If you look at the atlas of how drugs are prescribed in different parts of the country, there usually is a pretty straight correlation between the use of narcotic painkillers in areas where you have physical labor jobs, like mining, farming, logging, where people get a lot of back problems and muscle injuries and things of that nature. In many of these areas you have doctors who are generalists; they’re not specialists. So most folks are going to a general practitioner — a family doctor — and when they were told that OxyContin was a less abusable drug than drugs that had preceded it, they said, “Great. This sounds like a good thing for my patients.” So they started prescribing it very heavily.
Image of coal cars in West Virginia by Roger May via D. Smith Galleries