The best laid schemes leave no one to blame. The web that lays the trap is too complex, too intricate to untangle… and so it remains.

That is the case with the opioid epidemic. Should we blame the people who overdosed themselves for the thousands of deaths per year? Or should we blame the physicians who wrote their prescriptions despite a clear addiction? Or the pharmacy that filled them? Or the distributor who started shipping millions of pills to small towns every year? Or the company who actually makes the little pills? Or better yet, the Drug Enforcement Agency? You see the problem here—too many bad actors, each successfully deflecting blame toward one another.

That was, until Pulitzer-Prize-winning journalist Eric Eyre and his colleagues in West Virginia turned their laser focus toward one: the distributors. Death in Mud Lick (2020, Scribner) is the consolidation of Eyre’s years of work at the Charleston Gazette—now the Charleston Gazette-Mail—exposing the drug distributors of the opioid crisis that ravaged West Virginia and the country at large. His book is a gripping look into the greed and corruption sustaining the opioid epidemic and, above all, a tribute to good investigative journalism and its ability to hold those in power accountable.

Image courtesy of Goodreads.

Eyre’s writing is clear and concise—the work of a practiced journalist. Though the book covers a lot of ground, it is easy to follow each of the players and their obstacles. In most cases, the numbers speak for themselves. 

Eyre begins in Kermit, West Virginia, a coal-mining town whose workers are especially prone to injury. One company, H.D. Smith, noticed that in February of 2008 they had shipped 332,5000 hydrocodone pills to a single pharmacy in Kermit named Sav-Rite. The town’s 2000 Census population was 209. About 54,000 pills left Sav-Rite each day, all from legal prescriptions. H.D. Smith sent inspectors to interview pharmacy employees. But they continued shipping as if nothing strange happened.

Later, in the midst of his investigations, Eyre learned that between 2007 and 2008, distributors supplied Sav-Rite with nine million hydrocodone pills and tens of thousands of oxycodone pills, which calculates to more than eleven thousand painkillers each year for every resident of Kermit.

Statewide, the numbers aren’t much better. In a six-year period in West Virginia, distributors delivered 780 million hydrocodone and oxycodone pills to the state’s 1.8 million people. 1,738 people fatally overdosed in West Virginia during that time. 

Eyre’s personal involvement in uncovering the opioid epidemic began when someone tipped the Gazette off that West Virginia’s attorney general Patrick Morrisey’s wife worked as a political lobbyist for drug distributor Cardinal Health while Morrisey led a lawsuit against the same company. 

Throughout the next several years, Eyre would go on to write stories about how drug distributors pumped pills into small towns without regulation. He would be involved in long, stretched-out court battles against expensive lawyers to uncover distributors’ well-hidden data on how many pills were being sent where. He would witness multiple congressional investigations into drug distributors. 

During one such investigation, a top West Virginia police drug investigator likened the pharmaceutical companies to a drug cartel in which “the ultimate goal is to sell drugs and produce as much money as you can” through corruption and government infiltration.

Ultimately, Eyre got the numbers he was looking for after the Gazette’s volunteer lawyers teamed up with the Washington Post to make drug distribution data available to the public—the people most affected by it. The newspaper quickly published the data and made it easy to find information on your community. 

Although Eyre focuses on West Virginia (which had the highest per capita overdose rate), the opioid crisis certainly extends beyond the state’s borders. Between 2006 and 2012, distributors delivered 76 billion oxycodone and hydrocodone pills to Americans. From 2006-2014, almost 130,000 Americans fatally overdosed. 

Courtesy of Wikimedia Commons.

Neighboring state Ohio, for example, has also seen its fair share of the spotlight for its opioid crisis. Like West Virginia, Ohio has a large working-class population, and compared to the national levels, a lower median income rate and higher poverty rate. In 2018, 3,980 people fatally overdosed in Ohio, and the Toledo Blade reported that Ohio’s 2017 overdose rate was almost 3 times the national average. In 2015, more people overdosed in Ohio than any other state.

According to the Washington Post, “From 2006 to 2014 there were 4,414,339,501 prescription pain pills supplied to Ohio.” The two main distributors were Cardinal Health and McKesson Corporation. In Lucas county alone during that time period, there were 213,858,404 prescription pain pills supplied, enough for 53 pills per person per year. A single pharmacy, Heartland Healthcare Toledo, distributed more than 30 million of these pills. Thanks to Eyre’s work, the raw data for Lucas County is publicly available.

Ohio overdose death data from 2010-2015. Image courtesy of ATTN.

Ohio and West Virginia are just two of the more publicized states struggling during the opioid crisis, and two of the places where investigative journalism work has uncovered systemic problems. 

And at its heart, Death in Mud Lick is really an ode to journalism. Eyre often touts the phrase “sustained outrage,” which he calls a prerequisite to good investigative journalism. Eyre chose to work at the Gazette over bigger, better-financed publications because of its founder, Ned Chilton’s, commitment to that very idea: that journalists always need to be on the lookout for corruption and abuse. Eyre knew that he could make a difference in the West Virginia Capitol. And he did.

“The newsroom was full of journalists who believed in holding the powerful accountable, reporters who persevered in the face of people, obstacles, and forces that threatened to derail their efforts. This hometown newspaper instilled a David-like confidence that when you’re on the right track, the Goliaths of money and power could neither intimidate nor stop you. It was keeping sustained outrage alive,” Eyre writes in the book.

The book itself is Eyre’s own David and Goliath tale, a testament to what one man can do when the law is not working. While working at a small town newspaper constantly on the brink of bankruptcy, Eyre managed to uncover bit by bit how corrupt drug distributors were, until eventually he successfully sued to publicly release all of their distribution data, leading to a national reckoning and his Pulitzer Prize.

But Eyre didn’t do it completely alone, of course. Along the way, he had good lawyers that worked pro bono, a paper owner who took risks to fight for what is right and a distributor employee who leaked important files. While the fight against opioid distributors certainly is not over, Eyre and his colleagues provide us some semblance of hope that there is a way to affect change from any position. 

Death in Mud Lick demonstrates how important local journalism is in holding those in power accountable and asks us to consider the consequences of ignoring accountability. Of course, there are many factors at play in the opioid epidemic, but when each player deflects blame to all of the others, people die. While the distributors pumped millions of pills into the country, they saw what opioids were doing to Americans; they saw thousands of overdoses and child abuse cases increase; they saw hard working people become addicts focused only on getting their next hit. 

Eyre shows how it’s easy and appealing to blame the victims—to moralize the person who actually pops the pill, to say they knew what they were doing or that addiction is solely their fault. That’s certainly what distributors and pharmacists said. It’s also what lawmakers said. Eyre describes how, after a court victory against drug distributors, West Virginia lawmakers passed new legislation that barred people who attempted or carried out a felony from collecting monetary damages if their injuries were sustained while committing a crime. In other words, if an addict got pills illegally, they had no right to sue a distributor for wrongdoing. 

Regardless of how much agency you believe the victims of the opioid epidemic have, however, Eyre’s laser-focus on distributors shows that victim-blaming is ultimately a distraction from the players with real power. In the book, he uncovers the well thought-out scheme to keep blame off of the billionaires; by admonishing the morals of the people addicted to pills, distributors and manufacturers can make sure that no one is paying too much attention to the industry itself.

The takeaway isn’t that none of them are to blame, but perhaps that all of them are to blame. Eyre focused on distributors. He succeeded. But what about the other links in the chain? Corruption most certainly exists at almost every level—the DEA, manufacturers, local pharmacy boards, pharmacists, physicians and anyone who lets something slide or accepts bribes to keep quiet. It shouldn’t be a dilemma to put people above profit—and in this case, it’s quite literally life and death.


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