PORTSMOUTH, Ohio — More than a century ago, when mining jobs brought an economic boom to Southern Ohio that lasted for generations, folks in Ohio's Appalachian foothills used to say that coal was king.

But the new king is OxyContin.

The fifth-most-prescribed pain medication in the world, "oxy," or "OC," is a favorite of addicts, who crush and snort it or dilute it with water and inject it for a heroin-like rush.

The drug and its cousin oxycodone are the linchpin of a prescription-drug-fueled epidemic that has brought Scioto County to its knees. It's an epidemic caused by a flood of pain pills into the area -- plenty from legal local pain clinics and others imported from Florida and the Detroit area by dealers looking for an easy buck.

At the half-dozen or so pain clinics in this Appalachian county along the banks of the Ohio River, a handful of licensed doctors pump out prescriptions for an estimated 35 million pain pills a year to an ever-mushrooming population of pill-crazed patients who come from near and far just to cop.

Do the math, and it comes to roughly 460 pills for every man, woman and child in this county of 76,000 residents, according to 2008 state pharmacy board statistics.

It's gotten so bad that last year the local health commissioner declared a public health emergency, a rare step usually reserved for disease outbreaks.

Lisa Roberts, a city of Portsmouth public-health nurse on the front lines of the epidemic, says locals call it the "attack of the pill heads." She says a "pharmaceutical atom bomb" has brought the county to the verge of complete social collapse.

Statistics as bleak as tombstones back up Roberts' apocalyptic talk: The county has seen a 360 percent increase in accidental drug-overdose deaths and has the highest hepatitis C rate in Ohio, a rate that has nearly quadrupled in the past five years, thanks to junkies who are shooting up.

Sixty-four Scioto County babies born in 2009 came into the world with drugs in their system -- that's nearly one in 10 births. And swamped drug treatment centers say they are turning away thousands of locals who need help for prescription-drug addiction.

Stories of crimes committed by addicts in this community awash in pain pills float like ghosts through the air: Thieves dug the wires from the pitching machines for the Little League out of the ground twice recently to sell for scrap. The gumball machine was broken into at the Portsmouth health department for $20 in change. The manhole covers have disappeared off city streets.

"It's like they need it like they need oxygen, and they will do anything to get it," Roberts said.

In recent weeks, top government officials have taken more notice that Scioto County's pill problem has spiraled out of control. New Attorney General Mike DeWine is devoting a new prosecution unit to the prescription drug problem while federal Drug Enforcement Administration officials said they are actively working cases in the area.

"Scioto County is certainly one of the hot spots across the country when it comes to the abuse and diversion of prescription drugs," said Rich Issacson, a DEA spokesman.

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State lawmakers also are pushing to change Ohio's laws to make it tougher for pain clinics to operate and to force pharmacists to use a now voluntary prescription-drug tracking system to help detect doctor-shopping.

Gov. John Kasich -- who has said "the devil is now running that county" in describing the epidemic -- has named a prescription drug task force to tackle the problem. And he's cut a check for $100,000 in state money to get some help for more people who need treatment in Scioto County.

Last December, just a few weeks before he became Ohio's 69th governor, Kasich plunked down in a chair at the Portsmouth health department and asked a simple question: "How in the hell did it get this bad down here?"

It's a simple question, but it doesn't have a simple answer.

A convenient location for Ohioans, outsiders

Anyone with a map can tell you that the geography of Scioto County plays a role in the problem. The town sits at the junction of three states -- Ohio, Kentucky and West Virginia -- and has a major north-south artery, U.S. 23, that runs through on its path from Michigan to Florida.

Interstate 64, an east-west route that's a 50-minute drive away, cuts through Huntington, W.Va., on its path from Missouri to Virginia. Hook onto Ohio 52 from Huntington and shoot north and you hit Portsmouth.

The freeway traffic and overlapping jurisdictions, as well as generations of poverty that have created a thriving underground economy, all come together to form what Roberts likes to call "the perfect climate for deception."

"We are the ideal location for people who want to prescribe and dispense pain medication because here they can dispense over a wide geographic area, and the states aren't tracking prescriptions among them," Roberts said. "So it's impossible to tell where prescriptions are going once they leave the office."

One sunny February morning, a tiny waiting room in one Scioto County doctor's office was near capacity -- sending some of the mostly young crowd spilling out to their cars in the parking lot of a Portsmouth strip mall.

A few cars with out-of-state license plates sat with their engines running. A couple of guys in their 20s wearing Kentucky Wildcats basketball sweatshirts puffed on Marlboro Lights. Their car sported license plates from a Kentucky county more than an hour's drive away.

They rolled down their window -- but the pair had come to see the doctor and had no interest in rapping with a nosy outsider wondering what they were doing on this side of the Ohio River.

"We're just chilling, man," said one with a bit of a drawl. "We ain't got nothin' to talk to you about."

'What we have here is state-sanctioned murder'

If Scioto County is the center of prescription drug abuse in Ohio, then the eye of the hurricane is a stretch of Ohio River Road in Wheelersburg, a tiny burg a 15-minute drive outside the county seat of Portsmouth. On the unassuming retail stretch chock-full of gas stations, restaurants and hotels sits a trio of barely marked pain clinics a few minutes' drive from one another.

Bob Walton, a former elected trustee of Porter Township, the jurisdiction that oversees Wheelersburg, said that in 2007 he began noticing the code for "respiratory distress" showing up in ever-increasing frequency on emergency medical runs by township squads.

He quickly learned the victims were taking "the Portsmouth cocktail" -- the local name for a particularly lethal combination of opiates, sedatives and muscle relaxants responsible for most of the overdose deaths.

Walton also began noticing that break-ins and robberies were increasing -- from one or two in a night to as many as seven or eight. And the deputies who patrol for him were blaming it on local drug-addicted residents turning to crime to pay for their habits.

"It all coincided with the opening of the first pain clinic on Ohio River Road," Walton said as he sipped coffee at a McDonald's. "There's this opiate wall that exists in southeast Ohio, and it doesn't exist in other areas except in pockets. What we have here is state-sanctioned murder -- that's what it is. And it's allowed to happen."

Pain clinic doctors vilified, physician says

One of the Wheelersburg pain clinics is run by Dr. Margy Temponeras, whose office is tucked into a low-slung, concrete bunker of a building. The office was empty on a recent weekday afternoon, although security cameras inside and outside kept a watchful eye.

A friendly staffer appeared to explain the procedures to a visitor: Your doctor must fax your medical records to Temponeras, who will decide whether to accept you as a client. The application fee is $20 up front, and office visits are $240 plus medication costs.

Temponeras can do more than just prescribe pain pills at her clinic -- she also can fill prescriptions. This is all perfectly legal under Ohio law, and the "one-stop shop" setup is the case at several of Scioto County's pain clinics. It's also a practice that state lawmakers want to stop by allowing doctors to have only a one-day supply of drugs on hand.

In a brief phone interview, Temponeras complained repeatedly that pain clinic doctors are being unfairly portrayed.

"Some doctors are trying to help patients in a lot of pain -- we aren't drug dealers, and we aren't bad people," she said. "We are being vilified by the press and the fanatics who have had only negative experiences."

Temponeras said the problem in Scioto County is no worse than in any other part of the country. Asked why local fatal-overdose rates are so high, she implied that local officials have become obsessed with the issue.

"Those other counties don't keep the same statistics -- they aren't going and wasting taxpayer dollars on autopsies all the time," she said.

Sheriff's office faces perception problem

Some local residents raise questions about whether Scioto County Sheriff Marty Donini is doing enough to root out the problem.

Walton, the former township trustee, said he butted heads with the sheriff trying to get radar detectors installed in the cruisers that patrol the area where the pain clinics sit on Ohio River Road.

Walton thought strict speed enforcement near the clinics could turn up some informants who could help build cases against the pain clinics. But he said the sheriff "kept throwing up roadblocks."

"There is a reason why these pain clinics like to be set up in this little town here," Walton said. "They are real comfortable here, you know."

Locals are also quick to mention that the wife of a Scioto County sheriff's deputy owns a local pain clinic.

While both Asher Collette and his wife, Bobbie Lea, declined to speak with a Plain Dealer reporter, an attorney for Bobbie Lea Collette said his client worked two days a week at a Scioto County pain clinic but never owned it. Attorney Doug Graff said Bobbie Lea Collette bought a pain clinic in April 2010 -- after it had moved to Ross County, a stone's throw off U.S. 23.

Graff said Collette is "attempting to run one of the best pain clinics in the state" and said her operation has never been targeted by any law enforcement agencies.

"Neither her nor her husband make a choice as to who enforcement actions are levied against in Scioto County," Graff said. "That's up to individual law enforcement as to who they target, and hopefully it's bad actors."

Scioto County Prosecutor Mark Kuhn said the link to the sheriff's deputy creates a perception problem in the community. "I think the sheriff is horribly concerned about it, and that's all I can say on that," he said.

Donini did not respond to a request for an interview, referring questions to Capt. David Hall, who heads the department's narcotics bureau. Hall acknowledged that the deputy's wife owning a pain clinic may affect public perception, but he said it's impossible to do anything about it.

"We can't control what our wives do or don't do," Hall said. "But I can tell you from our standpoint it's not affecting the decisions we make on who we are going to go after or what we are going to prosecute. There's nobody we are afraid to go after around here."

Laws make building cases difficult, prosecutor says

Prosecutor Kuhn and others said at least one pain clinic in Scioto County is owned by a 50-year-old West Portsmouth man, Bart Journey, who pleaded guilty to attempted drug trafficking in January 2008.

"He walked into a search warrant and we found pills in his pocket," recalled Kuhn. "The prescription he had didn't match up -- it wasn't for the right dosage."

County court records show Journey was sentenced to five years of probation for his crime along with a 10 p.m. nightly curfew and 100 hours of community service.

Kuhn said felons like Journey should "absolutely" be banned from owning pain clinics. "At one time, we had four clinics in town with felons owning or involved in the management of those clinics," he said.

Kuhn says 80 percent to 90 percent of the drug cases his office brings involve prescription drugs, with the vast majority involving OxyContin. But he acknowledges that most involve street-level pill dealers, not doctors.

The prosecutor said it's nearly impossible to build cases against the legal pain clinics in part because of state laws that put a high burden on prosecutors to make the cases.

Ohio laws passed in the mid-1990s make it legal for doctors to prescribe as much pain medication to as many patients as they want, Kuhn said.

"A family doctor would never or rarely write a prescription in the amounts and combinations that we are seeing," Kuhn said.

Beyond the problems building cases against doctors, Kuhn said pain clinic operators have learned from periodic crackdowns in recent years on clinics that were openly flouting state laws.

"These people have seen enough doctors get hit before, and being sloppy is not what they are about anymore," Kuhn said. "If they do great paperwork, it's really tough to get them, so we have to nibble around the edges."