The jail in Letcher County, Kentucky, is tucked away at the back of the courthouse in downtown Whitesburg, invisible to pedestrians except for an open-air concrete structure on the roof where prisoners are allowed to exercise. Its size—fifty-four beds stacked inside a space the size of a three- or four-bedroom house—reflects the size of the rural Appalachian county it serves. Its population, however, far exceeds its official capacity: on any given day, there may be more than a hundred people inside. “When I got to the Letcher County Jail,” says Emily Estep, a recent detainee, “they didn’t have any cells open, so they put me in a closet. Like a locked-in closet. It didn’t have a toilet in it. It was so cold, I was froze to death. . . . They came and got me like if I needed to go to the bathroom or whatever, but it was just very inhumane.” Local news reports corroborate her account. In July 2020, a woman detainee was found dead inside the Letcher County Jail; the cause of her death—whether from Covid-19, a drug overdose, neglect, or something else—was never announced.
Municipalities in this former coal mining area of eastern Kentucky have built or expanded at least half a dozen jails like Letcher County’s in the last twenty years. The reason is the drug war. Beginning in 2001, law enforcement agencies in the region poured millions of dollars into fighting one class of drugs in particular: prescription pain killers. This event is now known as the “opioid epidemic,” and every year it attracts a great deal of coverage and commentary in books, articles, documentaries, and even TV shows. These accounts all tell the same basic story, with the same characters. On one side are the villains: Purdue Pharma and other large pharmaceutical companies, drug sales representatives, “pill mill” pain specialists, and street dealers. On the other side are the heroes: primary care physicians, parents, civic and faith leaders, scientists, and law enforcement officials. The accounts nearly always frame the epidemic as a static battle of good vs. evil, the chain of events comprising it as a linear, causal path of injury and response. Big Pharma targeted places like central Appalachia because they were poor and deindustrialized, and opioids became rampant there for those very same reasons. In response to the influx, civilian heroes banded together to fight back against the villains, using their tools of community action and litigation.
While well-intentioned, this narrative is incorrect. Communities in central Appalachia did not band together to fight Big Pharma; many of them were in fact torn apart by the punitive response to the epidemic, which came at a crucial moment in political and economic history. Community activists targeted their own neighbors for punishment and labeled them public enemies, creating a social atmosphere in which recovery was nearly impossible. Thousands of people were disappeared into cages, some never to emerge again; if and when they did get out, they were often still addicted, or marked with felonies, and thus cycled back into what one public defender described to me as the “felony trap.” The result has been an epidemic not suppressed but inflamed.
Law enforcement in particular played a major role. Contrary to what mainstream accounts claim, law enforcement did not valiantly sound the alarm on growing opioid use. Rather, they cracked down on drug users with militaristic zeal. The municipal lawsuits brought against Purdue and other pharmaceutical companies provide stark examples. These lawsuits are often framed in the media as David vs. Goliath moral crusades, of the Little Guy fighting the forces of Big Corporate Greed. Some of them are indeed that: they seek to reclaim health care and treatment costs caused by the epidemic. But these suits are also compelled by the soaring costs of law enforcement and incarceration. A 2007 lawsuit brought against Purdue Pharma by Pike County, Kentucky, claimed that the epidemic had cost the county $7 million in bonds and severance money. Buried in news reports was the fact that, according to former Sheriff Charles “Fuzzy” Keesee, nearly 80 percent of that money was spent on the county’s 2005 jail expansion “to deal with the [opioid] problem,” and the lawsuit aimed to recoup those costs. Big Pharma flooded the streets with pills, but law enforcement chose to criminalize it.
And there are other characters in this story whose actions do not fall neatly within the hero–villain binary. Politicians, for example, who obtained funding for the drug war and crafted punitive legislation to support it. Civic leaders who naturalized the increasing militarization of their communities. Journalists who exaggerated crime statistics and contributed to a moral panic. Community activists and faith leaders who demonized drug users and taught school children to do the same. These were choices that people made at various conjunctures; at no point was the future inevitable. And yet eastern Kentucky is now a region profoundly changed by new jails, lives lost, and families severed. Someone other than just Purdue Pharma must therefore be made to answer for the long-term impacts of the “opioid epidemic.” Who those people are, how they implemented their visions, and why they felt compelled to do so are questions with implications that extend far beyond setting the record straight.
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