The front page of Sunday’s Washington PostÂ (Jan. 13) featured the blackened face ofÂ coal minerÂ ForestÂ Ramey, 24,Â but the story was not about a deadly explosion orÂ workers trapped underground.Â AÂ Dark Addiction, by the Post‘s Nick Miroff, gives us a peak into the lives of coal miners who are struggling with painkiller abuse.
“Tazewell County, Va.Â The crowd is gathering early in the dirt parking lot outside the Clinch Valley Treatment Center, the only methadone clinic within 80 miles.Â …It is 2:45 am…the clinic does not start dosing until 5 am.Â …Many of the patients who fill the lot one recent morning have jobs in far-off mines that start at 6 or 7.Â They sleep upright in their vehicles, slumped up against the steering wheel, dressed for work in steel-toed boots and coveralls lined with orange reflective strips.”
Miroff interviewed police and other officials who said that abuse of prescription painkillers, including OxyContin, in Appalachia has not abated.Â Lt. Richard Stallard, director of the Southwest Virginia Drug Task Force said:
“The abuse and misuse of painkillers is the worst I have seen it in the 16 years I have worked narcotics in this area.”
I thank Nick Miroff and his editors for taking this story beyond the simple “Hillbilly Heroin” tale of rural Americans abusing OxyContin.Â There’s a reason for some of this painkiller abuse—workers who are seriouslyÂ injured on-the-job are seeking relief from chronic pain.Â AÂ Dark AddictionÂ introduces readers to some of them:
“‘Busted-up’ from 30 years working as a heavy-equipment operator and mechanic on the massive excavators used for strip mining and mountaintop removal, Jeff Trapp [a 54-year old miner] needed multiple surgeries to fix seven ruptured and herniated discs.Â …Trapp loaded up on painkillers, first Percocet and later OxyContin.Â
When the prescribed dose no longer did the job, Trapp took more.Â Then more.Â He began ‘doctor shopping,’ driving to Roanoke and Richmond to find physicians who would give him prescriptions.Â When the pharmacies couldn’t provide enough ills, Trapp found dealers who would. …He crushed the tablets and snorted them like cocaine off his kitchen table.Â He didn’t feel high, just ‘good.’Â The relief was instant.”Â
Jeff Vandyke, 34, workedÂ forÂ 15 years as an underground coal miner:
“He got his first prescription for OxyContin after a rock fall accident that left him with broken ribs, shoulder damage and spinal injuries.”
Vandyke was disabled from theÂ injury andÂ addicted for years to painkillers.
“The crippling pain and nausea of withdrawal pushed him to get help.Â He drives to a Kentucky clinic for a two-week supply of liquid methadone and says he has been clean for three years.”
Another former miner, Mick Wampler, 47, says he started working underground when he was 18.
“But he never had the nerves for it, he siad, and the sight of accidents sent him over the edge.Â He watched one friend lost an arm to a rock hauler and saw another electrocuted by a 900-volt mining cable.Â …’A lot of people are scared on the job,’ he said.Â They’ll use alcohol, anything.’Â After falling off a loader and breaking his leg, Wampler got a prescription for oxycodone.Â …Soon he was hooked on the high-potency Fentanyl patches, ripping them in two to wring out the drug, which he would cook up with vinegar and inject through the veins in his feet.Â ‘It was as good as heroin,’ he said.”
Jeremy Lowe is only 22 years old, he’s a coal miner
“who got hooked on Lortab (hydrocodone) after breaking his hand in an accident a year ago.Â Now he is one of the patients who wait in line at the methadone clinic every morning.”
I can’t help but wonder how theÂ substance abuse problemÂ might be different hadÂ these work-related injuriesÂ been prevented.Â Â
At the same time, there wasÂ Purdue Pharma (the makers of OxyContin) whoÂ falsely (and criminally) marketed theirÂ narcoticÂ as a less additive painkiller.Â As reported in The New York Times (here)Â
“That claim became the linchpin of the most aggressive marketing campaign ever undertaken by a pharmaceutical company for a narcotic painkiller—annual sales (1996) reached $1 billion. Â Purdue Pharma heavily promoted OxyContin to doctors like general practitioners, who had often had little training in the treatment of serious pain or in recognizing signs of drug abuse in patients.
“But both experienced drug abusers and novices, including teenagers, soon discovered that chewing an OxyContin tablet or crushing one and then snorting the powder or injecting it with a needle produced a high as powerful as heroin. By 2000, parts of the United States, particularly rural areas, began to see skyrocketing rates of addiction and crime related to use of the drug.”
In May 2007, Purdue Pharma executives pleadÂ guiltyÂ in federal court* toÂ charges that they “misled regulators, doctors and patients about the drugâs risk of addiction and its potential to be abused,”Â but by this time, the addiction epidemic in the mining communities and elsewhere had already taken hold.Â
Substance abuse problems do not occur in a vacuum.Â Whether it is an Iraq war veteran self-medicating to deal with symptoms of PTSD, or a nurse dealing with chronic back pain, the public health approach directs usÂ to look at prevention.Â This is true for the coal miners and otherÂ suffering individuals profiled inÂ AÂ Dark Addiction.Â
Nearly everyÂ bi-weeklyÂ issue ofÂ Ellen Smith’sÂ Mine Safety and HealthÂ News recountsÂ incidents in which miners suffer serious injuries, such as amputated fingers, crushed legs, broken collar bones and dislocated knees.Â Â This tells me weÂ aren’t doing enough to prevent these injuries—injuries that might be the firstÂ awful step toward chronic pain, disability and a possible downward spiralÂ ofÂ substance abuse.Â
After readingÂ Nick Miroff’s enlighteningÂ article, I recalledÂ initiatives several years ago by MSHA to addressÂ “alcohol and drugs on mine property” which included an advanced notice of proposed rulemakingÂ (ANRPM, 10/4/05, here)Â and a symposium sponsored byÂ MSHA and the States of Virgina, West Virgina and Kentucky entitled “Keeping America’s Mines Drug- and Alcohol-Free.”Â The event focused on theÂ potential safety hazards created by managers and employees who areÂ impaired by legal and illegal substances, and companies’ drug-free workplace programsÂ (certainlyÂ relevant and important topics.)Â
I went back to theÂ symposium’s summaryÂ reportÂ and was disappointed toÂ find nothing—absolutely nothing—about preventingÂ workplace injuries as a way to avoidÂ (at least) some cases of substance abuse.Â Â Should a little bit ofÂ money for the “war on drugs” be redirected to a war on workplace injuries?Â Â
*Note: The State of West Virginia received $44 million as part of the federal government’s settlement with Purdue Pharma.Â WV Governor Joe Manchin announced in his State of the State address that the money would be used “in a strategic spending plan for a drug-free West Virginia…we can make tremendous strides toward our drug war once and for all.”