Pillbillies

People kind of expect those darn kids, the ones who trample lawns and tag underpasses and egg cats, to graduate on to more serious transgressions. Illicit substance abuse has become commonplace in the United States, with drug rehab programs and legalization debates popping up left and right. But beyond the Lindsay Lohans and their drug-induced tabloid appearances, beyond Bob Marley paraphernalia, there’s an increasingly scary and common route for young adults experimenting with drugs: prescription drug abuse.

Prescription drugs are the most frequently abused new substance by youth. Since 2000, its abuse has increased by 30 percent as marijuana use remains unchanged. This (relatively) new path to a high has hit Appalachia particularly hard, although it is not restricted to this region. Tiny coal towns play host to under-the-radar pharmacies, dispensing drugs like Xanax, Vicodin and OxyContin at an alarming rate with minimal regulation. A new vocabulary has been created to accommodate this new pill culture, and the idea of a pillbilly pillin’ in the parking lot of a pill mill is nearing commonplace.

It’s difficult for law enforcement to keep up with the associated kickbacks; some county sheriffs estimate that as much as two-thirds of an officer’s caseload might be related to pill acquisition and pill induced crimes. Often prescription holders are targeted; veterans, home-care workers and older community members become the victims of armed robbery. Drug addiction in a region where families and individuals already don’t have as many resources stretches welfare programs thin and forces pill addicts to become creative in their acquisition of those next two to 80 milligrams.

Copper theft has become one of those creative schemes; telephone and power lines running on the top of secluded mountains are easy targets. Scrap copper was worth $4 per pound 2011, almost four times as much as it was in 2009, and the inability of law enforcement officials to supervise acres and acres of empty land makes its theft a relatively easy way to make a quick buck. Most copper thefts in Appalachia on mountaintops and in abandoned coalmines go on to fund drug addictions, so the incidences occur at a constant and high volume. Botched attempts lead to electrocutions. Effective and ineffective attempts alike lead to power outages, phone outages and increased costs for utility companies.

The impetus behind prescription drug addiction in rural Appalachia isn’t completely clear. When you consider poverty, mental illness, alcohol abuse, drug abuse and depression, it becomes a “chicken or the egg” debate. Despite increased risk of addiction and abuse in poorer areas, patients on Medicaid are still twice as often prescribed OxyContin. These patients are six times as likely to overdose on prescription painkillers, and the cycle of abuse can be traced back to the initial, legal distribution of drugs. Around 17 percent of prescription pill abusers receive those drugs from their own doctor, legally.

Given great access to prescription drugs in Appalachia, it’s not hard to follow the path of abuse. The addictiveness of OxyContin is undeniable. The drug itself is very similar in structure to heroin, only a few carbon molecules from matching it identically. Yet the prescription painkiller was originally marketed as less likely to result in addiction because of a unique time-release; the active ingredient in OxyContin is released gradually over 12 hours, preventing a euphoric high and subsequent period of withdrawal.

With this theoretical improvement in mind, OxyContin was marketed by Purdue Pharma as non-addictive. Sales representatives for the pharmaceutical company were given the autonomy to create fake scientific charts, touting non-addictiveness before the FDA corroborated it. Needless to say, these sorts of marketing practices prompted a lawsuit, and the difference between the addictiveness of OxyContin and the non-addictiveness that the company claimed was deemed to be worth nearly $635 million in 2007.

When it comes to drug addiction and crime, it’s often easy to blame the user. I have yet to hear a man claim he was held down and forced to consume OxyContin. There’s a certain degree of personal responsibility in each and every addiction. Environmental stimuli, however, provoke this epidemic of addiction in rural areas like Appalachia, and the treatment of prescription drugs by the American health system all but encourages this abuse. Without the development of appropriate infrastructure to deal with addiction, prescription drug abuse holds great potential for growth and further inclusion in popular culture. Before you know it, “The Beverly Pillbillies” could be airing every Thursday night at 9 p.m., and the cycle of abuse could become a permanent part of the Appalachian landscape.