LEBANON, Va. — At her very worst, Amber Wood was so desperate for the opioid high she had a dentist pull a tooth — and not even a particularly bad tooth, just one of those molars she didn’t think she’d need as much as she needed a pill. The dentist, she said, gave her a prescription for the opioid painkiller Lortab.
She’d been abusing drugs since the age of 13.
“None of us said when we went to pre-K, ‘You know what I want to be when I grow up? I want to be a drug addict.’ Nobody thought that. But the fact that these drugs were so accessible, everyone knows what doctors to go to,” she said this week after getting off work at a diner here in southwest Virginia.
She’s in recovery now, and has been for precisely 25½ months, she said. Wood, 26, a single mother with a 6-year-old child, detoxed in jail after getting arrested in June 2017 on drug charges she can’t fully remember.
She was diverted to drug court, a program in which she got drug-tested and saw a judge on a regular schedule to avoid being put behind bars. She’s training as a peer recovery specialist. At the diner, she’s been freshly promoted from dishwasher to cook. Though apprehensive about sharing her story in public, she wants to spread a positive message to other people in her situation: “There’s hope. There’s another side of addiction. You can get clean and have a productive life.”
Southwest Virginia is among the regions in the United States hardest hit by the opioid epidemic, which has roots in prescription painkillers. The pills don’t tell the whole story of the crisis, but the crisis can’t be described without reference to the pills.
The just-released Drug Enforcement Administration data obtained and analyzed by The Washington Post shows the swollen pipeline of prescription opioids from factories to pharmacies from 2006 to 2012. Nearly 1.6 billion pills flowed into Virginia, including nearly 17 million into Russell County, home to the town of Lebanon. That’s an average of 84 opioids per county resident per year.
The county just to the west, bordering Kentucky, is Wise County, which was shipped 34.9 million opioids, an average of 120 pills per resident. That does not include the small city of Norton, which is surrounded by Wise County and was shipped more than 8 million pills, which comes out to 306 pills annually per resident.
The opioid epidemic today has ravaged big cities as well as remote towns and has spared no demographic group. But it has been particularly brutal here in central Appalachia, which has seen the coal industry contract and now has some of the highest poverty and disability rates in the nation.
“It’s sort of ground zero everywhere,” said Kristie Jones, director of adult behavioral health services for the Cumberland Mountain Community Services Board, which operates the Laurels Recovery Center in Lebanon.
For a long time, there was little stigma attached to these powerful painkillers. They could be prescribed and distributed legally. But they helped lay a foundation for a disaster.
Some small-town drugstores handled more than 5 million opioids over the seven years covered by the DEA data, which was released by a court order after a legal challenge by The Post and the owner of the Charleston Gazette-Mail in West Virginia.
Jason Boyd, 45, is among those in recovery, and he recalls abusing pills back in the mid-1990s, when OxyContin, a slow-release painkiller manufactured by Purdue Pharma, first came into the market and the industry began heavily promoting it among health professionals as less likely than other opioids to be addictive.
“They made you feel real good. They gave you energy. Once you did it for one or two days, you couldn’t hardly do without them. It’d make you feel like you had the flu if you didn’t have none for a day or two,” Boyd said. “At that time, people was getting them from a doctor for a backache. Or they’d say, ‘I got a bad liver, I can’t take Tylenol pills.’ . . . You could go up any street, and out of 10 people, seven people had pills. Either selling them or doing them or both.”
Today it’s a lot harder to get those kind of opioid painkillers, at least legally. Medical guidelines have tightened. Doctors have been arrested as prosecutors target what they call pill mills.
“I think it’s difficult to overstate the deterrence effect of prosecuting a bad doctor,” said Thomas Cullen, U.S. attorney for the Western District of Virginia, which covers a vast, mostly rural area from Tennessee to Maryland. “When you put him and her in federal prison, that resounds across the medical community.”
Prosecutors for the commonwealth of Virginia have also targeted doctors. This past Friday, Michael B. Ford, 75, a well-known doctor with a practice in the tiny town of Appalachia, Va., and his wife, Una Faye Ford, 69, were each convicted of 15 felonies, including prescription fraud and Medicaid fraud. They did not plead guilty but instead entered Alford pleas, which acknowledge that the commonwealth had enough evidence to convict them if the case went to trial. They will be sentenced separately late this year and early next year.
The commonwealth’s attorney for Wise County and the city of Norton, Chuck Slemp, said patients could obtain prescriptions written by Michael Ford even without being seen by him.
Two Post video journalists visited the Fords at their home in Big Stone Gap but left at the request of another family member. An attorney for Michael Ford did not respond to a request for comment.
How and why Appalachia became the epicenter of the epidemic is partly due to the real need for painkillers among workers hurt in coal mines and in other types of physically demanding jobs, according to health-care workers. But the painkillers were more addictive than people realized.
“It just became its own industry — to overprescribe opioids. It was a moneymaker,” said Jones, the behavioral health official.
Addiction undergirds a host of social problems and pathologies, including domestic violence, said Hope Perkins, a former prosecutor who is now an attorney with the Southwest Virginia Legal Aid Society.
She tells the story of a woman who had been arrested for larceny, a common crime related to addiction. People sell stolen goods to pay for their drugs. The woman had no convictions for violent behavior and was permitted to enter the drug court system. But she kept failing her drug screenings and was on the verge of being sent to prison.
What she needed most was to get out of an abusive relationship with her partner, Perkins said. The woman filed assault charges against him, and with help from the Legal Aid Society obtained a protective order and a space in a shelter for victims of domestic violence.
“It takes a village to help these people break the cycle of addiction,” Perkins said. “Willpower alone doesn’t treat addiction, just like it doesn’t treat cancer.”
Prosecutors, while noting their success in convicting doctors of criminal activity, say they’re dealing with a new set of challenges as heroin and the synthetic opioid fentanyl are imported by drug dealers from big cities like Baltimore and Philadelphia.
They also report a dramatic spike in the use of methamphetamine, a homemade cocktail of drugs that is filling the vacuum created by the crackdown on pills. What makes meth a particularly nasty twist on the addiction crisis is that there’s no medical protocol for weaning people off the drug.
With opioids, patients can take a step-down drug, typically suboxone. There’s abuse with suboxone as well, which leaks into the street market and is routinely smuggled into jails and prisons, said Cullen, the U.S. attorney.
“If you crack down in one area, then we see an uptick back to street heroin, almost all of which is laced with fentanyl,” Cullen said. “You pivot from one to the next.”
Randy Jessee, senior director of behavioral health for Ballad Health, which runs hospitals in southwest Virginia and eastern Tennessee, said the drug epidemic hasn’t abated.
“We have specific drugs that come and go from the use pattern, and right now one of the significant issues is methamphetamine,” Jessee said. “These folks are addicts, and many of them will take a lot of things at one time. They’re multiple-drug users.”
Far from the corporate offices of the drug companies, people with addiction are trying to get healthy and rebuild their lives. Elizabeth Brooks, 24, of Big Stone Gap , Va., is one of them.
She was in college at the University of Virginia at Wise when she began using drugs with her boyfriend and decided to drop out. She used everything. She stopped going outside. She would stay inside for three months at a time. She only stopped using drugs when she found out she was pregnant on July 2, 2017, and went cold turkey. She believes that child saved her life. Her second child is due in August.
She described her life on drugs: “After a while there’s no making you happy anymore. You get tired. I don’t blame anybody really other than myself. It’s just easy to get to down here. Like every corner you turn, every street you go down, you can find somebody that has something.”
Amber Wood, the cook at the diner in Lebanon, has another story to tell: Her teeth were bad and she finally decided to have them pulled. She had 22 teeth pulled over three appointments a few months ago. But she refused opioids. She handled the pain with ibuprofen, and ice, and that worked just fine.
Steven Rich contributed to this report.