more often than not it was causing problems” both for the patients and for Huff. He noted an uptick in depression and memory loss, too, among the long-term opioid users at the practice—as well as alarming news stories about drug seekers in the community breaking into those patients’ homes or cars to steal their drugs.
When he moved his practice to the Carroll County hamlet of Laurel Fork to fill a spot left by two departing doctors in 2003, Huff was “deluged” with young-adult and middle-aged patients who’d been prescribed large amounts of OxyContin by his predecessors, concurrently with benzodiazepines such as Xanax, Klonopin, and Valium—“nerve pills,” as most in Appalachia call them. There was nothing in their charts to justify why they were getting so many prescriptions, Huff said, and he knew the added benzos put the patients at enormous risk of overdose. As one recovering addict in Lee County schooled me: “Around here, pairing an Oxy with a nerve pill—we call that the Cadillac high. If you’re gonna write this book, honey, you better learn the lingo.”
Many of Huff’s patients lived in nearby Galax, a factory town that had just witnessed the closing of two of its largest employers, Hanesbrands clothing and Webb Furniture, and continued downsizings in the town’s remaining plants. In the wake of the 1994 North American Free Trade Agreement and China’s entry into the World Trade Organization in 2001, many of the sewing factories and furniture plants were gravitating to cheaper-wage countries south of the border and in Asia.
OxyContin wasn’t just numbing pain and the depression that came along with it; the drug was now its own resource to be plundered. “You could get a big bottle of eighty-milligram tablets and sell them for a dollar a milligram, and you could pretty much live on that for a month,” Huff said.
Until Huff slammed the brakes on the Laurel Fork narcotics train.
“People freaked out on me,” he recalled. They were sick and in withdrawal, some of them not yet understanding they were addicted.
“Just about every day I was having to go in and face another ten people, and tell most of them, ‘I’m discontinuing your narcotics.’ It was really strenuous. It drained me,” he remembered.
One period was so awful that he got in his car and drove to Mississippi to see his sister for a long weekend. Two patients had threatened his life that week.
*
To one of the region’s longtime health-department directors, Dr. Sue Cantrell, a former pharmacist, the premiere of OxyContin could not have been timed worse. With the exception of mining, production jobs in the coalfields had never paid much. Cantrell remembered setting up a mobile clinic in the parking lot of the Buster Brown apparel factory in the early 1990s because the women who worked there did piecework—they were paid by the number of sewn pieces they produced—and they had zero sick leave. “They couldn’t leave work to have a pap smear or a breast exam, so we took the clinic to them,” Cantrell recalled.
“Even though the pay wasn’t great, those [production] jobs gave two things to our communities: One, families on the margin didn’t always have to be on the brink of not having food on the table or money for utilities. And the second, more important thing was the behavior it modeled for families, where people got up in the morning and went to work. A lot of people never finished high school, just like the people who went into the mines, but they used to have a source of income before it dried up to nothing—and there have been no jobs to replace those,” she said. Jobs in coal mining, once the number-one industry in central Appalachia, were cut in half between 1983 and 2012, owing to pollution regulations and competition from natural gas and cheaper low-sulfur coal out west. Automation in mining and the closings of factories that burned coal for power also contributed to the region’s decline.
The closings were just sinking in when Cantrell took her first call about OxyContin from a doctor in tiny St. Charles, the next-to-poorest town (population 159 and waning) in the poorest county in the state.
Tall and skinny, Dr. Art Van Zee stood out. He was a Vanderbilt-educated minister’s son from Nevada who spoke softly, with no discernible accent. He’d come to the region in 1976 at the age of twenty-nine because he wanted to work in a medically underserved community. The town’s new federally qualified community center, with its sliding-fee scale, was