A pharmacist in Celina, Tenn., was one of 60 people indicted on charges of opioid-related crimes last week, in a multistate sting. John Polston was charged with 21 counts of filling medically unnecessary narcotic prescriptions.
He was also Gail Gray's pharmacist and the person she relied on to regularly fill her opioid prescriptions.
"I take pain medicine first thing in the morning. I'm usually up most of the night with pain," she said. "I hurt all the time."
Living in a mountainous community on the Tennessee-Kentucky line, Gray has coped with a degenerative disk disease for more than 15 years, requiring multiple back surgeries. She says the chronic pain is totally debilitating without powerful opioids.
But with her druggist shut down, her high-dose prescriptions have been questioned by the other pharmacy in town.
"They wouldn't take me because I was red-flagged on my dose," she said.
The dozens of indictments across Appalachia left thousands of patients who are dependent on opioids to function on a daily basis scrambling, from Ohio to Alabama. Over 50 of those indicted were doctors, nurses or other medical professionals. So as agents were in the field making arrests, the Justice Department also coordinated with local agencies to deploy health workers to look for desperate patients.
U.S. Assistant Attorney General Brian Benczkowski said the enforcement was coordinated with health agencies and addiction treatment providers.
"That plan is designed to ensure that affected patients have continued access to care and are, at the same time, directed to legitimate medical professionals in the area," he said at a press conference in Cincinnati last week.
Amid an ongoing crackdown on overprescribing doctors in Appalachia announced in October, patient advocates have been increasingly concerned for pain patients and those abusing prescription drugs. Being suddenly cut off from medications they depend on can be dangerous. Patients could become so desperate from withdrawal symptoms that they may resort to street drugs and could overdose.
But this time, in Tennessee, the health department is working to connect people who need pain treatment to legitimate pain clinics. And the substance abuse department began plastering messages online just as the indictments were unsealed, giving patients a hotline to call.
"This is the first time that we have had this type of heads-up," said Marie Williams, who oversees Tennessee's substance abuse agency.
With previous stings that resulted in the closure of pain clinics, Williams said, her staffers have gotten, perhaps, one day to prepare. This time, it was nearly a month.
Overdose prevention specialists have been deployed to train families on how to use reversal drugs like Narcan. They've also been taping up flyers on shuttered clinic doors.
Williams said she hopes many who may have become addicted to painkillers will see the loss of their opioid supplier as a turning point.
"This is an opportunity to really change your life and get to be the person that you really want to be," she said.
One of the medical practices shuttered by the federal takedown is in the small town of Carthage, Tenn. Dr. Bowdoin Smith is charged with prescribing controlled substances without a legitimate medical purpose.
Suzanne Angel is a state-funded outreach nurse in the area who is helping contact patients in the wake of the crackdown. She has been warning local hospital and emergency responders to be on alert for patients who may act out of desperation to find addictive narcotics or who may even be suicidal. This month, the Food and Drug Administration acknowledged the risk of serious harm for patients who are abruptly taken off opioids and issued new guidance to prescribers for how to safely taper patients off high dosages of opioids.
"I'm sure that they feel depression, despair, maybe anger and fear about 'Who is going to take care of me?' and 'Is there going to be any support or services out there for me?'" Angel said. "I don't want them to feel alone."
Angel said there are now more alternatives to opioids, and it's possible patients could find another pain clinic.
Because of the current legal focus on opioids, it can be much harder to obtain higher-dosage pills. And among the thousands of patients getting their medication through questionable providers, many have legitimate needs.
"I've tried therapies. I've tried injections. I've tried several different things," said patient Gail Gray. "We didn't just start off taking opiates."
Gray found a new pharmacy, though it means driving to the next county. She expects it won't be long before she's seeking help again.
"We're being punished for people that do abuse drugs," Gray said. "The chronic pain patients are being punished for it."