What It's Like To Treat Opioid Addiction in Appalachia

Psychiatrist Sally Satel on her eye-opening year at a clinic in Ironton, Ohio.

- By Nick Gillespie

Why did prescription opioids bring so much misery to the small towns of postindustrial America?

The standard narrative puts the blame on OxyContin, a powerful painkiller supposedly pushed on rural Americans by the profiteers at Purdue Pharma, which ended up filing for bankruptcy and settling criminal charges with the federal government for $8.3 billion. In this telling, the opioid epidemic is a morality tale of capitalism run amok and regulations made toothless by anti-government zealots.

Sally Satel, a practicing psychiatrist who works at a methadone clinic in Washington, D.C., has a more complicated story to tell. In 2018, she moved to Ironton, Ohio, an economically depressed town in Appalachia, where she worked with patients and social service providers. Satel doesn’t stint on criticism of drug makers, but she says that the opioid crisis is an outgrowth of a century-old tradition of medicating pain as a way of tending to the broken bodies of the region’s laborers.