"One by one, the mourners came to me. I didn't want to talk. I didn't want to discuss what might have happened. I didn't want to be here. The lump in my throat was suffocating. I'm not meant to grieve like this . . . I wanted to go somewhere without all these eyes. Pain is easier to digest in solitude."

Mandi Fugate Sheffel was born in the heart of rural small-town America, in a place where "wild teaberry grows" and with creeks "as clear and cold as nature would allow." As a curious, sensitive child raised in a challenging environment, she formed a deep bond with her cousin Eric. As the pair grew up together, they sought a sense of belonging, and drugs and alcohol provided a temporary escape from the harsh realities of their lives. Everything shifted when Purdue Pharma launched aggressive marketing campaigns for OxyContin in central Appalachia.

In The Nature of Pain, Fugate Sheffel recounts coming of age during the opioid epidemic of the late nineties and early 2000s. She illuminates the importance of kinship and connection to place while exposing the bitter truths of a community transformed by opioids. With candid, lyrical prose, Fugate Sheffel reveals what life is really like for people in active addiction and recovery. Her lived experience as an eastern Kentuckian affected by the opioid crisis is an underrepresented story that must be heard. Fugate Sheffel's memoir is an aching tale of empathy for modern mountain folks—of love and grief, family and place, and the addictions that continue to pain them.