HEROIN OF THE HOLLOWS

Still, when someone offered her a yellowish 40 milligram pill, she took
it, chopped it up and snorted it. It was the start of a three-day binge,
and she was hooked.

"It's not like any other drug I've ever done," the 20-year-old says as
she takes a drag off her umpteenth cigarette.

Over the next year, her habit grew until she was taking up to eight
"40s" a day, she says. When her dad, a county school board member and
former mayor, found out, she tricked him into giving her more money by
saying she was being threatened by drug dealers.

The cash drain contributed to Tim Rutledge's loss of his grocery
franchise. But Kristen didn't care.

"When I got down to two, I started panicking," she says. "I had to get
out and buy some more."

Many in Appalachia call OxyContin "Hillbilly heroin." Its abuse may not
have started in the mountains, but it exploded here.

Across the region, people have overdosed on the powerful prescription
painkiller and robbed pharmacies and family members to feed their
habits.

"If this was an infectious disease, the Centers for Disease Control
would be in here in white vans," says Tim Rutledge. "There's no doubt
it's very much a plague."

To cancer patients and chronic pain sufferers, OxyContin is a wonder
drug that can return them to a semblance of normal life.

Dr. Michael Levy, director of pain management at the Fox Chase Cancer
Center in Philadelphia, calls Oxy "close to an ideal opiate." While most
strong pain medicines last only about four hours and take an hour or so
to work, patients on Oxy get a steady 12-hour release of pain medicine
with fewer side effects and less risk of liver damage.

"This product is better than anyone thought it would be when it was
released five years ago," he says. "This is a drug we need to protect,
because it really helps patients."

To addicts, however, Oxy produces a heroin-like high.

Purdue Pharma, the drug's maker, is willing to concede that Oxy abuse
has led to "somewhere between dozens and hundreds" of deaths in the past
two years, says David Haddox, Purdue Pharma's medical director.

"I am sure it has caused some deaths," he says, "but my feeling is there
is a magnification of this in the media."

Purdue Pharma has taken steps to limit the damage. The company has
stopped shipping its 160 milligram pills and has suspended shipment of
40s to Mexico because too many were finding their way back across the
border. The firm has offered tamper-resistant prescription pads in Maine
and other states, and it expects to help pay for a federal pilot program
to track narcotics prescriptions in Florida, Mississippi, Ohio, Virginia
and West Virginia. Purdue Pharma sent a representative to Gilbert in
January to address concerns; and it is running public service
announcements on local radio to warn against abuse.

Law enforcement officials insist the problems have not been overblown.
At least one dealer in Virginia has been charged with murder, and
manslaughter charges were filed in a Florida Oxy death. Several Virginia
doctors have been convicted of illegally dispensing the drug. Breaking
and entering and armed robbery charges related to Oxy have been filed
from Maine to Mississippi.

Michael Pratt, a prosecutor focusing on drug crimes in Kentucky,
Tennessee and West Virginia, sees reasons why OxyContin hit Appalachia
especially hard.

The Appalachian economy has long been dependent on coal and timber.
Those are industries that produce serious injuries, so there are large
numbers of people on painkillers.

"A lot of places, you got a headache, you'll tough it out," Pratt says.
"Down here it's like, 'Well, my grandfather's got some drugs. I'll take
that and it'll go away.' And it just escalates."

In addition, OxyContin sells on the street for $1 a milligram -- up to
$160 for the highest-dosage pill. In an area with chronic unemployment,
that kind of money is hard to turn down.

For years, prescription fraud for Valium and other drugs has been a
problem. "But," Pratt says, "we've never come upon something that kills
people so much. I mean, if it killed them, they really had to work at
it.

"Oxy rolls in. It's so powerful, it just lays waste."

"This is a nuclear bomb," adds Gregory Wood, a health fraud investigator
with the U.S. attorney's office in Roanoke, Va. "I was a cop in Detroit
and saw crack come through the ghettos, and I've never seen anything
like this."

Neither had the tiny town of Gilbert.

Like many coal towns, Gilbert, pop. 417, winds like a centipede along
the riverbank, pushing leg-like hollows out into the surrounding hills
near the Kentucky line.

OxyContin found its way here about five years ago. What started as a
gentle rain soon turned into a flash flood.

Police Chief Greg Cline blames the drug for at least four deaths in
town, and state police Sgt. J.J. Miller put the number at about a dozen
for the entire county. But that number includes people who may also have
been abusing other drugs.

A mental health counselor tells of a man who was having his teeth pulled
two at a time, because each visit meant a new Oxy prescription. Kristen
Rutledge has known people to shoot themselves for a prescription. Cline
has talked to cancer patients who were selling some of their pills.

"It seems like if you're around people who are doing it, you catch it,"
says Judy Compton, manager of the Compton Inn. "It's contagious."

She knows all too well. Her sister caught it, too.

Jeanie Compton was spoiled. Her mother gave her a red convertible BMW
before she could even drive, and a trailer home to live in. When she
wanted to get married at age 15, her mother drove her across the Tug
River.

Now it's all gone. The BMW? Traded for OxyContin. The trailer? Sold for
a few thousand dollars' worth of pills. The husband? Found slumped over
in the bathroom with a needle nearby, dead of a suspected Oxy overdose.

Jeanie's troubles began around 1991, when her adoring father died
suddenly at age 50. She started experimenting with drugs. Along came
Oxy.

At one point, Joyce Compton says her daughter was raiding the family's
motel for televisions, microwaves, mattresses, to supply her habit. Judy
Compton stopped letting her come to her house.

"She'd get up to leave and my stuff would fall out of her pantlegs," she
says.

>From a jail cell in nearby Logan, where she is serving time for
violating home confinement to seek drugs, Jeanie says she thinks she's
ready to get serious about kicking Oxy.

"I've said I'm either going to end up in jail or dead," she says. "Well,
I made it to the jail. I can't come back from the grave."

Locals have a nickname for the road: Pill Hollow.

"On one occasion I timed them, and in 30 minutes we had 45 cars coming
to one house," says Clyde Lester, a local school board member. Of the 20
or so homes wedged into the mountains around him, he says four were
occupied by dealers.

"A lot of those troubles that used to be in the cities have really come
home to plague this community," says the Rev. Denny May, whose
19-year-old daughter, Shanda, killed herself in 1999 shortly after
getting involved with Oxy.

When Pastor Clayton Cline asked his Baisden Community Church
congregation who had been affected by OxyContin, he says, "Almost every
one raised their hands."

One hand was his own.

About a year and a half ago, his daughter became addicted to OxyContin
after her husband received a prescription for an accidental gunshot. For
the past six months, Cline's daughter and son-in-law have been attending
a church-based methadone program in Georgia.

Debbie Trent sits in a middle school auditorium in Bluefield, Va., and
listens. She is a mental health counselor from Gilbert, where she is a
member of a new drug-awareness group called STOP -- Strong Through Our
Plan. She has driven two hours along mountain roads to see what folks in
southwestern Virginia are doing to battle OxyContin.

A self-described OxyContin abuser named Mary tells the group, "Addiction
stands on a mountaintop and throws down commandments: 'Thou shalt not
abandon me. Thou shalt put no one or nothing before me.'" She says she
lost her job and committed prescription fraud because of OxyContin.

Another recovering addict, a 38-year-old mother of two identified only
as Cindy, shuffles from one foot to the other as she explains how she
took 320 milligrams of Oxy in the morning before she had the strength to
take her boys to school. Friends thought she had cancer.

For two hours, people talk about the problem. Dennis Lee, Tazewell
County's top prosecutor, says 80 percent of the crime in his
jurisdiction is now related to OxyContin.

Sheriff H.S. Caudill says efforts to get a statewide prescription
tracking system failed in the legislature this past year. Just as local
firefighting is done by volunteers, Caudill tells the crowd, much of the
burden of stopping Oxy abuse will fall on them.

"I look at OxyContin as a huge forest fire," he says. "It's burning
everywhere in Tazewell County. ... There's not enough of us, ladies and
gentlemen. We need you."

Kristen Rutledge has three tattoos she doesn't remember getting. She
went through physical problems -- not menstruating for months,
constipated for weeks. She stopped writing in her journal.

When she finally decided to quit Oxy, she did it cold turkey. The
withdrawal lasted three days, the same as her first Oxy binge.

"I'd rather have died," she says, drawing her knees up to her chest. "I
was vomiting. I could hear things and see things. I had pain all over my
body, all over me -- my head all the way down to my calf."

Her habit cost her father thousands of dollars. OxyContin is still
costing Tim Rutledge: Now, he's giving the cash-strapped police
department money for undercover drug buys and taking out full-page
newspaper ads warning others about drugs.

Kristen says she's been clean for a month. But she's not kidding
herself.

"I'm still addicted," she says. "I'm just not using."