— Pills by the tens of thousands, then by the hundreds of thousands and ultimately by the millions found their way to this remote city tucked amid rugged, lush mountains in southwestern Virginia’s coal country. They were opioids, manufactured in bulk, prescribed by doctors promiscuously, prosecutors say.

They were sold liberally to pharmacies. Over the course of seven years, from 2006 through 2012, the big Walmart on the four-lane road at the edge of this city received more than 3.5 million opioids. The CVS at the end of the main street through town received more than 1.3 million.

Those numbers come from a Washington Post analysis of a newly released Drug Enforcement Administration database that tracked the manufacture and sale of opioids across the United States, and it shows that the pharmaceutical industry pumped out 76 billion pills over that seven-year period.

“It’s outrageous,” Charles Slemp, the commonwealth’s attorney for the city of Norton and surrounding Wise County, said Wednesday in his office. “It’s unfortunate that there’s that number of prescription drugs flooding the market. It is extremely disappointing that substances that are manufactured to help an individual are being sold and distributed at proportions that are poisoning not just individuals but an entire community.”


An aerial view of downtown Norton with the local CVS in the lower left. (Charles Mostoller for The Washington Post)

Last year, this city, Virginia’s smallest, and Wise County joined the commonwealth of Virginia and other local jurisdictions in a lawsuit against pharmaceutical companies, seeking millions in damages. The mayor, Joseph Fawbush, said one major reason for joining the litigation is to calculate how much the opioid epidemic has cost his community.

“You’ve got a backache, and all of a sudden you’ve got an opioid,” said Fawbush, 56, who is a funeral director and a native of Norton. He said a little more than a decade ago he noticed a dramatic rise in funerals because of opioid overdoses, though there haven’t been many the past couple of years.


Hundreds of thousands of people in the United States have died of opioid overdoses or other drug-related causes in the past decade because of an epidemic that experts trace to the introduction of Purdue Pharma’s painkiller OxyContin in 1996. The rise of pills as an illegal street drug was followed, after a law enforcement crackdown, by a spike in heroin use and then the surge in illicit fentanyl, a synthetic opioid some 50 times as potent as heroin.

The grim death toll has been accompanied by a shredding of families, with many children being raised by grandparents or by foster parents because the biological parents have died, are in jail, or have lost parental rights because of drug abuse.

“The kids I’m taking in — it’s all due to drugs now. Before, it was neglect,” said Crystal Miller, 32, a foster parent in a nearby town who has adopted three children and has four biological children.


Crystal Miller is a foster parent who over the past five years has taken in eight children whose parents lost their parental rights due to drug use. (Charles Mostoller for The Washington Post)

Sara Ring, Norton’s director of social services, said she frequently removes children from unsafe living conditions. She said she was shocked when she first took the job in 2014 and realized how often drugs were the source of the family dysfunction.

“These kids are dirty, and they’re hungry, and a lot of it ties back to drug use,” she said. “Once a parent starts using drugs and becomes addicted to drugs, that becomes their number one priority.”

She recounted one case of a 9-year-old girl who wanted to stay in her mother’s custody. But at the parental rights court hearing, the mother didn’t show up.

Ring said there’s no drug rehab facility in Norton, and many people with addiction are too poor to receive treatment at a private facility about an hour away. When someone does get clean, they almost invariably return to the same kind of situation that first fostered and sustained the addiction.

No one points solely to pills as the source of the drug epidemic. This is a small city in the back country, nearly an hour’s drive on winding roads from the nearest interstate highway. The hills are steep, the valleys narrow. It’s both remote and confined.

“There’s not a lot to do,” said Dennis Boggs, 45, a chef at Burger King. That’s his explanation for the drug use. “It gives them something to do around here.”


A “For Rent” sign hangs in a doorway of a vacant storefront in downtown Norton. (Charles Mostoller for The Washington Post)

The area’s Walmart store received 3.5 million opioids in seven years. (Charles Mostoller for The Washington Post)

The extraction of coal brought riches that flowed to companies and tycoons far away, noted some longtime residents shopping at the Walmart. They said the coal here is good coal — metallurgical coal — but what’s left is deep and expensive to mine.

“Everybody’s got the easy coal. Now it’s hard to get to,” said Steve Bates, 65, a retired schoolteacher who serves on the county board of supervisors.

“It’s the economy plus prescription drugs. Prescription drugs got out of hand,” said Joey Collins, 61, the manager at a lumber yard. “My sister wrote a song: ‘Something in these mountains brings you down.’ And I think there’s something to that. I think it’s easy to get down and get depressed. I know that’s not an excuse for the pills.”

Slemp, the prosecutor, says in dismay, “The population has declined, but the jail population has doubled.”

Without coal, the foundation of the economy is now health care. Sickness, disease and infirmity are growth industries in much of rural America.

There are two hospitals here, perched on high ground on the flanks of the central business district. The CVS is right down the hill from one of the hospitals and it has a drive-through pharmacy for convenience.


The CVS pharmacy in downtown Norton received 1.3 million opioids from 2006 through 2012. (Charles Mostoller for The Washington Post)

Officials note that patients come from many counties around, or even from Kentucky or Tennessee, which are both within an hour’s drive. That, plus a jurisdictional quirk of Virginia — cities are fully independent units, and not considered part of the surrounding counties — explain why Norton, with the Walmart and the CVS and fewer than 4,000 residents, is off the charts when it comes to the per capita sales of opioid pills, with 306 per person per year on average from 2006 to 2012.

The mayor, Fawbush, said he hopes that tourism — the lure of the mountains — can replace some of the lost coal income. The landscape, deep in the ridge-and-valley portion of the Appalachians, is dramatic. Norton is 2,200 feet above sea level; another 1,200 feet above the town is an overlook, known as Flag Rock (for a flag mounted on an outcropping), and visitors first pass by a Bigfoot statue. That’s an homage to a television documentary on the search for Bigfoot — known locally as the Woodbooger — that focused on this remote area.

Local officials stress that there’s hope even in this place experiencing hard times. The ongoing opioid epidemic has shown some tentative signs of easing slightly thanks to efforts to crack down on the “pill mills,” including doctors who, prosecutors say, have prescribed large quantities of opioids even without examining patients.

But officials also report a new eruption of methamphetamine use in recent years. Slemp, the prosecutor, said the methamphetamine spike is a “dangerous trend.”

Miller, the foster parent, said she is caring for a 4-month-old boy. The mother is addicted to meth and the baby was born addicted, coming shakily into the world, suffering from drug withdrawal.

Steven Rich in Washington contributed to this report.