The opioid crisis changed how doctors think about pain – Updated by Sarah Kliff Jun 5, 2017, 6:30am EDT


WILLIAMSON, West Virginia — This town on the eastern border of Kentucky has 3,150 residents, one hotel, one gas station, one fire station — and about 50 opiate overdoses each month.

On the first weekend of each month, when public benefits like disability get paid out, the local fire chief estimates the city sees about half a million dollars in drug sales. The area is poor — 29 percent of county residents live in poverty, and, amid the retreat of the coal industry, the unemployment rate was 12.2 percent when I visited last August— and those selling pills are not always who you’d expect.

“Elderly folks who depend on blood pressure medications, who can’t afford them, they’re selling their [painkillers] to get money to buy their blood pressure drug,” Williamson fire chief Joey Carey told me when I visited Williamson. “The opioids are still $5 or $10 copays. They can turn around and sell those pills for $5 or $10 each.”

Opioids are everywhere in Williamson, because chronic pain is everywhere in Williamson.

Dino Beckett opened a primary care clinic there in March 2014, on the same street with the hotel and the gas station. A native of the area with a close-cropped beard and a slight Southern drawl, Beckett sees the pain of Williamson day in and day out.

He sees older women who suffer from compression fractures up and down their spines, the result of osteoporosis. He sees men who mined coal for decades, who now experience persistent, piercing low back pain. “We have a population that works in coal mines or mine-supporting industries doing lots of manual labor, lifting equipment,” he says. “Doing that for 10 to 12 hours a day for 15 to 20 years, or more, is a bad deal.”

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