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“They did this to you.” Other characters drill this assuration into the mind of Demon, the main character of Barbara Kingsolver’s newest novel, “Demon Copperhead.” The book, set in a poor county in southern Appalachia during the opioid epidemic, deals with the large question of who is to blame for a crisis. Kingsolver uses the perspective of a young boy to showcase the true parties at fault in rural America, including the institutional structures that ruin lives, corrupt children, and send communities into cycles of ruin. Inspired by the sweeping narrative of Charles Dickens’s “David Copperfield,'' Kingsolver uses compelling characters and an underrepresented setting to create a heart-wrenching portrait of the American opioid crisis.

Demon Copperhead — his first name a twist on “Damon,” his last name owed to the red hair he inherited from his father — has a lot of troubles. From the beginning, though, he takes responsibility for his entire life. The novel starts with the words, “First, I got myself born,” and from there Demon faces a variety of harrowing childhood experiences, including an opioid-addicted mother, an abusive stepfather, intense grief, child labor, and negligent guardianship. The responsibility that he takes for matters outside of his control makes readers immediately sympathetic for Demon. His resilience is repeatedly put on display, even as the mental scars of trauma start to weigh down upon him. Demon briefly rises from his troubles to become a star on his local football team — but this respite is interrupted by a devastating injury. This leads to Demon’s first use of opioids, and then the novel follows the arc of his life after this dreaded introduction.

This novel draws upon both current problems in Appalachia and the way that Dickens brought the lives of the trodden-down into public consciousness. Kingsolver, known for her acclaimed novel “The Poisonwood Bible,” was raised in rural Kentucky. There, she saw the effects of the opioid crisis in Appalachia first-hand. After visiting Charles Dickens’s home in England, Kingsolver was inspired by his “impassioned critique of institutional poverty” and decided to tackle modern American problems in a similar fashion. Her novel is just as eye-opening about the opioid epidemic as Dickens’s stories were for Victorian readers. Kingsolver’s deep admiration for Dickens shines throughout the novel; she refers to him as her “genius friend in the Acknowledgements. Even Demon compliments Dickens directly: “Christ Jesus did he get the picture on kids and orphans getting screwed over and nobody giving a rat’s ass. You’d think he was from around here.”

Kingsolver reflects Dickens in other ways, too: Just as some people turn away from Dickens’s notoriously lengthy tales, the page count of “Demon Copperhead” — nearly 550 pages — has the potential to daunt readers. This is not without reason; books that reach this length often contain tangents that strike fast-paced readers as unnecessary. Sometimes the novel gets stuck in a “rinse and repeat” storyline, in which Demon escapes some form of torturous supervision just to get trapped in another. However, this torrent of misery is an effective way to emphasize the many obstacles that the people of Appalachia faced during the opioid crisis: a never-ending stream of misfortune that seemed inescapable.

The novel focuses on Demon, but it also features the strong women who shape his life. Although his mother’s addiction negatively impacts Demon, her love always stays with him. Other female influences in his life include Mrs. Peggot, his elderly neighbor who helps care for him when his mother is distracted, and June, another Peggot relative that becomes a guiding light in Demon’s life after he tunnels into addiction. Kingsolver crafts the Peggot women as the embodiment of resilience and kindness amidst the crisis. There are more amazing female characters, but the one that shines is Angus, Demon’s foster sister. Angus defies expectations of both Applachian and female stereotypes, and is one of the only characters that truly recognizes how much Demon has gone through. Kingsolver’s strong female characters show the especially intense struggles that women underwent during the opioid crisis — forced to face the dangers of addiction while often being put into roles in which they had to care for others.

The novel also stands against stereotypes of rural Americans — Demon often remarks that city people don’t understand Appalachian life. He begins to see how his county has been systematically ignored throughout the crisis and the way that opioids were peddled recklessly to vulnerable community members. Demon is able to survive the institutions that worked against him — but he also acknowledges that so many lives were not adequately protected. Kingsolver reveals the humanity behind the numbers of the crisis and the stereotypes that prevented help from coming to the places that needed it the most.

Overall, the novel has the potential to open the eyes of many Americans that have been sheltered from the opioid crisis, whether they were oblivious to its toll on rural areas or are too young to remember its significance and the scars that it has inflicted on some of our country’s most defenseless groups. The dreary subject matter will not be for everyone, and those afraid of lengthy novels may be intimidated, but “Demon Copperhead” is an odyssey not to miss. It highlights the resilience and strength that can grow from some of the world’s darkest places, and reminds us not to ignore and belittle those who have grown up in a world that works against them.