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I was in Ethan’s Place, a bar to which I’ve retired for many years after duck hunting. There, I met two men whom I’ll call Sean and James. Sean was a skinhead. He’d just a few days earlier been released from the Illinois state penitentiary after serving six years for grand theft auto and manufacture of methamphetamine with the intent to distribute. He was a thin and wiry six feet one, 170 pounds, with a shaved head and a predictable mixture of Nazi tattoos. He was twenty-six years old. James was black, twenty-eight years old, and a heavily muscled six feet three. His frame was less sturdy, it seemed, than his burden, for James moved with a kind of exhausted resignation, like someone who suffers from chronic pain. For the last six years, James had been serving with the Army Airborne, first in Afghanistan, where he participated in the invasion of that country; then in Iraq, where he was also a member of the initial offensive; and finally, as a policeman back in Afghanistan, where he’d found himself in the curious position of protecting people who had been shooting at him a couple of years before. Like Sean, James had been in a sort of prison, and he was finally home.

Shared history is stronger than the forced affiliations mandated by jail or the military, and pretty soon James and Sean, the black and the neo-Nazi, talked amiably about all the people they knew in common. They drank the local specialty, the Bucket of Fuckit, a mixture of draft beer, ice, and what ever liquor the bartender sees fit to mix together in a plastic bucket. As they played pool, James stalked around the table, shooting first and assessing the situation later, each time hitting the balls more aggressively. The contours of his face formed themselves into a look of desperate perplexity beneath the shadow of his St. Louis Cardinals cap. Why, he seemed to be thinking, will the balls not go in?

Sean, too, moved around the table with a kind of pent-up aggression. Whereas James’s muscular shoulders sagged in defeat beneath his knee-length Sean John rugby shirt, Sean’s movements were fluid and decisive inside his Carhartts. His confidence was palpable. The enormous pupils of his blue eyes brimming with lucid possibility, Sean easily crushed James in the game of pool. Sean was riding the long, smooth shoulder of a crank binge.

As I shot pool and talked with James and Sean over several nights, it hit me with great force that meth was not, in fact, following me around. Nor was it just a coincidental aspect of life in the places I’d happened to be in the last half decade, in Gooding or Los Angeles or Helena. Meth was indeed everywhere, including in the most important place: the area from which I come. There, it stood to derail the lives of two people with whom, under only slightly different circumstances, I could easily have grown up.

Meeting Sean and James took away the abstraction that I’d felt regarding meth since 1999. In the wake of what I’d seen in Greenville, writing a book about the meth epidemic suddenly took on the weight of a moral obligation. Around that same time, after a decade in New York City, I’d begun yearning to return to the Midwest. My desire to understand the puzzle of meth had now conspired with an instinct to view the fullness of the place I’d left when I was eighteen. So, too, was the need to consider both parts of the puzzle growing more urgent. By mid-2005, meth was widely considered, as Newsweek magazine put it in its August 8 cover story, “America’s Most Dangerous Drug.”

In the end, meth would have a prolonged moment in the spotlight during 2005 and 2006, which can in some ways be traced to a late-2004 series called “Unnecessary Epidemic,” written by Steve Suo for the Oregonian, an influential newspaper in Portland. In all, the Oregonian ran over two hundred and fifty articles in an unprecedented exploration of the drug’s ravages. Following the cover story in Newsweek, a Frontline special on PBS, and several cable television documentaries, the United Nations drug control agency in late 2005 declared methamphetamine “the most abused hard drug on earth,” according to PBS, with twenty-six million addicts worldwide. Even as global awareness of the drug grew, meth’s association with small-town America remained strongest. The idea that a drug could take root in Oelwein, however, was treated as counterintuitive, challenging notions central to the American sense of identity. This single fact would continue to define meth’s seeming distinctiveness among drug epidemics.

In 2005, after six years of trying, I got a contract to write this book under the assumption that meth was a large-scale true-crime story. In that version of the meth story, the most stupefying aspect is the fact that people like Sean could make the drug in their homes. Or that Coco, the Mexican teenager I’d met in 1999, would risk deportation for a fourth time in order to come to Gooding, Idaho, to sell the drug. By 2005, many law enforcement officers were being quoted in newspapers predicting that the state of Iowa would soon take over from my native Missouri as the leading producer of so-called mom-and-pop methamphetamine in the United States. For this reason, and because Sean and James had made it clear that they did not want to be written about, I’d been focusing my research on the state from which half my family comes, and which seemed poised to become the newest meth capital of America. One day, while poring over archived newspaper articles in the Des Moines Register, I came across an interesting quote made by a doctor in the northeast part of the state. I called the doctor one afternoon from my apartment in New York City. We talked for an hour and a half, during which the doctor began to change my thinking about meth as a crime story to one that has much more pervasive and far-reaching implications. What struck me most was his description of meth as “a socio cultural cancer.” Later that day, I spoke at length to the doctor’s twin brother, who was the former county public defender, and then to the assistant county prosecutor. The doctor lived in Oelwein. I made the calls on a Saturday. The following Wednesday, I was driving north on Highway 150, following flights from New York to Chicago to Cedar Rapids.

The doctor’s name is Clay Hallberg. Doctor Clay, as he’s known around town, is Oelwein’s general practitioner and onetime prodigal son. As his father had done before him for forty-five years, Clay has for two decades delivered babies, overseen cancer treatments, performed surgeries, and served as proxy psychologist, psychiatrist, and confidante to Oelwein’s wealthy farmers and poor meatpackers, to its Mexicans and Italians and Germans, its Catholics and Lutherans and evangelicals. Oelwein, replete with its humdrum realities and unseen eccentricities, passes daily through Clay’s tiny, messy office across the street from Mercy Hospital, one block north of the senior high school. Clay grew up in town and had come back following medical school and a residency in southern Illinois. He raised three children there with his wife, Tammy, all the while living down the street from his parents and his two brothers. Really, I went to Oelwein for the reason that Clay and his hometown seemed inseparable to me, in the same way that hometown America was becoming inseparable with meth. I thought Clay could explain to me how that had happened.

By May 2005, Oelwein was on the brink of disaster. As I stood on First Street in front of the post office, the signs of entropy were everywhere, and hardly less subtle than those in East New York, Brooklyn, or in Compton or Watts, in Los Angeles. The sidewalks were cracked, half the buildings on Main Street stood vacant, and foot traffic was practically nonexistent. Seven in ten children in Oelwein under the age of twelve lived below the poverty line. Up at the four-hundred-student high school, on Eighth Avenue SE, 80 percent of the students were eligible for the federal school lunch program. The principal, meantime, was quietly arranging with the local police to patrol the halls with a drug-sniffing dog—essentially, to treat the high school as a perpetual crime scene. The burned-out homes of former meth labs dotted the residential streets and avenues like open sores. At the same time, the Iowa Department of Human Services, whose in-home therapists serve as one of the only realistic options for dealing with a mélange of psychiatric ailments, drug addiction, and all manner of abuse in Oelwein, was cutting 90 percent of its funding to the town. The meatpacking plant was on the verge of closing its doors. The industrial park sat unoccupied. Unemployment was pegged at twice the national level. For Larry Murphy, Oelwein’s embattled second-term mayor, the question was this: How would he keep his town from literally vanishing into the prairie?