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On the Just Treatment of Appalachian Coal Towns

A small town main street with a green mountain in the background and an American flag

Detroit had automobiles, Pittsburgh had steel, and Boston had textiles. Amongst these former capitals of industrialization in the United States is one that is seldom mentioned: the coal kingdom of Hazard, Kentucky. Hazard started booming as a coal town in 1912 when a railway along the North Fork of the Kentucky River was built with a station there. Soon thereafter, nearby coal mines started opening frequently, making for an abundance of jobs and a rapidly growing population. Between 1920 and 1930, the population of Hazard grew from 4,348 to over 7,000. The small city still hosts a Black Gold Festival every September to celebrate its industrial roots.

However, Hazard’s once rich history has now turned into severe poverty, unemployment, and addiction. The population is currently 5,600—shrinking over 1,800 since its peak in 1940 despite heavy national population growth. Additionally, Hazard’s median household income of $20,690 is almost $40,000 under the U.S. median, with about 31% of its small population living below the poverty line. Perhaps the darkest aspect of Hazard’s downturn is the opioid addiction crisis. Perry County, Kentucky (where Hazard is located) had the most opioid-related hospitalizations in the nation in 2017, with 6% of the county’s population having been hospitalized due to opioid abuse. Three counties surrounding Perry were also in the top ten in the nation.

Hazard, however, is not isolated in the challenges it faces. Towns all over Appalachia have experienced severe downturn characterized by these same issues. To illustrate, six of the 15 states with the highest opioid death rates are Appalachian states (West Virginia is first with 43.4 out of every 100,000 people dying of opioid overdose, followed by Ohio at third, Maryland at fourth, Kentucky at 10th, Pennsylvania at 12th, and Tennessee at 14th). Between the years 1999 and 2016, the number of opioid-related deaths in Pennsylvania jumped 736 percent, while those in Kentucky, Ohio, and West Virginia jumped over 1,000 percent. These rates are compared to a national increase of 528 percent. With the opioid epidemic, Appalachian states also deal with unusually high poverty and crumbling infrastructure that has led to the contamination of drinking water.

Why is it that these challenges are so inflated in Appalachia? Why is a region of the U.S. that once prospered and was overflowing with opportunities for lucrative employment is now rapidly decaying? The most obvious reason is the decline in demand for coal. U.S. coal consumption peaked as recently as 2007 but has dropped 44 percent since then, reaching its lowest level in almost 40 years. This number is expected to drop another eight percent this year. Additionally, of the 1,470 coal-fired generators in the U.S. in 2007, 540 have been retired as of September 2018. The decrease in demand has inevitably resulted in a decrease in coal production, and therefore a decrease in coal jobs. Coal mining jobs in the U.S. have dropped a whopping 71 percent since 1985. This effect is more pronounced in Appalachia. Coal production in Appalachia fell 45 percent from 2005 to 2015, resulting in a loss of about 33,500 mining jobs since 2011. In Hazard in particular, the local coal industry now produces approximately 4.1 million tons of coal annually, dropping about 13 million tons since 2008, and losing about 13,000 coal jobs in eastern Kentucky since 2011. This year marks the lowest number of coal jobs Kentucky has had since 1898.

People across the nation have noticed Appalachia’s suffering, and have searched for causes behind it. Donald Trump in particular ran on a platform that included the revival of the Appalachian coal industry. He puts most of the blame for its recent lack of success on environmental regulations imposed by Democratic politicians. In one tweet referring to the Obama administration’s regulations on carbon emissions, Trump wrote, “Obama’s coal regulations will destroy the coal industry, put Americans out of work, raise electricity prices, and lead to blackouts.” Trump continues to tweet into his presidency about how he has “ended the war on coal.” The coal town of Hazard seems to agree, as 77.2 percent of voters in Perry County, Kentucky voted for Trump in 2016. However, Trump’s assumption that environmental regulations are destroying the coal industry and, by association, the economy of Appalachia, is overly simplistic. In fact, environmental regulations only account for approximately 3.5 percent of the total decline in U.S. coal production. The reality is that the coal industry is dying primarily of natural causes.

There are two main reasons behind the Appalachian coal industry’s decline: decreasing productivity, and competition with other energy sources. The former is caused by the dwindling supply of easily-accessible coal deposits in the Appalachian Mountains. After almost a century and a half of mining, miners now have to dig deeper into the mountains for usable coal. To offset this increased difficulty in mining, coal corporations have turned towards mechanization, which puts even more miners out of work. Even with a mechanized workforce, however, Appalachian coal cannot keep up with coal production in western states such as Wyoming, Montana, and Texas, where deposits are closer to the surface and therefore require less time and money to mine.

Along with challenges the coal industry faces to keep up production, it must also deal with higher competition with other sources of energy, namely renewable energy (wind power, solar power, etc.) and natural gas. Renewable energy is beginning to compete with coal because of rising concern amongst Americans about the environment. Burning coal is one of most harmful sources of electricity in terms of carbon emissions, and while it is cheap, Americans are beginning to prioritize environmental harms caused by energy sources over the economic costs they incur. This gives renewable energy sources (which are typically more expensive) an advantage over coal. Most competitive with the coal industry, however, is natural gas. In 2016, natural gas surpassed coal as the U.S.’s leading source of electricity. This is largely due to falling natural gas prices after the fracking boom of the late 2000’s. Natural gas is also cheaper to produce than coal, and burning natural gas puts out significantly less carbon emissions than coal.

Because the Appalachian coal industry is already becoming obsolete at the hands of struggling productivity and a more competitive energy market, it would be foolish and reckless for politicians to attempt breathing life back into it. Rather, these efforts should be put into diversifying Appalachia’s economy. Some coal towns are already beginning to do this. The residents of Hinton, West Virginia, for example, have started the Appalachian Beekeeping Collective, a nonprofit aimed at training out-of-work coal miners in beekeeping. This nonprofit has grown to operate in 17 counties throughout the state of West Virginia in just two years since its creation, and helps ex-miners earn money in a more sustainable field of work. Additionally, the state of Pennsylvania, which has traditionally been a coal state and is still one of the biggest energy producers in the U.S., is moving its economy to subsist on nuclear power and natural gas while coal is on the decline. Even Hazard is turning the site of one of its former surface mines into the USA Drone Port—a research and testing facility for drone companies to use. To supplement this, the Hazard Community and Technical College has introduced courses in unmanned technology, drone flight, photography, and videography: all skills that will translate well into USA Drone Port’s workforce. The Technical College has already graduated 200 students in these fields, many of whom used to be coal miners.

Unfortunately, the coal industry does not appear to be a significant part of the future U.S. economy. However, adapting to the future is possible, and many places around Appalachia are showing it. Appalachia is a region full of innovation, grit, and most importantly, people who are ready to work for the betterment of their communities, with or without coal.

 

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Reduction of Harm: Fentanyl Testing Strips for Drug Users

Photograph of a kit for needle exchange, including three needles, cotton pads, and alcohol wipes

In 2017, more than 49,000 Americans died from opioid overdoses, the highest rate that America has ever seen. Of these opioids on the rise is the illicitly manufactured fentanyl drug which can be mixed into heroin and other powdered drugs. Fentanyl is also a prescribed pain killer, but it is the illegally synthesized opioids made with this drug that have caused 29,406 deaths the past year in the US and a 22-fold increase from 2002 in overdose-related deaths. Fentanyl is a drug that is 50 times as potent as heroin and this deadly synthetic could be responsible for the worst drug epidemic in U.S. history.

There is now a way for users to take caution from using drugs that contain this synthetic opioid. On the market for $1 a piece, there are two-inch fentanyl testing strips. When drug users dip the strip into a drug it will reveal if the drug contains fentanyl by the presence of a red line. Along with detecting fentanyl, it can detect nine different chemically analogous drugs, such as carfentanil, which is 10,000 times as potent as morphine. The test strips were originally created for doctors who use them to test the urine of patients  who use fentanyl as a prescribed pain medication. BTNX Inc, a main commercial provider of these strips, is now selling more strips to harm-reduction groups and city/state governments then they are to doctors.

A study conducted by Research Triangle Institute (RTI) International,  looked to see if drug users would change how they used drugs if they had access to these fentanyl strips. They surveyed 125 heroin users from Greensboro, North Carolina at a needle-exchange program site. Eighty-one percent of users reported using the strips and 63 percent got a positive result for fentanyl in their drugs. Those who had a positive result for fentanyl were five times likely to change how they use in order to avoid overdosing. Responders reported using less drug then usual, administering a tester shot, pushing the syringe in slower than normal, and snorting instead of injecting. These practices can decrease the rate and amount of the drug that goes into the bloodstream making them a safer way to use.  Jon Zibbell, an author of the study, says, “An important insight from the study is that people who inject drugs can and will change their behavior when they have information about the risks involved. The bottom line is that fentanyl test strips may represent a new technique to prevent opioid overdose by allowing people to check street drugs for fentanyl and modify consumption behavior accordingly.”     

These testing strips have similar intentions to needle-exchange programs and naloxone antidotes for overdoses. Needle-exchange programs have been found to reduce the amount of blood-borne infections, keep the streets safer for kids with less loose syringes, and provide safe spaces for drug users who have been rejected from their families. These spaces create opportunities for users to turn their lives around and make productive, clean lives. Similarly, naloxone is a medication that will rapidly reverse overdose. It comes as an injection, auto injection, or nasal spray for trained personnel or family members of opioid users to access in case of emergency.

The intentions behind the fentanyl strips for drug users are morally sound in that they align with the needle-exchange programs and naloxone antidotes. They work to decrease overdose, spread of disease, and overall harm to users. However, we must consider if these fentanyl strips are actually effective at decreasing drug overdose. Are they actually being used as something productive, to decrease the amount of harm to users? Or are they promoting the drug industry as “safer” ways to use? If they do little to eliminate harm to users then they could just be weakening drug laws and promoting usage as an unintended consequence.

A few cities such as Baltimore, Philadelphia, Columbus, Ohio, and Burlington, Vermont, have started providing test strips at their needle-exchange sites. However, something that is restricting the wide distribution is that there are paraphernalia laws in place that prohibit the use of devices to aid drug users in using drugs. The needle-exchange sites are not nationally used today: fifteen states still outlaw them. Though this restriction has been loosened for when it comes to clean needles, it could still apply to test strips.

The cons of the testing strips, according to the RTI study, is that though users are more likely to change the way that they use the drugs, they do not stop using. The respondents said that they were more likely to reduce how much they use. They were also more likely to snort the drug instead of inject it, which leads to less being absorbed in the blood stream. However, none of the respondents said that they would throw out the drugs even though they had a 63 percent positive finding for the potent fentanyl drug. Not to mention, the cost of the strips may be too much of a burden for the users to take on as a way of protection.

On average, a clean syringe costs $0.97, similar to the $1 cost of a testing strip. The fact that the strips cost one dollar may seem like a cheap price but on average, heroin users inject four times a day. When injecting this frequently, the process could potentially become too costly to be worth clean syringes and testing strips to users. To counter this barrier, some people suggest that users should just assume that all heroin contains fentanyl and adjust accordingly. Jon Zibbell says, “We have a poisoning epidemic. When there’s E. coli in the lettuce, you test the lettuce. You have to test the product to see what’s in it.”

In order for these testing strips to be implemented in a positive way, there needs to be more solid evidence that they will function as harm prevention. From the Harm Reduction Journal, Don C Des Jarlais writes about how the way that needle-exchange programs were so successful was through vast amounts of research and activism to put the harm reduction measures into place. He says, “The researchers then provided the data needed to justify large-scale public expenditures on harm reduction programs (primarily by state and local governments). Without these public expenditures, the harm reduction programs would not have achieved the scope they needed to be successful to stop the HIV epidemic among people who inject drugs (PWID)”. Fentanyl testing strips seem to be in the horizon towards lowering drug overdose, but more research needs to be done. This research must prove that because of access to the fentanyl strips, drug users will change the way or amount that they use, ultimately proving that the fentanyl strips can decrease the rate of opioid overdose deaths.

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The Opioid Crisis and America’s Homegrown Cartels

photograph of a pill bottle with pills spilling out

The “crisis” of drugs in United States, dating at least to the “war” that Richard Nixon declared on “public enemy number one” in 1971, has seemingly become a permanent frame of our political life. After trillions of dollars spent and decades of chaos produced in Latin America, we have reached a point where the language of “crisis,” largely directed outside to other “sources,” seems to have moved home. But to what? Since 2016, drug overdoses have become the leading cause of death in America, 2/3 of which are related to opioids (a larger class that includes both plant-derived substances like heroin and semi-synthetics like oxycodone). For many, statistics like this are not necessary to recognize that, no matter which way you put it, the opiate crisis is our crisis. But how far are we willing to go in recognizing our complicity in it? Many will have to continue to deal with overdoses, withdrawal, relapse, and an unfortunate number of deaths. Socially, we should be questioning the corporate, marketing, and governmental practices that have reaped billions of dollars from an epidemic that is largely homegrown. Continue reading “The Opioid Crisis and America’s Homegrown Cartels”

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Drug Addiction: Criminal Behavior or Public Health Crisis?

It is painfully obvious that the United States is in the midst of an epidemic of opioid abuse. According to the US Department of Health and Human Services (DHHS), more people died from drug overdoses in 2014 than any other recorded year, and the majority of those overdose deaths involved opioids. DHHS and the Centers for Disease Control (CDC) claim that an increase in the prescription of pain medication is a primary driver of the opioid epidemic. According to the CDC, the amount of prescription opioids sold in the US has nearly quadrupled since 1999. However, Americans do not report higher levels of pain than they did in 1999.

Continue reading “Drug Addiction: Criminal Behavior or Public Health Crisis?”

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On Providing Safe Spaces for Drug Use

Under new legislation in Maryland, spaces will be provided for illegal narcotics to be ingested in clean facilities under the supervision of medical professionals. There are nearly 100 such facilities worldwide, largely in Europe, where they have existed since the early 1980s. In the United States, where rates of accidental death from opioid overdose have “quadrupled since the late 1990s,” these facilities are still largely a controversial possibility.

Continue reading “On Providing Safe Spaces for Drug Use”