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A Dark Addiction
"A lot of people are scared on the job," he said. "They'll use alcohol, anything." After falling off a loader and breaking his leg, Wampler got a prescription for oxycodone. A diabetic, he had needles, and shooting up was easy. Soon he was hooked on high-potency Fentanyl patches, ripping them in two to wring out the drug, which he would cook up with vinegar and inject through the veins in his feet. "It was as good as heroin," he said. He dabbled in that, too.
Years of negative publicity about OxyContin have made doctors wary of it and other oxycodone-based drugs, local health officials say, but records show that sales of the drug have increased. In 2006, 746,901 grams of oxycodone were distributed for retail sale in Virginia, nearly triple the amount sold in 1999, according to the Virginia Department of Health Professions. Although sales have slowed since 2001, they increased 9 percent from 2005 to 2006.
Police in the region say pain pills are entering Virginia from other states, even Mexico, where they can be casually bought along the border. They can also be ordered on the Internet through shady online pharmacies. The familiar schemes remain popular, too.
"We can't stop people from going doctor shopping," Tazewell Sheriff H.S. Caudill said. "We need a nationwide program to check if John Doe has already been to another pharmacy."
Doctors, meanwhile, have been giving out more methadone than ever. From 1999 to 2006, the amount of methadone distributed for retail sale in Virginia jumped from 30,531 grams to 146,479. An underground market for illegally diverted tablets and liquid doses is thriving.
"When we had problems with OxyContin being diverted, doctors started prescribing methadone," said Martha Wunsch, a researcher who has a grant from the National Institutes of Health to study southwestern Virginia's drug deaths.
Wunsch says that methadone in pill form, not the liquid version legally distributed through addiction clinics, is to blame for the bulk of fatal overdoses. In one study, she found that more than half of all fatal overdose victims had legitimate prescriptions for methadone tablets.
On its own, methadone can't deliver a "high" like oxycodone or other opiates, so users combine it with anti-anxiety drugs such as Xanax to intensify the effect, creating a toxic, often fatal, cocktail. Prescription pills have surpassed marijuana as the top drug of choice for new drug users nationwide, according to the White House's Office of National Drug Control Policy.
"There's not much to do around here," said Jeremy Lowe, 22, a miner who got hooked on Lortab (hydrocodone) after breaking his hand in an accident a year ago. Now he is one of the patients who wait in line at the methadone clinic every morning.
"A lot of my friends who went off to universities ended up coming back home and getting hooked," he said. "It's like it's fashionable to do drugs."
To many, the growing traffic at the Clinch Valley Treatment Center has made it a shameful symbol of the region's drug problem. Several Tazewell officials want to shut the center down or force it to move, seeing its for-profit business model and treatment mission as a conflict of interest. According to the clinic's policy, patients can buy methadone as long as they want; detoxification is voluntary.
The clinic's counseling staff members say that many patients need to be on some sort of drug to cope with severe, long-term pain and that methadone has made them functional. And for those who lack insurance or access to more personalized care, it is often the only affordable option.
"We need to change the way people look at successful drug addiction treatment," said the clinic's director, Sterlyn Lineberry. "Are we reducing harm to the individual? Is the person working? Taking care of their family?"
Wunsch, who used to run a methadone clinic in the region, says the biggest problem is the lack of state and federal support for more comprehensive treatment programs. And powerful stigmas persist. "A lot of people in southwest Virginia believe this is a moral weakness, not a public health problem," she said.
The Hard Way
Jeff Trapp knows people who have died from methadone but no one who has gotten off it the hard way. He has tried to decrease his dose, but the cravings come back every time. So instead, he drives.
Trapp sets his alarm for 12:30 a.m., waking after a few hours of sleep, and gets dressed in a dark room. His boss does not like that he goes to the clinic, and even less that it has made him late to work, and has threatened to fire him.
In the kitchen, Trapp makes coffee with the light low. There is a plastic bin above the cabinets to catch the rainwater where the roof leaks, and a picture of his wife at her high school graduation hangs on the wall. He carries another photo of her riding a motorcycle. She weighs 95 pounds, but she's a tough lady, he says.
When Trapp starts the pickup down the driveway at 1 a.m., the dogs stand on the doorstep and watch him go. Last year, he put 60,000 miles on the pickup, a 1993 Chevy. The road signs say his route is a designated scenic byway, the Trail of the Lonesome Pine, but Trapp drives it in the dark, and there is nothing to see.
"I don't want to be dependent on doing this every day," Trapp says. He could get permission for a two-week take-home supply of methadone, if he wanted it. He hasn't had a dirty test yet. But does he trust himself? No.
So instead, he drives.
"I don't want that temptation on me," he says. "I'd probably drink two bottles just to see how it felt."
He opens the window a crack to light another Winston, watching the shoulder for deer. When a car passes him on the left, Trapp recognizes the vehicle. He has seen it before, parked outside the clinic.
Staff photographer Andrea Bruce contributed to this report.