The Sunday Read: ‘Opioids Ravaged a Kentucky Town. Then Rehab Became Its Business.’

Ingrid Jackson had never lived in a trailer before, or a small town. She was born in Louisville, Ky., the daughter of a man with schizophrenia who, in 1983, decapitated a 76-year-old woman. Jackson was 1 at the time. In 2010, at 27, she was in a car accident and was prescribed pain pills. Not long after that, she began using heroin. Over the next decade she went through nine rounds of addiction rehab. Each ended in relapse. Her most recent attempt came in 2022 after her son was sentenced to life in prison for murder; he was 21.

In eastern Kentucky, a region that is plagued by poverty and is at the heart of the country’s opioid epidemic, the burden of addressing this treatment gap has mainly been taken up by addiction-rehab companies. Many stand more like community centers or churches than like medical clinics, offering not just chemical but also spiritual and logistical services with the aim of helping people in addiction find employment and re-enter society.

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