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Opioids Decimated a Kentucky Town. Recovering Addicts Are Saving It.

After the collapse of coal mining and the rise of the opioid epidemic, Hazard, Kentucky, seemed finished. Then locals started to rescue it.

In early 2020, Mandi Fugate Sheffel, 42, opened a tiny bookstore in her hometown of Hazard, in eastern Kentucky. Everyone thought she was crazy.

Downtown Hazard was a forbidding place to start any business, much less a bookstore. The coal mines that once supported the area had closed over the past few decades. Many brick buildings from Hazard’s heyday were gone, bequeathing a gap-toothed look to Main Street. The rest were empty or occupied by attorneys and bail bondsmen.

What’s more, Fugate Sheffel couldn’t afford a website or employees. She had never run a business before. And she had a complicated personal history to wrestle with.

But she loved to read—particularly contemporary Appalachian authors like Silas House, James Still, and Gurney Norman, who told stories that felt real to her. She figured others in town were tired, like her, of driving two hours to Lexington to buy books. 

So, on January 30, she opened Read Spotted Newt in a 250-square-foot space—the size of a small bedroom. 

Despite the shuttering of nearby coal mines and the devastation left in the wake of the opioid epidemic, eastern Kentucky is experiencing an economic revival.

I met Fugate Sheffel last spring when I visited Hazard (population 5,000) for the first time. I came to speak about my book, The Least of Us, about America’s drug-addiction epidemic. I had heard about the town, and had formed an image of it as the buckle on eastern Kentucky’s opioid belt. 

From Fugate Sheffel, though, I heard another story—one that I heard elsewhere in eastern Kentucky, and in West Virginia and southwest Virginia and the southern tier of Ohio.

“When you don’t have industry, you’re having ecological disaster and a drug epidemic—you would think all those things would get us to a place where the town would be uninhabitable,” Fugate Sheffel told me. “But that’s not what I’m seeing at all. I’m seeing a lot of people rally.”

The road to Hazard, the seat of Perry County, which has been the worst hit by opiates in the United States.

The loping hills of eastern Kentucky are studded with scores of towns like Hazard—and nearby Prestonsburg and Pineville and Corbin—that, over the centuries, emerged in the valleys and along its rivers. 

The beginning of these places stretched back at least to the middle of the nineteenth century and the first coal mines, mostly in the Allegheny Mountains, in the eastern part of the state. By the early twentieth century, coal dominated the region, with roughly 700,000 men and boys toiling in the mines of Kentucky and neighboring West Virginia. 

For decades, there was stability. Lots of jobs, no drugs. (In fact, Kentucky’s state House of Representatives passed a bill banning alcohol in 1914, four years before Prohibition. The bill died in the state Senate.)

In the 1990s, “as one declined and things got worse, the other increased and things got worse,” Les Stapleton, the mayor of Prestonsburg (population 4,000), 35 miles northeast of Hazard, told me about the correlation between jobs and drugs.

Larger forces over which locals had little or no control exacerbated things: the rise of natural gas, new environmental standards, our shifting political and cultural landscape.

By the early 2000s, the region had become the epicenter of the new opioid epidemic, which spiraled out of the Big Sandy River and flowed through eastern Kentucky, West Virginia, and southwest Virginia.

Downtowns emptied out. Buildings were abandoned. About the only new local businesses were “pill mills”—clinics that prescribed huge quantities of prescription painkillers. In the little evangelical churches, they prayed for an end to “hillbilly heroin.” 

Locals play basketball in Hazard.

Hazard, the seat of surrounding Perry County, had thrived for over a century with the mines, but when the mines closed the town mostly closed down, too. By the late 2010s, Perry County was the worst hit county in the United States when it came to opiates. 

Hazard, like so many of these places, took on a haunted feeling, as if the whole world that used to be here—people, storefronts, churches, marching bands, Friday night football, bowling leagues, quilting clubs—just disappeared.

But then, weirdly and unexpectedly, at the same time that everything was falling apart, things started to get better—and that old world started, very tentatively, to build itself back up.

In the past few years, some 43 businesses have opened in Hazard, creating 171 new jobs, said Bailey Richards, the town’s coordinator of downtown development. That includes a toy store, a café, a women’s boutique, a quilt and apparel place, and a smoothie shop. A longtime restaurant just moved downtown.

The population, which declined for most of the latter half of the twentieth century, now appears to be inching up: in 2010, there were just south of 4,500 people in Hazard; by 2021, that figure had jumped by 500 or so people, and everyone thought it would keep rising. That growth was driven mostly by outsiders—new families, mostly from cities in Kentucky, in search of a better future, and immigrants, including a nascent Latino community.

Shane Barton, the downtown development coordinator at the University of Kentucky’s Community and Economic Development Initiative, went so far as to call Hazard “a hip destination for young people.”

It was hard to say why this was happening. Gradually, people were becoming more aware of the crisis of Appalachia and were doing things trying to help. (President Bill Clinton paid a visit to Hazard in 1999 to bring attention to its mounting woes.) Covid pushed people to move out of the cities. And there were the recovering addicts; they weren’t expensive to hire if you needed a barista or someone to stock your shelves or paint your walls, and they were eager to work, to live.

Bailey Richards, Hazard’s coordinator of downtown development, poses for a picture overlooking the revitalized Main Street.

In Hazard, about a quarter of the new jobs are held by recovering addicts. In Pineville, an hour and a half southwest of Hazard, one-third of new jobs are filled by people in recovery, Jacob Roan, who oversees economic development in the town, told me.

“When somebody gets clean, they want to change the world, and have ideas of how to change the world,” Stephanie Callahan, a former addict and current business owner in Hazard, told me. “You do something just to prove you can do it.”

That’s what inspired Joey Jones—the can-do spirit. 

Jones and his wife, Nikki, grew up in Hazard, went to the University of Louisville, and in 2019, returned home after ten years away, now with two kids. 

Though a trained social worker, Joey Jones opened a toy store. This was last year. He called it Ready Set Play, and it’s on Main Street. Jones advertises on social media and, despite selling toys that are available online, he is expanding. 

Joey Jones grew up in Hazard, went to the University of Louisville, and in 2019, returned home after ten years away to open his toy store, Ready Set Play.

“The small business community here feels like family,” Jones said. 

Mandi Fugate Sheffel, who knew something about hard times and people coming together, agreed.

She had been in high school in the 1990s, as the mines were closing and pain pills were invading. “One day, we were drinking beer in the back of a truck,” she said. “Then, all of a sudden, these pills were everywhere.” By 1997, she was an OxyContin addict.

The addicts dubbed a local park “Pillville,” and Fugate Sheffel got out. She moved to western Kentucky, came home in 2002, got sober, married, had a son. She survived.

So did her bookstore, against all odds.

A few days after she opened it, in 2020, it was flooded. Then Covid hit and Kentucky’s governor banned in-store shopping, and Fugate Sheffel thought this might really be it for Read Spotted Newt.

But after local media reported on Read Spotted Newt’s woes, Fugate Sheffel started getting orders from all over. Soon, she said, “I was shipping books everywhere—Boston, Florida, Texas, L.A. Anybody who had any tie to eastern Kentucky who knew this was going on were like, ‘We gotta make sure she makes this work.’ ” 

By late 2020, she had moved to a larger space—a triangular building on a corner that once housed Hazard’s tourist welcome center. The city renovated it for her. 

A customer mid-shave at Wright’s Barbershop in Prestonsburg, Kentucky.

There are other pockets of hope scattered across the region.

In Prestonsburg, an hour north of Hazard, there are now five locally owned restaurants, all but one of which opened in the last five years. An Indian restaurant is coming soon. The two-block historic downtown once had eleven abandoned buildings. Now, all are occupied.

In Pineville, Kentucky (population 1,600), just north of the Tennessee line, the downtown was similarly decimated. Now there are boutiques, a hair salon, a furniture store, and several restaurants. Importantly, noted Jacob Roan, the town’s economic development director, “Those businesses are still in business six, seven years after opening.”

In Corbin (population 8,000), just up the highway from Pineville and pushing up against the Daniel Boone National Forest, several old buildings have been redone. They now house restaurants, a clothing boutique, a print shop, a café, an ice cream parlor, a record store, and a pinball museum. 

“Everybody is like, ‘What can I start? What’s missing around here?’ ” Corbin Mayor Suzie Razmus told me. 

Something else locals are starting to see in these places: people. On the street, outside their favorite coffee shop, chatting with a friend through an open car window. 

In the past, a town sprouted up around a big factory that employed hundreds or more people. 

But no one’s waiting any longer for factories or big-box stores—to say nothing of the mines or unions—to save them. “Too many have come in to try to save us, and they don’t,” Stapleton, the mayor of Prestonsburg, said. “We got to do it ourselves.”

Les Stapleton, the mayor of Prestonsburg, takes pride in his town’s appearance. “If a deer gets killed on the highway, I pull over and put it in the truck and get rid of it, because I don’t want people seeing that the first time they drive into town.”

Now, he’s facing a problem he could never have anticipated: a shortage of affordable housing. This has been driven, he added, by outsiders who, since Covid, have been moving to Prestonsburg and other towns across the region. A local internet company is expanding service throughout the town.

Jeff Siegler, whose firm Revitalize, or Die advises small towns on rebuilding, said the area’s success “has to be about small, incremental victories—one business at a time.”

The new generation of mayors, town councilors, and city planners across much of Appalachia, who had come through the disaster of the last three decades and seemed inspired by recovering addicts in their own communities, understood what Siegler was saying: small is good; local is good; people are good.  

Instead of trying to lure massive out-of-state companies with tax incentives, they were thinking about beautification projects and homeowners and places where people could congregate. 

“That’s the shift,” said Shane Barton, at the University of Kentucky. “How can we make our communities people-ready as opposed to industry- or investment-ready?”

Don Haley, owner of Broken Spoke Lounge, a bar and game hall in Hazard. Instead of trying to lure massive companies with tax cuts, area officials are focused on reviving their downtowns for the people who live there.

Still, progress is uneven, and many small-town economies are frail. Self-reliance may take them only so far.

The drug problem rages on. Fentanyl seems to be mixed into everything on the street, creating staggering numbers of overdoses. On top of all this, a form of perverse gentrification has taken hold that’s peculiar to this birthplace of the opioid epidemic. Legions of national drug treatment centers catering to the addicts have moved to the region—sopping up cheap real estate and pricing lower-income buyers and start-ups out of the market.

But at this point, that seems like a minor, mostly surmountable hurdle, at least to the people here who have stopped waiting for outsiders—coal companies, big-box retailers, Frankfort, Washington—to save them. 

A dilapidated building abuts a newly turfed field in Hazard.

That is definitely the way Stephanie Callahan, in Hazard, sees things.

Now in her early forties, Callahan, like Mandi Fugate Sheffel, was part of the generation consumed by Oxy. She got clean when she had a baby—this was 15 years ago—and built a career as a showroom saleswoman at a local furniture company. But she yearned to do something on her own. 

She loved fashion. For two years, she had been running a side hustle out of her bedroom, selling plus-size clothes. She hated that she had to go to Lexington every time she needed a new top or skirt.

So, in the summer of 2021, Callahan quit her full-time job and rented a space in downtown Hazard that had once been a gym. Her father said she’d lost her mind, opening a women’s clothing store during Covid. She did it anyway, calling it Hot Mess Express, which is what her mother and friends often called her.

She showed them: in her first two years, Callahan had 2,000 repeat customers. She now has nine part-time employees and will soon open a men’s store. 

“When somebody gets clean, they want to change the world,” Stephanie Callahan, a former addict and current business owner in Hazard, said of the town’s new can-do spirit. “You do something just to prove you can do it.”

It wasn’t just about the clothes. It was about people in Hazard, like so many towns, trying to find their way back to each other. 

“When I was growing up, we had arcades, movie theaters, mom-and-pop restaurants,” Callahan said. Now, “there’s no place for people to go talk to each other.” 

So, she put a brown leather couch, almost as an afterthought, in the middle of the store, intending it for men accompanying their wives and girlfriends to sit and scroll through their phones or read a magazine—kill time. Instead, it became the focal point of the store, and it made Hot Mess Express a community hangout as well as a women’s boutique. A little place, or nook, where people would say hi, catch up, laugh, hug, gossip. 

“It’s comfortable,” Callahan told me, referring to the couch. “I have a photo of the mayor asleep on it.”

Sam Quinones is the author of four books, including his latest, The Least of Us: True Tales of America and Hope in the Time of Fentanyl and Meth. You can follow him on X at @samquinones7.

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