Opioid addicts are using and collapsing in public in increasing numbers—their way of ensuring they won't OD and not be found until it's too late, Margaret Talbot explains in the New Yorker. "This is survival to them," she writes. "They're struggling with using but not wanting to die." Talbot heads to one region in particular, where the overdose death rate is the highest in the nation at 41.5 people per 100,000: West Virginia, where heroin proliferates and addicts are treated with both empathy by neighbors who recognize addiction as a disease, as well as contempt for being "community embarrassments." "Stop giving them Narcan … at the [taxpayers'] expense," wrote one commenter on a recent article about a local couple who ODed at their 13-year-old daughter's softball game. "They are sick," retorted another. "Shaming and judging will not help anyone."
The epidemic is so bad that in one county, when someone under 60 dies and local papers don't say why, it's assumed it was an OD. Talbot shadowed a paramedic, meeting various people who needed medical attention after using: a young woman passed out in her car in a parking lot, a man unconscious on his bathroom floor. Talbot explains locals turn to this self-medication to dull the physical pain of jobs like coal mining, the emotional pain of depression and PTSD, or the "psychic" pain of unemployment. One 42-year-old who lost his own brother to an overdose explains the "social vacancy" in a place where many "don't feel they have a purpose." But then there are those who do. They're the citizens desperate to help the addicts in their midst, taking in kids whose parents can't stop using or lobbying for detox centers, erring on the side of empathy. "I want to show people they deserve a chance," says a photographer who takes pictures of addicts in recovery. Talbot's story here. (In Massachusetts: opioid addicts who've developed amnesia.)