UNNATURAL CAUSES SICK AND DYING IN SMALL-TOWN AMERICA | Since the turn of this century, death rates have risen for whites in midlife, particularly women. The Washington Post is exploring this trend and the forces driving it. Read the related story.

Pastor Robin Robinson shows how the Oildale part of Kern County, Calif., is a rough place for people suffering addictions. (Lee Powell/The Washington Post)

When doctors cut off her painkillers, Samantha Burton went through withdrawal. Experts say it can feel like an extreme case of the flu, but Burton found the experience far more punishing.

Opioids “make your brain’s ability to create happy chemicals completely flaccid,” she said. “It wasn’t like I felt bad. I felt like I was going to die.”

So Burton, a professional illustrator who grew up in nearby Bakersfield, joined a stealthy parade of middle-aged white women trolling for drugs in Oildale, a dusty little town in central California known for its bountiful oil fields, its Appalachian-grade poverty and an open-air market for illicit drugs dubbed “Heroin Alley.”

A big increase in opiate overdoses is causing death rates to rise among white women in middle age in America. Usually, their drug use starts with a prescription. But when addiction sets in, their need often drives them to other sources: the hospital emergency room, the medicine cabinets of sick friends and places like Oildale.

Burton, now 42 and in recovery, started with a prescription for Percocet a decade ago to manage the pain of irritable bowel syndrome. The medication also calmed the manic noise of an undiagnosed bipolar disorder. When doctors cut her off, Burton said, finding more pills “became quite an occupation.”

For five years, she went regularly to Oildale, sometimes waiting hours in dark alleys or behind shabby trailers for strangers to sell her a handful of Vicodins for $5 apiece. Tall, fit and well-groomed, she was an obvious target for criminals. She was punched, threatened and robbed.

“I tried to dress down, but I still stuck out. I did not belong there,” she says. “It was incredibly dumb.”

Jesse Melendez, a recovered addict now in training as a minister in Oildale, said he sees women like Burton every day.

“It’s obvious they don’t fit in,” he said, “It’s obvious why they are here.”

Founded as a company town for oil field workers in the early 1900s, Oildale drew people from across the South and Midwest during the Dust Bowl and the Great Depression. Merle Haggard was born here and played country music at a local nightclub called Trout’s, where he helped create the Bakersfield sound.

Residents gather for free offerings in Oildale, Calif. (Bonnie Jo Mount/The Washington Post)

These days, Oildale is better known for poverty and drugs. Nearly 90 percent of its 33,000 residents are white, and 20 percent live below the poverty line. The poorest live within blocks of Beardsley Avenue and the alley behind it, alternately known as “Heroin Alley” or “Meth Alley,” depending on which drug is ascendant.

According to the Kern County Sheriff’s Department, nearly a third of the 1,600 drug-related arrests made in the sprawling county over the past year have occurred in tiny Oildale.

Two blocks from Beardsley, a weathered church was taken over a year ago by one of the largest and wealthiest churches in Bakersfield, the Canyon Hills Assembly of God. Most of its nearly 200 members are recovering addicts. Melendez is one of four young ministers in training who live in a small home next to the chapel and go door-to-door, inviting residents to Sunday services and Wednesday bible study.

Drug and alcohol addiction is a problem at each of Canyon Hill’s six church campuses, which stretch from the Sierras to the Central Coast. Even at the main campus in Bakersfield, with its boutique coffee shop and its panoramic view of the Tehachapi Mountains, pastor Robin Robinson estimates that 40 percent of his 5,000 congregants are addicts.

“The church is a natural hub for people who are broken,” Robinson said.

Robinson first noticed an upward trend in addiction around 2008, when the mortgage crisis hit and dozens of families at Canyon Hills lost their homes. Of the nation’s 3,007 counties, Kern County ranked 16th that year in foreclosure rates.

After the Great Recession lifted, the economic blows kept coming. Starting in 2012, California’s historic drought crippled Kern County’s largest industry, agriculture. Two years later, a worldwide plunge in oil prices walloped the area’s second-largest and most lucrative industry, oil and gas. Earlier this year, the Kern County Board of Supervisors declared a fiscal emergency.

In 2013, Canyon Hills began offering “Celebrate Recovery,” a 12-step program created at Saddleback Church in Lake Forest, 160 miles south of Bakersfield, and now offered in thousands of churches nationwide.

While the program helps many people, Robinson said many middle-aged white women struggling with opioid and alcohol addiction won’t attend the meetings. They prefer to reach out privately for help — or make desperate trips alone to Oildale.

“They don’t want their children to know. They don’t want their husbands to know. They don’t want their bosses to know. They are afraid of losing everything,” Robinson said.

“They are the ones who are supposed to keep it all together when things go wrong. They don’t think they have the right to unravel.”