9781422282519

CHAPTER ONE

OPIATES AND OPIOIDS

Deep in the Appalachian Mountains in Kentucky, where Pine Mountain and Cumberland Mountain meet, sits Bell County. For decades, the coal industry fueled the economy of this hardscrabble region. Eventually, however, the coal petered out, the mines shuttered, and the economy collapsed. Many people left the area to find work elsewhere. Unemployment rates were high, and in 2015 nearly two-thirds of adults did not have jobs. The median household income in 2013 was $25,228, and nearly 34 percent of Bell County’s citizens were living in poverty. Many people turned to drugs to lessen the pain that such difficulties can bring. The county’s coroner, Jay Steele, witnessed many tragedies caused by drugs. He saw a little boy in diapers crying near the body of his great-grandfather, who had taken care of him because his addicted parents and grandparents could not. He also watched as the adult children of another man who had just passed away ran to the local pharmacy, hoping to refill their father’s painkiller prescription to feed their addiction. “Day

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