_In the parking lot of a decommissioned bank, at Parrish, Alabama’s new town hall, at the southernmost tip of Appalachia, sits Alabama’s only Narcan vending machine. Narcan is the brand name for naloxone nasal spray, a medication that can quickly reverse an opioid overdose. The vending machine that houses it looks like one you might find at a highway rest stop—except instead of selling candy bars and soda for $1.25, it dispenses doses of lifesaving nasal spray for free. 

On November 6th, 2024, the day after Donald Trump won reelection on a drug policy platform that called for deportations and the death penalty for people who sell illicit drugs, I visited the vending machine and spent some time with its proprietor, Ryan Cagle of Jubilee House, Transform Network. 

Cagle is a pastor and harm reductionist who is determined to keep hope alive by keeping people alive in a county that was long the epicenter of America’s opioid crisis. He and I drove nearly eighty miles, refilling newspaper dispensers—those glass-fronted metal boxes that used to distribute alt-weeklies but which Cagle has repurposed as vessels for Narcan—at Rolling T Truck Stop in Carbon Hill, The Blue Store in Empire, as well as the vending machine in the parking lot of what used to be First National Bank in Parrish, Cagle’s hometown. 

Cagle, 33, is a burly, tattoo-covered, nose-ringed, larger-than-life former security professional who is now working on Master’s degrees in divinity and ecological justice. He designs tabletop roleplaying games and uses them in his pastoral work to draw out people who otherwise feel uncomfortable expressing emotion. Cagle speaks in entire paragraphs—about liberation theology, Dungeons and Dragons, the comparative benefits of various modalities of delivering naloxone, and the history of mining and quarrying in central Alabama. 

While holding forth on Jacob, Genesis, kingdom-building, and the tyranny of hope in a place like Parrish, Cagle used a car key to slit the packing tape on corrugated cardboard boxes of Narcan, placed doses in neat rows inside one of his newspaper-style dispensers, wiped soda stains off the dispenser’s white enameled top, and folded the cardboard boxes for recycling later. 

“This is, to me, a way we practice resurrection in a very literal, material way,” he said of his ministry. “It’s a way to love our neighbor, because our community is literally on fire with this crisis.”

_According to Alabama’s Opioid Overdose and Addiction Council, Walker County in 2023 had the third highest rate of nonfatal overdoses in the country. In one sense, that’s good news: Narcan’s resurrectionary properties—its ability to reverse overdoses and bring people back from the brink of death—is one of the reasons Walker County did not top the charts for overdoses that people did not survive.

The road to Walker County is overgrown with the evidence of unforeseen consequences. To get there from Birmingham, you head northwest on I-22 and pass through a series of old mining towns along a roadside swathed in kudzu, an invasive vine introduced to the American South in the late nineteenth century. Advertised as a solution to soil erosion, within fifty years of its arrival, kudzu had established itself as a vector for smog, agricultural diseases, and stink bugs. The Alabama Cooperative Extension System calls it “a classic example of a plant that was introduced with good intentions but that resulted in bad outcomes.”

To learn more about what has unfolded in Walker County over the last thirty years, I spoke with Stacey Fuller, a veteran and former nurse who lives outside of Bug Tussle on the border of Cullman and Walker counties. Fuller started her nursing career in 1994, around the same time the American Pain Society successfully pushed the Veteran’s Health Administration and the Joint Commission on Accreditation of Healthcare Organizations to declare pain the “fifth vital sign.” 

This policy change, like the introduction of kudzu in Alabama, had outsized consequences, Fuller explained. Because practitioners’ compensation was tied to patient satisfaction, and patient satisfaction was tied to access to painkillers like OxyContin, “I became a legal pusher,” Fuller said. “And then”—after she got into a car wreck in 2005—“I became a user.” 

Fuller spent about a year in Alabama’s Tutwiler Prison for Women in connection with drug-related convictions and now works as a case manager supporting people reentering the free world after prison. There are a lot of them in her area, many still struggling with addiction even after time in Alabama’s prisons, where drugs are more readily available than treatment and overdose deaths are common. 

Walker County is a manufacturing, mining, and quarrying hub that for six years held the awful distinction of having one of the highest rates of opioid prescriptions per capita in the United States every year between 2006 and 2012. More than 66 million opioid pills—enough for every resident to have 140 pills per year—flooded the county through legal prescriptions during those years, according to the Montgomery Advertiser.

Alabama’s public health infrastructure, strained by residents’ perennially poor health and starved by its refusal to expand Medicaid, was no match for the addiction crisis that followed. Though prescription numbers began to drop, people already experiencing addiction turned to dangerous street alternatives. Overdose deaths skyrocketed.  

Eventually, policymakers recognized the crisis of addiction and death. In 2015 and 2016, Alabama passed new laws allowing naloxone to be prescribed and administered with immunity, and allowing the State Health Officer and county health officers the authority to write standing orders for dispensing naloxone. Much later, in 2023, the FDA approved Narcan for over the counter nonprescription use. In 2017, Alabama established its Opioid Overdose and Addiction Council, a multi-stakeholder entity that reframed the crisis as a public health issue and poured money into treatment and recovery resources. The council began pushing Narcan into the hands of law enforcement officers and successfully advocated for the legalization of fentanyl test strips, which can be used to test substances for the presence of fentanyl. Today, anyone in Alabama can request free naloxone and fentanyl test strips to be mailed to their homes. 

Cagle distinguishes himself from the recovery community with his focus on harm reduction as its own end rather than exclusively to get people into treatment—and with his avoidance of state-sponsored systems in favor of a community-based approach.

“This is about stopping the police violence because if someone overdoses and they have Narcan available, they don’t have to call and report it, the cops don’t come up and they don’t get arrested.” 

Cagle’s wariness of law enforcement is founded, among other things, in the death of Tony Mitchell, a thirty-three year old who in January 2023 died of hypothermia after being brought to the Walker County Jail and held naked in a frigid cell during a mental health crisis. Seven jail staff have agreed to plead guilty in connection with Mitchell’s death, which was ruled a homicide. 

“Harm reduction and this work is about interrupting all potential flows of violence and destruction and death,” he said. “If you have to call the cops for an overdose? People are afraid to sometimes.”

_I asked workers at the sites of Cagle’s newspaper-style dispensers how they feel about hosting a resource that, from one perspective, saves lives, but from another, is purpose-built to attract people who use drugs. At the gas station in Empire, the woman working the cash register said most of the traffic at the dispenser happens after she leaves. She’s seen people overdose by the pumps, but she has never revived someone with Narcan herself. 

She said she wasn’t sure the dispenser makes a difference—but she wasn’t opposed to its presence.

Her sister died from an overdose on Mother’s Day a few years ago, the woman told me. She and her husband got a divorce over his substance use. “And then there’s the girl right down the road here; her mom died. Karma got her, I guess, because that’s who my sister always got her stuff from.”

The two women who run the truck stop in Carbon Hill shared similar stories. Neither has ever used Narcan to reverse an overdose, but recently, they had to bust out a man’s window after he passed out in the parking lot with his foot on the gas. First responders revived him, and when he came to, he threatened to sue the women for breaking his window. They have seen people taking Narcan from the dispenser, and they keep in touch with another local harm reductionist who sometimes refills it when Cagle isn’t available. Sometimes, they said, a nearby fire department takes Narcan when their supply runs low. “We had one person that got a message to me thanking me for putting it out there, because she had picked some up, and that night one of her family members had overdosed. “If it hadn’t been for her having that,” she said, “he would have died.”

They could only think of one instance where someone questioned why they would give away something for free that would enable people to keep using drugs. They laughed that criticism off. 

“They’re still gonna do it even though we have the Narcan,” one of the truck stop managers said. “But they’re not gonna be dead.”

_Cagle deeply understands the challenges people in addiction are facing. His father sold drugs, he told me, and he has lost family members and friends to addiction. His primary goal is to meet people where they are and get them the tools they need–Narcan and fentanyl test strips, but also HIV tests and Plan B contraception as long as it remains legal over the counter in Alabama; fresh produce from the community garden and the small farm he’s building in the football field next to the old high school; and food from the pantry and refrigerator he’s rigged up next to what used to be the Parrish Police Department, now a local government administration office, where kudzu in the parking lot is reclaiming a small fleet of municipal vehicles purchased in the early 2000s. 

“There’s all this stigma around addiction, obviously. And so part of the harm reduction work is also pushing back against that stigma, saying, these are people who deserve to live regardless of whether you agree with their choices or not,” he said. 

“We’re trying to sow imagination and grow resistance. And part of sowing imagination is allowing people to see beyond their stigma and beyond kind of the social scripts they’ve been given around addiction or poverty or whatever else. So they can imagine that things can be different, and there can be a different outcome here, and we can grow something totally different, and where we don’t have to worry about our neighbors dying regardless of whatever choices they make.”