Prescription painkiller addiction has been stereotyped as a rural problem, but in recent years, abuse of drugs like Oxycontin, Vicodin, Percocet, and Opana has spread across the country, to new areas and populations.
Rural Appalachia was indeed one of the early centers of the prescription opioid epidemic.
“There is a lot of legitimate use because coal mining is not an easy industry to be in. [Miners] will be prescribed opioids so they will be pain free and be able to go back to work.” says Dr. Jennifer Havens, an epidemiologist at the Center on Drug and Alcohol Research at the University of Kentucky College of Medicine.
But the availability of OxyContin in the region helped it spread well beyond those who needed it.
“A lot of the [prescription drug] abuse is driven by availability and that’s what’s available in this area,” says Dr. Havens. “The area I’m in in Appalachian Kentucky is about 200 miles from the interstate. You don’t have a lot of the drug trade you see in cities. There’s a lack of availability of heroin and cocaine.”
Rural Appalachians sometimes refer to Oxycontin as “hillbilly heroin” and to the Appalachian town of Oceana, West Virginia, as Oxyana, because the majority of its residents are addicted to the drug.
Since the late 1990s, abuse of the drugs has spread well beyond working-class Appalachian men. It is now not just a rural problem or even a suburban problem, but an urban problem, suggest recent studies of cities, including one from Columbia University Mailman School of Public Health’s Department of Epidemiology, which found that between 1990 and 2006 in New York City, overdoses from prescription opioids increased seven-fold.
That number has continued to rise, says Dr. Denise Paone, a research director at the New York City Department of Health & Mental Hygiene. In 2006, opioid analgesic overdoses represented 16 percent of all drug deaths. In 2010 they represented 32 percent.
“The vast majority actually start off from a legitimate prescription,” says Dr. Paone, though often it is passed on from the person who was prescribed the drug to a friend or family member.
Opioid pain reliever abuse is no longer just a male problem, either. Death from these drugs among women increased fivefold between 1999 and 2010, according to a recent report from the Centers for Disease Control and Prevention.
Women are dying at “rates that we have never seen before,” said CDC director Dr. Thomas Frieden, calling it “a sleeper problem,” that has gone under-identified by doctors and patients.
Those who do not legitimately need the drugs are getting them anyway. In 2010, one in 20 people aged 12 years and older reported using prescription painkillers for non-medical reasons, according to data from the Drug Enforcement Administration. That the majority of people who abuse—70 percent, according to the National Survey on Drug Use and Health—get the drugs from friends and family with prescriptions, as opposed to drug dealers, can give a misleading impression that these drugs aren’t that serious as street drugs.
“It’s a pill so it does not seem not as threatening as injecting—shooting up heroin, or snorting cocaine. Those perceptions are definitely a problem,” says Dr. Magdalena Cerdá, an assistant professor of epidemiology at Columbia’s Mailman School of Public Health.
The availability of painkillers and perception of them as relatively harmless is fueling dangerous new trends, especially around use among teenagers.
“The whole prescription drug culture among young people is very out of control right now between Adderall and opioids,” says Dr. Katherine Keyes, an assistant professor of epidemiology at Columbia University’s Mailman School of Public Health.
At “pharm parties,” for example, teenagers will get whatever drugs are in their parents’ house, put them in a bowl, and take their pick.
Patrick Daly, brother of Erin Daly, a journalist who runs the website Oxy Watchdog, first started taking OxyContin recreationally as a teenager, having obtained it through a friend. He eventually became addicted to Oxy as well as to anti-anxiety medication. He was ordered into and completed a drug rehabilitation program, but that was not enough. He eventually started taking heroin because it was a cheaper alternative. He died of a heroin overdose at age 20.
“He wasn’t able to get out of the spiral that he was in,” says Daly. Her brother’s story illustrates the importance of communicating broadly about the risks of OxyContin and other opioids, says Daly, who is also working on a book about her brother.
“My goal isn’t necessarily to demonize to these pills. It’s just about education. Let’s be informed about what we’re treating ourselves with and putting in our bodies,” she says.
Although there is little talk of banning the use of opioid analgesics altogether, regulators, health officials, and law enforcement are putting increased pressure on the group of people who are, perhaps unwittingly at the epicenter of the epidemic: doctors. It is doctors, after all, who are able to legitimate the use of drugs with a pen and a pad of paper.
Edited by Jordan Lite and Dana March.
Maps courtesy of the CDC.