Hillbilly Enemy: How JD Vance Abandoned Ohio

Photo via the Wisconsin Examiner

***

In June of 2016, current United States Vice President JD Vance was catapulted into the public eye by his memoir, “Hillbilly Elegy.” In the book, Vance reflects on his upbringing in Middletown, Ohio, a small town 45 minutes north of Cincinnati infamous for rampant addiction and a poverty rate almost double the national average. Vance recalls the struggles of his childhood friends and family, especially those of his mother, who was addicted to heroin and OxyContin for most of his life. 

Since the 1990s, the opioid epidemic has destroyed lives and families across America, especially for lower-income white people in the Midwest. Opioid overdoses have been responsible for nearly one million deaths in the past three decades, and despite decreasing fatalities in the last five years, the number of annual opioid overdose deaths remains more than six times higher than it was in 1999. Synthetic opioids kill roughly 200 Americans each day. The epidemic originated with the overprescription of drugs for pain, such as OxyContin or Percocet. This can be attributed to false advertising and manipulation by pharmaceutical companies, which intentionally misconstrued the addictiveness and danger of their drugs. In the 2010s, heroin swept through the streets, and now fentanyl is responsible for many overdose deaths. Lower-income whites are the most vulnerable population. Ohio is one of the most hard-hit states with the second-highest drug overdose rate in the U.S.; it has lost an estimated one million years of life in the last decade as a result of the epidemic. 

In “Hillbilly Elegy,” Vance graphically illustrates the devastating effects of opioids, and is resolved to provide solutions. His sympathetic narrative served as the foundation of his political career, which began with his 2021 campaign for senate. By then, he was nationally recognized for “Hillbilly Elegy”—which had been adapted into a movie in 2020—but not much else. Some, but not many, knew him for Our Ohio Renewal, a non-profit he founded in 2017 dedicated to issues of opioid addiction, joblessness, and broken families in Ohio. The organization crumbled within two years, which many attribute to Vance’s gross mismanagement and ulterior motives. Many have accused Vance of only founding Our Ohio Renewal in the first place as a stepping stone toward a career in politics. The organization’s single notable accomplishment was sending an addiction specialist, Dr. Sally Satel, to Ohio’s Appalachian region for a year-long residency program. However, once it was publicly uncovered that Satel received regular, significant financial support from Purdue Pharma, the producer of Oxycontin, Vance cut ties and the program floundered.

Protesters at the Republican National Convention (2024). Photo via SURJ.

Prior to his senate campaign—during the era of Our Ohio Renewal—Vance had a reputation for moderate conservatism. His memoir was tinged with typical Republican talking points: claims that social welfare made people lazy, and calling for a return to traditional family values. Still, he had publicly spoken out against U.S. President Donald Trump in the early years of his first presidential term, and generally presented himself as middle-of-the-road. Soon thereafter, however, his political platform and rhetoric began sliding further and further rightward, and his mistrust of Trump gave way to overt reverence. By the time his Senate campaign was in full swing, Vance was in the pockets of the corporate elite and took a hard Trump line on all notable political talking points, including addiction. Vance blamed immigrants for the opioid epidemic, calling for the building of a wall at the southern U.S. border, and criticized former President Joseph Biden’s social welfare policies. 

When Vance was selected as Trump’s running mate in 2024, opioids immediately took center stage in his VP campaign. Vance was chosen as a strategic appeal to the Midwest, a region that wanted above all to hear from their government that something was going to be done about the drug-induced cloud of death hanging over them. At the 2024 Republican National Convention, Vance declared, “Our movement is about single moms like mine who struggled with money and addiction but never gave up.” The next month at rallies across the Midwest, he called for drug dealers to face the death penalty, and claimed that he and Trump would close U.S. borders to “stop the drugs.”

Anti-addiction experts from Ohio, working for health organizations such as Harm Reduction Ohio and Project DAWN, have expressed concerns that they “don’t think [Vance] has a good understanding of what needs to be done.” They feel that, instead of reducing the crisis, “his policies—increasing the drug war and prison sentences and arrests—do the opposite.” In the months since Trump was elected, the scope of the national emergency presented by opioids has increased, but it is unclear what policy will be put in place to meaningfully save lives. 

Vance’s policies as a senator had little effect on the opioid crisis, and, as vice president, he has been more concerned with posting on social media about Ukraine than he has been with addressing his hometown. Trump and Vance present the epidemic as a crisis of national security, paying little attention to the healthcare, financial, and well-being needs of the people impacted. This aligns with the highly-individualized political narrative that Vance has purported since “Hillbilly Elegy.” Vance, to a degree, recognizes the genetic, socioeconomic, and environmental factors that can lead one to addiction, but he presents the solution as reliant on personal strength of character. He doesn’t believe in “safety nets” or “big government,” and most of his anecdotal evidence regards stories of people who either overcame or succumbed to addiction as a result of their individual choices. 

If that were truly how addiction worked, then perhaps exclusively targeting foreign drug producers would be enough. Unfortunately, more needs to be done. Programs are needed at an individual level to help support addicts and their families through sobriety, rehabilitation, and social reintegration. Many such programs already exist for low-income communities—addiction therapy, in/outpatient rehab, medical withdrawal procedures—and are covered by Medicaid. However, their resources are spread thin as is, and they do not get at the underlying social structures that lead low-income communities to addiction in the first place. Programs such as job training, legal advice, and poverty-reduction initiatives are what Ohio and Appalachia really need. But they seem unlikely to be enacted under the current administration. With the enormous federal budget cuts of late (recently commanding that $880 million be cut from Medicaid spending) it is unclear what will happen to the scant support already in place, much less hypotheticals to augment them. 

Others from Vance’s hometown, with similar upbringings to his own, have spoken out against his policies. They do not agree that social welfare makes people worse off, and many, in fact, have indicated that their life was significantly changed for the better by public support. Many Appalachians and white, low-income Ohioans feel humiliated by their portrayal in “Hillbilly Elegy.” They reject his “pull yourself up by your bootstraps” message, as well as the implication that Appalachia is poor not because of systemic inequalities, but because of the lazy, ignorant, immoral people who live there. Vance’s own hometown refused to celebrate when he was nominated and elected vice president. 

Vice President JD Vance is a man who undoubtedly has overcome a great deal of struggle in his life. I do not doubt that his convictions are true, and that he genuinely cares about the opioid crisis in Ohio. However, he is nevertheless blinded by his political career, and he has used the victims of the epidemic from his hometown—including his own mother—as pawns in a larger political scheme. Vance presents addiction in the same way that he presents all the problems facing Middletown: individual moral failings that can be fixed through hard work and grit. He refuses to address the institutional roots of the opioid epidemic, and he is (and has been) thus ineffective at fixing it. Tightening security at the southern border, increasing sentences for drug dealers, and ramping up the drug war will not fix Appalachia. And an American will die from an opioid overdose every five minutes until our politicians finally start to figure that out.