Death in Mud Lick

A Coal Country Fight Against the Drug Companies That Delivered the Opioid Epidemic

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A New York Times Critics’ Top Ten Book of the Year * 2021 Edgar Award Winner Best Fact Crime * A Lit Hub Best Book of The Year

From a Pulitzer Prize-winning investigative reporter at the Charleston Gazette-Mail, a “powerful,” (The New York Times) urgent, and heartbreaking account of the corporate greed that pumped millions of pain pills into small Appalachian towns, decimating communities.

In a pharmacy in Kermit, West Virginia, 12 million opioid pain pills were distributed in just three years to a town with a population of 382 people. One woman, after losing her brother to overdose, was desperate for justice. Debbie Preece’s fight for accountability for her brother’s death took her well beyond the Sav-Rite Pharmacy in coal country, ultimately leading to three of the biggest drug wholesalers in the country. She was joined by a crusading lawyer and by local journalist, Eric Eyre, who uncovered a massive opioid pill-dumping scandal that shook the foundation of America’s largest drug companies–and won him a Pulitzer Prize.

Part Erin Brockovich, part Spotlight, Death in Mud Lick details the clandestine meetings with whistleblowers; a court fight to unseal filings that the drug distributors tried to keep hidden, a push to secure the DEA pill-shipment data, and the fallout after Eyre’s local paper, the Gazette-Mail, the smallest newspaper ever to win a Pulitzer Prize for investigative reporting, broke the story.

Eyre follows the opioid shipments into individual counties, pharmacies, and homes in West Virginia and explains how thousands of Appalachians got hooked on prescription drugs–resulting in the highest overdose rates in the country. But despite the tragedy, there is also hope as citizens banded together to create positive change–and won.

“A product of one reporter’s sustained outrage [and] a searing spotlight on the scope and human cost of corruption and negligence” (The Washington Post) Eric Eyre’s intimate portrayal of a national public health crisis illuminates the shocking pattern of corporate greed and its repercussions for the citizens of West Virginia–and the nation–to this day.



In two years, out-of-state drug companies shipped nearly 9 million opioid pain pills to Kermit, West Virginia, a town with 382 people. The quintessential coal town, split by a pair of railroad tracks, was the home of Sav-Rite Pharmacy, which once had the dubious distinction of being among the country's top sellers of a highly addictive prescription painkiller called hydrocodone—packaged under brand names such as Lortab and Vicodin. Sav-Rite was the only game in town. The pharmacy's owner, Jim Wooley, sold used cars on the side, right there in the gravel lot beside Sav-Rite. It was quite a racket.

Kermit didn't have nearly enough customers to buy that many pain pills. You could step into just about any "pain management clinic" in the county and walk out with a bogus prescription for $150. Wooley—he pronounced it "OO-LEE"—had established a considerable footprint. Sav-Rite's clientele would travel from hundreds of miles away, from Ohio, North Carolina, Tennessee, and even Florida. Word spread fast and far when a pharmacy would fill any prescription so long as you paid in cash. When folks started asking questions about Wooley's booming business in the middle of nowhere, he had a ready answer. His customers were mostly tourists, just passing through Kermit, on their way to hunt or fish or ride four-wheelers in the mountains. But it was Sav-Rite that had become the tourist destination. Cars and pickups were backed up, trying to squeeze into the drive-through lane, choking Highway 52 through town. Wooley was a salesman, through and through, and he recognized that a waiting customer wasn't a happy customer. So he dragged a camping trailer onto the parking lot and sold hot dogs and chips and soda pop out of it. The concessions were cheap, the customers were happy, and Wooley could make a few extra bucks outside the pharmacy to couple with the millions he was making inside selling opioids. To the tourists.

To keep pace with demand, he needed reliable suppliers. There was no shortage. One was McKesson Corporation. It ranked sixth in the Fortune 500. A couple of years back, McKesson's CEO was the highest-paid corporate executive in the land. And the company didn't hesitate to fill Jim Wooley's round-the-clock orders. In 2006 and 2007, McKesson shipped 5 million hydrocodone pills to Sav-Rite, no questions asked. The following year, when Wooley's actions started raising suspicions—he opened a sham pain clinic up the road where addicts would pick up rubber-stamped prescriptions that only Sav-Rite would honor—McKesson, like a good corporate citizen, cut the pharmacy off. For two years. Once the authorities stopped snooping around, however, the global drug distributor resumed deliveries of hydrocodone and other powerful pain medications to Sav-Rite. But then Wooley got arrested for filling bogus prescriptions, and, well, that terminated the business relationship for good. It was lucrative while it lasted. McKesson's CEO denied responsibility and faced no penalty. Wooley almost got off scot-free as well. Prosecutors recommended no prison time for the pharmacist-turned-entrepreneur.

Across West Virginia, other small towns like Kermit were also drowning in prescription painkillers. Thirty miles east, McKesson combined with wholesale drug giant Cardinal Health—the fourteenth-largest US company—and two regional distributors to deliver 16.6 million pain pills over a decade to a single drugstore in Mount Gay, which has all of seventeen hundred residents. Those same companies, along with AmerisourceBergen—ranked twelfth in the Fortune 500—shipped 20.8 million prescription opioids to two pharmacies four blocks apart in Williamson, a town with twenty-nine hundred people, and only twenty miles from Kermit. Williamson was so overrun with painkillers that the locals started calling it Pilliamson. The white coats and blue suits made a fortune.

This was unbridled profiteering, yes, and it came with an undeniable public health cost. The pills were lethal. Take too many all at once, and you stopped breathing. People were taking hydrocodone and its more powerful cousin OxyContin, and they were accidentally overdosing in record numbers. Mingo County, where Kermit and Williamson are located, had one of the highest overdose death rates in the nation, according to the Centers for Disease Control. As the addiction crisis spread across the country, some health advocates sounded the alarm, but industry lobbyists snuffed out policymakers' efforts to stop the scourge. They found politicians willing to do their bidding. The regulators—the DEA, the pharmacy board—failed to do their jobs. Pablo Escobar and El Chapo couldn't have set things up any better. So the pills kept flowing, the number of deaths mounting. Federal laws and court orders kept the companies' dark secrets hidden from the public. They left nothing to chance. It was all too big. And, truth be told, they almost got away with it, the biggest heist amid the biggest public health crisis in US history. Almost.

But there was something the corporate pill peddlers didn't forecast, something that took them by surprise: an unlikely alliance between an ex-con and the crusading lawyer who couldn't keep her out of jail. Starting in 2007, they slung accusatory stones up, up, up the drug supply chain, from doctors to pharmacists to drug distributors.

As a statehouse reporter with the Charleston Gazette-Mail, I stumbled into the middle of their legal battle in 2013, uncovering secrets and lies that set up a collision course with three of America's largest corporations. That summer, I received a tip that Cardinal Health had helped pay for the inaugural party of West Virginia's newly elected attorney general, Patrick Morrisey. Cardinal's lawyer had headed Morrisey's campaign transition team, and Morrisey's wife had lobbied for Cardinal in Washington, DC, pocketing millions of dollars for her K Street firm. The previous attorney general—a twenty-year incumbent—had sued Cardinal on behalf of the citizens of West Virginia. Now, Morrisey, after Cardinal's top executives helped bankroll his campaign, was overseeing the suit; lawyers close to the case contended he was trying to sabotage it. Morrisey insisted he had stepped aside from the lawsuit, but I unearthed letters showing he had met privately with Cardinal lawyers about it, and court documents and emails revealed he was giving staff "specific instructions" on how to handle the suit. In retaliation, Morrisey set out to derail my investigation with one of his own—against my employer, a tenacious small newspaper in financial peril. His benefactors were counting on him to slam shut the door. But after the paper successfully fought to unseal court documents that the drug distributors wanted to hide from the public, the attorney general handed over previously confidential records that showed the companies' insidious pursuit of profits. Along the way, I wrote hundreds of stories about the devastation and misery that opioids had inflicted upon our state. I kept digging for answers, the smaller articles snowballing into the larger story of how it happened, how drug companies flooded small towns with millions of prescription opioids, and how they got caught. It all began with a seemingly unremarkable death in a place called Mud Lick.


1 A Death in Mud Lick

At sunup, Debbie Preece drove north on the two-lane blacktop that traced the Tug Fork of the Big Sandy River, hurtling onto a rutted gravel road that tunneled deep into the woods. She stopped with a jolt at the rust-bitten trailer in Mud Lick. The coroner had already picked up her brother's body and transported it to the morgue for autopsy. Debbie insisted that someone show her where William "Bull" Preece had spent his last hours. She was directed to a back bedroom, vacant save for a dresser and a torn mattress set atop a box spring. The sheriff's deputies had already removed the blood-spattered clothes and swept up the residue of crushed pills.

It was the first Monday in October 2005, five years since Bull had fallen from a ladder and injured his back at Penn Coal mine and secured that first prescription for pain pills, which led to another and another. Bull kept finding doctors to prescribe OxyContin and Lortab. He had been taking painkillers for two years before Debbie realized he was addicted. He'd slump into the sofa at her house and fall asleep. She tried to reason with him. She checked him into rehab. He'd stay a few days, then relapse. He lost his home after failing to pay the mortgage. He became a stranger to Debbie. The contents of a pill bottle would transform a once strong and proud coal miner into a coward prowling darkened streets and dive bars for his next fix. He tried to shed the addiction at a methadone clinic. He stopped going after six months. He told his sister he was taking pain medication, but he assured her he wasn't snorting pills or shooting up.

"Be careful," she had told him as he was leaving their mother's house in Kermit, the last time they spoke.

"See you tomorrow," he said.

After rifling through the single-wide, Debbie stepped outside, her platinum-blond hair afire in the morning sun, her brown eyes, rimmed with red, narrowing to scan the depths of the hollow. At forty-eight, she was three years older than Bull, so nicknamed because he was a bullheaded child.

Debbie noticed a white truck parked beside a shotgun-frame house with a broken porch. It was Bull's Ford Explorer. She swung open the passenger-side door and retrieved a stack of family photographs—Bull with his thirteen brothers and sisters, Bull with his arm around his father, Bull dressed in a navy firefighter's uniform and white cap beside the fire truck outside the Kermit VFD.

A man emerged from the house and waved Debbie inside. He wanted to show her something he had discovered in the truck's glove box. Prescription receipts and four orange plastic prescription bottles. They were empty. Every one of them.

The evening before his death, Bull and his estranged wife and another man had been drinking beer at a honky-tonk called Sweeties Teardrop Inn. They drove back to Mud Lick at 1:00 a.m. that Sunday. Bull fell asleep on the mattress. The man swiped Bull's truck and drove across the Tug Fork into Kentucky to buy more beer. On the way back, he lost control of the Explorer, ran it up a hill, and slammed into the neighbor's porch. Someone rushed the man who wrecked Bull's truck to the hospital in Louisa, Kentucky. He slipped out of the emergency room before the authorities figured things out and tried to arrest him. He got back to the trailer around 1:00 p.m., fell onto a couch, and turned on the television to watch the Cincinnati Bengals game. Bull was still on the mattress in the bedroom. He hadn't moved. Nobody bothered to wake him.

The recounting of events was unsettling. Debbie rolled the hard plastic bottles in her palm, then gripped them tight. The white labels revealed the missing contents: ninety Valium; sixty oxycodone; ninety OxyContin, an extended-release form of oxycodone; and thirty Zestril tablets. She recognized the drugs. A sedative, painkillers, a blood-pressure medication. She knew the dangers of mixing them. She had attended too many funerals not to know.

She squinted at the labels more closely, the fine print displaying an eleven-digit code, as well as the names of a pharmacy she had frequented dozens of times and a doctor she had known for years. Dr. Donald Kiser had worked at the Wellness Center and the hospital emergency room in Williamson, the Mingo County seat, a twenty-minute drive from her home in Kermit. But he had written Bull's prescription from his new office in Marietta, Ohio, three hours away. Nothing kept Kiser from practicing in Ohio, even though his lies had cost him his license in West Virginia. In late February 2005, Mingo County deputies had arrested Kiser and charged him with trading prescriptions for sex. The medical board rejected his request for a new license after Kiser marked no to a question about whether he had been charged with a crime during the past two years. Kiser alleged that Mingo authorities had trumped up allegations against him in retaliation for a lawsuit he had filed against them near the end of the previous year. That suit claimed Mingo deputies had falsely arrested him during a child custody dispute with his ex-wife. Debbie didn't trust Mingo County authorities either. She didn't discount that Kiser might have been railroaded. She had been willing to give him the benefit of the doubt.

The move to Ohio didn't slow down Kiser's business. His Mingo County clientele wouldn't desert him. Every week or so, a van would pick up Bull and other passengers at stops along the two-lane and shuttle them north to Marietta. The fare was paid in pills—twenty for each prescription filled from each passenger. The drivers, in turn, sold the painkillers on the black market. Kiser arranged the shuttle service. Everyone made a lot of money.

Thirteen days before seeing Kiser, Bull had picked up a prescription for ninety hydrocodone pills for pain and sixty Xanax for anxiety at a recently opened pain clinic in Stonecoal, just north of Kermit, and he had receipts for another 120 hydrocodones and ninety Xanax prescribed there that month by a doctor who had never laid eyes on Bull. That, added to Kiser's prescriptions, placed six hundred and thirty pills in his hands over the past forty-five days, or nearly three times the recommended dosage for a patient with severe pain—all dispensed by Sav-Rite Pharmacy, the lone drugstore in Kermit. He paid $558 in cash.

Bull's last prescription was filled on September 29. He'd lumbered into the Sav-Rite on Lincoln Street, and the pharmacy's owner was there that day. His name was on the storefront sign: JIM WOOLEY'S SAV-RITE PHARMACY. He was sixty-eight now, his beard bushy and white. Wooley was affable, friendly to his customers, always a smile on his face, a people person, a salesman. Bull's prescription caught Wooley's attention, but not because it was written by Dr. Kiser at a clinic 170 miles away in Marietta. Wooley not only knew Kiser, but he had recently loaned him $5,000, two days after Kiser was arrested at the pain clinic in Williamson. Everybody knew one another in Mingo County. Bloody Mingo, the locals called it—birthplace of the Hatfield and McCoy feud, the Matewan massacre, a place where mine owners and union workers settled disputes with rifles, but now a place where drug merchants were calling the shots. The pain-addled addicts didn't stand a chance.

Wooley would claim at a deposition that he didn't know about Kiser's troubles with the Mingo County Prosecuting Attorney's Office and the West Virginia Board of Osteopathic Medicine. Nobody had told Wooley, and, no, he hadn't read about it in the Williamson Daily News or Mountain Citizen, the newspaper published across the river in Kentucky. What gave Wooley pause about Bull's prescriptions was the switch from hydrocodone to oxycodone. So he pulled Bull aside and counseled him, right there at the pharmacy, warned him about the change to a stronger painkiller, and not to take the extended and immediate release at the same time, and, whatever you do, don't chew on the OxyContin. That was his advice. That was it.

Three days later, Bull was dead. He was forty-five. The autopsy report showed he died of oxycodone intoxication. He had five times the lethal limit for the drug in his blood. His death was ruled an accident. Four days before Christmas, the state's investigation and postmortem for William H. Preece—Case No. WV 2005-1018—was officially closed.

Debbie took the empty prescription bottles home with her and secreted them in an upstairs dresser drawer for safekeeping. She wanted something to hold on to. Bull's death wouldn't be forgotten. He wouldn't be another number, a statistic, in the overdose death toll. Somebody was going to pay, no matter the repercussions, no matter what her enemies and the scandalmongers might dredge up about the past. There would be a reckoning.

Several weeks after they lowered Bull into the ground, the phone rang at Debbie's house. Dr. Kiser wanted to talk. It was urgent. Was he calling to offer his sympathies? No. He asked Debbie for a copy of Bull's MRI, the one taken after the ladder fall. Could she send it? The doctor needed something to put in Bull's empty patient file.

Some things about Bull's death still troubled Debbie. The bloody clothing, for instance. Could someone have murdered her brother, then tried to cover up the crime by making it look like an overdose? Debbie hadn't ruled that out. Stranger things had happened in Mingo County. She wanted an appointment to speak to the medical examiner. She wanted to know why the autopsy was taking so long. She kept calling the morgue.

"I want to look at the man who did the autopsy on my brother," Debbie told the secretary who answered the phone.

After finally receiving a copy of the autopsy report, Debbie hopped in her car and headed north on the four-lane highway to the medical examiner's office in Charleston. Corridor G, as the route was known, was built for trucks to haul coal out. Debbie wound her way through humps of mountains, their ridges glowing red, orange, and yellow with the change of season. She passed three prisons and two Walmarts during the hour-and-forty-five-minute trip. Her destination, a tan-painted building with barred windows, stood across the street from a NAPA Auto Parts store and the First Advent Christian Church. A receptionist directed Debbie and her questions to Dr. Zia Sabet, the chief deputy at the morgue, the man who conducted Bull's autopsy. Had he kept blood and DNA samples? Yes. Were there any marks on the body? No. Could her brother have been killed? No marks, no bruises, nothing to suggest someone had attacked Bull, Sabet said. But what about the bloody clothing beside the mattress in the trailer? She had seen evidence photos taken by the sheriff. Sabet told her he did not have the clothing.

Debbie had questioned everything about her brother's death. His Explorer had been taken for a joyride. Someone had stolen Bull's gold necklace and the pills left in his prescription bottles after he died. Why did his so-called friends let Bull lie passed out in the trailer so long? Why did it take them so long to call the sheriff? She was told someone hid her brother's pill bottles in a stack of cinder blocks while the ambulance made its way to the trailer. They later partied with Bull's remaining pain medications, she heard.

"I suspicioned everything when those things were missing," Debbie said.

"Your brother died of an overdose," Sabet told her.

There was also the pill residue—and an empty bottle of Lortab that belonged to the trailer's owner.

"My brother did not snort pills. When you crush them, that's what you crush them for."

"How do you know your brother didn't do that?" Sabet asked.

"Because he told me he didn't."

And she believed Bull. He had always been a man of his word, hooked but honest.

After Bull's funeral, Dr. Kiser was frantic. For weeks that autumn of 2005, he kept calling Debbie, asking whether her dead brother had ever had an MRI and offering to pay for the film. In fact, Bull did have one. It was in a big brown envelope stored upstairs beside the prescription bottles. But why on earth would the doctor need the scan? Kiser had an explanation: He admitted to Debbie that he had no justifiable reason for prescribing OxyContin to Bull, and the authorities—Kiser wouldn't identify them by name or agency—were starting to ask questions about Bull's death.

Debbie was helping to care for an elderly man on kidney dialysis, and she still thought Kiser was a respectable doctor. She would call him for instructions about what color of dialysis bag to administer based on the man's blood work. Balancing the chemical levels wasn't easy. She respected Kiser's medical advice and appreciated his help. He didn't ask for anything in return. Even when Debbie heard about the charges against Kiser in February 2005, the news didn't change her opinion.

"They're saying they're going to indict me over your brother's death," Kiser told Debbie.

Kiser was hatching a cover-up for Bull's death, and somehow he had convinced Debbie to take part. At first, Debbie thought she was doing the right thing. She wanted to help Kiser. He had always helped her. They kept talking on the phone, never in person. Then one Sunday in November 2005, Kiser's girlfriend showed up at Debbie's house. Debbie handed her the brown envelope with Bull's MRI tucked inside. She never looked at it. She couldn't remember where or when it had been taken—probably at the hospital emergency room in Louisa, after the mine accident.

And now that her brother was dead, she was giving it up, just like that, a willing accomplice. She watched Kiser's girlfriend—Debbie's former sister-in-law—drop the envelope in the trunk of her car, close the hood, and drive away to Kiser's new office in Ohio.

Weeks later, Debbie started having second thoughts. Everyone knew Kiser was writing prescriptions for pain pills. Why else would vanloads of addicts travel three hours to see him? She was helping the doctor who had written the prescription that killed her brother. Had she lost her mind? Had she forgotten her promise? Finally, she picked up the phone and called the Mingo County sheriff and then the prosecutor.

"I've done something I probably shouldn't have done," she confessed.

2 Prescription for Pain

In 2005, Americans such as Bull Preece were dying of drug overdoses in record numbers, and the DEA's new enforcement chief, Joseph Rannazzisi, was determined to do something about it.

Fatal overdoses had doubled in six years, and most of the thirty thousand deaths were being linked to prescription painkillers, despite repeated assurances from the pharmaceutical industry that patients wouldn't become addicted. In West Virginia, OxyContin was initially the pain medication of choice, then later Lortab. Both were being prescribed at unprecedented rates. Both were potential killers. Between 1999 and 2004, the number of West Virginians who lost their lives to accidental drug overdoses jumped 550 percent. The Mountain State had the highest overdose death rate in the nation.

Rannazzisi, a twenty-year DEA agent who had risen up the ranks to head the agency's Office of Diversion Control, realized that traditional policing of doctors and pharmacists wasn't working—it wouldn't slow the avalanche of opioids. Instead, Rannazzisi and the DEA began targeting prescription drug distributors, which could act as a choke point in the pharmaceutical supply chain. The wholesale distributors were the middlemen. They purchased prescription pills from drug manufacturers, hauled them to regional warehouses, then delivered the medications to hospitals and pharmacies. The distributors were buyers and suppliers.

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. The DEA pitched the "Distributor Initiative" as an education campaign. Rannazzisi showed the companies examples of their own customers whose ordering habits and patterns suggested the painkillers were winding up in the wrong hands. Moreover, the DEA sent three letters to distributors over the next two years, outlining their responsibilities under the Controlled Substances Act, a federal law that had been on the books for thirty years. Aimed to create a tightly regulated distribution system that supplied drugs to patients who genuinely needed them, the act classified prescription opioids for their high potential for abuse. The distributors kept them locked up in vaults at their warehouses.

The face-to-face meetings and letters reminded the distributors that they were obligated to flag and report to the DEA "suspicious" orders—instances when pharmacies' painkiller purchases abruptly spiked from one month to the next. Rannazzisi warned the execs that their companies' licenses could be revoked if they didn't abide by the law. The DEA followed up with five national conferences for distributors about prescription drugs and how to stop them from being diverted and resold illegally by dealers on the street. The companies had been put on notice.

The distributors didn't exactly warm to the new program. They were logistics managers, not criminal investigators. They weren't going to evaluate the veracity of prescriptions. They weren't going to block orders. They were making billions of dollars a year selling opioids. The DEA was being unfair and unreasonable, shoving unfunded mandates down their throats. But the distributors didn't push back. Not yet.

A decade earlier, the makers of OxyContin had unleashed a sales force that took the country by storm. Purdue Pharma representatives descended like locusts. They swarmed medical offices, pushing doctors to prescribe a new wonder drug that vanquished pain, everything from sore backs to toothaches. Their mission was to sell more Oxy.

On Sale
Mar 31, 2020
Page Count
304 pages