Myrtle Bailey had a roof over her head, a husband and eight children.
But on June 24, 2010, the 52-year-old Granite City resident died in her bed of an overdose of hydrocodone, one of the nation's most commonly prescribed painkillers. Her death ended eight years of prescription drug abuse.
"My mom is the reason I don't want to take Tylenol for my headache," Jennifer Hughes said.
Bailey hurt her left shoulder in 1998 while taking out the trash at her waitressing job. She developed neck and back pain that never went away and left her on disability the last dozen years of her life.
She used prescription drugs for pain and nerves: a combination of hydrocodone and acetaminophen, the muscle relaxant Soma and the anti-anxiety drug Xanax, said her husband, Gary Bailey. The drugs stayed with her to the end, with the hydrocodone killing her and Xanax also in her system.
She never used street drugs. Her family said doctors supplied all she needed.
"When she was taking these she kind of forgot everything," Hughes said. "We all love mom. We would choose not to come around here. We never knew how she would be that day."
Hughes said the family wasn't surprised Bailey eventually died of an overdose. They wonder whether her life would have ended differently had her doctors treated the cause and not just the symptoms.
"They would kind of give her pills and be done with her," Hughes said.
Myrtle Bailey was one of six people in Madison County to die of drug overdoses within a four-day span in June 2010. She was also one of 62 to die of a drug or alcohol overdose last year in the county, by far the county's highest total in the past 10 years.
Madison County Coroner Stephen Nonn said he noticed an increase in overdose deaths in the middle of the past decade.
"You were going from one a month to one every two weeks," Nonn said.
Overdoses have become the No. 1 cause of accidental deaths in the metro-east, surpassing vehicle crashes.
The rising number of deaths so alarmed metro-east authorities that earlier this year they started a task force to combat the heroin problem. It also spawned protests by youths in Granite City, Belleville, Edwardsville and O'Fallon who demanded that leaders do something to stop their friends from dying.
But something important may have been missed. Heroin may be a growing problem, but it isn't the biggest problem.
Prescription drugs have been killing more people in the metro-east than heroin or any other street drug, according to a News-Democrat review of 357 confirmed drug overdose deaths from 2006 to 2010 in St. Clair and Madison counties.
Prescription drugs contributed to almost two-thirds of all overdose deaths during that span and were the sole cause of more than one out of three. That is more than double the number of deaths caused by heroin alone or in combination with other drugs.
Many of the overdose victims were like Myrtle Bailey, middle-age chronic pain patients with anxiety or depression who became addicted to prescription drugs.
"You can abuse them just as easily," Granite City Police Chief Rich Miller said. "The issue of prescription drugs is huge."
A rise in prescription drug overdose deaths in the metro-east follows a national trend, according to Dr. Wilson Compton, director of the Division of Epidemiology, Services and Prevention Research at the National Institute on Drug Abuse. He said an unprecedented epidemic of overdose deaths caused by painkillers began around 2000 and has spread to every part of the country.
The main culprits are pain-relieving prescription drugs known as opioids. These drugs, which in some cases are similar to heroin, include everything from codeine, hydrocodone and morphine to more powerful drugs such as oxycodone, methadone and fentanyl.
"The drugs help people," said Dr. Christopher Long, who is the director of forensic and environmental toxicology at the St. Louis University School of Medicine. "The question is, is it prescribed appropriately?"
Compton said national drug analysts don't completely understand why there's been an increase in prescription drug overdoses.
But they have an inkling.
The population is aging, pain comes with age, and painkillers are more commonly prescribed. Government production limits on hydrocodone and oxycodone have doubled in the past decade. And prescription overdoses have gone up for 15 years as the number of prescriptions has risen, Compton said.
"The general availability of these substances has increased," Compton said.
The Drug Enforcement Administration raised the painkiller quotas because of medical demand based on data collected from manufacturing and insurance industries, said Scott Collier, diversion program manager for the DEA's St. Louis division.
Collier has his own theory about why demand has increased. Only the United States and New Zealand allow broadcast ads for drugs, though companies are prohibited from advertising controlled substances.
"Now patients come to doctors to make demands," Collier said. "I'm not saying it is a bad thing, but I do think it plays a role."
Avoiding the issue
Myrtle Bailey's family doesn't blame a drug dealer for her overdose death.
"I blame it on doctors," Gary Bailey said.
Specifically Dr. Viwathna Bhuthimethee, who Myrtle Bailey visited in Alton for chronic pain for about the final year and a half of her life. Gary Bailey and other relatives said Bhuthimethee gave Myrtle Bailey prescription drugs, but do not believe he ever gave her tests or treatment for the underlying issues that caused her pain.
"Bottom-line is, they gave her too many scripts per month," said Bailey's ex-husband, Tommy Hughes. "Ninety of this, ninety of that."
Twice a month, Myrtle Bailey would go to Bhuthimethee's walk-in clinic in downtown Alton and wait for hours to get another round of prescriptions for Xanax and hydrocodone. Gary Bailey said the office would be filled with 30 to 40 people, many of whom he knew to be drug addicts.
"It was jam-packed anytime I was in there," he said.
Bhuthimethee's clinic was empty of waiting patients on Aug. 16, when a reporter visited. A makeshift sign hung near the receptionist stated: "We prescribe no narcotic drugs."
In July 2010, Bhuthimethee voluntarily surrendered his license to prescribe controlled substances after federal agents confronted him about illegally prescribing drugs for cash, an Alton Police Department report states. No action has been taken against his medical license, but Bhuthimethee said a federal investigation into his practices is ongoing.
"They think I killed a patient," Bhuthimethee said of the federal agents.
The doctor would not talk much about his practices or Myrtle Bailey because he is still under investigation.
He did say the DEA presented him with three cases of patients -- whom he did not identify -- who died of overdoses. He denied responsibility for their deaths, saying two of the patients only had small, nonlethal, amounts of Vicodin in their systems, and another drank alcohol with their medications.
"That's beyond our control," he said of the third patient.
The DEA would not comment on any case that had not been adjudicated. But a DEA agent told Alton Police an estimated 13 of Bhuthimethee's patients died of overdoses after being prescribed substances such as Xanax, Percocet and hydrocodone, the police report states.
"He treats the pain and not the problem," Alton Police Chief David Hayes said.
Taxpayers paid for Myrtle Bailey's drug addiction, her family said. She would use the $730 she received in monthly disability to pay for the $70 visit in cash. Then she used a state-issued medical card to cover the cost of the prescriptions.
Before seeing the Alton doctor, Myrtle Bailey saw a now-retired St. Louis doctor, whose name her family didn't remember. The family said he would fill the prescriptions and not really check on her, either. When the doctor retired, he referred her to Bhuthimethee, Gary Bailey said.
"If she did not get her medications, she was very mean," he said.
One attempt to get her off the medications ended quickly. Her family took her to a clinic at Barnes-Jewish Hospital in St. Louis that focused on looking for the source of the pain. She went once.
"She wouldn't want to learn how to deal with it," Jennifer Hughes said.
Health and law enforcement officials in the St. Louis area said so-called pill mills -- places where prescribers are more drug dealer than doctor -- are the rare exception and not the rule in the metro-east.
"We are not Florida," Madison County Chief Deputy Coroner Roger Smith said.
The coroner's office worked with the DEA on the Bhuthimethee case to track his patients' deaths. The investigation stretched on for more than a year and a half before federal agents acted against Bhuthimethee, the police report states.
Coroner Stephen Nonn explained these investigations are difficult because investigators have to determine which prescriptions are legitimate and which are illegitimate.
"It takes a long time to develop a pattern, unfortunately," Nonn said. "It's almost like the person has to die for the case to be built."
Hayes said investigating a doctor also takes inside sources, such as patients, many of whom do not want to cooperate because they are dependent on the drugs being prescribed.
Local police said the DEA, not police, normally investigates doctors. They forward complaints to the federal agency.
For a long time police were not aware of the prescription drug overdose problem, Nonn said.
"Why would they be? It's a prescription drug, so it's a legal drug," he said, adding it is a tough area for investigators because of privacy laws.
Smith added: "We don't clarify in our society whether it is a criminal problem or a medical problem."
Belleville Police Capt. Don Sax said if a person was hospitalized for a prescription drug overdose, police might never know unless foul play is suspected.
"If a person had lots of medical problems and they over-medicated themselves, it's not a crime," Sax said.
Doctors' tough call
Every day, patients pour into the emergency room at St. Elizabeth's Hospital in Belleville. Many are there to get narcotic pain medication.
On some days, half of the ER's approximately 100 patients are seeking refills to their pain meds to treat chronic pain or a work-related injury, said Dr. Rachelle Leach, the hospital's emergency medical director.
Who is a legitimate patient and who isn't is difficult to determine for ER personnel. They don't regularly see the patients. Some patients have been on pain medications for so long they are addicted and withdrawing, which causes additional pain, Leach said. Others are seeking drugs so they can abuse them or sell them on the black market.
"It is very difficult. We're literally stuck as the middle man," Leach said.
Leach said people who enter her ER seeking narcotics are every age, gender and race. But the chronic pain patients have something in common.
"I think they are chasing to be pain-free," she said.
There was a time when painkillers weren't being prescribed enough, said Kathie Kane-Willis, director of the Illinois Drug Consortium at Roosevelt University in Chicago. But over time, that has changed and some doctors began calling in prescriptions that were no longer needed, creating dependency.
"It's a lot of sloppiness," she said.
Chris Herndon, a doctor of pharmacy and an assistant professor at Southern Illinois University Edwardsville, said this dependency can come when patients aren't prescribed enough medications to relieve their pain, leading them to seek drugs on the street.
Some doctors are not doing their homework before prescribing drugs, but he said they are facing new federal regulations on prescriptions.
But what about patients?
"There needs to be more onus on the patients," Herndon said.
No bad docs
Determining a doctor has illegally prescribed drugs means proving the drugs were dispensed without a valid medical purpose, Collier said. Just because a doctor prescribes a lot of drugs does not mean they have done anything wrong -- there's no limit on amounts prescribed, Collier said.
The same standard applies when the DEA attempts to revoke a physician's license to prescribe narcotics: Did the doctor act outside the scope of accepted medical practice when prescribing narcotics? Prescribing drugs for cash without first doing an examination would be an example, Collier said.
The DEA is not going after the doctor who forgot to write something on a patient's chart. Collier said of the 1.4 million people registered to prescribe controlled substances last year, the DEA took action against only 107.
Doctors have remained relatively unscathed in St. Clair and Madison counties. Ten doctors in Southern Illinois since 2009 have voluntarily surrendered their DEA licenses for a variety of reasons including illegally prescribing drugs, Collier said. No doctors from the metro-east had their DEA licenses revoked, according to the DEA's online revocation list.
One tool investigators and doctors said helps combat abuse is the Illinois' Prescription Information Library. The electronic database established in 2008 allows patients' controlled substance prescriptions to be tracked by those handing out the pills.
"It has been a godsend for us," Herndon said.
It also helps law enforcement officers, who Collier said are not allowed to fish for information but can obtain the data if they can show probable cause.
One problem with the system is that Missouri is one of only two states that has no pill monitoring program or plans to establish a program, Collier said. That means patients here can hop between states and avoid detection of abuse.
Drug abusers also have the Internet and street dealers where they can buy pills. Some find their high within their own home from an ailing parent or in their grandparents' medicine cabinet.
Michael Scalise, a supervisory special agent in the St. Louis division of the DEA, said those who have prescription drugs in their home should secure the drugs and keep track of them, especially the ones they no longer use frequently.
"Everybody knows how many beers they have in their fridge but how many people know how many pain pills are in their cabinet?" Scalise said.
The pain ends
Bailey's family doesn't deny that she abused her medications. In fact, her toxicology report shows she even had alcohol in her system -- a potentially deadly combination.
Gary Bailey said she rarely drank but he never kept her from taking the pills, partly because she hurt too bad.
"She could hardly get out of bed," he said.
For years, she complained of back and neck pain, but it was only near the end of her life that doctors discovered -- after prodding from her husband to conduct tests -- she had osteoporosis. It was only after she died that her family learned she had the beginning of emphysema, too.
Jennifer Hughes thinks the drugs and emphysema were enough to kill her.
"Why didn't her doctor detect her emphysema?" Jennifer Hughes said.
Bailey is believed to have died in her sleep. Her death likely was painless. And expected.
"We always knew," Jennifer Hughes said.