When former Roanoke Times journalist Beth Macy was reporting her best-selling 2014 debut book, “Factory Man,” which chronicles a Bassett Furniture chairman’s fight against the tide of globalization, she began to hear the warnings.
Deputies from Henry County, around the Martinsville area, were saying all their calls were related to heroin and crystal meth. At the time, Macy was reporting on Bassett’s abandoned 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 talking about 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,” Macy 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, these drug reps argued that OxyContin was addictive in less than 1% of all cases, using virtually no scientific data to back the claim up.
“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 still grasping at memories of loved ones. It’s easy to see why they open up to her, Macy not only has a warm and engaging personality but 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 much better known. Her publisher finally got behind the idea.
“With the decline of newspapers, we don’t cover these distressed communities anymore,” Macy points out. “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 87%. During her research, Macy found only two rehabs in Virginia that allow patients to use medication-assisted treatment -- 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 plenty moments of humor and historical context -- for example, you’ll learn the term ‘hipsters’ came from Chinese opium smokers leaning on their hips. Her hungry curiosity allows the reader to soldier through horrors while establishing a panoramic view of our pill-happy society.
While working on the book at Virginia Center for the Creative Arts’ Sweet Briar writing colony, Macy utilized the Library of Virginia website for its archives. That’s where she stumbled across an 1884 letter in Richmond’s Daily Dispatch from a doctor begging the General Assembly to ban morphine, which was widely used by former soldiers (this was back when Bayer introduced heroin as cough medicine for children - 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, though.
“[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 places [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.