“It started when I got injured in a football game.”
“It started when I was trying to move a bookcase in a house I was cleaning. It fell over and broke three bones in my hand.”
“It started after my hernia operation.”
These are some of the stories I heard when I sat down in the early 2020s with people from Appalachia who were in recovery, or in active addiction with the hope of recovery still ahead. I wanted to write a novel about the epidemic of opioid use disorder that was tearing apart the place and people I love.
My first job was to listen: How does this happen to working people, mothers, high school athletes, none of whom imagined the hell that lay at the bottom of their first bottle of painkillers? Some started as kids, messing around with the stuff that showed up wherever they turned. Others were following a doctor’s orders. Some didn’t understand they were addicted at first. They only knew they needed a renewed prescription after the first one ran out, because they felt sicker now than they’d ever been in their lives.
As a member of the first War on Drugs generation, I was taught things about addiction that I’ve spent years unlearning. The government’s long campaign of selective incarceration and punitive propaganda sent officers into schools to tell us that bad people brought addiction on themselves when they didn’t have the gumption to “just say no.”
I’m shocked now at the cruelty of blaming illness on moral failure. Imagine telling children that pneumonia comes from weak willpower, or that a family member should be kicked out of the house for having cancer. Addiction alters the brain and body to become disastrously, even fatally, sick if the substance is withdrawn. It’s a condition nobody has ever asked for. Like any other disease, it can be treated medically, and also, importantly, with compassion. Where sympathy is withheld, resources for care do not flow.
Most of us now know how this plague arrived in Appalachia. Pharmaceutical companies studied the metrics and pointed to my corner of the map as a gold mine. Where work injuries are common and medical care is stretched far too thin, where centuries of extractive industries have taken out timber and coal and left behind broken infrastructures and folks of limited means, these companies found one more lucrative thing to harvest: our pain.
Most of us also know about the lawsuits against Big Pharma that forced changes in how painkillers are marketed and prescribed. Please do not think this means justice has been served. If you came to visit me, I could walk you down our country roads and point out all the houses where grandparents are raising little ones whose parents are incarcerated, sick or dead of addiction. The road to recovery here will be longer than my lifetime. Of all the stories I heard when I sat down to listen, the hardest to bear was this one:
“It started when I was in my mother’s womb.”
