RX Appalachia: Stories of Treatment and Survival in Rural Kentucky

by Lesly-Marie Buer

Using the narratives of women who use(d) drugs, this account challenges popular understandings of Appalachia spread by such pundits as JD Vance by documenting how women, families, and communities cope with generational systems of oppression. Prescription opioids are associated with rising rates of overdose deaths and hepatitis C and HIV infection in the US, including in rural Central Appalachia. Yet there is a dearth of studies examining rural opioid use. RX Appalachia explores the gendered inequalities that situate women’s encounters with substance abuse treatment as well as additional state interventions targeted at women who use drugs in one of the most impoverished regions in the US.

Genres: Nonfiction, Addiction

220 pages, Paperback

Published May 12, 2020

Reviews

[Alaina · Rating 5 out of 5]

Thoughtful, humanizing, and incredibly compelling. Truly a must-read if you have a remote interest in feminism and the opioid crisis. This was such a powerful critique of the current systems of care in place for some of our most vulnerable populations. I wish more than anything that we lived in a more equitable world and I am deeply grateful to the women in this ethnography for for sharing their stories and to the author for writing this. The current systems we have in place are so deeply flawed that it can be easy to lose hope but this book has prompted me to think more deeply about the ways I can support harm-reduction programs and then actually do it.

[Mark Aronson · Rating 5 out of 5]

A powerful and heartbreakingly honest look at the converging effects of disinvestment, the opiod crisis, and lack of effective social programs for women in rural eastern Kentucky. Excels at examining the realities of the burdens of social programs for this population while offering some possible directions forward at the end. A compelling and important read

[Dayna · Rating 5 out of 5]

A really thoughtful and humanizing examination of a crisis that is not actually a product of human failing. Can't wait to pass this along to radical social worker friends, I know it will be appreciated.

[Julia · Rating 5 out of 5]

Compelling and resolutely empathetic, Buer investigates the intersections between gender, addiction, Appalachian identity, and neoliberal policy--and the women who survive in the rifts everyday. A super accessible ethnography.

[Katie Dee · Rating 5 out of 5]

A tough read in terms of subject matter, but important for understanding the opioid epidemic and the role that pharmaceutical industries play in it, told through the eyes of ordinary people.

[Lori · Rating 2 out of 5]

Boring

This was one tough book to get through! It is very rare that I have to force myself to finish a book since I always try to finish books I start. Sometimes they get better as you go further into the book but IF it did, it was quite marginal.
I found it to be very heavy with statistics and rather light on the personal stories. In terms of the boredom and statistical issues, I can give you an example I found to be excessive. Many books -- if not most, have an introduction as did this book. I expected that and usually appreciate it. However THIS intro spanned about 25% of the book! It talked about Appalachia and its people, the poverty that is often generational, opioid usage, racial discrimination and also outlined what was in many of the chapters.
While the author DID include a handful of the women's stories, THIS was an area I would have wanted to see more details, more about the biological family dynamics, any trauma that occurred, did mom and dad work (if there were both parents in the picture)? Also, is everyone in Appalachia very poor? What are some of the businesses like if they have any major ones? Is there a grocery store where these women live? A hospital? Pediatrician? Department stores? Fast food restaurants? Pizza delivery? Taxi or city bus? Wouldn't a city bus help people with being more independent and having a chance to earn more per hour?
I feel bad for the author when I have to give a low rating but this one just doesn't resonate with me despite my interest in these kinds of topics.

[Danica · Rating 4 out of 5]

This book would be great for any healthcare worker who works with patients with substance use disorders. It's an anthropological study of women in Adams County, Kentucky, who have dealt with or are dealing with substance use, including prescription and illicit opioids and meth. Buer talks about the services available to them - drug counseling, drug court, medication assisted treatment - and the carceral state that inflicts violence over them and their families. A major theme is how the government frames these services as protecting white children, rather than the women themselves, so they'll often lose custody of their kids if they fail a drug test, and then without custody, they'll lose food assistance as well.

The thing I'm going to take away from this is that we've got to stop putting conditions on who we think are "worthy" to lead lives of dignity. We should stop making people jump through hoops in order to prove they deserve basic stuff like healthcare, housing and food. Like one woman had to get drug tested regularly, so she would work 12 hours at a factory job, drive an hour home, rest for an hour and a half, and then drive to get drug tested at 6 am the next morning. One woman was being abused by her partner, called the police, the police came and drug tested her, and she lost custody of her children when she was positive for marijuana. Incredibly inhumane and unreasonable system we have.

[Trenchologist · Rating 4 out of 5]

3+

Cogent, clear prose that's not too dry but not too thick as to stray from the topic; the main thesis laid out is met.

The interviews are presented piecemeal and as quoted outtakes that relate to various chapters rather than being fully documented, and I was interested in a more fully documented approach. But I saw how they worked and why that decision was made, for all that I'd have gladly read more one-on-one conversations alongside the social/welfare analysis.

[Madeline Attianese · Rating 5 out of 5]

I am currently a college student that is reading this book for my Medical Anthropology course. This book has opened up my eyes to issues and ways of thinking that have challenged what I thought I knew about substance use. I highly recommend reading Buer's book to expand your mind on the stigma around substance use, especially substance use in relation to women.

[Barb Spags · Rating 3 out of 5]

Interesting story with lots of anecdotes. The style isn’t my favorite due to repetitiveness of author’s points.

[Glenn · Rating 3 out of 5]

cannot remember why but i did not like this

[kay · Rating 5 out of 5]

"If every biased service provider altered their attitude, they would still be working in underfunded programs with problematic policies serving populations marginalized by exploitative economic and political processes." pg 198

"Violence can at times be a demonstration of care and solidarity. At other times, what looks like violence feels like violence, but that violence is as complex as the care with which it intertwines." pg 23

"Bupe programs are helpful because they allow people to slowly change their lives, including their routines. In inpatient or outpatient programs, by contrast, people are forced to quickly change their lives for ninety days or so." pg 144

"When people who use drugs are portrayed as uncaring or immoral, this justifies withholding resources, including societal care." pg 170

This book was such a compassionate exploration of the lives of Appalachian women who use drugs. Buer emphasizes that that their use of drugs is not and cannot be disconnected from the ways in which state and local systems further marginalize and often perpetuate their drug use by, reinforcing stigma, issuing punitive consequences, and not adequately offering day-to-day resources that decrease stress (transportation, child care, shelter etc.) Buer stresses the need to understand the complexities in these women's lives that lead them to substance abuse and complicate recovery, like sexual violence and the weight of intense unpaid care work. While also acknowledging the ways in which their (predominantly) whiteness allows them to interact with the carceral system in non-fatal ways, gain access to services designed to benefit white children, and face lesser stigma and punitive consequences than women of color that use drugs.