By  for The Guardian. Karen Jennings patted her heavily made up face, put on a sardonic smile and said she thought she looked good after all she’d been through.

“I was an alcoholic first. I got drunk and fell in the creek and broke my back. Then I got hooked on the painkillers,” the 59-year-old grandmother said.

Over the years, Jennings’ back healed but her addiction to powerful opioids remained. After the prescriptions dried up, she was drawn to the underground drug trade that defines eastern Kentucky today as coal, oil and timber once did.

Jennings spoke with startling frankness about her part in a plague gripping the isolated, fading towns dotting this part of Appalachia. Frontier communities steeped in the myth of self-reliance are now blighted by addiction to opioids – “hillbilly heroin” to those who use them. It’s a dependency bound up with economic despair and financed in part by the same welfare system that is staving off economic collapse across much of eastern Kentucky. It’s a crisis that crosses generations.

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