Outside Woodstock, I pass George’s Chicken, the poultry-processing plant where Ronnie Jones first arrived to work in a Department of Corrections work-release program, clad in prison-issue khakis. I pass the house nearby where a cop I know spent days, nights, and weekends crouched under a bedroom window, surveilling Jones and his co-workers from behind binoculars—a fraction of the man-hours the government invested in putting members of Jones’s heroin ring behind bars.
I head northwest toward West Virginia, the crumbling landscape like so many of the distressed towns I’ve already traversed in Virginia some four hundred miles south, down to the same hillary for prison signs and the same Confederate flags waving presciently from their posts.
At the prison, I park my car and walk through the heavy front door. A handler named Rachel ushers me through security, making cheerful small talk as we head deeper inside the concrete maze and through three different sets of locked doors, her massive cluster of keys reverberating like chimes at each checkpoint.
We pass through a recreation area, where several men—all but one of the prisoners black and brown, I can’t help noticing—push mops and brooms around the cavernous room, looking up and nodding as we pass. The manufactured air inside is cold, and it smells of Clorox.
Ronnie Jones is already waiting for me on the other side of the last locked door, seated at a table. He looks thinner and older than he did in his mug shot, his prison khakis baggy, his trim Afro and beard flecked with gray. He looks tired, and the whites of his eyes are tinged with red.
He rises from the chair to shake my hand, then sits back down, his hands folded into a steeple, his elbows resting on the table between us. His mood is unreadable.
The glassed-in room is beige, the floors are beige, and so is Rachel, in her beige-and-blue uniform and no-nonsense shoes, the kind you could run in if you had to. She tells us to knock on the window if we need her, then leaves for her perch in the rec room, on the other side of the window, the door lock clicking decisively behind her.
I open my notebook, situate the questions I’ve prepared off to the side, next to my spare pens. I’m thinking of Kristi and Ginger and of Tess’s mom, and what Jones might say that will explain the fate of these mothers’ kids.
Jones leans forward, expectant and unsmiling, and rubs his hands together, as if we’re business associates sitting down to hammer out a deal.
Then he takes a deep breath and, relaxing back into his chair, he waits for me to start.
PART ONE
The People v. Purdue
Pennington Gap, Lee County, Virginia
Former coal-mining facility, Lee County, Virginia
Chapter One
The United States of Amnesia
Though the opioid epidemic would go on to spare no segment of America, nowhere has it settled in and extracted as steep a toll as in the depressed former mill and mining communities of central Appalachia, where the desperate and jobless rip copper wire out of abandoned factories to resell on the black market and jimmy large-screen TVs through a Walmart garden-center fence crack to keep from “fiending for dope.”
In a region where few businesses dare to set up shop because it’s hard to find workers who can pass a drug test, young parents can die of heroin overdose one day, leaving their untended baby to succumb to dehydration and starvation three days later.
Appalachia was among the first places where the malaise of opioid pills hit the nation in the mid-1990s, ensnaring coal miners, loggers, furniture makers, and their kids. Two decades after the epidemic erupted, Princeton researchers Anne Case and Angus Deaton were the first economists to sound the alarm. Their bombshell analysis in December 2015 showed that mortality rates among white Americans had quietly risen a half-percent annually between the years 1999 and 2013 while midlife mortality continued to fall in other affluent countries. “Half a million people are dead who should not be dead,” Deaton told the Washington Post, blaming the surge on suicides, alcohol-related liver disease, and drug poisonings—predominantly opioids—which the economists later referred to as “diseases of despair.” While the data from which Case and Deaton draw is not restricted to deaths by drug overdose, their central finding of “a marked increase in the all-cause mortality of middle-aged white non-Hispanic men and women” demonstrates that the opioid epidemic rests inside a host of other diseases of despair statistically significant enough to reverse “decades of progress in mortality.”
At roughly the same time the Case and Deaton study was published, a Kaiser Family Foundation poll showed that 56 percent of Americans now knew someone who abused, was addicted to, or died from an overdose of opioids. Nationwide, the difference in life expectancy between the poorest fifth of Americans by income and the richest fifth widened from 1980 to 2010 by thirteen years. For a long time, it was assumed that the core driver of this differential was access to health care and other protective benefits of relative wealth. But in Appalachia, those disparities are even starker, with overdose mortality rates 65 percent higher than in the rest of the nation. Clearly, the problem wasn’t just of some people dying sooner; it was of white Americans dying in their prime.
The story of how the opioid epidemic came to change this country begins in the mid to late 1990s, in Virginia’s westernmost point, in the pie-shaped county sandwiched between Tennessee and Kentucky, a place closer to eight other state capitals than its own, in Richmond. Head north as the crow flies from the county seat of Jonesville and you’ll end up west of Detroit.
Geopolitically, Lee County was the ultimate flyover region, hard to access by car, full of curvy, two-lane roads, and dotted with rusted-out coal tipples. It was the precise point in America where politicians were least likely to hold campaign rallies or pretend to give a shit—until the unchecked epidemic finally landed on their couches, too.
Four hundred miles away, at the northern end of the Shenandoah Valley, a stressed-out preschool teacher would tell Kristi Fernandez around this time that her four-year-old son, Jesse, was too rambunctious for his own good. He was causing mayhem in the classroom, so Kristi took him to his pediatrician, who urged her to put him on Ritalin. She acquiesced two years later, the drug seemed to quell his jitters and anxiety, and the teacher complaints stopped.
But he was still her high-energy Jesse. You could tell he was hyper even by the way he signed his name, blocking the letters out joyfully and haphazardly, adding a stick-figure drawing of the sun with a smiley face below the first E. The sun’s rays stuck out helter-skelter, like a country boy’s cowlick, as if it were running and winking at you all at once.
*
Lieutenant Richard Stallard was making his usual rounds, patrolling through Bullitt Park in Big Stone Gap in Wise County near the Lee County line. This was the same iconic small town romanticized in Adriana Trigiani’s novel and film Big Stone Gap, the one based on her idyllic upbringing in the 1970s, when a self-described town spinster with the good looks of Ashley Judd could spend her days wandering western Virginia’s hills and hollows, delivering prescriptions for her family-run pharmacy without a thought of danger.
The year was 1997, a pivotal moment in the history of opioid addiction, and Stallard was about to sound the first muffled alarm. Across central Appalachia’s coal country, people hadn’t yet begun locking their toolsheds and barn doors as a guard against those addicted to OxyContin, looking for anything to steal to fund their next fix.