Editor’s note: This interview is accompanied by screenshots from the website for Mydayis. We provide the screenshots to underscore the way dangerous, addictive drugs are marketed to both medical professionals and the general public.
Beth Macy was a journalist for the Roanoke (Va.) Times and is the author of two best-selling non-fiction books. Factory Man is the story of the havoc caused by globalization in the American Furniture industry and the efforts of John Bassett III to resist the outsourcing trend and save jobs in his community. Truevine: Two Brothers, a Kidnapping, and a Mother’s Quest: A True Story of the Jim Crow South tells the remarkable true story of George and Willie Muse, two African-American brothers kidnapped from a field near Roanoke, Virginia and forced to work in a sideshow because they were albinos.
In Dopesick, Macy traces the use and regulation of cocaine and its derivative drugs from the 1800’s as an ingredient in ‘patent’ medicines to the mid-1990’s when Purdue Pharma released OxyContin, a drug they relentlessly marketed as a miracle drug for pain with no side effects and very limited possibility of addiction and abuse. She interweaves the story of a drug company cornering the ‘pain market’ with stories of young white teenagers and 70-year-old ex-coal miners hopelessly addicted to legally prescribed drugs.
Macy makes the case that the responsibility for the opioid crisis in America lies with Purdue Pharma, who marketed OxyContin, and a medical and legal system glacially slow in responding to the crisis.
This is not the story of ne’er-do-wells seeking out street drugs for a cheap high. It’s the story of a woman returning from routine surgery, given a 30-day course of OxyContin for pain, then struggling with addiction for years after. It’s the story of a 70-year-old ex-miner with a shoulder injury who, addicted to OxyContin, moved to street drugs because they were cheaper, sold everything he owned and stole from his family to avoid dopesickness. Very early in the addiction trajectory, within weeks or a couple of months, no one gets high any longer; they’re simply staving off the horrors of withdrawal.
It’s the story of middle-class high schoolers in Roanoke—good students, athletes, young people with promise—many of whom by the end of the book will be in jail, in rehab, or dead.
LitSouth: You were reporting for the Roanoke Times in 2012 and you’d been covering a wide variety of stories for the paper. When did you begin to realize there was a serious opioid problem in your own community?
Beth Macy: In 2010, it made front-page news that the son of a prominent Roanoke County jeweler [Spencer Mumpower] was arrested for selling heroin that resulted in a former classmate’s death. Many readers went, Holy crap! Upper-middle class white kids in the suburbs do heroin?
I followed that story for my paper in 2012 with a three-part series on how those two families’ lives had been upended by heroin, and I continued to follow their mothers’ stories. But wrongly, many families believed the moms were outlier cases of bad parenting.
In Dopesick, I trace what happened to the users left behind when Scott Roth was buried and Spencer Mumpower went to prison—I follow a single cell of pill-to-heroin users in an upper-middle class suburb where, unlike in the distressed rural hinterlands, young users had the money to more easily hide their addictions.
As one parent told me, “It was like a Dementor from ‘Harry Potter’ was swirling around the households of Hidden Valley, going, I want you and you and you and you.”
LS: You describe the late 90’s and early 2000’s as somewhat of the perfect storm for opioids in Appalachia. Mines and textile mills were shutting down at around the same time that Purdue Pharma was ruthlessly marketing OxyContin as an addiction-free pain killer. Marketing it as addiction-free meant doctors were initially comfortable prescribing long courses of the drug almost assuring many, many people would become addicted. How much did Purdue Pharma know early on about the nature of OxyContin and its potential for addiction and abuse?
BM: That is unclear, exactly, although, according to a confidential Department of Justice document published recently by The New York Times, Purdue officials knew early on that its drug was being diverted and abused. It is clear, as I report in Dopesick, that people in rural areas were besieged with OxyContin addiction and Oxy-related crime by the late 1990s. As Lee County, Virginia doctor Art Van Zee wrote to the company in 2000: “My fear is that these [rural areas] are sentinel areas, just as San Francisco and New York were in the early years of HIV.”
Within two years of the drug’s release, 24 percent of Lee (Virginia) High School juniors reported trying OxyContin, and so had 9 percent of the county’s seventh-graders. But for more than a decade, the company blamed OxyContin overdose deaths across the country on people who were using the drugs irresponsibly—it was always the fault of the addicted, not the overwhelming power of its drug, which was falsely heralded as being safer than its rivals. The FDA allowed the company to tout the drug’s delayed-absorption mechanism as being “believed to reduce the liability,” even though no long-term studies on addiction rates had been undertaken.
Meanwhile, the company blew rural people like Dr. Van Zee off, casting them as kooks rather than the prescient experts that they were.
LS: Can you describe the transition for many people from one market to another—from prescription pills to street drugs like heroin—and how quickly that transition can occur?
BM: For some, it happened as soon as OxyContin became reformulated in 2010, and many addicted users turned to the illicit heroin market. Some sought out other opioids in the form of Roxicodone, Lortab, or Opana. In 2014, hydrocodone-based painkillers got “upscheduled” into a more restrictive category, a time when local schools, the media, and prevention council leaders began to understand the connection between pills and heroin.
As my main character Tess Henry’s pill dealer told her in 2014: “Here, try this—it’s cheaper and a lot easier to get.” She took her first snort of heroin powder, same as she’d done with the crushed-up pills.
With the growing legalization of marijuana, drug cartels were champing at the bit to meet the demand for heroin (and, later, fentanyl). Within six months of the upscheduling, Tess had to inject heroin to get a bigger rush from the drug, and she needed ever-larger quantities of it “just to feel normal,” she told me— to stave off the excruciating pain of being dopesick.
LS: You talk about the police and the courts finding new ways to approach the addiction problem, shifting from punishment to treatment. Was it the sheer numbers involved in the opioid crisis which necessitated a shift in treatment and prosecution? Or was it more personal, as friends or family members, people they knew, became addicted?
BM: I think it is both the scale of the epidemic AND the fact that so many people know someone suffering from this disease.
LS: Did the fact that the numbers of addicted were becoming predominantly white change the legal and treatment equation?
BM: Yes, I’ve heard many times that no one cared about the “epidemic” when it was crack cocaine mainly affecting black people in the inner-cities. Now, we have an epidemic that spares no one—not the wealthy, not the poor, not blacks or whites. Although this epidemic began predominantly with non-college educated whites and opioid pills, it has shifted in recent years to all races and income and education levels. In Chicago, in fact, African-Americans now account for nearly half of all opioid-related deaths.
LS: Nearly all of the people you talk to ‘in the field’ from police to judges, medical personnel to social service workers, express shock and dismay at the lack of national interest or political will in relation to what is an epidemic by any measure. What do you think accounts for this apathy?
BM: It’s a very complicated issue, not easy to understand or parse, and often further complicated by opposing treatment ideologies and debates about incarceration vs. treatment. President Trump declared the opioid crisis not a national emergency — which he had pledged to do — but a public health emergency, which triggers less funding and a weaker authority to address the problem. Meanwhile, the opioid epidemic continues to take advantage of longstanding fissures between criminal justice and health systems — pointing for a need for more leadership and more urgency at all levels of government.
I personally would like to see more urgency from physician societies who could be leading voices in efforts to tear down barriers to treatment. The real answer to creating urgency is a truly invigorated democracy that elects leaders based on how they deal with problems, including this crisis. But barriers and stigma about opioid-use disorder continue to leave too many people disempowered from making their voices heard.
The 23 million people in recovery are a disparate group, with different treatment ideologies, and many (possibly as many as half) of them are worn out and/or not interested in becoming an advocate. In my opinion, The War on Drugs should be overhauled, with input gathered from other countries, including Portugal, that have decriminalized drugs and diverted public monies from incarceration to treatment, job creation, and criminal re-entry programs.
As James Baldwin put it, “Not everything that is faced can be changed, but nothing can be changed until it is faced.” I hope Dopesick gives Americans a clear-eyed view of how the crisis took shape and what still needs to be done about it.
[The divergent and openly hostile treatment ideologies for addiction make the path to recovery even more fraught. Studies show that patients prescribed Medication Assisted Treatment (MAT) have better overall outcomes. These medications (like Methadone, often prescribed to those addicted to heroin) are rejected by many Twelve Step based Programs and church affiliated facilities who instead argue for total abstention and won’t accept patients undergoing MAT.]
LS: Your stories of families are terrifying and heartbreaking. These parents and children are walking a tightrope between enabling and supporting their loved ones every hour of the day as they move from the streets to rehab, from home to jail. How do they maintain hope?
BM: They maintain hope because they have to. Some people do recover, but it is a long and rocky road. On average, it takes an opioid-addicted user eight years—and four to five treatment attempts—to achieve remission for just a single year. In my experience with interviewees, the ones who get on a stable medication-assisted program, with counseling and social supports, do the best. But there are so many barriers, including cumbersome regulations and stigma against people who are on MAT.
I find a lot of hope in the stories of people who are stabilized and on MAT — many are working, have their children back, some of them exiting disability roles. But they are a largely quiet bunch, unlikely to trumpet their experiences because of the stigma they have repeatedly faced.
LS: You mention that you grew up in an alcohol addicted family. Did covering these stories change the way you saw your own history?
BM: It certainly made me both more interested in writing about the issue, but at times it also brought up very unpleasant memories and ethical dilemmas, as I describe briefly in the book. Following these stories made me more grateful than ever that I was able to become the first person in my family to go to college and to enter the middle class, back at a time when a promising poor kid from a rural Midwestern town could attend university fully on need-based financial aid. Sadly, I don’t think such leaps are as possible today among the economically disadvantaged, especially those from distressed rural regions, where a stunning 80 percent of people don’t have college degrees.
Also, writing this book helped me understand that I won another kind of lottery, a genetic one —I can have one or two beers and enjoy them a lot, and then I can stop. That doesn’t make me smarter or better than my dad who could not. It makes me luckier.
Steve Mitchell is the author of Cloud Diary, a novel, and The Naming of Ghosts, a collection of short stories. He is co-owner of Scuppernong Books in Greensboro, NC. You can find him at www.authorstevemitchell.com