The least of these

The least of these is a biblical expression that gives moral shape to the book’s account of the opioid crisis: it asks whether people who are suffering are treated as members of a community deserving care, or left at the edges of systems meant to help them. The phrase appears as scripture on nurse-practitioner Teresa Gardner Tyson’s white coat, linking a Christian injunction to the work of caregivers and volunteers in Central Appalachia. Its force comes from that connection between a declaration of human worth and the practical question of who receives help.

Biblical Phrase and Ethical Measure

In the book’s closing movement, Central Appalachia is described as the birthplace of the modern opioid epidemic and as a place of unmet needs. The people working there include emergency medical technicians, preachers, probation officers, and nurse-practitioners. They advocate at public hearings, serve meals to people struggling with addiction in church basements, and take mobile clinics along difficult rural roads. Their work is presented as an enactment of the scriptural principle embroidered on Tyson’s coat: service to the least is service to Christ.

The phrase does not function simply as a pious conclusion. It supplies a standard against which the book’s institutions and communities can be judged. People living with addiction may be trying to survive withdrawal, while their relatives and local volunteers try to keep them alive; meanwhile, gaps between health care and criminal justice can deepen the vulnerability of both. The expression directs attention to those people not as abstractions or problems to be managed, but as the recipients of obligations that institutions and neighbors have too often failed to meet.

Who Is Left at the Edges

The book shows exclusion operating through silence and stigma as well as through formal policy. When reporting on heroin in the suburbs of Roanoke, Virginia, began in 2012, many families were too ashamed to speak publicly. In the same period, parents lacked the later Facebook groups that could connect them across the state and help them share treatment information, coping strategies, and material support. Shame isolated families just when collective support might have helped them navigate addiction, rehabilitation, prison, recovery, and relapse.

Stigma also shaped access to peer support and treatment. Tess Henry, who had attended twelve-step meetings, felt judged for taking buprenorphine; although Narcotics Anonymous officially accepted medication-assisted treatment, people asked to sponsor or mentor her declined. The divide between treatment informed by public health and attitudes prevalent in criminal justice and local recovery settings made support harder to secure. In this context, the ethical reach of the phrase includes people whose recovery is treated as less legitimate because it does not fit an abstinence-only ideal.

The book also sets the language of broad concern beside racial disparities in punishment and care. It observes that calls to avoid arresting one’s way out of the epidemic were often applied to mostly white opioid users, not to people such as Ronnie Jones, imprisoned for armed heroin distribution. At the same time, data cited from the Centers for Disease Control and Prevention indicated that doctors prescribed painkillers to people of color at substantially lower rates because they were less trusted not to misuse them. These contrasts show how the boundaries of sympathy and intervention can be drawn unevenly: some people are framed primarily as patients, while others are more readily subject to punishment.

Service Made Concrete

The book gives the phrase a practical setting in the free medical outreach organized by Teresa Gardner Tyson. One summer weekend each year, Remote Area Medical serves uninsured people in Wise County, Virginia, including children with undiagnosed diabetes and adults needing dental care. Its patients include people whose health needs have accumulated alongside poverty, lack of coverage, and substance use. The scene presents care not as an abstract promise but as a service people can reach and receive.

Craig Adams, a construction worker recovering from opioid addiction, came with his wife, Crystal, to have their teeth treated. He had served eight years in the state prison system after breaking into a pharmacy in Richlands while trying to steal OxyContin. By the time of the visit, he was taking Suboxone and had avoided illicit drugs for more than three years. He had delayed seeking care because he expected social-service workers to make him feel ashamed; instead, he encountered kindness. His experience makes the phrase’s ethical test tangible: whether a person with a history of addiction and imprisonment is met with humiliation or with care.

The Phrase’s Narrative Significance

The expression gathers the book’s closing emphasis on community without erasing the failures that make such work necessary. In one account, Janine Underwood told school-board members and county officials what was happening to families in her community and sought support for prevention work. The room responded with silence; the school board declined to support the program, and the county provided its usual two thousand dollars. Set against that inaction, the labor of clinics, caregivers, and volunteers becomes more than charity: it is a response to needs that public systems have recognized inadequately or left unmet.

The least of these therefore serves as both a religious reference and a structural principle for reading the book. It connects intimate experiences of shame and recovery to disparities in treatment, criminalization, and public investment, while directing attention toward the people doing sustained, local work. Its final emphasis is not that suffering has been resolved, but that the measure of a community lies in whether it makes room for those most readily ignored.