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United in Rage

Half-truths and myths propelled Kentucky’s war on opioids

The jail in Letcher County, Kentucky, is tucked away at the back of the courthouse in downtown Whitesburg, invisible to pedestrians except for an open-air concrete structure on the roof where prisoners are allowed to exercise. Its size—fifty-four beds stacked inside a space the size of a three- or four-bedroom house—reflects the size of the rural Appalachian county it serves. Its population, however, far exceeds its official capacity: on any given day, there may be more than a hundred people inside. “When I got to the Letcher County Jail,” says Emily Estep, a recent detainee, “they didn’t have any cells open, so they put me in a closet. Like a locked-in closet. It didn’t have a toilet in it. It was so cold, I was froze to death. . . . They came and got me like if I needed to go to the bathroom or whatever, but it was just very inhumane.” Local news reports corroborate her account. In July 2020, a woman detainee was found dead inside the Letcher County Jail; the cause of her death—whether from Covid-19, a drug overdose, neglect, or something else—was never announced.

Municipalities in this former coal mining area of eastern Kentucky have built or expanded at least half a dozen jails like Letcher County’s in the last twenty years. The reason is the drug war. Beginning in 2001, law enforcement agencies in the region poured millions of dollars into fighting one class of drugs in particular: prescription pain killers. This event is now known as the “opioid epidemic,” and every year it attracts a great deal of coverage and commentary in books, articles, documentaries, and even TV shows. These accounts all tell the same basic story, with the same characters. On one side are the villains: Purdue Pharma and other large pharmaceutical companies, drug sales representatives, “pill mill” pain specialists, and street dealers. On the other side are the heroes: primary care physicians, parents, civic and faith leaders, scientists, and law enforcement officials. The accounts nearly always frame the epidemic as a static battle of good vs. evil, the chain of events comprising it as a linear, causal path of injury and response. Big Pharma targeted places like central Appalachia because they were poor and deindustrialized, and opioids became rampant there for those very same reasons. In response to the influx, civilian heroes banded together to fight back against the villains, using their tools of community action and litigation.

Many communities were in fact torn apart by the punitive response to the epidemic, which came at a crucial moment in political and economic history.

While well-intentioned, this narrative is incorrect. Communities in central Appalachia did not band together to fight Big Pharma; many of them were in fact torn apart by the punitive response to the epidemic, which came at a crucial moment in political and economic history. Community activists targeted their own neighbors for punishment and labeled them public enemies, creating a social atmosphere in which recovery was nearly impossible. Thousands of people were disappeared into cages, some never to emerge again; if and when they did get out, they were often still addicted, or marked with felonies, and thus cycled back into what one public defender described to me as the “felony trap.” The result has been an epidemic not suppressed but inflamed.

Law enforcement in particular played a major role. Contrary to what mainstream accounts claim, law enforcement did not valiantly sound the alarm on growing opioid use. Rather, they cracked down on drug users with militaristic zeal. The municipal lawsuits brought against Purdue and other pharmaceutical companies provide stark examples. These lawsuits are often framed in the media as David vs. Goliath moral crusades, of the Little Guy fighting the forces of Big Corporate Greed. Some of them are indeed that: they seek to reclaim health care and treatment costs caused by the epidemic. But these suits are also compelled by the soaring costs of law enforcement and incarceration. A 2007 lawsuit brought against Purdue Pharma by Pike County, Kentucky, claimed that the epidemic had cost the county $7 million in bonds and severance money. Buried in news reports was the fact that, according to former Sheriff Charles “Fuzzy” Keesee, nearly 80 percent of that money was spent on the county’s 2005 jail expansion “to deal with the [opioid] problem,” and the lawsuit aimed to recoup those costs. Big Pharma flooded the streets with pills, but law enforcement chose to criminalize it.

And there are other characters in this story whose actions do not fall neatly within the hero–villain binary. Politicians, for example, who obtained funding for the drug war and crafted punitive legislation to support it. Civic leaders who naturalized the increasing militarization of their communities. Journalists who exaggerated crime statistics and contributed to a moral panic. Community activists and faith leaders who demonized drug users and taught school children to do the same. These were choices that people made at various conjunctures; at no point was the future inevitable. And yet eastern Kentucky is now a region profoundly changed by new jails, lives lost, and families severed. Someone other than just Purdue Pharma must therefore be made to answer for the long-term impacts of the “opioid epidemic.” Who those people are, how they implemented their visions, and why they felt compelled to do so are questions with implications that extend far beyond setting the record straight.

The Crime Panic

On the eve of OxyContin’s arrival in 1996, eastern Kentucky was in the midst of several crises. It was not just that the coal industry was going away but that other industries were rising to take its place, bringing with them a new working class. Extraction and farm industries that had employed mostly men were replaced by service and health care industries that employed mostly women, and this challenged prevailing structures of gender and work. It was also the case that these new industries could not provide the municipal tax revenues once provided by coal; they were not large enough, their wages and workforces incomparable to extractive heavy industry. The fiscal situation was further strained by the introduction of welfare reform in 1996, which shifted the formerly federal oversight of welfare distribution and job training to state and local levels. Municipalities were suddenly saddled not only with debt but social obligations they were unequipped to handle. The path ahead was therefore uncertain. Would the new economy initiate change at the political level? Would women demand greater representation in government? Would the very foundations of patriarchal society be overturned? All of these questions hung in the air, waiting for a spark.

UNITE’s task force became renowned for the flashy manner in which they arrested their so-called kingpins.

OxyContin was that spark. Most everyone is familiar with this part of the story: Purdue Pharma aggressively advertised OxyContin to the central Appalachian region, encouraging sales representatives to pressure and bribe doctors into overprescribing the drug to the region’s aging, debilitated workforce—a cheaper alternative to other forms of long-term care. Of the counties in the United States that received the greatest amount of opioids in 2000, 60 percent were in southeastern Kentucky. The effect it had on the area was world shattering in more ways than one. According to Dr. Kenneth Tunnell, a now-retired criminal justice professor from Eastern Kentucky University, prescription drug abuse in eastern Kentucky had historically been the domain of the upper classes, while the lower classes used alcohol and illicit drugs. “But OxyContin, unlike other pharmaceuticals, first took hold among working and lower classes and drifted upward into the respectable classes,” Tunnell writes. Another social inversion had thus occurred, as the drug transcended class and upended the existing order.

These destabilizing changes created an atmosphere of uncertainty and fear that was difficult for those whose social class had been disorganized by years of economic ruptures to make sense of. The political and media classes, on the other hand, wasted no time raising the simplified, reactionary specter of crime as both a metric of social change and a demand for action. According to the Boston Herald, OxyContin was “fueling a crime wave around the country, particularly in poor areas.” A news story from Tazewell County, in southwestern Virginia—cited by author Beth Macy in her popular account of the crisis, Dopesick—noted that, “between August 1999 and August 2000, 150 people had been charged with OxyContin-related felonies,” such as robbing pharmacies and stealing copper wire from abandoned mine sites. A Hazard, Kentucky, police chief claimed in 2001 that 90 percent of larceny crimes in the area were “to get money to buy OxyContin.” Former Kentucky Republican governor Ernie Fletcher published a study in 2003 that included the breathless claim that “OxyContin problems [are] overwhelm[ing] the law enforcement communities.” Many of these stories exaggerated stereotypes of Appalachian life in order to paint a portrait of a backwards region in the midst of a crime crisis.

According to publicly available data, however, there was no crime wave in Kentucky in the five years after OxyContin’s release, between 1996 and 2001. “Crime in Kentucky did not increase during that period . . . and violent crime rates were lower in 2001 . . . than 1996,” Dr. Tunnell wrote in 2005. The Hazard police chief’s claims were impossible to verify: crime rates had been fluctuating there since well before OxyContin arrived. The same was true for the statistic cited by Beth Macy about Tazewell County. An ATF agent assigned to the area had said that for “every year from 1996 to 1999, the crime rate [in southwest Virginia] doubled directly because of the influx of OxyContin.” But this was emphatically false—narcotics offense rates in southwest Virginia were about the same in 2000 as they were in 1995. In fact, as Dr. Tunnell wrote, between 1988 and 2000 “the ten states with the highest per capita OxyContin use had lower property crime rates than the 10 states with the lowest per capita OxyContin use.” Such trends were left out of public discourse, however, and the media consistently failed to interrogate public officials when they made hyperbolic claims.

This disconnect between reality and fantasy reflected a growing moral panic. “A lot of people who had a stake in this made exaggerated claims about crime,” Dr. Tunnell explained to me over the phone. “Everybody from local police officers to prosecutors to national politicians to really good newspaper men and women: they made claims that crime was increasing. And crime data are public. All a person has to do is look and see for themselves that no, crime was really not increasing at that time.” The panic exploded out of its containment zone in 2001; OxyContin had been around for five full years before people suddenly decided it was a crisis. Use and distribution had of course increased during that time, sending ripple effects throughout eastern Kentucky, but the picture was not one of a region torn apart by armed robberies, violence, and social destruction. Instead, it was one of people getting high in the privacy of their homes, or passing out in parks and grocery stores, or filling up hospital beds. It was not a crime wave but a massive public health crisis that required rational and humane solutions, like widespread access to rehabilitation.

But such solutions were not coming. In February 2001, eastern Kentucky lawmakers and police launched an all-out assault on low-level street dealers called Operation OxyFest; it earned the grim distinction of being the largest one-day roundup of drug dealers up to that point in Kentucky history. In his coverage of the event for the New York Times, reporter Barry Meier—who went on to write a book of his own about the crisis—reprinted claims used by former eastern Kentucky’s U.S. Attorney Joseph Famularo to justify the crackdown: “I personally counted 59 deaths since January [of 2000] . . . attributed to addicts using the drug, and I suspect that’s pretty conservative.” Famularo, who was a powerful person with a lot to gain from tough-on-crime activities, neglected to mention that attributing an overdose to a single drug is difficult, though this ambiguity is used in the same article as a defense by the medical director for Purdue Pharma. “The actual number [of OxyContin overdoses] likely will never be known with any degree of certainty . . . OxyContin use and its connection to drug-related emergencies have increased, oxycodone products evidently remain far less widely used than rhetoric often suggests,” Dr. Tunnell wrote in 2005. He pointed to a March 2005 article in the Journal of Analytical Toxicology that examined the records of 919 oxycodone-related deaths in twenty-three states across three years, concluding that “in only 12 cases OxyContin alone was found.” Meier’s gloss would be a recurring theme in the years to come, and fearmongering over the painkillers’ deadliness would continue to be used to justify such overzealous crackdowns.

At first, UNITE not only failed to fund rehabilitation—it actively rejected the most up-to-date science on how to treat addiction.

Operation OxyFest may have been a political success, but it had no material impact on the crisis. This was troubling to eastern Kentucky’s powerful Republican congressman Harold “Hal” Rogers who had dedicated his career to the economic development of the region. Throughout the 1980s and 1990s, Rogers used his position on the powerful House Appropriations Committee to bring billions of dollars in federal pork-barrel projects to his district, including three federal prisons and a $22.5 million Rural Law Enforcement Technology Center. A regionwide opioid problem was, to Rogers, bad for attracting new business. Fortunately, he had the power and the resources to do something about it. He also knew that for his initiative to succeed, it would need to be integrated into the community at the grassroots level. Community members had to feel like they were active participants in an existential struggle for the region. Rogers gave his program a name that would reflect that fundamental prerogative: Operation UNITE.

UNITEd We Fell

Operation UNITE launched in April 2003, just one month after the War in Iraq began, and its arrival in eastern Kentucky was reminiscent of that war’s shock-and-awe opening. UNITE’s full name—Unlawful Narcotics Investigations, Treatment, and Education—indicated a “three-pronged approach” to the crisis, unprecedented for its time. Highly militarized law enforcement was combined with treatment and community education to create a carrot-and-stick approach: police would bring dealers and users in off the streets, get them access to rehabilitation services, and then use them to teach others about the harms of drugs. It also encouraged citizens to start their own UNITE community actions groups to help spread awareness about the drug crisis. The program simultaneously aspired to punishment, humanitarianism, and hearts-and-minds outreach—all hallmarks of the War on Terror.

The problem (in both eastern Kentucky and the Middle East) was that these were contradictory aims, and one was prioritized over the others. Of the $8 million in federal funds that Rogers obtained to start UNITE, 70 percent went to its law enforcement task force, a team of roughly forty detectives selected from police and sheriff departments around the region. The task force’s targets were almost exclusively “street dealers,” a nebulous designation. One example was James Baker, of Breathitt County, Kentucky. In 2006, he was found guilty of first-degree drug trafficking and sentenced to five years in prison for selling a UNITE informant two Percocet pills, street value $25. Another example was eighty-seven-year-old Dottie Neeley, who was thrown in jail, along with her oxygen tank, for selling hydrocodone to a UNITE informant. Elderly people selling their pills in order to supplement their Society Security checks became such a problem that jailers openly complained about the strain it put on their deputies and jail resources. And yet according to a Kentucky State Police captain quoted by Kenneth Tunnell, “each day brings a new kingpin” depending on who “got their prescription filled.” As Dr. Tunnell pointed out, this is a poor analogy: a prescription was only about thirty pills—“hardly a ‘kingpin’s’ normal inventory.”

UNITE’s task force became renowned for the flashy manner in which they arrested their so-called kingpins. They preferred to hit dozens at a time, often in the early hours of the morning, kicking down doors and dragging the offenders out of bed. These high-adrenaline arrests were carefully orchestrated to achieve maximum press coverage. Arrestees were taken to a public holding space—usually a well-trafficked parking lot or a high school gymnasium—and put on display for their fellow community members. The media was invited to get photos and videos of shamefaced men and women shackled to holding facility floors in their pajamas. In the pages of Newsweek, the mayor of Hazard, Bill Gorman, likened it to the War on Terror. “It’s just ongoing,” he confessed wearily. Congressman Rogers was more resolute. “We’re here united to send a message to those who are ravaging our communities,” he said after a massive April 2004 roundup in Perry County. There was indeed unity being built, but UNITE’s approach to drug addiction proved that it was not among those who needed help.

Cindy Allison, a community activist in Harlan County, told me that in the early days of UNITE, she and a handful of community members formed a local chapter in the hopes that the organization would build a women’s rehab center in their community. “Women were raising children who were going to be the next generation and we needed sober moms. And we needed a place where moms could be close to their kids, because lots of people wouldn’t want to leave [for rehab] if they had to be away from their children.” One morning, UNITE invited Allison’s group to a press conference at the local high school. “We thought it was going to be an announcement about some sort of rehab facility,” she explained. But when they got there, “it was a public drug bust. . . . They brought everybody to the old high school gym as a holding area before they took them on to the jail. . . . And we were like, ‘We don’t want to be here because we don’t want to be associated with this part of it. . . . We want people to be able to reach out to us if they want help and not feel like . . . they’re going to be turned over to the cops.’”

At first, UNITE not only failed to fund rehabilitation—it actively rejected the most up-to-date science on how to treat addiction. After the Mountain Eagle newspaper in Whitesburg ran a feature in the summer of 2004 on the now industry-standard Medication-Assisted Treatment (MAT) method—of which Suboxone is one well-known example—UNITE’s Director of Treatment and Education, Cathy Stout, responded, “So far we’re not an advocate for that type of treatment.” Instead, she continued, “We arm you with the phone numbers that you need to go and search for treatment.” This was not an inconsequential choice; had UNITE led the way on MAT, it likely would have made a huge difference. But the few treatment facilities that did exist in the region took their cues from UNITE, and so they, too, rejected MAT. The Kentucky River Community Care facility in Jackson, Kentucky, even did so on the shocking grounds that the “culture” of eastern Kentucky was not ready to accept it. It was not until 2005 that Hal Rogers and UNITE provided the region with new treatment facilities and vouchers for treatment.

This attitude toward rehabilitation began feeding into the atmosphere of panic, paranoia, and rage. Because law enforcement received top priority, retribution against those perceived to be contributing to the problem began to seem natural, even noble. UNITE established a tip line that people could call and anonymously report suspected drug activity, which had the inevitable effect of blurring the distinction between users and dealers. UNITE also helped its community action groups find funding and organizing capacity for public forums and, eventually, anti-drug rallies. Some of these rallies were massive; one in Clay County in May 2004 drew an estimated three thousand five people—a shocking number for a county with a population of just twenty-four thousand. Another rally in Powell County, held by pastors vowing to “take the devil by the horns,” attracted about seven hundred people on a University of Kentucky basketball game night—a fact that demonstrates the gravity to which people assigned the issue, UK basketball being about on par with religion in the state of Kentucky. At these events, pastors and civic leaders would work the large crowds into purge-style anti-drug frenzies. “We need to kill the drug dealers!” Waynesburg Free Drug Coalition member Connie Frederick screamed at a Lincoln County public gathering. “That’s the only way you’re going to get rid of them.” Statements like this were common; it was a war, after all, and in the early 2000s, America was deeply invested in telling people that you do not win wars with compassion.

“Those community groups resembled as much as anything a mob,” says Ernie Lewis, the former head of the Kentucky Department of Public Advocacy. As a public advocate defending the usually indigent people swept up in UNITE’s roundups, Lewis came into contact with these groups through the courts. “Court watchers,” as they styled themselves, used a computer provided by UNITE to track all of the drug cases moving through their local court system on a given day. They would show up to drug offenders’ trials and place themselves in full view of the court, so that they could pressure judges, prosecutors, and juries to demand the most severe sentences available. According to John Becknell, a court watcher in Clay County, “If you’re waiting for the courts to combat drugs, how long are you going to wait?” Lewis, meanwhile, was dismayed that these people were not instead using their time to press for treatment options. “They had a hammer and so they saw everything as a nail, rather than . . . as a systems problem involving people who were addicted to drugs.”

Sharon Allen, a defense attorney in Jackson County, put the true impact of the community groups into perspective for me. “When we got ready to pick a jury for a . . . drug case,” she explained, “you now had to add to your list of things you’re asking the jury about: Are you a court watcher? Have you ever been to the court watch trainings? . . . Did you participate in the [anti-drug rallies]? . . . We had to be careful that [the defendants] were going to get a fair trial, so we had to weed out people’s involvement in other parts of these UNITE activities.” In 2004, Allen brought a legal challenge against UNITE’s ability to issue search warrants in counties where it had not filed the proper paperwork. The force with which community groups and the press came down on her was overwhelming, with some newspapers singling her out by name on their front pages. “It was almost like they took it personal that anyone would dare question UNITE’s ability to do this,” she said.

Drug court is simultaneously an admission that incarceration cannot solve the crisis and an insistence that drug users cannot be given free rein to do as they please, to get sober on their own time and terms.

So many drug cases were created in the task force’s first couple of years that municipalities found their ability to perform basic civic tasks impaired. “We were going to flood the court system because we were going at such a phenomenal rate,” UNITE president Karen Engle admitted. Their response was not to reduce the number of arrests being made, but to hire special prosecutors whose sole duty was to prosecute as many drug cases as possible. Public defenders, however, did not receive any extra funding or additional attorneys—despite the fact that their caseloads were also larger than ever. “We’re afraid that because of our caseloads, an innocent man is going to be convicted,” Ernie Lewis said at the time, stressing the scope of the problem. Lewis told me about a surreal meeting with members of eastern Kentucky’s U.S. Attorney’s office, where he requested additional help for the public advocacy program. “It was fascinating because I was on the agenda along with [UNITE] efforts to get a nice new office, I think there were five new big SUVs, all kinds of computer equipment. . . . They had more money than God.” But when it came to requesting some of that money for the region’s public defenders, “I got pretty much a cold reception. They kind of laughed me out of the room, and I didn’t get a thing for it.”

By 2008, UNITE had substantially altered the administrative and carceral landscape of eastern Kentucky. More than 18 percent of all state prisoners were behind bars because of drug-related offenses, and by 2009 the state’s per-capita incarceration rate led the nation. The Lexington Herald-Leader admitted that overcrowded jails were a direct result of “authorities [putting] more resources into finding and arresting prescription pill abusers,” while state Senator Joey Pendleton complained that “drug users [were] sapping [Kentucky’s] budget.” UNITE, however, was unfazed. “We cannot stop arresting people and simply let them by just because jails are full,” said Karen Engle. “We realize that’s a problem, but we can’t stop arresting them simply because they have to sleep on a mat.” Counties thus saw no other solution than to build more jails. From 2001 to the present, they sank millions of dollars into either expanding or constructing carceral infrastructure, often at the expense of civil infrastructure like roads and water systems. Perry County, which also holds Knott County prisoners, built the Kentucky River Regional Jail in 2001. Lee County, which holds Breathitt County’s prisoners, opened the Three Forks Regional Jail in 2002. Pike County’s jail was expanded in 2005. Harlan County expanded the Harlan County Detention Center in Evarts in 2007. And Knox County opened its new jail in 2019, while Laurel County followed suit with a new facility in 2020.

Many of eastern Kentucky’s indebted municipalities are now locked into a felony trap of their own, as carceral infrastructure has become a reliable source of revenue: if there will always be people in jail, and if the number of prisoners is only going up, then municipalities can keep selling more bonds to build more jails. In the minds of municipal planners, there will always be prisoners for the carceral infrastructure to “serve,” but there might not always be civilians for civil infrastructure to serve. That reality is best demonstrated by an astonishing statistic from researchers Jack Norton and Judah Schept: “If incarceration rates were to continue to rise in Kentucky as they have since 2000, every person in the state would be behind bars in 113 years.” At the same time, this situation can also become a burden for municipalities, which have to continue seeking out new revenue streams to support their investments, arresting more and more people in the process. Ending the drug war would, of course, put an end to this imperative, but it would also spell administrative disaster and, possibly, dissolution. So the war must continue, both as a fiscal and political necessity.

Despite its lingering effects on incarceration rates, if you were to ask someone on the streets of eastern Kentucky today about Operation UNITE and its impact on the region, you might get a weird look. You mean that drug bust thing from back in the day? They would probably remember it as akin to a tornado or an earthquake, some sort of disaster that definitely changed things but is now consigned to history. That is because UNITE is today a shell of its former self. After the Democrats took control of Congress in 2007 and reformed earmark spending, Rogers was unable to supply UNITE with the federal funds it needed to continue large-scale operations. Other actors in the state stepped in to pick up the slack, however. Former Democratic Kentucky attorney general Jack Conway waged his own war against opioids in a failed attempt to beat his Republican opponents in 2010 and 2015, and local departments still have all the infrastructure put in place by Rogers and UNITE. The state continues to punish drug users on a mass scale, and even though it has tried in recent years to pivot to less violent rehabilitation solutions, it cannot dig itself out from under a soaring rate of incarceration. The wounds UNITE left behind will remain for a long time, in damaging if not immediately visible ways.

The Felony Trap

In September 2019, Rolling Stone published a disturbing story about vigilante groups in Ohio who use Facebook to doxx suspected drug dealers and users in their community. Groups like Meth & Heroin Dealers Exposed, Akron Shoot Your Local Heroin Dealer, and Madison Alabama Drug Dealers Exposed do not discriminate between users and dealers, nor do they care about accuracy. They simply aim to send a message: “You are being watched. Sell Heroin . . . and you will be exposed to your neighbors, the police, your kids’ school, your family, and your life as you know it will change the way you have changed the lives of the people you sell poison to.” Twenty-year-old Megan Scaletta came under their crosshairs after she and her boyfriend were suspected of dealing, and her date of birth, address, and nickname were published for everyone to see. She died half a year later, the victim of a relapse.

Dutiful liberals rely on Big Pharma and the Sackler Family as the story’s chief villains because it is easy, familiar, and even somewhat comforting.

Extralegal actions like these are seeded in the ground first plowed by UNITE. When White House Drug Czar John Walters declared at UNITE’s launch that the program would “serve as a model for the rest of the nation,” he was not just referring to its law enforcement component, but its community-driven approach. What made UNITE so appealing to other areas around the country was the way it channeled the rage and fear of working- and professional-class individuals into something other than class struggle. For a brief time in eastern Kentucky, the War on Drugs was not only waged from above; it was a grassroots war, and everyone was pressured to take a side. Nothing less than the future of the region was at stake. This was a powerful idea in a place and time that had seen profound social and economic upheaval.

The people behind UNITE—Hal Rogers, Karen Engle, prosecutors and law enforcement officials—did not set out to design a system of social control; they were compelled in that direction by the exigencies of the moment. The region had been so thoroughly torn apart by the forces of austerity, deregulation, and market restructuring that its labor force was no longer “presentable” to the outside world because the individuals in that labor force were engaged in activities not befitting of the normative American worker. Therefore, in order to attract outside investment, individuals had to be reformed for exploitation by new industries that could replace coal. This was motivated partially by a gendered view of work; anyone with eyes could see that there already were new industries in the region, but the problem was that these new industries employed the wrong people. And so the physical, social, and chemical environments had to be made “clean” for the businesses that would employ the right people. In this way, UNITE was no different from recent attempts to retrain miners to code, or to “transition” the local economy to a “silicon holler” tech hub.

The idea that drug users must be existentially changed through sobriety is not unique to UNITE: it also motivates some of the non-carceral “solutions” to the opioid crisis. Drug court is the most widely used and praised. It is a diversionary program that allows offenders to serve out a probationary period outside of jail, as long as they meet certain requirements, like finding employment and passing regular drug tests. Nearly every person I spoke with in the process of researching this piece—from the most conservative prosecutor to the most progressive reformer—supports the drug court model. And yet its existence as a coercive, cost-saving measure is apparent. Pulaski County’s Drug Court Case Specialist Mellissa LaRusch put it bluntly in 2008: “For every $1 spent on Drug Court graduates, [Kentucky] saves $2.72 on what it would have spent on incarcerating [drug users].” Even then, it is not funded adequately, which in turn dictates the kinds of users who are allowed to participate. According to public health practitioner and author Lesly-Marie Buer, “Limits on funding and treatment capacity have led to a program that minimizes complications by admitting people who are most likely to graduate from the program.”

Drug court is a telling case study in that it is simultaneously an admission that incarceration cannot solve the crisis and an insistence that drug users cannot be given free rein to do as they please, to get sober on their own time and terms. One former drug counselor I spoke with found drug court’s aims conflicting and difficult to follow: “You can’t even follow the code of ethics where you’re not harming [a drug user]. Because if you say, ‘Yeah, probation officer? This dude has meth in [his urine],’ you’re sending him back to jail, and how are you helping them? That’s just doing harm. Jail is harmful.” They continued, “[Drug court] also erases this truth that recovery is not a linear thing. Like even the counselors of drug court will tell you, ‘Oh you’ll probably relapse, and it’s okay to mess up, because that’s what the science says.’ But if your counselor is saying it’s okay to mess up, but then you go to jail for messing up, it’s kind of contradictory.”

These contradictory attitudes toward drug use, of letting some succeed while others stay tied into the system, lay bare the reality that many find difficult to admit: drug use has no intrinsic meaning but is instead a social relation. We ascribe meaning onto it based on the political and economic realities of our times. Alcohol is responsible for more deaths a year than opioids, for example, and yet there is no talk of an “alcohol epidemic.” We are not however beholden to these narratives; they can always be changed. The epidemic was constructed by a series of decisions made by people looking to exploit an opportunity that Purdue provided—yet many to this day, police and prosecutors alike, insist that they did nothing wrong. Which brings me back to the question I’ve asked myself repeatedly since first digging into the history of UNITE. Would we live in a different world today had things been handled differently in those crucial first years?

The answer is stuffed inside the gaping maw of the felony trap, the jail, where the contradictions of UNITE’s approach are on full display. “They’ll just stick you in a hole for seven or eight months,” Emily Estep told me. “Could you imagine being locked in a room for eight months and not seeing the light of day over a petty drug charge, when you could just go to a treatment center for the same cause, and a way better outcome?” The former drug counselor explained how this could actually exacerbate someone’s need to use. “What do you say to somebody who had a baby in jail, shackled to a bed, about how she should use mindfulness to get clean? . . . Is your use chaotic if you’re getting high because you had a baby shackled to a bed and then they took it from you? I’m not sure it is. Sounds pretty traumatic to me, and like a good reason to get high.” None of this was inevitable, a truth driven home by attorney Sharon Allen. “There could have been a way to fund things without doing it the way they did,” she explained, pointing to the high-profile roundups, the public shaming, and the community vigilantism.

Unfortunately, we seem to have learned nothing from the experience. As I write, a recent copy of the Whitesburg Mountain Eagle sits next to my computer. On the front page reads the headline, “Arrest may be county’s first related to the deadly drug Fentanyl,” followed by a detailed account of the arrest and a photo of the drug meant to frighten the reader. Read from one angle—the angle intended by its author—the account is heroic: a sheriff’s deputy arrives at a house where a man has just ingested a substance from a mysterious bag resting on a nearby table. This substance is powerful, apparently a hundred times more powerful than morphine, thereby granting its user superhuman strengths and abilities that, from the perspective of a police officer, have no other outlet than the absolute destruction of society. The officer has no choice but to subdue him by violent means and so ensure that the streets and hollers of eastern Kentucky may one day be liberated from the grip of this deadly epidemic.

Read from another angle, however, the story is tragic. The man who was arrested had simply requested medical assistance after taking the drug. The paramedics then alerted the police, and the man refused to cooperate once they showed up, whereupon the deputy tased him and threw him into the Letcher County Jail. There are no indications he was selling the drug for personal gain; rather, he was merely in possession of the latest deadly item to qualify an individual for consignment to a cage, and so the situation inverted from one of help to one of pain.

I’ve become fixated on those crucial minutes between when the paramedics received the call and when they alerted the police. Tens of thousands of incarcerated people, millions of dollars in carceral infrastructure, and untold amounts of pain and misery reside in those few minutes. They dictate the stories we tell ourselves about the epidemic: that people are whole until they take a specific substance, after which they are irreparably transformed into something else. If they die they become a martyr; if they live and get sober they become a trophy; and if they keep using, or help others obtain the drug, they become a public enemy. Regardless of their fate, they are never seen as fully human again—they are not quite like us, and they never will be. We may tell ourselves that we are humanizing victims of the crisis by telling their stories, but until the social nature of drug use is acknowledged—until we can honestly account for the process by which one substance (opioids) is transformed into something illicit while the use of another substance (alcohol) is licit—then the epidemic’s true nature will remain mystified.

It is important that we keep track of the real chain of events. Dutiful liberals rely on Big Pharma and the Sackler Family as the story’s chief villains because it is easy, familiar, and even somewhat comforting. If the crisis is simply a matter of capitalism gone wrong, of corporations abusing their exalted position in society, then with a few tweaks to the existing order, everyone can have their Atticus Finch moment and go home. But if reactionary taxpayer activists or our current policing paradigm also contributed to the problem, then the solution becomes infinitely more complex. If that’s the case, then we might have to start asking why it’s necessary that large swathes of the population be rendered surplus for society to function “properly.” We might have to ask if defund the police is a demand just as relevant to rural areas as urban ones. We might have to ask whether society itself must change.

Because the same people who are responsible for so much pain are not just in my rural community; they are in yours, too, and sooner or later you will also fall victim to their help—the infrastructure they are building every day demands it. With each new prison, police cruiser, and prosecutor, the law enforcement apparatus and the politicians and journalists who uphold it stake out a greater and greater social space that you must either submit to or get out of. They remind us daily just what they mean. A few months before the deputy arrested the man with Fentanyl, the same sheriff’s department posted a video to their Facebook page featuring a montage of all the drugs they had seized over the previous two years. Behind the montage played the song “My Town” by the country group Montgomery Gentry. The song choice was intentional, meant to send a message that the community belongs to cops, rather than the drug users, the workers, the unemployed, and the downtrodden. But the message, while grim, is not entirely hopeless. If the town can belong to someone, we have to ask, as the next drug scare approaches: Can it belong to us?