When Beth Macy sounded the alarm on America’s opioid crisis in her best-selling 2018 book, “Dopesick,” the situation was dire. Four years later, it’s only gotten worse.
Overdose deaths climbed to new heights during the coronavirus pandemic, topping 100,000 for the first time last year, and that number is projected to rise even higher in the coming years. More than a million Americans have died from overdose since 1996, and an estimated 3 million are currently addicted to opioids. Nearly a third of Americans say addiction is a problem in their family.
In “Raising Lazarus,” Macy focuses on solutions, although there are no easy ones. She profiles front-line workers in the nation’s hardest-hit rural areas, for whom occupational hazards include being stuck by dirty needles in the trap houses they frequent, but who are more concerned with the social stigma and obstructive politics that stand in the way of their work. She deconstructs myths about addiction that have held back effective public health policies. And she offers hope, however muted, that the opioid epidemic is indeed a solvable problem.
The Virginia-based journalist has spent years documenting the suffering of the epidemic’s victims, many of whom were healthy and productive until they were given what they thought were harmless prescriptions for pain — and their lives were destroyed. In a moving narrative, Macy introduces us to a 52-year-old woman living beneath a West Virginia Turnpike overpass, who became addicted to OxyContin following back surgery in 2002, when she was raising a family with her preacher husband. Her addiction snowballed into heroin use, and she’s been homeless for the two decades since. Another mom, trying to get sober after becoming hooked on OxyContin when it was prescribed for a back injury, suffered a relapse while on probation for a drug-related crime. “Fearful of losing custody of her kids for a failed drug screen, she drank Clorox because her pill dealer swore it would erase the OxyContin from the test,” Macy writes. “Instead, it killed her.”
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In “Dopesick,” Macy examined the epidemic’s ground zero: the 1996 introduction of OxyContin, a powerful pain pill that its developer, Purdue Pharma, falsely claimed was impossible to get hooked on. After millions of Americans did get hooked, the drug was redeveloped in a form that can’t be abused through crushing, snorting, or injection. But that just meant that those already addicted, who faced excruciating withdrawal symptoms if they quit cold turkey, turned instead to heroin and hyper-potent fentanyl, with deadly consequences. Between 2011 and 2020, Macy reports, opioid prescribing fell by 60 percent while overdose deaths doubled.
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Macy eschews the false objectivity of “both sides” journalism and directly identifies the villains of this story: the Sackler family, who own Purdue Pharma, and the incompetent policymakers and greedy executives who compounded what the Sacklers started. But to a certain extent, Macy notes, we’re all complicit. “Whether we realize it or not, most of us continue blaming the victims rather than the corporations, politicians and impotent regulators who allowed the wealthy to poison our nation,” she writes.
Many of us have friends and relatives struggling with opioid addiction. But we’ve done little to help, in part, Macy says, because we’re operating under outdated, dangerous assumptions about the disease. A number of us — including more than half of America’s medical providers — wrongly believe that people who are hooked on opioids can never truly recover. It’s hard to help people if you don’t think they can get better.
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Even more deadly is the assumption that there’s some benefit to cutting off contact with our addicted loved ones, withdrawing our support, and letting them hit rock bottom on their own. If anything, Macy says, the heartbreak of abandonment drives countless overdose deaths.
The stigma associated with opioid abuse derives from yet another false assumption: that addicts are not like us — that they are damaged or weak-willed or inherently bad. They are not, Macy stresses. They were just unlucky enough to get hooked on a drug that, more likely than not, was originally prescribed by a doctor they trusted, without any warning that it would lead them down a dangerous path.
The solution is not abandonment, and it’s not to jail drug offenders, by far the dominant response to addiction in this country. Neither is it abstinence-based rehab, Macy says: About 70 percent of people who undergo residential treatment for opioid addiction relapse in the following year. Instead, harm-reduction measures that meet people where they are — including needle exchanges and hepatitis treatment for users who aren’t ready to quit using — have done the most good. In the era of fentanyl, a drug so strong that a slight miscalculation in dosage can kill, our first priority should be to prevent overdose deaths, Macy argues. The longer people stay alive, the better their odds of recovering.
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That is Macy’s most hopeful message: People can recover. And they do. But the process is often messy.
The book’s title refers to the biblical story of Jesus raising Lazarus from the dead. Lazarus had been dead four days, wrapped in a burial shroud and enclosed in a tomb, when Jesus instructed his followers to unbind him from his burial cloths. It was a miracle, but it wasn’t pretty for those who witnessed it up close. And it’s not unlike the work of treating addiction, according to a North Carolina outreach worker, Rev. Michelle Mathis. “It doesn’t always smell like flowers, and you might get a little something on you,” Mathis tells Macy. “But the people who are willing to work at the face-to-face level get to see the miracle and look it in the eye.”
RAISING LAZARUS: Hope, Justice, and the Future of America’s Overdose Crisis
By Beth Macy
Little, Brown, 400 pages, $30
Jennifer Latson is a Houston-based journalist and the author of “The Boy Who Loved Too Much,” a nonfiction book about a rare genetic disorder that makes people irrepressibly friendly. Follow her on Twitter @JennieLatson.