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

by Beth Macy

“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.”

the system is inept and flawed.

The drug’s too addictive, the money too good. “You whack one [dealer], and the others just pop right up, like Whac-A-Mole,” Bassford said.

“We’ll score a huge drug bust that we’ve been working on for maybe a year, and all that does is create a vacuum in the market that lasts maybe five to seven days,”

Before the rule took effect, patients could have their pills refilled automatically as many as five times, covering up to six months—one reason narcotic prescriptions quadrupled from 1999 to 2010, and so did deaths.

With the legalization of marijuana in a growing number of states, drug cartels were champing at the bit to meet the demand for heroin, a market they needed to grow. “They were looking at a thirty to forty percent reduction in profits because of legalization,”

“The market is so saturated, I can’t say it enough: There is so much heroin out there,” sold not only by former crack dealers eager to diversify their product but also by subordinates, or subdealers, Perkins said. So much that Roanoke police seized 560 grams of the stuff in 2015 alone—the equivalent of 18,666 doses or shots.

The idea was to create a public-private partnership where “angels,” or trained volunteers, helped funnel addicts into treatment, mentoring them during the cumbersome and usually relapse-ridden march toward sobriety—kind of like an on-call NA sponsor, only with the skills of a social worker able to take advantage of the city’s housing, mental health, and job resources.

Virginia’s legislature had repeatedly turned down attempts to pass Medicaid expansion in the wake of the Affordable Care Act, sacrificing $6.6 million a day in federal funds and insurance coverage for four hundred thousand low-income Virginians—a frequent source of frustration for opioid-affected families and health care advocates.

“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,”

But Frederick Douglass had it right when he said, “Power concedes nothing without a demand.”

HIV, spurred by the sharing of dirty heroin needles, was on the rise again, with sixty-five new cases reported that year in rural southwestern Virginia alone.

An NAS baby is a portrait of dopesickness in miniature: Their limbs are typically clenched, as if in agony, their cries high-pitched and inconsolable. They have a hard time latching on to either breast or bottle, and many suffer from diarrhea and vomiting.

barriers to treatment were more formidable than she’d understood, as was the epidemic’s scope. It wasn’t just the money and limited treatment capacity that waylaid people; it was the morphine-hijacked brain, the scrambled neurotransmitters that kept people from thinking clearly or regulating their pain with nonnarcotic substances, or imagining the possibility of feeling happy again.

“I want to get this out of me,” John told Janine, between screams. “It’s like a demon, and I want to get it out.”

Government help was on the way in many states, but the national treatment tapestry remained a hodgepodge, divided not only along geographical but also firm ideological lines.

The latest research on substance use disorder from Harvard Medical School shows it takes the typical opioid-addicted user eight years—and four to five treatment attempts—to achieve remission for just a single year. And yet only about 10 percent of the addicted population manages to get access to care and treatment for a disease that has roughly the same incidence rate as diabetes.

it is killing people for that myth to be out there—that the only true cure is abstinence.”

I had the better part of a day to try to discern how a sleepy agricultural county nestled in the Blue Ridge Mountains, with covered bridges and lovingly preserved two-hundred-year-old log homes, had gone from having a handful of heroin users to hundreds in a few short months, and how much Ronnie Jones was to blame for it.

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.

Winchester was becoming a magnet for people in recovery across the state, including ex-offenders who came for treatment and ended up staying because of its multitude of halfway houses—fourteen in a city of just twenty-seven thousand people—and of newly announced jobs.

In 2016, the Woodstock office had two probation officers tasked with doing monthly check-ins, field visits, and drug screening for 204 people,

“If we reduced our prison population by twenty-five percent, that’s twenty billion dollars we could save. And if we invested half of that in treatment, we could really increase people’s likelihood of success.

Portugal, which decriminalized all drugs, including cocaine and heroin, in 2001, adding housing, food, and job assistance—and now has the lowest drug-use rate in the European Union, along with significantly lowered rates of drug-related HIV and overdose deaths. In Portugal, the resources that were once devoted to prosecuting and imprisoning drug addicts were funneled into treatment instead.

The birthplace of the modern opioid epidemic—central Appalachia—deserves the final word in this story.

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?

America’s approach to its opioid problem is to rely on Battle of Dunkirk strategies—leaving the fight to well-meaning citizens, in their fishing vessels and private boats—when what’s really needed to win the war is a full-on Normandy Invasion.

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.

CDC figures showed that residents of two rural Virginia towns had been prescribed more opioids per person than any other place in the country. (The top locality was Martinsville, and the fourth was Galax,

“The more we talk about the epidemic as an individual disease phenomenon or a moral failing, the easier it is to obfuscate and ignore the social and economic conditions that predispose certain individuals to addiction,”