Night lingers in Appalachia, but there are rays of sunlight

Harry Caudill talked with U.S. Sen. Robert F. Kennedy
during his visit to Eastern Kentucky in February 1968.

In 1963, Harry Caudill of Letcher County published Night Comes to the Cumberlands: A Biography of a Depressed Area, a book that brought national attention to poverty in Appalachia and spurred the War on Poverty. Fifty years later, as part of a year-long series, the Lexington Herald Leader is examining the challenges that Kentucky Appalachians still face on their path to progress, and the story of heartbreak and hope includes the region's contentious battle with drug abuse.

From 2000 to 2010, the number of drug-overdose deaths in Kentucky rose a staggering 296 percent, highlighting the state's drug abuse epidemic that now kills more than 1,000 Kentuckians a year. But communities have started to rise up and fight back against this lethal weapon, and for the first time in 10 years, deaths from prescription-drug abuse in Kentucky declined last year.

Still, the state's highest rates of overdose deaths are consistently found in Eastern Kentucky, where chronic poverty and economic hardships remain and numerous factors make it one of the worst areas in the nation for prescription drug abuse, experts say. Poverty is at the top of the list, reports Estep.

Click here for an interactive version of this map, with individual county data.

Social rank is also a key predictor of drug abuse, which consider how people see their place in the world and their ability to improve their lot, and many people in Eastern Kentucky rank low because of chronic poverty, Robert Walker, a researcher at the Center for Drug and Alcohol Research at the University of Kentucky, told Estep: "It's the belief that I can't do anything to fix this or make my life any better. That is a profound risk condition for drug abuse."

Another factor was the region's chronic health problems, reports Estep. It is well documented that Appalachians suffer from disproportionately poor health and have increased risks of adverse health outcomes, compared to the rest of the nation and the rest of the state; many people addressed these problems with drugs, which unintentionally led to drug addiction.

Public assistance also played a role in the developing drug abuse problem. "Medicaid recipients can get prescription drugs at little cost, and some people then resell them for cash," Estep writes. For example, in Clay County, which has the third highest rate of drug overdoses per 100,000 people, 42 percent of residents were eligible for Medicaid in fiscal 2012, compared with 18.8 percent statewide.

Eastern Kentucky's ongoing battle against pills started well before a decade ago as the area suffered economic devastation of the Great Depression and doctors handed out pills to mask pain for injured coal miners and the sick poor, Caudill wrote, adding that the drudgery of coal-camp life also drove the use of pills.

Fifty years later, Estep writes, "Rising drug abuse added misery to the economic malaise, and corruption among public officials inflamed the drug problem. Drug dealers helped power brokers buy votes, then benefited as some local police and other officials turned a blind eye to their illicit sales."

A story of heartbreak and hope in Manchester

The story of one recovering addict, Melanda Adams, embodies these forces. Her home Clay County was at the center of the prescription-drug explosion, and her father, the county school superintendent, was convicted in a vote-buying scheme that he said he joined to help oust officials who were protecting drug dealers.

Social use of alcohol and drugs led Adams to start abusing drugs, but by the time she was 23, she was snorting as much as $800 worth of OxyContin pills and methamphetamine a day, she told Estep, adding that people start abusing drugs for a variety of reasons, and the shame of their addiction then becomes part of the reason to keep abusing them. "Your soul is tormented, really," she said.

Her craving for drugs led Adams to steal the ingredients that a drug dealer had provided her boyfriend to make a batch of meth, for which she suffered an almost fatal beating that still didn't curb her addiction. After stints in jail and in rehab, police found her agitated and bleeding in her home. She remained in jail for three months, where she suffered from the sharp pain of detoxification and withdrawal. Then she started on the road to recovery, reports Estep.

Fueling problems of addiction faced by thousands, Eastern Kentucky counties used corrupt relationships with local police and political officials in their illegal businesses, which included selling drugs.

Jurors convicted Adams' father, school Supt. Douglas Adams of vote fraud in a number of elections. As part of his defense, Adams said his motivation for getting involved in the most notorious election at issue in the trial, the 2002 primary for county clerk, was that the incumbent, Jennings B. White, had been protecting drug dealers, reports Estep. Adams said he was fighting against White to save his daughter and others who had fallen victim to drugs.

In the late 1990's, Congress designated Eastern Kentucky as a High Intensity Drug Trafficking Area, which led to efforts that helped dry up the county's drug rings. The FBI led investigations, "leveraging charges against drug dealers to pursue investigations of local officials," reports Estep. In the end, more than a dozen public officials or election offers in Clay County had been convicted. This shook up the local political structure, which was necessary for the community to take a stand against drugs, Estep reports.

Now, as a result of greater community awareness, activism against drugs, and targeted law enforcement, drug overdose deaths in Clay County have fallen from 43 in 2011 to 27 in 2012. Coroner Danny Finley also credits this reduction to better practices by many doctors, and new state laws that have cracked down on pain clinics and over-prescribing doctors, reports Estep.

While the fight against drugs is never over, Melanda Adams is proof that there's hope in Manchester and hope for Clay County. "She has clear eyes, a big laugh and a feisty 6-year-old daughter," reports Estep. She runs her own convenience store and says its important for drug addicts who feel trapped to know that they are more than just addicts. "There is a chance," she told Estep. "Give 'em that hope."