RX Appalachia: Stories of Treatment and Survival in Rural Kentucky

by Lesly-Marie Buer

Overview

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

Product Details

ISBN-13:	9781642591231
Publisher:	Haymarket Books
Publication date:	05/12/2020
Pages:	220
Product dimensions:	5.40(w) x 8.40(h) x 0.80(d)

About the Author

Lesly-Marie Buer is an activist and public health practitioner at Positively Living/Choice Health Network in Knoxville, Tennessee. Her work on substance use and harm reduction has appeared insuch publications as Boston Review, the Journal of Appalachian Studies, and North American Dialogue.

Table of Contents

Introduction An Ethnography of Intervention 1

Chapter 1 How Did We Get Here? 27

Chapter 2 Facing the State 59

Chapter 3 The Therapeutic State 91

Chapter 4 Punitive Rehabilitation 111

Chapter 5 The Pharmaceutical Approach: Suboxone 129

Chapter 6 Strategies for Making Do in Broken Systems 151

Chapter 7 Moving Forward 187

Appendix A Few Relevant Advocacy Organizations 203

Acknowledgments 207

References 211

Notes 231

Index 257

Editorial Reviews

"At its very core, Rx Appalachia is a call to action for all of us to expand our consciousness of how poliitcal, social, and physical enviroments impact opiod use disorder. What do we do after we read it? Well, that is up to us." —Journal of Appalachian Studies

"Lesly-Marie Buer's Rx Appalachia is a compelling account of substance abuse in Central Appalachia that at last puts race and gender at the forefront of analysis. Buer, a harm reductionist and medical anthropologist, offers a layered portrait of the lives led by women who use drugs and their experiences navigating treatment programs too often shaped by punitive impulses than evidence-based research. A rare book that combines a powerful systemic critique within humanely-rendered stories of coping and survival, Rx Appalachia is a clear and accessible primer about the people and places now synomous with America's new addiction crisis." —Elizabeth Catte, author of What You are Getting Wrong About Appalachia and Pure America

"Lesly-Marie Buer’s ethnographic study RxAppalachia examines what happens to women and mothers who use drugs and get caught up in the intertwined therapeutic, rehabilitative, and often punitive practices of public and private addiction recovery programs including drug courts. Buer analyzes the entangled dimensions of care and cruelty, domination and love, family and community, and the discursive and disciplinary techniques that are involved in so-called “rehabilitation” efforts. What good such programs might do is often undercut by inadequate funding and by their tendency to ignore or worsen the stereotypes and the structural and systemic inequalities, constraints, and violence their clients face on a daily basis—often within the programs themselves. The ethnographic site of this brilliant book is Appalachia but it is a must-read for scholars, practitioners, students, concerned citizens, and clients everywhere." —Dwight B. Billings, Emeritus Professor of Sociology, University of Kentucky

"Reproductive Justice demands that we provide parents who use drugs with sufficient resources such as housing and access to comprehensive reproductive health care, knowing that parents' well-being is intrinsically linked to that of their children. Dr Buer makes a strong case for why tax dollars spent on policing and incarceration are harmful and no substitute for adequate social supports and basic human rights. This book makes the case for why we can't simply wait on the state to rectify the many injustices that plague the lives of people and especially women in Appalachia - we must take care of each other now." —Anna Carella, Co-Director, Healthy and Free Tennessee

"In this riveting account, Buer defies the media version of the opioid crisis in Appalachia, a story of overnight villains and victims. She listens to the women who for years have navigated punitive and highly gendered and racialized state policies, deeply unequal social structures, and state divestment. She asks women who use drugs—who have been told over and again how to “fix” themselves and to whose standards—what they believe they need for themselves and their caring networks of family and friends. Their refreshing narratives intertwine with Buer’s careful contextualization to produce a bold vision for harm reduction in Appalachia. A necessary book for those seeking to understand the opioid crisis and the broader political economy of which it is part." —Jessica Wilkerson, author of To Live Here, You Have to Fight: How Women Led Appalachian Movements for Social Justice

"In the midst of the latest drug scare focused on opioids, pregnant women have once again become the objects of state surveillance and control. Lesly-Marie Buer's book arrives just in time to provide information needed to evaluate and challenge government responses that focus on separating families and fixing mothers rather than the economic, social and public health policies that undermine women's health and lives. With moving accounts by mothers of their desperate efforts to do whatever it takes to get their children back and revelations of sometimes shocking state action – including compelled religious education and prohibitions on needed medical treatment, this beautifully written book is a must read." —Lynn Paltrow, Executive Director of National Advocates for Pregnant Women

"Anyone who does research or practice in rural communities affected by drug use will agree with my feeling that we have long needed this book. This deep ethnographic examination into the lives of women in Appalachia who use drugs serves a vital antidote to shallow representations of rural drug use in the age of the opioid epidemic. Buer is comprehensive in her approach to understanding not only the histories and inequities that contribute to drug use, but also the ways that the design of public health and social systems to address these health disparities inadvertently can harm those who they are meant to serve. While this book helps us to understand the larger inequities that have led us to here, it also begins to help us understand the path to move forward." —Claire Snell-Rood, author of No One will Let Her Live: Women's Struggle for Well-Being in a Delhi Slum

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