Inside the Opioid-Filled Living Rooms Along America’s Rust Belt

In desolate towns across West Virginia, opioids have become the new normal.

Man armed with a rifle sitting at a window of the West Virginia's Rust Belt

Jesse Boggess, armed with a rifle, sits at the window of his home. He was awarded 16 different medals during service in the Vietnam War from 1969 to 1970, including a Medal of Honor. Now he lives by himself deep in the woods in the Appalachian Mountains. From his kitchen window he shoots small animals that come into his range. Jesse suffers from post-traumatic stress, and is on medication. (Photo by Espen Rasmussen/Panos Pictures)

Espen Rasmussen, an award-winning Norwegian photographer, is used to traveling the globe to shoot. His book TRANSIT, which documents the experience of refugees worldwide, features photos from Chad, Lebanon, Bangladesh, Syria, and Georgia, among others. West Virginia’s Rust Belt, then, might not seem like it would rank high on the list of places for him to visit.

However, he’s recently become a frequent visitor to the state’s forlorn mining towns, meeting locals, soaking up the scene, and taking lots of pictures along the way. His interest in the area was sparked, he says, by how different it is from the typical idea of America.

“In West Virginia, it’s not New York, it’s not Washington D.C.,” he says. “It’s a different culture and people. I would say it’s more open and friendly, and it was easier to [take photos].”

So open and friendly, in fact, that he was allowed to take some surprisingly intimate shots for this series, capturing images that portray both actual nudity and the raw, naked reality of America’s opioid crisis.

When selecting images for an essay, Rasmussen’s main focus is on the narrative, he says, but there’s one shot here that stands out: A young woman, dressed up in a cat costume, sits on a bed as her boyfriend and a friend smoke Oxycontin next to her. When asked about the photo, Rasmussen doesn’t seem disturbed by it. It was a pretty typical night, he says.

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Chelsea (21) together with Alvin and her boyfriend Eric smoke OxyContin in her mother’s trailer before going out for a party on Halloween. West Virginia has the highest rate of overdose deaths in the U.S. (Photo by Espen Rasmussen/VG/Panos)

“This was Halloween—they used it for partying,” he says. “They used it before we went out to party in the club, when they came back they used it, and then they went to bed afterward.”

Opioid use is so widespread in the region, he says, that people like the woman in the photo and her boyfriend don’t really feel ashamed of it. Its ubiquity is something he attributes to the opioid industrial complex and the number of miners prescribed it for the physical wear and tear their job entails. That said, his young friends were still aware of the dangers.

“They were not ashamed,” he says, “but they were like—they said to me, this young girl, for example, that she really didn’t want to do it but she was really addicted to it. And her boyfriend also told me, ’Okay, we haven’t done this for so long yet, but soon it will feed on us.’”

People start using for innocuous reasons like Halloween partying or to relieve the pain of a lifetime spent stooping in mine shafts and get hooked before they realize it, Rasmussen says. That initial desire to try opioids, he suspects, has a lot to do with the larger economic issues endemic to the Rust Belt.

“These people who don’t leave Beckley or don’t leave these small places, they really want to do something bigger or want to do something else,” he says. “But because of economic reasons or because of lack of education or family reasons or other things, they stay.”

It’s a tale as old as time—getting messed up to kill time in your small town—but one given extra urgency by the scourge of opioid addiction. The issues of poverty and drug addiction that Rasmussen encountered in West Virginia surprised him, he says, shattering his preconceived notions about America.

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A cross at the roadside in the Appalachian mountains. (Photo by Espen Rasmussen/VG/Panos))

“We look at the U.S. as a developed nation, you know? In Norway, when we talk about the U.S., it’s about great movie actors, the culture and everything. And then you come to West Virginia and you see another reality. You find the same kind of problems you find in [poor] African countries or Asian countries.”

While the rawness of that particular shot is unparalleled, especially for those of us who do not live in the midst of the opioid crisis, that same real, visceral quality is present in the entire series. And Rasmussen was careful to focus on subjects that he feels represent a more real, less stylized experience of Appalachia. There’s been a lot of photography work done in West Virginia, he notes, but he fears that too much of it focuses on the stereotype of old mountain hillbillies.

“I was very afraid of that when I worked on this project,” he says. “I don’t want to only meet those guys, the strange old man with the kazoo. For me, it was important especially to be with young people. To see what they did and how they lived their life.”

Indeed, his shots capture an experience that is often overlooked by the rest of the country. But one that also has a lot to say about it.

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Branden (29) and Rachel (29) on their all-terrain vehicle (ATV, quad bike) close to Beckley where they live and have started a family. “We changed our lives for the better. Too many people fall into drugs, crime and alcohol here,” Branden says. (Photo by Espen Rasmussen/VG/Panos)
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People smoking the opioid painkiller OxyContin. It is crushed before being heated and inhaled. A single tablet can cost up to $45 dollars. (Photo by Espen Rasmussen/VG/Panos)
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A couple of friends help Steve jumpstart his all-terrain vehicle (ATV, quad bike) before driving off into the mountains in West Virginia. (Photo by Espen Rasmussen/VG/Panos)
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A party at Bill’s house in the Appalachian Mountains, an area of high unemployment after the coal mines closed in West Virginia. (Photo by Espen Rasmussen/VG/Panos)
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A party at Bill’s house in the Appalachian Mountains, an area of high unemployment after the coal mines closed in West Virginia. (Photo by Espen Rasmussen/VG/Panos)
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A view along Harper Road which leads into the heart of what used to be a busy coal mining region in West Virginia. (Photo by Espen Rasmussen/VG/Panos)
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Miners change after their shift in a coal mine. The 32 miners work eight-hour shifts but the working conditions are tough. They breathe in dust while crawling through the low tunnels, many end up with disabilities. “Working in the coal mine is a lifestyle. If you manage, you earn good money. But unfortunately, a lot of the mines have closed, so there is a huge lack of jobs in the area,” says owner Kevin Calloway. (Photo by Espen Rasmussen/VG/Panos)
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People playing pool in a small bar in West Virginia. (Photo by Espen Rasmussen/VG/Panos)
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Eric and Chelsea in the trailer they share with Chelsea’s mother after a party at a local bar in West Virginia. (Photo by Espen Rasmussen/VG/Panos)