Donald Trump is to order his health secretary to declare a public health emergency in response to the US’s escalating opioid epidemic. But while the announcement that the president intends to “mobilise his entire administration” to combat the crisis will be seen as an important symbolic moment, there will be no new funds to deal with an epidemic claiming 100 lives or more a day.
The declaration, which follows a report from the president’s opioid commission recommending he proclaim an emergency, is for 90 days and can be renewed. Under the health service act, the president will instruct his health secretary to make the declaration. The White House said the administration chose to use health legislation because the alternative of declaring a national emergency is usually reserved for natural disasters. It would also be likely to give more immediate access to large scale funding.
A senior White House official said the crisis is an “urgent priority for the president” and that the declaration under the health service act will help the administration direct additional resources toward some of the worst hit areas, such as expanded access to telemedicine in rural areas of Appalachia where medical resources are limited. It will also allow the administration to appoint specialists and address doctor shortages, as well as direct some money used to treat HIV/Aids toward people within that programme who are also addicted to opioids.
The declaration is not expected to immediately address the mass prescribing of opioid painkillers underpinning the epidemic.
But there will for now be no new money for the kind of measures some state governments are pressing for including greatly increased funding of long term treatment centers.
The White House said it is having a “conversation with Congress” about new funding. It said that the administration has spent $1bn to deal with the crisis since Trump took office although that money was allocated while Barrack Obama was in power.
Barack Obama’s former drug czar, Michael Botticelli, has backed a ban on the high-strength opioid painkillers at the heart of the US overdose epidemic now claiming about 50,000 lives a year.
Botticelli supported a petition to the Food and Drug Administration (FDA) by families of opioid victims, doctors and health organisations seeking the removal of the powerful painkillers from pharmacy shelves.
Activists see the “citizen petition”, which legally requires a response – Congress passed legislation in 2007 that requires the FDA to rule on citizen petitions within 180 days – as a test. It will show whether the FDA is finally turning away from policies that critics contend have contributed to the epidemic by putting the financial interests of pharmaceutical companies ahead of public health.
Among the signatories was Dr Andrew Kolodny, co-founder of Physicians for Responsible Opioid Prescribing, who said that high-dose opioids not only significantly increased the likelihood of addiction but endangered lives when taken accidentally.
He said that 11 million Americans had misused an opioid pill in 2015, and many of them were borrowing pills to deal with aches and pains without knowing how strong they were.
“Borrowing that one pill can lead to a fatal overdose,” he said. “These are not medicines. These are lethal weapons that should be removed from the market.”
The petition says that a person taking high-strength opioids is twice as likely to develop an addiction as a person taking the low-strength version. Botticelli supported the call for their removal from the market but said that it should be matched by an effort to reduce the number of opioid prescriptions. Although the numbers have been falling since the epidemic drew political attention, doctors still wrote 240m prescriptions for opioids last year – roughly equivalent to one for every American adult.
“We clearly know that high dosage increases the probability of addiction. Where we have products that are dangerous, it’s important to call for their removal. It is equally as important as doctor prescribing behaviours,” said Botticelli.
The petition is part of a day of events in Washington and across the US led by an activist group, Fed Up!, to raise awareness of the opioid epidemic and to demand policy changes. Bereaved families rallied at the White House to demand the Trump administration take action to curb the distribution of opioids and fund treatment for those addicted. Victoria Allendorf, who lost both sons on the same day to an opioid overdose, spoke of the helplessness of watching a child struggle with addiction and then slowly dying.
Among the drugs the activists want withdrawn are higher strength versions of OxyContin. Its launch 20 years ago with a marketing campaign claiming that it was neither addictive nor dangerous kickstarted the opioid epidemic, which swept out of Appalachia and across the country. Both claims were false and the manufacturer, Purdue Pharma, has paid out hundreds of millions of dollars to settle legal actions. Three of its executives were also convicted of crimes over the false claims.
Judy Rummler, the chair of Fed Up!, signed the petition on behalf of her organisation. Rummler’s son, Steve, died of an opioid overdose in 2011. Fed Up! has been a strong critic of the FDA, saying that it is compromised by financial relationships with the pharmaceutical industry and has bowed to political pressure from a powerful lobby to approve dangerous drugs.
But Rummler said there were signs the FDA’s policy is shifting. In June, the FDA called for the removal of a high-strength opioid, Opana, from pharmacy shelves as a public health hazard just a decade after it was approved for sale in controversial circumstances. Opana was rejected in 2003 as unsafe but approved three years later after the rules of the process were rewritten amid accusations that pharmaceutical companies had undue influence over the process.
The manufacturer withdrew the drug after the FDA call. The new FDA commissioner, Scott Gottlieb, implicitly acknowledged criticisms of his agency when he endorsed a report by the National Academies of Sciences, Engineering, and Medicine in July that recommended that approval take into account “the public health effects of the inappropriate use of these drugs”.
“We’ve already begun to put this policy to work. Last month, the agency requested the removal of an opioid product from the market based on concern that the product’s risks associated with its deliberate misuse outweigh its intended benefits when it was used as directed and lead to dangerous unintended consequences,” he said.
On Tuesday, Gottlieb phoned Emily Walden, who has been among the strongest critics of the FDA for its approval of Opana after her son died of an overdose of the drug. Walden declined to discuss the details of the conversation but said she was impressed.
“He has given me hope for sure,” she said. “I feel like for the first time in a long time we have an FDA commissioner who is willing to correct some of the mistakes. It seems like he understands this issue.”
Botticelli said he thought the FDA was finally changing course. “It does seem there’s been a significant shift around FDA’s framework on opioids,” he said.
Kolodny called for the federal government to commit $60bn over the next 10 years to provide treatment to people addicted to opioids to bring down the rising death toll. Botticelli was not confident it would happen. He criticised Donald Trump for his failure to follow through on a call by his own opioid commission to declare a national emergency. He said that the president could not say he takes the crisis seriously while at the same time proposing deep cuts to the healthcare funding that provides treatment for people who are addicted.
Of all the people Donald Trump could blame for the opioid epidemic, he chose the victims. After his own commission on the opioid crisis issued an interim report this week, Trump said young people should be told drugs are “No good, really bad for you in every way.”
The president’s exhortation to follow Nancy Reagan’s miserably inadequate advice and Just Say No to drugs is far from useful. The then first lady made not a jot of difference to the crack epidemic in the 1980s. But Trump’s characterisation of the source of the opioid crisis was more disturbing. “The best way to prevent drug addiction and overdose is to prevent people from abusing drugs in the first place,” he said.
That is straight out of the opioid manufacturers’ playbook. Facing a raft of lawsuits and a threat to their profits, pharmaceutical companies are pushing the line that the epidemic stems not from the wholesale prescribing of powerful painkillers - essentially heroin in pill form - but their misuse by some of those who then become addicted.
In court filings, drug companies are smearing the estimated two million people hooked on their products as criminals to blame for their own addiction. Some of those in its grip break the law by buying drugs on the black market or switch to heroin. But too often that addiction began by following the advice of a doctor who, in turn, was following the drug manufacturers instructions.
Trump made no mention of this or reining in the mass prescribing underpinning the epidemic. Instead he played to the abuse narrative when he painted the crisis as a law and order issue, and criticised Barack Obama for scaling back drug prosecutions and lowering sentences.
But as the president’s own commission noted, this is not an epidemic caused by those caught in its grasp. “We have an enormous problem that is often not beginning on street corners; it is starting in doctor’s offices and hospitals in every state in our nation,” it said.
Opioids killed more than 33,000 Americans in 2015 and the toll was almost certainly higher last year. About half of deaths involved prescription painkillers. Most of those who overdose on heroin or a synthetic opiate, such as fentanyl, first become hooked on legal pills.
This is an almost uniquely American crisis driven in good part by particular American issues from the influence of drug companies over medical policy to a “pill for every ill” culture. Trump’s commission, which called the opioid epidemic “unparalleled”, said the grim reality is that “the amount of opioids prescribed in the US was enough for every American to be medicated around the clock for three weeks”.
The US consumes more than 80% of the global opioid pill production even though it has less than 5% of the world’s population. Over the past 20 years, one federal institution after another lined up behind the drug manufacturers’ false claims of an epidemic of untreated pain in the US. They seem not to have asked why no other country was apparently suffering from such an epidemic or plying opioids to its patients at every opportunity.
With the pharmaceutical lobby’s money keeping Congress on its side, regulations were rewritten to permit physicians to prescribe as many pills as they wanted without censure. Indeed, doctors sometimes found themselves hauled before ethics boards for not supplying enough.
Unlike most other countries, the US health system is run as an industry not a service. That gives considerable power to drug manufacturers, medical providers and health insurance companies to influence policy and practices.
Too often, their bottom line is profits not health. Opioid pills are far cheaper and easier than providing other forms of treatment for pain, like physical therapy or psychiatry. As Senator Joe Manchin of West Virginia told the Guardian last year: “It’s an epidemic because we have a business model for it. Follow the money. Look at the amount of pills they shipped in to certain parts of our state. It was a business model.”
But the system also gives a lot of power to patients. People coughing up large amounts of money in insurance premiums and co-pays expect results. They are, after all, more customer than patient. Doctors complain of patients who arrive expecting a pill to resolve medical conditions without taking responsibility for their own health by eating better or exercising more.
In particular, the idea has taken hold, pushed by the pharmaceutical industry, that there is a right to be pain free. Other countries pursue strategies to reduce and manage pain, not raise expectations that it can simply be made to disappear. In all of this, regulators became facilitators. The Food and Drug Administration approved one opioid pill after another.
As late as 2013, by which time the scale of the epidemic was clear, the FDA permitted a powerful opiate, Zohydro, onto the market over the near unanimous objection of its own review committee. It was clear from the hearing that doctors understood the dangers, but the agency appeared to have put commercial considerations first.
US states long ago woke up to the crisis as morgues filled, social services struggled to cope with children orphaned or taken into care, and the epidemic took an economic toll. Police chiefs and local politicians said it was a social crisis not a law and order problem.
Some state legislatures began to curb mass prescribing. All the while they looked to Washington for leadership. They did not get much from Obama or Congress, although legislation approving $1bn on addiction treatment did pass last year. Instead, it was up to pockets of sanity to push back.
Last year, the then director of the Centers for Disease Control, Tom Frieden, made his mark with guidelines urging doctors not to prescribe opioids as a first step for chronic or routine pain, although even that got political pushback in Congress where the power of the pharmaceutical lobby is not greatly diminished.
There are also signs of a shift in the FDA after it pressured a manufacturer into withdrawing an opioid drug, Opana, that should never have been on sale in the first place. It was initially withdrawn in the 1970s, but the FDA permitted it back on to the market in 2006 after the rules for testing drugs were changed. At the time, many accused the pharmaceutical companies of paying to have them rewritten.
Trump’s opioid commission offered hope that the epidemic would finally get the attention it needs. It made a series of sensible if limited recommendations: more mental health treatment people with a substance abuse disorder and more effective forms of rehab.
Trump finally got around to saying that the epidemic is a national emergency on Thursday after he was criticised for ignoring his own commission’s recommendation to do so. But he reinforced the idea that the victims are to blame with an offhand reference to LSD.
Real leadership is still absent – and that won’t displease the pharmaceutical companies at all.
Breanne McUlty knew about Dr Rajan Masih long before she met him.
McUlty was still a teenager, hooked on whiskey and methamphetamine and soon to be dealing heroin, when she first heard about the doctor. Masih was a respected, prosperous family man running a hospital emergency room.
But McUlty knew from those of her friends who preferred to get high on painkillers – effectively heroin in a legal pill – that Masih was the go-to doctor for illicit opioid prescriptions in Grant County, West Virginia.
“Everybody knew him as pretty much the top drug dealer around here,” said McUlty “Maybe he got greedy. Everybody makes mistakes just like I did. He’s a decent person now, trying to make up for it.”
But Masih was more than a dealer. The doctor was also hooked on the pills he was feeding to other opioid addicts.
The lives of the privileged physician and the young woman whose upbringing set her on the path to addiction and selling hard drugs while she was still a child eventually crossed after each was freed from years in prison. They shared a parole officer who drug tested them, and approved where they lived and worked. They also shared a belief that incarceration saved them from early deaths.
“Arrest was the best thing that could have happened to me because I could not and I would not stop,” said Masih. “It was a downward spiral and I would have died.”
McUlty was 25 when she finally returned to her home town of Petersburg, the capital of Grant County, two years ago. Masih was 51 when he was released a few months earlier, stripped of his licence to practice medicine and with little idea what his future held in the struggling rural town of about 2,500 people.
Freedom from prison and drugs gave the two former inmates clearer perspectives on the epidemic that has hit their state harder than any other. It has by far the highest overdose death rate in the country at double the national average. Opioids kill more West Virginians than guns and car accidents combined.
The crisis reaches across generations, from former coal miners to students, although doctors increasingly notice a trend among the young to go straight to heroin whereas many older people come at it through prescription opioids.
In their own ways, McUlty and Masih determined to do what they could to combat the epidemic they contributed to. But they have been daunted by the scale of the challenge.
“I came home from prison thinking I was going to make a difference. I’m going to help all these people,” said McUlty. “Because I’m different now they’re going to see that they can be different too. It was a slap in the face when everybody was: ‘Screw you. You think you’re better than us now’. I think everybody accepted their fate. Nobody really wants help. The people I really want to get to, they just turn their heads. They say: ‘I’m not that bad off. I can stop when I want to stop’.”
‘I just wanted to be free’
Masih, who was born in Chicago and is married to a former police officer, was working as an emergency room doctor a decade ago when he crashed a racing car and hurt his back. He self-medicated with samples of an opioid painkiller, hydrocodone.
“It was unbelievable. Not only did it take my pain away but I immediately felt this is amazing. I like my job. I like talking to people. I’m not irritated and angry with patients all the time,” he said.
When the samples ran dry, Masih wrote fake prescriptions in the names of his mother, wife and children.
“After a few months I crossed that line where if I don’t have pills every four to six hours I’m in withdrawal. I have no energy. Everything hurts. I can’t think straight. Just getting more pills would immediately bring me back to my new normal,” he said.
Masih was well aware of the danger of addiction and conducted ultrasounds on his own liver to check for damage. But he kept taking the pills even as they left him ever more physically and emotionally detached from his family of five children.
“I wanted my life back. I’d look at people sitting on their porch, playing with their kids. Here I am obsessed with getting my next pills and staving off withdrawal. I was caught in this trap. I just wanted to be free,” he said.
By then, Masih had gone from addict to dealer in a state with the highest demand for prescription opioids in the country. Rogue doctors across West Virginia were prescribing dangerous quantities of pills to just about anyone who paid cash. In some parts of the state, doctors ran “pill mills” that did nothing but issue prescriptions for opioids, making millions of dollars.
Drug companies were pouring opioids into West Virginia, delivering 780m painkillers into a state of just 1.8m people over a five year period to 2012, according to an investigation by the Charleston Gazette-Mail.
Demand grew in part out of the physical toll of coal mining. Miners long used moonshine, marijuana and prescription pills to cope with the stresses and pain of work underground. But there had never been anything like the hydrocodone and oxycodone flooding onto the market in the 1990s. They were so effective and easy to get that miners often passed them out among themselves. Few were told how addictive these drugs were.
Before long, opioids were so widely prescribed doctors noted rising addiction among people who had taken them to deal with relatively minor conditions such as broken bones. The drugs were in so many bathroom cabinets that word spread among young people looking to experiment that opioids provided a powerful high. The pills began to displace meth amphetamine which had long been used as inoculation against the struggles of life in marginalised communities.
“Drugs like oxycodone, hydrocodone, they treat all kinds of pain,” said Masih. “The pain of being a single mom looking after a kid. The pain of that person who doesn’t have a job. The pain of, I’m 20 years old, nobody cares. The pain of being bullied. The pain of I’m gay. It treats all of those pains. It’s less about physical pain. It’s more about this social angst of there are no jobs. The economy’s crushed. This is a state that’s been marginalised in so many ways. Drugs are a solution to that.”
Opioids proved by far the most deadly.
Things fall apart
By the time Masih sank into addiction, McUlty was dealing in drugs even though she was barely in her teens.
She remembers her father using cocaine and meth amphetamine, and drinking heavily. Then he branched into prescription opioids. “He couldn’t get out of bed without them,” she said.
Eventually the abuse to his body put him in hospital in a coma.
Her mother left, taking her younger sister. McUlty describes struggling to find food in the house but said there was a steady stream of users and dealers passing through.
Drugs were so much part of the daily routine that when someone asked the 15 year-old to sell a bit of morphine it seemed a natural thing to do. Before long she was dealing regularly. By then, McUlty was also regularly drinking liquor.
McUlty’s father confirmed her description of his dependence on drugs and alcohol, and the part it played in pushing his daughter along the path of dealing and addiction.Although Petersburg is a small town, she managed to avoid arrest for drugs but was convicted of stealing a pair of shoes. She was also expelled from school for disruption.
At 16 she was pregnant. By then McUlty was homeless. “I was on probation. Some anonymous call said I was pregnant and I was walking the streets. Sometimes I was barefoot and looked helpless I guess. My dad was driving by one day and saw me and said ‘You’ve got a court order’ and gave me the papers,” she said.
The court made McUlty agree to move into a shelter for teenage mothers but she soon fled to Maryland where her daughter was born. Then she returned to Petersburg and slipped back into the old routine. “I really didn’t think there was a different way. I thought it was always going to be like that,” she said.
For a while, the important thing for McUlty was to hang on to her daughter and she got back together with her daughter’s father. But things quickly began to unravel. Her boyfriend was a heavy drug user and they fought a lot. McUlty moved in with her grandparents but was desperate for money so she started selling crystal meth.
She went to a party and woke in a cupboard with no memory of the previous few hours but certain she had been raped. It never occurred to her to call the police. Instead she fell back on crystal meth.
“It gives you a lot of energy but after a while your mental health starts floating away. You get really really thin. It eats away at your teeth. It messes with your brain. You start imagining things. Hallucinating. You hate it but can’t stop,” she said.
Salvation for Masih came from a pharmacist who called the Drug Enforcement Administration (DEA) with suspicions about his prescribing. Armed DEA agents arrested him at the emergency room.
“They asked me questions about an individual who overdosed on medications I prescribed. This individual died. They asked me: ‘Did you write these prescriptions?’. I said: ‘Yes I did’,” he said.
A DEA agent testified that of the 16 people who died from opioid overdoses in the area in the two years before Masih’s arrest, three were his patients. Masih prescribed one of them hundreds of opioid pills, far above recommended dosages, immediately before the man’s death. He also prescribed the fentanyl patches that killed a woman.
Masih faced 136 charges but reached a plea deal admitting a single count of illegally supplying opioids to a patient he knew to be injecting them. The doctor was jailed for four years and lost his medical licence.
“I think I got a very fair deal out of the whole thing,” he said. “I 100% accept responsibility for what happened to me.”
Many in Petersburg speak highly of Masih. Hundreds of people signed an online petition praising him as a doctor and calling for his release. Others are more sceptical, including the county sheriff who regards Masih as guilty of more than he was convicted of but said the former doctor turned his life around and is respected in the town.
Masih says he prescribed “recklessly” but not intentionally.
“Recklessly to me means my barometer is off because I just took six hydrocodone and obviously this is not a sane decision making process,” he said.
Does he feel responsibility for the deaths?
“I don’t. I realise that many people became addicted to drugs or dependent on drugs as a result of me. I believe that people may have overdosed on medications that I prescribed. But these were people who already had been on narcotics for years through other doctors. I basically continued to do what their physicians had prescribed for them,” he said.
‘Pure souls turn black’
By the time Masih went to prison in 2010, the authorities were finally responding to the epidemic and cracking down on pill mills. That drove up prices on the black market and cheap heroin filled the undiminished demand.
McUlty did not miss the opportunity. She hooked up with Mexican dealers in Columbus, Ohio, a five hour drive west. She turned a 3.5g “eight ball” of heroin for $600 into several thousand dollars worth of individual hits on the street in Petersburg.
“It was very easy. I had mules go to Ohio with me. They would use condoms to hide it. Put it inside themselves. We would give addicts money and some of the drugs to take us. They’d do anything,” she said. “There is just so much money to be made in West Virginia, it’s kind of hard to walk away once you get the hang of it.”
Before long, McUlty reckons she was the leading heroin supplier in Petersburg. She was 19 years old.
By then, McUlty had little contact with her daughter. If she had a family at all, she reckoned it was the Mexican dealers in Ohio. At the same time she was still using crystal meth.
“I was losing my mind, going crazy on it. I was watching the people I was selling meth to waste away and knew that would happen to me,” she said. “Addiction brings out the worst in people. Pure souls turn black. Even with the nicest person, the happiest person. They end up robbing and stealing. Hurting people.”
The end came when the police stopped a car she was travelling in and found a meth lab.
“We all went down because everybody was saying: ‘It’s not mine’,” she said. “One guy actually had business cards saying: ‘Can’t get up and go?’ with a picture of crystal meth on the card.”
A few months later, McUlty learned that another woman in the car was cooperating with the police. McUlty wrote her letters from jail warning that she would get killed and threatening to burn the woman’s house down.
“I guess if I’d had the chance, as mad as I was, I probably would have done something. But I don’t know if I would have burnt their house down,” she said.
McUlty was jailed for four years.
“Federal prison saved me. This was my way out. I grew up in prison,” she said.
For the first time in years, contact with daughter became more important than getting a fix or doing a deal.
“I wrote her every single day. I wrote her poems. I drew her pictures,” she said.
But McUlty did not see her daughter. Her grandmother, who was caring for the child, cut off contact. The young mother found missing her daughter the toughest thing about incarceration.
Prison helped Masih realise the scale of the epidemic. The former physician got an education from other inmates on the web of deception used by addicts to “doctor shop” in search of prescriptions using fake ID’s of changing one letter of a surname to bypass prescription monitoring programmes. Women used maiden and married names to double up on prescriptions. Artificial urine pumped through false penises to pass drug tests.
But it was the dealers who were most organised. They shuttled groups of hard up elderly people to the doctor for opioid prescriptions, paying them a few hundred dollars for half of the pills. And they brought buyers in from out of state by the bus load.
“The medical community has no idea how organised this is as you sit in your office. It was just unbelievable to me,” said Masih. “To someone who’s a diligent drug diverter, this is a business. They are able to see any number of doctors and scam them into prescriptions.”
Masih said they were not the only ones scamming. Pharmaceutical companies pushed opioid drugs designed to deal with pain caused by cancer as appropriate for less severe conditions, all with the complicity of federal medical institutions.
Today, he finds it astonishing that most of his education on treating pain came from pharmaceutical company salesman. Masih attended courses on diagnosing headaches, skin cancer and end-of-life care but said the only information he received about opioids was from a representative of Purdue Pharma, the manufacturer of the powerful OxyContin pills at the heart of the epidemic.
The salesman, who had no medical training, arrived each week with pizza to assure Masih that claims of addiction were exaggerated and to press him to prescribe more of the drug.
“I got the bulk of my education about opioid narcotics from drug reps. They’d come in with a glossy brochure and tell us, you need to be writing this now,” he said. “It was aggressive.”
Among Purdue’s tactics, state investigators later found, were salesmen threatening to back legal action against doctors who resisted patients’ demands for OxyContin.
“I feel a tremendous sense of betrayal,” said Masih. “These companies misrepresented the research, glossed over things. That’s a travesty. These people have just profited endlessly from firing the gun off the shoulder of doctors.”
Complicity went down the line. The DEA’s investigation of Masih led to the prosecution of a local pharmacy, Judy’s Drug Store, for filling illegitimate prescriptions. It paid a $2m civil penalty to settle the case in 2014. That in turn prompted a wider investigation of a drug distributor, McKesson, for failing in its legal obligation to monitor deliveries of prescription drugs to pharmacies. McKesson paid $150m to settle the case earlier this year.
Masih emerged from prison determined to do apply the lessons he learned.
“Prison changed me. It made me have a life of gratitude. It’s given me a purpose. I want to give back. I caused a lot of damage,” he said.
Starting over
Today, Masih gives talks on ways to roll back the epidemic by changing opioid prescribing. He has patented a system to monitor prescriptions through retina scans and thumbprints to curb “doctor shopping”. He has also written two textbooks on what he learned about all the ways dealers and addicts get prescription drugs, and on substance abuse in prisons.
Masih struggled to find work as a convicted felon stripped of his medical licence but last year landed a post running an addiction recovery centre in Petersburg.
“What we are seeing is that there are those older people who started with narcotic pain pills, transitioned to heroin because it’s dirt cheap. Then there are those 18 or 20 year olds who went straight to heroin. They started smoking it. Very rapidly it evolves to injection,” he said.
What most alarms Masih is that for all the political statements about combatting the opioid epidemic, he doesn’t see any real change in the medical profession.
“Nothing has changed. Everyone’s radar is up but at the end of the day we know the number of prescriptions nationwide have increased from 2015 to 2016,” he said.
McUlty too has a better understanding of the epidemic now she is not in the midst of it.
“A lot of people I’ve talked to, they started doing drugs because of their situation. Products of their environment or something bad happened to them and they’re just trying to get over the depression. Sometimes they just look for entertainment. That’s what being American is about. I think people just live to party and don’t think about the things that really matter,” she said. “I know a lot of the people started really getting addicted to pain killers because a lot of the jobs in West Virginia you get injured a lot. A lot of labour. The doctors are just handing them out like candy. It just got worse. Their kids started using them.”
McUlty has rebuilt her life. Her daughter is living with her again. Last year she had another child, a son with her fiance who is also a recovering addict. She had trouble landing a job because of her felony conviction but eventually found work in a chicken factory, cleaning birds for $9.50 an hour.
She is part way through a photography course and is working on a film about her experiences. She is also volunteering to help refugees. Her father has fought back against addiction. He got onto medication and off the drugs. Still, the tragedy did not stop after prison. McUlty watched her brother, Bryan, die in hospital from heart disease brought on by the use of dirty needles.
McUlty works to educate whoever will listen about drugs but says not many want to hear. She offered to give a talk to students at her former high school but the administration has yet to take her up on the offer.
“I never could get the word out. It seems like there’s more hopelessness than any one person can do anything about. I try,” she said.
She is not optimistic about Petersburg.
“You can’t trust anybody in this town. It’s a wreck. If you want to stay clean, you’ve got to stay alone,” she said. “I don’t know what can be done. I don’t think law enforcement can put a stop to it because people are always going to find a way. Even in the county jail, people were high. They smuggle it in. Pills. Weed.”
McUlty plans to leave after the summer and move to Atlanta where her fiance has transferred his job at a sanitation company.
“When I was a teenager, you’re not somebody unless you’ve got drugs in your pocket. I don’t want my kids to grow up in the same situation. I know it’s everywhere but here it’s everybody. I want to get away from that,” she said.
Spectres of mass shootings, jihadis and immigrant hordes have grown to haunt parts of 21st century America as communists and the atom bomb once did. But each fear, rational or not, generally held its own as a distinct threat.
If your children’s school went into lockdown, chances are you had visions of a gun-obsessed loner blasting his way through the classrooms. When airport security rummaged through your underwear while you were still in it, it was al-Qaida or Isis you cursed. And if you were worried about immigrants, other than because of skin colour, it may well have been because you believed the deceit that they were going to steal your job. Each fear in its place.
Then came 2015, the year of blended anxieties.
Donald Trump started by shifting the debate from policy about undocumented immigrants to the smearing of Mexicans in general as rapists, drug traffickers and all around criminals.
The Republican frontrunner then seized on the heartrending scenes of refugees, particularly Syrians, arriving in Europe on flimsy boats and tramping en masse across the continent in search of sanctuary, to add terrorism to the list of immigrant dangers.
The rest of the Republican field waded in after the Paris attacks with the complicity of cable news. Isis is in Syria. Syrians refugees are arriving in Europe. Paris is in Europe. Therefore the murderers at the Bataclan were Syrian refugees.
More than half the nation’s governors, all but one of them Republican, dutifully stepped up by barring Syrian refugees from within the borders of their states. No matter that they lacked the authority to do any such thing or any way of enforcing the ban. Nor that almost all the killers in Paris were French or Belgian citizens, and of Algerian or Moroccan descent, with the exception of two men travelling on fake Syrian passports whose real identities are still a mystery.
Trump, standing sentinel on the border, was not deterred. He latched on to a report by the rightwing Brietbart that eight Syrian “illegal aliens” had been “caught” by federal agents attempting to cross into Texas. Trump tweeted: “Eight Syrians were just caught on the southern border trying to get into the U.S. ISIS maybe? I told you so. WE NEED A BIG & BEAUTIFUL WALL!”
As it turned out, the Syrians were two families, including four children, who were neither “illegal immigrants” nor “caught”. They had declared themselves openly at an immigration post after crossing from Mexico.
The threads came together in November in San Bernardino, California, as a married couple, Syed Rizwan Farook and Tashfeen Malik, shot 14 people dead in an attack that FBI investigators say was jihadi-inspired. The killings tied the knot of fear of immigrants, terrorism and gun rampages.
Congress leapt into action, voting to require foreigners who do not normally need a visa to enter the US, such as most Europeans, to get one if they have visited Syria or Iraq.
Funnily enough, Republicans were a little less enthusiastic about addressing the third strand of the knot – how these terrorists got their weapons. Even when it came to keeping weapons out of the hands of people Homeland Security regards as too much of a threat to permit to fly in the US, gun rights won out.
Yet it was the ease with which Farook was able to get weapons, through a friend who bought them in a gun shop, that made the whole attack possible or at least so deadly.
The Brady Campaign to Prevent Gun Violence calculates that seven children and teenagers are shot dead in the US each day. That means more die in a week than all the Americans killed by jihadi terrorism in their own country in all of 2015.
It was of course the mass shootings that got the attention. There were more than 300 in 2015, only two of which were carried out by alleged Muslim terrorists. The response to the killings was often more guns.
In the days following Chris Harper Mercer’s murder of 10 people at Umpqua community college in Roseburg, Oregon sales at the local gun shop surged.
After the Roseburg killings, President Obama challenged news organisations to “tally up the number of Americans who have been killed through terrorist attacks over the last decade, and the number of Americans who have been killed by gun violence”. Politifact did just that in early October, before the San Bernardino shootings, and came up with 24 vs 280,024. Those who have died from gun violence over the decade is now somewhere past 300,000, which dwarfs even the 9/11 attacks.
Fortunately cable news was there to keep everyone’s eye firmly on the ball. Wolf Blitzer’s first question of the CNN Republican debate in Las Vegas this month was about protecting Americans from jihadis. That issue took up the first hour of the debate. He did not pose a single question about mass shootings or gun control.
The exaggerated fears of jihadis on the doorstep tend to be of less concern among people, mostly African Americans, who have good reason to be more afraid of those ostensibly protecting them. The Guardian recorded 1,125 people killed by the police this year as the body of video evidence of trigger-happy officers and a taste for excessive force grew.
There were other things to be alarmed by, if not afraid of, which did not get the wider discussion they deserved. Among them was research showing a rising death rate among middle-aged white Americans.
African Americans remain at greater risk from premature death in large part because of the consequences of systemic poverty and lack of opportunity, not least restricted access to decent healthcare, as well as violence.
But the shock in the study of middle-aged white people lay in the reversal of a longstanding trend of falling death rates in contrast to every other group, including African Americans, and unique in the developed world. Many died prematurely of drugs or drink. Suicide now kills almost as many middle-aged white Americans as cancer used to when it was the primary cause of death in that group.
Because those worst affected tended to have the lowest incomes, it appeared to have a lot to do with desperation and despair rooted in growing economic inequality and financial struggles.
That is its own kind of violence with implications beyond the middle-aged or white Americans that should alarm everyone and have politicians reaching for answers. But the year of living anxiously meant the Republicans and cable news kept us afraid of what is least likely to kill us.
Karen Jennings patted her heavily made up face, put on a sardonic smile and said she thought she looked good after all she’d been through.
“I was an alcoholic first. I got drunk and fell in the creek and broke my back. Then I got hooked on the painkillers,” the 59-year-old grandmother said.
Over the years, Jennings’ back healed but her addiction to powerful opioids remained. After the prescriptions dried up, she was drawn to the underground drug trade that defines eastern Kentucky today as coal, oil and timber once did.
Jennings spoke with startling frankness about her part in a plague gripping the isolated, fading towns dotting this part of Appalachia. Frontier communities steeped in the myth of self-reliance are now blighted by addiction to opioids – “hillbilly heroin” to those who use them. It’s a dependency bound up with economic despair and financed in part by the same welfare system that is staving off economic collapse across much of eastern Kentucky. It’s a crisis that crosses generations.
One of those communities is Beattyville, recorded by a US census survey as the poorest white town – 98% of its 1,700 residents are white – in the country. It was also by one measure – the Census Bureau’s American Community Survey 2008-2012 of communities of more than 1,000 people, the latest statistics available at the time of reporting – among the four lowest income towns in the country. It is the first stop for a series of dispatches by the Guardian about the lives of those trying to do more than survive in places that seem the most remote from the aspirations and possibilities of the American Dream.
Beattyville sits at the northern tip of a belt of the most enduring rural poverty in America. The belt runs from eastern Kentucky through the Mississippi delta to the Texas border with Mexico, taking in two of the other towns – one overwhelmingly African American and the other exclusively Latino – at the bottom of the low income scale. The town at the very bottom of that census list is an outlier far to the west on an Indian reservation in Arizona.
The communities share common struggles in grappling with blighted histories and uncertain futures. People in Beattyville are not alone in wondering if their kind of rural town even has a future. To the young, such places can sometimes feel like traps in an age when social mobility in the US is diminishing and they face greater obstacles to a good education than other Americans.
At the same time, each of the towns is distinguished by problems not common to the rest. In Beattyville it is the drug epidemic, which has not only destroyed lives but has come to redefine a town whose fleeting embrace of prosperity a generation ago is still visible in some of its grander official buildings and homes near the heart of the town. Now they seem to accentuate the decline of a main street littered with ghost shops that haven’t seen business in years.
Jennings shook off her addiction after 15 years. She struggled to find work but eventually got a job serving in a restaurant that pays the $300 a month rent on her trailer home. She collects a small disability allowance from the government and volunteers at a food bank as a kind of atonement. Helping other people is, she said, her way of “getting through”: “I just want to serve God and do what I can for people here.”
It was at the local food bank that Jennings spilled out her story.
“There are lots of ways of getting drugs. The elderly sell their prescriptions to make up money to buy food. There are doctors and pharmacies that just want to make money out of it,” she said. “I was the manager of a fast food place. I used to buy from the customers. People could come in for a hamburger and do a drug transaction with me and no one would ever notice.”
Even as Jennings related the toll of drug abuse – the part it played in destroying at least some of her five marriages, the overdose that nearly cost her life and the letter she wrote to her doctor begging for the help that finally wrenched her off the pills – she spoke as if one step removed from the experience.
“You get hooked and you’re not yourself. You go on functioning. You do your job. But I really don’t see how I’m alive today,” she said.
It was only when Jennings got to the part about her son, Todd, a bank vice-president, that she faltered. “I lost my son three years ago from suicide. My lifestyle contributed to his depression. I take responsibility for my part of it,” she said.
The cluster of people waiting their turn to collect a cardboard box containing tins of beef stew, macaroni and cheese instant dinners, bread, eggs and cereal passed no direct comment as Jennings recounted her history.
Some of them carried their own sense of defeat at having come to rely on government assistance and private largesse. But afterwards there was a whiff of suspicion from others who seemed to see the decades-long decline of their communities as a moral failing.
“I’m not one for helping people who don’t help themselves but sometimes you do the best you can and you still need help,” said 63-year-old Wilma Barrett who, after a lifetime of hard work farming and digging coal, was unsettled to find herself reliant on welfare payments and the food bank. “A lot of it’s our own fault. The Lord says work and if you don’t work and provide for yourself then there’s no reason why anyone else should. I know it’s easy to give up but the Lord tells us not to give up. Too many people here have given up.”
Eastern Kentucky falls within that part of Appalachia that has come to epitomise the white underclass in America ever since president Lyndon Johnson sat down on the porch of a wood cabin in the small town of Inez in 1964 and made it the face of his War on Poverty.
The president arrived virtually unannounced at the home of Tom Fletcher, a 38-year-old former coalminer who had not held a full-time job in two years and was struggling to feed eight children. The visit offered the rest of the US a disturbing glimpse into a largely hidden world where houses routinely lacked electricity and indoor plumbing, and children habitually failed to get enough to eat. The 1960 census records that one in five adults in the region could neither read nor write.
Half a century later, while poverty levels have fallen dramatically in some other parts of the country in good part thanks to Johnson, the economic gap between the region and much of the rest of America is as wide. And its deprivation is once again largely invisible to most of the country.
Beattyville’s median household income is just $12,361 (about £8,000) a year, placing it as the third lowest income town in the US, according to that Census Bureau 2008-12 survey.
Nationally, the median household income was $53,915 in 2012. In real terms, the income of people in Beattyville is lower than it was in 1980.
The town’s poverty rate is 44% above the national average. Half of its families live below the poverty line. That includes three-quarters of those with children, with the attendant consequences. More than one-third of teenagers drop out of high school or leave without graduating. Just 5% of residents have college degrees.
Surrounding communities are little better. Beattyville is the capital of Lee County, named after the commander of the Confederate army of Northern Virginia in the civil war, General Robert E Lee.
Five of the 10 poorest counties in the US run in a line through eastern Kentucky and they include Lee County. Life expectancy in the county is among the worst in the US, which is not unconnected to the fact that more than half the population is obese. Men lived an average of just 68.3 years in 2013, a little more than eight years short of the national average. Women lived 76.4 years on average, about five years short of national life expectancy.
A few months before he visited eastern Kentucky, Johnson said in his State of the Union address: “Our aim is not only to relieve the symptoms of poverty, but to cure it and, above all, to prevent it.”
Over time, the focus of that effort shifted to inner-city poverty and many of the programmes Johnson launched came to be seen as aimed at minorities, even though to this day white people make up the largest number of beneficiaries.
But when the president sat on Fletcher’s porch in Inez, he had in mind rural poverty of an almost exclusively white region where the coal industry – which for a while provided jobs but not the much-promised prosperity – was already receding and people struggled for more than a basic income from the land.
Television pictures of Johnson’s visit presented Americans with a hardness of living in the midst of some of the greatest beauty the US has to offer. Life in a log cabin buried in the forest from which it was hewed is romantic until you have to collect water by bucket in the dead cold of winter.
The War on Poverty did relieve many of the symptoms. Food stamps and housing grants, healthcare for the poor and older people and improved access to a decent education have kept millions from struggling with the deprivations Johnson encountered in Inez. There are few homes in eastern Kentucky without electricity and indoor toilets these days. But the promised cure for poverty never materialised.
Three decades after Johnson’s visit, Fletcher was still unemployed but receiving disability benefits. His first wife had died of cancer. His second had been convicted of murdering their three-year-old daughter and attempting to kill their four-year-old son with a drug overdose to claim the life insurance.
A film of Johnson’s visit describes joblessness in the region as primarily attributable to “lack of industrialisation and losses in the coalmining industry”.
People in eastern Kentucky still call it “coal country”, even though the decline continued largely unabated and the number of jobs in the industry fell with the passing of each presidency. There were 31,000 under Bill Clinton but fewer than 14,000 by the time George W Bush left power.
The number of people employed in mining in eastern Kentucky has fallen by half since Barack Obama came to power, although the long history of decline has been conveniently set aside in the clamour to blame the current president. The more cautious critics say Obama is anti-coal because of his environment policies. But a no less popular view in the region is that it is part of president Obama’s war on white people.
Beattyville and Lee County did well out of oil, too, until the 1980s. A decade later, the largest employers in the town were a factory making uniforms, a data company and a private jail holding prisoners from Vermont. Now, the garment and computer businesses are gone and Vermont has just moved its prisoners to Michigan, where it is cheaper to house them.
The largest employer in the county is now the school system. There are five times as many healthcare workers in eastern Kentucky as miners. “Coal country” is today little more than a cultural identity.
The office of Ed Courier’s Sturgeon Mining Company is on the high street. Its few remaining mines involve people digging coal out of hillsides. “I’ve been in the coal business since ’78 and the last five years I’ve been trying to get out of the coal business. There’s no future for it here,” he said.
Courier’s office is an old store front on Beattyville’s Main street. He nodded towards the window and commented caustically on how many former shops in the once bustling town centre were given over to payday loan companies and charities. One gave away what is popularly known as the “Obama Phone”, a free mobile available to anyone on food stamps or other assistance that provides 250 minutes of calls per month.
“Things were really good when I came here in ’72 and I ended up staying. When I came here there were three new car dealerships. There hasn’t been a new car dealership here since ’89,” he said. “There’s no future here. I have a sense of sadness. I wish people had a better life.”
The War on Poverty lives on through federal grants. Food stamps, employment programmes and disability allowance have cushioned many people from the harshest effects of the retreat of jobs from the region. Some families still struggle to put enough food on the table but their children are fed – if not well in the sense of healthily – at school.
Federal money also built Vivian Lunsford a new house – a spacious wooden bungalow with a balcony on two sides and forest to the back, constructed in a ravine just outside Beattyville. The narrow road from the town winds past simple log cabins buried in the trees.
“They’ve probably been there since the early 1900s,” she said. “I don’t know how people live in them. They’re real basic. Their only running water is the stream. But people just keep staying there. They don’t want to leave. It’s the pride. The heritage of that land.”
Before getting the house Lunsford, 38, was unemployed and homeless. Her mother applied for a grant and a cut-rate mortgage on her daughter’s behalf without telling her, in order to build a more modern and spacious version of the old wood cabins. Lunsford repays the mortgage at $389 a month, less than it would cost to rent.
“There’s so much grant money went toward it that so long as I live there for 10 years I don’t have to pay that grant money back,” she said.
Lunsford was also able to land a job with the Beattyville housing association that built her home, which she shares these days with her partner and his school-age daughter.
“This place is notably poorer. You can’t just go out and get a job in McDonald’s. A Walmart is an hour away. I can go to my daddy’s in Florida and the world is like a different place. Here is more stuck in time,” she said.
“Our homeless situation is really different to a big city. It’s couch surfing. You’ve got lower income people, grandparents with their children and spouses living there with the grandchildren. They’re all crammed into this one house. There’s a lot of them.”
Other people on the waiting list for new homes – wooden bungalows or trailers – are what she calls “burn downs”, whose homes were destroyed by fire from candles, kerosene heaters or pot belly stoves. Many of those are in homes disconnected from electricity and other utilities to save money.
“Utility bills are outrageous in a trailer because they lack insulation. I have a little lady I’ve been helping with, Miss Nelly. She’s in her late 70s. Her electric bill in the wintertime here runs about $400 a month. She can’t afford that. Trailers don’t heat good,” she said. “Some people choose not to connect to utilities to save money. A lot of people here, their income is like between $500 and $700 a month. That’s all they get. That’s not a lot, especially if you’ve got kids and the price of gas and car insurance and you’ve got all these things that have to be paid."
Still, the rehousing programme is not without its issues. Bob Ball built Lunsford’s home. He also built one for a man in his early 20s called Duke and his wife, both of whom were unemployed and had been living in a caravan.
Ball has since hired Duke as a worker. Federal money keeps the builder’s business alive but he still commented with a hint of disapproval at the government funding homes. “He got a new house so young. We all paid for that,” said Ball.
Through much of the 19th century, this part of the Bluegrass State was romanticised in stories of rugged frontiersmen and courageous hunters as the epitome of American self-reliance. None more so than Daniel Boone, a hunter and surveyor at the forefront of settling Kentucky. A good part of Lee County carves into a national forest named after him.
“Cultural heritage here is important,” said Dee Davis, whose family was from Lee County, though he grew up in a neighbouring county where he heads the Center for Rural Strategies. “The first bestselling novels were about this region. It was at one time the iconic America. This kind of frontier: white, noble. This was the iconography.”
By the time Johnson arrived a different image had taken hold – that of the anti-modern, moonshine swilling, gun toting, backwards “hillbilly”. The stereotype was perpetuated on television by a popular 1960s comedy show, The Beverly Hillbillies, in which unsophisticated mountain folk find oil on their land, get rich and move with their guns, bibles and Confederate sympathies to live among California’s millionaires.
In 2003, Davis led a campaign against a CBS plan to remake the comedy as reality television by setting up a poor Appalachian family in a Beverly Hills mansion. One mocking CBS executive remarked on the potential: “Imagine the episode where they have to interview maids.”
Davis beat back CBS but said the planned programme reflected a sense that white people living in poorer communities were blamed for their condition.
“There’s this feeling here like people are looking down on you. Feeling like it’s OK to laugh at you, to pity you. You’re not on the same common ground for comparison as someone who’s better off or living in a better place. That doesn’t mean it’s always true, it just means we feel that burden quickly. We’re primed to react to people we think are looking down on us. That they judge us for our clothes, judge us for our car, judge us for our income, the way we talk,” he said.
“This is the poorest congressional district in the United States. I grew up delivering furniture with my dad. No one ever said they were in poverty. That’s a word that’s used to judge people. You hear them say, I may be a poor man but we live a pretty good life for poor people. People refer to themselves as poor but they won’t refer to themselves as in poverty.”
Karen Jennings encountered the prejudice when she first left Beattyville.
“When I went to Louisville as a teenager to work in Waffle House I had this country accent. They laughed at me and asked if we even had bathrooms where I come from. People here are judged in the bigger cities and they resent that,” she said. “The difference is the cities hide their problems. Here it’s too small to hide them. There’s the drugs, and the poverty. There’s a lot of the old people come in here for food. The welfare isn’t enough. Three girls in my granddaughter’s class are pregnant. This is a hard place to grow up. People don’t hide it but they resent being judged for it.”
The stereotype has evolved. Deepest Appalachia may still be thought of as backward and dirt poor but it’s now also widely known as in the grip of a prescription drug epidemic. Without prompting, it’s the first thing Steve Mays, Lee County’s de facto mayor, talks about.
Mays is the county’s judge-executive, an antiquated title that carries political but no judicial authority. His office is in Beattyville, where he was born and was a policeman for 16 years, half of them as chief of police.
“When I worked as a police officer and chief there was drugs here and we made a lot of busts, but things are getting worse,” he said. “We don’t have a lot of jobs here. Some people look for a way out. They haven’t accomplished what they wanted to and they’re just looking for that escape, I guess. They get that high and once it gets a hold of you they have a hard time getting away from it. They don’t think the future looks good for them or they don’t feel there’s any hope so they continue to stay on that drug.
“It’s people of all ages. You feel sorry for them. Good people. It takes their lives over. They do things you wouldn’t normally think they’d do. Stealing, writing bad cheques, younger girls prostitute themselves out for drugs.”
Mays feels the sting all the more acutely because his daughter was convicted of illegally obtaining drugs from a local pharmacy where she worked.
In 2013, drug overdoses accounted for 56% of all accidental deaths in Kentucky and an even higher proportion in the east of the state.
Leading the blight is a powerful and highly addictive opioid painkiller, OxyContin, known locally as “hillbilly heroin”. Typically it is ground down and injected or snorted to give an instant and powerful high.
Its misuse is so routine that the bulk of court cases reported in the local papers are drug related. Just about everyone in Beattyville has a story of the human cost. Some mention the decline of the town’s homecoming queen, Michele Moore, into addiction in the 1990s. Moore struggled by as a single mother living in a trailer home before she was stabbed to death by a man while the two were taking drugs.
At about that time, Beattyville’s police chief, Omer Noe , and the Lee County sheriff, Johnny Mann, were jailed for taking bribes to protect drug smugglers. Five years later, the next Lee County sheriff, Douglas Brandenburg, went to prison for a similar crime.
Amid the relentless destruction of life, there is little that shocks. But four years ago residents of Harlan County – a couple of hours’ drive to the south-east – were shaken by a series of deaths over six weeks of parents of members of the local boys and girls club. Eleven of the children watched a parent die.
Getting the drugs isn’t difficult. Elderly people sell their prescription drugs to supplement some of the lowest incomes in the US. The national average retirement income is about $21,500. In Beattyville it is $6,500.
Last year, a pharmacy owner in nearby Clay County, Terry Tenhet, was jailed for 10 years for illegally distributing hundreds of thousands of pills after police tied the prescriptions to several overdose deaths. In 2011 alone, he supplied more than 360,000 OxyContin pills in a county with only 21,000 residents. Those prescriptions were mostly written by doctors in other states.
Prosecutors alleged that for years a single pain clinic nearly 1,000 miles away in south Florida had provided the prescriptions for a quarter of the OxyContin sold in eastern Kentucky. The bus service to Florida is known to police and addicts alike as the “Oxy Express”.
In 2012, Dr Paul Volkman was sentenced to four life terms for writing illegal prescriptions for more than 3m pills from a clinic he ran in Portsmouth, Ohio, on the border with eastern Kentucky. Prosecutors said the prescriptions had contributed to dozens of overdose deaths.
Another doctor, David Procter, is serving 16 years in prison for running a “pill mill” at which at least four other doctors were involved in the illegal supply of drugs to eastern Kentucky.
There is little sympathy for doctors or pharmacists acting as dealers, but there is a view in Beattyville and surrounding towns that people have been exploited by something bigger than a few medics, largely because they are regarded as “backward”.
Davis said the drug companies aggressively pushed OxyContin and similar drugs in a region where, because of a mixture of the mining, the rigours of the outdoors and the weather, there was a higher demand for painkillers.
“You couldn’t go to a doctor without seeing a merchant there. Here’s this synthetic opium product that’s supposed to be good for palliative care – cancer patients – and they start selling it as regular pain medicine. They knew how highly addictive it was and they sold it anyway,” he said. “I live in a town of 1,500 people with seven pharmacies as well as pain clinics and methadone clinics and the full backup industry. Everybody gets paid, doctors and pharmacists and lawyers.”
Recently released research shows that abuse of powerful opioid painkillers is in part responsible for a sharp rise in the death rate among white middle-aged Americans over the past two decades, particularly less-educated 45- to 54-year-olds. The report by academics at Princeton university also blamed misuse of alcohol and a rise in cheaper high quality heroin along with suicides. The researchers said they suspected that financial stress played a part in people taking their lives.
OxyContin’s manufacturer, Purdue Pharma, was penalised $634m by a federal court in 2007 for misrepresenting the drug’s addictive effects to doctors and patients. Purdue is now being sued by the Kentucky government. The state’s attorney general, Jack Conway, accuses the company of concealing information about the dangers of the drug in order to increase profits, and its salespeople of claiming OxyContin is less addictive and safer than it is.
“I want to hold them accountable in eastern Kentucky for what they did,” Conway told the Lexington Herald-Leader. “We have lost an entire generation.”
Purdue has denied the claim.
Late last year the Beattyville Enterprise reported that pharmacists in the town were appealing to drug companies for greater control over another prescription medicine, Neurontin, which is increasingly in demand and has been found at the scene of overdose deaths. Heroin use is also on the rise.
Ask where people get the money for drugs and just about everyone blames it on welfare in general and the trade in what is known locally as “pop” – soft drinks – in particular.
Close to 57% of Beattyville residents claim food stamps. They are paid by electronic transfer on the first of the month. That same day, cases of Pepsi and Coca-Cola are marked down sharply in supermarkets and disappear off the shelves, often paid for with food stamps.
They are then sold on to smaller stores at a lower price than they would pay a distributor, in effect turning several hundred dollars of food stamps into cash at about 50 cents on the dollar.
The “pop” scam has become shorthand in Beattyville among those who regard welfare as almost as big a blight as the drugs themselves.
“We have a lot of dope and the like around here,” said Wilma Barrett at the food bank. “Food stamps go to pay for it. You can see it happening and it’s sickening. It’s become a kind of trap for us out here.”
Courier, the mining company owner, took a similar line, saying welfare had dragged Beattyville down. “It’s made things worse. It’s disincentivised people from even trying. You can’t create a handout and expect people to pull themselves up. You have to give them the incentive to improve. I feel sadness that they’re being trapped,” he said.
April Newman scoffed at the idea that she was trapped by welfare. She said it had kept her and her children, aged one to four years old, from near destitution after she escaped a bad six-year relationship.
“You definitely do feel resented because I resented myself. People look down on you for it,” she said.
In order to get free housing and financial assistance, Newman was obliged to sign on to a Kentucky programme providing financial assistance to low-income families with children in combination with training or volunteering. She receives a living allowance – not formally a pay cheque – of about $800 a month after signing up with AmeriCorps, a federally run national service organisation. She also receives $600 in food stamps. The state covers healthcare costs for the children.
“It’s hard to get by on that but I have learned. Being on my own and being a single mother, you have to learn to budget. So if I know that school clothes are coming up, or if Christmas is coming up, three to four months in advance, I start to slowly save. That way if things come up, I have the money for it. I’ve just learned to save really well,” she said.
Newman’s federal housing is in a stark block on the edge of town where she doesn’t feel particularly safe. “I won’t be living here long though. I’m actually going to try to do better and move out. You can’t raise children in places like that,” she said.
But to move out, she’ll need to pay the rent and the prospects for a full-time job are bleak.
Wilma Barrett does not have much sympathy for people in Newman’s position, even though she too has come to rely on government assistance.
“We owned a farm and we dig our own coal out of the hill. I had a heart attack and had to quit work four years ago. That’s when I started coming over [to the food bank],” she said. “I have a milk cow, chickens for eggs. We didn’t need a hog this year as we had some meat left in the freezer from last year.”
Barrett and her husband pull in about $1,100 a month in welfare payments and food stamps. But she has little time for younger people she regards as unwilling to work. “If you’re not picky about what you do, there’s always something. A job that pays $6 an hour is better than zero. I was raised on a farm with a couple of mules. I have three children and all of them know how to work.”
In the late 19th century, Beattyville was trumpeted by the investment company developing the town as “the gateway to the development of all the great mineral, lumber and agricultural resources” of eastern Kentucky.
Closed store front, Main Street, Beattyville. Photograph: David Coyle/Team Coyle for the Guardian
“If a block of wood be thrown into the waters west of the mountains dividing Kentucky from Virginia it will wind its way between towering mountains and rich valleys until it floats over the dam at Beattyville. Eastern Kentucky cannot be developed without Beattyville becoming a large and important city,” it said.
It was not to be. Within a few years, railways had replaced rivers as the principal means of moving goods and the trains came nowhere near Beattyville. Neither did the highway system that spread across America over the 20th century.
In the end, what eastern Kentucky got was not development but plunder.
“From the beginning, the coal and timber companies insisted on keeping all, or nearly all, the wealth they produced,” wrote Caudill. “They were unwilling to plough more than a tiny part of the money they earned back into schools, libraries, health facilities and other institutions essential to a balanced, pleasant, productive and civilised society. The knowledge and guile of their managers enabled them to corrupt and cozen all too many of the region’s elected public officials and to thwart the legitimate aspirations of the people.”
Even during the War on Poverty, as billions of dollars were poured into the region, programmes were hijacked to serve politicians and money was diverted by members of Congress to prop up support in constituencies far from those for which it was intended.
Yet ask who is responsible for Beattyville’s woes today and fingers in the town frequently point at one man.
“Since Obama it’s got bad,” said Courier. “There’s the economy but also a lot of EPA [Environmental Protection Agency] regulations. There’s been a lot of changes in the law over the past two or three years with hollow mining. As for large-scale mining here, it’s finished. I employed 50 people at the peak. Now it’s six.”
The numbers don’t back up Courier’s claims. The industry has been in decline for decades. Coal production in eastern Kentucky has fallen by 63% since 2000. Mechanization ate into the number of jobs long before that.
Davis said there had been a political campaign by the mining industry to blame the government for the decline led by an industry-funded group, The Friends of Coal.
“In the coinciding of the decline of coal jobs and the corresponding decline in the economy, the Friends of Coal campaign went from car shows and football games to music events – it was very cultural – and began to deflect pressure on the industry to blaming government policy. They put up posters: Stop the war on coal,” he said.
“We’re in a place right now where a tonne of coal costs about $68 to mine in eastern Kentucky and about $12 to mine in Wyoming. They’re importing more Wyoming coal here than they’re using east Kentucky coal. But if you ask people why this is, it’s Obama. They won’t blame the market, they blame the policy. It’s been very convenient to shift it to the black guy.”
Hostility to the US’s first black president runs deep. In an editorial, Beattyville’s largest circulation newspaper, Three Forks Tradition, described Obama as “trying to destroy the United States as we know it”. It accused him of waging war on “Anglo-Saxon males, who work for a living, believe in God and the right to keep and bear arms” and called the president and his then attorney general, Eric Holder, “race baiters with blood on their hands”.
“He has driven racial wedges between the people that will take generations to heal,” the editorial said without irony.
Vivian Lunsford pushed a page torn from a small notepad across her desk at the housing association. The writing on it was in pencil in capital letters. It was a tribute to Mitch McConnell, the Kentucky senator who is the Republican leader in the US Senate. “Mitch will keep us good,” it said, adding he would protect Kentucky from people who were “against coal”.
“My stepdaughter wrote that,” said Lunsford. “She’s too young to think it for herself. God knows who put that into her head. It wasn’t me. But that’s how they think around here. She’s hears it at school. She hears it from her friends and their parents. You hear it a lot.”
Another Beattyville resident offered a forthright assessment of Republican support in the town.
“It’s crazy, it really is. It’s not just this county, it’s the surrounding counties. There’s so many people on welfare and yet they vote Republican and it’s crazy. I’m embarrassed, I really am. I understand a lot of it’s because they’re afraid what colour is our president, and that’s what they go on,” the person said.
A few hours later the resident asked not to be named “because although every word I said is true it would upset people around here”.
Steve Mays, Lee County’s de facto mayor, is a Republican. He has a picture of McConnell on the shelf behind his desk. “I like Mitch. He’s very supportive of me when I need grants or something. He always tries to come through for me,” said Mays.
But just a few months earlier, McConnell had claimed “massive numbers” of people were receiving food stamps “who probably shouldn’t” and described the programme as “making it excessively easy to be non-productive”.
This put Mays in a bind. His party routinely demonises people who receive welfare – but many of his voters rely on it. Mays said he regarded welfare as “a trap”, but acknowledged that without it the town would die.
“It’s catch 22. I don’t know what you do. I see people who really need the help. I see them in this office every day. They struggle and couldn’t make it without it. But I see some people taking advantage of it too,” he said. “I’m not completely against welfare. I don’t think just anybody should get it, I don’t agree with that. There’s people that need it but it’s taken advantage of by people that could work. But I’m not one of those who says there shouldn’t be welfare.”
Still, he acknowledged the seeming contradiction of people voting for a party that was so scornful of the government assistance their town survived on.
“You’re right, Republicans are against that. But that’s not why people around here are registered Republican. It’s because of local candidates or family history. My dad was Republican. I’m raised a Republican and voting Republican. That’s just the way it is,” he said.
This is routinely, and sometimes sneeringly, characterised by Democrats in other parts of America as poor white people voting against their own interests. It’s a view that exasperates Davis.
“They say, why aren’t these people voting their self-interest? People always vote their self-interest if they can see it. If they believe the government doesn’t work, if they believe that the Democrats don’t really give a shit about people like them, don’t want to be in the same room with them, they want their vote but don’t want to hang out with them, then as they see it they’re voting their self-interest,” he said.
So what’s the future?
“It’s bad. I don’t think rural America has a future,” said Courier. “The advantage rural areas had in the past of cheap labour is gone. We used to have a lot of little factories in this area but they’ve gone to Mexico or China. In rural areas housing is cheap but everything else costs more. Utility rates are higher. Food and transport are higher. Management doesn’t want to live in rural areas. Education is horrible here. This is a third-world county. My kids grew up here until they were eight or nine, then they went to school in Louisville [a 145-mile drive away]. I wouldn’t send them to school here."
Mays worried that Beattyville and Lee County were losing their best educated while the most dependent remained. “These kids come out of high school and graduate with honours, and go on to graduate college. We’ve got a lot of them. There’s a lot of smart people here but there’s not a lot of opportunity for them here once they graduate college. Normally they won’t stay here. We need to find a way to encourage them to stay,” he said.
Just as the railways and highways bypassed Beattyville in the last century, so high-speed internet has failed to penetrate through to the town in more recent times. Most people rely on slow and expensive connections through satellite providers. It’s a further discouragement to businesses.
Mays said the county was rooting its hopes for the future in more rustic pastimes. “We’ve got rock climbing and four counties here just got together and invested in a recreation park for off-road vehicles. We’re trying to get canoes on the river. We’ve got a lot of cabins here and a lot of people coming here from all over this country. We’re trying to work on that aspect of it because that’s what we’ve got going for us. We just need a break,” said Mays.
“I feel positive about the future. I wouldn’t want to live anywhere else but Lee County. We’ve got our problems but we’ve got good people … I’ve seen people with a lot of money that wouldn’t give $10 to help somebody out but in this area even people who don’t have a lot, when somebody gets down and sick, or if they’ve got cancer, they band together and they raise as much money as they can for that person to help them.
“I feel like the drug problem is our biggest issue. Not only does it destroy lives but the economic situation. If a company’s not going to come in because they don’t have a lot of workforce to choose from, or don’t feel like they do, there’s your jobs gone. And then people that move out of here. A lot of people move out of here to bigger places to find jobs. So your population starts going down even more. I don’t know how to change that. I’m not smart enough to say how to do it. But if somehow it could be reined in, I think we could grow.”
So, is the American Dream dead in Beattyville?
“If you don’t experience the American Dream, if you’ve never been taken out of the box, I don’t think you believe in it,” said Vivian Lunsford: “People have to be able to see or feel it or touch it to believe.”
Ed Courier said it lived on, but only for those who escaped Beattyville. “There’s opportunities if you go to college. But not for those who stay here. This place is being left behind,” he said.
April Newman agreed with that sentiment. She saw her dream being fulfilled far from Beattyville. “I really want to be a teacher and I have to get out of this town to do that,” she said. “There’s no options here. I don’t want to stay here. I don’t want my children to stay here. There’s so much that goes on. It’s just really sad.”
Dee Davis said the American Dream lived on even for those who could not escape Beattyville, but in a different way. “It’s not the dream of the immigrants so much as the dream of being OK, of surviving,” he said.
The three young men climbing into the pickup truck close to the Oregon border cheerfully acknowledged they were about to break federal law. But they won’t be doing it for much longer.
Anthony, Daniel and Chris bustled out of a marijuana shop in Vancouver, Washington, clutching bags of weed as they headed home a short drive over the bridge to Portland, Oregon.
Crossing state lines with drugs is a federal offence but that has not discouraged the steady stream of customers from Portland taking advantage of Washington’s legalisation of recreational marijuana sales last year.
But starting on Thursday, Oregon joins Washington in permitting the sale of marijuana for recreational use to anyone over the age of 21.
“I’ve been coming across since they legalised it here,” said Anthony. “But it’ll be closer and it’s going to be much more cheaper in Portland. And I won’t have to cross the bridge. Not that I’ve ever seen the cops lining up to catch us.”
The open sale of recreational marijuana has come more swiftly to Portland than many expected. Legalisation was only approved in a ballot measure last November whereas Washington state took 18 months to open its first shops.
To speed up the process, Oregon has approved recreational sales through existing medical marijuanadispensaries, bypassing lengthy background checks which have slowed the roll-out across the state line.
But it caught off-guard many of the dispensary owners who did not expect open sales to begin until the middle of next year.
Mike Chappell, owner of Silver Stem Fine Cannabis in Portland, used to own a marijuana store in Colorado, which legalised sales last year.
He said that whereas several dozen stores opened on Colorado’s first day of legalization, “in Portland we’re looking at 130, if not more, that are eligible to sell recreational marijuana,” he said. “We have no idea what’s going to happen, if we should expect a big line on the first day. It’s going to be the first time you can access it legally within a couple of blocks of your house. ...We’re planning to see 200 customers a day if not a little more than that. But maybe nothing happens. We’re gearing up for the line but it’s unknown.”
If Vancouver, Washington, is anything to go by, Chappell’s shop is going to be busy. The three young men were shopping at the New Vansterdam marijuana shop where its marketing director, Shon Harris, said they have about 1,000 customers a day between two outlets. Nearly 300 items are listed on a “menu” from marijuana leaf to an array of edibles including sweets.
“People dabble,” he said. “People are becoming more open to the idea now that it’s been legal in Washington.”
Outside, the number plates of cars reveal the diversity of its customers. Alongside those from Washington are Oregon, Alabama and Utah plates. “We’re the closest store to PDX (Portland airport),” said Jim Mullen, co-owner of The Herbery marijuana store in Vancouver. “They come straight from the airport to here. They still have suitcases in the car. Mostly on the weekends, from everywhere.
“It’s crazy. You have the United States of America but we’re not united on this by a long shot when you can go to jail in Texas for having a joint but come here and buy it freely. You can fly with it out of PDX to any other city in Oregon, legally.”
But the bulk of Mullen’s out-of-state business comes from Portland and the start of open sales in Oregon is a threat to the income of a significant proportion of marijuana sales at shops in Vancouver.
Washington outlets will be at a disadvantage not only because Portland residents will be able to buy legally just up the road without the admittedly small risk of being arrested for breaking federal law, but also on price.
Washington imposes a tax of 37% on marijuana sales which brought the state close to $70m in revenue to July. Oregon will charge just 25% when taxes kick in in January. Until then, there will be no tax at all. That is likely to price marijuana in Portland well below that in Vancouver, although legal sales in both places are more expensive than on the black market.
Mullen said Washington marijuana stores still have one advantage. For now, only marijuana plant will be on sale in Oregon whereas he sells it in many other forms, including foods.
“Worst case scenario is we’re going to see about a 35% drop in business but there are a number of people that come over to Washington to buy edibles, concentrates and vape cartridges which are products that the Oregon stores are not going to be able to sell for another year,” he said.
Daniel said he could find cheaper marijuana on the black market but it wasn’t worth the trouble. “People are tired of being ripped off on the street. And in the shop you get a lot more variety. It’s all about the flavour, the selection,” he said.
Although the black market is cheaper, Mullen said many people don’t want to go there.
“You’ve got people who are older that smoked in college and now that it’s legal they’re getting back into it but don’t have any connections to buy. And you’ve got a great variety of products in the retail stores. You’ve got edibles. You’ve got concentrates. You’ve got flower. You’ve got 50 different strains of flower. We’re like Macy’s for marijuana. It’s not the black market. It’s safe,” he said.
Still, the marijuana business faces problems even though it is now legal under state law.
For a start, there are strict limits on advertising. Marijuana sales cannot be promoted on radio or television.
While the drug remains illegal under federal law, the Internal Revenue Service still wants its share of taxes on the business. But because marijuana is a Schedule I drug under the federal Controlled Substances Act, shops cannot claim the normal business deductions, such as rent and the cost of labour.
Major banks refuse to deal with marijuana businesses. In Oregon and Washington they bank through local credit unions but that still means they can only accept cash because the big banks control the credit card industry which creates additional security risks. Mullen thinks all this will change in time.
“There are a lot of people who don’t like it. They are paranoid about it, they think it’s still the devil’s drug. But there is an inevitably. When states are voting to legalise medicinal use, that’s a quantum leap forward from where we’ve been. I think there’s without question a groundswell across the United States for the legalisation of this product,” he said. “It’s a new industry. Someday Costco and Walmart will take over but I was hoping to get about a decade out of it for the industry to get a lot of small businesses established because this is generating so many jobs and so much revenue. It’s great not to have the big corporations involved.”
Ashley Yates views the “I Love Ferguson” campaign as more of a political statement than an expression of support for the city at the eye of a storm over civil rights. And it’s not one she’ll be endorsing any time soon.
Yates is among a clutch of young African Americans who have emerged from the violent backlash over the police killing of Michael Brown in August to lead the challenge to a white establishment that has coalesced around an organisation, “I Love Ferguson”, which is attempting to revive the city’s image.
Ferguson’s political leaders, overwhelmingly white in a city that is two-thirds black, hoped that the protests over Brown’s death would lose steam and fade away. Instead they evolved from the initial televised nightly clashes between angry residents and a militarised police force into a different kind of confrontation that has come to divide the city even more than Brown’s killing.
A group of ad hoc organisations born out of alliances formed on the streets, including Millennial Activists United, which Yates co-founded, used unrelenting, sometimes in-your-face protests to keep alive demands that the officer who shot the unarmed teenager, Darren Wilson, be put on trial. But as the campaign grew and gained momentum it shifted to a broader focus on racial profiling and the use of force by the police in Ferguson, St Louis and beyond.
It also moved from the mostly black neighbourhood where Brown died to Ferguson’s more prosperous, and much more white, business district. There the noisy, anger-infused attempts by protesters to press their case have led to open hostility, turned the farmers market into a political football and prompted accusations of “domestic terrorism”.
The controversy has also put the protesters at odds with some longstanding civil rights leaders, who are concerned that confrontation equates to violence. Yates and other leading activists regard the tactics of an earlier generation as dated. She says what was right in pressing for specific goals such as ending segregation on buses or the right to vote is different from attempts to confront what she describes as a state of mind among many Americans that views black people “as a threat and savages”.
“The thing I am positive of is that this is a brand-new movement,” said Yates. “You’ve seen people go from flooding the streets and being out there not knowing what to do and reacting to police violence to actually become organisers and strategising and learning how to make systemic change on a mass scale.”
But the heart of the campaign remains in Ferguson, to the frustration of city luminaries such as a former mayor, Brian Fletcher, who founded the “I Love Ferguson” group in the immediate aftermath of Brown’s killing.
“I’ve been in tears several times because it’s my home town and it’s not being portrayed as it is. The bigots, the racists left years ago. The whites who live here want to,” said Fletcher. “We’ve lost sight of the fact that Michael Brown died. It’s become more of a civil rights issue. The protesters are putting all the civil rights issues of the US on the backs of Ferguson residents.”
To Yates and others, that is precisely the point.
“I think people have come to realise this is not about Mike Brown,” she said. “It is, but there’s a larger issue. This is about the criminalisation of black people. It’s not just the local issue, it’s a national issue. We’ve come to realise that in the last two months.
“This is about John Crawford, who was an innocent man in Ohio gunned down in Walmart for carrying a Walmart product [an airgun]. Meantime you have white citizens who make a concerted effort to take AK47s and M16s into public spaces to exercise their second amendment rights. If you don’t see that the reason that both of them were shot was that black is viewed as a threat, then we still have work to do and we’re committed to doing that work until people open their eyes.”
Millennial Activists United and other groups, such as Lost Voices and Hands Up United, whose most prominent face is Tef Poe, a St Louis rapper and artist, have concentrated their more recent demonstrations in Ferguson on the more prosperous South Florissant road. They began there in part because the police station sits towards the bottom end of the street. But it is also a busy area for restaurants and shops where protesters can more effectively take their message to those they want to hear it.
The nightly demonstrations, sometimes just a handful of people, sometimes much larger, have raised tensions. Protesters complained of being refused service in local bars and took to demonstrating outside. Then came an incident at Faraci Pizza where they accused the owner, Jim Marshall, of pulling a gun on them.
“The protesters were banging on the windows,” said Fletcher. “They claim he showed a weapon. He denies that. There were protesters around his business. He asked them to stay off his property.”
Protesters attempted to shut Faraci down. White residents turned up in large numbers to keep it open by queueing for pizza. The demonstrators saw that as a stand against their cause.
It was a different story at the farmers market, which many on the South Florissant side of Ferguson regarded as one of the places whites and blacks intermingled most in the city. It shut down early for the season after demonstrators marched through in what locals say was a threatening manner.
“We cancelled the very wonderful street festival because of the same thing,” said Fletcher.
“I Love Ferguson” is running a fundraising campaign on behalf of businesses hit by looting in the initial rioting or because of a collapse in trade after the heated atmosphere discouraged shoppers from neighbouring suburbs.
Fletcher has been a vocal critic of the nightly demonstrations, blaming them on “outside agitators”. Certainly there has been a steady stream of supporters from beyond Ferguson and St Louis, including the couple who travelled from Tennessee to sell T-shirts emblazoned with “Don’t shoot”. But Yates said her group and other local organisations made a conscious decision to move the protests to South Florissant and that it is mostly locals participating.
“No matter where I go, black is viewed as a threat, so why not stand in front of your eyes and show you that fear is removed?” she said.
But, she added, she would rather have dialogue than confrontation.
“We are really trying to talk to the officers on the front line on the humane level. Not having diatribes but speaking to them as people: if you have orders, and you know that they’re wrong, will you obey them or will you choose to respect humanity and your morality?” she said.
Yates said “I Love Ferguson” contacted her recently and offered a meeting with Brian Fletcher which has yet to take place.
“We are willing to sit down and talk about where this impression came from that it’s outside agitators and the views that he holds, not only about the murder of Mike Brown, not only about the subsequent protests, but also this idea we’re imposing something on them,” she said.
Angelique Kidd has been maintaining her own vigil outside the police station when she is not at work at the local library. She has lived in Ferguson for 11 years and got involved after the police chief, Thomas Jackson, initially said he would name the officer who shot Brown and then didn’t. So she painted a question on her car: “Who shot Michael Brown?” The next thing she knew she was surrounded by police cars. One of the officers was taking pictures.
Now she has a different slogan painted on her car: “Film the police”.
Kidd’s stand hasn’t gone down well with some in the neighbourhood.
“I don’t know if the protests are making a difference at all but I think they’re costing me a lot of friends, especially because I’m white. A lot of people who go by flip me off,” she said. “I had a woman call me a looter. To some people looters and protesters are the same. People need to open their eyes to what’s happening here.”
Kidd is disdainful of the “I Love Ferguson” campaign.
“People like Brian Fletcher want to make it Ferguson against the protesters,” she said. “Some people care more about their image and property taxes.”
The demonstrators’ more confrontational tactics have drawn frowns from some traditionally minded civil rights activists. Yates is not going to apologise for it. She and Tef Poe crossed swords with a group of clergy at a mass meeting on Sunday evening that was billed in part as a strategy session. Instead it featured one cleric after another condemning injustice and telling Bible stories but not proposing to do anything.
Tef Poe was quickly at the microphone, criticising the earlier speakers for not joining the protests on the streets.
“The people who want to break down racism from a philosophical level, y’all didn’t show up,” he said.
Yates followed him.
“People take our anger and they try to make it violent when the real violence is the AKs and the M16s pointed at our heads,” she told the crowd, to loud cheers. “I’m OK with being angry. I think when you see what’s happening in our streets, if you see a dead body lying in the street for four and a half hours and that doesn’t make you angry, you lack humanity.”
The intellectual and activist Cornel West acknowledged that an older generation “has been too obsessed with being successful” and dropped the ball on civil rights.
Yates said that meeting marked a turning point.
“This is not the civil rights movement. It’s very, very different,” she said. “There’s an entirely different lane that I’m not sure that older people who went through that, or who really admire that movement, understand if they’re not in the street. I think that’s where a lot of the disconnect came in that you have not seen the clergy on the streets.”
The protests have had tangible successes. They have drawn a national spotlight on police killings of young black men. The backlash prompted the Justice Department to launch an investigation of Ferguson’s police department for civil rights violations. The city council has said it will set up a civilian oversight board for the police and made changes to the racially charged system of ticketing for driving offences.
Yates, Tef Poe and other young African American leaders are appearing onstage alongside political leaders such as Senator Claire McCaskill, taking their views to a wider audience. The mayor of St Louis has agreed to meet the protesters. But Yates says it is not nearly enough.
“We’re not seeing the impact that we deserve, the policy changes which reflect the severity and the gravity of the issue. We’re not seeing people removed from power that have aided in this tragedy, that have aided in the hurt of the community. Thomas Jackson is still in power,” she said.
“But on a smaller scale – a more humane, one-to-one scale – I have seen some changes. I have talked to some people in positions of authority that have said they want to see changes as well. We’ve definitely gained some ground in that people understand that we’re not going away and this issue was not something that was bred out of our imagination.”
Fletcher is one of those who says he believes change is coming, at least to Ferguson’s almost all white city council. Black voter registration is up by 30% and new political leaders are emerging.
“I do see African Americans running [for election],” she said. “But I’m concerned if they’re not running for the right reasons. Are they running with a chip on their shoulder and to fire everybody up and get rid of the police chief?”
Here are a few questions you won’t hear asked of the parade of Israeli officials crossing US television screens during the current crisis in Gaza:
What would you do if a foreign country was occupying your land?
What does it mean that Israeli cabinet ministers deny Palestine’s right to exist?
What should we make of a prime minister, Binyamin Netanyahu, who as opposition leader in the 1990s was found addressing rallies under a banner reading “Death to Arafat”?
These are contentious questions, to be sure, and with complicated answers. But they are relevant to understanding of the Israeli-Palestinian conflict today. They also parallel the issues routinely raised by American journalists with Palestinian officials, pressing to consider how the US would react if it were under rocket fire from Mexico, to explain why Hamas won’t recognise Israel and to repudiate Palestinian anti-Semitism.
But it’s a feature of much mainstream journalism in the US, not just an issue of coverage during the last three weeks of the Gaza crisis, that while one set of questions gets asked all the time, the other is heard hardly at all.
In years of reporting from and about Israel, I’ve followed the frequently robust debate in its press about whether Netanyahu really wants a peace deal, about the growing power of right-wing members inside the Israeli cabinet opposed to a Palestinian state, about the creeping air of permanence to the occupation.
So it has been all the more striking to discover a far narrower discourse in Washington and the notoriously pro-Israel mainstream media in the US at a time when difficult questions are more important than ever. John Kerry, the US secretary of state, and a crop of foreign leaders have ratcheted up warnings that the door for the two-state solution is closing, in no small part because of Israel’s actions. But still the difficult questions go unasked.
Take Netanyahu’s appearance on CBS’s Face the Nation on Sunday. The host, Bob Schieffer, permitted the Israeli leader to make a lengthy case for the his military’s ground attack, guiding him along with one sympathetic question after another. Finally, after describing Netanyahu’s position as “very understandable”, Schieffer asked about dead Palestinian civilians – but only to wonder if they presented a public relations problem in “the battle for world opinion”.
There has been fine reporting from on the ground in Gaza by courageous American journalists who have laid bare the price being paid by ordinary Palestinians. That, in turn, has prompted some stiff questioning in American TV studios of Israeli officials about the scale of civilian deaths and shelling of schools and hospitals. Some pro-Israel American pundits admit to have becoming “less pro-Israel”.
But the broader framework of how the conflict is presented in the US is more troubling.
An analysis by Punditfact of CNN coverage during the first two weeks of the latest Gaza crisis showed that appearances by Israeli officials outnumbered Palestinian officials by more than four-to-one. There were substantially more interviews with what Punditfact called Palestinian “laymen”, but they included the relatives of a Palestinian-American beaten by Israeli soldiers that offered little insight into the bigger picture.
All appearances by Palestinian officials were outnumbered by interviews with a single man: Israel’s former ambassador to the US, Michael Oren,whom CNN hired as a Middle East analyst earlier this year. The network presents Oren as a kind of neutral interpreter, when just a few months ago he was vigorously defending Israel on behalf of Netanyahu’s government. His limited value as an analyst was swiftly exposed by his assertion that Hamas was trying to get Israel to kill as many Palestinian children as possible as part of a media strategy.
The number of guests booked or sources quoted has never been balanced on this issue in the mainstream American press, but more important is the nature of interviews and the broader coverage when Israel and Palestine are not thrust into the news by a fresh surge in violence.
At one extreme is Fox News, where last week Sean Hannity shouted down a Palestinian guest, Yousef Munayyer, because he would not condemn Hamas as a terrorist organisation, then proceeded to terminate the interview.
Munayyer, director of the Jerusalem Fund in Washington, has appeared repeatedly on CNN where he is treated more respectfully. But he told me he is frequently brought on to answer accusations from the Israeli side, rather than explain the Palestinian perspective in the way that Israeli officials and commentators are allowed to lay out their case.
“Most of the time I go on it is to be put on the defensive, in response to a conversation that’s framed around Israel’s security concerns first and foremost,” Munayyer said.
Palestinians should face difficult questions about recognition of Israel, about Hamas’s policies and actions, about how peace would work in practice.
But on the other side, I’ve rarely seen a major channel match that kind of routine close questioning of Israeli officials about the position of a government packed with ministers hostile to a Palestinian state, who advocate annexation of much of the occupied territories and who propose second-class citizenship for Arabs.
Israel’s preferred representatives in the US media – Oren, plus the Israeli ambassador to the UN, Ron Prosor, and Netanyahu’s spokesman, Mark Regev – all project the country as a liberal democracy, an unwilling occupier that is thirsting for peace.
Danny Danon, the increasingly powerful chairman of the central committee of Netanyahu’s Likud party, openly opposes a Palestinian state and has said the prime minister doesn’t believe in it either. “I want the majority of the land with the minimum amount of Palestinians,” Danon, whom Netanyahu just fired as deputy defense minister for being critical of opposition to a ceasefire, told me last year.
And Israel’s ultranationalist foreign minister, Avigdor Lieberman, wants a good chunk of Israel’s Arab population stripped of citizenship.
Perhaps none of these men will get what they want. But they hold important levers of power, and good journalism would seem to demand that probing questions get asked about where Israel is headed under such leadership.
That kind of piercing American journalism can be found, mostly in foreign-policy journals and long magazine articles, such as David Remnick’s insightful report in the New Yorker last year on the rising political power of Jewish settlers. But much of the press demonstrates a frightening lack of inquiry, and if the mainstream media won’t do it, others are increasingly willing to do it for them.
It’s no secret that younger Americans do not rely on the nightly news, cable networks or printed newspapers for information in the way many older people do. The internet has opened access to foreign news media, which often has a different take in Israel, and has opened up a stream of links to to first-hand accounts as well as writing by analysts and activists who offer insights and information wilfully ignored by the Bob Schieffers and Sean Hannitys of the world.
There is evidence of a shift in public opinion, mostly generational: a Pew poll this month showed falling support for Israel among younger Americans. Over 65s backed the Jewish state by 60% to just 9% support for the Palestinians. Among young adults, aged 18-29, just 44% were behind Israel with backing for the Palestinians rising to 22%.
As opinion shifts, it will be harder to go on presenting just one side of the story.
An Israeli army officer who repeatedly shot a 13-year-old Palestinian girl in Gaza dismissed a warning from another soldier that she was a child by saying he would have killed her even if she was three years old.
The officer, identified by the army only as Captain R, was charged this week with illegal use of his weapon, conduct unbecoming an officer and other relatively minor infractions after emptying all 10 bullets from his gun's magazine into Iman al-Hams when she walked into a "security area" on the edge of Rafah refugee camp last month.
A tape recording of radio exchanges between soldiers involved in the incident, played on Israeli television, contradicts the army's account of the events and appears to show that the captain shot the girl in cold blood.
The official account claimed that Iman was shot as she walked towards an army post with her schoolbag because soldiers feared she was carrying a bomb.
But the tape recording of the radio conversation between soldiers at the scene reveals that, from the beginning, she was identified as a child and at no point was a bomb spoken about nor was she described as a threat. Iman was also at least 100 yards from any soldier.
Instead, the tape shows that the soldiers swiftly identified her as a "girl of about 10" who was "scared to death".
The tape also reveals that the soldiers said Iman was headed eastwards, away from the army post and back into the refugee camp, when she was shot.
At that point, Captain R took the unusual decision to leave the post in pursuit of the girl. He shot her dead and then "confirmed the kill" by emptying his magazine into her body.
The tape recording is of a three-way conversation between the army watchtower, the army post's operations room and the captain, who was a company commander.
The soldier in the watchtower radioed his colleagues after he saw Iman: "It's a little girl. She's running defensively eastward."
Operations room: "Are we talking about a girl under the age of 10?"
Watchtower: "A girl of about 10, she's behind the embankment, scared to death."
A few minutes later, Iman is shot in the leg from one of the army posts.
The watchtower: "I think that one of the positions took her out."
The company commander then moves in as Iman lies wounded and helpless.
Captain R: "I and another soldier ... are going in a little nearer, forward, to confirm the kill ... Receive a situation report. We fired and killed her ... I also confirmed the kill. Over."
Witnesses described how the captain shot Iman twice in the head, walked away, turned back and fired a stream of bullets into her body. Doctors at Rafah's hospital said she had been shot at least 17 times.
On the tape, the company commander then "clarifies" why he killed Iman: "This is commander. Anything that's mobile, that moves in the zone, even if it's a three-year-old, needs to be killed. Over."
The army's original account of the killing said that the soldiers only identified Iman as a child after she was first shot. But the tape shows that they were aware just how young the small, slight girl was before any shots were fired.
The case came to light after soldiers under the command of Captain R went to an Israeli newspaper to accuse the army of covering up the circumstances of the killing.
A subsequent investigation by the officer responsible for the Gaza strip, Major General Dan Harel, concluded that the captain had "not acted unethically".
However, the military police launched an investigation, which resulted in charges against the unit commander.
Iman's parents have accused the army of whitewashing the affair by filing minor charges against Captain R. They want him prosecuted for murder.
Record of a shooting
Watchtower 'It's a little girl. She's running defensively eastward' Operations room 'Are we talking about a girl under the age of 10?' Watchtower 'A girl of about 10, she's behind the embankment, scared to death' Captain R (after killing the girl) 'Anything moving in the zone, even a three-year-old, needs to be killed'
One of the stranger sights of the refugee crisis that followed the 1994 Rwandan genocide was of stretcher-bearers rushing the dying to medical tents, with men running alongside reciting Bible verses to the withering patients.
But on Robertson's US television station, the Christian Broadcasting Network, that reality was reversed, as he raised millions of dollars from loyal followers by claiming Operation Blessing was at the forefront of the international response to the biggest refugee crisis of the decade. It's a claim he continues to make, even though an official investigation into Robertson's operation in Virginia accused him of "fraudulent and deceptive" claims when he was running an almost non-existent aid operation.
"We brought the largest contingent of medicine into Goma in Zaire, at least the first and the largest," Robertson said as recently as last year on his TV station.
Now a new documentary lays bare the extent of the misrepresentations of Operation Blessing's activities in the Democratic Republic of Congo, formerly Zaire, that it says continue to this day.
Mission Congo, by David Turner and Lara Zizic, opens at the Toronto film festival on Friday. It describes how claims about the scale of aid to Rwandan refugees were among a number of exaggerated or false assertions about the activities of Operation Blessing which pulls in hundreds of millions of dollars a year in donations, much of it through Robertson's televangelism. They include characterising a failed large-scale farming project as a huge success, and claims about providing schools and other infrastructure.
But some of the most damaging criticism of Robertson comes from former aid workers at Operation Blessing, who describe how mercy flights to save refugees were diverted hundreds of miles from the crisis to deliver equipment to a diamond mining concession run by the televangelist.
Throughout the Rwandan refugee crisis, when more than 1 million people fled into neighbouring Zaire and started dying en masse of cholera, Robertson told his viewers that Operation Blessing was at the forefront of saving lives.
"It was the most important first medical shipment on the scene out of everything," he said of one aid delivery as he appealed for donations.
In another broadcast, Robertson said Operation Blessing was saving thousands of lives.
"The death toll in this particular camp went down to almost zero because of our people being there," he said.
Robertson claimed that Operation Blessing sent plane-loads of doctors.
"These are tents set up with our doctors and our medical teams that came from here to work as hard as they could to save lives," Robertson said over pictures of a large tent of children on drips being tended by nurses and doctors.
But the film was of MSF medical staff at work. Operation Blessing had just one tent and a total of seven doctors. MSF officials who worked in Goma told the documentary-makers that they had no recollection of even seeing Operation Blessing – let alone working with it.
"What's really unacceptable is that Operation Blessing took photographs of MSF workers and then used this in their fundraising," said Samantha Bolton, the former MSF spokeswoman in Goma.
Officials from other aid operations said that Operation Blessing was not anywhere near the first or largest groups working in Goma. Jessie Potts, the operations manager for Robertson in Goma in 1994, told Mission Congo that the medicines that did arrive were not of great use in fighting the cholera epidemic.
"We got a lot of Tylenol. Too much. I never did understand that. We got enough Tylenol to supply all of Zaire. God, I never saw as much in my life," he said.
Then, Potts said, suddenly everything changed. "Operation Blessing, several weeks into the operation, decided not to send any more medical teams," he said. The flights to Goma dried up.
Robert Hinkle, the chief pilot for Operation Blessing in Zaire in 1994, said he received new orders. "They began asking me: can we haul a thousand-pound dredge over? I didn't know what the dredging deal was about," he said.
The documentary describes how dredges, used to suck up diamonds from river beds, were delivered hundreds of miles from the crisis in Goma to a private commercial firm, African Development Company, registered in Bermuda and wholly owned by Robertson. ADC held a mining concession near the town of Kamonia on the far side of the country.
"Mission after mission was always just getting eight-inch dredgers, six-inch dredgers … and food supplies, quads, jeeps, out to the diamond dredging operation outside of Kamonia," Hinkle told the film-makers.
The pilot said he joined Operation Blessing to help people. Of the 40 flights he flew into Congo, just two delivered aid. The others were associated with the diamond mining. "We're not doing anything for those people," he said. "After several months I was embarrassed to have Operation Blessing on the airplane's tail." He had the lettering removed.
Robertson ordered an airstrip carved out of the bush next to the town of Kamonia, 800 miles from Goma. On his television show he left the impression this was part of his aid operation.
The televangelist was also raising donations for Operation Blessing's other activities in Congo. These included a 100,000-acre farm near the town of Dumi, which Robertson claimed had produced a large harvest of corn and was a "tremendous feeding station".
"The soil is unbelievable. You stick anything in the ground and it grows. You put a shovel in and it starts sprouting," he said in appealing for donations.
In fact, the farm at Dumi had already failed. The soil was of poor quality and Operation Blessing brought seeds from the US unsuited to the region.
To this day, Robertson continues to solicit donations on the back of the project, on the grounds that although the farm failed, it left a legacy with a school that established a "foundation of education" in the town. 2011 posting on the Operation Blessing website described the school as "thriving".
"Despite the turbulence over the years, the children of Dumi still gather to learn and grow in the little school house on the plateau," it said.
Yet Mission Congo visited the Dumi school at the same time and filmed it abandoned, stripped of its desks and falling down.
Similarly, local leaders in Kamonia said that they were promised schools, roads and a hospital by Robertson's mining company – but none of it materialised.
Robertson's activities in Congo were initially exposed by a Virginia newspaper, the Virginian Pilot, in the 1990s. The investigation by Bill Sizemore prompted the attorney general in Virginia, where Operation Blessing is registered, to order a probe by the state's office of consumer affairs.
Its report concluded that Robertson made "fraudulent and deceptive" statements with claims to be ferrying doctors and medical aid to Goma when he was delivering diamond-mining equipment. It accused Operation Blessing of "misrepresenting" what its flights were doing, and of saying that the airstrip at Kamonia was part of the aid operation when it was "for the benefit of ADC's mining operation".
It also said Robertson had falsely portrayed the Dumi farm as hugely successful when it had already failed.
"Pat Robertson made material claims, via television appeals, regarding the relief efforts. These statements are refuted by the evidence in this case," the report said.
But the Virginian authorities declined to prosecute Robertson, describing his misrepresentations as a "blemish". Mission Congo notes that leading state politicians were recipients of large donations from Robertson.
Robertson has been embroiled in mining controversies elsewhere in Africa. He supported the then president of Liberia, Charles Taylor, during that country's civil war without revealing at the time that he had an $8m investment in a Liberian gold mine. Taylor was already indicted by a UN war crimes tribunal at the time and was later convicted of crimes against humanity.
Robertson has consistently denied the accusation of misusing donations and claimed that the Virginia authorities' failure to prosecute effectively cleared him of wrongdoing. He has acknowledged the diamond mining operation but said that it was small scale and produced few gems.
