VERMONT—Rural Vermont is beautiful this time of year. The Green Mountains are especially green, and buttercups line the hilly two-lane roads through Christmas tree farms and produce stands. Beehives buzz, cows crowd together under shade, and American flags wave outside of many homes.

But all is not well in Vermont, or in the rest of rural New England. This sparsely populated area of the country has seen some of the biggest spikes in drug overdose deaths, mostly due to heroin and other opioids. In 2010, Vermont had zero heroin-related deaths. In 2015, the small state saw 53 heroin or fentanyl-related deaths. Fentanyl is an opioid with higher potency than heroin that drug dealers often cut into heroin.

In 2015, the number of Vermonters seeking addiction treatment increased by 40 percent. Everyone knows someone affected by the drug: A random young man I talked to at a pizza place in Burlington had just written a letter on behalf of his heroin addict friend facing sentencing for a robbery, and another friend had died from an overdose.

“[Heroin dealers are] infecting these little towns that people never thought possible,” said Gilles Gentley, a former heroin addict and the director of admissions for Teen Challenge Vermont.

The opioid crisis raging around the country has garnered national attention, but these rural communities have few resources to fight the scourge. The state of Vermont has only five residential substance abuse treatment facilities.

Christian organizations, typically concentrated in cities where they can reach the most people in need, are not reaching these remote areas. Vermont 2-1-1, which keeps a database of organizations in the state helping those with addictions, lists one Christian organization in the state offering counseling and residential recovery: Teen Challenge Vermont, which has a home for men.

A few isolated Christian programs sprinkle rural New England, like His Mansion in New Hampshire and Our Father’s House in Maine, but Teen Challenge (an arm of the Assemblies of God) is one of the few established Christian addiction recovery programs operating outside of big New England cities. Organizations can transport addicts in rural areas seeking treatment to facilities in cities, but the local organizations are important because they operate within a web of relationships in the small towns and countryside. Teen Challenge Vermont staffers know addicts’ parents, wives, pastors, and parole officers.

Teen Challenge Vermont is over capacity now, along with the other residential programs that are part of Teen Challenge New England. Right now 53 men fill up the Johnson, Vt., home, and the group has added more beds at another home 17 miles away. The staff is looking for another property to buy nearby as well as to expand their beds, because they don’t see any signs of the heroin problem ebbing.

When Teen Challenge’s Gentley was in high school in the early 1990s, he said, kids used marijuana and sometimes LSD. But no one ever used heroin—“that was something that happened in New York City.” People who have worked in these rural addiction recovery programs for years say they used to deal mostly with older alcoholics. They now deal with many younger men, in their teens and 20s, addicted to heroin.

Mark Warren, 26, is from West Burke, Vt., a small town about an hour from the Canadian border. He likes to hunt and fish, and he worked in logging, like his father. But his father, an alcoholic, died when Warren was 6 years old, and Warren struggled with anger and grief ever since. His family is Christian, but he said he pushed relationships away, including a relationship with God—who he perceived had taken his father from him.

Everyone Warren knew in school drank or did drugs. He started drinking as a teenager, then started smoking pot, and then turned to pills, and when he couldn’t get pills, heroin. In his early 20s, Warren spent 3½ years behind bars—for what he didn’t say, but he did say there were more drugs in prison than outside.

After Warren left prison, he kept up his habit and kept getting into trouble. His mom talked to Teen Challenge’s Gentley, whom she knew through church, and gave her son Gentley’s number. Warren, who was on probation, said he woke up in the middle of the night and decided it was time to enroll in Teen Challenge. He’s been there three months.

The Vermont Department of Corrections has 10 beds at the Teen Challenge house, where men like Warren can choose to go on probation or parole. Keith Tallon, a longtime DOC staffer and a Christian, is the district manager of the probation office in Rutland, where the heroin problem is acute. He said Teen Challenge was the only Christian recovery program he knew of in Vermont, and said the group has a “big impact.”

Sporting a buzz cut, Warren wore a Carhartt shirt, and took a break from working on some flooring on the Teen Challenge campus. Gentley says Warren talks about himself as if he isn’t smart or perceptive, when he is both.

Warren says pride kept him from seeking help for a long time. “You want to tuck it away,” he said. “You had a bad day, as a man you don’t want to go cry on somebody’s shoulder. ... Then you bottle it all up, and before you know it you’re 25 years deep in life and you’re still full of anger over something that happened when you were 6.”

He says God has given him a new outlook: “I think it’s Matthew 11:28-30: Pick up my yoke and walk with me. That’s not the exact Scripture, but pretty much what it says is, walk with him and he’ll take your burdens. You don’t have to live like that anymore.”

The common path to heroin, the path that Warren followed, is through pills. The opioid crisis has its roots in the 1990s when doctors were writing more and more prescriptions for narcotics. Maine psychiatrist Art Dingley, who treats people with addictions, says the Centers for Medicare and Medicaid Services (CMS) told doctors they were undertreating pain, and to prescribe more narcotics (see sidebar below).

Patients would become dependent on the drugs after an injury or surgery. In the last few years, the government and doctors have tried to tighten control on prescription opioids, pushing up the street price of prescription drugs like oxycodone. Addicts moved to the cheaper, and more dangerous, heroin.

Heroin dealers coming from New York City, just a few hours away from Vermont, have flooded the rural areas. Teen Challenge’s Gentley remembers seeing a helicopter drop drugs in the woods near his hometown of Newport, Vt., near the Canadian border. Users can go through hundreds, if not thousands, of dollars of heroin in a week.

“It’s the gold rush,” said Pastor Rick Welch, the director of Teen Challenge Vermont and a former heroin addict.

But Warren’s experience reveals one asset that small-town Vermont has over big cities: close-knit community relationships. Drug users in cities are often disconnected from their families; at Teen Challenge Vermont, many of the calls come in from mothers, grandfathers, aunts, and pastors. A person with a heroin problem often can’t hide it here.

Eric Morrison, 41, was an alcoholic. One day he had a gas leak at his house in rural Vermont, and the man who came to fix it asked Morrison why he was drinking on a Tuesday. Morrison shrugged—what else is there to do but drink? The man came back to visit later and invited him to his Methodist church in town. Morrison declined, but then he was walking his dog in town later, and the man pulled his car over. “You ready?” he asked.

“I’m like, leave me alone!” remembered Morrison. “He did this for a few days, every time he’d drive by. So finally one Sunday, June 20 last year, he pulled next to me and said, ‘You ready?’ And I said, ‘Yep, I’ve had enough.’”

Morrison packed his bags right then and went to live at the Teen Challenge Vermont house, where he has been for a year. The repair man who dogged him often visits.

Gentley’s small-town Vermont community—his wife, his mom, his mom’s pastor, and some of his friends—also got him into Teen Challenge. Gentley had grown up hearing about Teen Challenge at his church. When he was in the depths of his addiction, he told his family they were “nuts” if they thought he was going there. But so many other programs hadn’t worked for him, and his wife told him he couldn’t come home if he didn’t seek help. He enrolled.

This is a common story. When Welch, now the director of the Vermont campus, arrived at Teen Challenge for treatment 20 years ago, he thought he was in “the mothership of the nuthouse.”

“They want to hallelu, pray for me,” said Welch. “I thought, ‘Get away from me.’ But I came to know Jesus here. He messed up my life.”

Teen Challenge has an unorthodox approach, focusing on the gospel and emphasizing a relationship with God as a solution to addiction. The program is very strict: The men have a schedule from 6 a.m. until 10 p.m. They all work during the day, and they must get their GED to graduate from the program. Teen Challenge doesn’t take government funding. The Vermont organization raises its money from local churches and from businesses where the men work.

Fifteen months of work, sobriety, and Christian teaching is a lot to ask. Gentley estimates 30 to 40 percent of those who enter the program graduate. But that radical approach is often the only one that works. Getting off heroin, Gentley and Welch agreed, is “excruciating.”

“What are you going to do in 30 days?” Welch said about most programs. He went through 16 programs before landing at Teen Challenge. “It’s like a spin dry.”

Common state-funded clinical solutions give addicts doses of methadone or buprenorphine (also known as Suboxone), narcotics that will keep users away from heroin on the street that might be laced with fentanyl. Welch, who has used methadone, said kicking that drug was harder than heroin. Teen Challenge doesn’t allow methadone or buprenorphine, seeking to address the underlying addiction without putting the methadone “Band-Aid” on the problem.

Nowadays, Gentley is the one on the phone with parents and family members trying to convince their loved ones to enter a program. The parents of one 26-year-old addict had been calling him for some time as they together tried to get him in the program. The young man finally agreed, but then changed his mind when his family went to bring him to the house. At 10 o’clock one night in March, Gentley received a phone call from the mom: The man had overdosed and died.

“It’s the worst feeling in the world,” Gentley said.

Family members of those addicted to opioids often feel helpless if addicted loved ones won’t seek the kind of help groups like Teen Challenge offer. Sgt. Matt Baker, a 23-year veteran of the Oxford County Sheriff’s Office in rural Maine, struggled to find help for his addicted daughter. He and his wife offered space in their home to their 23-year-old daughter Ronni, her boyfriend, and their 11-month-old baby. Ronni had struggled with drinking and marijuana but managed to be clean during her pregnancy. Baker talked to her “a thousand times” about getting help, but she said she had the problem under control.

After the baby came, she was working and seemed to be doing well. But then she suddenly stopped breastfeeding. Baker, who worked the night shift and whose wife worked as a teacher during the day, didn’t know what was going on. His daughter, her boyfriend, and their child would go to their room in the evenings, and Baker thought they were going to bed. He later found out the couple were using heroin.

Last year he came home from work one night and found his daughter unresponsive in the upstairs bathroom. Her face and lips were blue, and the veteran police officer knew immediately what had happened—an overdose. He didn’t have any Narcan, the nasal spray that revives people from an opioid overdose. “Basically,” he said, “my daughter died while I was doing CPR on her.”

When the EMTs arrived, all they could do was take her body out on a gurney. He found out later that she and her boyfriend had gone through $3,000 worth of heroin in the last two weeks of her life. Baker and his wife are currently raising their granddaughter, now 2 years old. As we talked, he was looking at his work computer—another overdose was just reported, and he knew the woman.

He tells family members of other addicts that they can’t help someone who won’t acknowledge a problem, but he urges: “Keep after them. … Constantly offer them help.”

Overview of an epidemic

America’s opioid epidemic hit the headlines just before the New Hampshire primary in February, as mournful parents asked presidential candidates what they would do about it. The epidemic quickly fell off the front pages as contenders moved on to debate how long their fingers were and other silly things, but the tragedy is not going away.

How big: About 46,000 Americans died last year from overdoses of drugs, mostly opioids: heroin but also highly addictive, man-made, morphine-like pain relievers such as oxycodone, Percocet, and hydrocodone. Opioids reduce the perception of pain and can bring temporary elation, but a dose too high depresses the respiratory system, leaving blue-lipped users not breathing, and sometimes dying.

That’s the iceberg’s tip. The National Survey on Drug Use and Health in 2014 asked Americans age 12 or older whether they had illegally used a drug within the past 30 days. Ten percent—27 million—said yes. For 4 out of 5 drug users, that means marijuana, which some states are legalizing. For about 5 million Americans, it means pain pills or heroin, and sometimes death.

How did 5 million become addicted? The epidemic began with a worldview: In the 1980s the World Health Organization (WHO) declared “freedom from pain” to be a universal human right. Doctors, seeing some pain as inevitable after injuries and operations, have long been cautious about prescribing powerful addictive opioids, but organizations had some patients rating their doctors, and ratings fell if the patients didn’t feel good. Some hospitals told doctors they could be sued if they didn’t treat pain with opioids.

Journalistic laziness then played a part. In 1980 the New England Journal of Medicine published a one-paragraph letter from a Dr. Hershel Jick noting that in his database few patients treated with opioids while in hospitals became addicts. The paragraph said nothing about dosage or how long the patients used opioids. Some freedom-from-pain advocates began calling Jick’s letter a “study.” Time, for a 2001 story titled “Less Pain, More Gain,” apparently did not take the time to check out the paragraph: It called Jick’s letter a “landmark study” that showed fear of addiction was “basically unwarranted.” Wrong.

Medicaid laxness also contributed: Medicaid cards enabled holders for a $3 copay to get the hundreds of pills a “freedom from pain” doctor prescribed. The patient could use some pills and sell others on the street for thousands of dollars. Some who became addicted would not give in, and eventually beat the scourge. Many others succumbed. —Marvin Olasky