APPALACHIA TARGETS PAINKILLER ABUSE

Summit Calls for Campaign to Seek Federal Aid to Fight Epidemic

PIPESTEM - Drunken driving is almost a thing of the past in eastern
Kentucky's Martin County.

Of 27 recent DUIs there, only three were alcohol-related. In the other
24, the drivers had been "pillin.'"

John Voskhul, who works on prescription drug abuse coverage at the
Lexington Herald-Leader, used that anecdote to illustrate the enormity
of the problem in Appalachia. He spoke at a summit Wednesday for the
Coalition on Appalachian Substance Abuse Policy, which brings together
doctors, policymakers, journalists and people who counsel and treat
drug addicts in West Virginia, Virginia, Kentucky and Tennessee.

The summit, funded by the Appalachian Regional Commission, continued
Thursday at Pipestem State Park. One of its main goals was to figure
out how to get the federal government to pay more attention to
Appalachia's painkiller abuse epidemic.

"Individually, within our states, we're not going to pull all the
weight that we need to," said Bruce Behringer, a rural health expert
at East Tennessee State University and an adviser to the Appalachian
Regional Commission.

"We need to get our fair share. The federal government's spending an
awful lot of money on this," treating prescription drug addicts and
battling abuse. "How much of it's coming here?"

Each state and sub-region has its own pattern of prescription drug
abuse, presenters from different parts of Appalachia demonstrated. In
some areas, Oxycontin abuse still rages. In others, it's Lortab. In
some areas - including West Virginia - a drug used to wean opioid
abusers, methadone, is starting to hit the streets and cause overdose
deaths itself.

"Why is it happening here? 'Cause y'all don't matter in Washington,"
said Susan Rook, former host of CNN's TalkBack Live. Rook became an
advocate for drug recovery after recovering from drug addiction herself.

"You can't approach it the way you're approaching it - 'Help us
because we deserve it,'" she told the assembled Appalachians.

"Lawsuits work. Political activism works. Take a bunch of coffins up
to Washington, D.C., and dump 'em on the Capitol steps. Raise hell."

Why has prescription drug abuse hit Appalachia so hard? Several
theories have been floated - high unemployment, low education, a large
disabled population that need pain medication.

Brenda Hughes, who works with drug-addicted women in the mountains of
eastern Kentucky, offered another explanation: Drug abuse is related
to another problem that plagues high-poverty areas, domestic violence.

"My typical client was born into a family in which one or more parents
abused substances - alcohol, or usually other drugs," said Hughes,
director of trauma programs at the Kentucky River Community Care
mental health center.

"She'll tell me, 'Well, when daddy was drunk when we were growing up,
sometimes he'd beat on me. ... Sometimes he would shoot at us. I think
he liked to see us kids run and scream.

" 'I was scared to death,' she'll say. 'All the time. All the time. I
thought I was going to die every day. I thought we were all going to
die.'"

Hughes' typical client was often raped, too. All that repeated trauma
causes certain brain reactions. And guess what, Hughes said. "Those
same neurocircuits in the brain ... also respond to drugs. It's the
same circuit. She has found a drug to relieve her stress."

Often, the patient has been in a relationship with an abusive man. She
goes to a doctor, perhaps for broken bones. The doctor usually doesn't
put two and two together and come up with domestic violence, Hughes
said. But often, the doctor notices something else wrong with the
patient: depression.

"She's usually prescribed benzos and opioids," two classes of
prescription drugs often abused in Appalachia. "She comes to rely on
her nerve pills and pain pills to get through the day."

If this woman wants to get clean, where does she go? Well, she could
go to a center like Hughes'. But there's only one in Hughes' whole
eight-county region of eastern Kentucky, and it "can only accommodate
about 100 women at its current funding level."

Almost 2,300 women in that eight-county region are substance-addicted,
and could use a center like Hughes', according to estimates based on
national averages (because few figures are available for Appalachia,
Hughes said).

"We don't like looking at our underbelly. No, we don't. But until we
do, until we say this is the problem," drug abuse solutions in
Appalachia will stay under-funded, Hughes said.