what to say.
“She didn’t want to do it,” Honaker recalled. “Margie would say, ‘God knows I wouldn’t be doing this if I didn’t have to choose between paying a bill or going to the doctor to get the medicines I really need,’” for diabetes and high blood pressure.
Within the span of three months, Honaker had mastered the classic drug-seeking emergency-room trick, beginning with an impassioned complaint about kidney stone pain. “I’d say, ‘My back’s killing me,’ and [in the ER bathroom] I’d pierce my finger, then put a drop of blood into my urine sample,” she recalled.
*
She’d leave with a prescription for Percocet. She was a full-blown opioid addict when she resorted to stealing the money her husband set aside for paying the electric bill and spending it at the office of a well-known Lebanon doctor who began most of her visits to him with the question “What do you want?”
The Board of Medicine suspended Dr. Dwight Bailey’s license to practice medicine in 2014 for excessive prescribing and poor record keeping, noting that five patients had died from drug overdoses while under his care—but that was more than a decade after Honaker first came through his doors.
Honaker went on to steal painkillers from her husband’s elderly grandmother. She bought pills from people who paid one dollar for their OxyContin prescriptions using their Medicaid cards. “They’ve got to choose to eat or pay their electric bill. But if they’re on Medicaid, they can sell their drugs to supplement their income,” she said.
In an Appalachian culture that prides itself on self-reliance and a feisty dose of fatalism, peddling pills was now the modern-day moonshining. Some passed the trade secrets down to their kids because, after all, how else could they afford to eat and pay their bills?
*
“It’s our culture now, taking pills,” said Crystal Street, whose father, an octogenarian, got hooked on morphine and Dilaudid in the wake of a coal-mining injury. By 2016, he was on house arrest for selling prescription pills from his nursing-home bed. “I come from a long line of distributors,” Street told me.
We spoke at an addiction clinic in Lebanon, where she and Honaker were being treated with the medication-assisted treatment (MAT) drug Suboxone. Like its methadone predecessor, Suboxone staves off dopesickness, reduces cravings, and, if prescribed appropriately and used correctly, doesn’t get you high.
Both middle-aged, Street and Honaker had each been jailed. They took turns telling twin near-death stories, one beginning where the other left off. They’d both lost their teeth. “You get sick and throw up. Or you leave pills in your mouth and it takes the enamel off,” Honaker said. Neither had ever had steady work. “You couldn’t keep a job because you’d steal if you worked at a restaurant,” Street added. “Or you just couldn’t get up and go—you were too sick.”
Honaker put in: “At the end of your journey, you’re not going after drugs to get high; you’re going to keep from being sick.”
*
Art Van Zee saw it unfolding, and he was terrified. Within two years of the drug’s release, 24 percent of Lee High School juniors reported trying OxyContin, and so had 9 percent of the county’s seventh-graders. And Van Zee not only met with worried parents; he’d been called out to the hospital late at night about the overdose of a teenage girl he’d immunized as a baby. He remembered the exact position at the St. Charles clinic where he’d first held her. He was standing by the counter, made of materials recycled from a long-gone coal company’s commissary where coal miners once gathered to collect their pay in scrip.
The miners had portions of their pay deducted from their salary to build the clinic in 1973. They’d also organized bake sales and talent shows, and spent years soliciting donations, many of the efforts shepherded by a trio of plucky nuns who’d migrated to the region a decade earlier, heeding LBJ’s and Robert Kennedy’s call to help Appalachia fight the War on Poverty. Nicknamed the Nickel and Dime Clinic, it was literally built by coal miners and community activists, people who chipped in every penny of their spare change.
These weren’t simply Van Zee’s patients who were showing up in the ER; they were also dear friends, many of them descendants of the coal miners whose pictures lined his exam-room walls. They hailed from nearby coal camps with names like Monarch, Virginia Lee, and Bonnie Blue. When patients recognized a relative in the old black-and-white photos, Van Zee took the time to