LEXINGTON, Ky. — Shawn Clusky has seen every side of Kentucky's battle with pain pill addiction over the past 10 years.
Clusky first tried OxyContin at age 17 with his school buddies, shortly after the high-powered narcotic painkiller went on the market. He was an occasional user and seller until about age 21, when he became fully addicted.
When he was 25, he got arrested at a Lexington gas station for selling $15,000 worth of pills. Clusky received probation, but was still using until he was sent to the WestCare rehabilitation center in eastern Kentucky.
He now works there as a counselor.
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"A lot of times people believe a drug addict comes from poverty," he said. Not true. "Nine out of 10 of the guys I partied with came from millionaire families; their parents didn't use, they had good families."
Ten years ago, Kentucky learned it had a major drug problem.
OxyContin, a powerful prescription painkiller, was being abused at alarming rates in the Appalachian areas of eastern and southern Kentucky. A decade later, the level of pain pill abuse throughout the state and across the country is at epic levels, officials say.
Despite some successes — including several high-profile drug arrests across the country, increased treatment programs and the adoption of prescription drug monitoring programs in 43 states — the problem is now so entrenched that the cheap flights and van rentals drug traffickers use to travel from Florida to Kentucky and other states to peddle "hillbilly heroin" are nicknamed the "OxyContin Express."
The sheer scope of the problem is a key reason.
Kentucky often ranks at or near the top in U.S. measures of the level of prescription pain pill abuse.
According to a study by the Substance Abuse and Mental Health Services Administration, there was a fourfold increase nationally in treatment admissions for prescription pain pill abuse during the past decade. The increase spans every age, gender, race, ethnicity, education, employment level and region.
The study also shows a tripling of pain pill abuse among patients who needed treatment for dependence on opioids — prescription narcotics.
The rate of overdose-related deaths more than doubled among men and tripled among women in Kentucky from 2000 to 2009, according the state Cabinet for Health and Family Services.
Nearly every family in eastern Kentucky has been touched by prescription-drug addiction and death.
In the late 1990s, it was easier to find OxyContin — pure oxycodone with a time release — in Kentucky. The pill's maker, Purdue Pharma, was selling it "hand over fist" to doctors in eastern Kentucky, rich with coal mine injuries and government health care cards, Clusky said.
Clusky said a high school friend who worked at a pharmacy would steal the pills for his friends, so "It didn't cost any of us anything."
When many of the eastern Kentucky pill sources dried up after law enforcement raids in 2001, Clusky said, the trade moved to Mexico, where oxycodone could be bought for pennies over the counter and sold for as much as $100 a pill in the rural U.S. Clusky began making trips to Nuevo Laredo, driving back home with thousands of pills. By this time, heroin was his drug of choice. He often traveled to larger cities, where heroin could be found more cheaply.
"Five hundred dollars worth of heroin would last me a week. Five hundred dollars worth of oxy would last me one day," Clusky said.
Clusky lived part time in Ohio, sometimes making three doctor-shopping trips a day from Lexington to Dayton. He did a few stints in rehab, at one point trying methadone and Suboxone to treat his opiate addiction. It didn't work.
"I was as useless to society on methadone as I was on heroin," he said.
Nationally, prescription drug abuse has become a front-burner issue. There are more recovery options available now than a decade ago, but many states still don't have enough treatment available for all who need it.
Though Kentucky was no stranger to the abuse of prescription drugs long before federal regulators approved OxyContin in 1996, so many people in rural areas, including Appalachia, started abusing OxyContin in the late 1990s, it earned the nickname "hillbilly heroin."
Many chronic pain sufferers said the drug helped them immensely.
But abusers figured out they could crush a pill and snort or inject it, destroying the time-release function to get a whopping 12 hours' worth of the drug in one rush.
OxyContin quickly became the drug of choice in eastern Kentucky.
"You could leave a bag of cocaine on the street and no one would touch it, but leave one OxyContin in the back of an armored car and they'll blow it up to get at it," U.S. Attorney Joseph Famularo said at the February 2001 news conference announcing the first major roundup involving the drug.
By 2002, a quarter of the overdose deaths in the nation linked to OxyContin were in eastern Kentucky, authorities said.
Police, regulators and elected officials charged that Purdue Pharma, the Connecticut-based maker of OxyContin, marketed the drug too aggressively, feeding an oversupply and diversion onto the illicit market.
Purdue Pharma denied that, but the company and three top officials ultimately pleaded guilty in 2007 to misleading the public about the drug's risk of addiction and paid $634.5 million in fines.
Authorities had begun pushing back long before that against growing abuse of OxyContin and other prescription drugs, but addicts and traffickers kept finding ways to get pills.
"Law enforcement adjusts, and the criminals adjust," said Frank Rapier, the head of the Appalachia High Intensity Drug Trafficking Area, which includes 68 counties in Kentucky, Tennessee and West Virginia.
Kentucky Rep. Hal Rogers' voice grows tight with frustration whenever he talks about the prescription drug epidemic that's gripped Appalachia for more than a decade.
"Crook doctors operating these pill mills" in Florida are running rampant and are fueling the flow of illegally obtained prescription drugs to states such as Kentucky, Rogers, the chairman of the House Appropriations Committee, told Attorney General Eric Holder during a recent hearing. "My people are dying."
The White House "has got to act," Rogers said. "We've got more people dying of prescription drug overdoses than car accidents."
The Obama administration counters that it's the first to publicly call the prescription drug abuse problem an epidemic, has stepped up drug arrests and has directed millions in funding to state monitoring programs. The administration says it also has focused efforts on the Appalachia High Intensity Drug Trafficking Area, which includes 68 counties in Kentucky, Tennessee and West Virginia.
In the meantime, Rogers hopes legislation he's co-sponsoring with Rep. Vern Buchanan, a Florida Republican, calling for a tougher federal crackdown on so-called "pill mills" — pain clinics that dispense prescription drugs — will help stem the flow of drugs across state lines.
The measure includes provisions to support state-based prescription drug monitoring programs; to use the money from seized illicit operations for drug treatment; to strengthen prescription standards for certain addictive pain drugs; and to toughen prison terms and fines for pill mill operators.
The bill comes on the heels of Florida Republican Gov. Rick Scott's calls to repeal a monitoring program modeled after Kentucky's and designed to stem interstate prescription drug trafficking — a move lawmakers from Florida and Kentucky and White House officials oppose.
Scott has cited concerns about costs and patient privacy rights. He's turned down a $1 million donation by Purdue Pharma to help pay for a prescription database.
(Estep and Hjalmarson, of the Lexington Herald-Leader, reported from Lexington. Abdullah Reported from Washington.)
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