A Political Ecology of Ohio’s Opiate Crisis
August 30, 2017
“After moving here to the east side of town, after living on the west side my whole life, I had really really bad dizzy spells, which I was admitted for time after time, and which they called it Pot’s disease, where the blood pressure bottoms out. But I was never sick … I don’t remember ever being sick at all until we moved to where we are.”
These are the words of Connie, a 40-something grandmother and church pastor. Connie, by her own admission, does not look the part of a stereotypical heroin addict: she is five feet tall, with short bright red hair and a big personality. She talks openly about her love for Christ and family. Connie is a recovering heroin addict who has now been clean for two years. She has struggled with illness over the past two decades, having many surgeries performed. Her doctors prescribed a variety of opiates over this time to help her cope with her illness. Eventually, one day, she tells me that her opiate addiction led her to try heroin:
“I was already with this girl. We were pretty sick one day, and we didn’t have much money. A 30mg pure Percocet is $30. You pay $1 a mill. That’s a lot. When you get to the point that you’re addicted that you need four to feel, that’s a lot of money. She said, you know I think my son-in-law might be able to get us some powder. And I said, powder? Cocaine? I don’t want that. And she said, no some heroin, you know it’s an opiate so if we just did like a line or something it would keep us from being so sick and then we could always go back to our pills. That was the first time.”
Connie’s progression from opiate to heroin addiction via self-medication was repeated to me in several other instances. In one, a woman with fibromyalgia described using a product called ProTandem; the product’s website describes it as utilizing naturally occurring enzymes to “fight the effects of aging and increase health at the cellular level.” An acquaintance of the same woman later administered ProTandim to his wife near the end of her fight with amyotrophic lateral sclerosis (ALS). Another family described how their deceased patriarch smoked marijuana (at the time still medically illegal in Ohio) while bedridden with lung cancer to alleviate his daily pain. And still another told me of her relative with chronic pain as a result of ovarian cysts who was addicted to opiates and had recently started using heroin.
Opioid abuse in the United States has reached crisis levels. In 2015, 20,101 deaths in the United States were attributed to prescription pain medicine overdose; a further 12,990 were attributed to heroin overdose (Rudd et al. 2016). Many of those people obtained opiates legally through a physician. The relationship between opioid and heroin abuse has been well documented: often, opioid addicts, especially those whose insurance does not cover medication, turn to heroin as a cheaper alternative to pills (Kane-Willis et al. 2011; Muhuri et al. 2013; Unick et al. 2014). This crisis has captured national attention, recently dominating a large portion of the recent health care reform debate.
However, one question I do not see asked often enough is: why are people being prescribed these opioids at such a high rate in the first place? It has been proposed that greedy physicians and pharmaceutical companies are placing profit over people, and this is probably the case to some extent. But the opioid crisis is particularly acute in regions of the country that have experienced an economic downturn in recent decades. In Ohio, for example, where the collapse of the manufacturing industry has led to an exodus of good-paying jobs and a declining share of the population, the number of accidental overdose related deaths increased a whopping 642 percent between 2000 and 2015 (ODH 2014). The state’s opiate overdose death rate is 24.7 per 100,000—the third-highest in the nation and significantly higher than the national rate of 10.4 (KFF 2017). Other states atop the list with more than double the national rate include West Virginia, New Hampshire, Rhode Island, Massachusetts, and Kentucky. Each of these states has a historic economic base in manufacturing and/or extractive industries, and each is whiter than the average US population.
I propose that there is something geographically particular about this crisis. Drawing on ethnographic fieldwork I conducted in Ashtabula County, Ohio, between 2014 and 2016, I argue that the US opioid crisis is situated across a postindustrial Midwestern landscape in relation to social, ecological, and economic processes including manufacturing, agriculture, community, economic decline, migration, and environmental pollution. In order to fully understand how these relationships unfold to produce the contemporary opioid crisis, it is necessary to adopt a “political ecology of things” approach in which the agency of human and nonhuman actors emerges from their assemblages with one another (Bennett 2010). Such an approach emphasizes not only traditional actors of sociocultural systems—people, economies, knowledge, lifeways—but also the nonhuman objects—especially drugs and toxins—that make up their world. To do this, I will first review the environmental history of Ashtabula County as a model of Midwestern decline in the past half century. I will then address the ethnographic evidence that motivates my hypothesis.
Ashtabula County: An Environmental History of Midwestern Decline
Ashtabula County is the geographically largest in Ohio. With a 2016 estimated population of 98,231, much of that area remains rural and agricultural. The US Census profile in Figure 1 illustrates that Ashtabula’s demographic indicators are typical of the rural United States: lower median income and rates of higher education, and higher rates of senior citizens, poverty, and non-Hispanic white residents. The county seat, the City of Ashtabula, is located along the shores of Lake Erie. Ashtabula is approximately halfway between the two larger cities of Erie, Pennsylvania, and Cleveland, Ohio. In the mid-twentieth century, Ashtabula Harbor (Figure 2) was a noted shipping port. Residents could find good-paying jobs in one of many industries that made its home in the region: shipping, coal, manufacturing, agriculture, and the like composed the main economic base for Ashtabula County.
Near the end of the century, fortunes changed for the region. The neoliberalization of global economies has resulting in an expansion of free trade, thereby opening channels for cheaper labor and products to be acquired from abroad. Concurrent with the acceleration of the “information economy,” the result has been the decline of US manufacturing and thus economic insecurity for many citizens accustomed to upward mobility (Bonvillian 2016). Many Americans in towns and cities across the Midwest lost their jobs either directly as the result of a factory closure or indirectly from the economic decline that reverberated in communities where manufacturing was a major industry base.
As one informant named Mike described, the decline started in the 1970s and 1980s and precipitated thereafter. Mike moved away early in that time to work in Arizona; upon his return, he described seeing more crime and drugs than before leaving. Incomes declined as factories shuttered; the introduction of a Walmart Supercenter in the late 1990s accelerated the closing of various family owned businesses. As factories and businesses shuttered in this time, a number of consequential problems began to make themselves apparent. Following passage of the 1980 Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA), three sites in the county were listed on the National Priorities List for rehabilitation in 1983, only one of which has since been removed (EPA 2017b, 2017c). The US Environmental Protection Agency (EPA 2017a) identified six “beneficial use impairments” in relation to one of these superfund sites—Field Brooks—that impacted normal water quality and usability along the Ashtabula River.
The Postindustrial Midwest Landscape
“Rusted out factories scattered like tombstones across the landscape of our nation …”
— President Donald Trump, inaugural speech, 21 January 2017
Today, Ashtabula County suffers from higher unemployment and poverty rates than the national average (ODJFS 2017). Even despite the steady decline of manufacturing in the United States post-NAFTA, one in four Ashtabula County workers is employed in manufacturing, demonstrating the industry’s continued significance to the local economy (Data USA 2017). This creates tension between those who want to clean up Ashtabula County’s polluted environment and those who fear that doing so could cause the further erosion of a major economic engine. And like so many other postindustrial small towns across the Midwest, Ashtabula County has become home to a severe opiate crisis. At the County Children’s Services Board, courts are backed up because of the number of foster cases involving addicted parents (Dennis 2017).
The notion that Ashtabula County is a microcosm for national social problems is not limited to my research. Ashtabula County has received more attention than usual over the past year because its geography, demographics, and cultural legacy make it an archetypical community of the kind President Donald J. Trump targeted in his campaign. The popular American political website FiveThirtyEight published a feature article on the county just days before Trump became the first GOP nominee since Ronald Reagan to win in the traditionally blue county (Malone 2017). Other national news outlets in the past year have profiled Ashtabula County’s opiate crisis, lending credit to the notion that there is something locally specific about the crisis (Lurie 2017).
Drawing on the concept of a “blasted landscape”—a landscape that has been profoundly transformed, often considered “ruined” (Kirksey et al. 2014)—I propose that Ashtabula County is representative of a postindustrial Midwestern landscape. A number of human and nonhuman factors defines such a landscape. Talking to residents of Ashtabula County about how they define their environment, one receives the familiar, “expected” answers: maple and oak trees, Lake Erie, the Ashtabula River and its many streams, the rolling Appalachian Hills, the seasonal changes, and the various birds, fish, and mammals that occupy this territory are all frequently mentioned by my informants. However, they also mention features of the environment that were human-made: the factories and the various alarms and sirens that sound when they release something into the air; the site of a poor person’s unkempt front yard, filled with garbage; drug addicts hanging around Walmart and the Ashtabula Towne Square, pacing and waiting for their next customers, with discarded syringes littering the pavement around them. Each of these is mentioned as well as a symbol of environmental decline and degradation.
A Manifesto for the Postindustrial Midwest?
Everywhere I turn in Ashtabula County, it seems as though someone I know has a story like this. The materiality of the situation is difficult to discern; environmental toxicology is an imperfect science, and the burden of scientific proof is frequently placed on communities to prove that they are victims of an (environmental) injustice. But a regional folk ontology seems to be forming in the collective conscious that, somehow, the different toxins—factory pollutants and drugs—are interconnected. To this end, it is worth investigating if there is merit to their claims. Exploratory ethnographic work like the work I conducted is frequently useful in generating hypotheses; the next step would be to seek out information on the specific medical conditions for which opiates are being prescribed. Any known links between particular illnesses and their causes can be identified using spatial data, while any unclear links can spur additional research to make their pathways visible.
Richard Bargielski is a PhD student in applied anthropology at the University of South Florida. His research focuses on the changing political landscape of the United States. He would like to extend special thanks to Zac Caple for his feedback.
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Data USA. 2017. “Ashtabula County, Ohio.”
Dennis, Justin. 2017. “State Custody Emergencies Triple in County; Drug Use Linked.” Star Beacon, 20 February.
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Malone, Clare. 2017. “One Ohio County’s Struggles Are Fueling Trump’s Support.” FiveThirtyEight, 3 November.
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Unick, George, Daniel Rosenblum, Sarah Mars, and Daniel Ciccarone 2014. “The Relationship between U.S. Heroin Market Dynamics and Heroin-Related Overdose, 1992–2008.” Addiction 109 (11): 1888–1898.
USCB (United States Census Bureau). 2017. “QuickFacts: Ashtabula County, Ohio.”
Tags: heroin, Midwest, Ohio, opiate crisis, opioid epidemic, opioids, Richard Bargielski
Cite as: Bargielski, Richard. 2017. “A Political Ecology of Ohio’s Opiate Crisis.” EnviroSociety, 30 August. www.envirosociety.org/2017/08/a-political-ecology-of-ohios-opiate-crisis.