Post series on rural death rates end in another town that says 'This isn't the place it used to be'

A billboard on US 23 in Chillicothe offers help. Locals say the road
brings dealers from the north; it leads south to Portsmouth, site of
Dreamland, Sam Quinones' book about how "pill mills" helped create
the opioid epidemic. (Washington Post photo by Bonnie Jo Mount)

The Washington Post ended its year-long series about "an epidemic of self-destruction in small-town and rural America" with a visit by Joel Achenbach to Chillicothe, Ohio, where 40 people died of overdoses in 2015, three times the number recorded in 2012.

"Chillicothe was once protected from urban pathologies by its very remoteness. Today, everyone lives in a wired, networked, smaller world," Achenbach reports. "Addiction is like termite rot, eating at the foundation of a community. This cultural self-destruction is particularly pernicious when women with children can’t function as mothers."

In an accompanying piece, Achenbach takes a broader look: "It’s a national phenomenon without a single, simple explanation. A study by Princeton economists Anne Case and Angus Deaton, published in late 2015, brought national attention to the spike in the white death rate. Our data analysis showed that this was driven largely by increased mortality in white women, and we also found a geographical gradient: The death rates had jumped most significantly outside big cities."

Achenbach drove US 50, "the backbone of America," and found people "falling victim to drugs, drink and suicide — the so-called diseases of despair. . . . They’ve found a great deal of traction in places facing economic decline and social stagnation. That describes much of rural and small-town America and certainly the industrial areas of the so-called Rust Belt. . . . As globalization took hold, factory jobs grew scarcer in small cities as well. The U.S. economy began to concentrate wealth in big cities and along the coasts. Unions lost power, and unskilled labor jobs saw little or no wage growth. Now add to this the prescription painkillers heavily marketed since the 1990s. There arose a pill economy, with pills as good as cash. The opioid epidemic exploded in places that are far away, physically and culturally, from the neighborhoods where lawmakers and media figures typically live."

Achenbach writes, "Along the road, I talked to judges, police officers, truant officers, addiction recovery counselors, addicts, and ordinary people coming and going. There was a common theme: This isn’t the place it used to be."