A hardscrabble region where employment is often limited to working the mines or working in prisons, Appalachia also has become home to some of the nation's worst addiction problems, the Washington Post reported Jan. 13.

OxyContin first appeared as a drug of abuse in the region almost a decade ago, but experts say prescription-drug abuse is worse now than ever. In western Virginia, for example, 248 people died of overdoses in 2006, a 270-percent increase from a decade earlier.

The region's coal industry is booming, and many addicts -- and former addicts now on methadone maintenance -- work in the mines. Defying common stereotypes, the addiction problem is worst in the region's rural areas. And methadone, an addiction treatment for some, has become the drug most commonly associated with fatal overdoses. Some methadone is diverted from addiction clinics, some from doctors who prescribe it as a painkiller now that OxyContin has fallen into disfavor.

"The abuse and misuse of painkillers is the worst I have seen it in the 16 years I have worked narcotics in this area," said Lt. Richard Stallard, director of the Southwest Virginia Drug Task Force.

Some miners slid into addiction while treating pain associated with years of hard labor, or to numb the stress and fear associated with the job. Drug testing in bigger mines has led many to lose their jobs, but addicts often can still find work in smaller, less-well-paying mines. However, the state of Virginia has been cracking down, last year passing a law requiring drug testing as a condition of employment as well as random testing of miners.

"I can't find nobody to work," said Noah Vandyke, 60, who runs the small Pioneer Coal mine. "The younger generation, you can't hardly find one that will pass a drug test ... Every family in the area has been affected by drug abuse, and it ain't just coal miners."

Some officials in rural Tazewell County want to shut down the region's only methadone clinic, the Clinch Valley Treatment Center, saying that a for-profit company shouldn't be in the treatment business. Clinic director Sterlyn Lineberry says people need to rethink their concept of addiction and recovery. "Are we reducing harm to the individual? Is the person working? Taking care of their family?" she said. "A lot of people in southwest Virginia believe this is a moral weakness, not a public health problem."