Former Roanoke Times journalist Beth Macy was reporting what would become her best-selling 2014 debut book, “Factory Man,” about a Bassett Furniture chairman’s fight against the tide of globalization, when she first heard the warnings.
Deputies from Henry County around the Martinsville area were saying that nearly all of their calls were related to heroin and crystal meth. Macy had been reporting on abandoned Bassett plants accidentally being burnt down by desperate folks ripping the copper wire out of the buildings to resell.
At first, the reporter didn’t put the two stories together.
“I thought it was just economic desperation,” Macy says from her Roanoke home while discussing her searing new book, “Dopesick: Dealers, Doctors, and the Drug Company that Addicted America.” With devastating clarity, the author charts the rise of an opioid epidemic that began in Southwest Virginia and is now blamed for 145 American deaths daily. Data emerged a year ago showing that Martinsville had the number one opioid prescription rate in America.
“This goes back to Purdue Pharma reps using data they bought, targeting areas with high disability claims and work injury in places dominated by one business or industry,” she explains. “Their goal was to find doctors already prescribing immediate-release opioids so they could convert those doctors to OxyContin, which would last over 12 hours for uninterrupted sleep. But it was much, much stronger.”
As part of their assault on common sense, the drug reps argued that OxyContin was addictive in less than 1% of all cases, using virtually no scientific data, she notes.
“The FDA allowed them this squishy claim that Purdue trumpeted as fact. It was repeated over and over again like a game of telephone gone awry, as I write in the book,” Macy says. “So many forces at work created this perfect storm: from a big push in managed care insurance that covered pills but not physical therapy, to all the money that was spent by pharma on lobbyists and political contributions.”
And just how much money are we talking? Try a billion in lobbying efforts alone, eight times more than the gun lobby, according to Macy. Her book may seem like it's arriving a little late, but that’s not the fault of the author. In 2013, she wrote a three-part series for The Roanoke Times about how heroin use had suddenly jumped into middle and upper class suburbs.
“People didn’t really get it at the time,” she says, noting that her agent was nonplused when she originally pitched a book on the subject. So she began working on a different nonfiction book, “Truevine,” about two African-American brothers stolen from their Roanoke family and forced into carnival life. That successful book has been optioned by actor Leonardo DiCaprio, while “Factory Man” was so beloved by Tom Hanks that he is planning to produce an HBO mini-series. Both projects are in active development but not yet greenlit, Macy says.
Since the publication of "Dopesick," the author has kept in touch with many of her sources -- namely, grieving mothers. It’s easy to see why they open up to her on a painful subject; Macy has a warm and engaging personality as well as the burning curiosity and empathy of a top-tier journalist. By the time she went back to her agent with ideas for her third book, the heroin problem and its connection to gateway opioid pills were better known. Her publisher finally got behind the idea.
“With the decline of newspapers, we don’t cover these distressed communities anymore,” Macy says. “Also we don’t go back and say how are people doing there now. … I really think [journalist] Robert Caro’s ‘time equals truth’ is true.”
Another reason “Dopesick” stands out within the growing company of books on this subject is Macy’s exploration of the heated debate around treatment strategies. These include abstinence-only, 12-step programs and ongoing drug treatment, or medication-assisted treatment, known as MAT. In France, where all physicians can prescribe the suppressive opioid medication, buprenorphine, overdose rates plummeted a whopping 87%. During her research, Macy found only two rehabs in Virginia that allow patients to use MAT-- in Galax and Northern Virginia.
“Not enough doctors here are waivered to prescribe MAT, there are unwieldy federal regulations that create waiting lists,” the author says. “If we know they prevent overdose deaths in 40 to 60% of cases, why aren’t we making those more widely available with counseling and social supports as science suggests is the best way?”
One reason is that many doctors and blood technicians are worried about the stigma of hard drug users in their waiting rooms, she says. That's what led Macy to deliver an angry speech to a conference of doctors at Carilion Roanoke Memorial Hospital. “I said, at the very minimum, every doctor who took a free item from a pharmaceutical company should feel morally compelled to get a waiver to prescribe buprenorphine – and the response was crickets. They don’t want to hear it.”
Macy admits the topic of her latest book is a depressing one. Pages are filled with wasted and traumatized lives, as well as angelic heroes who take on the system and help those suffering. However she’s such a skilled writer and reporter, really a Virginia treasure, that she found ample moments of humor and historical context -- for example, you’ll learn the term ‘hipsters’ came from Chinese opium smokers leaning on their hips. Her bright curiosity allows the reader to soldier through darker horrors for a panoramic view of our pill-happy society.
While working at Virginia Center for the Creative Arts’ Sweet Briar writing colony, Macy utilized the Library of Virginia website and its archives. She stumbled across a letter from 1884 in Richmond’s Daily Dispatch written by a doctor begging the General Assembly to ban morphine, then widely being used by former soldiers; this was back when Bayer had introduced heroin to kids' as cough medicine - go figure.
What she saw in the doctor’s letter still gives her chills.
“He says something like, if we don’t get a handle on this problem, we’re going to get so numbed out we’re going to elect a despot,” she recalls. “Thank God for archives!”
Macy stops short of making a direct connection between Donald Trump’s victory and the opioid epidemic.
“[Rural voters] are not stupid. But hey, the Democrats weren’t even talking about helping them out,” she says. “Trump was out there talking about saving coal, fixing the opioid problem. It was bunk … But if you go to these [former coal camps around St. Charles] with people living in burned-out houses. I’ve been to Haiti and places in the [developing world], it looks worse than that.
"I’ve never seen this kind of poverty.”
Beth Macy will give a reading from "Dopesick" on Tuesday, Aug. 14 at the Library of Virginia at 6 p.m. There will be a reception at 5:30 p.m. Co-produced by Chop Suey Books.