Crushing Up Pain Pills and Spitting Out Lives in West Virginia Coal Country

An economically devastated swath of Appalachia became ground zero for America’s alarming epidemic of opioid addiction. These are the people trying desperately to lift themselves up and out.

Crushing Up Pain Pills and Spitting Out Lives in West Virginia Coal Country

When I met JR and Nikki they’d just run away from their own lives. They were penniless, with a backpack full of clothes and a purse containing two cans of potted meat, a packet of crackers and a syringe. They were walking down a set of train tracks between Danville and Madison at the center of West Virginia’s coal country. It was hot out. The air shimmered, thick with creosote oozing from the railroad ties.

I asked them for directions and they asked me why I was walking to Madison. I told them I was hitchhiking through southern West Virginia to learn about oxycodone, about how it had marbled through the hills of this isolated pocket of Appalachia, pushing methadone clinic check-ins up 500% in five years in some parts of the region, and raising the regional death rate from overdose to eight times the national average. They told me about being “D.O.A” at the ER, about smuggling almost a thousand pills a month from Florida to West Virginia, and about the nightmares their toddler had after a crowbar-wielding addict ripped open their front door to get at the drug safe.

The Madison town border on Rt. 85 in the heart of West Virginia's southern coal fields.
The Madison town border on Rt. 85 in the heart of West Virginia’s southern coal fields.

We snuck down behind a little league field and I watched as JR cooked up a 20mg Roxicodone pill on a spoon and shot it into both of their arms, using an iPhone charger to tie off. It was the Fourth of July. Their pupils constricted. Nikki threw up the potted meat.

I had arrived in Appalachia coal country — a geographically unique region spreading across the border between West Virginia and Eastern Kentucky — two days earlier, intent on spending the next week hitchhiking and looking for stories about the region’s opioid epidemic.

I was headed east toward Hamlin when I caught my first ride. Becky was a round woman with limp, thinning blonde hair and sun-slapped skin. I sat in the back next to one of two kids. He stared. Becky smoked. The Pontiac struggled.

Becky’s “Lil’ Sis” was a teenager when they prescribed Oxycontin for her endometriosis. It was the boys at her school who showed her how to crush the pills and snort them.

“It happened so quickly,” Becky said.

Lil’ Sis would come round the house to “see the baby” but instead steal jewelry and cash while no one was looking. Fraud and burglary became a part of her life and, twelve years later, she was locked up on multiple counts of theft.

“[Lil’ Sis] had the kid just before she went in,” said Becky. It took three days until the newborn even began to show withdrawal symptoms. They had the child on life support for fourteen days before going home with a little infant methadone kit.

Unfortunately, Lil’ Sis’ story is not uncommon. Of the 115 babies born at Welch County’s community hospital in 2011, over 40 had been exposed to drugs.

The web of factors responsible for this drug epidemic is complex.

Ambulance entrance for the Lick Branch Mine two miles east of Swiss, West Virginia. Many mines in southern West Virginia have dedicated ambulance entrance due to the high frequency of miner injuries.
Ambulance entrance for the Lick Branch Mine two miles east of Swiss, West Virginia. Many mines in southern West Virginia have dedicated ambulance entrance due to the high frequency of miner injuries.

One hundred fifty years ago, the southern Appalachian Mountains stood as one of the east coast’s last great strongholds of rural frontier life. But by 1900, ninety percent of the coal-rich land in Mingo and Wayne counties was owned by outside capitalists. Over six hundred “company towns” — where political organizations came under the control of corporate owners and policy was directed toward economic interests — were constructed between 1900 and 1930. They outnumbered independent incorporated towns five to one. Mountain men became company men. They toiled beneath the earth, sucking black dust and pinching off the occasional limb at the joint. They purchased groceries from the company store, visited the company doctor and sent their kids to the company school.

As one might expect, mining profits did not trickle down. By the mid-twentieth century, coal country had become emblematic of entrenched American poverty. It was a visit to the region that so unsettled John F. Kennedy in 1960, sparking a promise that led to Lyndon B. Johnson’s “unconditional war on poverty” in 1964.

Yet, throughout the latter half of the twentieth century, regional mining jobs continued to decline, towns withered and welfare became a way of life for many.

Starting in the 1990s, this swath of Appalachia began dealing with another dark outside influence.

Released by pharmaceutical giant Purdue Pharma in 1996, the sustained-release opiate OxyContin saw annual sales grow from $48 million to $1.1 billion between 1996 and 2000. By 2004, it was the most prevalent abused prescription opiate in the country. Marketed as a treatment for ailments such as chronic back pain — a common complaint in coal country — OxyContin is billed as a ‘slow-release’ preparation of oxycodone. But for addicts uninterested in a slow release, crushing the tablets and snorting or injecting them quickly put an end to that. By 2002, unintentional overdose deaths from prescription opioids surpassed those from heroin and cocaine nationally and, in West Virginia, prescription rates were running close to five times the national average. The demand was massive. Coal country saw the rise of what came to be known as “pill mills” – physicians’ practices specializing in unwarranted opiate prescriptions.

My new acquaintance JR was eight years old when he first heard about OxyContin, fifteen when he got his first opioid prescription and eighteen when his mom first sat him down and shot him up on his birthday.

“She said she did it because she knew I’d be doing it,” he said. “You know, she wanted to make sure I did it right.”

Today JR is 25. He’s been dating Nikki for seven years. He’s got a tattoo wrapping around his eye and the words “Faith” and “Hope” etched across his knuckles. All three tattoos came from ink-dipped staples behind bars.

Nikki is short, rotund and drawled, with near-black roots popping from beneath near-gold hair. In 2008, her dad and uncle went into business buying OxyContin prescriptions from pill mills in Florida and trafficking them up to coal country. Demand outpaced supply and, since Nikki and JR were struggling financially, her dad soon asked JR to join the venture.

“You could take $1,500 down there,” JR said, “pay for your doctor’s appointment and all your prescriptions, hotel for a night, and you can come back up here and sell 180 thirties in less than a day for $5,400.”

JR always names pills by their concentration. “180 thirties” refers to 180 30mg pills.

The three men worked in a rotating schedule, each driving to Florida once every three weeks. When they arrived back in Beckley, West Virginia, JR handled distribution from the apartment where he and Nikki lived with their infant son. He was selling a lot of pills, and he was shooting a lot pills.

On one trip back from Florida, he nodded off after shooting a thirty in the back seat with a lit cigarette in his hand. His whole crotch was ablaze before the driver noticed and woke him up. Instead of putting it out, JR just started singing happy birthday to the driver’s daughter sitting in the front seat.

“I used to have to have five thirties in the morning or I’d start to get sick,” he said.

Then one night, after locking the drug safe and retiring to the living room, Nikki heard one of their baby’s toys squeak from across the apartment. She walked over to the bedroom, “and there was a guy standing there,” she said. “He had a bandana on all the way around his face. He had latex gloves on and a crowbar and a metal pipe.”

They’d forgotten to slide the deadbolt and three men had popped the lock with a credit card. JR came running in but one of the men quickly pinned him to the couch with the crowbar while the other two carried out the safe. Nicki screamed; the men told her to “shut the fuck up.” The baby wailed each night for the next couple months.

In 2010, Nikki took a job at a pain clinic in Beckley that was known as a local pill mill.

“Me and the nurse practitioner alone, we seen a hundred patients alone a day,” she said. “People would just go in there and tell [the doctor] that they wanted 120 thirties, 120 fifteens, and he’d just give them to him.”

Often, the doctor would sign prescriptions from behind closed doors and give them to the nurses to distribute. Sometimes patients didn’t even have to come into the office. JR started paying patients to pick up prescriptions Nikki wrote, giving them forty of the pills for free and keeping the other eighty.

For a couple of years, this all ran smoothly. But then, in two quick strokes, the whole foundation of JR and Nikki’s operation started rotting out. First, Florida made it illegal for people to get prescriptions for opiates with out-of-state IDs. There were still drug dealers they could work through, but the costs – and the stakes – were much higher. Second, the Beckley pain clinic got investigated and Nikki was fired. Just like that, JR said, within a matter of months, “I went from having anything I wanted to not having nothing.”

Without pills, Nikki and JR got desperate quickly. “Your body will just, like, ache and you’ll have, like, these sicknesses,” Nikki said.

JR draws Roxicodone into a syringe for intravenous injection after mixing the pill with a little water and cooking it on a spoon with a lighter.
JR draws Roxicodone into a syringe for intravenous injection after mixing the pill with a little water and cooking it on a spoon with a lighter.

JR tried taking a job at Arby’s, but one day, in withdrawal, “the smell of grease, I started…I had to puke,” and he vomited out the drive-thru window. He lost another job after stealing a carton of cigarettes and giving them to his mom, who attempted to return them to get cash for pills.

“It came to the point,” Nikki said, “that we’re not allowed back in Wal-Marts because we stole so much stuff out of them.”

“I walked straight out of Wal-Mart, two days in a row, with $2,500 worth of electronics,” JR said. “I just put it in a buggy and walked out. Second time I got caught.”

“If I made a $200 check, we’d spend $170 of it on drugs in two days and be broke for a week and a half,” Nikki said.

“I stole medicine out of my grandfather’s cabinet after he got knee surgery.”

“I can’t even tell you how many bad checks we wrote.”

Eventually, as restrictions on OxyContin got tighter and tighter in coal country, heroin started filling the gap. It was cheap and it was powerful.

Nikki ties off with a phone charger cable as JR administers 15mg of Roxicodone in the back of a Madison, West Virginia little league field.
Nikki ties off with a phone charger cable as JR administers 15mg of Roxicodone in the back of a Madison, West Virginia little league field.

“One time we’d just re-upped and we were with another guy,” Nikki said, recalling a frightful experience. “When I got done I just fell over in the back seat of the car…my face went blue and everything, instantly…the guy that we was with he was on parole and…he got out of the car and picked me up and threw me out into the snow and just left me. By the time the ambulance got there fifteen minutes later, I was ‘dead on arrival.’ They barely had enough time to bring me back.”

“I was giving her CPR when the cops came,” added JR, who had two warrants out for his arrest. He says the police tried to spin attempted murder but he was out on bail in less than a week. The night of his release he wound up “dead on arrival” at the same hospital, from the same batch of heroin.

In September of last year, JR was convicted of cutting down over four hundred feet of telephone cable in order to extract the copper wire for pill money — in the process knocking out phone service to much of the county.

Soon afterwards, they lost custody of their son. They tried to go clean but the drugs were everywhere around them. Finally, in a moment of desperation, they ran away from Beckley, from the life, from the drugs. The next morning, walking on the train tracks, I asked them for directions.

“I hate that I got addicted,” Nikki said after I watched her shoot up in the grass behind the little league field. “I want to quit so bad, but I’d rather have a pill than a place to sleep at night.”

It was around noon on the Fourth of July. A couple kids and their dads had arrived to play ball. JR and I stood up. Nikki finished puking up the potted meat. We shook hands and said goodbye. I have no idea what happened to them next.

I hitched toward Oceana, or “Oxyana” as people call it, then over the next couple days, south toward Welch. Locals lamented how recent carbon regulations put in place by the EPA have sped up the already shrinking coal-mine job market.

“For every coal mining job that goes, there’s ten other jobs that goes with it,” said Bernie Sidebottom of Bernie’s Cole Street Deli in Logan, West Virginia. “I’m 56, been here my whole life and I’ve never before seen it this bad.” Bernie went out of business on August 1st.

Hitching southwest from Bob White, West Virginia, I was picked up by a laid-off coal miner smoking weed in a trucker’s cap. Driving on hairpin turns with country music blasting from his pickup, we got to laughing. He offered me a peanut butter and jelly sandwich but, when we got to his trailer, he said his wife was junk-sick and I should leave.

“Besides,” his wife said, smoking a cigarette and staring me down behind a purple robe in the dimly lit kitchen, “it’s not like we got no bread.”