The opioid crisis has made many headlines, but I hadn’t wrapped my head around how serious the problem is until reading this excellent book by Beth Macy. Macy has been a reporter in Roanoke, Virginia, for decades. (In fact, I took a couple of writing classes that she taught when I lived in Roanoke, and she encouraged me to take up writing myself — encouragement that led to my first and only newspaper job.) Much of the book looks at how opioids — in the form of Oxycontin and other prescription drugs and then heroin — took over the Appalachian communities of western Virginia and eventually made their way through the Shenandoah Valley and into some of the wealthiest communities in Roanoke.
The crisis has been going on in coal country since the late 90s, almost immediately after Oxycontin was introduced. Aggressive pharmaceutical marketing led doctors to prescribe the potent painkillers, having been told they were safe, and patients quickly got hooked. When they tried to stop, they got “dopesick.” The pain of withdrawal led to reckless behavior, such as injecting drugs to get a more potent high and turning to heroin when the pills ran out. And the depressed economy made selling pills an appealing prospect, and crime went up as people stole pills and valuables that allowed them to buy more pills. The community was transformed.
Doctors and law enforcement sounded the alarm right away, but, of course, it didn’t become a headline-making national crisis until it reached the suburbs. In Roanoke, wealthy and upper-middle-class kids started taking the pills, and their families didn’t understand what was happening until it was too late. Or, if they did understand, they were too ashamed to speak up. Eventually, though, a community of families touched by opioids forms, and Macy follows their struggles with grief over lives lost and drive to help those who are still alive but trying to kick the addiction.
It’s a grim picture, and Macy takes a hard look at why so many of the current solutions aren’t working. The get-tough tactics are just filling jails, taking people away from communities of support. And abstinence-only recovery programs force those who are addicted into painful withdrawals, when medication-assisted treatment could ease recovery. Yet, even if abstinence-only programs are effective, they, like all recovery programs, are ridiculously hard to get into. Seeing the struggle suburban families faced getting help made me even more heartsick for the poor rural people trying to get clean.
Issues of politics and race sit at the edges of the story. The opioid crisis is more of a white problem (partly because doctors have been less likely to trust black patients with these prescriptions), but there are some common threads between the response to opioids in poor white communities and the war on drugs in black inner-city communities. And reading about the problem made me feel compassion toward the folks who were so desperate that they’d vote for anyone who offered some sort of change, even if what he offered was a lie (which it was). And Macy highlights the heroes who have been fighting the good fight in Appalachia for decades. If you want to understand the crisis, this is a great place to start.