MANCHESTER — Holed up in the closet of a rundown house on Bray Creek, Melanda Adams cried out in despair.
Living an addict's hell, the 24-year-old woman had a nosebleed that wouldn't stop after enduring another beating from her boyfriend. He helped her get pills and meth, so she always went back to him, even after the time he dug a shallow grave for her pummeled body.
Adams had been raised a Baptist, but sitting in the closet that night in March 2004, she thought there couldn't be a God if her life was so wretched. "Show yourself to me," Adams demanded of God.
That's when she heard a noise. Crawling out of the closet, Adams met a Manchester police officer coming down the hall. Police had gotten a tip about meth being made at the house. "She looked like death," Manchester police Chief Chris Fultz said.
Adams was among the tens of thousands of people sucked under as a tidal wave of prescription-drug abuse swamped Eastern Kentucky beginning in the late 1990s, shattering families, fueling crime and killing thousands. Clay County, where Adams lives, was among the places that suffered mightily.
The hilly county had long been one of the poorest in the nation, and the coal mines that once provided at least some jobs were mostly gone. Rising drug abuse added misery to the economic malaise, and corruption among public officials inflamed the drug problem. Drug dealers helped power brokers buy votes, then benefited as some local police and other officials turned a blind eye to their illicit sales.
One family's drug operation at a rural house generated more traffic at times than the drive-through at the local Wendy's restaurant. After state and federal authorities finally arrested the family in 2000, a federal magistrate said they had "been able to operate almost openly without local authority interference."
It would take determined efforts by local citizens, a far-reaching federal investigation, new law enforcement and treatment programs, and changes in laws to inspire hope — however tenuous — of a more promising course for the county.
Drug abuse is not a new problem in Eastern Kentucky.
"Pain-masking sedatives" became commonplace in the region's coalfields decades ago as doctors, stretched thin and pressed to help legions of injured miners and sick poor people, handed out "bags and bottles of pills," Whitesburg lawyer Harry M. Caudill wrote in his 1963 book Night Comes to the Cumberlands: A Biography of a Depressed Area .
Anxieties that grew from the economic devastation of the Great Depression, which hit the Cumberland plateau particularly hard, and the drudgery of coal-camp life also drove the use of pills, Caudill said.
"Without time, inclination or knowledge to treat deepening complexes and manias, the doctors simply dispensed handfuls of sedatives," Caudill wrote.
Nothing in Eastern Kentucky's past, however, prepared it for the onslaught of a new pill called OxyContin.
The drug was developed as a remedy for moderate to severe pain, such as that suffered by some people with cancer or crippling arthritis. The pills, introduced in 1996, were a boon to people with chronic pain.
The medicine had a time-release formulation, but abusers quickly learned that they could crush the pills and get a huge blast of the drug for a heroin-like high.
Eastern Kentucky was among the rural areas where abuse mushroomed beginning in the late 1990s as doctors — some unaware of the risk, some acting out of greed — wrote OxyContin prescriptions by the thousands for people clamoring for the drug.
Landry Collett, a state police officer, remembers seeing an OxyContin pill for the first time in 2000 during a traffic stop in Leslie County, next to Clay County. The driver had to tell him what it was, but Collett and other officers quickly became familiar with the drug.
"It was like an explosion, a free-fall of people being on pills," said Collett, whose job is to disrupt highway shipments of illegal drugs.
A 2001 report from the Appalachia High Intensity Drug Trafficking Area said the number of OxyContin pills dispensed to state residents jumped from 4.86 million in 1999 to 9.36 million in 2000.
That put Kentucky's consumption rate nearly 53 percent above the national average. The state ranked first in the nation in non-medical use of pain relievers from 2002 through 2004, the federal Substance Abuse Mental Health Services Agency estimated.
As officials began describing the problem as an epidemic, the body count rose.
Overdose deaths in Kentucky climbed a whopping 296 percent from 2000 to 2010, with the highest rates concentrated in Eastern Kentucky. Prescription painkillers and anti-depressants drove the grim toll, according to a 2012 study by the Kentucky Injury Prevention and Research Center at the University of Kentucky.
After a decade of rising abuse, 979 Kentucky residents died of drug overdoses in 2010 — more than the number killed in car wrecks. The rate of overdose deaths was third-highest in the nation.
"I think that OxyContin problem was the catalyst that started a very serious drug problem here," said Gary Douglas, a former addict who now counsels addicts at Kentucky River Community Care. "We're still seeing the effects of that today."
Clay County was at the center of the explosion.
Pills "flooded the streets" in the county, said Fultz, the Manchester police chief.
"You seen people that you grew up with that you would have never dreamed would be on drugs so bad," Fultz said.
Melanda Adams was one of those people.
Adams started drinking alcohol with friends at football games in Manchester when she was 13 or 14, a bit of youthful rebellion in a small town without much for kids to do. Then she went with the crowd to other drugs.
She was riding around with friends the first time she snorted a crushed-up OxyContin pill. The rush of powerful pain medication into her system was so overwhelming that she threw up. But it was the hot local drug, so she kept at it.
"It was the only thing I could get, so I done it," Adams said.
By the time she was 23, she was snorting as much as $800 worth of OxyContin pills and meth a day.
She was the daughter of the county school superintendent, but she lived with a high school dropout who made meth with her for them to snort, or to sell to get money for OxyContin.
Caught up in the exhausting pursuit of the next pill or dose of meth, Adams went for weeks at a time without contacting her family. Her father would ask school bus drivers to watch for her on their routes so he would know she was alive.
Her older sister, Danielle Collins, remembers the fear from those days. She once asked their father not to post bond for Melanda to get out of jail, because at least she was off the streets.
"Every day is just a burden, wondering if you're ever gonna get 'em back," Collins said. "It was awful going through that, wondering where she was."
Collins said her little sister — an outgoing blond with a bright smile — had been in modeling as a child. At the height of her addiction, though, she had lost so much weight she could wear children's clothes.
"I was on death's door," Adams said.
A range of factors combined to make Eastern Kentucky one of the worst spots in the nation for prescription drug abuse, according to people who have studied or fought the problem.
The region's high poverty rate topped the list.
A key predictor of drug abuse is social rank — how people see their place in the world and their ability to improve their lot — and many people in Eastern Kentucky rank low because of chronic poverty, said Robert Walker, a researcher at the Center for Drug and Alcohol Research at the University of Kentucky.
"It's the belief that I can't do anything to fix this or make my life any better," Walker said. "That is a profound risk condition for drug abuse."
Another factor in the growth of prescription drug abuse was the region's high rate of workplace injuries and chronic health problems; many people received powerful drugs for legitimate problems, then got hooked.
Public assistance also played a role. Medicaid recipients can get prescription drugs at little cost, and some people then resell them for cash.
In Clay County, 42 percent of residents were eligible for Medicaid in fiscal 2012, compared with 18.8 percent statewide.
Police and prosecutors argue that aggressive marketing by Purdue Pharma, the maker of OxyContin, also fueled abuse of the drug.
The company falsely claimed that OxyContin had less potential for abuse than other drugs, and it pushed doctors to overprescribe the product, federal prosecutors would eventually charge. In 2007, the company and three top executives pleaded guilty to misleading doctors and were ordered to pay $634.5 million.
"Purdue Pharma is one of the main causes of the problem," said U.S. Rep. Harold "Hal" Rogers, R-Somerset, whose district was the epicenter for pill abuse.
Doctors also played a role.
Some were unwittingly scammed by patients faking pain, but other, unscrupulous physicians wrote prescriptions for a staggering number of pills, cashing in on the surge in abuse they were feeding.
After federal prosecutors said two doctors in Johnson County wrote prescriptions for 6.9 million pills in a year's time, U.S. District Judge Karen Caldwell told one of them, Frederick Cohn, that he had cynically preyed on addicts.
"Instead of having to go out on the street and sell crack cocaine to our kids, you donned a white coat and hid behind respectability," Caldwell said when she sentenced Cohn to prison in December 2003.
Corruption was another key ingredient in Clay County's drug problem.
Kenneth Day, a drug dealer who used his pawnshop as a front, testified in a 2010 trial that he bought votes for then-county Sheriff Edd Jordan and other candidates in the 1980s and 1990s.
That bought him protection, Day said, when a prosecutor asked how his involvement in politics related to his drug business.
"Well, I knew that as long as I stayed in Clay County that I would never have no problem with none of the local officials," Day testified. "I had Edd Jordan's word on that, that he would never bother me."
Todd Roberts, a onetime assistant police chief in Manchester, testified that before a hotly contested local primary in May 2002, he had confiscated $80,000 from a drug dealer named Eugene "Moose" Stewart.
Not long after, then-county Clerk Jennings B. White and Jordan asked him to return the money to Stewart because the drug dealer was going to buy votes for them, Roberts said. However, Roberts had already turned the cash over to federal authorities.
Jordan has denied being involved in illegal activity, but federal prosecutors listed him as an unindicted co-conspirator in a widespread federal investigation that led to the conviction of more than a dozen onetime public officials or election officers in Clay County.
Vote-buying by people vying for power and control over jobs had long been a part of the county's political culture by the time of the 2002 primary, in which opposing sides kicked in an estimated $400,000 to pay voters.
"A lot of people thought there was nothing wrong with vote-buying," said Carmen Webb Lewis, who defeated seven-term mayor Daugh White in November 2006 as White was under federal investigation.
There also was a perception that the local court system was not effective in combating drugs.
Clay County was among the places where police carried out the state's first major OxyContin roundup, charging a total of 200 people there and in other counties in February 2001. Eight months later, half the cases in Clay County had been dismissed, some for lack of prosecution.
"You take a drug dealer that sees no repercussions he's going to continue to do it," said Jeff Culver, a former Manchester police chief.
In one corruption case, Roberts and Vernon Hacker, a Manchester councilman and head of the city-county 911 system, shielded a drug dealer who had done them a favor.
Bobby Joe "Fabio" Curry had burned down a vacant house in Manchester in 1999 at the request of Roberts, Hacker and White. The city wanted to build a police station and 911 center at the site, but the owner of the house wouldn't sell.
After the arson, Roberts and Hacker tipped Curry off to police activity, Curry said.
"I just thought I had it made," Curry, who sold OxyContin and cocaine, told the Lexington Herald-Leader in 2007, after he had been charged in federal court.
Roberts and Hacker pleaded guilty in the federal drug and corruption case.
A drug problem as severe as Clay County's can flourish only in the shadow of corruption, U.S. District Judge Danny Reeves has said in Clay County cases.
"You allow drug-dealing to go on because that's how — that's fuel for the fire. It keeps certain people in office," Reeves said in one 2010 case.
Sometime in 2003, Melanda Adams sated her craving for drugs by stealing the ingredients that a drug dealer had provided her boyfriend to make a batch of meth.
When the dealer came to get his meth, her boyfriend and others took Adams to an isolated spot in the woods off an old logging road, dug a shallow grave and beat her, trying to force her to tell whether she'd stolen the meth.
Adams lay in the dirt thinking she was going to die. She was so tired of being an addict that she didn't care.
"It was kind of like a peace," she said.
When her attackers took a break from hitting her, a friend who came by saw her and created a ruse, telling the others that police were on the way.
The friend took Adams home, but she soon went back to her abusive boyfriend, desperate for drugs.
Whatever the reasons why people start abusing drugs, blocking out the shame of their addiction and what they've done because of it becomes part of the reason to keep abusing them, Adams said.
"Your soul is tormented, really," she said.
By March 2004, when police found Adams, agitated and bleeding as she came out of the closet, her parents had tried everything, including jail and unsuccessful stints in rehab.
This time, her parents left her in jail for three months.
It took the first month for her drug-soaked body to detoxify. It felt as if her skin were inside-out and being cut with glass shards, Adams said.
But as another woman at the jail sang Amazing Grace over and over, Adams said, she also experienced salvation — the beginning of a hope for life without drugs.
When she got out of jail, Adams went to a faith-based rehabilitation program.
She was painfully thin, and her skin was damaged from longtime meth abuse, said Jeff Coots, who helped run the Perry County program.
"She was a very sick young lady," Coots said.
While Adams fought her addiction, a growing number of people in Manchester desperately tried to push back the darkness of drugs that cloaked Clay County.
Ken Bolin, pastor of Manchester Baptist Church, remembers the event that galvanized him.
A girl about 12 years old had been coming to the church. Her mother was an addict, using needles to inject drugs and prostituting herself to support her habit.
Bolin had tried to get help for the woman, but he couldn't find a treatment bed for her quickly. By the time he did, the woman balked at trying to break free from drugs.
Two days before Christmas 2003, the woman walked to a drug dealer's house, collapsed on the way home and died in the cold. The coroner called Bolin to come console the 12-year-old girl, and he preached the woman's funeral Christmas Eve.
"It was devastating to me," he said.
The death convinced him that churches needed to step up and fight addiction as a spiritual problem — an emptiness that the church had to work harder to fill.
Doug Abner, a Pentecostal minister at what was then Manchester Community Church, also thought people of faith had not done enough to fight drugs.
Some didn't know what to do, or didn't see fighting drug abuse as being part of their mission to win souls. Many were in denial about the severity of the problem before the wave of deaths, Abner said.
"When your kids start dying, you look at things different," he said.
Bolin, Abner and a small group of pastors started meeting each Saturday morning, praying about the problem and how people of faith could tackle it. The group grew as more pastors, church members and the parents of children who had died joined.
"We began to pray desperately," said John Becknell, a member of the church that Abner pastored.
Ultimately, the group decided to take a public stand with a march through town.
The organizers advertised the march and contacted more than 60 churches, but they didn't know what kind of response to expect. If turnout was low, drug dealers and corrupt politicians would write off the effort, Abner said.
On the morning of the march — May 2, 2004 — Abner got a call from a local official. The man, whom Abner didn't want to name, cautioned against having children come to the march, saying there was talk that a drug dealer would plow a car into the crowd.
"It was another one of those veiled threats," Abner said. He hung up.
As the morning dawned rainy and unseasonably cold, organizers were worried. They shouldn't have been.
An estimated 3,500 people — nearly 15 percent of the county's population — marched more than a mile to a rally at a city park. Ministers prayed for forgiveness for not acting sooner, and for help to stand strong from then on.
It felt as if a new day had come for the county, said Karen Kelly, who attended as head of Operation UNITE, a regional anti-drug task force.
"You just had the feeling this is different," Kelly said. "It was profound."
As the pushback by local residents gathered steam, a palpable sense of optimism developed among many people.
Faith-based recovery programs for addicts spread among churches, and residents worked to establish a local residential recovery center.
Charlie McWhorter, a businessman who had taken part in the Saturday prayer meetings, donated land for the center, and U.S. Rep. Hal Rogers helped to obtain more than $1.5 million in federal money to build it. The center, which uses a faith-based program, is called Chad's Hope in honor of McWhorter's son, who overdosed and died in July 2004.
As hard as his son's death was, good has come from it, McWhorter said.
"We don't know God's plan," McWhorter said. "If he'd have never died, we may never have had a facility."
A television station at Abner's church began broadcasting local government meetings, and volunteers started a program to monitor court proceedings.
Becknell ran an ad in The Manchester Enterprise seeking volunteers for the program. Ninety people showed up — an indication of the perception that people charged with crimes faced few repercussions, Becknell said. "A lot of people were angry," he said.
Meanwhile, the federal investigation upended the county's political landscape, ensnaring a circuit court judge, the county clerk, the mayor, city council members, the assistant police chief, county magistrates and the school superintendent: Melanda Adams' father.
Elections have been cleaner since, and people have run for office who wouldn't have in the days when vote fraud was pervasive, Abner said.
In 2007, the city council designated Manchester as the City of Hope.
The march and other developments inspired anti-drug efforts elsewhere.
Christian broadcasters did stories on Manchester, and a group made a movie about the march and conditions that led up to it, called Appalachian Dawn. Bolin and Abner have spoken about the effort around the country. There also was hope for economic renewal after a Florida waste-recycling company said in 2009 that it would build a factory in Manchester and hire 1,400 people. In a county where the poverty rate was double the state level at the time, the news was like a thunderclap.
"We were tickled to death," said Margy Miller, who heads a local group called Stay in Clay that is working to improve the local economy.
These days, some people think that the energy and optimism that bloomed after the anti-drug march have waned.
The factory project collapsed, discouraging many people. Jobs remain scarce; more than 35 percent of residents are poor, and the county has steadily lost population since 2000 as people move away for work.
The never-ending nature of the drug problem has ground people down. Bolin, the Baptist preacher, said he and others have not given up and are not discouraged, but he acknowledges being tired.
"There is no quick fix," said Bolin, who volunteers on the local drug court team. "Evil doesn't quit."
Fultz, the police chief, said people "were calling in tips right and left" about suspected drug activity after the march, and he felt a sense of progress. But the drug problem evolved.
Addicts sought other pills after many doctors became more cautious about prescribing OxyContin and the maker reformulated it to curb abuse. People also learned to produce small batches of meth with chemical reactions in crude labs made from soft-drink bottles.
Meth abuse has increased recently, Fultz said.
"We're not back to square one, but we've lost ground," Fultz said.
There are positive signs, though.
Drug-related deaths in the county dropped from 43 in 2011 to 27 in 2012, said Coroner Danny Finley, who has received high marks for his activism on the issue of overdoses.
After taking office in 2011, he began digging through pill bottles at death scenes to see where the drugs were coming from. He talked to the media to highlight the overdose problem, and he shared his findings with any agency he thought could help: police, medical regulators, congressional offices, even the state poison control center.
Finley said several factors helped drive down drug deaths, including greater community awareness, enforcement efforts by police, better practices by many doctors, a change in state law to crack down on unscrupulous pain clinics, and action by state medical regulators to shut down overprescribing doctors more quickly.
"We have in effect limited the oversupply," Finley said.
In August, the city of Manchester hired Chad Thompson, a former drug addict, to run a program aimed at helping drug abusers find treatment options. It's perhaps the only Kentucky city its size with such a program.
The effort is a personal mission for Thompson, 30, who started abusing OxyContin while in high school, eventually needing $500 to $700 worth of pills a day.
Thompson's family owned a hardware business, and he would take money from the deposit bag after hours. Other times, he sold personal items for a fraction of their value to get pills. Once, his father gave him a hunting bow worth $800; he kept it for three days and sold it for $100.
He finally quit after a friend overdosed and died in the parking lot of a pizza place in June 2005.
"It could as easily have been me," Thompson said.
Four days in August show how far Clay County has come in its fight against drugs — and how far it has to go:
On Aug. 16, a Friday, nearly 300 people gathered at Eastern Kentucky University's branch campus in Manchester to celebrate stories of recovery in the 10 years since the launch of Operation UNITE.
As the crowd cheered, men from Chad's Hope — some were in the program with financial help from UNITE — held up signs describing their old life, then flipped them over to a description of what they are now. "Needle junkie" became "Jesus junkie."
Participants unveiled UNITE's "Hope Wall," with photos of people who have beaten addiction, including Melanda Adams.
"In the midst of these cries for help, we're beginning to see tears of joy," Hal Rogers said.
Even as people gathered for the event, however, Manchester officers were taking Jason Cottongim, 34, to jail after finding him passed out in a car with a meth lab in the seat, according to a citation.
That same day, state police arrested Ernest D. Barrett, 46, on charges of growing marijuana after spotting 24 plants near his home.
On Aug. 18, a 19-year-old man killed himself with a shotgun blast to the head. The man had significant quantities of meth and marijuana in his system, said Finley, who listed drugs as a contributing factor in the death.
On Aug. 19, Richard Dalrymple, an officer on a federal drug task force, swore out a complaint alleging that Terry R. Smith, who lived in a large brick house across from a collection of run-down mobile homes at Horse Creek, had been getting people to collect pills from pain clinics in other states for him to resell. The case has ties to two other cases in the area in which defendants are charged with murder for allegedly killing three people they thought had cooperated with police.
The fight against drugs is never over, but Melanda Adams is proof that there's hope in Manchester.
She got kicked out of the faith-based recovery center at one point because of her attitude, but she went back, buried her nose in the Bible and walked out of the yearlong program clean. She has been drug-free since.
Adams said her faith has been the key to staying off drugs, giving her a new focus and an avenue to remain accountable for sobriety.
She has clear eyes, a big laugh and a feisty 6-year-old daughter. She runs her own convenience store.
Adams and her sister head Operation UNITE's Clay County coalition, which arranges drug-prevention and education programs for youngsters.
It's important that people trapped where she once was know that they are more than drug addicts, she said.
"There is a chance," she said. "Give 'em that hope."