Opioid misuse in Appalachia: political ecologies of care

Abstract

Over half of the drug overdoses in the United States are due to opioids, with overdoses now considered the leading cause of injury-related death nationally. Rural Appalachia is popularly considered the “epicenter” of the opioid epidemic. Drawing on approaches of political ecology of health and geographies of care, we aim to understand how COVID-19 is transforming the landscapes of addiction in Pennsylvania, West Virginia, and Kentucky. We highlight historical, political and economics factors that lead to spatial variation in local experiences of the epidemic. This includes histories of deindustrialization, changing agrarian and energy economies, and political partisanship. Analyzing 35 interviews with professionals working in opioid misuse treatment, we show how certain individuals and regions are differently vulnerable to addiction. We find that spatial differentiation in care is shaped by ideological and institutional tensions about what care can and should look like, and ways in which care is being financialized to the potential detriment of those in need.