On the outskirts of Kingsport, Tennessee, Kim, a therapist, faces a small group of people sitting in folding chairs. She’s helping them rid their life of illegal drugs.
The attendees are all white and working class, self-described “dirt poor”, and none with college degrees. They have come to spend hours talking of past and present pains, offer each other support, and pee in a cup. If they pass the test, they will get their weekly prescription of Suboxone, an FDA-approved narcotic for opioid addiction treatment. Or as it is called on the streets, “fake heroin”.
Kingsport is where the Appalachians cross into eastern Tennessee. It’s a factory town cut in two by train lines and surrounded by hills. The few parts that are flat are stuffed with shopping malls, themselves filled with franchises. On maps, the area is mostly colored green for national forest, or brown for the hills. But on maps showing drug overdoses in the US it is dark red, the color used for the most deaths.
Fifteen years ago, the map of the US was all blue, with few deaths reported. Since then, deaths from drugs have doubled, and what was once a small isolated red spot in Kentucky has grown larger and darker, overtaking Kingsport and the rest of central Appalachia. The area has been overrun with a demand for illegal drugs, opioids and tranquilizers. 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 also 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.”