Rx Abuse in Appalachia

AUGUST 01, 2006
Cmdr John Burke

The Roanoke Times recently reported that drug deaths in southwest Virginia had leveled off over the past 3 years, with a total of 216 in 2005. Most of these drug deaths were attributable to prescription medications. These figures have tripled over the past decade, with numbers stabilizing at between 200 and 220 over the past 3 years. The counties in southwest Virginia have between 2 to 5 times the statewide averages for drug deaths.

This area of the United States, which also includes parts of far eastern Kentucky and western West Virginia, has long been a hotbed of prescription drug abuse. The 1990s saw a lucrative exchange of oxycodone products, most notably Tylox (oxycodone and acetaminophen) capsules that could be abused by breaking them open and snorting the narcotic to achieve the "high."

Appalachian residents would travel many miles, even to our area in southwest Ohio, to scam doctors and pharmacists to obtain the red capsules for their own addiction or resale in their part of the country. There has always been much speculation as to why this rural area of the country had high rates of addiction to pharmaceuticals.

One of the most popular thoughts is availability. Getting heroin and cocaine to rural areas of the country, where people know all their neighbors, is not an easy task and may not prove to be worthwhile to big-city dealers and their runners. This beautiful area of the country can be a several-hour drive off of interstate highways, with cell phone service oftentimes not available. This is likely not a positive environment for those wanting to traffic in illicit drugs and attempt to avoid law enforcement in the process.

Residents in these regions work hard for a living—maybe involving coal mining, logging, or farming. These are all occupations prone to injury and pain, likely to be relieved by prescription drugs. The more prescriptions written increase the potential for availability to those who would abuse or sell these drugs.

The possible factor here that cannot be overlooked is the poverty that is present in this region of the United States. The availability of prescription drugs and the lure for making a quick dollar is also likely a factor in the abuse and overdose death rate in this part of Appalachia.

According to The Roanoke Times' article, the Virginia Medical Examiner's Office attributed 70 of the drug-related deaths to methadone, 51 to hydrocodone, and 36 to oxycodone products. The methadone deaths were virtually all the result of pills or wafers, not the treatment centers dispensing their product to addicted clients.

I have worked for several years on a joint project that identifies "hot spots" of prescription drug abuse across the United States. The most prevalent area month after month, by far, is this area of Appalachia. The answer to this problem is not easy, but it can only be solved by the 3-prong approach of law enforcement, education, and rehabilitation. It takes all 3 to truly be effective in the long run, and for each to cooperate with the other—another piece of the puzzle that is often missing.

Virginia is hoping that the expansion of its prescription-monitoring program statewide will reduce the diversion and the ultimate deaths. I hope so too, as this region is in need of relief from this devastating addiction to pharmaceuticals.

I have traveled to this area many times, either on vacation or to provide some much-needed drug-diversion training to law enforcement or health professionals. I am always encouraged by the will and stamina of the folks who live in Appalachia when I visit there, and I come home knowing that many good people are trying very hard to tackle a difficult problem. Their success is a lifeor- death issue to several hundred people that die from prescription drug abuse every year in Appalachia.

John Burke, commander of the Warren County, Ohio, drug task force and retired commander of the Cincinnati Police Pharmaceutical Diversion Squad, is a 38-year veteran of law enforcement. Cmdr Burke also is the current president of the National Association of Drug Diversion Investigators. For information, he can be reached by e-mail at burke@choice.net, via the Web site www.rxdiversion.com, or by phone at 513-336-0070.