“Dopesick,” Beth Macy’s deeply reported account of how opioids came to savage so many Appalachian families, concludes with a wrenching image of Patricia Mehrmann tenderly preparing her 28-year-old daughter, Tess Henry, for burial. Tess is a major figure in the book, with Macy detailing how, for nearly two years, the author herself would even ferry Tess to rehab support groups, hold her infant during sessions and visit her in psych wards.
But despite Tess’s valiant efforts to wrest free of addiction, her body was found in Las Vegas on Christmas Eve in 2017, naked, covered with burns, inside a plastic bag at the bottom of a dumpster.
Tragically, since the 2018 publication of “Dopesick,” from which the popular Hulu series of the same name was loosely drawn, America’s opioid crisis has only gotten worse. During 2021, a pandemic year that isolated the vulnerable from friends, family and treatment, overdoses grew to nearly 108,000, a terrible record, according to federal data.
Now in “Raising Lazarus,” Macy, no longer struggling with why, has moved on to an even more impenetrable question: How the hell do we extract ourselves from this quicksand?
In many ways, the new book represents Macy, one of the pre-eminent chroniclers of the nation’s opioid epidemic, at her full-bore fearless best. Heartsick and determined, she grills drug policy scholars and former drug czars alike.
She comes out emphatically advocating an approach called “harm reduction,” which argues that those in throes of addiction should have access to clean needle exchanges, safe injection sites, food, shelter, clothing; then methadone or buprenorphine, drugs tailored to blunt cravings; and not least, a plethora of social services.
As David Herzberg, a historian of drug policy at the University at Buffalo, tells Macy, “I wish we could just accept that people do drugs, that they have very serious risks, and then build a way to pragmatically make those risks as minimal as possible.”
She accompanies a colorful array of Appalachian street warriors fighting to help wherever the misery of addiction leads. They bring clean needles, pizza, condoms, fresh socks and hepatitis C testing kits to “trap” houses (where illegal drugs are used), drive to parking lot encampments and visit holding cells rank with the stench of vomit-filled buckets, where the newly arrested writhe in opioid withdrawal.
With her big heart affixed conspicuously to her sleeve, Macy introduces readers to people mired in addiction and to those who seek to help them. (The two are often not mutually exclusive.) She angrily watches the pushback to harm reduction, as communities refuse to allow needle exchanges and rail against buprenorphine, claiming incorrectly that it just replaces one addictive drug with another. One scene captures both the outreach and repudiation: At an encampment behind an IHOP, a social worker squats to minister to a dopesick man in a wheelchair who has just picked maggots out of his infected, injection-related wounds. While she gently applies ointment, two Charleston, W.Va., police officers approach and hand him a flier from their stack of eviction notices.
The book is replete with many such agonizing scenes. But “Raising Lazarus” is even more overstuffed than “Dopesick”: There are so many programs, each with acronyms and angels, that they tend to bleed together. In her zeal to be comprehensive, Macy sacrifices a measure of reader-friendly momentum and focus, even as she acknowledges that the crisis is “an elephant,” difficult to get one’s arms around neatly.
But the opioid epidemic, which touches on race, economics, health, politics, crime and stigma, is not just an elephant. It is a herd of elephants.
In the past 18 months alone, a slew of opioid-related reported books has joined the growing literature, some perhaps less ambitious than Macy’s, but with sharper focus, including “The Hard Sell,” by Evan Hughes, about an opioid startup that ended in federal criminal charges, and “American Cartel,” by Scott Higham and Sari Horwitz, which examines the political and corporate collusion that contributed to the proliferation of the drugs.
Perhaps as ballast to the harm reduction missionaries, Macy devotes numerous chapters to court battles over Purdue Pharma, the maker of OxyContin, the prescription opioid, and its owners, members of the billionaire Sackler dynasty. She views the Purdue litigation through the lens of family survivors and their lawyers, some of whom she introduced in “Dopesick,” who now seek justice.
But these chapters feel like a misfire, particularly since much of the material is not new, including her re-creation of the well-documented crusade of the artist Nan Goldin, who emerged from an addiction to painkillers to lead very public shamings of the Sacklers.
Macy gives extensive credit to lawyers whom those familiar with the Purdue litigation might view as minor players. As she grapples dutifully with the Gordian knot of the case, which is currently before the U.S. Court of Appeals for the Second Circuit, the tortuous demands of the yearslong litigation flatten Macy’s more typically lively, evocative prose.
Two recent books take on the Sacklers and the case in a more skilled, directed fashion: “Empire of Pain,” by Patrick Radden Keefe, and “Unsettled,” Ryan Hampton’s firsthand account of the Purdue bankruptcy labyrinth.
By now, legal observers might even call the Purdue cases, which, in this iteration, began in 2013, a sideshow to the eruption of opioid-related battles in state and federal courts now unfolding against many other defendants. In the years since “Dopesick” was released, a far wider, complex and pernicious origin story about the pill proliferation has emerged. As noted by Higham and Horwitz, both reporters for The Washington Post: Even as far back as 2006, when Purdue manufactured 130 million pain pills, Mallinckrodt, a giant manufacturer of generic drugs, manufactured 3.6 billion pills, nearly 30 times more. Johnson & Johnson has been sued, as have the national pharmacy chains and drug distributors. Major missteps by the Food and Drug Administration and Drug Enforcement Administration have also played roles in the opioid disaster.
Prescription painkillers, either from doctors or drug dealers, no longer dominate the overdose rates, as Macy observes. By 2016, those pills, increasingly recognized as potentially addictive, became harder and more expensive to acquire; seekers turned to heroin, which is not only cheaper but more readily available. More recently, fentanyl, a synthetic opioid unrestricted by poppy-growing seasons, has become the cheapest and most lethal of the three, a journey detailed by Sam Quinones in his 2021 book, “The Least of Us.”
Macy concludes with suggestions for tackling the opioid epidemic. Elevate the national drug czar to a cabinet-level post, she says. Do not impose a one-size-fits-all approach on recovery. Direct the first funds from the opioid litigation to the scrappy nonprofit programs whose dedicated street workers scramble into corners where policymakers do not venture.
When that money does start flowing in earnest is another question, though.
The nationwide opioid litigation, now in its 10th year, is beginning to cough up settlements and verdicts. The results have been decidedly mixed. In West Virginia, for example, a large group of counties and cities just settled their lawsuit against the country’s three largest distributors for $400 million.
But several weeks earlier, a ruling came down in the bitter case that Macy noted in “Raising Lazarus,” brought against the same defendants by the city of Huntington and surrounding Cabell County, often called the opioid epidemic’s ground zero. A federal judge ruled in favor of the drug distributors.
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