Jennifer Poff Cooper
“Nothing can be changed until it is faced,” said former Roanoke Times reporter and New York Times best-selling author Beth Macy of the opioid crisis.
Macy is doing just that with her newest book “Dopesick: Dealers, Doctors, and the Drug Company that Addicted America,” which she discussed at the Christiansburg Public Library Tuesday night.
The event was free and open to the public, with standing room only. Macy’s mix of stories, shocking statistics and possible solutions kept the audience riveted.
Retiree Marjorie Modlin said she attended because she had read Macy’s other books, “Factory Man” and “Truevine,” and feels Macy is an “outstanding writer.”
Also, said Modlin, the subject matter is important.
“It’s on the news every day,” she said.
Peggy Dunn noted she saw fellow teachers present, saying that not only does she talk about “Dopesick” in her classes but also that students and their families are affected by the subject matter.
Macy began by acknowledging that this is a difficult topic and expressing sympathy for those who have experience loss due to drug overdoses. There have been 72,000 deaths due to opioid overdoses, she said.
The big picture is that the epidemic is “festering and growing,” said Macy. Thirty thousand lives have been lost in the past 15 years, and that many are expected to be lost just in the next five years. Drug addiction is a chronic relapsing disease. Macy said that it takes five to six treatment episodes over eight years for one year of sobriety. The epidemic also reveals “fissures in society,” such as the philosophies of punishment versus treatment of drug addiction.
“Dopesick,” which took Macy two-and-a-half years to write, goes deep in three different Virginia communities – Lee County in southwest Virginia, the suburbs of Roanoke and Woodstock in northern Virginia.
Macy’s book focuses on Appalachia, but she emphasized that the opioid crisis is national. Life expectancy is going down, especially in middle-aged men without college degrees. This is mostly due to “diseases of despair” such as suicide, alcoholism, and drugs.
The book’s title “Dopesick” refers to the slang of being in the throes of addiction withdrawal, symptoms of which include diarrhea, sweats, vomiting, and restless legs. “People say it’s like the flu times 100,” said Macy.
Macy said the only way she could tell this story was by “getting close” to the families and first responders. In fact, Macy follows up on her subjects even when she is done with her writing.
Her compassion and care shine through. For example, she wears a necklace given to her by one of her deceased subjects’ mothers; the mother wears a matching necklace.
One issue Macy addresses is why it took so long for society to recognize the opioid crisis. She said that it “took root in politically unimportant places.” The declining city of Martinsville has been listed as an opioid prescribing capital.
Macy herself played a part in getting the epidemic noticed locally. In 2012, her last story as a Roanoke Times reporter was about addictions in the tiny Hidden Valley area of Roanoke.
These addictions were easier to hide because the kids had money, Macy said. Plus there was shame and stigma associated with addiction so families kept quiet. Some of these addicts have been imprisoned, and some have died.
Macy places much blame on the pharmaceutical industry. Purdue Pharmaceuticals “flipped the narrative,” she said.
The standard went from opioids being used only for end-of-life pain to being used for minor lower backaches.
The pharmaceutical companies also targeted their sales representatives at doctors who prescribed the most opioids and gave sales reps bonuses of up to $100,000.
When the prescription drugs were reformulated to become less addictive and became harder and more expensive to obtain, drug dealers stepped in with heroin to fill demand.
Macy’s stories of the Roanoke teens showed how difficult treatment is to get despite how much money or how many connections the family might have.
“We don’t have enough doctors willing to have addicts in their waiting rooms,” said Macy.
Virginia, she said, is largely leaving it to volunteers to deal with the biggest drug epidemic ever.
The question, then, is “how do we impose order and hope on a chaotic and despairing story?” asked Macy. Her solution was to focus on the people fighting back.
One rural doctor wrote Purdue Pharmaceuticals to let them know opioids are still addictive; he was seeing babies born addicted and patients overdosing.
In 2016, the Centers for Disease Control guidelines changed to tell doctors not to prescribe opioids as a first-line option.
Medicaid is the number one tool for help, said Macy, so Medicaid expansion in Virginia was a huge victory. With it, 300,000 to 400,000 more people, many of them with substance abuse problems, will be covered.
Drug courts and programs such as Roanoke City’s Hope Initiative began to focus on medication-assisted treatment (MAT) instead of punishment. Macy clearly is an advocate of MAT.
She said that abstinence only treatment works 10-11 percent of the time, while MAT’s success is 50-60 percent. Plus, with MAT patients are less likely to get and spread HIV and hepatitis C and less likely to engage in criminal activity.
Other tenets of Macy’s argument for changing the trajectory of the drug epidemic:
• Expand treatment capacity, as waiting lists are anywhere from three weeks to two years. “People in the book died before I could get home and type up my notes,” said Macy.
• Create more re-entry options, because it is hard for felons to get jobs.
• Expand and improve drug courts, which focus on treatment not punishment. Parents of addicts are begging for their children to be included. Prosecutors are starting to see that MAT is not just substituting one drug for another, said Macy.
• Be willing to take on unsupportive communities. No one wants drug treatment centers in their back yards, but Macy cites advocates who kept pressing until they succeeded.
• Embrace harm reduction over tough love.
People wonder how many chances society should give drug addicts, Macy said. She cites the Bible, in which Jesus says to forgive seventy times seven times.
Macy’s background reporting on the Appalachian region for nearly three decades gave her a bird’s eye view into the intractable crisis she has delved into so deeply. She personally embraces not only activism but also the people involved. “This is the hardest thing I’ve ever written,” she said.
Macy’s talk was the first of three scheduled in a fall local author series at the Christiansburg library. The next event is mystery writer Tracee deHahn on Tuesday, October 2, followed by Mary Bishop on Tuesday, Oct. 16. Both events will be at 6 p.m.