“Pillbillies”–another stereotypical word about Appalachia

Melissa Martin, Ph.D.

“A stereotype is a generalized statement or belief applied to everyone in a group, as though the entire group is the same. Any belief or characteristic, applied to an entire group, immediately makes it invalid because no characteristics are held by everyone in the group…Stereotypical beliefs sometimes come from some degree of truth, however. There is probably someone in the group who fits the stereotype” says Lenora Billings-Harris. I agree. In his younger years, my maternal grandfather boiled moonshine in a still hidden in the deep woods, but not every grandpa in rural Appalachia brewed alcohol.

The expression “pillbillies” is being used by some media sites to describe the opioid crisis in Appalachia. It’s a combination of hillbilly and pill. Type the word “pillbillies” on the Internet and myriad articles ensue.

“Sticks and stones may break my bones, but words will never harm me” wrote Robert Fulghum. Really? Words are very powerful. Humans communicate with words.

Ohio, Kentucky, and West Virginia residents are targeted as “pillbillies” because of the statistics on prescription drug addiction in rural Appalachian areas. People in non-Appalachian regions with drug addiction are not called “pillbillies.”

Pillbillies is also the title of a 2014 self-published fiction novel by K.L. Randis and she followed it up with continuation of the story in a series. The main character is a drug addicted pill-pusher from the Pocono Mountains in Pennsylvania and another character that is out to get him to avenge his sister’s death. Do her novels help or harm Appalachian stereotypes?

The phrase “pill mills” was used to describe the doctor’s offices that prescribed massive quantities of opiate pain pills with the main prescription drug being OxyContin. And OxyContin was called “hillbilly heroin.”

And some news headlines imply that the widespread drug abuse and addiction of Appalachians is because of their own doing. But, what about the doctors who wrote mega prescriptions and the pharmacists who filled mega prescriptions? And what about the pill pipeline from Florida called “The OxyContin Express”—mega doses of opiates from the sunshine state, courtesy of Floridian physicians. And what about the drug companies? In 2007, Purdue Pharma pleaded guilty in federal court in Virginia to misleading doctors and patients by making false claims about Oxycontin’s safety and paid $600 million in fines. In May of 2017, Ohio Attorney General Mike DeWine announced that Ohio is suing five pharmaceutical companies for the same offense.

However, Oxycontin is not the only opioid narcotic being abused. What about Vicodin, Lortabs, Percocet, Dilaudid, Opana, fentanyl, morphine and codeine? According to WebMD “Opioids are available in pills, liquids, or suckers to take by mouth, and in shot, skin patch, and suppository form.”

When Pill Mills Closed

Over the past decade law enforcement began cracking down on clinics. When the pill mills dried up, those addicted to prescription painkillers turned to heroin as a last resort. Patients became involved with dealers, needles, and the illegal purchasing of opium.

There are legitimate conditions where pain pills are necessary. What about our wounded veterans of war? What about workers who are seriously injured on the job? What about individuals with permanent chronic pain like the West Virginia coal-miners? What about cancer patients?

And, yes, there is a group of individuals without physical pain conditions that abused opiates before turning to heroin. And there is a group of younger adults that experimented with heroin first and got hooked. But, this is not confined only to Appalachia.

Prescription Opioid Abuse Outside of Appalachia

A 2016 article by Dr. Sanjay Gupta, CNN Chief Medical Correspondent stated, “Today’s typical heroin addict starts using at 23, is more likely to live in the affluent suburbs and was likely unwittingly led to heroin through painkillers prescribed by his or her doctor.”

USA Today printed an article in 2013, “OxyContin a gateway to heroin for upper-income addicts” and reported “These lawyers, nurses, cops and ministers are showing up in the detox ward at Carolinas Medical Center, desperate to kick an opiate addiction that often starts with powerful prescription painkillers such as OxyContin and Vicodin.” White collar workers as well as blue collar workers are addicted to painkillers.

A report in 2011 by the Substance Abuse and Mental Health Services Administration found increases in the number of people seeking heroin treatment in 30 of the 39 states studied. The Appalachian Region only includes counties in 13 states.

Appalachian Stereotyping

Appalachian people, both rural and urban, have experienced stereotyping of their culture and region in news media and art depictions for generations. The book Confronting Appalachian Stereotypes: Back Talk from an American Region by editors, Billings, Norman, and Ledford discusses origins and reactions to “hillbilly” stereotypes through essays.

Ivy Brashear wrote the following in her 2016 thesis, Rural Reality: How Reality Television Portrayals of Appalachian People Impact Their View of Their Culture, for the University of Kentucky.

“As I have made clear in this study, the story of our place has been constructed by people in positions of economic or political power for 300 years, and the stereotypes that make up that constructed story have been recycled in times of great economic strife, upheaval, or transition…Now, perhaps more than ever before, we must begin to tell a different narrative about Appalachia. Not just because we’re tired of other people getting it wrong so often; but, because we cannot hope to transition the region’s economy into something that is equitable and just for the most people if we are living under the shroud of other people’s idea of who we are. We know who we are; we just need everyone else to know that, too. And perhaps the most critical aspect of retelling our narrative is that we must believe in who we are, and believe that who we are is worthy and deserving of so much more than what we’ve been given and what we’ve been told we are for 300 years.”

I agree. The dramatized reality television shows, such as Call of the Wildman, Moonshiners, Buckwild, and Here Comes Honey Boo Boo, exaggerates rural living. TV producers search for examples of stereotypes to hype and exploit for ratings. And Appalachia is becoming modernized as the earth turns, like other USA regions. We are not stuck in a hopeless and helpless time warp as the media portrays. But, positive Appalachian stories do not garner currency from commercials.

The Merriam-Webster Dictionary defines hillbilly as “often disparaging + offensive: a person from a backwoods area.” Collin’s English Dictionary says, “If you refer to someone as a hillbilly, you are saying in a fairly rude way that you think they are uneducated and unsophisticated because they come from the countryside.”

Appalachian neighbor, you get to decide to use or not to use the words “pillbillies” and “hillbillies.”


Melissa Martin, Ph.D.

Melissa Martin, Ph.D. is an author, self-syndicated columnist, educator, and therapist. She resides in Scioto County, Ohio. www.melissamartinchildrensauthor.com.

Melissa Martin, Ph.D. is an author, self-syndicated columnist, educator, and therapist. She resides in Scioto County, Ohio. www.melissamartinchildrensauthor.com.