White corflute flags in varying stages of decay were raised across the hill overlooking Marcum Terrace, a public housing estate sunk in the south of Huntington, West Virginia. Many surrounding residents have surrendered their near-worthless properties and left town, but for those who live in Marcum, rows of brown bricks distinguished only by their red peaks, death is the most prolific escape route.
Nearby, a tilting house has ‘Dead inside—do not block driveway’ spray-painted on the boarded-up garage; a family of three sold ancient appliances, Christmas decorations and a spice rack on their front lawn; a family of four a few doors down bought drugs from an old black car pulled up outside their house.
‘Welcome to the opioid capital of America!’ the enquiring shopkeeper of a battered old store half-laughs. He sells beer, candy and the Herald-Dispatch, the local paper for the tri-state area, the corners of West Virginia, Ohio and Kentucky, separated by the sinuous Ohio River, conjoined by their status as the forefront of America’s opioid crisis. The day’s top story was a 52-year-old pharmacist pleading guilty to providing prescriptions for hundreds of the high-strength opioid OxyContin, for $200 a pop, at the Unique Pain Clinic she ran with her 82-year-old father, who had already pleaded guilty to the same offence.
One in four people are addicted to opiates or heroin in Huntington, population 48,000. Marcum Terrace was infamously the site of 27 overdoses in five hours last year, when a batch of heroin laced with Carfentanil, an elephant tranquiliser 10,000 times more potent than morphine, was brought to the neighbourhood by a new dealer. ‘It used to be that you knew someone down the street from you was on drugs,’ a local pastor told me, ‘now everyone knows someone on drugs in their family.’
The sun had arrived with the weekend, a gift following a freezing week of mid-spring sleet; the wrens and warblers were out celebrating, the blossoms would join them only a few days later. The year’s weather turned on a dime this Saturday afternoon, but almost every house in Marcum and the streets of south Huntington has closed doors and shuttered windows.
The ubiquitous ‘no trespassing’ sign slapped on rusted fences of what felt like every second house was the height of emotion, and a kind of local insignia, but there was no mounting rebellion here. Huntington has capitulated to agony: the facade of despair and isolation, the portrait of American emptiness.
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The defining text of modern American ruin isn’t the Bible or the Second Amendment, but the Diagnostic and Statistical Manual of Mental Disorders, known as the DSM. With a large amount of funding from the pharmaceutical industry, the DSM was updated in the late 1990s to include pain as the ‘fifth vital sign’ of acute conditions. And the industry had a solution.
In 1995, Purdue Pharma had invented OxyContin, an ‘addiction-proof’ medicine that bound pain receptors in the brain to numb them, purporting to herald a new era of pain management, 12 hours of relief that would change lives. As jingos were rolled out to doctors along with significant financial incentives to prescribe Oxy—‘It’s Bonus Time in the Neighborhood! Get in the Swing with OxyContin!’—it should have been apparent within months that the drug’s foundations were marketing, not medicine.
‘Before they came out with Oxy, everyone had a bit of pain,’ says Terry Collison, director of Huntington’s First Steps Recovery Centre, ‘but no-one expected to be miraculously cured of it. And they then they did it all legally.’
Between 2007 and 2012, West Virginians consumed 780 million OxyContin and Vicodin pills, collectively known as ‘hillbilly heroin’. As deaths from opioids were burgeoning, dosages were increasing, from 5mg tablets up to 30mg; as the prevalence of addiction was becoming highly apparent, the CEOs of the three biggest drug distributors were pocketing more than US$100 million a year in salaries and bonuses. The head of McKesson, one of the major companies, became the highest-paid CEO in America. The Sackler family, outright owners of Purdue, became the fourteenth-richest family in the country.
The political class was paid off, with at least US$4.4 million going to Republicans and US$2.6 million to Democrats in House races in the primary and general elections alone last year. The Pharmaceutical Research and Manufacturers of America, the industry’s primary lobby group, has put together a US$100 million war chest for this year alone to fight restrictions on opioids and the regulation of drug prices. Appalachia may be the front line of the crisis, but it is spreading across the nation. More than 90 Americans are dying each day from opioid overdoses, closing in on 200,000 this century—far more than are dying by gun violence. The most common group of those dying are aged 45 to 54.
• • •
There were 86,000 people living in Huntington in the 1950s, a key railway and port for the state’s coal industry, now another part of the larger tale of Midwest industrial towns emptying out over the past few decades. Huntington’s streets host thousands of sighing, abandoned houses, often barely distinguishable from the occupied ones. There are no marauding gangs, pickpockets, ‘no-go zones’ or gunshots at night. The homeless living outdoors are gathered in tents on the river bank, booby-trapping their little patch with fishing-wire lines and dogs, only wanting to be left alone. Violent crime has decreased steadily since the 1980s. For all of Huntington’s troubles, there is an almost disturbing lack of the sinister.
‘We get ’em in here to love on ’em,’ says Terry Collison in her office at First Steps. The drop-in centre is for people addicted and those recovering, ranging from teenagers to the elderly; a place to drink coffee, watch TV, play games, come down, or get away for the many people who live in halfway houses or squat in the empty shells around town. ‘Those houses’, she sighs, ‘are a different type of alone.’
Luke, 36, has lived in Huntington all his life, from when the drug runners from Detroit to Atlanta first realised there was fertile ground almost exactly halfway between them. A kind of big brother at First Steps, he is in the latter stages of drug court rehabilitation. ‘This is our family now, our community,’ he says, noting he recently left his wife of 14 years because she can’t stop using. ‘I’ve been in and out of jail for 18 years, I’m getting 25 to life if I’m going back,’ he says. ‘First thing you gotta change is people, places, and things.’
Part of his new family is Lezlie, 23, who has never known anything outside the horror. ‘I’ve been an addict since I was 12 years old,’ she says, as she shows me her tapestry of tattoos, coating her skin from just below her jaw down to her toenails. ‘Tattoos have become the new coping mechanism for me, a place to sit and be quiet with my thoughts,’ she says, having been clean for three months. ‘After my baby died,’ her voice fades, ‘it’s been my only thing.’
Lezlie grew up in McDowell County, south of Huntington, a place so desolate that even Walmart has left. Like almost everyone in West Virginia, Lezlie had family who had worked in the mines, ‘but I grew up in a drug-addicted home—parents, aunts, uncles, that’s what was done.’ She moved to Huntington when she was ten. It was then that ‘mum gave me my first Oxy’.
• • •
Plagues are the things of higher powers, and what has reigned down on Huntington over the past decade is corporate might of the most heinous kind, in a place where everyone is supposed to be free.
Appalachians have long been characterised as wild, isolated people, and in turn they have been treated with indifference and brutality. In 1921 some 10,000 coal miners took up arms against strikebreakers and law enforcement in the Battle of Blair Mountain. Their fateful nine-day stand was the largest insurrection in the country since the Civil War. The miners’ legendary solidarity in the following decades saw writers John Dos Passos and Edmund Wilson come to bear witness. Workers across the state fought for ‘gold plated’ healthcare over pension plans; black lung was a standard, early death. Despite more than a century of antagonism between bosses and workers, nothing could prepare them for Wall Street’s arrival in the early 2000s. ‘There was a concerted effort by coal operators to break the union,’ says Phil Smith, director of the United Mine Workers of America.
Workers were no longer able to speak up about their own health and safety issues. Then they went after health care benefits. People began getting hurt more, and being prescribed these new drugs to cope—and there was no mechanism in place to help them get off, there was no longer a robust health care arrangement. The pharmaceutical companies saw a ready market, and they colluded to flood it.
Meanwhile Wall Street dealmakers were squeezing, stripping, flipping, indebting and pillaging the coal companies for more than the stuff in the ground was worth. Corporate executives, often with no experience in the industry, banked on a continuously rising coal price. When it tanked in the mid 2000s, mines were bankrupted and abandoned, companies folded. It was the workers who eventually paid, owed hundreds of millions of dollars in health and retirement plans, with no entities to pay them.
• • •
In the waiting room of the police station, Brad, 24—another native with a family crest emblazoned with black lungs—asks what the hell I’m doing here. I ask his opinion on the question no-one can seem to answer: why Huntington? ‘Honestly, I think it’s cos we’re so poor. There’s no jobs here, people go through the programs and then they got nothin’ to do. Most offenders just wind up offendin’ again.’ He turns his attention to two middle-aged women sorting out parking fines at the counter, asking them straight up if they have any pills.
‘I got the blue and the yellow, 10mg,’ one replies.
‘You got any white? Less tylenol in them—yeah, they’re good—you could bank if you wanted to,’ Brad replies. ‘Yeah, you could really bank,’ he says again into the airless room, as an officer opens the door and calls him in. ‘I don’t care what you say, I didn’t do it!’
‘We’ve got witness statements, Brad.’
When I go out on patrol with Constable Miller, who fell into policing three years ago after training as a nurse, he says they see overdoses almost every day, adding that the officers know they are now thoroughly desensitised to witnessing the dead and dying. ‘I don’t socalise in Huntington any more,’ he says as we drive past empty bars in the main street. ‘Just keep seeing too many people from work.’
As we drive around, he stops to introduce me to frequent offenders, such as Harley (‘he’s always good for something on him’) and Stephanie (‘one of our most well-known ladies’). It’s small-town, polite, Midwesternly—there are jokes, enquiries about Stephanie’s father’s health—but back in the car it feels like we’re out hunting for sport. ‘Sometimes we don’t even get to ’em, they just go straight to the hospital,’ he remarks of overdose victims.
The city code on intoxicating substances makes overdosing effectively illegal, so police can issue an arrest citation, effectively a fine of US$80, which, if left unpaid for two weeks, triggers a warrant for their arrest, and a minimum of three days jail. Almost no-one pays the fine.
Donald Trump murmured campaign platitudes about solving the opioid crisis, and even gave the task to son-in-law Jared Kushner—along with Middle East peace. So far it’s been a friendlier political problem, couched in its white, regional, despairing-class terms than the crack epidemic was to the black inner cities. As though enough people weren’t dying on the frontlines of the crisis, Attorney-General Jeff Sessions—famous for once saying that he thought the Ku Klux Klan were ‘okay until I found out they smoked pot’—announced a renewed effort in the war on drugs. ‘Prosecutors should charge and pursue the most serious, readily provable offense,’ his May memorandum reads, instructing prosecutors to enforce mandatory minimum sentences. He made his announcement in Charleston, the capital of West Virginia.
The war on drugs never saw much of a ceasefire, so it’s terrifying to think what will become of the Lezlies of America, non-violent criminals who will likely be stripped of the chance of rehabilitation they have now. America has already emptied its black men into the prison system, now female incarceration has begun to surge. Undocumented Latinos are easy targets, the Trump administration so far having shown less inclination than Obama to deport them.
Sessions has reversed the Obama administration’s attempt to phase out private prisons, which collectively make hundreds of millions of dollars in profits each year and donate very handsomely to political candidates. The two major private prison corporations have seen their stocks soar by more than 100 per cent since Trump’s election. Most importantly the prison system, both public and private, provides low-cost labour. Companies such as McDonald’s and Bank of America pay inmates a few dollars a day for their labour, which in turn gives those inmates basic privileges.
It costs $25 a day to put someone through a program of intensive homestay rehab in Huntington, around $70 a day to put them in prison. A Sessions-led enforcement binge would provide the prison system with a whole new caste of the poor, unemployed, poorly educated, thoroughly broken people of the Midwest—‘my people’, as Trump likes to call them—who were in all likelihood already too disenfranchised to vote at all.
• • •
Luke, Lezlie and I sat wasting another day at First Steps watching Storage Wars, a reality show where contestants gamble on the resale value of repossessed goods. Endless ad breaks seemed to feature only medicines for chronic conditions and life insurance, displaying the circular horror of nothingness in the long industrial hangover.
Identity today is formed around the cable news channel you watch, the place you buy your coffee, not your job or your community; for the poor and disaffected of the Midwest, their mode of consumption is administering pain relief behind drawn shutters. Huntington is as close as we’ll ever get to the mythical Middle America, because it is the epicentre of decay in life after the American century.
Wages have stagnated for 30 years; meagre welfare benefits are cyclically reduced and denied. Public-housing lists are being closed as they are simply decades too long, while living in cars or on the streets is increasingly criminalised. Pregnant women are incarcerated at alarming rates, and churches known to aid undocumented migrants are raided by immigration agents. Millions of sick people forgo medical treatment due to the expense. Life expectancy is decreasing.
Yet Luke doesn’t want to entertain any suggestion of a system designed to keep them down. ‘It’s not anyone else’s fault what I do,’ he says. ‘At first we do blame everyone for our problems, but when we’re recovering, we find our part in everything. I have no-one to blame but myself.’
He is enchanted with the Narcotics Anony-mous program, and still attends daily meetings that instruct its members in spiritual guidance and individual responsibility. All of the rehab programs in Huntington are based around the Anonymous system, despite evidence showing that at best 8 per cent of participants stay sober. Ironically, pharmaceutical programs supervised by doctors have been shown to be far more effective.
Of course, addiction can only be solved by the self, but as the language of personal responsibility echoes around the room in First Steps, where most people can’t get a job or a place to live, it’s difficult to escape the thought that while everyone is busy just surviving, there is no chance to take on a system that a study by Princeton and Northwestern University academics recently declared has moved from democracy to oligarchy.
• • •
Migration has always been integral to America. Last century saw 5 million flee Jim Crow for relative safety in the north, while the depression dustbowl saw starving farmers descend on California. Today, people are moving less than ever—but the places they are leaving are centres of hopelessness in the former rust belt. Anyone with capital or good fortune is fleeing to the coasts, carving out value like mountain coal, leaving the residue of a hollow, impoverished interior. Upward mobility could now be simply described as the opportunity to leave.
What happened in November was not the start of a new era but the rupturing of entrenched decay. Voting decisions are manifold, but the swing of the rust belt states was undoubtedly responsible for the election of President Trump. America has withered inside, its prosperous coastal cities are another country when compared to a heartland without a pulse and demanding to draw the shutters and withdraw from the world.
Lezlie has only ever left West Virginia twice, on drug runs to Detroit and Ohio, but once her ankle bracelet is removed she intends to move with her daughter to a new town, to try to escape the only life she has ever known. People around her keep dying (one friend died of an overdose while I was there, just days after the second anniversary of his sobriety, graduating from his residential rehab program and renting a place on his own).
A grim echo of that other political system of the twentieth century, Lezlie is the new American citizen, the socioeconomic system being reproduced in the character of the people. She is terrified of state discrimination and violence (‘My daughter is biracial,’ she says. ‘I’m scared I’ll have to explain to her that something happened to her dad.’) As a convicted felon she is not allowed to vote, her education and social status leave her only the most menial of employment opportunities, such as minimum-wage fast-food jobs paying US$7.25 an hour, with no health cover. She will have no rights as an employee, but be expected to pick up and move whenever and wherever work becomes available.
She will be subject to continuous surveillance, such as drug testing, for minimal welfare. She will be constrained by psychic borders in a country that tells her she has no right to success. Her only options in the post-American century are as a consumer or a sinner; her only value is as an empty vessel occupying the wasteland of what she, and all of us, were told is history’s conclusion.