Michael Barrett and Jenna Mulligan, emergency paramedics in Berkeley County, West Virginia, recently got a call that sent them to the youth softball field in a tiny town called Hedgesville. It was the first practice of the season for the girls’ Little League team, and dusk was descending. Barrett and Mulligan drove past a clubhouse with a blue-and-yellow sign that read “Home of the Lady Eagles,” and stopped near a scrubby set of bleachers, where parents had gathered to watch their daughters bat and field.
Two of the parents were lying on the ground, unconscious, several yards apart. As Barrett later recalled, the couple’s thirteen-year-old daughter was sitting behind a chain-link backstop with her teammates, who were hugging her and comforting her. The couple’s younger children, aged ten and seven, were running back and forth between their parents, screaming, “Wake up! Wake up!” When Barrett and Mulligan knelt down to administer Narcan, a drug that reverses heroin overdoses, some of the other parents got angry. “You know, saying, ‘This is bullcrap,’ ” Barrett told me. “ ‘Why’s my kid gotta see this? Just let ’em lay there.’ ” After a few minutes, the couple began to groan as they revived. Adults ushered the younger kids away. From the other side of the backstop, the older kids asked Barrett if the parents had overdosed. “I was, like, ‘I’m not gonna say.’ The kids aren’t stupid. They know people don’t just pass out for no reason.” During the chaos, someone made a call to Child Protective Services.
At this stage of the American opioid epidemic, many addicts are collapsing in public—in gas stations, in restaurant bathrooms, in the aisles of big-box stores. Brian Costello, a former Army medic who is the director of the Berkeley County Emergency Medical Services, believes that more overdoses are occurring in this way because users figure that somebody will find them before they die. “To people who don’t have that addiction, that sounds crazy,” he said. “But, from a health-care provider’s standpoint, you say to yourself, ‘No, this is survival to them.’ They’re struggling with using but not wanting to die.”
A month after the incident, the couple from the softball field, Angel Dawn Holt, who is thirty-five, and her boyfriend, Christopher Schildt, who is thirty-three, were arraigned on felony charges of child neglect. (Schildt is not the biological father of Holt’s kids.) A local newspaper, the Martinsburg Journal, ran an article about the charges, noting that the couple’s children, who had been “crying when law enforcement arrived,” had been “turned over to their grandfather.”
West Virginia has the highest overdose death rate in the country, and heroin has devastated the state’s Eastern Panhandle, which includes Hedgesville and the larger town of Martinsburg. Like the vast majority of residents there, nearly all the addicts are white, were born in the area, and have modest incomes. Because they can’t be dismissed as outsiders, some locals view them with empathy. Other residents regard addicts as community embarrassments. Many people in the Panhandle have embraced the idea of addiction as a disease, but a vocal cohort dismisses this as a fantasy disseminated by urban liberals.
These tensions were aired in online comments that amassed beneath the Journal article. A waitress named Sandy wrote, “Omgsh, How sad!! Shouldnt be able to have there kids back! Seems the heroin was more important to them, than watchn there kids have fun play ball, and have there parents proud of them!!” A poster named Valerie wrote, “Stop giving them Narcan! At the tax payers expense.” Such views were countered by a reader named Diana: “I’m sure the parents didn’t get up that morning and say hey let’s scar the kids for life. I’m sure they wished they could sit through the kids practice without having to get high. The only way to understand it is to have lived it. The children need to be in a safe home and the adults need help. They are sick, i know from the outside it looks like a choice but its not. Shaming and judging will not help anyone.”
One day, Angel Holt started posting comments. “I don’t neglect,” she wrote. “Had a bad judgment I love my kids and my kids love me there honor roll students my oldest son is about to graduate they play sports and have a ruff over there head that I own and food, and things they just want I messed up give me a chance to prove my self I don’t have to prove shit to none of u just my children n they know who I am and who I’m not.”
A few weeks later, I spoke to Holt on the phone. “Where it happened was really horrible,” she said. “I can’t sit here and say different.” But, she said, it had been almost impossible to find help for her addiction. On the day of the softball practice, she ingested a small portion of a package of heroin that she and Schildt had just bought, figuring that she’d be able to keep it together at the field; she had promised her daughter that she’d be there. But the heroin had a strange purple tint—it must have been cut with something nasty. She started feeling weird, and passed out. She knew that she shouldn’t have touched heroin that was so obviously adulterated. But, she added, “if you’re an addict, and if you have the stuff, you do it.”
In Berkeley County, which has a population of a hundred and fourteen thousand, when someone under sixty dies, and the cause of death isn’t mentioned in the paper, locals assume that it was an overdose. It’s becoming the default explanation when an ambulance stops outside a neighbor’s house, and the best guess for why someone is sitting in his car on the side of the road in the middle of the afternoon. On January 18th, county officials started using a new app to record overdoses. According to this data, during the next two and a half months emergency medical personnel responded to a hundred and forty-five overdoses, eighteen of which were fatal. This underestimates the scale of the epidemic, because many overdoses do not prompt 911 calls. Last year, the county’s annual budget for emergency medication was twenty-seven thousand dollars. Narcan, which costs fifty dollars a dose, consumed two-thirds of that allotment. The medication was administered two hundred and twenty-three times in 2014, and four hundred and three times in 2016. (...)
Heroin is an alluringly cheap alternative to prescription pain medication. In 1996, Purdue Pharma introduced OxyContin, marketing it as a safer form of opiate—the class of painkillers derived from the poppy plant. (The term “opioids” encompasses synthetic versions of opiates as well.) Opiates such as morphine block pain but also produce a dreamy euphoria, and over time they cause physical cravings. OxyContin was sold in time-release capsules that levelled out the high and, supposedly, diminished the risk of addiction, but people soon discovered that the capsules could be crushed into powder and then injected or snorted. Between 2000 and 2014, the number of overdose deaths in the United States jumped by a hundred and thirty-seven per cent.
Some states became inundated with opiates. According to the Charleston Gazette-Mail, between 2007 and 2012 drug wholesalers shipped to West Virginia seven hundred and eighty million pills of hydrocodone (the generic name for Vicodin) and oxycodone (the generic name for OxyContin). That was enough to give each resident four hundred and thirty-three pills. The state has a disproportionate number of people who have jobs that cause physical pain, such as coal mining. It also has high levels of poverty and joblessness, which cause psychic pain. Mental-health services, meanwhile, are scant. Chess Yellott, a retired family practitioner in Martinsburg, told me that many West Virginians self-medicate to mute depression, anxiety, and post-traumatic stress from sexual assault or childhood abuse. “Those things are treatable, and upper-middle-class parents generally get their kids treated,” he said. “But, in families with a lot of chaos and money problems, kids don’t get help.”
In 2010, Purdue introduced a reformulated capsule that is harder to crush or dissolve. The Centers for Disease Control subsequently issued new guidelines stipulating that doctors should not routinely treat chronic pain with opioids, and instead should try approaches such as exercise and behavioral therapy. The number of prescriptions for opioids began to drop.
But when prescription opioids became scarcer their street price went up. Drug cartels sensed an opportunity, and began flooding rural America with heroin. Daniel Ciccarone, a professor at the U.C.-San Francisco School of Medicine, studies the heroin market. He said of the cartels, “They’re multinational, savvy, borderless entities. They worked very hard to move high-quality heroin into places like rural Vermont.” They also kept the price low. In West Virginia, many addicts told me, an oxycodone pill now sells for about eighty dollars; a dose of heroin can be bought for about ten.
A recent paper from the National Bureau of Economic Research concludes, “Following the OxyContin reformulation in 2010, abuse of prescription opioid medications and overdose deaths decreased for the first time since 1990. However, this drop coincided with an unprecedented rise in heroin overdoses.” According to the Centers for Disease Control, three out of four new heroin users report having first abused opioids.
“The Changing Face of Heroin Use in the United States,” a 2014 study led by Theodore Cicero, of Washington University in St. Louis, looked at some three thousand heroin addicts in substance-abuse programs. Half of those who began using heroin before 1980 were white; nearly ninety per cent of those who began using in the past decade were white. This demographic shift may be connected to prescribing patterns. A 2012 study by a University of Pennsylvania researcher found that black patients were thirty-four per cent less likely than white patients to be prescribed opioids for such chronic conditions as back pain and migraines, and fourteen per cent less likely to receive such prescriptions after surgery or traumatic injury.
But a larger factor, it seems, was the despair of white people in struggling small towns. Judith Feinberg, a professor at West Virginia University who studies drug addiction, described opioids as “the ultimate escape drugs.” She told me, “Boredom and a sense of uselessness and inadequacy—these are human failings that lead you to just want to withdraw. On heroin, you curl up in a corner and blank out the world. It’s an extremely seductive drug for dead-end towns, because it makes the world’s problems go away. Much more so than coke or meth, where you want to run around and do things—you get aggressive, razzed and jazzed.”
Peter Callahan, a psychotherapist in Martinsburg, said that heroin “is a very tough drug to get off of, because, while it was meant to numb physical pain, it numbs emotional pain as well—quickly and intensely.” In tight-knit Appalachian towns, heroin has become a social contagion. Nearly everyone I met in Martinsburg has ties to someone—a child, a sibling, a girlfriend, an in-law, an old high-school coach—who has struggled with opioids. As Callahan put it, “If the lady next door is using, and so are other neighbors, and people in your family are, too, the odds are good that you’re going to join in.”
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Two of the parents were lying on the ground, unconscious, several yards apart. As Barrett later recalled, the couple’s thirteen-year-old daughter was sitting behind a chain-link backstop with her teammates, who were hugging her and comforting her. The couple’s younger children, aged ten and seven, were running back and forth between their parents, screaming, “Wake up! Wake up!” When Barrett and Mulligan knelt down to administer Narcan, a drug that reverses heroin overdoses, some of the other parents got angry. “You know, saying, ‘This is bullcrap,’ ” Barrett told me. “ ‘Why’s my kid gotta see this? Just let ’em lay there.’ ” After a few minutes, the couple began to groan as they revived. Adults ushered the younger kids away. From the other side of the backstop, the older kids asked Barrett if the parents had overdosed. “I was, like, ‘I’m not gonna say.’ The kids aren’t stupid. They know people don’t just pass out for no reason.” During the chaos, someone made a call to Child Protective Services.
At this stage of the American opioid epidemic, many addicts are collapsing in public—in gas stations, in restaurant bathrooms, in the aisles of big-box stores. Brian Costello, a former Army medic who is the director of the Berkeley County Emergency Medical Services, believes that more overdoses are occurring in this way because users figure that somebody will find them before they die. “To people who don’t have that addiction, that sounds crazy,” he said. “But, from a health-care provider’s standpoint, you say to yourself, ‘No, this is survival to them.’ They’re struggling with using but not wanting to die.”A month after the incident, the couple from the softball field, Angel Dawn Holt, who is thirty-five, and her boyfriend, Christopher Schildt, who is thirty-three, were arraigned on felony charges of child neglect. (Schildt is not the biological father of Holt’s kids.) A local newspaper, the Martinsburg Journal, ran an article about the charges, noting that the couple’s children, who had been “crying when law enforcement arrived,” had been “turned over to their grandfather.”
West Virginia has the highest overdose death rate in the country, and heroin has devastated the state’s Eastern Panhandle, which includes Hedgesville and the larger town of Martinsburg. Like the vast majority of residents there, nearly all the addicts are white, were born in the area, and have modest incomes. Because they can’t be dismissed as outsiders, some locals view them with empathy. Other residents regard addicts as community embarrassments. Many people in the Panhandle have embraced the idea of addiction as a disease, but a vocal cohort dismisses this as a fantasy disseminated by urban liberals.
These tensions were aired in online comments that amassed beneath the Journal article. A waitress named Sandy wrote, “Omgsh, How sad!! Shouldnt be able to have there kids back! Seems the heroin was more important to them, than watchn there kids have fun play ball, and have there parents proud of them!!” A poster named Valerie wrote, “Stop giving them Narcan! At the tax payers expense.” Such views were countered by a reader named Diana: “I’m sure the parents didn’t get up that morning and say hey let’s scar the kids for life. I’m sure they wished they could sit through the kids practice without having to get high. The only way to understand it is to have lived it. The children need to be in a safe home and the adults need help. They are sick, i know from the outside it looks like a choice but its not. Shaming and judging will not help anyone.”
One day, Angel Holt started posting comments. “I don’t neglect,” she wrote. “Had a bad judgment I love my kids and my kids love me there honor roll students my oldest son is about to graduate they play sports and have a ruff over there head that I own and food, and things they just want I messed up give me a chance to prove my self I don’t have to prove shit to none of u just my children n they know who I am and who I’m not.”
A few weeks later, I spoke to Holt on the phone. “Where it happened was really horrible,” she said. “I can’t sit here and say different.” But, she said, it had been almost impossible to find help for her addiction. On the day of the softball practice, she ingested a small portion of a package of heroin that she and Schildt had just bought, figuring that she’d be able to keep it together at the field; she had promised her daughter that she’d be there. But the heroin had a strange purple tint—it must have been cut with something nasty. She started feeling weird, and passed out. She knew that she shouldn’t have touched heroin that was so obviously adulterated. But, she added, “if you’re an addict, and if you have the stuff, you do it.”
In Berkeley County, which has a population of a hundred and fourteen thousand, when someone under sixty dies, and the cause of death isn’t mentioned in the paper, locals assume that it was an overdose. It’s becoming the default explanation when an ambulance stops outside a neighbor’s house, and the best guess for why someone is sitting in his car on the side of the road in the middle of the afternoon. On January 18th, county officials started using a new app to record overdoses. According to this data, during the next two and a half months emergency medical personnel responded to a hundred and forty-five overdoses, eighteen of which were fatal. This underestimates the scale of the epidemic, because many overdoses do not prompt 911 calls. Last year, the county’s annual budget for emergency medication was twenty-seven thousand dollars. Narcan, which costs fifty dollars a dose, consumed two-thirds of that allotment. The medication was administered two hundred and twenty-three times in 2014, and four hundred and three times in 2016. (...)
Heroin is an alluringly cheap alternative to prescription pain medication. In 1996, Purdue Pharma introduced OxyContin, marketing it as a safer form of opiate—the class of painkillers derived from the poppy plant. (The term “opioids” encompasses synthetic versions of opiates as well.) Opiates such as morphine block pain but also produce a dreamy euphoria, and over time they cause physical cravings. OxyContin was sold in time-release capsules that levelled out the high and, supposedly, diminished the risk of addiction, but people soon discovered that the capsules could be crushed into powder and then injected or snorted. Between 2000 and 2014, the number of overdose deaths in the United States jumped by a hundred and thirty-seven per cent.
Some states became inundated with opiates. According to the Charleston Gazette-Mail, between 2007 and 2012 drug wholesalers shipped to West Virginia seven hundred and eighty million pills of hydrocodone (the generic name for Vicodin) and oxycodone (the generic name for OxyContin). That was enough to give each resident four hundred and thirty-three pills. The state has a disproportionate number of people who have jobs that cause physical pain, such as coal mining. It also has high levels of poverty and joblessness, which cause psychic pain. Mental-health services, meanwhile, are scant. Chess Yellott, a retired family practitioner in Martinsburg, told me that many West Virginians self-medicate to mute depression, anxiety, and post-traumatic stress from sexual assault or childhood abuse. “Those things are treatable, and upper-middle-class parents generally get their kids treated,” he said. “But, in families with a lot of chaos and money problems, kids don’t get help.”
In 2010, Purdue introduced a reformulated capsule that is harder to crush or dissolve. The Centers for Disease Control subsequently issued new guidelines stipulating that doctors should not routinely treat chronic pain with opioids, and instead should try approaches such as exercise and behavioral therapy. The number of prescriptions for opioids began to drop.
But when prescription opioids became scarcer their street price went up. Drug cartels sensed an opportunity, and began flooding rural America with heroin. Daniel Ciccarone, a professor at the U.C.-San Francisco School of Medicine, studies the heroin market. He said of the cartels, “They’re multinational, savvy, borderless entities. They worked very hard to move high-quality heroin into places like rural Vermont.” They also kept the price low. In West Virginia, many addicts told me, an oxycodone pill now sells for about eighty dollars; a dose of heroin can be bought for about ten.
A recent paper from the National Bureau of Economic Research concludes, “Following the OxyContin reformulation in 2010, abuse of prescription opioid medications and overdose deaths decreased for the first time since 1990. However, this drop coincided with an unprecedented rise in heroin overdoses.” According to the Centers for Disease Control, three out of four new heroin users report having first abused opioids.
“The Changing Face of Heroin Use in the United States,” a 2014 study led by Theodore Cicero, of Washington University in St. Louis, looked at some three thousand heroin addicts in substance-abuse programs. Half of those who began using heroin before 1980 were white; nearly ninety per cent of those who began using in the past decade were white. This demographic shift may be connected to prescribing patterns. A 2012 study by a University of Pennsylvania researcher found that black patients were thirty-four per cent less likely than white patients to be prescribed opioids for such chronic conditions as back pain and migraines, and fourteen per cent less likely to receive such prescriptions after surgery or traumatic injury.
But a larger factor, it seems, was the despair of white people in struggling small towns. Judith Feinberg, a professor at West Virginia University who studies drug addiction, described opioids as “the ultimate escape drugs.” She told me, “Boredom and a sense of uselessness and inadequacy—these are human failings that lead you to just want to withdraw. On heroin, you curl up in a corner and blank out the world. It’s an extremely seductive drug for dead-end towns, because it makes the world’s problems go away. Much more so than coke or meth, where you want to run around and do things—you get aggressive, razzed and jazzed.”
Peter Callahan, a psychotherapist in Martinsburg, said that heroin “is a very tough drug to get off of, because, while it was meant to numb physical pain, it numbs emotional pain as well—quickly and intensely.” In tight-knit Appalachian towns, heroin has become a social contagion. Nearly everyone I met in Martinsburg has ties to someone—a child, a sibling, a girlfriend, an in-law, an old high-school coach—who has struggled with opioids. As Callahan put it, “If the lady next door is using, and so are other neighbors, and people in your family are, too, the odds are good that you’re going to join in.”
Image: Eugene Richards
