Death in Mud Lick: A Coal Country Fight against the Drug Companies That Delivered the Opioid Epidemic

by Eric Eyre

The DEA hadn’t paid much attention to distributors before, and that suited the companies just fine. Then, in 2005, Rannazzisi came knocking. The gruff, sharp-tongued DEA agent arranged a series of one-on-one meetings with the nation’s largest distributors—McKesson, Cardinal Health, and AmerisourceBergen. The three companies controlled 85 percent of drug shipments. They had the buying power to put a stranglehold on painkiller mania; Americans were consuming more than 80 percent of the world’s supply of oxycodone, and 99 percent of its hydrocodone.

Purdue Pharma quickly figured out Appalachia was a ripe market for the drug. The region had a history of heavy painkiller use. Its workers mined coal, operated heavy machinery, putting them more at risk for accidents and injury. There was also isolation, poverty, despair. The little round pill could fix just about anything.

By January 2010, Cardinal reached a decision. It upped Family Discount’s hydrocodone limit to 150,000 pills each month—more doses than most retail pharmacies dispense in a year. The tiny pharmacy in a town of seventeen hundred people suddenly became Cardinal’s number one customer for prescription painkillers in the entire state. And no company distributed more pain pills in West Virginia than Cardinal Health.

With the numbers no longer blacked out, I could see that AmerisourceBergen alone had distributed 119 million doses of highly addictive drugs to West Virginia pharmacies between 2007 and 2012, or roughly eighty pills for every man, woman, and child in the state. About 90 million of those pills were prescription opioids such as Lortab, Vicodin, and OxyContin. The company shipped another 27.3 million tablets of alprazolam or Xanax, the antianxiety medication that addicts often took with painkillers. Even smaller wholesalers, such as H. D. Smith, had big numbers—12.4 million hydrocodone pills and 3.2 million oxycodone pills over the same years.

Cardinal was the top seller of prescription painkillers in West Virginia. It had saturated the state with hydrocodone and oxycodone—a combined 240 million pills between 2007 and 2012. That amounted to 130 pain pills for every resident. The lawsuit cited huge shipments to the counties most affected by the drug problem: Logan, McDowell, Boone, and Mingo. These counties were in the heart of the state’s southern coalfields. The region was shedding population, towns were dying, people were overdosing in record numbers. Hope was hard to find.