It wasn’t until heroin began to infiltrate affluent local towns that her readers began to realize the havoc the opioid crisis could wreak anywhere, Roanoke, Virginia-based journalist Beth Macy says.
Macy set out to shed light on the opioid crisis, from the communities impacted by it to the corporations that fueled it and, thus far, have faced relatively meager consequences. Her book “Dopesick: Dealers, Doctors, and the Drug Company that Addicted America,” which was published in August, struck a chord with readers and reached the New York Times bestseller list.
At the Rx Drug Abuse & Heroin Summit, which will take place in Nashville in April, Macy will discuss her experiences in researching the opioid crisis for “Dopesick” and her next project that will begin to explore solutions. Ahead of her appearance the Rx Summit, she spoke with Addiction Professional.
Editor’s note: This interview has been edited for length and clarity.
In writing “Dopesick,” you talked to a wide variety of individuals impacted by the opioid crisis. How much of what you heard confirmed what you suspected going into the project, and what did you learn along the way?
This grew out of a newspaper series I had done in 2012, when heroin had really heavily hit this wealthy suburb called Hidden Valley in our reporting area. It made front-page news that these wealthy kids were involved, and I did a three-part series. Readers spit up their coffee when they read it, going, “What? Wealthy, white people are doing heroin?” It was just a decade ago, but people had no idea. I had read stories about oxycontin being a problem in our far southwest Appalachian towns. The Roanoke office of the U.S. attorneys tried to take Purdue to a count in 2007 with the $600 million fine for criminal misbranding, but nobody went to jail and that was sort of a mixed-bag win. It gave me a place to delve into the connection between oxycontin and heroin, which people didn’t yet understand. I didn’t either until “Dreamland” came out and things like Deaton and Case, the Nobel-winning economists who showed for the first time in American history our life expectancy was going down largely because of opioid overdoses—that and other deaths of despair. When I started putting that piece together, I realized I could write about the connection between oxycontin and heroin and what, at the time, was becoming a fentanyl epidemic as well, the third wave of it.
As I was finishing up my reporting, we heard about an even more current wave of polysubstance use. Heroin, fentanyl and methamphetamine was making a huge comeback. A lot of the drug users I was interviewing were using whatever they could get their hands on. I was trying to interview experts, going, “Users tell me that methamphetamine helps with opioid withdrawal.” They said, “There’s no way. It works on different receptors.” I said, “This is what they’re telling me.” I’m very much a reporter who goes to the ground, tries to talk to as many people as I can, and try to come up with a way to make a story out of it that is true and accurate. The main theme of “Dopesick” was saying these are human beings, many of whom were initially addicted because of drug companies that lied to them and the doctors about the addictive nature of these drugs and unleashed this crisis on America. We’ve got to start treating these folks as patients worthy of medical care and not simply as criminals. ... I was talking to someone yesterday, and he pointed out the revenue from oxycontin was $35 billion, yet if a person sells $3,500 of heroin, it’s a five-year mandatory minimum sentence.
You see the media writing about this litigation right now, and there’s a tendency in these stories to talk about the greed of the Sacklers, and there’s good copy in all that. But the tendency is to get stuck in the weeds of what’s happening with these lawsuits and the money and these greedy executives, and forget about the fact we have 2.5 million people addicted to these drugs. What are we going to do for them? Hopefully this settlement money reaches them, but last time it sure didn’t. Not one dollar of that $634 million fine went to treatment.
What kind of reception have you gotten from people within the addiction treatment industry since “Dopesick” was published?
I’m pretty critical of the rehab industry, which I feel is not very regulated or standardized. There are a lot of rehabs, especially those that don’t allow medication-assisted treatment or are taking advantage of families in crisis; I haven’t gotten a lot of feedback from them. I have gotten a lot of feedback from people on the ground who work in mental health and substance use disorder. They’ve been buoyed by the book and are glad that the issue is getting the attention it deserves. I feel like I’m hitting my head against the wall sometimes, saying the same things about the need for Medicaid expansion, syringe exchanges and harm reduction, and medication-assisted treatment. But, there are still a lot of barriers when you see only 1 in 10 people actually get treatment. We know that when you get treatment, every dollar spent on treatment saves $12 on healthcare and criminal justice costs. It makes sense in so many ways—a human level, a financial level. That’s what I’m going to look at in my new book—how we get over those hurdles to getting people who need help the help that they need.
At the Rx Summit, you’re going to be talking to a very diverse group of stakeholders. What message do you want to convey to them?
Remembering that there has been a lot of research done on this and a lot of science, and we still have not enough people with access to treatment. Often times, families are spending hundreds of thousands of dollars to send people to out-of-state rehabs that don’t even offer the kind of treatment that science says is the best.
I have a piece coming out in The Atlantic about a treatment innovator I have been covering for a couple years, a young woman who has cracked the code of treatment in rural areas, where there are a lot of cultural and financial barriers. That’s an interesting story I’ll be talking about.
One of the things she’s done is manage to merge healthcare and criminal justice. So often, people fall into this gap between healthcare and criminal justice, between treating people as patients or as criminals. She found a creative way to do that, and that’s what I’m all about—solutions. I’ll be spotlighting some unexpected heroes in my new book, and she’s one of them. When communities come together and try things that haven’t been done before and have success, you see people getting excited for the first time. We had a huge hospital, a nonprofit corporation, and I called them out: “You should be doing buprenorphine in the ER.” They said, “That’s not our purview. We don’t believe in treating one drug with another drug.” They started doing it and two years after I saw people being turned away right and left, never treated for their substance use, there’s a front-page story in our paper today about what great success they’re having and how they’re now trying to help other hospitals. When people start having success after they’ve been sort of hopeless, they become evangelists. That’s what I want to do.