Since the prescription pill tragedy began about 10 years ago, Appalachia has been in the thick of it. This beautiful area of rolling, wooded hills hides the high levels of poverty and poor education on which drug addiction breeds. Appalachia has long been accustomed to high levels of addiction to tobacco, alcohol and meth, and in the past decade it has similarly embraced “Hillbilly Heroin,” as opioid painkillers have come to be known locally.
Caraway has watched the epidemic take hold. He remembers his astonishment when he first started seeing patients coming in with signs of addiction to massively powerful opiate painkillers, having been put on them for comparatively mild complaints.
“That was stunning to me — that a primary care doctor would write large doses of potent opioids for relatively benign pain conditions was extraordinary,” he said.
He also remembers the moment the penny dropped — the realization that the US was falling into a crisis of epic proportions. It was when a patient came to see him who had been complaining of muscle aches and pains of the sort you might feel after a long run, or if you had a light case of flu. His doctor had put him on 540mg a day of the most commonly prescribed opioid painkiller, OxyContin.
“Let me give you a little understanding about that,” Caraway said. “OxyContin is up to two times more potent than morphine. So this is the equivalent of about 1,000mg of oral morphine. That’s a whopping dose that is every bit as potent as heroin, every bit as addictive. I was stunned that someone would prescribe this level of medicine to someone who wasn’t suffering from end-of-life cancer.”
After that experience, Caraway watched as similar cases became more common. He watched as the problem fanned out from the medical world into the realm of illicit drug dealing as addicted patients, desperate for money to pay for their habit, began to sell the prescription pills on the street.
“I’ve seen it tear apart families and lead to loss of life. The most horrifying thing I’ve seen is that this is causing hopelessness leading to suicide and murder,” Caraway said.
Among those he has tried to help wean themselves off the drugs was an engaged couple. Shortly before the wedding, the woman overdosed on painkillers and died.
“He was devastated, but he kept on taking the pain pills,” Caraway said.
Other patients have included a judge who became addicted after treatment for an injury, a sports star whom he would not name who lost everything — his wife, six children and home — to the habit, and chief executives of major companies.
Caraway treats patients who have severe pain and genuinely need treatment with powerful opioids. He does not treat active abusers. However, several of his patients have had experiences relating to the epidemic of painkiller addiction. Take John Brumfield, 61, who ruptured a disc in his spine and has been on painkillers for many years. After friends heard that he was on them, Brumfield started observing something strange.
“If we had people over to the Super Bowl or a holiday season party, I’d notice that my medicines would come up short, no matter how good friends they were,” he said.
Twice people broke into his house to get to the drugs. Like Geni, he ended up installing a safe to secure the drugs. And he stopped having parties.