Middletown, Ohio – The speech was JD Vance's opportunity to introduce himself to a national audience.
Vance, a rookie senator from Ohio, had just 18 months of experience in Congress when Republican presidential nominee Donald Trump chose him to be his 2024 running mate.
It was a Monday in July when Vance’s election was announced. That Wednesday, Vance was on stage at the Republican National Convention, preparing to address voters across America.
What she decided to share was a glimpse into her family's history with opioid addiction.
“Our movement is for single mothers like mine, who struggled with money and addiction, but never gave up. I’m proud to say that tonight my mother is here, 10 years clean and sober. I love you, Mom,” he said, as his mother, Bev Vance, blew him a kiss from the crowd.
The crowd erupted in chants of “JD’s mom! JD’s mom!” Vance has since made tackling the opioid crisis a mainstay of his campaign appearances.
This month, at a rally in Byron Center, Michigan, he outlined a vision in which he and Trump would close U.S. borders to “stop drugs.” Then, a few days later, in Kenosha, Wisconsin, he called for the death penalty for drug traffickers.
But in Vance’s home state of Ohio, addiction experts and advocates say they have yet to hear any policy proposals in this year’s presidential race that adequately address the complex nature of the opioid crisis.
Jackie Phillips Carter, health commissioner for Vance's hometown of Middletown, said neither Democrats nor Republicans have proposed viable solutions.
“There are so many obstacles and blockages,” he said, “that I don’t think anyone is serious about addressing the issue.”
Barriers to access
When attorney Dennis Cauchon reflects on the obstacles to addressing the opioid crisis, he thinks of his colleague Dylan Stanley.
Cauchon is president of Harm Reduction Ohio, a drug-fighting nonprofit based east of the state capital, Columbus. In 2018, he hired Stanley to lead community outreach.
He excelled in his role and Cauchon credits him with saving countless lives.
“Dylan was one of our first and best naloxone distributors,” Cauchon said, referring to the nasal spray used to reverse the effects of an opioid overdose.
But Stanley herself struggled with addiction and relied on methadone to treat her opioid use disorder.
But to get the medication, he had to take a bus across Columbus: Only certified treatment programs can dispense the drug, which is strictly regulated. And when he did arrive, there was always a line out the door.
Four years ago, Stanley died of a probable drug overdose at age 30, Cauchon said. He left behind a 2-year-old daughter, Ruby.
While Cauchon said he respects Vance's personal story, he feels the Republican's tough proposals are unlikely to make a difference when it comes to helping those struggling with addiction, like Stanley.
“I don't think he really understands what needs to be done. There are a lot of people who have good intentions but do the opposite of what should be done because it is a complex issue,” said Cauchon.
“His policies — escalating the war on drugs, prison sentences and arrests — have the opposite effect. I don’t think that’s his intention, but I do think that’s the result.”
A chronicle of decadence
Since the mid-2010s, Ohio has consistently had one of the highest rates of overdose deaths in the country.
While the death toll has declined significantly in recent years, the state still averages 45.6 deaths per 100,000 people, the 10th highest rate in the country.
The crisis hit Middletown, Vance’s hometown, particularly hard. In the five years between 2017 and 2022, Middletown’s Butler County had one of the highest rates of overdose deaths in the state.
Vance captured the crisis in his bestselling autobiography Hillbilly Elegy, in which he painted a portrait of Middletown as a decaying Rust Belt town, filled with shuttered stores and crumbling parks.
She also told the story of her mother's problems with heroin and OxyContin, a prescription opioid.
The book's publication in 2016 propelled Vance to national stardom, and that same year he founded Our Ohio Renewal, a nonprofit created to “combat Ohio's opioid epidemic.”
Vance explained that the organization's goal was to help “the grandparents, aunts and uncles who were caring for many of the children who had been orphaned by the epidemic.”
She even lobbied the state legislature to support “caregivers” who help family members affected by opioid addiction.
But in 2021, Our Ohio Renewal closed. It had faced criticism for hiring an addiction specialist with ties to Purdue Pharma, a now-bankrupt pharmaceutical company accused of aggressively promoting highly addictive opioids like OxyContin to consumers.
And experts who spoke to Al Jazeera questioned whether the nonprofit was of much help.
“He really didn’t do anything. I deal with this issue every day across the state and we had no contact with him,” Cauchon said. “He didn’t do any good, but he didn’t do any harm either.”
Feeding stereotypes?
But some critics argue that Vance's depiction of the region actually caused harm by fueling stereotypes about the root causes of addiction.
In Hillbilly Elegy, for example, Vance attributes the creation of the situation in Middletown to a “culture in crisis.”
“You can walk around a city where 30 percent of young people work less than twenty hours a week and not find a single person conscious of his or her own laziness,” Vance writes.
Scotty Robertson, a Middletown pastor who grew up in the Appalachian coalfields of West Virginia, found Vance's airing of his family's addiction problems problematic for several reasons.
The book, Robertson explained, allowed Vance to present himself as a model of success, while those around him were often described as uneducated and drug addicts.
“I think the context in which the story is told actually reinforces the stereotype, in light of how he uses history to aggrandize himself,” she said.
Robertson believes Vance's current political stance is another reflection of those stereotypes.
Vance, for example, has opposed “housing first” policies that would provide housing for those facing homelessness, fearing they would introduce “people with serious drug problems” into communities.
“It is a political agenda that dehumanizes,” Robertson said. “If [his] “If the story was told to help Vance achieve the right results, then I think the story could have been used for humanizing purposes.”
Middletown Health Commissioner Phillips Carter also believes part of the difficulty in addressing addiction lies in breaking down stereotypes about who is vulnerable. She wants the public to understand that those struggling with addiction are just regular people.
“The biggest challenge now is always to incorporate the human component,” he said. “Often the biggest challenge is trying to bring humanity and education about the fact that addiction is a disease.”
Changing course
There are also significant barriers to obtaining treatment for addiction and related illnesses, Phillips Carter added.
“It’s very difficult to get mental health treatment,” she explained. “There is insurance, but there is also red tape. People can’t go to multiple programs. Sometimes women can’t get treatment where men go. Sometimes a family loses their children if they… [a parent] “Get into treatment.”
But she and other experts believe there is reason for hope. Overdose deaths in Ohio are down 34 percent so far in 2024, compared with the same period last year.
Nationwide, deaths declined in 2023 for the first time in five years. New federal regulations easing restrictions on methadone were also announced in April.
Ohio itself invests nearly $100 million annually in prevention, harm reduction, treatment and recovery responses.
Cauchon, president of Harm Reduction Ohio, credits local and state leaders, such as Gov. Mike DeWine, for working across party lines to reduce the death toll.
“Is the response all it could be?” asked Cauchon. “No, but it is much better than it was five or ten years ago.”
