Hydrocodone Abuse on Rise in Appalachia

The extent of prescription painkiller abuse in central Appalachia drew national attention about five years ago, when oxycodone was the drug of choice for many people. The drug, most commonly known under the brand name OxyContin, was so widely abused it earned the nickname "hillbilly heroin."

As OxyContin came under scrutiny, doctors were more careful about how they prescribed it. Many switched to hydrocodone products, which were already popular but didn't have the same stigma.

All 50 states saw increases in the distribution of hydrocodone between 2001 and 2005. But the trend was particularly significant in the South, where all of the top 10 states in terms of increased distribution are located, the DEA says. Four of the top five _ Tennessee, West Virginia, Kentucky and Alabama _ include parts of Appalachia.

Authorities say hydrocodone is so popular in this region partly because it's easy to acquire. Street drugs like heroin are harder to come by in sparsely populated rural areas. Prescription painkillers can be found at every pharmacy and pain clinic, as well as ordered over the Internet.

"When I started in this field, the primary client was involved with alcohol," says David Bailey, a community resource specialist with the West Virginia Prevention Resource Center.

"I wish it were still alcohol. Not that that's not a very dangerous drug, but the addiction (to painkillers) seems to be much more intense, much more severe within a shorter period of time."

It is a mistake to focus on a single drug, said Dr. Peter Cohen, medical director of the Maryland Alcohol and Drug Abuse Administration. He pointed out that while hydrocodone abuse has grown slightly in Maryland since 2002, it is still far less commonly abused than street drugs like heroin.

From 2005 to 2006, the number of people admitted to Maryland drug rehabilitation programs with hydrocodone addictions grew from 284 to 596, according to figures from the drug abuse administration. But the number of heroin addicts admitted to treatment in the same period stayed at nearly 16,000.

The problem is not hydrocodone or even opiates per se, Cohen said, but addiction itself.

"If you're an opiate addict, you're going to find something, based on what's available and what you prefer," he said.

The DEA is considering moving drugs containing hydrocodone from being classified as so-called Schedule III drugs to being Schedule II drugs. The reclassification would mean it would be harder to obtain refills. Doctors and pharmacies would also have to keep more stringent records about how many prescriptions are written and filled.

Dotson has been off drugs since a religious experience in 2001. He got a job and is a board member of Strong Through Our Plan, a local anti-drug group.

He is determined to stay off drugs, and recently chose to pull out his own tooth with pliers to avoid the temptation of receiving a prescription for a hydrocodone-based painkiller after the extraction.

On a recent day, Dotson pointed out the spot under the bridge where he lived and pointed to the spot in the Guyandotte River where he was baptized after getting clean. Not all of his friends were so lucky, he said.

"You've got three choices," he said. "You either die, go to prison or get saved. Mostly, people around here are dying."