Treatment & Mistreatment, Our Complicated Relationship with Pain: Inside Appalachia


It’s been about 20 years since the opioid epidemic first exploded across Appalachia, and now doctors are shifting away from prescribing opioids for long-term pain. 

But this shift away from pills has met resistance from some  doctors and patients.

In this episode of Inside Appalachia, we’ll hear why addiction hit Appalachia so hard. We’ll also find out what the medical community is doing to fight the pain pill epidemic.

Addiction specialists talk about why overcoming opioid addiction often means learning to cope with emotional and mental pain, as well as physical pain.

Last summer, the Centers for Disease Control (CDC) announced new guidelines for treating chronic pain. Doctors are recommended not to prescribe opioids as a first choice for patients suffering from chronic pain. The recommendations are voluntary for doctors, and they don’t apply to cancer patients or people undergoing end of life care, but it does signal a shift in the way the medical community is approaching pain management.

Instead of prescribing opioids, the CDC says doctors should first try to encourage their patients to do physical therapy, yoga, chiropractic or exercise therapy for their long term-chronic pain. That’s because studies have found that one in four patients receiving long-term opioid therapy in primary care settings struggle with opioid use disorder.

How Does Mental Health Affect Opioid Addiction?

Overcoming opioid addiction often means learning to cope with emotional and mental pain, as well as physical pain. Michael Holdren says he took pills to help him deal with the emotional pain of being separated from his family. Like many addicts, his problem started with an injury while working a physically demanding job – on an oil rig in Pennsylvania.

Holdren has taken suboxone for two and a half  years to control his addiction. He’s a patient at the Charleston Comprehensive Treatment Center in West Virginia. It’s an outpatient substance abuse treatment program that also offers medication assisted treatment, also known as MAT, which means doctors prescribe methadone, suboxone, subutex, and vivitrol to patients addicted to opioids. These medications help patients to reduce their craving for opioids. Patients are required to attend weekly individual and group therapy from counselors at the treatment center.  

How is the Shift Away from Opioids Affecting Patients with Chronic Pain?

A few of you sent your stories about what it’s like to live with pain in Appalachia. In the responses we received, here are some treatments people said they’ve used to cope with their chronic pain:

  • Massage
  • Yoga
  • Lidocaine Patches
  • Acupuncture
  • Pain medication including long-releasing opioids and muscle relaxers

The Struggle to Stay

Also in this episode we’ll hear the next installment of our new series The Struggle to Stay. This week, we’ll learn about Colt Brogan’s struggles with drugs, and what he did to break free.  

Music in today’s show was provided by Dinosaur Burps, Larry Dowling, Ben Townsend, Macklemore and Ryan Lewis, Heroes are Gang Leaders and Marisa Anderson. 

Patrick Stephens is our audio mixer. Roxy Todd helped produce. We also had help from West Virginia Public Broadcasting reporter Clark Davis and Eric Newhouse. Jesse Wright is our executive producer. He also edited our show this week.

We’d love to hear from you. You can e-mail us at Find us on Twitter @InAppalachia or @JessicaYLilly