AMERICAN PAIN (24 page)

The organized gangs and cartels that supply the United States with illegal drugs had always avoided eastern Kentucky, for pretty much the same reasons major businesses stay away: too many hills, too few people. So folks who wanted to get high made do with what they had, which for a long time meant cooking moonshine. Certain families made a good living from making and running shine. Other folks in the community may have disapproved of liquor, but they also tended to distrust the government and outsiders. Local resources like timber and coal seemed mainly to enrich folks from other places. At least moonshine revenue stayed in the mountains.

As vets came back from Vietnam with a taste for new highs, moonshine gave way to marijuana. Turned out the rugged mountains and humid climate of eastern Kentucky were excellent for growing weed. By the 1980s marijuana was believed to be the state’s number one cash crop. Most pot farmers grew high-grade plants in clusters no bigger than the John Deere Model Ds they once used to bring in forty acres of burley tobacco. A sixty-square-foot plot could yield about $60,000. Pot was harvested three times a year, and buyers came in to evaluate and bid on it just as tobacco buyers had for generations. In some areas, 40 percent of the community was involved in the trade, which meant basically everybody was dependent on its cash, from the feed-and-seed to the filling station.

Most Appalachian marijuana rings were organized within families. Life in eastern Kentucky revolves around extended families. People figured out who they were by looking at their clan—more than the church, the job, the club, the school. Certain families controlled the majority of the marijuana trade. They also ran the other black-market establishments and trades, the illegal roadhouses and prostitution rings. Through interstate marijuana contacts, they eventually branched into transshipment of harder drugs. A light plane full of cocaine would fly in from Louisiana or Florida and land on an abandoned airstrip in the mountains, where it would be off-loaded and transported via pickup truck along an old bootlegger route to Pittsburgh or Chicago.

Twenty years ago, there was no widespread black-market trade in painkillers. But pills were always part of life in the coalfields. Mining camp doctors prescribed painkillers liberally. They were overwhelmed by torn bodies and black lung and backs damaged by hunching over for hours in narrow shafts. Miners took to trading pills, deciding themselves when they needed medication. The other primary jobs—timber and farming and construction—also involved manual labor, which meant injuries . . . and pills. It didn’t help that the state had one of the highest cancer rates in the country and that doctors were scarce. Painkillers got folks back on their feet and back to work faster than physical therapy or other intensive treatments.

OxyContin appeared in 1996, and its purity and strength was like nothing eastern Kentucky had ever witnessed. Stocking pharmacy shelves with pure oxycodone pills in the mountains was like throwing dry timber on a smoldering ground fire—the whole forest blew up. OxyContin didn’t spread like weed or cocaine, because there was no pipeline needed. Pills were already everywhere, systematically and legally funneled through a national distribution system. OxyContin abuse didn’t spread like a product. It spread like an idea: in conversations, over the Internet and the phone, and face-to-face.

Between 1998 and 2001, a cluster of nine counties on both sides of the Kentucky/West Virginia border received more prescription narcotics per capita than anywhere else in the country. The pills were everywhere, and it was a casual thing. In the early days, say 1999 or 2000, the dealer tended to be the old lady down the street who was prescribed twice as many pills as she used. Often as not, a drug deal went like this—you dropped by the old lady’s house, maybe had a cup of coffee at the kitchen table, asked after the family, traded a few stories, then cash for an old bottle of pills.

Casual . . . until the user tried to stop using. Young people trying the pills were familiar with smoking weed and drinking beer. They’d had no exposure to hardcore opiates. They weren’t ready for the withdrawal, the fever and sweats and throbbing pain as every cell in the body ached for a fix. They went back for more.

Supply and demand kicked in, and the street price bumped up to about $1 per milligram. Theft and petty crime reports rose. Pharmacies were robbed. Emergency room doctors saw more and more people complaining of pain. In a matter of months, police departments went from receiving an OxyContin-related call every couple of months to three or four phone calls a day. Perry County Park, a wooded roadside recreation area with a walking track and a mini-golf course, turned into an open-air pill market. They nicknamed it “Pillville.”

In 2003, the
Lexington Herald-Leader
released a trove of stories about how painkillers were crippling eastern Kentucky. The series included dozens of stories about how the drug had turned eastern Kentucky into the Wild West, sketches of backwoods judges and their connections to drug defendants, nuggets about how the Kentucky State Police didn’t trust local law or prosecutors. The package detailed how no less than four former sheriffs who’d been removed from office due to criminal charges—mostly drug-related—had run for office again in eastern Kentucky in 2002. How two sheriff’s candidates in different counties had been murdered that election season—again, drug-related. One piece reported on the state’s biggest pill mill, a clinic located in a tiny Greenup County town forty miles down the Ohio River from Huntington, West Virginia. Five doctors there eventually pleaded guilty to churning out prescription after prescription.

Hal Rogers, the US representative from eastern Kentucky since 1980, read the
Herald-Leader
series and reacted like the twelve-term congressman he was. Two months later, he unveiled a regional drug task force called Operation UNITE. The organization, funded by federal grants, would combine law enforcement, treatment, and education under one umbrella. Over the next three years, UNITE’s officers confiscated more than fifty thousand pills and arrested some eighteen hundred people. The state also passed tighter controls on doctors and painkillers.

Purdue Pharma was also changing how it did business in Kentucky. In 2001, Purdue retooled its sales pitch for drug reps in fifteen Kentucky counties. Those reps were told to discuss only abuse prevention with their doctors. Purdue also told its reps that the company would no longer pay them bonuses on OxyContin sold to doctors who were arrested for improper prescribing.

And the measures worked. Sort of. After 2003, the number of pain-killers prescribed and sold in Kentucky plateaued. Reporters turned to other matters.

But officials soon noticed contradictory trends. Despite the leveling off of sales figures in Kentucky, and outright decreases in eastern Kentucky, the number of fatal drug overdoses in the state continued to rise. Steeply. In 2001, there were 339. The next year, 435. Year after that, 551. In 2006, 711.

Same went for babies born addicted to drugs. In 2001, sixty-two Kentucky newborns were hospitalized for neonatal abstinence syndrome. The next year, ninety-three. Two years after that, 166. By 2007, 275.

Most overdose deaths in Kentucky involved a mixture of drugs. The most common drugs, by far, were alprazolam and oxycodone. There might be thirty or forty cocaine-related deaths in a typical year. Maybe one heroin death, often none.

So where were the drugs coming from?

What gradually became clear in 2005 and 2006 and 2007 was that Kentucky users were leaving the state for their drugs. Seven states border Kentucky, with seven different sets of drug laws and regulations and seven different levels of prescription drug scrutiny. Few states kept track of prescriptions as closely as Kentucky. Eastern Kentuckians were arrested with pills from doctors in Detroit; Philadelphia; Cincinnati; Slidell, Louisiana. But increasingly, the destination for painkillers was Florida, which didn’t track prescriptions of controlled substances at all.

One early Florida pill runner was a sixty-four-year-old Kentucky grandmother named Jewell Padgett. Two-dozen people were traveling from Kentucky to Florida to buy pills, and Padgett paid for expenses and kept a portion of the pills. After Padgett was arrested in 2006, her son blamed the whole thing on Kentucky doctors who were afraid to prescribe painkillers since the crackdown. His ailing mother was forced to travel to Florida. He said: “They wouldn’t give her medication she needed. They’re scared up here.”

Around that time, another go-to candyman for several Kentucky oxycodone rings was Dr. Roger Browne, who had a practice in Coral Springs, Florida. Dr. Browne made the mistake of getting too close to his patients. First, a girlfriend got arrested for selling pills back home in Carter County. She told the feds in Lexington about Dr. Browne. Another patient started working with the feds and wore a wire one night when he met the doctor for drinks. The informant told the doctor that he’d bring some buddies on his next trip to Florida.

“That’ll work,” Dr. Browne said.

The buddies were federal drug agents. In April 2008, they raided Dr. Browne’s clinic and found the medical records of almost five hundred Kentucky residents. Dr. Browne pleaded guilty to conspiring to distribute oxycodone and was sentenced to two and a half years in prison.

Didn’t matter. By mid-2008, the word was out all over eastern Kentucky: New pain clinics were opening every week in Broward County. Kentuckians began traveling to Florida by the van-load.

In Rockcastle County, Sheriff Peters was just beginning to learn about the pill pipeline in early 2009. That’s around the time his friend Shelby told him about the trip she and her daughter and Alice Mason had made to Florida to confront some pill mill doctor. The sheriff knew Lisa’s mother pretty well. They’d worked together years ago at Renfro Valley, the country music concert venue. He wasn’t happy that she’d put herself in harm’s way like that. But he wasn’t surprised. That was Shelby. No, what surprised him was that Alice Mason had traveled that far from Hummingbird Lane. He couldn’t believe Shelby was talking about the same gap-toothed farmwoman he’d met. Folks like Alice Mason didn’t travel to Lexington, let alone Fort Lauderdale.

Sheriff Peters was right. Only once had Alice spent more than a day outside of Kentucky. The big trip had happened around 1969. Alice had been thirteen or fourteen. Her mom’s sister had moved down to Winter Haven, Florida, and one day she came back to Kentucky and picked up the whole family, except Alice’s father, and took them to Florida for two weeks. Alice told her sons about the experience sometimes, how flat it was in Florida, the strange weather, how one time she saw the sky pouring rain on one side of her aunt’s house and nary a drop on the other side. It was exciting. But Alice was glad to get back home to Rockcastle County after that trip, and she never left again, other than a couple of daytrips to state parks in Tennessee when the boys were little. She went to Mount Vernon a couple of times a week to pick up groceries, and that was about it. Young Kevin seemed to go everywhere in the world, but not Alice. She stayed home. Florida had so many people, and not people she knew.

But she had to understand what happened to Stacy, why the doctor had prescribed him so many oxycodones. She thought about this question all the time, what she would say to Dr. Cadet, wondering what Dr. Cadet would say. There had to be a reason.

So when Lisa said they should go to Florida, Alice surprised herself by saying, yes, she wanted to go.