A Trump region’s fight against its opioid epidemic

Addiction to legally prescribed pain-relief medication is rife in eastern Tennessee

In the second part of her series "Coast to Coast: Travels in Trump's America", Washington Correspondent Suzanne Lynch travels to eastern Tennessee . . . 

Crossing the Great Smoky Mountains, the stretch of the Appalachian range that divides North Carolina and Tennessee, the pretty town of Dandridge comes into view.

Founded in 1773, it proudly holds the status as the second-oldest town in Tennessee.

As Beverley, who runs an antique store in the town, tells me, it was named after the first wife of George Washington, Mary Dandridge Washington, an association that saved the town from destruction in the 1940s.


When president Franklin D Roosevelt ordered a hydraulic dam to be built on the huge French Broad river nearby, Dandridge was the only town in the region that was protected from flooding, after FDR’s wife intervened to save the town due to its connections with a former first lady.

Today, walking around the small streets is like stepping back in time. Old shop fronts line the small main street, and antique stores and pretty boutiques are housed in preserved buildings. At Tinsley Bible drugs store on the main street, you can not only buy prescriptions but order an ice-cream sundae at the old-fashioned soda fountain in the store – a feature of small American towns that disappeared in most places by the 1970s.

It is also a place where an Irish accent plays well.

The Scots Irish, mainly Protestant immigrants from Ulster, settled in the Appalachian region in the late 18th century, an influence that can still be traced in the bluegrass-style music associated with the region.

Preparations for the annual Scots-Irish festival at the end of September are in full swing, with flyers and posters everywhere.

White population

But the dainty shopfronts and slow pace of life project a very specific version of America rooted in the past – predominantly white, Anglo-Saxon and Christian. As I walk along the streets, there are very few African-American or Hispanics.

This is Trump country. The president comfortably won Tennessee in last year's election, taking 61 per cent of the vote.

Like many of the big states of the south, Tennessee is now solidly Republican, but wasn't always so – Bill Clinton won Tennessee in 1992 and 1996. Its emergence as a solid red state is part of a general drift by white, working-class America from the Democratic Party to the Republican Party – a demographic that was ripe for Trump's message of economic nationalism.

In Jefferson County, the area of east Tennessee where Dandridge is located, the president won 71 per cent of the vote compared with 18 per cent for Hillary Clinton.

Wayne Maxwell, who runs a boutique with his wife in the main street of Dandridge, is one of the few who did not vote for Trump. Proudly sporting a Dandridge Scots Irish festival T-shirt, he says his biggest worry is foreign policy, and how Trump will respond to threats like North Korea. He says most of his friends in the town voted Republican.

Outside the quaint residential streets, most residents have very different views to Wayne, 23-year-old Kristine – who has two toddlers with her – says she is happy with the state of the country. “I’ve lived in Jefferson County all my life, and I’m pretty happy with what the president is doing.” She has a medical condition and is covered by Medicaid, the state programme for low-income people. “As long as they don’t go changing things I’ll be pretty good.”

‘A little wacky’

Others have a more nuanced view of Trump, aware of his shortcomings, even though they continue to support him. Susan Rice, who is heading into the local supermarket with her 13-year-old daughter Trinity, is a Republican voter who supported Trump in November.

“Trump is a little wacky, but I do think he’s getting things done. I like the fact that he is not trying to do things to keep everyone happy. I think as a society that we have moved too far in the direction of trying to make everyone happy all the time.”

She turns to her daughter: “Does everyone in your school like the school principal? I bet they don’t, but she keeps the rules in place.”

She says that she and her family are very engaged with the news but make sure to get their information from a variety of sources. She finds affinity with the low-tax, low-regulation economic model that underpins the Republican ethos rather than the moral or religious concerns of many of the party. For her, healthcare is a primary concern, and she is hopeful Trump will change things.

“I was not happy with the changes introduced by Obama. My husband and I are both working individuals. We have consistently had health insurance, we’re in good health, but our costs went up with Obamacare.

“We’re that base of people that pay in and are healthy, but we don’t have enough people putting in, so you end up having a lot of people who say, ‘I guess I don’t have to pay anything’. A few people can’t carry everybody. I’m not saying it was perfect before Obamacare but someone needs to put pen to paper and come up with a solution.”

Importance of coalmining

Kim, who is on her way to work in the local mall where she works in the bank, is also a Trump supporter. From neighbouring Kentucky, she moved to Tennessee last year and is happy with how Trump is performing. "For me and my family, the main election issue was coalmining. My step father lost his job in the coalmines in November, but recently got a new job in mining in May, so we're quite happy with how the president is doing."

Away from the cute shopfronts in downtown Dandridge, there is also a darker side to this region of eastern Tennessee. In the rural areas, a mile or so outside the town, poverty is high and there are few opportunities for a white working-class community which feels left behind by globalisation and changes in technology.

Addiction to opioids – legally prescribed pain-relief medication – is rife in the area. The opioid crisis has emerged as a major public health concern across the United States. According to the Centres for Disease Control and Prevention, 91 Americans die daily from opioid overdoses. The problem is particularly acute in poor – mainly white – working-class areas where unemployment is high, including eastern Tennessee.

In the last few weeks, in a high-profile case, the mayor of Nashville lost his only son to a drug overdose.

Dr David Reagan, chief medical officer at the Tennessee department of health, says the problem began in the late 1990s and early 2000s. "Around this time, we saw an increase in opioid prescribing and dispensing, accompanied by the mistaken message that opioids were not very addictive and people who were in pain were highly unlikely to become dependent to their pain medication." Tennessee established a prescription-monitoring programme in 2002 in a bid to tackle the issue.

Opioid epidemic

Gerard Stranch of Nashville-based Branstetter, Stranch & Jennings is representing a group of Tennessee district attorneys who have filed lawsuits against makers of opioid drugs.

“The opioid epidemic is absolutely devastating these communities. In Sullivan County [adjacent to Jefferson County], for example, out of 1,000 live births, 48 are born addicted to opioids,” he says. “Almost every single person has a family member or friend whose lives have been devastated by addiction.”

Several further cases are expected to be brought in the next few months, as prosecutors attempt to hold pharmaceutical companies liable for the addiction crisis. It is the latest effort to try to confront the issue.

“I think district attorneys who are faced with so many of these cases on their lists realised there was nothing coming out of Washington, nothing coming out of Nashville to tackle this issue,” says Stranch. “These lawsuits argue that some pharmaceutical companies knowingly participated in the illegal drug market.”

The opioid addiction issue is gaining national attention. Trump appointed New Jersey governor Chris Christie to head an opioid commission earlier this year. The issue also contributed to the collapse of the Republican plan to repeal and replace Obamacare as senators from states which are badly affected by the addiction crisis protested at potential cuts to addiction services.

Many of those who voted for Trump come from the communities that are hit by the crisis.

Sean, who works in construction and is a big supporter of the president, says he knows many who have been affected by addiction. "I know a lot of people who have been struggling with addiction. One of the guys I went to school overdosed last year. There is just nothing for people to do around here. The nearest town is Knoxville, but most people have left."

Does he feel that Trump will deliver for the community? “It’s early days. I like him. I think most people like him. At least he’s trying to shake things up. He’s listening. We’ll see.”