Dopesick: Dealers, Doctors, and the Drug Company that Addicted America

by Beth Macy

“As long as it was in the lower economic classes and marginalized groups, like musicians and people of ethnic minorities, it was OK because it was with those people,” said Spencer’s counselor, Vinnie Dabney, an African American who took his first sniff from a bag of heroin his sophomore year of high school, in 1968, and was a mostly functional user for thirty years. (Needle-phobic, he never once shot up.)

“But the moment it crossed those boundary lines from the inner city into the suburbs, it became an ‘epidemic,’” said Dabney, shaking his head. After two drug-related jail stints, he left court-ordered treatment in the late 1990s to get a master’s in counseling and now works as a mental health and substance abuse counselor who leads support groups for users taking the maintenance drug buprenorphine, or bupe (more commonly known by the brand name Suboxone). “It’s ludicrous, this thing that’s been knocking on your door for over a hundred years, and you’ve ignored it until finally it’s like a battering ram taking your doors off the hinges. “It’s a monster now, but nobody paid any attention to it until their cars were getting robbed, and their kids were stealing their credit cards.” The worst of it, Dabney warned, was that people were getting hooked at even younger ages, and making the switch faster from pills to heroin.

The science is far from clear, according to a 2014 data review. Some studies show that ADHD-diagnosed children treated with stimulants have lower rates of addiction to some substances than those who weren’t medicated, while other studies suggest that exposure to stimulants in childhood can lead to addiction in adulthood.

Colton died at eleven-thirty on the morning of November 4, 2012, All Saints Sunday, while his parents were in church. A few hours later, when a policeman showed up on their stoop to say that Colton had “expired,” they were initially confused. Expired? No, their younger son was dead. To add insult, no charges were filed against the middle-aged dealer, because it’s impossible to pin blame on a single batch of pills when an autopsy rules “multiple toxicity,” as it did in Colton’s case, the police chief confirmed.

Though Christopher Waldrop was away at rehab and not allowed to come home, Jamie made a point of sitting next to one of his high school friends at the service, in an increasingly familiar role. She and a handful of other local moms were preparing to out themselves and their families, understanding, finally, that survival had to trump shame. Jamie pledged to help her son’s friend find a bed at a treatment facility the moment he was ready to go. “His parents were in total denial,” she said.

Near the tail end of Spencer Mumpower’s prison sentence, he had lost twelve friends, and five others were now in prison or jail. “He’s had very few friends get clean, either through going to rehab or jail, but the ones who didn’t are either dead, or they have parents who enable them, and they continue to do drugs,” Ginger Mumpower said. “Most of his friends have never seen jail; they either talk their way out, or their parents buy their way out.” When Colton Banks died, in 2012, for every one opioid-overdose death, there were 130 opioid-dependent Americans who were still out there, still using the drugs.

The real perfect storm fueling the opioid epidemic had been the collapse of work, followed by the rise in disability and its parallel, pernicious twin: the flood of painkillers pushed by rapacious pharma companies and regulators who approved one opioid pill after another. Declining workforce participation wasn’t just a rural problem anymore; it was everywhere, albeit to a lesser degree in areas with physicians who prescribed fewer opioids and higher rates of college graduates.

With the highest per capita rate of heroin use in the country, Baltimore residents were six times more likely to die from an opioid overdose than the national average.

The Ronnie Jones arrest, when it finally came in June 2013, was almost anticlimactic. Poetic, just about, the way it featured the usual cascade of drug-bust interactions: an informant tip, followed by a recorded buy that led to one of Jones’s main subdealers, a former Marine who’d been kicked out of the Corps for alcohol-related charges before spiraling into heroin addiction.

Later that day, when Metcalf finally got his first close-up look at Ronnie Jones in a county jail interviewing room in Front Royal, he found him to be “very smug, very arrogant.” The feeling was mutual. “He was very aggressive; he harassed people,” Jones said of Metcalf. Jones hated him for delivering a subpoena to the mother of his oldest child—at work, embarrassing and intimidating her, he said—and for interviewing Jones’s mom.

Metcalf and Jones hated each other instantly. But they had more in common than either of them knew.

Chapmanville was, in retrospect, another perfect breeding ground for the opioid epidemic, with OxyContin moving in just as most of the mines were shutting down in the late 1990s, and the only viable economic option—beyond disability and illicit drug sales—was joining the military, one that Metcalf took. He chose the Air Force because the recruiter promised he’d have a job in law enforcement waiting for him when he got out. Playing cops and robbers as a kid, he’d always insisted on being the cop. “I distinctly remember teachers skipping entire chapters in textbooks because ‘you will not need this when you are working in the mines,’” he told me in late 2016. It took precisely one visit to an active low-coal mine for Metcalf to understand that his future wasn’t at the bottom of one.

By arresting Jones, Metcalf was not only doing his job; he was atoning for the sins of his father. His wife, though, was starting to complain about his obsession with Jones—he routinely worked till midnight or later, leaving her stranded at home with their four kids. With every new conspiracy chart, he promised he’d request a desk job “after this case.”

The rule was: The money had to be paid back to Mack, via Western Union or MoneyGram, before the next order could be placed. The arrangement not only contributed to the exponential growth in heroin in Woodstock and bigger profits for both Mack and Jones, it also created a paper trail that Metcalf could follow. “They thought, ‘These country bumpkins will never figure this out,’” Metcalf said.

“We don’t have the capacity to try everyone involved in a ring of hundreds of people,” Wolthuis said. “But we do try to cut the heart out of the monster.”

But the rehab Jesse went to was aimed at abstinence, as most were, then and now. “The whole system needs revamped,” said Tracey Helton Mitchell, a recovering heroin user, author, and activist. “In the United States, we are very attached to our twelve-step rehabs, which are not affordable, not standardized from one place to another, and not necessarily effective” for the opioid-addicted. Clearly, more recent data supports ongoing MAT, but there is a catch: “One of the reasons people stay so hopeless about the epidemic is that, in any given episode, they only see a small proportion of people get into remission,” Harvard researcher John Kelly told me.

“I was puking,” Dennis recalled of their last day together. “I told him, I was like, ‘I gotta gotta get this dope.’” “I’m not trying to do dope,” said Jesse, who’d spent the summer injecting black-market Roxys. But the pills had worn off, and he, too, had been throwing up off and on all day. He tried eating his two favorite foods—McDonald’s chicken nuggets and macaroni and cheese—but couldn’t keep them down. As soon as Dennis made the buy, Jesse relented, deciding it would be his final hurrah before returning to rehab. They hosted a going-away party at a friend’s house. Late that night, a mutual friend broke down crying when she saw Jesse shoot up in front of people; he’d never before been so open about his heroin use, she told me. But Jesse assured his friends that he liked the rehab he was returning to. Even though he missed his mom and twin teenage sisters, Jesse said, he liked being with people his age going through the same struggle as he was. He hugged Dennis’s girlfriend, Courtney Fletcher, and told her, “I promise, I’m gonna be OK.”

I had just interviewed Dennis’s girlfriend, Courtney, the mother of his children. She was attending community college to become a paralegal; her kids went to a federally funded day care facility while Dennis’s father paid for their housing. She was working at McDonald’s in Strasburg, where Jesse bought his McNuggets on the weekend of his death. One of the low-level dealers in the Jones/Shaw ring—the guy who sold them the heroin that killed Jesse—often showed up at her drive-through window for food.

“The most damaging thing Purdue did, it wasn’t the misbranding of OxyContin they got in trouble for. It was that they made the medical community feel more comfortable with opioids as a class of drugs,” Kolodny told me. “But had the FDA been doing its job properly with regards to opioids, we never would have had this epidemic.”

Americans, representing 4.4 percent of the world’s population, consume roughly 30 percent of its opioids.

Among Roanoke’s first long-haul drug runners was a pretty brunet in her midtwenties whose name reflected her Hawaiian heritage: Ashlyn Keikilani Kessler.

She was an unlikely addict, a young mom and paralegal with a criminal justice degree from Jerry Falwell’s Liberty University. But her descent into drugs followed a familiar story line: After the birth of her son, in 2008, she was prescribed Lortab for mastitis, an infection not uncommon among breastfeeding mothers. She had lingering lower-back pain, too—the baby’s head had been resting on her spine throughout her last trimester. When the Lortab ran out, her obstetrician wrote her another script, for oxycodone. Within six weeks of giving birth, Ashlyn said, she was hooked. When her doctor left town after a few months and his replacement refused her refill requests, she bought black-market OxyContin through a friend of a friend. She occasionally stole Lortab from her disabled octogenarian grandfather. She switched to Roxicodone in 2010, when OxyContin became abuse-resistant, then to heroin when the black-market Roxys became more expensive and harder to get. “It’s unreal how many people followed that same pattern: Oxys-Roxys-heroin,” she told me. “If you ask me, OxyContin is the sole reason for all this heroin abuse. If I had the choice between heroin and Oxys, I would choose Oxys.…With pills, you always knew what you were getting.”

Two years into her addiction, she was fired from her job for too often being late or absent. Her co-workers had no idea she’d been shooting up in a stall of the law-firm restroom where they worked. (She had to have surgery once after a heroin needle became stuck in her arm but told colleagues “some crazy lie that I’d cut it on a fence.”)

Ashlyn realized there was no story to tell herself that didn’t begin with the first of the Twelve Steps, she told me: She was powerless to overcome her addiction. She was about to lose her son, who was six at the time, because she had chosen heroin over him.

“Most human organizations that fall short of their goals do so not because of stupidity or faulty doctrines, but because of internal decay and rigidification. They grow stiff in the joints. They get in a rut. They go to seed.”

“I worked just to use, and I used just so I could work,” Tess explained. “There was no in between.” But that phase was brief, and neither Tess nor her mom had any idea what was coming next. Or that the molecule had another even higher card to play. No matter how low Tess got, it seemed there was always a deeper and fresher hell awaiting her.

At the Roanoke city jail that night, with every pore on her body aching and every muscle spasming, a female jailer greeted her with a tiny cup. “Here, take this,” the jailer instructed. The woman handed Tess the medicine, which had been ordered as a result of a routine urine screen. Inside the cup was a low dose of Tylenol with the opioid codeine. It was designed to keep the fetus growing inside Tess from going into sudden, potentially fatal opioid withdrawal. Twenty-five and five foot seven, Tess was down to 120 pounds. She hadn’t had a regular period in two years. She had no idea she was at the end of her second trimester of pregnancy. At least in jail, for the immediate future, she and the baby were safe.

Back in 2015, Roanoke police chief Chris Perkins, forty-six, knew immediately fentanyl was going to be a game changer. It meant more teenagers would be drawn to the ever-potent blends, able to get high simply by snorting the drug and avoiding the stigma new users have about injecting and, later, the telltale track marks. It meant some would buy counterfeit pills that were sold to them as Xanax or oxycodone but were actually fentanyl.

Turn in your drugs, and I’ll hook you up with treatment instead of handcuffs. By early 2017, the Gloucester model, called Police Assisted Addiction and Recovery Initiative, had been adopted by two hundred police agencies in twenty-eight states.

Perkins hated political maneuvering. In his ideal world, the economics of securing help worked like this: Since addicts would be diverted from jail, the cost savings from their empty jail beds could be put toward treatment. “The problem is, it’s easier to give money to the corrections system—to the tune of one billion in the state of Virginia—than it is to take a couple of million dollars and provide inpatient treatment for our problem,” he railed, blaming politics and the tendency among jailers and sheriff’s departments to cling to bloated incarceration budgets championed during the War on Drugs, even though two hundred of the city jail’s eight hundred beds were typically empty.

Perkins pointed out that most addicted users return to the streets from jail with more drug contacts than they had when they arrived. “I said it all a thousand times, but I couldn’t get anybody to listen because the sheriffs are elected officials with powerful lobbyists, and a poor old appointed police chief doesn’t stand a chance,” he said.

Van Zee had no idea then that the OxyContin epidemic would become a heroin epidemic, which itself would lead to more deaths from HIV and hepatitis C. From a distance of almost two decades, it was easier now to see that we had invited into our country our own demise.

Asked what her goal was in early 2016, Tess told me: “To be a good mom to my son. For right now it’s just to get some good sober time, and eventually go back to school and live a normal life. Luckily, I have a nice family, and I’m not dead or serving prison time. I’ve been given second and third chances, so…”

Among public health officials, buprenorphine is considered the gold standard for opioid-use disorder because it reduces the risk of overdose death by half compared with behavioral therapy alone.

Almost every Virginia law enforcement official I interviewed for this book despised Suboxone, and most Virginia drug-court judges refused to allow its use among participants. (Nationally, roughly half of drug courts permit use of MAT, though the scales seemed to bend toward acceptance as the crisis deepened.) Critics compared the British makers of Suboxone with Purdue Pharma because of their zest for market saturation and noted that clinic operators have a financial incentive not to wean someone off the drug.

Tess relapsed not long after giving birth, Patricia discovered when she came home from a walk in the woods to find a man lurking around her mailbox. He told Patricia he’d come to return thirty dollars he owed Tess, but Patricia guessed, correctly, that he was a drug dealer. Tess went back to treatment in Galax for another month while the grandmothers kept the baby, then around six weeks old.

If you were drawing a Venn diagram comparing Suboxone attitudes among public health experts and criminal justice officials in the Appalachian Bible Belt communities where the painkiller epidemic initially took root, the spheres would just barely touch.

As early as 1963, progressive researchers conceded that designing the perfect cure for addiction wasn’t scientifically possible, and that maintenance drugs would not “solve the addiction problem overnight,” considering the trenchant complexities of international drug trafficking and the psychosocial pain that for millennia has prompted many humans to crave the relief of drugs.

It was February 2016, and Patricia believed Tess was using again—items from the house started vanishing, including a laptop, and she discovered empty heroin baggies in her bathroom trash—but Tess vehemently denied it.

By May, Tess was couch-surfing in low-rent apartments in southeast Roanoke and using heroin daily. She posted a cry for help on her Facebook page, ending with a quote from a Lil Wayne/Eminem song: “Been to hell and back / I can show you vouchers.” She went by the street name Sweet T. Though the Hope Initiative was still months from opening its doors, Jamie reached out to Tess on Facebook: “Call me if you need help. I might just know of something right up your alley, Girl. Much love.”

We were sitting in the same room where Coffman and Bill Metcalf had mapped out Jones’s heroin ring. It was next to the kitchen, where a TRUMP–PENCE sticker was pasted on the refrigerator door. Not only did the detective have zero empathy for the addicted, but he also lacked any scientific understanding of the morphine molecule’s pull. Nor did some of my dear friends, longtime members of AA, who remain staunchly opposed to harm reduction and MAT for those working its twelve-step program. “There’s a reason why some people think NA and AA are cults,” said Mitchell, who used methadone, needle-exchange programs, and a secular support program called LifeRing to treat her heroin addiction. “They can’t take in any other information because it throws a different light on their own personal recovery.”

“She felt she couldn’t get off anything unless she was on something else, but that’s what a lot of drug addicts do; it’s the addictive personality,” Danny Gilbert said. “I think it’s asinine to tell a drug addict you’ve got to be clean before you can come to my facility.” (In the treatment center’s defense, it couldn’t afford to have medical staff on hand to supervise detox and/or medications, Jamie said.)

“I was thinking to myself, ‘If this was Tess, how would you feel right now, family?’” She firmly believed that Tess still had the potential to recover, to become a loving mother to her son. Patricia was still showing her grandson family pictures, coaching him to say “Mama” when she pointed to Tess. But new custody issues were emerging that Patricia kept secret from Tess—and she knew that Tess could die before they were resolved. She had already chosen the spot where she would sprinkle her daughter’s ashes if it came to that: at a confluence of the Cape Fear River and the ocean where they had loved walking the dogs and searching for sand dollars, not far from the family’s old beach house.

It was Mother’s Day 2017. Tess wished Patricia a happy one, via text. “I love you,” Tess wrote. “But this [is] bullshit all of it,” especially being away from her son. “I’m going to [find] a way home,” she said. She signed the text to her mother ominously, using her street name: Sweet T.

“I’ve read The New Jim Crow twice,” Ronnie said. He’d also read lawyer Bryan Stevenson’s majestic Just Mercy, a memoir about his work against the racial bias and economic inequities inherent in the criminal justice system, which included efforts on behalf of falsely accused death row inmates. “It had me crying when I read it,” he said. These books we had both read challenged the tough-on-crime government narrative of the past forty years, one that fostered the shift in public spending from health and welfare programs to a massive system of incarceration, with a fivefold increase in imprisonment and corrections spending that soared from $6.9 billion in 1980 to $80 billion today. Whereas Bill Metcalf, the ATF agent largely responsible for Jones’s twenty-three-year prison sentence, took inspiration for his life’s work from the image of the brain frying like an egg and Nancy Reagan’s “Just Say No” slogan, Alexander and Stevenson saw fearmongering and institutional racism in mandatory minimum sentences, three-strikes sentencing laws, the abolishment of parole, and “stop and frisk” policing. This was Ronnie’s third time in prison. He already knew that one in three black men was destined to end up incarcerated, only to find himself branded as a felon and second-class citizen the moment he got out, blocked from the mainstream economy and propelled into a dystopian loop of jail, joblessness, and back to jail. He knew that drug-involved offenders, who represent half the incarcerated...

Why had blacks failed to become ensnared in opioid addiction? That question was addressed in 2014 data issued by the Centers for Disease Control and Prevention: Doctors didn’t trust people of color not to abuse opioids, so they prescribed them painkillers at far lower rates than they did whites. “It’s a case where racial stereotyping actually seems to be having a protective effect,” marveled researcher Dr. Andrew Kolodny of Brandeis University. Put another way: By 2014, while young whites were dying of overdose at a rate three times higher than they did in 2002, the death rate for people of color was relatively unchanged.

Ronnie was obstinate to a fault, recalled Thomas Jones III, and would talk back to teachers and to their mom. “The weird thing is, he wasn’t a very bad kid; it was more of his total disregard, at times, for authority. I learned that it was best just to try to stay out of his warpath.” Now a music promoter based in Charlotte, Thomas Jones said his brother had a brilliant business mind and had helped him, when he was younger, with his advanced math homework even as he refused to do his own. Their family was not without connections. His uncle Petey Jones was a linebacker on the 1971 state-champion team memorialized in the movie Remember the Titans, which was set against a backdrop of racial tensions brought on by the integration of Alexandria’s high schools.

“I play those incidents over and over in my head,” he said of his first few legal charges. “If I had never drove that girl’s car and then [the car with the stolen goods], I could’ve been probably in the military now and having a regular life.” Jobs were hard to get. Because of Ronnie’s felony record, his applications were turned down by Burger King, McDonald’s, Walmart, and Lowe’s. For a time, he worked at Food Lion in Maryland, driving an hour each way to get there. A cousin introduced him to cocaine dealing, he said, whereupon Ronnie realized that he could stock shelves for two weeks and not come close to making what he could dealing drugs in a single day. The math was irresistible.

Though he’s never been in legal trouble, Thomas said he is regularly profiled, pulled over ostensibly for speeding—presumably because he’s a thirtysomething black man with tattoos driving a Lexus through his middle-class Charlotte neighborhood. Though the experience is frightening, he always looks forward to the moment in the exchange when the officer runs his license, and it comes back crystal clean, with the vehicle registered to his wife, a third-generation operator of a successful bail-bonding company. “I don’t have the leverage to get smart or act crazy when I get pulled over,” he said. “My goal every day is to make it back to my wife in one piece so I can live to fight another day, so I’m just ‘yes, sir, no, sir,’ and all that.” He feels for Ronnie and other ex-offenders getting out of prison. “They don’t rehabilitate you in prison, and they don’t make it easy for you to get a job. I truly believe they don’t make it easy because they want you back, and they want you back because that’s the new factory work in so many places now—the prison.

“I promised myself I’d never grow up to be like my father, and while I may not have an addiction to an actual drug, I do feel my addiction,” he said. “I’m addicted to that lifestyle. It wasn’t my intention. I didn’t want to do it. But no one would give me a job in the field I’d trained for, and no one would let me create my own.”