The front page of Sunday’s Washington Post (Jan. 13) featured the blackened face of coal miner Forest Ramey, 24, but the story was not about a deadly explosion or workers trapped underground.  A 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.  The crowd is gathering early in the dirt parking lot outside the Clinch Valley Treatment Center, the only methadone clinic within 80 miles.  …It is 2:45 am…the clinic does not start dosing until 5 am.  …Many of the patients who fill the lot one recent morning have jobs in far-off mines that start at 6 or 7.  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.  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.  There’s a reason for some of this painkiller abuse—workers who are seriously injured on-the-job are seeking relief from chronic pain.  A Dark Addiction 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.  …Trapp loaded up on painkillers, first Percocet and later OxyContin. 

When the prescribed dose no longer did the job, Trapp took more.  Then more.  He began ‘doctor shopping,’ driving to Roanoke and Richmond to find physicians who would give him prescriptions.  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.  He didn’t feel high, just ‘good.’  The relief was instant.” 

Jeff Vandyke, 34, worked for 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 the injury and addicted for years to painkillers.

“The crippling pain and nausea of withdrawal pushed him to get help.  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.  He watched one friend lost an arm to a rock hauler and saw another electrocuted by a 900-volt mining cable.  …’A lot of people are scared on the job,’ he said.  They’ll use alcohol, anything.’  After falling off a loader and breaking his leg, Wampler got a prescription for oxycodone.  …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.  ‘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.  Now he is one of the patients who wait in line at the methadone clinic every morning.”

I can’t help but wonder how the substance abuse problem might be different had these work-related injuries been prevented.  

At the same time, there was Purdue Pharma (the makers of OxyContin) who falsely (and criminally) marketed their narcotic as a less additive painkiller.  As reported in The New York Times (here) 

“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.  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 plead guilty in federal court* to charges that they “misled regulators, doctors and patients about the drug’s risk of addiction and its potential to be abused,” but by this time, the addiction epidemic in the mining communities and elsewhere had already taken hold. 

Substance abuse problems do not occur in a vacuum.  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 us to look at prevention.  This is true for the coal miners and other suffering individuals profiled in A Dark Addiction. 

Nearly every bi-weekly issue of Ellen Smith’s Mine Safety and Health News recounts incidents in which miners suffer serious injuries, such as amputated fingers, crushed legs, broken collar bones and dislocated knees.  This tells me we aren’t doing enough to prevent these injuries—injuries that might be the first awful step toward chronic pain, disability and a possible downward spiral of substance abuse. 

After reading Nick Miroff’s enlightening article, I recalled initiatives several years ago by MSHA to address “alcohol and drugs on mine property” which included an advanced notice of proposed rulemaking (ANRPM, 10/4/05, here) and a symposium sponsored by MSHA and the States of Virgina, West Virgina and Kentucky entitled “Keeping America’s Mines Drug- and Alcohol-Free.”  The event focused on the potential safety hazards created by managers and employees who are impaired by legal and illegal substances, and companies’ drug-free workplace programs (certainly relevant and important topics.) 

I went back to the symposium’s summary report and was disappointed to find nothing—absolutely nothing—about preventing workplace injuries as a way to avoid (at least) some cases of substance abuse.   Should a little bit of money for the “war on drugs” be redirected to a war on workplace injuries?  

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*Note: The State of West Virginia received $44 million as part of the federal government’s settlement with Purdue Pharma.  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.”