Their leader, Robert Gipe, smiled as he drove the un-airconditioned vehicle over Black Mountain, hoping to pry open a few more hearts. In addition to two illustrated novels, Gipe has produced seven plays set against the backdrop of opioid addiction and declining coal. In all his work, he tackles difficult topics like family dysfunction, poverty, and drug abuse, and yet he somehow manages to keep trudging through it to flat-out create. For more than two decades, he has helped Appalachia frame its woes, making art out of near-unimaginable suffering and earning accolades from thought leaders and big-time funders alike. His art is both homespun and cutting-edge, a call to grieve and to foster positive change. 

He and his troupe of actors, a volunteer collective called Higher Ground, were heading to Wise to perform Needlework, Gipe’s latest and most serious play. This particular showing came at the request of the region’s progressive health-department director, Dr. Sue Cantrell, who’d recently pulled off a coup: She had convinced local police and politicians to sign off on the opening of a needle exchange in Wise—a health-department first in the entire state of Virginia. 

Cantrell hoped that this showing of Needlework, sponsored via federal public-health education grants, would soften attitudes in her community about harm reduction, even as she understood that detractors likely wouldn’t come to the play. Local law enforcement—some of whom were still opposed to the exchange—had just reported their first infant overdose: While crawling on the ground, an eleven-month-old girl found an opioid pill, and it took three doses of Narcan to bring her back. Hepatitis C rates in the region were now five times higher than the state’s rate, seventeen times higher for cases of acute hepatitis B. And now even several nondrug users in the community had contracted hepatitis after using an infected family member’s razor or toothbrush. 

“It’s the only thing we haven’t tried yet to curtail the rates of infection,” Cantrell said to the group gathered to watch the play, referring to the syringe exchange but also to the possibility of changing attitudes through live performance. 

It sounded like she was hoping Gipe could break through the literary fourth wall and actually turn some of the problems of his home region around. She, too, had been a fan of Higher Ground since its inception. Gipe’s brother has pastored at her church. 

I first devoured Robert Gipe’s books and plays because I wanted to understand Appalachia. I was searching for deeper insights than the victim-blaming bootstrap narrative espoused in J. D. Vance’s best-selling book, Hillbilly Elegy—and where else but one of Gipe’s plays would you see convicted felons on a stage, acting right beside probation officers, teachers, and recovery coaches, all of them already bonded in their mutual need to talk about the hard problems around them? 

After spending two and a half years immersed in researching and writing my own book on the opioid crisis, focused on its origins in Appalachia and catastrophic spread across the country, I hoped Gipe could help me process my own secondary trauma. Appalachia has witnessed so much pain and premature death that the public defender’s office in Harlan County talks informally about erecting a memorial wall. A school board member told me she worries about the growing number of “homeschooled” kids who are actually kept out of school in order to move product for their drug-dealing parents—or so teachers won’t smell methamphetamine on their clothes and turn their parents in. In Harlan County, once the site of intense mineworker strikes, the population has dropped from seventy-five thousand to twenty-seven thousand since 1940, with nearly a third of residents now living in poverty and more than a quarter of working-age adults on disability. 

Visiting rural Ohio recently to see family and to give a graduation speech at my alma mater, I was struck by some of the parallels I witnessed in the farm towns that had once seemed idyllic to me: shuttered storefronts, drug-dealer roundups on my old newspaper’s front page, and worries voiced by a high-school buddy (now a cop) who’d inadvertently stuck his hand with a needle while arresting a drug user/dealer who later admitted he had hepatitis C. I took my young nephews out for chili dogs and then suggested we walk across the street to the town park afterward rather than drive. “Aunt Beth, I don’t want to step on heroin needles,” the eleven-year-old said. 

I leaned on Gipe’s counsel for the same reason that many people in Harlan County seek him out: I was looking for a little hope, a spurt of laughter, and a dose of the deep understanding he has for the people he lives among. Gipe, fifty-five, remains beloved in Harlan, even as his star continues to rise, because he remains relatable. Most every day, he wears a black t-shirt with a pocket on the chest, the kind you buy at Walmart in packs of six. Into the neck of said shirt he clips a black Pilot Precise pen (extra fine). He drives to work in a sedan pre-owned by his late mother, after carrying his six-foot-five frame down the sixty-nine stairs that descend from his hillside home overlooking the town. In a downtown pizza restaurant, there’s a waitress with an arm tattoo from his 2015 illustrated novel, Trampoline, featuring its heroine Dawn Jewell and this voice balloon: “The mountains seemed empty, but I knew they weren’t.” 

Dawn Jewell is Gipe’s vehicle for voicing the problems of rural America, especially of its younger generation, people who have never known a world without weekly drug busts and talk of the so-called Cadillac High (an OxyContin paired with a Xanax). A plucky young woman who wears black fingernail polish and listens to Black Flag, Dawn Jewell is torn about whether to save herself by fleeing or to remain on the mountain with her dysfunctional family, including her opioid-addicted mother and a Mamaw who means everything to her. She falls down mountains, gets drunk in the snow, busts her brother Albert’s jaw with her high-school French book, and falls in love with the voice of a DJ from the next town over whose “voice was soft, like the sound a Christmas tree makes when you throw it over the hill.” In Gipe’s 2018 sequel, Weedeater, Dawn Jewell is four years older and a wife and mother. Though she now lives in a quiet trailer park in a slightly kinder and milder landscape outside of Kingsport, Tennessee, she can’t escape her people—including her brother, who tracks her down at her copy-shop job. 

“How’d you know where I was at?” 

Albert’s rat eyes twinkled like gas in a mower can. He said, “Hug?” 

To fuel him in the morning, Gipe drinks iced espresso with tonic water, partly because he likes the way it tastes and partly because, well, he’s sleepy. The first time I interviewed him on the phone, back in 2016, we compared notes on insomnia. “I’m up worrying . . . so you don’t have to,” he said, half-joking. Among the subjects occupying him at 3 A.M. are, in no particular order: funding cutbacks at Southeast Kentucky Community and Technical College, where he has directed the Appalachian Program since 1997; the rapid dismantling of the public sector everywhere (thanks, Koch brothers); and the assorted details involved in helping a community recover from three generations of trauma. 

By the time we met in person this year, I felt like I knew him better than I probably did. We were sitting on his hilltop front porch, with its treehouse view, chuckling about the fact that, earlier in our careers, we had both had stories rejected by the Oxford American, but now here we were. 

Gipe’s plays are built on real-life stories that his Appalachian Studies students and members of the community have been collecting, in oral-history form, for more than fifteen years. Many of the students were raised by their grandparents—“if they were raised by anyone at all,” Gipe said. At least one was high on OxyContin when he interviewed his grandmother, then stole from her to fund his next fix on the way out her door. 

Gipe recalled Higher Ground, the troupe’s first play, from 2005, a musical whose show-stopping number at the end of the first act was a song called “Pain.” It featured zombielike patients singing in rounds as a bucket-brigade of cast members passed money toward a doctor, who was flinging prescriptions around like confetti. At the time, a real-life local doctor had just been imprisoned for illegally prescribing OxyContin, and on opening night in nearby Cumberland, people in the audience were loudly whispering, “That’s Dr. Sawaf.” (Ali Sawaf was one of the first doctors in the region prosecuted for overprescribing.) In an edgy and not-so-subtle form of resistance, the actor portraying him also happened to be a doctor. “I was fully prepared for nobody to come back for the second act,” Gipe said, unclear at first whether the whisperers were angry at or aligned with the troupe. Not only did people return, but for one showing a cast member arranged for twenty women from a nearby rehab center to attend, and it became hard for the cast to concentrate because the women were weeping so loudly throughout the show. 

The Higher Ground collective (which fluctuates between forty and ninety actors, depending on the show) mines lighter events, too. Like the time a roadkill beaver made its way into the hands of a local biology teacher known for collecting plant and animal specimens for her classroom. The teacher—whose daughter, Elana Scopa Forson, is in the collective—called every taxidermist in Harlan County with a plea about the gifted beaver (“I got this big ole fat beaver I need stuffing”). The rodent was unusually plump and, for roadkill, remarkably undamaged. 

Today, the beaver sits left of center stage in Needlework, a point of comic relief. It perches there, illuminated and frozen on its mount, as the actors cycle on and off the stage. 

It perches as the plot crescendos to the same debate taking place in towns and cities across America: Is it morally correct to give away clean needles in exchange for used ones that might be harboring hepatitis C and HIV, both of which are dangerously on the rise because of America’s opioid crisis? Or, is that simply enabling illegal drug use?  

_N eedlework invites its Bible Belt audiences to chew upon the controversial concept of harm reduction—the idea that it’s okay to meet addicted people where they’re at by giving them clean syringes, offering disease testing, and referring them for treatment. That it’s okay to treat them like human beings with a disease and therefore worthy of medical care. 

Even when your strung-out dad has taken a cleaver to your dog. Even when your hopped-up-on-meth grown son has intentionally run your dog over in your driveway, on account of, “The damn thing wouldn’t get out of my way.” Even when you borrow your mom’s 
jacket, only to rest your hand in the pocket and jab a dirty needle into your finger. (True stories, all.) 

A needle exchange “ain’t going to solve the problem,” a character named Burley says to Betty, who is operating an underground syringe exchange from her porch, passing the needles off as “zucchini bread” hidden inside brown paper bags. “People who shoot up are to the point they don’t care if they have clean needles. For every one you help, there’s ten more that won’t take the time.” 

The actress who plays Burley should know. Her name is Mona Lisa Floyd, and here’s another true story from the files: She was one of those who shot up so much she didn’t care; who cycled in and out of prison for two decades; who fully expected to die one day with a needle stuck in her arm. 

Today she’s fifty-five years old and a probationer in the county’s Drug Court, and for the first time in decades, she’s doing legitimate work (in a coffee shop), performing community service (in the play and elsewhere), and training to be a peer-recovery coach. Her IV-drug-induced hepatitis C, which once turned her skin and eyes yellow and gave her chronic kidney disease, is cured. 

Floyd compared OxyContin’s arrival in her community in the mid-1990s to a tornado. “It gets in these mountains, and it just ricochets from mountain to mountain, and it doesn’t let up,” she told me in a phone interview a week before I saw Needlework. “My friends are all dead—car wrecks, overdoses. I’ve got twenty-five good friends that’s dead of drugs, and I know about fifty people in prison right now.” 

The cast has rallied behind Floyd’s recovery, giving her gas and motel money when she had to travel to northern Kentucky for peer-support specialist schooling. They cheered when they saw her making amends with her grown daughter, who no longer has to hide belongings from her, fearing she’ll steal and pawn them to buy drugs. Her actual probation officer plays guitar in the Americana band, Kudzu Killers, that accompanies most of the Higher Ground shows. 

I found myself rallying behind her, too, as she recounted her recovery, rare as hen’s teeth among the opioid-addicted. (Nationwide, only ten percent get any treatment at all, and that figure is likely lower in impoverished Harlan.) As of the trip to Wise in early June, it had been seventeen months since she last injected or sold drugs, nine months since she snorted meth or swallowed an illicit pain pill. 

I had first phoned Gipe not so much to interview him as to ask for guidance on my own forthcoming book, Dopesick, which tracks the progression of the opioid epidemic as it landed in three kinds of communities— what first arrived with OxyContin in distressed rural communities then morphed to a heroin/fentanyl epidemic in cities and suburbs and, more recently, spread to farm towns like where I grew up. 

My book focuses on the families and first responders who are fighting back, I told him, because that was the only way I could stay (sort of) sane while immersed in such grim material. I told him about an author-friend who had quoted Mister Rogers, advising me to “look for the helpers.” I told him about a journalist-friend who reports on the epidemic from Boston, telling me, “You might need to make it seem more hopeful than it actually is,” both for my own sanity and to help the public stomach what many were unprepared to see. 

Among the Central Appalachian heroes featured in my book are a feisty drug-counselor nun and a country doctor working just across the mountain from Gipe in Lee County, Virginia. Both had repeatedly challenged Purdue Pharma to reformulate its drug as early as 2000—in person and via letter— warning about the dangers of unleashing a nationwide epidemic. 

“The extent and prevalence of the problem is hard to overemphasize,” Dr. Art Van Zee wrote in one early letter. “My fear is that these are sentinel areas, just as San Francisco and New York were in the early years of HIV.” 

Though “hillbilly heroin” was only beginning to make national news nearly two decades ago, Van Zee was already seeing some late-stage effects in the form of more patients with injection-related abscesses and hepatitis C; in the form of people selling everything they owned, from their farms to their bodies, to get their hands on yet more pills. More than once he’d been called out at night to tend to the overdose of a teenager he’d immunized as a baby. 

Van Zee’s work grew to focus on treating addiction and its accompanying diseases. At the same time, Gipe was trying to help people process the epidemic by calling upon their own storytelling tradition. The goal was to “fly beneath the radar of the power structure . . . not just gathering stories, but gathering people together,” Gipe told the Italian ethnographer Alessandro Portelli, whose acclaimed decades-long account They Say in Harlan County: An Oral History praised the Higher Ground collective for helping the region reclaim its culture and even heal its collective soul. 

Gipe wasn’t sure about all that. “Portelli thought that Higher Ground was going to save us,” he said. But onstage and off, the progress has come in baby steps. 

“It’s okay to villainize big pharma, but I’ve spent so much time just trying to help people go on living and to figure out some way to give life meaning and move forward and find community without being angry,” he told me in 2017. 

The name “Higher Ground” was meant to metaphorically link the memories of community elders who’d survived floods unleashed by clear-cutting and mining disasters to the more recent challenge of surviving the flood of pills unleashed by big pharma. Floods also were the rare occasions when people ignored divisions of race, class, and politics because a flood wasn’t a problem people solved alone; they had to count on their neighbors and on government support. 

So it went with the aftermath of OxyContin, Gipe’s work argued, as the plays and, later, his novels, focused on young Appalachians struggling to voice their anger about their relatives mired in addiction. Struggling to see their dad as a person with a disease rather than the asshole who killed their dog in a drug-fueled rage. Struggling to decide whether to stay in the region or flee. 

The work is bighearted without being treacly, respectful yet honest and raw. And it is thoroughly grounded in the people and mountains of Harlan County, where Gipe has lived for more than two decades. Gipe isn’t interested in marketing himself as the anti–J. D. Vance, probably to his publisher’s chagrin. “I’m doing this because I’m doing it, and I always have,” he told me. 

Historian Elizabeth Catte says that, unlike Vance’s, Gipe’s work defies stereotype because it has percolated organically and from the ground level up: Cast members were initially recruited from neighborhood youth centers, churches, and local festivals with names like Poke Sallet and the Kingdom Come Swappin’ Meetin’ Festival. “I often struggle in my work to articulate the space where you both love the place you’re from, and you hate the place you’re from,” said the Tennessee-reared Catte, whose book, What You Are Getting Wrong About Appalachia, was published recently as a fierce rebuke to Hillbilly Elegy. “Robert’s plays help people access these deep feelings they have about their issues but in a way that allows them to connect with other people and build community.” 

Because the actors have contributed their own stories and interviews—and most of the plays have been written in teams, with Gipe at the helm—participants have some control over their narratives. “Ideas about consent and agency are huge when you’re talking about vulnerable communities,” Catte explained. “So it’s a great model for talking about the problems of our region without that added layer of voyeurism” sometimes exhibited by national writers and photographers parachuting in for projects that border on poverty porn—including Vance, according to many people I interviewed from Central Appalachia who ranted: “He’s from Ohio! He isn’t even a real hillbilly!” 

A native Ohioan myself, I have now spent more than half my life living along the edge of Appalachia in Virginia, working for the Roanoke Times for twenty-five years before quitting to write books in 2014. But I grew up in a small town, in a family that had known poverty and addiction for generations, one reason I have always gravitated toward stories of outsiders and underdogs, whether it’s the dislocated factory workers who people my first book, Factory Man, and who reminded me of my resilient mom; or the opioid-addicted in Dopesick, whose struggles and inability to work reminded me of my alcoholic dad. 

And yet I was reminded time and again as I traveled to report this book that, like Vance, I was also not quite a real hillbilly. One Kentucky-born activist warned me angrily not to fall into the same trap as Vance, whom she believes blamed poor Appalachians for their problems instead of the rapacious mining and pharmaceutical corporations that had set them up for failure time and again. If I used the word “pillbilly” one time in my book, she told me, she would never speak to me again. 

When I told Gipe about our exchange, he chuckled knowingly, and said, “Right,” stretching the word into at least two syllables. 

Gipe grew up doodling and writing stories in Kingsport, Tennessee, with a father who supervised workers in an Eastman Kodak warehouse, and a mother who worked as a nurse. His luck was above average, in other words, and he went to Wake Forest University partially on a National Merit Scholarship. His brother, Will, is a Presbyterian minister near Charlotte, and his nephew, Will Jr., is a video coordinator for the basketball team at the University of Richmond who would love to return to his hometown of Wise if only he and his wife could find equivalent-paying jobs. The Gipe men all play basketball, and they’re all duck-your-head-under-the-doorway tall. A tight-knit bunch, they’ve grown even tighter in the wake of the matriarch’s death and Robert’s divorce. 

“My uncle, he’s the people’s champ,” Will Gipe Jr. says. “Every time I go to Harlan, I feel like there’s all these people leaning on him and wanting his advice or time.” 

Robert Gipe wrote recently about the dissonance of being an educated, middle-class person making art in one of America’s poorest towns: “I grew up with only a few things going wrong and most things going right for most people I know. It’s easier when fewer things go wrong in your life to think you’re smart or better than the people who are always in the soup. 

“But you’re not. You’re just luckier.” 

If the plays are his vocation, the books, with their sad and funny (but mostly sad) drawings, are his release—the one thing that he alone controls. Making art out of that long-ago student who talked Gipe into driving to the bank and taking $700 out of his account so the kid could fix his car. Or the people hitching rides who sometimes make him late for work. (“You’re just a white man with a car and a conscience,” a hitchhiker cautioned him once.) 

The illustrations are a nod to his dad, a consummate talker and storyteller who, when he really wanted to get his sons’ attention, would implore them: “Look at me.” There’s a drawing on almost every page of Gipe’s books, a cartoon wherein the main character looks directly at the reader to emphasize his or her point. 

Many are comically cynical, such as when Dawn Jewell hears about her aunt directing a community college art project designed to preserve Appalachian culture, all ripped straight from Gipe’s day job. With her hair and glasses askew, Dawn Jewell harrumphs directly to the reader: “I don’t think it does ANYTHING.” (Like Gipe, Dawn is delightfully subversive. “Boo the fuck hoo,” she says in Trampoline.) 

Gipe tries not to take himself too seriously, but clearly many influential people do. The Smithsonian featured the Higher Ground troupe as part of its 2016–17 exhibition “By the People.” He’s brought in more than $5 million in grants for the plays and other community development projects, with funders ranging from the Rockefeller and Annenberg foundations to the Appalachian Regional Commission (ARC). A 2002 Rockefeller grant funded the first Higher Ground play as well as other public art projects, including a series of tile-mosaic sculptures spread throughout Harlan County to celebrate the region’s diverse history. The one in Cumberland features a local woman who wrote letters for illiterate immigrant miners in the 1920s to send back to their families in Italy and Hungary—another true story originating with local oral histories. “She wrote my wife in Italy telling her to come to Harlan County,” one totem says in colorful, hand-shaped tiles. On another side of the sculpture, next to the tiled image of a miner carrying his lunch pail: “Many a time she sewed twenty-dollar bills in the hem of a pair of overalls for a miner to mail overseas.” 

With his decade-long track record of framing the problems of Appalachia, Gipe is now being drafted to fix them with a $596,000 workforce development grant from ARC. It will culminate in the renovation of downtown buildings in three Harlan County communities but was plotted by Gipe with the overarching goal of addressing the region’s workforce challenges in the areas of design (via a community mural-making project), hospitality (“’cause a lot of people that work as servers here do not appear to have eaten at a restaurant”), and construction. In a region that hasn’t seen commercial development in decades, the buildings will be renovated by presently unemployed or underemployed local roofers and construction workers who will be paid training wages. 

The day after the play in Wise, Gipe and I drove around the county and toured the abandoned buildings, which he envisions as combination community centers, arts venues, and small-business incubators. Standing in the middle of a long-ago vacated Belk department store in downtown Harlan, under a leaky roof, Gipe broke from his wry, even demeanor to deliver a rant about a vacant lot near the Belk building he had envisioned as a mural-covered courtyard, accessible to the future Belk-turned-community center. But the lot’s owner wouldn’t budge, even though Gipe raised and offered $7,000 more than what the property was assessed at. “I spent a lot of my spring futilely trying to acquire this fucking vacant lot,” he said, pointing to the scrubby plot of grass between two brick buildings, with creeping ivy and weeds— which is, incidentally, the background for his author photos. 

“I call that the Five Families Phenomenon,” I told him. I saw it play out in Factory Man in places like Bassett and Martinsville, Virginia, towns once humming with factories that refused to adapt to a new economy because the handful of families that had always held sway over the communities refused to give up the reins. 

“Right,” comes his two-syllable verbal nod. “When you look at any other town that’s rebounded from the ashes, they’ve all done it by somebody saying, ‘I’m gonna sacrifice so we can grow.’ That’s what we’re fighting; it’s the same thing.” 

Gipe has a lot of cred in Harlan, so the notion of a creative solution for the vacant lot isn’t a lost cause—yet—particularly since all his projects are collaborative, with input from community leaders, local stakeholders, creative placemaking experts, and the college. Higher Ground actors are active in the redevelopment project, too, including Elana Scopa Forson, who plays the main character in Needlework—the one operating the underground needle exchange. 

On months when they’re not performing, the troupe meets for a potluck to coordinate the work, goof around, brainstorm roadblocks, or just to vent. “It feels like we’re doing something,” said Scopa Forson, also a professor at the college. “It feels better than just sitting around doing nothing.” 

Oddly enough, the mood before the Wise showing of Needlework felt almost celebratory. In the hallway of the theater at the University of Virginia’s College at Wise, activists, social workers, and Higher Ground fans mingled with health-department workers who handed out information about infection rates and the town’s soon-to-open syringe exchange. “It’s just the hardest of the hardest subjects that we live with here,” said Sharman Chapman- Crane, who’d driven over the mountain from Eolia, Kentucky, and had seen all but one of Gipe’s plays. Her local newspaper runs a readers’ column made up of anonymous calls, and she could tell from that alone that there was still a lot of work to do around harm-reduction attitudes. “If we’re gonna do a needle exchange for addicts, then diabetics should get free needles, too,” went the critics’ most common refrain. 

The troupe was definitely about to preach to the converted. That was especially clear near the end of Needlework, when an IV drug user named Velda is dying of her hepatitis C infection—even though she had gone one hundred and ninety-one days without doing drugs. 

“I don’t blame her daughter for hating her,” says Velma, the dying woman’s sister. 

“But I don’t hate her,” the daughter responds. “If all I can do is make sure she is healthy enough to make it to a point where she wants to change for herself, then I’m going to do it. I hated the situation and I suffered for her choices, but I don’t hate her.” It’s a classic harm-reduction response. 

By that moment in the hour-long play, there was barely a dry eye in the audience or on the stage—for both the characters in the play and the people playing them. Velma, the naysaying sister, is sobbing by the end of the scene, and it’s unclear whether the woman playing her is acting or whether she’s thinking about her overflowing caseload in the Harlan County public defender’s office, all of it dominated by opioid-related crime and, increasingly, meth. You can see the pain in her face as Betty, the underground syringe operator, is arrested at the play’s end and a cast member breaks the fourth wall to ask the audience: “What do you think SHOULD happen?” Should Betty go to jail, or should the county officially adopt Betty’s policy of providing clean syringes to users? 

The play, initially commissioned by a group called United for Substance Abuse Prevention in nearby Letcher County, Kentucky, has informed localities and police departments wrestling with the question of syringe programs, with Wise and the Kentucky towns of Pikeville and Whitesburg agreeing to syringe exchange, joining some forty-five other communities in Kentucky. The play also traveled to Louisa, Kentucky, two weeks after that community’s county officials declined to fund such a project. “They couldn’t get past the enabling aspect of it,” said Matt Brown, a Louisa city council member who runs recovery treatment centers in the state (and is pro–syringe exchange). 

The enabling argument echoed what a police chief said in May when he put the brakes on a similar project in Roanoke, Virginia, the mid-sized city where I live, and what the police officer in Wise who’d revived the overdosed baby with Narcan told me: “I just don’t think it’s right to give them more needles when they’re already all over the place, littering all our roads.” 

Though he said he would do what he was told, the Wise officer didn’t believe it was right to open a syringe exchange in his town; he didn’t foresee it helping that little baby who might grow up to get stuck by one of those dirty needles. (Users trade in their dirty needles for clean in a one-to-one exchange.) 

It wasn’t my place to convince the officer to think about all the disease-harboring needles he sees strewn along the roadside, or to tell him about my nephew being afraid to walk to his town park, or my cop buddy who’s now spent a stressful year undergoing periodic testing for hepatitis C. Or my friend in Roanoke whose kids recently stumbled upon three used needles while walking to school. But in time, I hope, law enforcement officials will come to see the public-protection benefits of syringe exchange. 

“There are steps to accepting it, like the stages of grief,” Gipe told me in 2016. “You have to get people to a place of generosity, where they can see the larger good beyond what this might mean for an individual addict.” 

Back then, he was still assembling what he calls “story circles,” where participants shared stories about needles that would later be folded into the play. He saw a parallel between the harm-reduction movement and the mountaintop-removal activism he spent years working on with a citizens’ group, culminating in the protection of the top seven hundred feet of Black Mountain from strip mining in 1998. “You’re up against a wall that you’ve either got to climb, tear down, or figure out a way around it.” 

Back then, Mona Lisa Floyd, the supporting actress in Needlework, was still shooting up meth and pain pills. She hadn’t yet befriended her fellow cast member Elana Scopa Forson, although she knew who she was. Not long ago Scopa Forson, a biology teacher just like her mom, installed a “blessing box” of free goods, from personal hygiene products to canned goods, in her front yard because she knew that all around the place where she lived, on the outskirts of Cumberland, well over half of the children live below the poverty line. 

Scopa Forson and other cast members are increasingly taking leadership roles in Higher Ground as Gipe concentrates on the building projects and tries, with varying degrees of success, to step back. “I’m ready for my Obi Wan role,” he said. 

Admittedly tired, he was cagey when I asked whether he foresaw leaving Harlan, possibly to live near his activist girlfriend, Amelia Kirby, currently working on her master’s degree in Richmond, Virginia. (She’s known for having co-owned a popular bar in Whitesburg where miners hang out alongside poets and where the region’s first-ever drag show was held.) 

Like the Nobel-winning short-story writer Alice Munro, who refuses to leave her small Canadian community, Gipe understands that small towns, even distressed ones, have something that trendy urban regions can’t claim: “When you live in a small town, you hear more things, about all sorts of people,” Munro told a Paris Review interviewer in 1994. 

When you live a big city and you’re among the lucky, your bubble insulates you, Munro suggested. And, in some ways, that also makes you more naive, and maybe even less protected, than you know. It’s hard to perceive social threats when you only mix with like-minded, like-incomed folk. That inability to see beyond one’s station helped fuel the opioid epidemic as it moved stealthily across all demographic borders, cloaked in denial, stigma, and shame. 

From our bubbles, we did not see the dead canary in the coal mine because we had not cared to look at it. We did not see that we had invited into our medicine cabinets—indeed, into almost every corner of our country—our own demise. 

But people in Harlan did. The actors on the Needlework stage had been processing addiction-related despair for two decades now. As one of them put it during the post-show talkback in Wise: “When we first started doing these plays in 2005, when prescription medication was very very rampant, neighbors had stopped talking to neighbors, and that is not an exaggeration. And it was killing our community. 

“We needed a format to talk about the pain, and this was it. This made it easier for people to talk again.” 

From Robert Gipe’s perch sixty-nine steps above Harlan, he sees the span of the town’s humanity—the dog-killers and the truant teens and the blessing boxes alike. The need is particularly visible here and therefore more worrying, he knows. 

But so is the grace. 

On the rattletrap bus to Wise, amid the clatter and the stuffed-beaver prop and the thighs sweating on plastic seats, Gipe heard Mona Lisa Floyd reciting another character’s lines from Needlework, and he knew in that moment that Higher Ground had converted her. 

“Feel that breeze?” she said, looking out the open window, repeating a line from the play’s last scene. They were passing by another former strip-mining site, not far from the runaway rock that killed the little boy. “That’s that cool breeze that comes up Sizemore Holler at the end of a summer day,” Floyd recited. “And when you feel that cool air, you feel like you can breathe for the first time all day long? You feel that, baby?” 

It was harm reduction in its purest form. 

Header Image: Untitled, ca. 1969, by Ralph Eugene Meatyard. The Estate of Ralph Eugene Meatyard courtesy Fraenkel Gallery, San Francisco