Opioids ravaged Appalachia. I’m one of the survivors

I want to write about the first time I did a pill. It was a turning point, one of those things you’ll think you’ll never forget. But I can’t. I don’t remember. I don’t remember any of my first-time meetings with drugs except for OxyContin. 

It was my junior year of high school and OxyContin was showing up everywhere, in the hallways at school, parties on the weekend and in medicine cabinets all over central Appalachia. I was with my cousin Eric, who was like a brother, the first time I did an OC. It was fall and we were riding around in the hills when we came across a mutual friend. He was eager to share. OxyContin was unlike anything else. At that time people were excited to introduce anyone they could find to this new drug. We sat in the cab of his truck and split a 20-milligram pill between the three of us. And I knew right then that’s all I ever wanted. If I could feel that way for the rest of my life, everything would be okay. It would become a never-ending cycle, with specific memories sticking out more than others when I look back, but the first time is groundbreaking, life changing. 

I was the senior class vice president of my high school. When I graduated in 1999, I left with a GPA higher than 4.0. I was a tennis stand-out. I was not supposed to be a drug addict. 

But that’s exactly what I became. In 2002, after my third failed attempt at college and living away from home, I returned to eastern Kentucky — and I had no way of knowing what I was coming home to. Over the past year and a half, I had no communication with my friends in the region. OxyContin was everywhere. People I had known my whole life who would have never considered drugs were now full-fledged addicts. 

By that time, the effects of Purdue Pharma’s aggressive marketing campaign were evident all-over eastern Kentucky. In a region plagued by high cancer rates and chronic pain patients due to the physical demands of the coal industry, the numbers for non-OxyContin opioid prescriptions were 2.5 to 5.0% higher than the national average. This was how Purdue Pharma decided where to spend its marketing dollars. During this time, pain became a vital sign, and there were trends to liberate the prescribing of opioids to treat general pain. Purdue Pharma targeted physicians with high opioid prescribing rates and courted them like it was Saturday night. They implemented a patient starter coupon program for free limited prescriptions up to a 30-day supply. If that doesn’t reek of a corporate attempt to get people hooked, I don’t know what does. This was a tactic that street dealers had used for years. But when you put on a suit, and it comes from a pharmacy, people are slower to catch on. By the time the program ended, 34,000 coupons were redeemed. 

The line between nothingness and death is thin. Using is figuring out how much to take to find a magical state of equilibrium. My goal was to find a state of being so far away from living that my only function left was breath. Complete numbness of the body and mind, a shutdown of all parts of my brain that react and obsess over the outside world. The anxiety and obligations quietened as the brain was flooded with feel-good chemicals. 

Immediately I was in a world of possibilities, flooded with boundless energy and no fears. All the social pressures and uncertainty lift. I am exactly who I want to be with no reservations. I liken this to waiting in line for a rollercoaster: Hours of anticipation and achy legs for a three-minute rush. 

But for a brief moment, every day, I was balanced. I would find a job and get out on my own, out from under my mother’s watchful eye. I would finish that degree I had started a hundred times. I would get clean once and for all. This would be it. I didn’t need drugs; I wasn’t like everybody else that cycled in and out of here. I realized my potential. They were just junkies. But in the end, every day would bring the same pain, the same guilt, and shame that would drive my addiction forward. I would chase that relief from myself for as long as I could. I longed for the day that some contentment could be achieved without using chemicals. To move through the world as others do.

The opioid epidemic has been called “the deadliest drug crisis in American history.” Of the 105,000 people who died from drug overdoses in 2023, nearly 80,000 deaths were attributed to opioid abuse. I’m one of the lucky ones.

After years of active addiction and struggle, I finally found recovery through rehab and working the 12 steps. I’m now a small business owner in Hazard, Kentucky; I run a small independent bookshop called the Read Spotted Newt, which fuels my creativity and offers me a way to make amends to the community I abused for years. 

Representation is critical to finding your place in the world. I strive to curate a collection geared toward young readers growing up in eastern Kentucky so they have access to stories in which they can see themselves. In a world that often demoralizes rural Americans, and Appalachians in particular, it is imperative that we understand the value of our experience. For me, this is the antidote for the shame we have been taught to feel about our region.  

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We have been given a unique opportunity to right the wrongs inflicted by the pharmaceutical industry. As part of a national settlement that includes opioid distributors and manufacturers, opioid abatement settlement funds are being distributed among the hardest hit areas of the country. Kentucky will be awarded more than $900 million dollars over the next several years. Through my work with the Sycamore Project at the Foundation for Appalachian Kentucky, I’ve made it my mission to ensure that communities and those who have been directly impacted are aware of the funding opportunities, with the understanding that this is blood money and they have a right to be in the room where decisions on spending are being made. This money cannot be used for enforcement, because we know that policing our way out of this problem hasn’t worked. Instead, it will be allocated for treatment, prevention, harm reduction and research. 

Now, from my window at the bookshop on the corner, I see people like him every day. I wonder if he has a home. I wonder if he has anybody who cares where he’ll sleep tonight. That’s something that’s changed since Eric’s been gone. The homeless population. We are at least two, in some cases, three generations deep in the opioid epidemic. People have lost their family homes, and there’s no one to fall back on when times get hard. People are living on the streets, and the faces change every day. We make eye contact, and he reaches for the door handle. He stops outside just short of the door and finishes his cigarette, folding a bandana into a makeshift mask. His clothes are clean, and he’s wearing a backpack. I’m cautious, and that makes me feel judgmental. Right away, he comments that I sell Ale-8-One, an iconic Kentucky soda. “I like this place already,” pointing to the mini-fridge. 

The silence sits between us awkwardly. Struggling to make eye contact, I notice his hands are red and swollen. It’s unseasonably warm, so he’s wearing a T-shirt. I can see knots under the skin in the bends of his arm. We strike up a conversation about a Tom Petty book. He throws out the term “memoir,” which catches me off guard. He tells me about the daughter of a woman he’s been staying with, how she’s an artist. Would I consider hanging her work in the store? He knows she’s good because his girlfriend has her paintings hanging around the house.

I wonder what her house looks like. I see it with a mattress on the floor, clothes thrown about, scarcely furnished. And then there are the paintings and canvases, too small and oddly proportioned compared to the wall. I agree to give her a shot and some space in the store to sell her work. Maybe that’s what she needs. I go back to his use of a literary term for which I didn’t give him credit. He tells me he wishes someone had helped him. He wishes for a do-over. I can see myself where he stands today. I had that chance. I had that do-over. 

I think about Eric — how long he’s been gone, how he was robbed of the benefits of aging and hindsight, how he lives on through my work. How a do-over would have been impossible for him with everyone around him still using. There are a lot of tough decisions in those early years of recovery. Staying away from people you know and love, opening yourself up to strangers, and learning to trust. Trusting when you haven’t been able to trust anyone in years. Maybe you’ve never trusted anyone at all. 

Early on, I stayed clean to please everyone around me. Many people invested time and resources into my recovery, and I didn’t want to disappoint them. I was so tired of letting people down. The people-pleasing kicked in because it’s all I’ve ever known. I had to be good and do good so they would love me. At some point, though, I started staying clean for me. I wouldn’t sabotage myself for fear of failure. I’d trust the process and relinquish control. The days got easier.  

I should have been nervous, maybe apprehensive, that he was here. He picked up a Stephen King book and told me his favorite serial is the “Green Mile” series. I can tell he’s a reader. Probably like a lot of other addicts, the type of personality that becomes obsessed with hobbies and new topics. The kind that becomes so passionate that they must learn it all. So talented and so sensitive. 

I’m curious how often he wants to look around inside. I wonder if he’s only here now to escape the rain. 

“How much for this one?” he asked as he held the Tom Petty book in his hands, carefully rubbing the cover. He begins flipping through the pages.

“$28.95,” I say as I go over to show him some cheaper paperbacks I have in stock. It’s presumptuous of me to think he doesn’t have the money for that book. Instead, he decides on an Ale-8 and an “Odyssey” button for his backpack. His wallet is worn black leather and is connected to his belt by a chain. He digs around until he finds a folded 20 deep in a side pocket. I wonder how long that 20 has to last him. As I ring him up and begin to make the change, he tells me about joining LinkedIn because the job market around here is so tough. 

“Already found me one that pays people to write reviews about hunting equipment,” he looks up and makes eye contact when he begins to talk about writing. 

“It’s only 400 words weekly, and you can work from home. Sounds like a dream gig to me.” I can hear the tone of his voice shift. 

I hand over his change. He doesn’t seem to notice that I didn’t charge him any sales tax. I’ll eat the 20 cents. 

I hate that he is 44, and this could be it for him. Bouncing around from couch to couch, putting needles in his arm, and having to love everything from afar. I wish I could buy that Tom Petty book for him. I wish I could give it to him with no repercussions. As he turns to go, he says he’ll be back to support small businesses. He likes having something like this downtown. I wish there were a way I could do something to help him. But out the door and up the street, it’s pouring the rain, something I seem more concerned about than him. I’d like to know if he’s read “The Odyssey.”

Thirty years later, we are still learning how to navigate this epidemic. Gone are the old adages of tough love and hitting bottom. Now we approach this disease with community — with meeting people where they are. That’s why it’s important for me to live my recovery out loud. To give hope and instill empathy in those who are tempted to give up the fight. In the words of bell hooks, “rarely if ever, are any of us healed in isolation.”