But it's also one of the deadliest places in America for prescription drug abuse.
With roughly 54 deaths per 100,000 people, the far southeastern county of 30,000 residents has the worst prescription-drug death rate in the state and the eighth worst in the nation, according to federal statistics.
“Everybody's hurting in our area,” said Sharon Teaney, co-director of the Lighthouse Mission Center, which helps homeless and drug-addicted people in Bell County. “Everybody feels the pain.”
The crisis strains local law enforcement and social services as it brings more crime, broken families and a steady stream of funerals.
Sheriff Bruce Bennett estimates that 98 percent of the county's crime is drug-related, with prescription drugs being a major contributor.
Bell is spending $1.1 million on its jail — said Judge-Executive Albey Brock. Trafficking prescription drugs, as well as methamphetamine, and drug-related crimes such as theft are the leading reasons people are incarcerated, Jailer Rex Miller said.
Roughly 3.5 percent of Bell grandparents are raising their grandchildren, almost twice the state average, according to the U.S. Census Bureau's American Community Survey. In most cases, “they are raising the children because the parents are drug addicts,” Teaney said, including an 80-year-old grandfather raising three small children.
The problem afflicts people of every income level and sometimes has its roots in legitimate prescriptions.
That was the case for Steve and Pam Sulfridge, who were prescribed opiate painkillers after Steve underwent knee surgery and Pam was injured in a car wreck. The prescriptions cost roughly $20 each.
But the Middlesboro couple became addicted to the drugs and eventually spent their savings, income, 401K and about $160,000 in back taxes — all told about half a million dollars over five years. They've had to rebuild their lives and marriage.
“We're paying for our mistakes every day,” said Pam Sulfridge, who, along with her husband, has been drug-free for five years.
Experts point to several reasons for Bell County's high rate of prescription drug deaths — few good jobs, little for young people to do and easy access to nearby states where prescription drugs are easier to get.
And as the crisis rises, the money to fight it has fallen off.
Rebekkah Helton Burkett lost her job as a school substance abuse counselor in Bell County when Operation UNITE, a nonprofit agency formed to fight drug abuse in southeastern Kentucky, lost almost half of its funding in 2008-09.
The local schools had paid for her position with an Operation UNITE grant and were forced to lay her off. But the community rallied behind her, raising money to keep her on staff.
Teaney said Kentucky officials need to make the fight against drugs in her region a priority.
“We desperately need help” she said. “It seems like it's getting worse, not better.”
Addiction hurts everyone
Even Bell residents who don't abuse prescription drugs pay for the problem.
In July, someone broke into Lighthouse Mission Center's tool trailer and stole power tools used to help out in disasters, and Teaney said she strongly suspects drug addicts. Another time, the stakes from tents used for a children's carnival were stolen, presumably for scrap metal that could be sold to pay for drugs, she said.
Petty crime, such as smaller thefts, has increased in Middlesboro, Bell's largest city, which can be attributed to prescription drug-seeking behavior, said Jeff Sharpe, chief of the Middlesboro Police Department.
“Instead of going in the house and hauling out TVs and big-ticket items, they are hauling out small things they can get to easily,” he said. “And the first thing they go for is the medicine cabinet.”
The police also are getting more reports of prescription fraud and of people stealing prescription drugs from family members. Sharpe also said he's seen more thefts of copper wiring and pipes from abandoned homes — materials addicts sometimes sell for quick money.
With so much drug crime, the Bell County Police and court system spend most of their time and resources fighting it. “In District and Circuit criminal cases, I would be surprised if 90 percent aren't drug-related,” said Bell County Circuit Court Judge Robert Costanzo, who helps oversee the county's felony drug court program.
Such crime has far-reaching effects.
Prescription drug abusers are “running the costs of goods up because they're stealing,” Brock said.
These people also can become delinquent in paying taxes and utility bills, among other things, which places an increased share of the burden on residents who do pay, he said. “There are definitely no winners in this.”
During the eight years Bennett has been sheriff, his department has made 200 drug-trafficking arrests.
While his office has made strides, he said more still could be done. His office has seven road deputies on staff but could easily accommodate 30 deputies with work. That would mean that cases could be solved quicker and more drug dealers could be taken off the streets.
At the same time, the budget for Bell County Commonwealth's Attorney Karen Greene Blondell's office — along with every other commonwealth and county attorney's office in the state — has been hit with budget cuts and mandated furlough days.
“It's all we can do to get all the work done, to keep the cases moving,” Blondell said, adding that the office has been able to keep up with cases so far.
A close-knit community fights back
Seeing the toll on its county, this close-knit community has been pulling together to tackle the prescription drug crisis.
Burkett, for example, said she's helped some students affected by drugs turn their lives around. One of them was Tayler Partin, a Middlesboro High School graduate who was a straight-A student and varsity cheerleader. Partin, who abused prescription drugs for two and a half years, began meeting with Burkett in September 2007 after another student told school officials that Partin snorted painkillers after a football game.
“If I had not been caught, I would be either in jail, dead or in a God-awful relationship with some user,” she said. “I would never been able to reach my potential.”
Pineville resident Cathy Woolum said seeing “drugs being dealt openly in downtown” spurred her to action, leading her to help start a group that later became the Operation UNITE Bell County coalition.
“It was like a train was coming down the middle of the street, and no one was doing anything to stop it,” she said of drugs.
UNITE has tried to bring more prevention efforts and recreational opportunities for youth, since many residents cite a lack of activities for kids as a reason some turn to drugs.
Bell's UNITE coalition, along with other groups throughout the state, has mixed the anti-drug message with other activities, said coalition member Donnie Caldwell. The lessons have been coupled with basketball, ATV riding, air soft gun shooting and archery.
Caldwell, who also is the Bell County Drug Free Communities director, is most proud of his First Tee Pine Mountain program, one of several programs worldwide that teaches character development and values through golf. The program has an anti-drug message that has been adopted by First Tee programs nationwide. From 2003-09, 1,143 young people have participated in the Bell program.
UNITE also has prevention efforts for adults. On Jan. 11, the Bell County coalition took part in Operation UNITE's Accidental Dealer initiative, which teaches adults how to secure their medications.
Other efforts have focused on bringing more treatment to the area.
“Treatment facilities and treatment resources are desperately needed,” Blondell said. “To me that is heartbreaking — when you see people who you believe could benefit from treatment and the resources aren't there.”
Some local faith-based groups have stepped up to try and help fill the gap with support groups.
Teaney works on several initiatives. The Lighthouse Mission Center in Pineville offers support group sessions, a jail ministry and outreach at an alternative school for teens through its Lifeline of Bell County program. “We've had some success stories,” she said. “We'd like to have more.”
Covenant United Methodist Church in Middlesboro started a Crossroads ministry for addicts. On Thursday nights, Pastor Phil Hill and other church leaders meet with addicts at the Old Redman Lodge, a building they outfitted to look like a coffeehouse mixed with a music club.
The court system is trying to foster rehabilitation through its intense 18-month drug court program that allows participants to avoid jail time but carries stiff penalties, which can include incarceration, if rules are broken, Costanzo said. Participants must take twice weekly drug tests and get a job and more education, among other things.
At any one time, about 30 people are in the program, which started roughly nine years ago, he said. But there's enough need to double the number of participants within 60 days if the money were there.
“Right now I have to pick and choose,” Costanzo said. “I could have two that are excellent candidates. One I'm able to take, and one I can't.”
Teaney also feels a lack of employment opportunities helps feed the area's addiction. Bell's unemployment rate was 12 percent in November, the latest month available, compared to 10.2 percent statewide. Its poverty rate is nearly 33 percent, twice as high as in Jefferson County. Her group is trying to start a jobs program to train people in fields such as cosmetology and construction. The Lighthouse Mission Center has been working with the Bell County School Board to open a career training center in the district's former vocational building.
But other factors leading to the drug problem are much harder to remedy.
The county isn't far from Interstate 75, a straight shot to Florida where prescription drug seekers have historically found easier access due to fewer restrictions on prescribing. Bell also shares its borders with Virginia and Tennessee, which don't participate in the Kentucky All Schedule Prescription Electronic Reporting System, or KASPER — software available to doctors, pharmacists and law enforcement to track narcotic prescriptions.
People seeking drugs can hop across the border to get prescriptions from doctors unaware of a person's prescription history.
Woolum found it difficult to reflect on the positive work in the county in the face of the recent death statistics and the overwhelming factors that are out of their control.
But she can't help feeling that anti-drug efforts have made an impact.
“We're No. 1 in the state now,” she said. “But where would we be if we didn't have these efforts going on here?”
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