Last month’s report by the Trust for America’s Health (TFAH) identified West Virginia as leading the nation in drug overdose deaths, with a rate of 28.9 per 100,000 residents. The state’s fatal overdose rate increased by 605 percent between 1999 and 2010, and has jumped 1,056 percent since 1979. The majority of these deaths are attributable to the abuse of addictive prescription painkillers.
Filmmaker Sean Dunne (born 1981) highlights this drug epidemic in his documentary Oxyana. The film centers on the small coal mining town of Oceana in Wyoming County in southern West Virginia. The prevalent abuse of the pain killer OxyContin has earned the town the nickname “Oxyana.”
The film contrasts the natural beauty of Appalachia with the economic devastation of the small town. Scenes of tree-covered mountains and streams are intercut with those of dilapidated mobile homes and their trash-strewn yards, squalid living conditions, and vacant and shuttered buildings.
The film tells the stories of some 20 residents, most of whom are struggling with drug addiction. The interviews are extremely affecting: we encounter families torn apart, mothers who have lost their children and turned to prostitution to feed their addictions, a former coal miner whose addiction left him living under a bridge, a man suffering from brain cancer who shoots up on pain medicine with his wife, and a young man who describes how his father murdered his mother and younger brother over pills before committing suicide.
One 23-year-old resident claims half his graduating class is dead because of pills. “Two years after I graduated I think six of my friends passed away due to prescription drugs. And last year I helped bury three of my best friends due to drugs,” he explains. “And it’s sad … some of them had kids, and those kids will never be able to live down the fact that their dad OD’d … and that breaks my heart.”
The younger residents explain that there is little or nothing in the way of economic opportunity or entertainment available in the rural town. According to a recent study by The Opportunity Nation, nearly one in five West Virginia youth between 16 and 24 are neither working nor in school, nearly five percentage points higher than the national average.
“If you don’t work in the mines, the only other way you got to make anywhere close to working in the mines is to sell drugs,” one man says. A mother of an addicted son explains how prescription drugs create an underground economy “that’s far superior to a legitimate economy… [M]ost of the kids that are doing it, I mean, they’re looking at service sector jobs that don’t pay well and they can make a lot of money [selling drugs].”
The young man whose father killed his family explains just how much money is to be made. Paying a Washington, D.C. doctor $1,000 in cash, he walks away with a cache of pills: a month’s supply of 450 OxyContin 30-mg-tablets—to be taken at a rate of 15 per day—as well as 200 10-mg-tablets of methadone and 150 pills of Adderall. Just 100 of the OxyContin pills are worth $4,000 when resold, he says.
Residents explain how the arrival of OxyContin to the small rural town some 15 years ago changed it from a safe and peaceful area into one dominated by distrust in which murders, overdose deaths, break-ins and robberies, domestic abuse and child neglect are increasingly the norm. The term “oxy-cuted” has come to be used to describe the growing number of those who overdose on the drug.
While drug abuse is a complex social problem in which poverty and mental illness reinforce each other, there are many factors which have made the Appalachian coalfield communities particularly susceptible to it. The impoverished coalfield counties of southern West Virginia and eastern Kentucky have some of the nation’s highest rates of depression, obesity, heart disease, diabetes, cancer and chronic pain, combined with high illiteracy, deep poverty, poor living conditions and some of the lowest rates of education.
There is also the history of prescription pain medication use encouraged by coal company doctors to keep miners working as long as possible under back-breaking conditions. Centers for Disease Control statistics indicate that the average West Virginian gets about 18 prescriptions a year, the highest in the nation.
Dunne focuses his film on the personal devastation of drug abuse, which, while emotionally effective, fails to offer any objective explanations of its root causes. The film also offers no factual details.
However, a few glimpses of the depth of the crisis do come through, including in a revealing interview with an emergency room doctor at the region’s Raleigh Central Hospital.
“We go through 150 or so people a day here and we’ll have an overdose that probably leads to a death every day,” relates the doctor. However, he explains, those who already dead when emergency medical personnel arrive don’t show up in those numbers. In the hospital’s delivery room, which services several surrounding counties, “half the babies in the nursery are on methadone” at any given time due to the mothers’ drug abuse.
Dunne sees Oceana as a “familiar narrative” in which “Greed that led to overprescribing pharmaceuticals that led to addiction that [has] led to poverty, lawlessness and hopelessness.” This approach turns reality on its head and tends to place responsibility for the deepening social crisis in Appalachia on its residents.
“Here is a place that represents our failures as a country, a microcosm of everything that’s wrong with the American Dream,” claims Dunne. “Residents who were once talented, charismatic, hard-working, God-fearing, normal people have been reduced to nothing by the uncontrollable lure of this pill.”
The drug abuse, in fact, is an appalling manifestation of the social crisis enveloping America, not the population’s moral downfall. In so far as the political establishment tries to control the epidemic, it resorts to more money for police and prisons, while slashing budgets for drug treatment facilities and mental health clinics. West Virginia has only 558 drug treatment center beds in a state where federal data estimates 119,000 people need substance abuse treatment.
Dunne’s Oxyana also fails to examine the role of the coal industry in stifling economic development in the region or the devastating impacts of mechanization and globalization over the past half century. The scenes of active coal mining in the film give the impression of a thriving coal industry that has plenty of well-paying jobs to offer those willing to work.
Dunne’s film is also silent not only on the role of the pharmaceutical industry, which has amassed vast fortunes off the abuse of prescription drugs, but on the part played by US Food and Drug Administration, which has facilitated the epidemic through its approval of these powerful drugs.
While in many ways the epicenter for the prescription drug epidemic, Central Appalachia is not alone in reporting rising abuse. TFAH reports that more than six million Americans abuse prescription drugs and that overdose deaths have quadrupled nationally since 1999, overtaking fatal vehicle accidents as the leading cause of injury and death in the US.