By Beth Macy
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Beginning with a single dealer who lands in a small Virginia town and sets about turning high school football stars into heroin overdose statistics, Macy sets out to answer a grieving mother’s question-why her only son died-and comes away with a gripping, unputdownable story of greed and need. From the introduction of OxyContin in 1996, Macy investigates the powerful forces that led America’s doctors and patients to embrace a medical culture where overtreatment with painkillers became the norm. In some of the same communities featured in her bestselling book Factory Man, the unemployed use painkillers both to numb the pain of joblessness and pay their bills, while privileged teens trade pills in cul-de-sacs, and even high school standouts fall prey to prostitution, jail, and death.
Through unsparing, compelling, and unforgettably humane portraits of families and first responders determined to ameliorate this epidemic, each facet of the crisis comes into focus. In these politically fragmented times, Beth Macy shows that one thing uniting Americans across geographic, partisan, and class lines is opioid drug abuse. But even in the midst of twin crises in drug abuse and healthcare, Macy finds reason to hope and ample signs of the spirit and tenacity that are helping the countless ordinary people ensnared by addiction build a better future for themselves, their families, and their communities.
“An impressive feat of journalism, monumental in scope and urgent in its implications.” — Jennifer Latson, The Boston Globe
This evil is confined to no class or occupation. It numbers among its victims some of the best women and men of all classes. Prompt action is then demanded, lest our land should become…stupefied by the direful effects of narcotics and thus diseased physically, mentally, and morally, the love of liberty swallowed up by the love of opium, whilst the masses of our people would become fit subjects for a despot.
—Dr. W. G. Rogers, writing in The Daily Dispatch (Richmond, VA), January 25, 1884
A mother’s love for her child is like nothing else in the world. It knows no law, no pity, it dares all things and crushes down remorselessly all that stands in its path.
—Agatha Christie, “The Last Séance” (from The Hound of Death and Other Stories)
In 2012, I began reporting on the heroin epidemic as it landed in the suburbs of Roanoke, Virginia, where I had covered marginalized families for the Roanoke Times for two decades, predominantly those based in the inner city. When I first wrote about heroin in the suburbs, most families I interviewed were too ashamed to go on the record.
Five years later as I finished writing this book, nearly everyone agreed for their names to be used, with the exception of a few, as noted in the text, who feared going public would jeopardize their jobs or their safety.
I’m indebted to the families I first met in 2012 who allowed me to continue following their stories as their loved ones grappled with rehab and prison, with recovery and relapse. I’m also grateful for insights gleaned from several rural Virginia families, advocates, and first responders, many of whom were quietly battling the scourge almost two decades before I appeared on the scene. Several law enforcement officials spoke with me on background and on the record, including a few who had arrested their own relatives for peddling dope. So did scores of doctors and other caregivers who, after working fourteen-plus-hour days, did not feel their work was complete without getting the story of this epidemic out there.
A few interviewees died before I had time to transcribe my notes, including one by his own hand after relapsing and fearing that his wife—whom he loved more than anything in the world—would divorce him. “If she ever figures out she don’t need me,” he confided, “I’m screwed.”
Their survivors continued talking to me during their most fragile moments, generously texting and calling and emailing photographs long after their loved ones’ battles were over. One requested my MP3 recording of her departed loved one’s interview, so desperate was she to hear his voice again. Another shared her deceased daughter’s journals.
I’m particularly indebted to four Virginia moms: Kristi Fernandez, Ginger Mumpower, Jamie Waldrop, and Patricia Mehrmann. More than anyone, they helped me understand the crushing and sometimes contradictory facets of an inadequate criminal justice system often working at cross-purposes against medical science, and a health care bureaucracy that continues pumping out hard-core pain pills in large doses while seeking to quell cravings and turn around lives with yet more medication.
In sharing their experiences, these mothers hoped readers would be moved to advocate for life-saving addiction treatment and research, health care and criminal justice reform, and for political leadership capable of steering America out of the worst drug epidemic in modern history. Until then, they hoped their children’s stories would illuminate the need for patients not only to become more discerning consumers of health care but also to employ a healthy skepticism the next time a pharmaceutical company announces its latest wonder drug.
Two years into a twenty-three-year prison sentence, on a day pushing 100 degrees, Ronnie Jones had his first visitor. I’d spent almost a year listening to police and prosecutors describe Jones, imprisoned for armed heroin distribution, as a predator. After three months of requests, I walked along the manicured entranceway of Hazelton Federal Correctional Institution on the outskirts of Bruceton Mills, West Virginia. The air was so thick that the flags framing the concrete-block structure hung there drooping, as still as the razor wire that scalloped the roofs.
In the state’s northeastern crook, bordering Pennsylvania to the north and Maryland to the east, Preston County had once been dominated by strip-mining. But by the mid-2000s, most of the mines had shut down, and the prison had taken over as the county’s largest employer, with eight hundred guards and staff.
My August 2016 interview had taken several weeks to arrange with the Bureau of Prisons pecking order in Washington, D.C., but first I had to navigate weeks of curt back-and-forth with Jones, over the prison’s monitored email, to get his OK. “Exactly who have you spoken to as of today that was involved with my case?” he wanted to know. What personal information about him did I intend to use?
Jones agreed to let me visit, finally, because he wanted his daughters, in kindergarten and first grade when their dad was arrested in June 2013, to understand “there’s a different side of me,” as he put it. The last they’d seen him, a week before his arrest, he had delivered birthday cupcakes to their school.
I thought of the “tsunami of misery” Jones had first unleashed in Woodstock, Virginia, as his prosecutor put it, before it fanned out in waves over the northwestern region of the state and into some of Washington’s western bedroom communities in 2012 and 2013. In just a few months’ time, Jones was presiding over the largest heroin ring in the region, transforming a handful of users into hundreds.
As I made my way to the prison, I calculated the human toll, the hundreds of addicted people who ended up dopesick when their heroin supply was suddenly cut by Jones’s arrest: throwing up and sweating and shitting their pants. When Jones was jailed in 2013, many of the newly addicted Woodstock users began carpooling to the nearest big cities—Baltimore, Washington, and even Martinsburg, West Virginia, aka Little Baltimore—to score drugs, converging on known heroin hot spots and playing drug-dealer Russian roulette.
I didn’t yet know that a single batch of heroin was about to land in Huntington, West Virginia, four hours west of Jones’s cell, that would halt the breathing of twenty-six people in a single day, before the week was out. Those overdoses were fueled by the latest synthetic opioid, carfentanil, imported from China with a stroke on a computer keyboard. Carfentanil is an elephant sedative one hundred times stronger than fentanyl, which is twenty-five to fifty times stronger than heroin. For the fifth year in a row, the state of West Virginia’s indigent burial-assistance program was about to exhaust its funds from interring opioid-overdose victims.
Similar surges were happening across the country, from Florida to Sacramento to Barre, Vermont. Every person I interviewed that summer, from treatment providers to parents of the addicted to the judges who were sending the addicted to prison or jail, was growing more burdened by the day. The enormity of America’s drug problem was finally dawning on them and on the rest of us—two decades after the opioid epidemic first took root. (Although the word “opiate” historically refers to drugs derived from the opium poppy and “opioid” to chemical versions, the now more widely accepted term “opioid” is used in this book for both forms of painkillers.)
Drug overdose had already taken the lives of 300,000 Americans over the past fifteen years, and experts now predicted that 300,000 more would die in only the next five. It is now the leading cause of death for Americans under the age of fifty, killing more people than guns or car accidents, at a rate higher than the HIV epidemic at its peak.
The rate of casualties is so unprecedented that it’s almost impossible to look at the total number dead—and at the doctors and mothers and teachers and foster parents who survive them—and not wonder why the nation’s response has been so slow in coming and so impotently executed when it finally did.
Ronnie Jones had run one of the largest drug rings in the mid-Atlantic United States, a region with some of the highest overdose rates in the nation. But I wasn’t driving to West Virginia for epidemiological insights or even a narrative of redemption from Jones.
I’d been dispatched to prison by a specific grieving mother, clutching a portrait of her nineteen-year-old son. I wanted to understand the death of Jesse Bolstridge, a robust high school football player barely old enough to grow a patchy beard on his chin.
What exactly, his mother wanted to know, had led to the death of her only son?
I’d been trying to address that same question for more than five years, in one form or another, for several mothers I knew. But now I had someone I could ask.
Three months before visiting Jones, in the spring of 2016, Kristi Fernandez and I stood next to Jesse’s grave on a rolling hillside in Strasburg, Virginia, in the shadow of Signal Knob. She’d asked me to meet her at one of her regular cemetery stops, on her way home from work, so I could see how she’d positioned his marker, just so, at the edge of the graveyard.
It was possible to stand at Jesse’s headstone—emblazoned with the foot-high number 55, in the same font as the lettering on his Strasburg Rams varsity jersey—and look down on the stadium where he had once summoned the crowd to its feet simply by running onto the field and pumping his arms.
In a small town where football is as central to identity as the nearby Civil War battlefields dotting the foothills of the Blue Ridge, Jesse loved nothing more than making the hometown crowd roar.
He had always craved movement, the choke on his internal engine revving long after his peers had mastered their own. As a toddler, he staunchly refused to nap, succumbing to sleep on the floor midplay, an action figure in one hand and a toy car in the other. This restlessness was part of the epidemic’s story, too, I would later learn. So were the drugs Jesse’s high school buddies pilfered from their parents’ and grandparents’ medicine cabinets—the kind of leftovers that pile up after knee-replacement surgery or a blown back.
Jesse had been a ladies’ man, the boy next door, a jokester who began most of his sentences with the word “Dude.” When he left his house on foot, the neighbors did a double take, marveling at the trail of cats shadowing him as he walked.
Kristi pointed out the cat’s paw she had engraved at the base of Jesse’s headstone, right next to the phrase MISS YOU MORE, a family shorthand they had the habit of using whenever they talked by phone.
“I miss you,” she’d say.
“Miss you more,” he’d tell her.
“Miss you more,” she’d answer. And on and on.
Kristi takes pride in the way the family maintains Jesse’s grave, switching out the holiday decorations, adding kitschy trinkets, wiping away the rain-splashed mud. “It’s the brightest one here,” his younger twin sisters like to say as they sweep away the errant grass clippings.
When I pulled into the cemetery for our first meeting, Kristi had taken it as an omen that my license plate included Jesse’s number, 55. She’s always looking for signs from Jesse—a glint of sun shining through the clouds, a Mother’s Day brunch receipt for $64.55. To her, my license plate number meant our meeting was Jesse-sanctioned and Jesse-approved.
Kristi used to think that maintaining Jesse’s grave was “the last thing we can do for him,” she told me, choking back tears. But right now she’s obsessed with the story of her son’s swift descent into addiction—the missing details that might explain how Jesse went from being a high school football hunk and burly construction worker to a heroin-overdose statistic, slumped on someone else’s bathroom floor. If she understood the progression of his addiction better, she reasons, maybe she could help other parents protect their kids from stumbling down that same path.
“I just want to be able to say, ‘This is what happened to Jesse,’ so I can be educated, so I can help others,” Kristi says. “But in my mind, the story doesn’t add up, and it drives me crazy.”
Maybe a mother’s questions about a child’s death can never be totally answered, and yet Kristi’s pain sits there between us, no less urgent today than it felt on the day he died. To comprehend how she was left with these questions—and how our country came to this moment—I needed to widen the scope of my investigation both in geography and in time. I would fold in questions from other mothers, too, who wanted to understand why their addicted sons were imprisoned now instead of in treatment; why their addicted daughters were still out on the streets, God only knew where.
When a new drug sweeps the country, it historically starts in the big cities and gradually spreads to the hinterlands, as in the cases of cocaine and crack. But the opioid epidemic began in exactly the opposite manner, grabbing a toehold in isolated Appalachia, Midwestern rust belt counties, and rural Maine. Working-class families who were traditionally dependent on jobs in high-risk industries to pay their bills—coal mining in southwest Virginia, steel milling in western Pennsylvania, logging in Maine—weren’t just the first to experience the epidemic of drug overdose; they also happened to live in politically unimportant places, hollows and towns and fishing villages where the treatment options were likely to be hours from home.
Jesse Bolstridge was born in the mid-1990s, when opioid addiction first took root. His short life represents the arc of the epidemic’s toll, the apex of which is nowhere close to being reached.
If I could retrace the epidemic as it shape-shifted across the spine of the Appalachians, roughly paralleling Interstate 81 as it fanned out from the coalfields and crept north up the Shenandoah Valley, I could understand how prescription pill and heroin abuse was allowed to fester, moving quietly and stealthily across this country, cloaked in stigma and shame.
Set in three culturally distinct communities that represent the evolution of the epidemic as I reported it, Dopesick begins in the coalfields, in the hamlet of St. Charles, Virginia, in the remote westernmost corner of the state, largely with the introduction of the painkiller OxyContin in 1996.
From there, the scourge not only advanced into new territories but also arrived via a different delivery system, as the morphine molecule shifted from OxyContin and other painkillers like Vicodin and Percocet to heroin, the pills’ illicit twin, and, later, even stronger synthetic analogs.
As the epidemic gained strength, it sent out new geographic shoots, moving from predominantly rural areas to urban and suburban settings, though the pattern was never stable or fixed. Heroin landed in the suburbs and cookie-cutter subdivisions near my home in Roanoke in the mid-2000s. But it wasn’t widely acknowledged until a prominent jeweler and civic leader, Ginger Mumpower, drove her addicted son to the federal prison where he would spend the next five years, for his role in a former classmate’s overdose death.
I covered Spencer Mumpower’s transition from private-school student to federal inmate at the same time I witnessed the rise in overdose deaths spread north along I-81 from Roanoke. It infected pristine farm pastures and small northern Shenandoah Valley towns, as more users, and increasingly vigilant medical and criminal justice systems, propelled the addicted onto the urban corridor from Baltimore to New York. If you live in a city, maybe you’ve seen the public restroom with a sharps container, or witnessed a librarian administer Narcan.
While more and more Americans die of drug overdose, it is impossible to not look back at the early days of what we now recognize as an epidemic and wonder what might have been done to slow or stop it. Kristi Fernandez’s questions are not hers alone. Until we understand how we reached this place, America will remain a country where getting addicted is far easier than securing treatment.
The worst drug epidemic in American history didn’t land in the bucolic northern Shenandoah Valley until 2012, when Ronnie Jones, a twice-convicted drug dealer from the Washington suburbs, arrived in the back of a Virginia Department of Corrections van and set about turning a handful of football players, tree trimmers, and farmers’ kids who used pills recreationally into hundreds of heroin addicts, as police officers told the story.
The transition here, in the quiet town of Woodstock, was driven by the same twisted math I’d witnessed elsewhere, as many users began with prescriptions, then resorted to buying heroin from dealers and selling portions of their supply to fuel their next purchase. Because the most important thing for the morphine-hijacked brain is, always, not to experience the crushing physical and psychological pain of withdrawal: to avoid dopesickness at any cost.
To feed their addictions, many users recruit new customers. Who eventually recruit new customers. And the exponential growth continues until the cycle too often ends in jail or prison or worse—in a premature grave like Jesse’s adorned with teddy bears, R2-D2 action figures, and the parting words of mothers like Kristi engraved in granite: UNTIL I TAKE MY FINAL BREATH, YOU WILL LIVE IN MY HEART.
To reach Ronnie Jones, I head north on the nearest “heroin highway,” I-81. I travel roughly the same path in my car, only in reverse, that Jones’s drugs did by bus, his heroin camouflaged inside Pringle’s cans and plastic Walmart bags on the floor beside him or his hired drug runners.
On the suburban outskirts of Roanoke, I drive near the upper-middle-class subdivision of Hidden Valley, where a young woman I’ve been following for a year named Tess Henry was once a straight-A student and basketball star. At the moment, she’s AWOL—her mother and I have no idea where she is—although sometimes we catch glimpses of her on our cellphones: a Facebook exchange between Tess and one of her heroin dealers, or a prostitution ad through which Tess will fund her next fix.
I pass Ginger’s Jewelry, the high-end store where parents of the addicted still drive from two hours away simply because they can think of nowhere else to turn. They’ve read about Ginger’s imprisoned son in the newspaper, and they want to ask her how to handle the pitfalls of raising an addicted child.
Up the Shenandoah Valley on the interstate, I pass New Market and think not of the men who fought in the famous 1864 Civil War battle but of the women who grew poppies for the benefit of wounded soldiers, harvesting morphine from the dried juice inside the seed pods. Three decades later, the German elixir peddlers at Bayer Laboratories would stock America’s drugstores with a brand-new version of that same molecule, a pill marketed as both a cough remedy and a cure for the nation’s soaring morphine epidemic, known as “morphinism,” or soldier’s disease. Its label looked like an amusement advertisement you might have seen on a circus poster, a word derived from the German for “heroic” and bracketed by a swirling ribbon frame: heroin. It was sold widely from drugstore counters, no prescription necessary, not only for veterans but also for women with menstrual cramps and babies with hiccups.
Outside Woodstock, I pass George’s Chicken, the poultry-processing plant where Ronnie Jones first arrived to work in a Department of Corrections work-release program, clad in prison-issue khakis. I pass the house nearby where a cop I know spent days, nights, and weekends crouched under a bedroom window, surveilling Jones and his co-workers from behind binoculars—a fraction of the man-hours the government invested in putting members of Jones’s heroin ring behind bars.
I head northwest toward West Virginia, the crumbling landscape like so many of the distressed towns I’ve already traversed in Virginia some four hundred miles south, down to the same HILLARY FOR PRISON signs and the same Confederate flags waving presciently from their posts.
At the prison, I park my car and walk through the heavy front door. A handler named Rachel ushers me through security, making cheerful small talk as we head deeper inside the concrete maze and through three different sets of locked doors, her massive cluster of keys reverberating like chimes at each checkpoint.
We pass through a recreation area, where several men—all but one of the prisoners black and brown, I can’t help noticing—push mops and brooms around the cavernous room, looking up and nodding as we pass. The manufactured air inside is cold, and it smells of Clorox.
Ronnie Jones is already waiting for me on the other side of the last locked door, seated at a table. He looks thinner and older than he did in his mug shot, his prison khakis baggy, his trim Afro and beard flecked with gray. He looks tired, and the whites of his eyes are tinged with red.
He rises from the chair to shake my hand, then sits back down, his hands folded into a steeple, his elbows resting on the table between us. His mood is unreadable.
The glassed-in room is beige, the floors are beige, and so is Rachel, in her beige-and-blue uniform and no-nonsense shoes, the kind you could run in if you had to. She tells us to knock on the window if we need her, then leaves for her perch in the rec room, on the other side of the window, the door lock clicking decisively behind her.
I open my notebook, situate the questions I’ve prepared off to the side, next to my spare pens. I’m thinking of Kristi and Ginger and of Tess’s mom, and what Jones might say that will explain the fate of these mothers’ kids.
Jones leans forward, expectant and unsmiling, and rubs his hands together, as if we’re business associates sitting down to hammer out a deal.
Then he takes a deep breath and, relaxing back into his chair, he waits for me to start.
The People v. Purdue
The United States of Amnesia
Though the opioid epidemic would go on to spare no segment of America, nowhere has it settled in and extracted as steep a toll as in the depressed former mill and mining communities of central Appalachia, where the desperate and jobless rip copper wire out of abandoned factories to resell on the black market and jimmy large-screen TVs through a Walmart garden-center fence crack to keep from “fiending for dope.”
In a region where few businesses dare to set up shop because it’s hard to find workers who can pass a drug test, young parents can die of heroin overdose one day, leaving their untended baby to succumb to dehydration and starvation three days later.
Appalachia was among the first places where the malaise of opioid pills hit the nation in the mid-1990s, ensnaring coal miners, loggers, furniture makers, and their kids. Two decades after the epidemic erupted, Princeton researchers Anne Case and Angus Deaton were the first economists to sound the alarm. Their bombshell analysis in December 2015 showed that mortality rates among white Americans had quietly risen a half-percent annually between the years 1999 and 2013 while midlife mortality continued to fall in other affluent countries. “Half a million people are dead who should not be dead,” Deaton told the Washington Post
- A New York Times Bestseller
American Society of Addiction Medicine Annual Media Award Winner
2018 Kirkus Prize Finalist
2019 Library of Virginia People's Choice Award for Nonfiction finalist
2019 Ohioana Book Award in nonfiction finalist
Andrew Carnegie Medal shortlist
800-CEO-READ 2018 Business Book Awards Longlist
A New York Times Bestseller
One of New York Times Book Review's 100 Notable Books of 2018
New York Times critic Janet Maslin's Top Five Best Books
An NPR's On Point Top Title of 2018
One of Literary Hub's Ultimate Best Books of 2018
One of ALA's 2018 Notable Books
A Chicago Tribune Best Book of the Year
One of Atlanta Journal-Constitution'sBest Southern Books of 2018
One of Newsweek's 61 Best Books of 2018
Washington Post Best Book of the Year
An Amazon Best Book of 2018
One of Anne Lamott's Favorite Books of 2018
—John Warner, The Chicago Tribune
—Jessica Roy, Deputy Editor of Elle, Best Books of 2018
—Misty Hawkins, The Charleston Express
—Mackenzie Dawson, New York Post
—Nancy Howell Agee, Becker's Hospital Review and President of the American Hospital Assosiation
- On Sale
- Aug 7, 2018
- Page Count
- 384 pages
- Little, Brown and Company