“You don’t know how sad that is, to know the lengths even your friends will go to to get these drugs,” Brumfield said.
A couple of years ago, Brumfield went one better: He implanted what is essentially a mobile safe into his body. Under Caraway’s supervision, he had a box embedded under the skin of his stomach into which opiate derivatives can be injected and then pumped in micro amounts through a tube direct into his spine.
“No one can get at my drugs now. I no longer have to worry about people I thought of as my friends trying to take it from me,” Brumfield said.
Mark Maynard, 37, knows what addiction to prescription pills does to you. In 2006, he was working on a metal roof when he slipped and fell 9m, smashing seven vertebrae. He was put on OxyContin and rapidly became addicted. He had to take ever larger doses to ease the pain and suffered cravings when he went without. At the peak of his addiction, he was taking 250mg of OxyContin, three 800mg Ibuprofen tablets, three doses of Neurontin, two of Lyrica, plus Diazepam and Ativan every day. His nadir came a couple of years ago on Christmas Eve. He had taken his two children to his mother’s house and stayed up to wrap the presents. He took too much OxyContin and passed out. When he woke up eight hours later he was in the living room.
“I’d wet myself, the kids had gone and I was on my own with wet pants, not remembering anything that had happened,” Maynard said.
After that, Maynard pulled himself together. Under Caraway’s care he gradually reduced his intake and is now on a much lower dose of painkillers and doing well. However, many of his friends have not been so lucky. He knows about 10 people who are in prison or have overdosed and died as a result of opioids.
Black market drugs are freely available in the area, much of it trafficked through the so-called OxyContin Express: people travel down to Florida, home to many unscrupulous doctors and their “pill mills,” where prescriptions for painkillers can be bought no questions asked, and bring the spoils back to Appalachia to be sold on the street for up to US$100 a pill.
“It’s hard to find people round here who don’t take pain medicine,” Maynard said.
Finally and very belatedly, the US authorities have begun to grapple with the problem. The Centers for Disease Control and Prevention have named painkiller abuse a No. 1 priority, police have begun closing down pill mills in Florida, physicians are being educated about the dangers of overprescribing and in Appalachia new rules have been introduced that require doctors who treat more than half of their patients for chronic pain to be registered. Purdue Pharma has also reformulated OxyContin so that if the pills are crushed, they turn into a gloop that cannot be injected or snorted.