why do surgeons still prescribe so many: Sally Satel, “Taking On the Scourge of Opioids,” National Affairs, Summer 2017: 9; Mark C. Bicket et al., “Prescription Opioid Analgesics Commonly Unused After Surgery: A Systematic Review,” JAMA Surgery, Nov. 1, 2017: https://jamanetwork.com/journals/jamasurgery/article-abstract/2644905.
legitimate pain stabilized by the drugs: Bob Tedeschi, “A ‘Civil War’ over Painkillers Rips Apart the Medical Community—and Leaves Patients in Fear,” STAT, Jan. 17, 2017.
A journalist and former colleague of mine: Tonia Moxley email, with X-ray, to author, July 24, 2017.
gabapentin, which is increasingly sought: Carmen Heredia Rodriguez, “New on the Streets: Gabapentin, a Drug for Nerve Pain, and a New Target of Abuse,” Kaiser Health News, July 6, 2017.
two employees charged with drafting it: Told to me privately by a Centers for Disease Control and Prevention program analyst at the Poynter Institute’s “Covering the Opioid Crisis,” Washington, D.C., Sept. 26, 2016.
residency programs in the field of addiction medicine: Author interview, Campbell, and David E. Smith, “The Evolution of Addiction Medicine as a Medical Specialty,” AMA Journal of Ethics, December 2011. As of 2014, the list of residency programs: http://www.abam.net/wp-content/uploads/2013/04/ABAMF-Accredited-Program-Summaries-2013-14-1.pdf.
“because Big Pharma’s going to keep”: Author interview, Caroline Jean Acker, June 15, 2017.
largest free medical outreach event: Author interviews, Teresa Gardner Tyson, Feb. 23, July 6–7 (on Health Wagon), and May 24, 2017 (Health Wagon event that was precursor to Remote Area Medical event), and follow-up interviews by phone and text over the summer of 2017.
hadn’t used illicit drugs in more than: Author interview, Craig Adams, July 25, 2017.
state of health of RAM patients: Higher overdose death rates in rural America as outlined in these CDC statistics: https://www.cdc.gov/mmwr/volumes/66/ss/ss6602a1.htm?s_cid=ss6602a1_e.
“In Central America, they’re eating beans”: Quote by RAM volunteer Dr. Joseph F. Smiddy, in Trip Gabriel, “When Health Law Isn’t Enough, the Desperate Line Up at Tents,” New York Times, July 23, 2017.
“On the other side of the cities”: Author interview, Dr. Art Van Zee, Sept. 24, 2016.
For decades, black poverty had been concentrated: Caroline Jean Acker, Creating the American Junkie: Addiction Research in the Classic Era of Narcotic Control (Baltimore: Johns Hopkins University Press, 2002), 225.
same counties where Donald Trump performed: Shannon Monnat, “Deaths of Despair and Support for Trump in the 2016 Presidential Election,” Pennsylvania State University, Department of Agricultural Economics, Sociology, and Education Research Brief, Dec. 4, 2016. (Monnat now works at Syracuse University.)
“when one of us makes a mistake”: Author interview, Wendy Welch, May 22, 2017. Welch is the director of the Graduate Medical Education Consortium and author of Fall or Fly: The Strangely Hopeful Story of Adoption and Foster Care in Appalachia (Athens: Ohio University Press, 2018).
founded in 1980 by a Catholic nun: The Health Wagon was started by a Massachusetts native who’d served as a midwife in Africa before volunteering in Appalachia. Sister Bernie Kenny regularly got carsick on the twisty roads: “Every scratch on the old RV, Sister Bernie put it there,” Tyson said, grinning.
school district depopulation and austerity: Sara Gregory, “Final Bell Tolls at Coalfields School—Wise County, the Beacon of the Coalfields School Divisions, Closes Another School,” Roanoke Times, May 28, 2017.
The fifty-four-year-old teacher hadn’t had insurance: Author interviews, Brenda Bolling, St. Paul Health Wagon stop, July 6 and 24 (telephone follow-up), 2017.
recent death of a forty-two-year-old patient: Author interviews, Tyson and patient’s father, Tony Roberts, March 28, 2017.
Reggie Stanley, forty-five, who died: Author interview, Tyson.
“He was a great guitar player”: Written on his Mullins Funeral Home guest book, July 5, 2017.
Cantrell had been holding town-hall: Author interview, Dr. Sue Cantrell, Aug. 8, 2017.
every legislator in the coalfields had voted: Author interview, Sarah Melton, July 24, 2017. No substantive crime increase in needle-exchange areas: Melissa A. Marx et al., “Trends in Crime and the Introduction of a Needle Exchange Program,” American Journal of Public Health, December 2000: 1933–1936, available at: https://www.researchgate.net/publication/12217407_Trends_in_crime_and_the_introduction_of_a_needle_exchange_program.
Across the border in West Virginia: Early results from Huntington needle exchange were positive, according to Christine Vestal, “Early Results of W.Va. Towns’ Needle Exchange Program Show Progress,” PBS NewsHour, June 6, 2016. Even bare-bones exchanges operating on as little as $10,000 annually were found to be cost-effective, considering that the cost to treat a single hepatitis C infection ranged from $65,000 to $500,000. In other localities, needle-stick injuries to police officers were reported 66 percent less often; Tessie Castillo, “Law Enforcement Lead West Virginia Efforts to Implement Syringe Exchange Programs,” Huffington Post, Dec. 15, 2015.
IV drug users in the region: Author interview, Melton.
like many of the returning Vietnam soldiers: Among the 20 percent of American servicemen in Vietnam who became hooked on heroin, only 20 percent went on to abuse the drug once they returned to their hometowns. Some attributed this low rate to the fact that the people and places associated with prior heroin use were powerful triggers to reuse: Lee N. Robins et al., “Vietnam Veterans Three Years After Vietnam: How Our Study Changed Our View of Heroin,” American Journal on Addictions, April 2, 2010.
“I won New Hampshire because”: Donald Trump explaining why he won the Republican primary in New Hampshire (though he did not win the state’s general election), from Liam Stack, “Trump Called New Hampshire a ‘Drug-Infested Den,’ Drawing the Ire of Its Politicians,” New York Times, Aug. 3, 2017.
most Americans support federal financing: “Public Ranks Children’s Health Insurance, Marketplace Stabilization Higher Priorities Than ACA Repeal,” Kaiser Family Foundation poll, Sept. 22, 2017. The poll found that Medicaid and Medicare buy-in ideas are more popular than single-payer, which was affirmed by 54 percent of those polled. Data analysis from Eric Levitz, “America Is Not a ‘Center-Right Nation,’” New York Times, Nov. 1, 2017.
to court nonwhite voters, including Hispanics: U.S. Census Bureau, “Voting and Registration in the Election of November 2016,” released in May 2017.
“You’ve got too many leaders just not responding”: Author interview, Bryan Stevenson, July 12, 2017.
“really bad for you”: Aubrey Whelan and Don Sapatkin, “Advisers: Trump Won’t Declare Opioid Crisis a National Emergency,” Philadelphia Inquirer, Aug. 9, 2017.
A few days later, he seemed to change his mind: Brianna Ehley, “Trump Says He Will Declare Opioid Crisis a ‘National Emergency,’” Politico, Aug. 10, 2017.