I followed up my reading of Barbara Kingsolver’s Demon Copperhead with Beth Macy’s nonfiction report of the opioid crisis, Dopesick. I missed it when it was published, or rather knew it existed, but figured I knew the story. And, I did, but in only a general, standing outside looking in kind of way. Drugs were devastating communities in southwest Virginia, already devastated by poverty as the coal industry tanked.
Macy, a reporter based in Roanoke, Virginia, a city central to the story, introduces us to the human beings living out my truncated summary. Like Kingsolver, she begins in Lee County, Virginia, where a few locals were sounding alarm bells decades before anyone was paying attention, and then moves her narrative up Route 81, the “heroin highway,” Along the way, she stops in Abingdon, Virginia, where Purdue Pharma executives, makers of Oxycontin, were forced to face at least some accountability, a fine with no jail time, an insult to those who suffered from their ruthless marketing and deep legal pockets.
She spend times in her own town, particularly the privileged suburbs where nice white kids were suddenly dying, and one of them, son of a local business woman, was heading to prison for providing the killing dose of heroin. From there she goes to Woodstock, a bucolic community in the northern Shenandoah Valley where a mother hopes to ease her grief a bit if she can understand why her beloved son died.
As most of the victims themselves are either deceased or disappeared, Macy spends most of her time with mothers and local activists, some of whom managed to survive addiction and are now devoting their lives to saving others against overwhelming odds. It’s clear that, while Kingsolver used David Copperfield as the basis for her characters and plotting, the contemporary setting and events are drawn from Macy’s book from sleazy doctors who take advantage of addicts to pharm parties where young people pass around bowls of various types of pills, a sort of Russian roulette.
A friend told me that after I read Dopesick, I would be pissed. And, he was right. If you want to hear directly from a primary source, Dr. Van Zee, the Lee County doctor who sounded those early alarms, testified in front of the Senate Committee on Health, Education, Labor, and Pensions in 2002 as part of a discussion of balancing the risks and benefits of Oxycontin. The whole testimony is worth a read but do a search on Van Zee to get to his remarks. And just a reminder that these remarks were made ten years before that Roanoke County boy went to prison for supplying the heroin that killed his friend and sixteen years before Macy’s book was published.
Kingsolver’s characters are largely poor rural whites, those at the forefront of the epidemic, the ones Van Zee was seeing in his clinic in the early days of Oxy. Demon references the rich kids in high school, those whose parents owned the coal mines and other industries, but they are not really part of the story. And for most people the opioid crisis wasn’t a story until it moved out of the inner cities and mountain hollows. Nice, middle class white kids were dying, and suddenly people wanted to know why. But, even then, the response from law enforcement, medical authorities and government officials was simply inadequate to the magnitude of the problem and, as Macy calls it, the morphine molecule itself.
I learned a new word from this book: iatrogenic, or doctor-cause addiction. I was reminded of an interview Terry Gross did with Travis Reider, a bioethicist who found himself addicted to painkillers after a motorcycle accident. He described the dysfunction around opioids and makes the same point Kingsolver and Macy do: the medical community is good at getting people addicted but then walk away when help is needed to get clean as though it wasn’t their fault that you followed their directions.
I have just begun Macy’s new follow up, Raising Lazarus. She is chronicling the work of those on the front lines of the continuing epidemic, particularly people who are doing harm reduction through handing out syringes, fentanyl test strips, and Narcan, all controversial practices. Underlying their work is the belief that those suffering from substance abuse disorder are loved and respected as human beings under the power of a force greater than themselves.