Introduction by Barbara Kingsolver
Photographs by Tamara ReynoldsMs. Kingsolver is the author of “Demon Copperhead.” Ms. Reynolds is a documentary photographer based in Nashville.

“It started when I got injured in a football game.”

“It started when I was trying to move a bookcase in a house I was cleaning. It fell over and broke three bones in my hand.”

“It started after my hernia operation.”

These are some of the stories I heard when I sat down in the early 2020s with people from Appalachia who were in recovery, or in active addiction with the hope of recovery still ahead. I wanted to write a novel about the epidemic of opioid use disorder that was tearing apart the place and people I love.

My first job was to listen: How does this happen to working people, mothers, high school athletes, none of whom imagined the hell that lay at the bottom of their first bottle of painkillers? Some started as kids, messing around with the stuff that showed up wherever they turned. Others were following a doctor’s orders. Some didn’t understand they were addicted at first. They only knew they needed a renewed prescription after the first one ran out, because they felt sicker now than they’d ever been in their lives.

As a member of the first War on Drugs generation, I was taught things about addiction that I’ve spent years unlearning. The government’s long campaign of selective incarceration and punitive propaganda sent officers into schools to tell us that bad people brought addiction on themselves when they didn’t have the gumption to “just say no.”

I’m shocked now at the cruelty of........

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