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

by Beth Macy

After a day passed, I tried to break the news gently to Kristi over the phone that Ronnie hadn’t even recognized Jesse’s name. In that respect, Ronnie Jones was no different than the drug reps in their tailored suits and SUVs: He had failed to see the harm his drugs had caused. And why should he be any different?

If my own child were turning tricks on the streets, enslaved not only by the drug but also criminal dealers and pimps, I would want her to have the benefit of maintenance drugs, even if she sometimes misused them or otherwise figured out how to glean a subtle high from the experience. If my child’s fear of dopesickness was so outsized that she refused even MAT, I would want her to have access to clean needles that prevented her from getting HIV and/or hepatitis C and potentially spreading them to others.

In Appalachia, he conceded, poverty and poor health were not only harder to camouflage; they were increasingly harder to recover from. For decades, black poverty had been concentrated in urban zones, a by-product of earlier inner-city deindustrialization, racial segregation, and urban renewal projects of the 1950s and 1960s that decimated black neighborhoods and made them natural markets for heroin and cocaine. Whites had historically been more likely to live in spread-out settings that were less marred by social problems, but in much of rural America that was clearly no longer the case. These were the same counties where Donald Trump performed best in the 2016 election—the places with the most economic distress and the highest rates of drug, alcohol, and suicide mortality.

She’d floated the idea of turning some of the area’s subsidized housing units into “clean living facilities,” with wraparound services and support group offerings, not unlike substance-free college dorms. “We need to support this as a chronic disease the same as we support cancer and other diseases,” Cantrell said. “Not just evidence-based treatment and drug prevention programs but broadening it to meaningful education that leads to jobs with a living wage so there are options to stay in the area—or to leave.”

How do you inspire hope in a middle-school boy whose goal in life is to become a “draw-er,” like his parents before him and their parents before them? Did a president who bragged about winning a swing state—telling the president of Mexico, “I won New Hampshire because New Hampshire is a drug-infested den”—win because voters genuinely thought he could fix it, or because too many people were too numbed out to vote? Voters should judge politicians at all levels on the literal health of their communities, lawyer Bryan Stevenson explained. And while most Americans support federal financing of health care and even a slim majority approves of single-payer, those reforms will likely remain political nonstarters until more voters begin defining themselves in contrast to the billionaire class holding sway in Washington. Also needed are more efforts to court nonwhite voters, including Hispanics (of whom 74 percent are currently registered to vote), African Americans (69 percent), and Asian Americans (57 percent).

Rather than puritanical platitudes, we need a new New Deal for the Drug Addicted. But the recent response has been led not by visionaries but by campaigners spewing rally-style bunk about border walls and “Just Say No,” and the appointment of an attorney general who believes the failed War on Drugs should be amped up, not scaled back. Asked in August 2017 why he hadn’t taken his own commission’s recommendation to label the epidemic a national emergency, President Trump dodged the question. He said he believed the best way to keep people from getting addicted or overdosing was by “talking to youth and telling them: No good, really bad for you in every way.” A few days later, he seemed to change his mind, saying he would make the emergency official, even as he remained tethered to a law-and-order approach.

To be fair, the crisis had been cruelly ignored by both sides of the political aisle. The Obama administration had also been slow to address the crisis and tepid when it did. Caroline Jean Acker, the historian who is also a harm-reduction activist, told me she was scolded during a 2014 NIDA meeting for championing needle exchange and naloxone distribution after a speaker attempted to separate “good” addicts, or people who became medically addicted, from the illicit, or “bad,” users—as if there were no fluidity between the two. “The worst thing for politicians, I was told, was for them to appear they were being soft on drugs. Even under Obama, federal [Substance Abuse and Mental Health Services Administration] employees were told not to use the term ‘harm reduction,’” she said, sighing.

Even law enforcement tightened up procedures. In June 2017, the DEA recommended that first responders wear safety goggles, masks, and even hazmat suits to avoid skin contact with fentanyl and other powerful synthetics after reports of officers having to be Narcanned when they inadvertently brushed up against them on calls. But these guidelines came way too late for caregivers in the coalfields: Tyson’s life-and-death scare in Clinchco took place more than a decade earlier—in 2006.

Everywhere in America, it was painstaking to walk skeptics through the social, criminal, and medical benefits of helping the least of their brethren, but worth it—even if you had to get your ass kicked.

The local schools had recently adopted new prevention models, after studies showed kids were more likely to use drugs after DARE. (One advocate told me she remembered her classmates sharpening the DON’T off their DARE pencils so they actually read DO DRUGS.) A new school policy diverted first-time juvenile offenders into treatment instead of expulsion or jail.

At one meeting, Loyd tried to explain the science behind addiction—that it was a chronic brain disease, and relapses were to be expected—when a woman in the audience interrupted to ask, “Just how many chances are we supposed to give somebody?” He tried to appeal to the group’s humanity, as Gaeta had done in Boston, pointing out that addiction already was in their neighborhood. Simply turning their heads away out of fear or sanctimonious denial was equivalent to enabling the spread of overdose deaths—quite possibly, even, in their own families.

If the federal government wouldn’t step in to save Appalachia, if it steadfastly refused to elevate methods of treatment, research, and harm reduction over punishment and jail, Appalachia would have to save itself.

Two years earlier, Robin had moved into an apartment, downsizing from the suburban split-level where she’d raised her only child. It had been hard to leave the Hidden Valley home: the place where she’d removed all the bathroom doors, thinking that might keep Scott from shooting up; the yard where she’d grown the massive sunflower field after his death. Occasionally, stray sunflowers still sprout up in the yard of her former home—eight feet tall, some of them, with a dozen or more blooms. They are not just memorials to Scott Roth but also to the epidemic’s intractability. The young woman who bought Robin’s house had not only been addicted to heroin herself (she’s been sober now for more than four years), but her sister, twenty-seven-year-old Joey Gilbert, is the one who relapsed and died in March 2017, despite the Hope Initiative angels’ herculean efforts to help her. Had Joey had access to Medicaid health insurance and a clear path forward for continuing her MAT, her family firmly believes, she’d be alive today.

By the time the women lined up a facility that would allow her to be on MAT, Betsy had fled to New York, partly to avoid an upcoming court date for drug charges. A few days later, she overdosed on fentanyl-laced heroin in Central Park, where EMS workers revived her and let her go. The last Janine heard from Betsy, she had taken off for New Jersey, where she was now presumably trading sex for drugs.

“The problem is, we don’t even know where she is” or, worse, what pimp and/or drug dealer she was now beholden to. In a November 2017 phone call, Tess was hopped up on crystal meth, Patricia believed, and paranoid that “gang stalkers” were trying to kill her. As she walked down the streets of Las Vegas, she thought people in passing cars were flashing their lights at her. She thought strangers were shouting her son’s name. “All Tess has to do is tell us where she is, and the treatment people will come and pick her up.”

On Christmas Eve, in the Dumpster of a central Las Vegas apartment complex, a homeless man foraging for cans discovered Tess. She was naked, inside a plastic bag, and there were partial burns on her body and the bag, as if whoever murdered her had tried to erase the evidence of her death. The cause of death was blunt head trauma. The story made national news, and Patricia, determined that people should understand both the disease of addiction and her daughter’s incredible strength, spoke to every reporter who contacted her. The attention made some family members uncomfortable.

She was dead now, her grieving family a perfect microcosm of the nation’s response to the opioid epidemic: well-meaning but as divided as it was helpless, and utterly worn out.

Tess finally made her flight home the night of December 30. It was unseasonably cold in Virginia, the winds howling and furious. The snow flurries reminded Patricia of all the cold nights she’d spent worrying about Tess. She was still sleeping with her cellphone, awaiting Tess’s transport to Roanoke. Just after midnight, she texted me: Her body has arrived. It took funeral-home technicians two days to make Tess presentable enough for Patricia to view her body. Her head had been shaved in Las Vegas, for the collection of evidence, and Tess’s older sister had picked out an outfit from one of Tess’s favorite shops, including an embroidered vest, leggings, and a bright silk-cashmere headscarf with a boisterous, smiling Frida Kahlo. In a windowless nook of a downtown Roanoke funeral parlor, not far from where Tess once roamed the streets, Patricia caressed the back of the scarf, as if cupping a baby’s head, and told her poet goodbye. It was January 2, Tess’s birthday. She would have been twenty-nine. Patricia tucked the treasures of her daughter’s life inside the vest—a picture of her boy and one of his cotton onesies that was Tess’s favorite, some strands of Koda’s hair, and a sand dollar.

“If I could wave a magic wand, I’d want everybody to get educated about addiction,” said Angie Gray, the Martinsburg public-health nurse—a sentiment that consistently rose to the top among the experts I talk to. “In Appalachia, it used to be we’d mow each other’s grass, take food to people who were needy. But because of this opioid crisis, we’ve started to turn on each other, and we’re trying to find someone to blame, when the blame is much higher above us.”

Martin Luther King Jr. wrote that “the moral arc of the universe is long, but it bends toward justice.” History will eventually prove these addiction-treatment innovators correct. But how many people struggling with opioid-use disorder will die before bureaucratic gatekeepers in our courts, health departments, governments, and police departments figure out that it’s actually their job to foster change and that they, too, could be turning handsprings?