The Pharmacist Who Saved a Town

Hillston is a town of 2,100 people in the Appalachian foothills of eastern Kentucky. In 2010, when the opioid epidemic was reaching its peak in communities like ours, Hillston had the highest per-capita opioid prescription rate in the state. The pill mills had set up shop in the county seat thirty miles away, and the prescriptions they wrote flowed through every pharmacy in the region. I was the pharmacist at the only drugstore in Hillston — a small, independent shop that had been in my family for three generations.

I watched my community being destroyed. I filled prescriptions for patients I had known since childhood — neighbors, classmates, parents of my children's friends — who were receiving quantities of opioids that no legitimate medical practice would prescribe. I could see what was happening: the escalating doses, the early refill requests, the pharmacy shopping when I refused to fill early. I knew, with certainty, that some of these people were going to die. And for a long time, I felt powerless to stop it.

What could a pharmacist in a town of 2,100 people do about an epidemic that had killed hundreds of thousands of Americans and that the full force of the DEA, the CDC, and the medical establishment had failed to control? The answer, I discovered, was: talk to people.

I started small. When a patient came in with a prescription that concerned me, I didn't refuse to fill it — that just sent them to another pharmacy. Instead, I asked them to sit down with me for five minutes. I asked how they were doing. I asked about their pain. I asked if they knew the risks of the medications they were taking. I offered alternatives — physical therapy referrals, non-opioid pain management strategies, addiction treatment resources. Most importantly, I listened.

Over time, those five-minute conversations added up. Patients who had been on escalating doses of opioids for years began to ask about tapering. Family members who had been afraid to confront their loved ones about addiction began to bring them to the pharmacy for conversations. The local physicians, who had been prescribing out of habit and pressure rather than conviction, began to call me before writing opioid prescriptions — asking for my input, my recommendations, my support.

It took years. There were relapses, overdoses, funerals. Not everyone made it. But Hillston's opioid prescription rate dropped by sixty-two percent between 2010 and 2020 — a steeper decline than the state or national average. The drugstore is still there, and I am still behind the counter, and I still have those five-minute conversations every day. The epidemic is not over. But in one small town in Appalachia, it has been pushed back — not by legislation, not by law enforcement, but by the simple, stubborn act of talking to people, one conversation at a time.