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

by Beth Macy

“Ritalin is a pipeline to disability here,” one Lee County health care manager told me, describing the federal program as a coping mechanism for poverty and workplace uncertainties.

A hospital administrator I know from nearby eastern Kentucky recalled a Drug Abuse Resistance Education officer asking her high school classmates what they wanted to be when they grew up. “A drawer,” one young man said. “You mean an artist?” “No, a draw-er.” Someone who draws disability checks. It was the only avenue he could imagine for himself, the only way to get himself and his family fed.

Well over half of Lee County’s working-age men—a staggering 57.26 percent—didn’t work. (The trend line was somewhat bette...

If OxyContin was the new moonshine in rural America, disability was ...

By 2016, for every unemployed American man between the ages of twenty-two and fifty-five, an additional three were neither working nor looking for work. Having dropped out of the workforce entirely, they had numerically vanished from the k...

Disability claims nearly doubled from 1996 to 2015. The federal government spent an estimated $192 billion on disability payments in 2017 alone, more than the combined total for food stamps, welfare, housing subsidies, and unemployment assistance.

Those of us living highly curated and time-strapped lives in cities across America—predominantly mixing virtually and physically with people whose views echoed our own—had no idea how politically and economically splintered our nation had become. And also how much poorer and sicker and work-starved the already struggling parts of the nation truly were—because we didn’t follow that story.

We were safe in our ignorance, or so we thought—content to stereotype drug addiction as the affliction of jobless hillbillies, a small group of inner-city blacks, and a few misguided suburban kids. But another invisible hand was upon us. Heinrich Dreser’s drug moved seamlessly across city and county lines, with zero regard for politics, race, neighborhood, or class.

Like so many of the region’s petty thieves, the arsonist was propelled by fear of becoming dopesick, added another local prosecutor, who told me that 75 percent of all police calls in the county now involved heroin or methamphetamine, or, increasingly, a combination of both.

“Crystal meth controls all the dockets now” in rural Virginia, a local drug task force officer told me. “If you’re addicted to painkillers, you become so lethargic you can hardly function. But meth keeps you going if you need to run the streets to go get your next dose of heroin or pills, to keep you from getting sick. It allows you to function. There’s a reason they call it ‘high-speed chicken feed.’

But I had failed, just as the police and parents had, to connect young adults like Spencer to the rural addicted, even though Spencer told me he’d come to his heroin addiction the same way they had—through prescription opioid pills.

Our culture seems to excuse drug- and other risk-taking in white middle- and upper-middle-class kids, especially young men. The same liberties, when taken by rural poor whites or people of color—wherever they live—come across as more desperate, born of fundamental wants or needs that can’t be satisfied. But as I’ve come to learn, gauged strictly by drug use, there is no less urgency and desperation in America’s middle and upper classes today.

People whose parents or grandparents were drug- or alcohol-addicted have dramatically increased odds of becoming addicted themselves, with genetics accounting for 50 to 60 percent of that risk, Lembke explained; she noted that the correlation between family history and depression is much lower, 30 percent. Other risk factors for addiction include poverty, unemployment, multigenerational trauma, and access to drugs.

“It’s important to note, it’s really not just the unemployed and the poor who are vulnerable today; it’s really everybody, especially underchallenged youths or youths who aren’t engaged in school or other meaningful activities,” Lembke said.

“One time I got pulled over, I had ten bags at my feet, and they didn’t know what it was so they didn’t look at it.”

“We’d sometimes have one overdose where the son would die, then the next day the father would die, then the next day the mother would die,” the Roanoke-based medical examiner said. “If it had been an infectious disease, there would have been widespread panic.”

State health officials in Richmond had originally dismissed her research, telling her the same thing they’d said to Sue Cantrell, the rural health-department director: “This is a regional problem.”

Opioids infiltrated the toniest suburbs not by way of families but by peer groups.

“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.

Back then you could maintain that way because the drug’s potency was low—3 to 7 percent, compared with 40 to 60 percent today—and the police paid little attention, since white kids in the suburbs weren’t dying or nodding out in the football bleachers.

“But the moment it crossed those boundary lines from the inner city into the suburbs, it became an ‘epidemic,’...

“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.

In the wealthiest Roanoke County suburbs, illicit pill-taking commenced, shared on TruGreened lawns, next to school lockers, and in carpeted basements while clueless parents in Cave Spring and Hidden Valley were making family dinners upstairs.

Spencer’s master class in drug abuse had gone unheeded, boxed away into a category of Things That Happen to Other Families.

Andrew Bassford, the assistant U.S. attorney who prosecuted Spencer’s case, took an angry phone call from the Roanoke County school superintendent, who was mad that he’d openly addressed the accessibility of heroin and OxyContin in her schools. “How dare you tell the newspaper these things?” the superintendent seethed. Bassford, who also works as a brigadier general in the U.S. Army Reserve, was unmoved by the scolding. “I say these things because I know them to be true,” he said. “Your schools are a pit because your students have money, and money attracts drugs.”

Victoria remembered the first time she tried to crush an abuse-resistant Oxy, following Purdue’s long-awaited reformulation in 2010, and it worked exactly as Barbara Van Rooyan envisioned it would when she petitioned the FDA, demanding an opioid blocker, or antagonist, be added to the drug: “If you tried to crunch ’em, they’d gel up on you. You couldn’t even snort ’em, let alone shoot ’em. After that, the pills either went dry or were just too expensive to get. And everybody who used to deal pills starting dealing heroin instead.”

Almost to a person, the addicted twentysomethings I met had taken attention-deficit medication as children, prescribed pills that as they entered adolescence morphed from study aid to party aid. On college campuses, Ritalin and Adderall were not just a way to pull an all-nighter for the physics exam, never mind that they were prescribed to your roommate, not you; they also allowed a person to drink alcohol for hours on end without passing out.

Between 1991 and 2010, the number of prescribed stimulants increased tenfold among all ages, with prescriptions for attention-deficit-disorder drugs tripling among school-age children between 1990 and 1995 alone.

“And we’re prescribing to ever- and ever-younger children, some kids as young as two years old,” said Lem...

Lembke pins the opioid epidemic not just on physician overprescribing fueled by Big Pharma but also on the broader American narrative that promotes all pills as a quick fix. Between 1998 and 2005, the abuse of prescription drugs increased a staggering 76 percent.

“What happens is, we’ve changed our whole culture, from one where kids don’t take pills at all to one where you’ve got a third or more of kids who are on pills to stay well because of what are believed to be chronic health conditions,” Burton said. “They get so used to taking pills that eventually they end up using them for a recreational high.”

So it went that young people barely flinched at the thought of taking Adderall to get them going in the morning, an opioid painkiller for a sports injury in the afternoon, and a Xanax to help them sleep at night, many of the pills doctor-prescribed.

So it went that two-thirds of college seniors reported being offered prescription stimulants for nonmedical use by 2012—from f...

After snorting the crushed-up Oxys, inhaling the heroin powder was easy—and the heroin was cheaper, more intense, and, increasingly, it was everywhere he went.

Though he was deeply troubled by Scott Roth’s death, little else but drugs mattered anymore.

“It was like shooting Jesus up in your arm,” Brian said of his first IV injection. “It’s like this white explosion of light in your head. You’re floating on a cloud. You don’t yet know that the first time is the best. After that, you’re just chasing that first high.”

“I would spend six hours a day driving around Roanoke picking up drugs, waiting for phone calls, going to ATMs.”

“The cellphone is the glue that holds it all together for the modern drug user,” Brian told me. “In high school, I snuck out of the house a number of times to meet people at the bottom of the driveway, and my parents had no clue. Aside from taking my cellphone away, my parents also could have looked at my text message logs and gotten a sense of what was going on.”

Between the outpatient Suboxone programs (none of which worked, the family said) and multiple residential rehabs and aftercare sober-house programs (two of which, eventually, did), the Waldrops would spend more than $300,000 on treatment—not counting the drug-related legal fees or the thousands in stolen checks and credit-card bills for gift cards, which were traded to dealers for drugs. (A $200 gift card goes for $120 worth of pills, Jamie explained.) “I was a pretty bad robber,” Christopher, her youngest, said.

“We lived like that for years; it was our new normal. Until they go off to rehab, you don’t realize just how dysfunctional your life has become.”

“We got most of our pills from him,” Christopher said of the middle-aged addict. “He’d get four hundred thirties [Roxicodone], then some fifteens [Roxicodone], Xanax, and Klonopin all prescribed to him at once by the same crooked doctor. You can use a lot and still make five thousand dollars a month off that, if not more.”

The weekend of Colton’s death was supposed to be his last hurrah before getting clean. He had an appointment with an addiction specialist lined up for Monday—he’d stuck not one but two Post-it notes on the dashboard of his car reminding him to go.

Two years before Colton’s death, a family friend in Fredericksburg, Virginia, lost his son to a heroin overdose, and Drenna remembered thinking, “Why can’t you control your kid?” She apologized, later, for having judged.

“At first you’re just so embarrassed,” Drenna said. “You think you’re doing right as a parent, but then these drugs take over their life, and nobody talks about it because it’s this dark, hidden secret.”

“They think they’re invincible.”

How many addicts, after all, have moms who can afford not just to send their dopesick son to a second $30,000 rehab but also to accompany him on his flight to Montana so he won’t, at the last minute, back out?

Fewer than one-quarter of heroin addicts who receive abstinence-only counseling and support remain clean two or more years. The recovery rate is higher, roughly 40 to 60 percent, among those who get counseling, support group, and medication-assisted treatment such as methadone, buprenorphine, or naltrexone.

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.

Across the nation, police chiefs and sheriffs were beginning to lament, “We can’t arrest our way out of this epidemic.” That sentiment illuminated the folly of the decades-long War on Drugs, in which drug users are arrested four times more often than those who sell the drugs.

The local emergency room was by now accustomed to the classic fake and fraud: a moaning patient claiming kidney stone pain and pleading for Dilaudid, also known as “that one that starts with a D.”