firm of the former New York mayor and U.S. attorney.

They start their story with his final phone call last year to John Brownlee, the U.S. attorney for the Western District of Virginia, who was about to bring charges against the company and three executives for "perhaps the most aggressive promotional campaign for a high-powered narcotic ever undertaken. It promoted the drug not only to pain specialists, but to family doctors with little experience in treating serious pain or recognizing drug abuse. As a result of the expanded access, critics charged, OxyContin wound up in the high schools and street corners of rural America where curious teenagers crushed the pill, defeating the time-release formula, and ended up addicts, or in some cases, dead."

From June to October 2006, Brownlee and Giuliani met or spoke six times. In the last of those conversations, the prosecutor told Giuliani "that he expected to ask for a grand jury indictment by the end of the month. Plea discussions ensued and Mr. Brownlee ultimately agreed that the three executives would not have to do jail time. . . . After years of denial and a high-profile public relations campaign, the company was forced to admit that it had misled doctors and patients. But to the parents of young people who had died getting high on OxyContin, the absence of jail time was evidence of Mr. Giuliani’s influence."

Not so, U.S. District Judge James Jones said when he accepted the plea agreement, which fined the company and the executives $634 million. “It has been implied that because Mr. Giuliani is a prominent national politician, Purdue may have received a favorable deal from the government solely because of politics,” he said. “I completely reject this claim.” (Read more)

Presidential candidates need small-town values and solutions for small-town problems, columnist says

The first presidential caucus and two of the first three primaries occur in states with disproportionately rural populations, but "There are few small town economic issues being discussed," even though most presidents grew up in small towns, columnist Don McNay writes in the Richmond (Ky.) Register and other Community Newspaper Holdings papers.

"Small-town populations are getting older and their young people are moving to big towns for jobs. Large factories are moving to foreign countries and nothing is replacing them. Is anyone candidate talking about the small towns? If so, please let me know. I hear more debate about rooting for the Boston Red Sox than saving the beauty of small town life. I don't hear anyone talking about rural drug addiction and the dangers of Oxycontin."

After noting his recent column about Rudy Giuliani's work to keep makers of Oxycontin out of prison, McNay writes, "Oxycontin is a primary contributor to the decline of rural America. A whole generation of young people are addicted, dying, neglecting their children and not able to hold a job. For some reason, Oxycontin has been a small town problem. The drug is not as popular in urban areas. Thus, it is ignored by the national media and national candidates. It's more fun to argue about the Red Sox."

McNay, left, writes that a friend commutes 50 miles from his rural home to a large city because, as the friend said, "There are big-town values and small-town values." And that sets the stage for his closing argument: "Small-town people are used to accountability. Everyone knows each other and what they do. At my peak weight, I tried to buy a box of donuts. The grocery clerk looked at the donuts and said 'Aren't you the guy who writes about dieting for the newspaper?' I put back the donuts and got serious about weight loss.

"I laugh at all media attention given to Giuliani and his mistress sneaking off to their fancy love nest. If Rudolph had lived in a small town, he wouldn't have been able to get away with cheating on his wife. Everyone would have known about the affair immediately. . . . Living life in public makes you think before you act. It's a moral compass that candidates need to have. I've been touting small-town candidates like Mike Huckabee and John Edwards. I don't know if they have a plan for rural America but they have a sense of what rural life is like. I want a president who grew up knowing that if they cheated on their spouse or cheated on their diet, someone would hold them responsible." (Read more)

Writer says Robertson should note harm done by Giuliani clients: OxyContin makers

Columnist Don McNay writes in The Richmond (Ky.) Register and other newspapers that he was surprised at televangelist Pat Robertson's endorsement of Rudy Giuliani for president, but not because "Rudolph's multiple marriage lifestyle does not jibe with Robertson's philosophies. I was stunned at the endorsement because Rudolph Giuliani was the lawyer who kept the makers of Oxycontin out of jail." For a Washington Post report on Giuliani's legal work for Purdue Pharma, click here.

McNay continues, "I am willing to bet that Pat Robertson has never even heard of Oxycontin and doesn't know about Giuliani's involvement. The mainstream media spend a lot of time talking about Rudolph's multiple marriages, and his friend who got indicted. They've ignored how Giuliani made his living. Helping a company that sold addictive drugs is worse than being married a few times. Each issue is a reflection of a person's character but Rudolph's divorces and affairs only hurt him and his immediate family. Oxycontin has hurt thousands of families. . . .

"Giuliani's post-mayoral career has gotten scant attention and the horrors of Oxycontin has been felt primarily in rural states, like Kentucky. Rudolph may march to the presidency, with Pat Robertson by his side, winning urban states and never having to atone for his part in the Oxycontin story. If Rev. Robertson wants to have an impact on society, he could come to Kentucky. He could visit and see the wasted lives, the wrecked families and the absolute pain that the Oxycontin has caused." (Read more)

Native of southeastern Kentucky town describes its "culture of addiction" for national audience

Natasha Watts, right, left tiny Blackey, Ky., to go college four years ago. When she returned, she found almost all her friends and acquaintances addicted to prescription drugs such as OxyContin. The problem is bigger than that drug, she explains in an Appalachian Media Institute essay that aired on National Public Radio. She says more must done for Blackey and other towns like it in Eastern Kentucky than just taking OxyContin away:

It's not hard to see how we got to this point. With hundreds of injured coal miners, this area has one of the highest chronic pain rates in the country. For generations we've suffered from all kinds of pain — without the kinds of health services we needed to deal with addiction, poverty, and depression.

She recalls watching her fellow high school students crush pills and snort them on their desks, and she says that now she has no "social circle" in her hometown. This "epidemic" has ravaged the community, she says.

We're going to live with the human costs of addiction here for generations. Addicts who get clean still won't be able to find jobs in our coal-dependent economy. The mother who finally gets her kids back from the courts won't be able to make up for all the years apart. We have paid for the addiction epidemic with our sisters', brothers', mothers', fathers', grandparents' and friends' lives.

The piece is one of the many multimedia presentations produced by Watts for AMI, and more can be viewed at its Web site. To listen to Watts' full essay on addiction, go here.

Kentucky county to join others' lawsuit against makers of OxyContin

Citing an increase in overdose deaths from OxyContin last year, officials in Pike County, Ky., are planning to join other Kentucky counties in suing the company that makes the drug, reports the Appalachian News-Express of Pikeville. Officials had considered a suit since June, and this week the county hired a local law firm to represent it, Loretta Tackett reports. In July, in federal court in Virginia, Purdue Pharma L.P. of Stamford, Conn., accepted a $600 million fine and three of its managers agreed to pay $34.5 million for misleading the public about the painkiller’s addictive qualities.

Pike County is at Kentucky's eastern tip and is the state's largest county in land area. Its coroner found that oxycodone, the generic name for OxyContin, was involved in 13 of the county's 46 drug-related deaths in 2006. In 2005, that number had been seven of 57 cases, but both may be low; officials said many deaths are not handled by the coroner. In autopsies of 484 overdose victims in Kentucky last year, state medical examiners found oxycodone in 78. Pike County likely would join other Kentucky counties in the suit, which Attorney General Greg Stumbo is expected to file Oct. 4 in Pike Circuit Court. (Read more)

Overdose deaths from OxyContin, other drugs on the rise again in rural Virginia

Fatal drug overdoses killed 264 people in western Virginia in 2006, a 22 percent increase from last year, reports Laurence Hammack of The Roanoke Times. Those deaths accounted for 40 percent of the state's drug overdoses, even though the region has just 20 percent of the state's population. The 2006 total also represented a 294 percent increase from a decade ago, as prescription drug abuse has become a "public health epidemic," Dr. Martha Wunsch told Hammack.

In recent years, however, federal prosecution had targeted OxyContin and its marketing, and the number of fatal overdoses had stopped climbing between 2003 and 2005, Hammack reports. "Back in the heyday of OxyContin, it had really gotten bad," Richard Stallard, head of the Southwest Virginia Drug Task Force, told Hammack. "But right now, it is the worst I've ever seen it."

In many of these rural areas, the overall population has plateaued or even declined, which makes the growth in overdoses hard to explain, Hammack writes. John Dreyzehner, co-chairman of the Appalachian Substance Abuse Coalition for Prevention and Treatment, told Hammack there is a renewed sense of commitment to stop the problem. "I think if the problem is in the community, the solution is in the community, and I think the community is stepping forward to address the problem," he said. "But that doesn't mean it will happen overnight." (Read more)

Administration official told OxyContin prosecutor to slow down, put him on hit list when he didn't

A senior U.S. Department of Justice official tried to delay or derail a pending plea agreement with Purdue Pharma, manufacturer of the painkiller that became a scourge in Central Appalachia, according to the U.S. attorney handling the case -- and eight days later, the prosecutor's name showed up on a list of nine U.S. attorneys that the now-resigned aide recommended for dismissal.

John L. Brownlee, the U.S. attorney for the Western District of Virginia, testified before the Senate Judiciary Committee yesterday. Brownlee said Michael Elston, then chief of staff to the deputy attorney general, called him on his cell phone at home Oct. 24. The Roanoke Times reports: "Elston said he had been talking to attorneys for Purdue about concerns that prosecutors were moving too quickly, Brownlee testified." Brownlee said he asked if Elston was calling on behalf of the deputy attorney general, and when Elston told him no, he told Elston that "he needed to back out of the case." The next day, Brownlee obtained a plea agreement from the company and three executives to pay $634.5 million in fines for over-promoting OxyContin.

Amy Goldstein and Carrie Johnson of The Washington Post report, "Justice Department officials said it was not unusual for senior members to weigh in on major criminal cases. . . . Brownlee and other former prosecutors said nighttime calls such as Elston's, coming just hours before the end of a long, complex case, are unorthodox, particularly when the department's criminal division already has signed off on a case. Brownlee said the head of the division had authorized him that afternoon to execute the plea agreement. . . . Brownlee ultimately kept his job. But as Attorney General Alberto R. Gonzales confronts withering criticism over the dismissals, the episode in the OxyContin case provides fresh evidence of efforts by senior officials in the department's headquarters to sway the work of U.S. attorneys' offices." (Read more)

The committee's main focus yesterday was Brownlee's handling of the case. He has been criticized for not pushing for jail time for the three executives, and by "others who say the prosecution is a setback in the effort to provide relief to millions of Americans who suffer from chronic pain," Laurance Hammack of the Times reports, with help from The Associated Press. "Sen. Arlen Specter, R-Pa., didn't buy Brownlee's explanation that the government had no evidence that top Purdue officials knew of a marketing campaign in which its sales representatives downplayed OxyContin's potential for abuse and addiction." (Read more)