Appalachia is known for its beautiful scenery and breathtaking mountain ranges. Yet it has a much darker, deeply rooted issue. That is, an issue with opioid addiction. Opioids had a strong hold on the people of the Appalachian regions. However, as time has passed, many organizations and the communities of Appalachia have been trying to reduce opioid addiction.
It all started in the coal camps of Eastern Kentucky and West Virginia. In these coal camps, everything was owned by the coal companies, their homes, schools, graveyards, and churches. The men from these families, as well as the male children, would rise before the sun to make their way to the mines and return when the sun returned, and the moon arrived. They would work in the mines for hours in the dark, and within the darkness lay danger.
This danger was everywhere in the mines. There was fear of the mines collapsing, carbon monoxide filling the crevasses in which the men worked, being mangled by the very equipment that they used, and unprompted explosions that left them disfigured or worse, dead . The deaths or disfigurement of these miners were nothing to the coal companies. To them, these men were mere pawns, indispensable as they could easily be replaced by many others who also wanted to work in the mines.
Due to these dangers, many men were afraid to work in the mine or go back. As a result of these fears, miners would turn to the camp doctor for help. This doctor would prescribe “gentle sedation and mild euphoria with morphine pills and tinctures of powdered opium dissolved in alcohol. As hydrocodone and oxycodone became available in the 1920s and late 1930s, respectively, he added these remedies to his repertoire.” The purpose of prescribing this mix of opioids was to reduce the miners’ pain, whether physical or mental. This was to get the miners back to the mine to increase profits.
As physicians prescribe these opioids, they had no restraints or restrictions. They would prescribe these opioids to stop the pain of injuries sustained in the mine, but also to quiet the minds of the many men who had seen the countless deaths of their fellow comrades.
After the coal industry peaked at 630 million tons of coal in 1947, many companies began to lay off their workers as mechanization began to rise. As a consequence of this, physicians had to prescribe opioids for psychological pain instead of physical pain. At the same time, Federal Welfare benefits came to Appalachia in the 1930s as a part of the New Deal . The New Deal was a series of programs that President Franklin D. Roosevelt established to stabilize the economy, provide jobs, and provide relief for those who were suffering .
Since many people had not worked for a long time, many relied on these welfare grants. These men could only receive these benefits if they showed proof of disability, so they would go to “Welfare Doctors” . Men would go to these doctors with lists of symptoms to convince the doctors that they were indeed too sick to work . By the end of the 1960s, these physicians replaced camp doctors and continued to prescribe opioids for those who still worked in the mine.
In 1996, Purdue Pharma introduced OxyContin to Appalachia for the first time . This drug was highly marketed in Appalachia with the purpose of helping miners with chronic pain, and because this company claimed that the addictiveness of this drug was less than one percent . As a result of this false advertisement, many physicians began to prescribe OxyContin more leniently, causing many people to take this drug when they did not need it, increasing addiction .
Since Purdue Pharma made the mistake of claiming that OxyContin was not addictive and doctors overprescribed this drug, it became a huge problem in Appalachia . Once it became known that OxyContin was addictive, it was easy for the public to get their hands on it, as it was readily available. This caused OxyContin to become the most abused drug in the United States by 2004 .
In many small towns, word of mouth helped to spread the word about where you were able to buy and get OxyContin. This also helped spread the word about pill mills or fake pain clinics that wrote prescriptions for people and allowed a huge profit off of Medicaid and Medicare.
The history of opioids in Appalachia demonstrates that drug epidemics don’t appear out of nowhere. They are brought to places that already have problems of addiction, and that causes a huge spread of a new drug, causing more addicts. Currently, Appalachia does not worry about OxyContin. It worries about fentanyl-laced heroin, methamphetamine, and counterfeit fentanyl pills . Many Appalachians hope that addiction rates will begin to decline as new companies and people move to the region.
References
HISTORY.com Editors. (2026, January 5). New Deal. Retrieved from History: https://www.history.com/articles/new-deal
Lembke, B. (2018, April 27). 1996: The Start of Appalachia’s OxyContin Addiction. Retrieved from Medium: https://medium.com/spring-2018-introduction-to-appalachian-studies/1996-the-start-of-appalachias-oxycontin-addiction-b086f409a402
Satel, S. (2023). Opioids and Appalachia. Retrieved from National Affairs: https://www.nationalaffairs.com/publications/detail/opioids-and-appalachia