In small towns where residents were used to leaving their doors unlocked, patrol officers were suddenly seeing people pushing stolen lawnmowers, four-wheelers, and even garden tillers down the street. “We called it ‘spot and steal,’” recalled Rev. Clyde Hester, who joined Van Zee and Sue Ella in their Lee Coalition for Health, the grassroots group. “They’d look for things during the day—weed eaters were popular—and then at night they’d come back and pick them up,” he said. To fuel his OxyContin habit, Hester’s own son stole his gun, which the minister later retrieved from a local pawnshop.
A man in Dryden killed a young man attempting to break into his house to steal his wife’s prescription drugs, which he’d spotted above the kitchen-sink windowsill—down the road from Van Zee’s house. And as metal prices rose, Sheriff Parsons reported thieves stealing everything from copper cemetery vases to wires plucked from a telephone pole that addicted users had chopped down. Parsons even had his stepson arrested for stealing his own personal checks to buy black-market OxyContin. “There is literally not a family in this county that has not been impacted by this drug,” he told me in 2017, a statement I heard in every Appalachian county I visited.
In early 2001, Van Zee and the Lee County Coalition for Health launched a petition drive asking the FDA to order a recall of the potent painkiller, via a website called recalloxycontinnow.org.
Drawing deeper lines in the sand between Van Zee and the industry, and also between him and most of his physician peers, the petition received more than ten thousand signatures, most from Lee County and the result of a standing-room-only town-hall forum he organized at the high school in March 2001. “In a place where people barely have money for gas in their cars, by far this was the biggest crowd I’d ever seen gathered in Lee County,” one organizer told me. Eight hundred people attended, some sitting in the auditorium aisles. Roanoke-based U.S. attorney Bob Crouch called OxyContin “the crack of Southwest Virginia,” with Oxy overdose deaths now substantially surpassing those caused by cocaine and heroin.
The next month, the DEA developed a “national action plan” to monitor Purdue, asking the company to limit distribution of the drug, rethink its marketing strategy, and consider reformulating the drug to be abuse-resistant. This marked the first time in the agency’s history that it targeted a specific drug to be policed by its manufacturer to prevent diversion and abuse.
In response, the company announced a ten-point plan to curb abuse, including the distribution of tamper-resistant prescription pads, an educational program aimed at alerting teens to the dangers of prescription drugs, and a $100,000 grant for the creation of a statewide prescription monitoring program, or PMP, to halt doctor-shopping. The company also stopped distributing its most potent form of OxyContin, the 160-milligram pill, and reduced shipments to Mexico in light of reports that the drug was being smuggled back into the United States—sometimes by people making the twenty-three-hour drive from Virginia’s coalfields to the Mexican border or flying with pills taped to their back.
With great fanfare in July 2001, the FDA announced it had worked with Purdue to put a black-box warning on the drug, the strongest type of prescription-drug caution. The goal was to help prevent inappropriate prescriptions, misuse, and diversion.
But a company spokesman downplayed the black box, calling it “more of an exercise in graphic design” and pointing out that legitimate users didn’t experience the high created by abusers who snorted or injected the drug. The real victims, executives said time and again, were their “legitimate patients,” who would be denied OxyContin if its distribution were restricted.
That year, a former Purdue rep remembered, the salesperson attended one of the company’s new seminars on diversion and abuse, meant to educate reps so they could inform authorities about suspected diversion. It was now possible for a rep who called on indiscriminate prescribers to earn as much as $100,000 a quarter in bonus pay alone, the rep told me. “It behooved them to have the pill mills writing high doses,” the rep added. “The [diversion/abuse] seminar was just a cover-their-ass type of thing.”
*
“Let’s be clear,” a Purdue Pharma spokesman said in August 2001, in a meeting with Virginia’s attorney general. “The issue is drug abuse, not the drug.” The product shouldn’t be blamed for deaths, because in many cases the victims were also drinking alcohol and taking other drugs.
Van Zee scoffed, telling a Roanoke Times reporter: “To me, that’s like somebody who was shot with a howitzer and a BB gun, and you walk up and say it’s a little hard to tell what killed him. Was it the howitzer that took off half his chest, or was it the BB gun?”
Another set of scales fell from the doctor’s eyes as a distinct possibility flashed before him: No one in federal government would take seriously the concerns of a country doctor until opioid abuse took hold in the cities and suburbs. “If it’s a bunch of poor folks up in the mountains, it doesn’t affect them personally,” he said.
*
Purdue had tried in vain to quiet the Appalachian naysayers a few months before, in March 2001, by offering Stallard and other county leaders a $100,000 “grant” they could put toward drug treatment and law enforcement. The offer had come the day after a meeting Van Zee arranged between Purdue executives and concerned family members, including a prominent Pennington Gap banker, the one whose addicted son had already blown through $80,000 of his life savings. If Purdue wouldn’t listen to local doctors and cops, Van Zee reasoned, maybe it would listen to someone whose son’s addiction had nearly depleted his 401(k).
“We are an average family,” the banker said in his appeal to the executives, showing them a picture of his son. The banker had grown up in the Monarch coal camp, putting himself through college one night-school class at a time. Before his son stole from the family to buy black-market OxyContin, he had been a good student and a burly outdoorsman. “Surely you have got enough patriotism to worry about this country?” the banker said. He pointed out that the company must have known Lee County (population twenty-three thousand) had an OxyContin problem before Lee County did, considering that it was sending as many pills to the region as it was to areas five times the size. “I’m sorry your family is having such a problem,” Purdue’s chief executive officer, Michael Friedman, said.
At the meeting’s end, the executives stunned the group when they laid out an ad they planned to place in the local newspaper, a full-page “open letter” to the people of Lee County. In it, the company contended that Purdue had not targeted its marketing to areas like Appalachia with high disability or Medicaid rates, nor had the company known of the drug’s abuse potential. Purdue Pharma also disputed suggestions that it could quickly or easily reformulate the drug.
The parent meeting had been a setup. Whereas Van Zee thought the company might finally be willing to make some compromises—“Art…really thought Purdue would feel some empathy” toward the banker, Sue Ella recalled—it was plain now that was not the case. The meeting had been brokered to shove the ad down the group’s throat.
Sue Ella blew up, telling Haddox: “You have done more to hurt Appalachia than the coal industry has ever thought about doing.”