POVERTY AND ADDICTION IN APPALACHIA CASE STUDY

Then (1800s-early 1900s)

• Cool miners and timber industries

  • Injuries prompted the use of opiates (not widespread

Mid 1900s-1970s

• Rise of unemployment

• Black lung diseases and other chronic health conditions

• Limited healthcare

1990s (Oxy and the ‘Start’ of the Opioid Crisis)

• 1996: Purdue Pharma marketed OxyContin as a low-risk painkiller

• Appalachia targeted due to the poverty, high rates of workplace injuries

• Pill Mills

2000s (Crisis escalates)

• Heroin becomes desirable as a cheaper, accessible alternative after pill mills are shut down.

• Communities start to feel the impact of addictions (e.g., overdoses)

2010s (The Fentanyl Crisis)

• Synthetic opioids like fentanyl enter the drug supply, which causes spikes in overdoses

• Lack of resources

• Overdose deaths increase drastically, over 400%-45,838 deaths in 2016

Now (2020s Opioid Crisis)

• Criminal Justice System remains the primary response: incarceration often replaces treatment.

The Product of the Opioid Epidemic

• Structured inequality 

• Pharmaceutical industry targeting

• Historical economic exploitation

• Evolving drug supply

Why is Appalachia so poor?

• Historical economic dependence

• Structural inequality (and disinvestment)

• Persistent poverty

• Poverty is not “cultural”-- it is deeply rooted in structural, historical, and economic exploitation

• Culture-of poverty thesis

Why was Appalachia so disproportionately impacted?

• Social Isolation

• Educational attainment is low

• Unemployment is high

• Injury prone employment and marketing

• Lack of economic and educational opportunities.

• Transportation is challenging

• Inadequate access to healthcare

Systematic review: of decade-long trends in rural Appalachian opioid and related drug epidemics

• Substantial increases across states, especially with multi-substance use

• Oxycodone, hydrocodone, and methadone were among the most commonly used opioids among rural prescription opioid-using populations.

• Young, white men (often in the range of 25-54 years of age, with several studies reporting an average age between 30-39) were at greatest risk for fatal and nonfatal overdose in rural areas.

• Also at risk: women, Criminal Justice System-involved populations, and adolescents

  • 8th Graders in rural Appalachia are 104% more likely to use amphetamines

Impact of addiction on the community

• Negatively impacts interpersonal relationships

• Poor academic performance

• High mortality rates

• Multigenerational addiction

• Increased infectious diseases (e.g., Hepatitis C, HIV)

• Impact on child welfare (e.g., children removed from parents' custody)

• Economic burden on county, state → perpetuates poverty

Culture-of-Poverty Theory

• "I guess this is how I went to live."

• The idea that the poor discouraged by their own failures do not teach their children the values they need to succeed

• But the theory turned into blaming victims of poverty

What does criminalization of poverty mean?

Instead of treating addiction as a health crisis, the U.S. often responded with criminalization. Drug policy tends to punish poverty and illness, rather than address root causes.

Response to Appalachia

• Community-based coalitions

• Expand access to treatment

• Harm reduction

• Addressing Sigma

• Criminal Justice System

The different responses reveal systemic racial and class disparities in U.S drug policy

• Where Black communities faced punishment, white communities more often receive treatment.

• Both epidemics showed how the criminal justice system steps in where social services fail.

Population Impacted in the Crack Epidemic

Primarily Black, urban communities

Population Impacted by the Opioid Crisis

Primarily white, rural communities

Media Framing in the Crack Epidemic

Criminal behavior, “Super predators,” perpetuating stereotypes

Media Framing in the Opioid Crisis

Compassionate, Public health crisis, victims

Policy Response to the Crack Epidemic

War on Drugs, mandatory minimums, mass incarceration

Policy Response to the Opioid Crisis

Drug courts, treatment programs, and corporate accountability

Law enforcement in the Crack Epidemic

Aggressive policing, racial profiling

Law Enforcement in the Opioid Crisis

Harm reduction, police diversion programs

Results of the Crack Epidemic

Explosion in prison population, community destabilization, and economic decline

Results in the Opioid Crisis

Push for decriminalization and rehabilitation

Culture-of-Poverty Theory

"I guess this is how they want to live."