The Ohio River Valley has seen some of the largest jumps in mortality rates among people in midlife — those between ages 25 and 64 — in recent years. Appalachia has been hit especially hard by the opioid epidemic, and Ohio and West Virginia have suffered the worst, with the highest rates of overdose deaths.
Since the drug epidemic started spiraling out of control, Detective Sgt. Randy Stewart with the sheriff's office in Belmont County, Ohio, has seen the effects tear families up.
"Going out, taking these young kids in body bags and seeing how it crushes the parents — it's tough," Stewart says.
He and his fellow officers have responded to overdoses all over the rural county: "Alongside the roadway," Stewart says. "Pull-offs. Back roads. Bathrooms for gas stations, restaurants, the truck stop. We pulled overdoses out of all those areas."
Wearily, he says he sees no sign of things turning around.
"Not to sound negative, but we haven't beat this yet," Stewart says. "I don't even think we're close. From what I see on a daily basis, we're kind of in last place here."
"Like a butterfly effect"
Health data for Belmont County show that the county ranked 50th of 88 Ohio counties for health outcomes. As with the rest of the state and the U.S. overall, Belmont County is seeing a trend of people dying younger, as life expectancy dips.
"They're losing years of potential life that they could have been a productive citizen in the county," says Linda Mehl, director of nursing with the Belmont County Health Department.
There is no one factor behind these numbers: Smoking, obesity, alcohol abuse and organ system diseases all contribute, along with drug overdoses. Broader economic conditions factor in, too. Over the years, the Ohio River Valley has seen the bottom fall out of the coal and steel industries — the engines that built these towns and that used to employ tens of thousands of workers.
"It's kind of like a butterfly effect," says Daniel Grady, public health emergency preparedness coordinator with the Belmont County Health Department. "People lose their jobs. They lose their health insurance, so that means preventative care takes a hit. And then, just the depression and everything that goes along with losing a job. Everything spreads out from something like that."
This year, federal law enforcement agencies descended en masse on the Belmont County seat, tiny St. Clairsville, with a population of about 5,000, startling onlookers. The FBI and the Drug Enforcement Administration were there, as well as a panoply of other agencies: "There were acronyms I never even heard of before," recalls Grady.
In separate sweeps, the feds raided the offices of two local doctors, Troy Balgo and Freeda Flynn. They were among 11 physicians across Appalachia charged by the Justice Department with allegedly overprescribing opioids and other controlled substances. Balgo and Flynn have both pleaded not guilty to the charges. Now, a sign on the door of Balgo's pain management clinic reads, "Office open but not seeing patients at this time."
St. Clairsville's Main Street is dominated by the county's massive, ornate sandstone courthouse, topped by a statue of Lady Justice. She's blindfolded, with the scales of justice balanced in her hand. "You can see her for miles away, if you're driving into the county," says chief criminal assistant prosecutor Kevin Flanagan. "I'll tell you what — when the sun is either going down or coming up, you don't see a better sight."
Over the last six years, Flanagan has seen his drug caseload climb exponentially as he prosecutes more and more high-level felony offenses. Drug-related crimes now make up about three-quarters of his caseload.
"As somebody who's lived here, grown up here, has family here, to see the impact of that is absolutely painful," Flanagan says. "Our judges say it best: 'You have options — your choice is to either find sobriety, go to jail or die.'"
"I think we do a heck of a job trying to do what is necessary for people to beat their addiction," he says. "We're absolutely unsuccessful a lot of the time. That's heartbreaking. But we keep trying."
"Why don't they say what it is?"
The drug epidemic that has ravaged these Ohio River communities has followed a now-familiar progression. For many, it started with prescription opioids. Then, drug users switched to heroin, which was cheaper. Now, law enforcement officials are seeing more and more methamphetamine, a powerful stimulant.
"Right now, methamphetamine is the drug of choice," says detective sergeant Stewart. "It's probably topped the charts around here."
"Talking to these people that we arrest, methamphetamine gives them that 'go' to work those 16-, 18-, 20-hour shifts that the oil fields are requiring," Stewart says.
"On one side, you got to love the fact that that job base is coming back to the area," Stewart says. "But in my position, from what I've seen from the influx of gas and oil, we as law enforcement probably are not ready for what's coming. ... A lot of good is coming in. It'll be followed by a lot of bad."
Fatal drug overdoses in Belmont County peaked in 2016 with 20 deaths, nearly all from opioids, including oxycodone, morphine, heroin and fentanyl. One of the last county residents to fatally overdose that year was Kimberly Moore Angus, a mother of two from Powhatan Point. The 29-year-old died on Dec. 2, 2016.
"When my husband went upstairs, I heard him say, 'You better come up here,' " recalls Angus' mother, Cindy Moore, as she chokes back tears. "And I came up there, and she was laying on the floor with the needle beside of her. It was horrible."
Moore says she can think of at least 10 others who died from a drug overdose, among them a nearby neighbor, extended family ("just died right there on the porch"), family by marriage ("overdosed on the couch"), a friend's grandson ("they found him on the bathroom floor, dead").
Moore says, "I look in the paper every day and see young people that have died, and it doesn't say why. Why don't they say what it is?"
So that's exactly what she did when she sat down to write the obituary for Angus: She told the truth. The obit reads, "Her mother and father found her on the floor dead from an overdose of drugs. They ask that her death would not be for nothing. If you are using drugs, her parents plead with you to stop and get help."
"I was mad when I wrote that," Moore says. "I was very angry. I was angry at Kim, and I was angry at the drug people. I don't know if it helped anybody or not, but I was honest about it."
Moore has just come from a support group for family members dealing with their loved ones' addictions. When the pastor leading the meeting asked the group, "Could it get any worse?", Moore burst out immediately with a rueful reply: "I don't think it could get any worse. Oh, my God."
That week, her son Steven Moore was sentenced to life in prison after pleading guilty to murder. At his sentencing, he told the court, "I'd like to apologize to the victims. ... It wasn't me — it was drugs."
"I earned my sickness"
A drive along the Ohio River between West Virginia and Ohio takes you past the hulking, rusted skeletons of heavy industry: the behemoth structures that fueled the rise of these towns.
"Tough little steel towns — they're called scrappy little towns," says Patrick Cassidy, a labor and employment lawyer from Wheeling, W.Va., as he drives past mile after mile of mills and factories, many of them now hollowed out or abandoned. The latest insult he points out?
"Another bad sign of the times: This is one of the hospitals that just shut down," he says.
In September, two hospitals here closed within weeks of each other, one on each side of the river, leaving some 1,100 workers out of a job and residents with fewer options for health care.
Cassidy thinks back to his father, who worked in the steel mills upriver for 40 years, breathing in smoke from the coke furnaces.
"And he ultimately died of emphysema, probably because of that. That's a typical story," Cassidy says. "My dad liked to say on his final illness, when he was dying, he said, 'Son, I earned my sickness.' That's the way he looked at it."
Back then, maybe it was the job that killed you. Now, Cassidy says, it's more likely the lack of one.
"That's what I think it is," he says. "Lack of opportunity, leading to desperation, leading to, 'I don't care about my health. What's it to me? It's hard enough for me to make it through the day. Wouldn't mind trying a few opioids at night just to make me feel a little better.' I think it's all about that, frankly. And it's just so sad."
Still, Cassidy loves this area and is committed to seeing it revitalized, with hopes of attracting well-paying middle-class jobs.
"When I see the Ohio Valley, even with the decline, I see opportunity," he says. "I see that it could be different, but keeping the same values that I think it had when we were growing up, which is a place to work for an employer with some reciprocal loyalties. ... It takes an attitude change about how we work our economy and how we care about our neighbors and our friends."
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