It takes the average user eight years and five to six treatment attempts just to achieve one year of sobriety. And in an era of fentanyl and other even stronger synthetic opioids, many users don’t have eight years.
As recently as a few years ago, the opioid crisis could be referred to as a “silent epidemic,” perhaps in part due to its degrading nature. Opioid addiction is frequently described using metaphors of slavery, or enslavement, and those within its clutches are liable to feel acutely ashamed. No longer, however, is it possible to argue that the scourge of opioid addiction is being overlooked.
No doubt that is partly due to the growing enormity of the problem. For each of the past several years, more people have died from drug overdoses than American service members were killed during the entire Vietnam War.
Meanwhile, energetic and compassionate journalists have been doing outstanding work, covering the crisis from various vantages. Chief among them is Beth Macy, a New York Times-bestselling author, who first began noticing the effects of opioid addiction as a reporter for the Roanoke Times, where she worked for 25 years until 2014. Now she is out with Dopesick: Dealers, Doctors, and the Drug Company That Addicted America. Gracefully written and deeply reported, Dopesick should act as a vade mecum — a handbook, a guide, an essential introduction — for anyone who may be seeking insight into the deadliest and most vexing drug epidemic in American history.
Beth spoke to The Fix over email:
The Fix: The first chapters of your book, on the origins of the opioid crisis, cover some material that others have explored (most notably Barry Meier, in Pain Killer: An Empire of Deceit and the Origin of America’s Opioid Epidemic). Still, I don’t have the sense that many people are aware of the role that Purdue Pharma played in setting off current epidemic. Briefly, what is their culpability? And why do think their crimes aren’t crimes better known?
Beth Macy: I think Meier’s book, Pain Killer, was too early, initially published in 2003, and it was largely set in central Appalachia — a politically unimportant place. Also, let’s not overlook the role that Purdue took in stifling Meier. As I write in the book, company officials had him removed from the beat after his book came out, arguing that he now had a financial stake in making Purdue look bad.
After the 2007 plea agreement, in which the company’s holding company, Purdue Frederick, pled guilty to criminal misbranding charges and its top three executives to misdemeanor versions of that crime, Purdue and other opioid makers and distributors spent 900 million dollars on political lobbying and campaigns. Purdue continued selling the original OxyContin formula until it was reformulated to be abuse-resistant in 2010, continued for years after that pushing the motion that untreated pain was really the epidemic that Americans should be concerned about. Their culpability in seeding this epidemic is huge.
You weren’t able to talk directly with any of the Purdue executives who made fortunes from OxyContin, and who criminally misled the public about its addictive potential. But you spent an afternoon interviewing Ronnie Jones, who is currently serving a lengthy prison sentence for running a major heroin distribution operation in West Virginia. How were Jones’s crimes (and his rationalizations for his behavior) different from those of the Purdue executives you wrote about?
Great question. Jones refused to see that he brought bulk heroin to a rural community in ways that overwhelmed families and first responders in the region with heroin addiction; he told me he believed he was providing a service — his heroin did not have fentanyl in it, he argued, and it was cheaper than when people ran up the heroin highway to get it in Baltimore (and safer because they could stay out of high-crime places).
At the 2007 sentencing hearing, Purdue executives and their lawyers repeatedly claimed they had no knowledge of crimes that were happening several rungs down the ladder from them; that the government had not proved their culpability in the specific crimes. According to new Justice Department documents unearthed and recently published by The New York Times , that was simply not true. For two decades, Purdue leaders blamed the users for misusing their drug; they refused to accept responsibility for criminal misbranding that resulted in widespread addiction and waves of drug-fueled crime that will be felt in communities and families for generations to come.
You quote a health care professional who said that previous drug epidemics began waning after enough people finally got the message: “Don’t mess with this shit, not even a little bit.” That provoked a thought: Shouldn’t we be long past this point with opioids? On the one hand, I’m enormously sympathetic to anyone who is struggling with addiction. But it’s frustrating to realize that the opioid crisis is still building. Why aren’t more people as risk-averse about heroin as they obviously should be?
The crisis is still building because the government’s response to it has largely been impotent. And it’s been festering for two decades. Opioid addiction doesn’t just go away. It takes the average user eight years and five to six treatment attempts just to achieve one year of sobriety. And in an era of fentanyl and other even stronger synthetic opioids, many users don’t have eight years. I hope we will soon get to the point of public education where no young person “messes with this shit, not even once,” but right now we still have 2.6 million people with opioid use disorder. Even though physicians have begun prescribing less, we still have all these addicted people who should be seen as patients worthy of medical care, not simply criminals. Too often that doesn’t happen until we’re sitting in their funeral pews.
One of the women you write about, Tess Henry, slid down a long road. You got to know her and her family quite well, over a number of years. And some of the other stories in this book are just as heartbreaking.
It was a lot of pain to absorb and process, yes. And yet my heartache was nothing at all compared to what these families are going through.
In a couple instances, Tess reached out to you directly, asking you for help. How did you calculate how to respond?
I took it case by case; I just went with my gut, and I got input from my husband and trusted friends along the way. I decided it was okay to drive Tess around to [Narcotics Anonymous] meetings, recording our interviews as I drove, with her permission. But it wasn’t okay when she texted me late one night to come get her from a drug house. (I referred her plea to her mother and recovery coach instead.)
I occasionally gave her mother unsolicited advice because I cared about her and I cared about Tess, and I felt I had access to objective information about medication-assisted treatment that Patricia didn’t have. When Tess was murdered on Christmas Eve, I put my notes away and for several days just focused on being a friend to her mom. But I did accompany the family to the funeral home when they made arrangements (taking occasional notes), and I was there in the room of the funeral parlor with her mom and her grandfather when they said goodbye to her. It took funeral technicians two days to prepare her body for that. It was the most heartbreaking scene I’ve ever witnessed. There was no need to take notes in that moment. I will never forget it as long as I live. I said a tearful goodbye to our poet, too.
Was there ever a risk, over the course of your reporting, of becoming too involved in the lives and predicaments of the people you were writing about?
Always there’s a risk, but I’ve been doing this for more than 30 years now, and I know that my greatest skill — which is that I get close to people — can also be my Achilles. When I trust my gut and try to do the right thing — always also getting advice from editor and reporter friends along the way, including my husband, who is just so smart and so spot-on always — it usually works out.
I’m grateful to have read Dopesick. But at various times it left me infuriated, appalled, and depressed. Can you leave us with anything to be hopeful about?
There are some pretty heartening grassroots efforts that I spotlight at the book’s end, mostly involving providing access to treatment and harm-reduction services. And Virginia just became the 33rd state to approve Medicaid under the Affordable Care Act, which will help 300,000 to 400,000 people in the commonwealth have access to substance use disorder services. Seventeen more states to go! There is so much more work to be done, especially in Appalachia, where overdose deaths are highest and resistance to harm reduction programs (easy-access MAT and syringe exchange and recovery) can be severe. My goal is that Dopesick not only educates people but also mobilizes them to care and create what Tess Henry called “urgent care for the addicted” services in their own hometowns.
