Updated: Jul 22
Drug addiction is an issue that continues to draw clear geographic, political, and class distinctions in the US.
Since the opioid epidemic began garnering national attention a few years ago, many of America's most prominent media outlets have devoted resources to covering it. Editors send their best writers into the most broken communities in rural America in an attempt to humanize the crisis that is stealing lives at an alarming rate. However, until we acknowledge the root causes of opioid abuse and addiction in rural communities, and admit our inherent biases toward the people who suffer most from this crisis, we stand little chance of ever solving it. More importantly, until Americans decide that poor, broken, and addicted people matter, nothing will change.
I have written previously about my own family's struggle with addiction and about the ways major pharmaceutical companies benefit from our heartbreak. Like most people who live in Appalachia, the opioid epidemic is personal for me rather than abstract. Members of my family have lost their lives and their livelihoods to opioids. However, no matter how many of us write our own stories, and no matter how many talented journalists come to our communities to write about the gravity of the opioid crisis, it seems impossible to push policy makers to actually do anything about it.
Members of Congress, both Republican and Democrat, give lip-service to the opioid crisis, but judging from their actions, it seems pretty clear that none of the elected officials in D.C. give two shits about a problem that primarily impacts rural white trash. Even those who represent the communities hardest-hit by the opioid epidemic offer little more than meaningless tough language and the standard "thoughts and prayers" rhetoric. Those thoughts and prayers aren't worth a damn to the people in rural America who are losing their family members to drugs, particularly when those offering said thoughts and prayers actually have the power to work toward meaningful solutions.
There are three important problems at play in the way Americans and American lawmakers are seemingly lethargic in their response to this crisis. First, while opioids ravage many rural communities, a few individuals and corporations are making billions by selling their poison to those who become hopelessly addicted to it. Second, there remains in the US a pervasive notion, despite reams of evidence to the contrary, that addition is simply the result of stupid people making poor choices. Finally, because the opioid epidemic largely targets poor and rural areas, there's less urgency on the part of urban elites to advocate for solutions. Taken together, these three problems are indications of why policymakers seem to have little interest in helping those whose lives and communities are being ruined by opioids.
I call these simultaneous processes the "white-trashification" of the opioid epidemic. For most Americans, the problem is a distant one. Those on the political right tend to attribute blame to the addicts, and those on the political left tend to think of it as a problem that affects primarily rural Trump voters who liberals perceive as voting against their own interests and therefore too ignorant (or hateful or racist) to care about. In both instances, the victims are perceived as white trash whose lives and stories, let's be honest, are not always important to Americans. As Nancy Isenberg's book White Trash: The 400-Year Untold History of Class in America indicates, those on the lower end of the socioeconomic spectrum have existed outside the mainstream of American life for generations. So long as Americans can continue to "other" those suffering from the opioid epidemic, in the same way they've always "othered" white trash, there exists little hope of relief.
I realize that "white trash" is a loaded and caustic term. Last summer, I wrote an essay titled "Blessed are the White Trash," and since the publication of that essay, I get emails regularly from folks who are upset about my use of the term. I understand the raw emotion attached to that term more than most people. I grew up white trash. When I was in school, other kids picked on me because of my white trash status. Largely because I grew up in this environment, I developed imposter syndrome. I let other people convince me for much of my life that, because I came from poverty, I would never be as good as everyone else. I continue to use "white trash" because I know firsthand what a powerful term it is. I want to take ownership of it, turn it around, and show those who continue to use it in a hurtful manner just how hateful and despicable a concept it is. I believe that words mean things, and I continue to use these words because the phrase "white trash" is more meaningful and powerful than any euphemism for the concept could ever be. Because of the power of this term, and the psychological baggage that comes with it, I believe it is important for us to explore the white-trashification of things like the opioid epidemic.
The first part of this white-trashification process involves the influence and power of the corporations that manufacture and distribute opioids. I have a fundamental mistrust of large corporations in part because I have devoted my career to studying the problematic nature of power structures in global history. Primarily because of the role of prescription drug manufacturers in the opioid epidemic, I have a hard time conceptualizing drug companies as benevolent providers of miracle cures. Sometimes, they do important work. Other times, though, they are simply predators, preying on sick and broken people for the sake of profit. Purdue Pharma, in particular, engages in a brand of evil that should shock our sensibilities. Their popular painkiller Oxycontin has caused more heartbreak and death than perhaps any legal drug in American history, and Purdue has been shamefully responsible for getting people hooked on the drug.
Purdue and other pharmaceutical corporations have lawmakers on their side. They pay their political dues, and the result is that these politicians continue to avoid cracking down on Purdue for poisoning communities and killing Americans with their products. Often, Purdue gives money to lawmakers whose own constituents are dying from Oxycontin. For example, in the 2016 election cycle, Purdue wrote a check for $10,000 to one of my senators, Richard Burr. Thousands of Burr's constituents in rural North Carolina have died from Oxycontin, but addicts lack political clout. Realities like this lead me to have little hope that lawmakers will crack down on the pharmaceutical companies who are responsible for fueling the opioid epidemic with deadly addictive products and aggressive marketing practices.
The second part of the white-trashification process involves the unfortunate and widespread blaming of the victims whose lives are destroyed by opioids. Every time I write about the opioid crisis, people leave comments on my social media posts blaming addicts for their addictions. These comments infuriate me, because I can't help but think that they usually come from people who have never been willing to understand the world as addicts experience it. They come from a place of mean-spirited disregard for human suffering. These people believe that addiction is a moral failing, not a disease. These people are wrong. As David Sheff demonstrates in his book Clean: Overcoming Addiction and Ending America's Greatest Tragedy, science should be at the heart of how we treat addiction in the U.S., and viewing addiction as a moral failing rather than as a disease defies the science of addiction and recovery.
Because opioid addiction disproportionally targets the rural poor, it is even easier to dismiss these suffering humans as white trash and attribute their woes to their own stupid choices. This line of thinking offensive and out of touch with scientific fact, and it also conveniently ignores the fact that most of the individuals who are addicted to opioids first got the drugs from medical professionals who prescribed them legally. This reality reveals a troubling blind spot in the way healthcare professionals treat pain. While there certainly exists a genuine need to prescribe opioid painkillers, we must decide where to draw the line between treating legitimate pain and exposing individuals in pain to dangerously addictive drugs. Particularly since opioid manufacturers were often dishonest with healthcare providers about the addictive nature of their drugs, it is long past time for hard and serious conversations about limits on these powerful drugs.
The final part of the white-trashification of the opioid epidemic combines this victim-blaming mentality with the reality that most victims of the opioid epidemic live in impoverished rural areas, isolated from urban centers. While opioids are an equal-opportunity poison, those in urban areas and those from households of elevated socioeconomic status have plenty of financial and healthcare resources to treat addiction. Those who live in rural communities lack both the healthcare infrastructure to treat addiction and the financial resources to pay for recovery treatment. When those who live in urban areas see family members and others in their communities struggling with opioid addiction, they often also see the plethora of resources available to addicts from affluent families or locales. It is easy to assume, then, that those in rural areas might also have access to readily-available treatment. This is not the case.
This chasm between rural and urban Americans also reveals a widening divide in political ideologies between those in urban areas and those who live in rural communities. Stereotypically, urban areas are blue and rural areas are red. The electoral map from the 2016 election indicates that this is generally the case in recent years. Accordingly, an increasingly bitter view of urban liberals toward rural conservatives can potentially influence the way those in urban areas view those who suffer most from the opioid epidemic. Even when top-notch media outlets send reporters to rural communities to personalize and humanize the tragedy, it is easy for left-leaning urbanites to write those struggling with opioid addiction off as Trump supporters, and, therefore, intellectually and culturally unequal. As we continue to struggle in the U.S. with polarized political views, it becomes even less likely that left-leaning urban-dwellers will develop enough sympathy for right-leaning rural folks to advocate aggressively on their behalf. That being the case, then, the only advocates left for many conservative rural Americans, apart from themselves, are their elected representatives, who are almost exclusively Republicans bought and paid for by big pharma.
Though I have little faith that urban Democrats and rural Republicans will ever understand their shared values, I believe one of the keys to addressing the opioid epidemic is for all Americans understand the nefarious nature of those who perpetuate the cycle of addiction, even when those responsible wear expensive suits or white coats. The problem is perpetuated by greedy corporations and by unethical doctors who run strip-mall pain clinics. This should piss Democrats off regardless of who the victims are. However, the political left has shown very little regard for rural America in recent years. This blind spot, incidentally, is one of the leading factors in Donald Trump's electoral success. I also hold little faith that rural Republicans will ever understand that the people they send to D.C. to represent them actually represent the interests of wealthy donors who see rural Americans not as people to serve but as profit centers to exploit. To be elected, GOP members of Congress need only go to their districts, shout about how the liberals want to take away guns and murder babies moments before their birth, and ride the resulting wave of anger back to election. Similarly, urban Democrats need only yell about increasing inequality (while simultaneously doing nothing about it) and accuse Republicans of trying to rob people of healthcare. It is almost never necessary for either group to acknowledge the sufferings of those of different political leanings.
Despite these political impasses that inject the American political process with the a sort of stasis that guarantees no progress, some stark realities remain. In 2016, even though the prescribing rate of opioids had fallen from 2012 record highs, there were as many opioid prescriptions as residents in a full twenty-five percent of all U.S. counties. In some counties, there were enough opioid prescriptions for each person to have four prescriptions. Common sense should dictate that even in the sickest counties there should not be such a saturation of opioid painkillers. Any reasonable person should look at those statistics and know that something is broken. Yet, despite these stunning statistics and dire warnings from the Centers for Disease Control and Prevention, very little tangible action is being taken by the federal lawmakers who have the power to fix this mess. The opioid epidemic has become nothing more than another political talking point meant to fool voters into thinking that elected officials care about suffering humans.
As I said at the outset of this essay, until Americans decide that poor, broken, and addicted people matter, nothing will change. Recently, we witnessed the aggressive promotion of tax cuts that disproportionately benefits profitable corporations and the wealthy while Congress continued to refuse to provide funding for the Children's Health Insurance Program. If one is to interpret the political actions of the elected elites in the U.S. as an indication of which humans matter and which do not, then regardless of which party is in power, it becomes evident rather quickly that poor people simply do not matter. Therefore, Americans will continue to watch their neighbors die in record numbers and write them off either as addicts who should have made better choices or as rural white trash who should make better choices at the ballot box.