Pubdate: Tue, 10 May 2016
Source: Guardian, The (UK)
Copyright: 2016 Guardian News and Media Limited
Author: Chris Arnade


After the Factories and Mines Closed, Drug Abuse Filled the Vacuum. 
Overdoses Are Now Common but Help Is Hard to Find, Writes Chris Arnade

On the outskirts of Kingsport, Kim, a therapist, faces a small group 
of people sitting on folding chairs. She's trying to help them rid 
their lives of illegal drugs.

The attendees are all white and working class, describing themselves 
as "dirt poor", and none has a college degree. They have come to 
spend hours talking of past and present pains, to offer each other 
support and urinate in a cup. If they pass the test, they will get 
their weekly prescription of Suboxone, a federally approved narcotic 
for opioid-addiction treatment. Or as it is called on the streets, 
"fake heroin".

Kingsport is where the Appalachian mountains cross into eastern 
Tennessee. It is a factory town cut in two by train lines and 
surrounded by hills. The flat parts are stuffed with shopping centres 
full of franchises. On conventional maps the area is mostly green for 
national forests or brown for the hills. But on the map listing drug 
overdoses it is dark red, the colour used for the most deaths.

Fifteen years ago, that map was all blue, with few deaths reported. 
Since then, deaths from drugs have doubled, and what was once a small 
red spot in Kentucky has grown larger and darker, swallowing up 
Kingsport and the rest of central Appalachia as the area has become 
overrun by the demand for illegal drugs, tranquillisers and 
opioids  a group that includes heroin and medical painkillers such as 
morphine, codeine, Vicodin, OxyContin and related drugs. As a 
consequence, it has also been overrun with the pain, upturned lives 
and death that follow addiction.

The reasons behind the surge in demand are unclear and everyone asked 
has a different explanation  some are repeated so often in the press 
they have become street mythology. There is the pain-pill story: 
"They prescribed so many pain pills so easily back in the 1990s, we 
all got addicted." There is the gang-from-big-city story: "The heroin 
highway runs straight through them hills, right up to Detroit. When 
demand up there dried up, the gangs needed a new market and came here."

A little of each is true, but the reality is more complex and thus 
harder to fix: drugs enter as hope exits, and in much of central 
Appalachia, hope has left.

Kim hears stories of suffering from her patients every day. Born and 
raised in Kingsport, she had her own struggle with drugs, but has 
been free of them for 14 years. "There is just such great despair and 
hopelessness," she says.

"With the coal mines closing, middle managers laid off from the 
plants, we have new economic despair. Folks who have little, and 
little offered to them. It's a breeding ground for addiction."

Regardless of the reason for the demand, the supply followed. You can 
buy any variety of pills and drugs  illegal, legal, diet, exercise, 
pain relief, cocaine, methamphetamine and heroin - in almost any car park.

The drugs have come in waves, each more dangerous than the last. 
First it was meth, then the police cracked down. Then it became 
pills, and the police cracked down. Now it is heroin - and the stuff 
coming is dangerous. "The heroin here has been stomped on so many 
times, cut with other shit by so many people, by the time it gets 
here, it is straight up poison," an attendee said.

The public health response has been as slow as the dealers were fast. 
Where other places responded by giving out clean needles or rolling 
out supervised injection facilities, in central Appalachia they have 
mostly given out scoldings and Bibles. The vastly underfunded 
treatment centres available are mostly built around the premise of 
addiction as a moral failing, solved via abstinence and religion.

Yet as the death toll climbs, attitudes are shifting. The latest 
change has been the use of Suboxone, which, as one 20-year heroin 
user at the meeting said, "keeps me from getting sick and needing 
heroin but doesn't fuck me up". But a Suboxone prescription is hard 
to get and often expensive. The rules are complex and strict, and 
only the lucky few with good insurance get it paid for.

Jerry Chappell, 55, lives an hour from the Kingsport clinic where he 
gets his prescription. He grew up poor and his father was a heavy 
drinker who beat his children. He never finished school, chased away 
by a teacher who called him stupid. He's spent his life doing 
physical work, accumulating pains and injuries until his body broke 
down. "Not knowing your ABCs, you have to work harder, because that 
is the only work you can get," he says.

Chappell began taking drugs early, drinking and smoking cannabis. "I 
did drugs to feel happiness and joy and forget all my pains and 
problems. My body always ached and I felt so dumb. Nobody wanted me. 
I would have killed myself without them."

He did not touch anything harder than that until he fell off a ladder 
and broke his neck. Then doctors "started pushing pain pills on me. I 
didn't like them, but they told me I had to take them. To work again.

"It was the first time I was ever hooked to something and would get 
sick from not using. Then they took away my prescription. I ended up 
selling all my valuable stuff to buy pills on the streets. I hated 
who I had become."

Now he is on Suboxone, which costs half his disability cheque, and 
turned to religion. "I got saved. When you are told all your life 
you're unworthy [and] dumb, you start believing it. God has changed 
that for me."

Bertha Porter, 28, lives well over an hour from her clinic, in a 
trailer park in a tiny town nestled in a valley. Without a car or 
public transport, she has to find someone to drive her there. Often, 
the round trip costs $60 (UKP40) or more.

She and her husband have been using drugs since they were 13 or 14, 
absorbing each new substance as it swept over the region. "I started 
with alcohol and weed, moved to meth and bath salts [synthetic drugs 
such as mephedrone], and then pills. I stopped before heroin got 
here." She has had a prescription for Suboxone for six months.

"Being clean, it ain't normal for me. I grew up with drugs and 
fucked-up people all around me. My dad was a dealer, and all my 
friends used. We didn't have anything else to do. There was no other 
jobs, coal mines were closing left and right."

David Coffey, 33, was found dead last July, with a mix of heroin, 
crystal meth, and Phentermine diet pills in his system. His mother, 
Rhonda, sits quietly in a trailer park trying to put the awfulness in 
some sort of context, to figure out how a child she knew as shy and 
cautious could end up dying from drugs.

"He was bored and lonely. There really wasn't much for him here. Or 
for any kids. No quality jobs, just service industry and call 
centres. The good companies that were here when I grew up  Raytheon, 
Univac - are gone.

"Now everyone is scared, with little stability. Community is also 
gone. Everyone is hard to each other, and kindness is now considered 
a weakness," she says.

Like many addicts, David's last years were filled with moments of 
being clean, and ugly periods of falling back into drugs. Getting him 
what little help was available took up most of Rhonda's time. "There 
is little treatment here. Drugs are everywhere, but everybody is 
pretending it isn't happening and embarrassed by it."

Rhonda saw that stigma after her son's death. "When David died, 
someone told me, 'It's OK, you don't need to tell anyone how he 
died.' I decided then and there to tell everyone as loud as I can.

"The next day I put it in his obituary that he died from drugs. If I 
can help one person, because of his death, then his death will be 
less painful. So I am going to tell anyone who will listen."

That denial is something Kim deals with constantly. "People are dying 
here in droves, and people are embarrassed. We are a small town. 
Appearances still matter. When you fail here, people look at you funny."

But even those who appear to have done well can fall prey to drugs. 
Matt Miller, 28, is from a family with working parents who are not 
rich, but not poor either. He was captain of his American football 
team, did well in high school and won a prestigious college 
scholarship. For his first few years in college, he did well. Then he 
hit a rough patch. He got stressed and depressed. Roommates had pills 
and so he drank and took pills.

A few years later, unable to find his favourite pills, he turned to 
heroin. By then his life had become defined by the need for drugs. 
Lying, stealing and cheating followed.

He cleaned up, after many failed attempts, with the help of his 
mother, Jennifer, who was herself changed by the process. "At first I 
did all the wrong things, tried tough love, but it didn't work. It is 
not the way to do it. You have to be realistic about what the person 
is going through," she says.

Matt has now been free from pills for more than a year, and counts 
himself lucky. His nephew and best friend, Jared, started using pills 
at the same time. In May 2013, Jared overdosed on Roxicodone, 
becoming one of the statistics that has turned eastern Tennessee a 
darker shade of death.

The loss of hope can be seen in economic numbers, like falling wages, 
or the number of factories and mines shut. Yet there are other 
equally painful changes that are hard to measure. How integrated are 
people with the community? Do they feel a sense of place, of 
belonging, of enthusiasm for the future?

The tight social structures that once defined central Appalachia gave 
way to the ordinariness of strip malls, franchises and disposable jobs.

In Kingsport, the crowds and energy are on the new street filled with 
chain stores, not the historic district. On my last night in town, I 
sat at a local bar. A young woman came in, sat on her own and ordered 
a large margarita. She downed it quickly and ordered another, and 
another, talking to everyone at the bar and looking at her phone. 
Despite her getting drunker and drunker, the barman kept smiling and 
serving her.

As I paid to leave, the barman asked me why I was in Tennessee. I 
said it was to write about addiction and heroin. He nodded politely, 
and as he was making the woman's fifth margarita, told me of his 
friend who had become lost to drugs. "It is awful here. So many 
people on pills. And now heroin. I just don't know why anyone would use it."
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MAP posted-by: Jay Bergstrom