About half of those living in McDowell County depend on some kind of relief check such as Social Security, Disability, Supplemental Security Income (SSI), Temporary Assistance for Needy Families, retirement benefits, and unemployment to survive. They live on the margins, check to check, expecting no improvement in their lives and seeing none. The most common billboards along the roads are for law firms that file disability claims and seek state and federal payments. “Disability and Injury Lawyers,” reads one. It promises to handle “Social Security. Car Wrecks. Veterans. Workers’ Comp.” The 800 number ends in COMP.
Harry M. Caudill, in his monumental 1963 book Night Comes to the Cumberlands, describes how relief checks became a kind of bribe for the rural poor in Appalachia. The decimated region was the pilot project for outside government assistance, which had issued the first food stamps in 1961 to a household of fifteen in Paynesville, West Virginia. “Welfarism” began to be practiced, as Caudill wrote, “on a scale unequalled elsewhere in America and scarcely surpassed anywhere in the world.” Government “handouts,” he observed, were “speedily recognized as a lode from which dollars could be mined more easily than from any coal seam.”
Obtaining the monthly “handout” became an art form. People were reduced to what Caudill called “the tragic status of ‘symptom hunters.’ If they could find enough symptoms of illness, they might convince the physicians they were ‘sick enough to draw’... to indicate such a disability as incapacitating the men from working. Then his children, as public charges, could draw enough money to feed the family.”
Joe and I are sitting in the Tug River Health Clinic in Gary with a registered nurse who does not want her name used. The clinic handles federal and state black lung applications. It runs a program for those addicted to prescription pills. It also handles what in the local vernacular is known as “the crazy check” -- payments obtained for mental illness from Medicaid or SSI -- a vital source of income for those whose five years of welfare payments have run out. Doctors willing to diagnose a patient as mentally ill are important to economic survival.
“They come in and want to be diagnosed as soon as they can for the crazy check,” the nurse says. “They will insist to us they are crazy. They will tell us, ‘I know I’m not right.’ People here are very resigned. They will avoid working by being diagnosed as crazy.”
The reliance on government checks, and a vast array of painkillers and opiates, has turned towns like Gary into modern opium dens. The painkillers OxyContin, fentanyl -- 80 times stronger than morphine -- Lortab, as well as a wide variety of anti-anxiety medications such as Xanax, are widely abused. Many top off their daily cocktail of painkillers at night with sleeping pills and muscle relaxants. And for fun, addicts, especially the young, hold “pharm parties,” in which they combine their pills in a bowl, scoop out handfuls of medication, swallow them, and wait to feel the result.
A decade ago only about 5% of those seeking treatment in West Virginia needed help with opiate addiction. Today that number has ballooned to 26%. It recorded 91 overdose deaths in 2001. By 2008 that number had risen to 390.
Drug overdoses are the leading cause of accidental death in West Virginia, and the state leads the country in fatal drug overdoses. OxyContin -- nicknamed “hillbilly heroin” -- is king. At a drug market like the Pines it costs a dollar a milligram. And a couple of 60- or 80-milligram pills sold at the Pines is a significant boost to a family’s income. Not far behind OxyContin is Suboxone, the brand name for a drug whose primary ingredient is buprenorphine, a semisynthetic opioid. Dealers, many of whom are based in Detroit, travel from clinic to clinic in Florida to stock up on the opiates and then sell them out of the backs of gleaming SUVs in West Virginia, usually around the first of the month, when the government checks arrive. Those who have legal prescriptions also sell the drugs for a profit. Pushers are often retirees. They can make a few hundred extra dollars a month on the sale of their medications. The temptation to peddle pills is hard to resist.
Harry M. Caudill, in his monumental 1963 book Night Comes to the Cumberlands, describes how relief checks became a kind of bribe for the rural poor in Appalachia. The decimated region was the pilot project for outside government assistance, which had issued the first food stamps in 1961 to a household of fifteen in Paynesville, West Virginia. “Welfarism” began to be practiced, as Caudill wrote, “on a scale unequalled elsewhere in America and scarcely surpassed anywhere in the world.” Government “handouts,” he observed, were “speedily recognized as a lode from which dollars could be mined more easily than from any coal seam.”Obtaining the monthly “handout” became an art form. People were reduced to what Caudill called “the tragic status of ‘symptom hunters.’ If they could find enough symptoms of illness, they might convince the physicians they were ‘sick enough to draw’... to indicate such a disability as incapacitating the men from working. Then his children, as public charges, could draw enough money to feed the family.”
Joe and I are sitting in the Tug River Health Clinic in Gary with a registered nurse who does not want her name used. The clinic handles federal and state black lung applications. It runs a program for those addicted to prescription pills. It also handles what in the local vernacular is known as “the crazy check” -- payments obtained for mental illness from Medicaid or SSI -- a vital source of income for those whose five years of welfare payments have run out. Doctors willing to diagnose a patient as mentally ill are important to economic survival.
“They come in and want to be diagnosed as soon as they can for the crazy check,” the nurse says. “They will insist to us they are crazy. They will tell us, ‘I know I’m not right.’ People here are very resigned. They will avoid working by being diagnosed as crazy.”
The reliance on government checks, and a vast array of painkillers and opiates, has turned towns like Gary into modern opium dens. The painkillers OxyContin, fentanyl -- 80 times stronger than morphine -- Lortab, as well as a wide variety of anti-anxiety medications such as Xanax, are widely abused. Many top off their daily cocktail of painkillers at night with sleeping pills and muscle relaxants. And for fun, addicts, especially the young, hold “pharm parties,” in which they combine their pills in a bowl, scoop out handfuls of medication, swallow them, and wait to feel the result.
A decade ago only about 5% of those seeking treatment in West Virginia needed help with opiate addiction. Today that number has ballooned to 26%. It recorded 91 overdose deaths in 2001. By 2008 that number had risen to 390.
Drug overdoses are the leading cause of accidental death in West Virginia, and the state leads the country in fatal drug overdoses. OxyContin -- nicknamed “hillbilly heroin” -- is king. At a drug market like the Pines it costs a dollar a milligram. And a couple of 60- or 80-milligram pills sold at the Pines is a significant boost to a family’s income. Not far behind OxyContin is Suboxone, the brand name for a drug whose primary ingredient is buprenorphine, a semisynthetic opioid. Dealers, many of whom are based in Detroit, travel from clinic to clinic in Florida to stock up on the opiates and then sell them out of the backs of gleaming SUVs in West Virginia, usually around the first of the month, when the government checks arrive. Those who have legal prescriptions also sell the drugs for a profit. Pushers are often retirees. They can make a few hundred extra dollars a month on the sale of their medications. The temptation to peddle pills is hard to resist.
