On the outskirts of Kingsport, Tennessee, Kim, a therapist, faces a small group of people sitting in folding chairs. She’s helping them rid their life of illegal drugs.
The attendees are all white and working class, self-described “dirt poor”, and none with college degrees. They have come to spend hours talking of past and present pains, offer each other support, and pee in a cup. If they pass the test, they will get their weekly prescription of Suboxone, an FDA-approved narcotic for opioid addiction treatment. Or as it is called on the streets, “fake heroin”.
Kingsport is where the Appalachians cross into eastern Tennessee. It’s a factory town cut in two by train lines and surrounded by hills. The few parts that are flat are stuffed with shopping malls, themselves filled with franchises. On maps, the area is mostly colored green for national forest, or brown for the hills. But on maps showing drug overdoses in the US it is dark red, the color used for the most deaths.