ASHCAMP — Shawn Clusky has seen every side of Kentucky's battle with pain pill addiction.
Clusky, who was raised in Pike County, first tried OxyContin at age 17 with his school buddies, shortly after the high-powered opioid painkiller went on the market.
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, Clusky said.
It was a drug that didn't discriminate.
"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."
Clusky has been an abuser, a dealer, a patient and now a mentor helping others fight addiction. He knows all too well how the drug can destroy a life — and he knows that the war in Eastern Kentucky is still an enormous struggle 10 years after the issue exploded into public view following a series of high-profile drug busts.
No matter what steps authorities have taken in the last decade to clamp down on prescription drugs, criminals and addicts still find ways to get pills, and the drugs exact a toll in overdoses, deaths and ruined lives.
When many of the Eastern Kentucky pill mills dried up after law enforcement raids in 2001, the trade moved to Mexico. After Kentucky implemented a prescription drug monitoring system, addicts and traffickers eventually started getting drugs from other states that didn't have those systems, including Georgia and Florida.
"They shut down the doctors here and it moved to Mexico. If you shut down Florida, they'll just move to some other state," Clusky said.
Kentucky's prescription-pill problem has jumped back into the national headlines in recent months, in large part because of the so-called "pill pipeline" between Florida and Appalachia. Actions by Florida's new Republican Gov. Rick Scott to spike plans for a prescription drug monitoring system have echoed all the way to Washington and were a discussion point during a three-day trip to Kentucky by federal drug czar Gil Kerlikowske.
While there have been some positive steps in fighting pill abuse, steep hurdles remain. Overdose-related deaths continue to rise, but the state doesn't have enough treatment options available for all the people who need it. And the state budget for treatment has been stagnant.
Clusky and many others see treatment and education as the best weapons to fight this war.
"People used to use OxyContin, and now they're using Roxicet, and next they'll be using Opana that's starting to come out," said Clusky. "You need to focus on treating the people who are addicted now and educating the people who aren't addicted."
Clusky ultimately kicked his drug habit, but it took him a while to find his way.
He was in the first wave of people to get hooked on OxyContin in the late 1990s in Eastern Kentucky.
Unlike other painkillers available at the time, OxyContin was pure oxycodone, with a time-release function designed to provide steady relief over an extended period.
Many chronic pain sufferers said the drug helped them immensely.
Abusers figured out they could crush an OxyContin and snort or inject it, destroying the time-release function to get a whopping 12 hours worth of the drug in one rush. The drug's popularity exploded.
"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," then-U.S. Attorney Joseph Famularo said at a February 2001 news conference.
That event was to announce the first major pushback by authorities — an investigation called OxyFest 2001, in which more than 200 people were charged in federal court and several Eastern Kentucky counties, mostly for selling OxyContin.
Three top officials of Purdue Pharma, the maker of the drug, ultimately pleaded guilty to misleading the public about the drug's risk of addiction and paid $634.5 million in fines.
When several Eastern Kentucky pill mills dried up after 2001, Clusky was among those who went to Mexico, where people could buy OxyContin over the counter for pennies a pill and sell it for up to $100 a pill in the rural United States.
Clusky, who later developed a heroin habit, lived part-time in Ohio, sometimes making three trips a day from Lexington to Dayton to buy pills on the street to sell in Eastern Kentucky.
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.
In 2006, at age 25, he got busted at a Lexington gas station for selling $15,000 worth of pills. Clusky received probation and kept using drugs until he failed a drug test and a Fayette County probation and parole officer sent him to WestCare rehabilitation center in Pike County.
He said WestCare's structure and discipline and method of complete abstinence from drugs, alcohol and tobacco were what he needed to get clean. He spent six months in rehab, and for the past four years has worked for WestCare as a mentor.
The residential facility in a peaceful spot along Elkhorn Creek in far southeastern Pike County opened in 2005. It has graduated between 500 and 600 men and has grown from 35 beds to 88. Judges have grown more willing to work with the program, often writing orders with advice from specialists at WestCare and realizing that although jail often won't help an addict get clean, court-ordered rehab often might.
Local attitudes toward the facility have changed from when it first opened, when neighbors were wary of "pill heads" living up the road, said Clinical Director Mike Williams.
WestCare has recently partnered with Pikeville College School of Osteopathic Medicine. Students visit the facility to learn about treatment and the disease of addiction.
That's what needs to happen, professionals say.
"Stop ignoring what is happening when we know how to fix the problem," Williams said. "We need the support."
Treatment funding has been stagnant in Kentucky, however.
The amount the state put in for substance-abuse treatment from its general fund went down from $6.7 million in fiscal year 2006 to a budgeted figure of $6.4 million this year.
Other funding has helped make up the difference, but overall, the amount budgeted for treatment in Kentucky this year is less than in fiscal 2009.
Meanwhile, the rate of overdose-related deaths among men in Kentucky more than doubled from 2000 to 2009 and tripled among women. The total number of overdose deaths rose from 403 in 2000 to 978 in 2009, according to statistics released by the state Cabinet for Health and Family Services.
Kerlikowske, director of national drug-control policy, visited Kentucky late last month to highlight the nation's problem with prescription drugs because the state has been a hot spot.
There are opportunities to cut into the problem with measures such as education for young people and use of prescription-monitoring programs, he said, but treatment has to be a key part of that effort.
Kentucky authorities applauded when Florida lawmakers approved creating a prescription-monitoring system in 2009, saying it would help in efforts to cut the pill pipeline to Kentucky and other states.
It didn't sit well in Kentucky when Scott, Florida's new governor, said he wanted to scrap plans for the system.
Kentucky Lt. Gov. Daniel Mongiardo said the move amounted to an invitation to drug traffickers and addicts to come to Florida, and Frank Rapier, director of the Appalachia High Intensity Drug Trafficking Area, said police felt like they'd been kicked in the teeth.
"To take a step back like this is incredible," Rapier said.
The issue remains under debate in Florida.
Kerlikowske said he would like to see Florida have a prescription- monitoring program. The problem of interstate pill pipelines won't change until every state has a system to monitor prescriptions dispensed there, police say.
A game changer
The eastern part of the state has remained a hot spot for prescription drug abuse, but police said they've seen an increase in Central Kentucky as well.
Marijuana and cocaine used to be the main drugs seized in Lexington, but officers have seen a shift from cocaine to pills, police Chief Ronnie Bastin said at a recent meeting.
"The game has changed," Bastin said.
Police said a man charged in a January triple homicide in Lexington had been to Florida to get pills with the victims.
Boyle County Sheriff Marty Elliott said police there have investigated a man suspected of importing a large amount of pills from Florida and Georgia. The prescription drug problem in the area is worse than a decade ago, he said.
"Prescription pills are destroying a lot of lives," he said.
Prescription opioid abuse surpassed heroin and cocaine use in Kentucky around 2001. Rates are still climbing, but more slowly than the national average of 8.5 percent in 2005, according to the annual National Survey on Drug Use and Health.
These days, OxyContin is not as prevalent on the streets in Eastern Kentucky as it once was. Oxycodone pills, which aren't as powerful, are more widespread.
Some doctors became reluctant to prescribe OxyContin because of the controversy over the drug.
The main reason for the switch, though, is that it's easier to get oxycodone in Florida, said Dan Smoot, law-enforcement director for Operation UNITE.
"They like OxyContin better," he said of addicts, "but they'll take what they can get."
Kentucky still ranks at or near the top in U.S. measures of the level of prescription pain pill abuse.
For instance, a federal agency estimated that in 2007—08, Kentucky tied for the second-highest percentage of people 12 and older who had engaged in non-medical use of pain relievers, said Robert Walker, an associate professor at the University of Kentucky and researcher at UK's Center on Drug and Alcohol Research.
Kentucky's rate was 6.58 percent, the same as Oregon's. Oklahoma was in the top spot and all three were well above the national level of 4.89 percent.
Still, there have been some positive developments over the last decade. One addition to the fight since 2001 is Operation UNITE, which Republican U.S. Rep. Harold Rogers set up in 2003 to fight drugs in his district in Eastern and Southern Kentucky.
The growth of drug courts, which give people charged with crimes a chance to stay out of jail if they stay clean, has also been positive, police said.
"There's just so many success stories we never had" a decade ago, Smoot said.
Churches and non-profit groups have added recovery programs, and in 2005, the Kentucky Housing Corp. started Recovery Kentucky, which now has more than 1,700 beds at 14 centers around the state, with more planned. Half those beds are for people on probation or coming out of prison.
The centers aren't licensed as treatment providers, but operate with a 12-step program and mentoring to deal with substance abuse.
There are fewer licensed treatment slots for women than men in Kentucky, and the wait to get into recovery or treatment facilities for either can stretch from weeks to months.
Part of the intent of a measure lawmakers approved this year was to reduce the state's prison population and use some of the savings for drug treatment.
However, it would take doubling or tripling of the current funding to meet the state's needs, Walker said.
"I think the scope of the problem has just gotten so huge that any of our resources for dealing with it are pretty darn limited," Walker said.