'The Pill Mill of America': Where Drugs Mean There Are No Good Choices, Only Less Awful Ones

Portsmouth, Ohio, once known for making things (steel, shoes, bricks), is now known for drugs, and labeled by some as the “pill mill of America”. The city peaked at 40,000 people in 1940, and as it emptied of factories and jobs – some made obsolete, some moved away – it also emptied of people and hope.

Now it is a town half the size, filled with despair and filling withdrugs.

On my first night in town, a beat-up car parks next to me, positioned in the darkness cast by my van. The passenger, a middle-aged woman, injects the driver in the neck. He stays still, head tilted to expose a vein, as she works the needle in, while two young boys play in the back seat.

Done, they pull away as I try to fool myself into thinking I didn’t see what I saw.

For six days in Portsmouth, over three trips, I keep trying to fool myself. Eventually, I am unable to just watch and listen.

Portsmouth is beautiful. It lies along the intersection of the Ohio and Scioto rivers, ringed by sharp hills. It has plenty of well-kept neighborhoods filled with people doing fine, yet living here also means being constantly reminded that things are not all well.

In a fast food parking lot, a small group is hanging out, smelling of alcohol, sweat, and piss. On the fringe, under the shade of the awning, a man leans against a shopping cart filled with empty cans, blankets and children’s toys. The cart also holds two small children, one boy and one girl.

Stunned, I go inside to collect my thoughts and watch. A woman in dirty clothes and a tiny pink backpack comes in to clean up and buy food. She hands the food to the man and children, before heading to the roadside, where she stands with a cardboard sign saying: “Homeless Hungry Anything Helps”.

I go outside to talk to the man. James (his name has been changed) is 39, and the woman with the sign is Meghan (her name was also changed), the mother of the two children, aged two and three.

The cart smells, the blankets inside damp and dirty. The kids sit still as we speak.

James is polite and soft spoken, his focus shifting between the kids in the cart and Meghan on the corner. He explains that they were evicted a year and a half ago for “non-payment” and after a stint in a shelter, they took to the street. When I ask him how he can be on the streets with two kids, he clarifies: “We ain’t really homeless right now. We crash in a shed behind the house of a friend.” I ask him if the shed has water and heat and he smiles and says: “We have a cord we run out to the shed. It has been warm the last three nights, so that’s good.”

I tell him I am a reporter writing about drugs and poverty, and ask him if there is anything I can do to help. He smiles and says no, they are all fine.

I continue to see them over the next few days along a commercial strip, Meghan standing by the side of the road holding her sign, staring straight ahead, her expression vacant, while James pushes the cart with the kids in it, collecting bottles and cans. Sometimes he stops to let them play.

One afternoon I run into him in the McDonald’s bathroom, filling plastic bottles with water to clean his children.

Outside I ask him more questions about his situation, and he tells me his history with drugs. “I was born in Portsmouth and raised around drugs. Everyone used them. My father drank, and I started drinking when I was a teenager. Then started Percocets when I was 19. Then I moved to the harder stuff like Oxy 80s, then heroin.” I ask him if he still uses drugs, “No, I don’t. Well, only Suboxone [an opioid medication used to treat opioid addiction]. I buy it from the street since I don’t have a prescription.”

Most drivers ignore the family. Police pass without stopping. One woman drops off two slabs of bottled water, and a minister inquires about their condition, but otherwise they are unseen. I think about calling child protective services, but it is clear James cares and is attentive. I also assume I am missing part of their story. Surely others have called. Perhaps others have inquired more than I have. Perhaps things are more complicated than what I see.

Besides, there is so much visible pain in Portsmouth, it is hard to focus on any one situation.

A few blocks across the railroad tracks from James and his family is an area with dope-sick women walking a loop around emptied warehouses, smiling and waving at some cars, hiding from others.

Kayla (her name has been changed), 36, calls to me from the passenger side of a parked car. She is dressed in sweatpants and a windbreaker. The driver, Michelle, 32, is dressed in pajama bottoms and a flimsy low cut shirt. They ask if I am a photographer. I tell them yes. Kayla smiles: “You found the hoe stroll.” They both look exhausted, dirty, and sick. “We haven’t had a date today and need a fix bad.”

Kayla started using pills after high school, then moved to heroin, and then four years ago “started prostituting”. I ask her if she is comfortable talking. “Sure, as long as you don’t take a picture of my face. I don’t want my family to see. This is degrading.”

I ask her about Portsmouth. “There is nothing to do here but drugs. You around family members who use, around friends who use. When you start using drugs you are accepted for who you are, including your imperfections. For many people, myself, that is hard to stay away from.”

They sit in the car, listening to the radio, both picking at sores, riffing on their lives. “Being out here, sucking men for money for drugs, this is degrading. I have no interest in sex nymore. I hate men. I just want to get clean and get out of this place.”

While we talk an older woman, in her late 60s, parks across the street, and then leans against the hood while she smokes. Michelle and Kayla watch her. “She is working the streets. At that age! Daaaaaaaamn.” A pickup truck with a huge American flag decal covering the back window pulls up to her, slows down, and the older woman approaches the truck.

Jen Medve, 35, knows the loop well. She walked and worked it for seven years. When I ask her about it she is simple and blunt: “It was horrid. Just horrid.”

She has recently cobbled together a different life, put herself in rehab, gotten off drugs, and is focused on being a mom for her one-year-old daughter, her sixth child.

Her daughter Cricket (“I like unconventional names”) clings tightly to her as she tells of being pulled into drugs and sex work. “I ran away at 14 because of abuse and ended up in a foster home. Then I bounced around.”

Once the drugs began (Vicodin at 24) it progressed to heroin (“everyone was doing it”), and then sex work. “I had to do dope so often I couldn’t maintain a regular job. I started prostituting after awhile. It was either that or be sick. Everybody knows where the girls are and I lived in the area, so anytime I tried to walk guys would try to pick me up.”

Eventually, when she was desperate enough, Jen “just went with it”.

I first meet Kimberly Conley, 19, as she sits outside a downtown rehab clinic, gossiping with friends. She stands out. She is happy, shy and sweet, not having succumbed to the hardness and cynicism that can come with addiction.

Hearing her speak is jarring. She tells a rough story in a gentle voice: “I was born a premie – addicted to crack, to a mom addicted to crack who died from heroin in 2015. December 11, 2015. It was like her seventh overdose. My dad? He was in prison for cooking meth. He has been in prison five or six times. I started weed at 12, pills and heroin and meth at 13. At 15 I got pregnant with my first child. I just had my second child.”

She was adopted at the age of one by her grandmother, Vickie, who she still lives with in a trailer on a hill. I drive up to meet them, navigating through a working class neighborhood of small homes, trailers and lots of dogs.

I find them sitting on the porch, gossiping, and laughing. Vickie is blunt, friendly, and sharp-toughed. She offers me a soda, and when I ask for a diet, she laughs. “Who do you think you are. A model? I may be fat, but I can lose the fat, but when you are ugly, you can’t lose the ugly.”

She is retired after 28 years as a cook in the school system. When I ask if there are drugs around, she laughs. “Oh honey yes, this is Portsmouth. This is the armpit of Ohio.” She points to the neighborhood, “Everything around here is dope-town. Xanie’s, Oxy’s, meth, we got it all. Nothing for kids here. When I was young we had dances at the community centers. Now they have nothing. No work around here unless you are a nurse, or a doctor, or lawyer.”

Vickie doesn’t do drugs (“except for my smokes”), and so she has become the de facto mother for an entire neighborhood, a calm center in a tornado. That tornado eventually pulled Kim in. “When I adopted Kimberly I promised her mom I would keep her in her life. Biggest mistake I made.”

Kim gets up to chase after a child and comes back. “I would go hang out at my mom’s trailer, with all my cousins. We would play there, spend evenings there. It is where my mom got me on heroin. At 13. My mom was doing it. Everyone was doing it. I wanted to do it because I thought it would be fun.”

Her grandmother pulls her onto her lap. “Ain’t she the smartest and prettiest thing. She is still my baby girl. Now I want her to get out and see how other people live the good life. If you are young you better leave Portsmouth, or else you will get into drugs.”

Kim smiles and hugs her grandmother. “I graduated with honors from high school. I want to join the army and get away. Far far away. There are so many drugs here. I just don’t want to be a part of it.”

During my time in Portsmouth I cannot stop thinking about James, Meghan and their kids. I ask everyone about them (including people at the rehab clinic), and many know of them.

When I ask if anyone has called child protective services, or why the police haven’t stopped them, I get variations of, “they probably have”, or “I assume someone else has, so I haven’t”. Everyone ends with a version of, “not sure it will do much good though, since everyone is just so overwhelmed”.

Portsmouth is overwhelmed, and in danger of becoming far worse. It is in danger of becoming a place so saturated with drugs that the shocking becomes normal. It already is a place where people roll their eyes at ambulance sirens, mouthing “another OD”. It already is a place where some men pester and proposition dope-sick women for sex. It already is a place where some kids’ childhoods are traumas to be navigated.

Portsmouth is now a town where you see two dirty kids being pushed around in a shopping cart.

The last afternoon I find James playing with his children beneath a flowering tree and I ask once more if there is anything I can do. He says no. I ask him why he keeps the kids with him, and he smiles: “I was raised around drugs. I don’t want that for my kids.”•••

I get in my car and I think of everyone I met in Portsmouth, and all the pain I have seen and heard. I think of Kim up on the hill with her grandmother, telling me: “What do I want most? To get away from here, have a job, a home and then kids. I want the fairy tale ending.”

I call the Scioto County Children Services and tell them about two kids in a shopping cart. And then I sit, turn on the radio, and feel like complete utter crap. I feel like complete utter crap my entire drive home, when I get home, and as I write this.

After a few weeks, I call to follow up. I am told by Dr Lorra Fuller, the executive director of the Public Children Services Association of Ohio, that “the children are safe” but beyond that she cannot speak on case specifics, only procedural generalities.

“When we get involved with families with active drug use or homelessness, we achieve safety for the children. Which means we may help the family find residence, or we make take the children into custody, or place them with a relative, or foster care.”

I don’t feel good about what I did. I came in, saw a lot of pain, and then dealt with it by making a call to possibly have someone’s children taken away. Then I left, a luxury most people in Portsmouth don’t have.

I also don’t believe I had a choice. I had come to document Portsmouth and found a great deal of despair, including two kids being pushed in a shopping cart near the side of the road. Ignoring them would have been lying about the problem.

Once I got closer they appeared to need professional help, so I called for the expertise of child protective services. Not calling would have been denying what I saw.

That is the thing about poverty and drugs. There are no good choices, only less awful ones.

• Scioto County Children Services currently has about 220 children in custody, up from about 88 five years ago. They take donations, either directed for use to all their families and children, or a particular family.