Dopesick

by Beth Macy

  With the legalization of marijuana in a growing number of states, drug cartels were champing at the bit to meet the demand for heroin, a market they needed to grow. “They were looking at a thirty to forty percent reduction in profits because of legalization,” explained Joe Crowder, a Virginia state police special agent and part of the federally funded High Intensity Drug Trafficking Area program that designated Roanoke a heroin hot spot in 2014. “Between the pill epidemic and the less liberal prescribing of pain meds, cartel leaders said, ‘Guess what’s purer, cheaper, and we can make it all day long?’”

  Some dealers encouraged underlings to “hot pack” their product, giving superhigh potencies to new users to hook them quicker. Once the user is hooked, the product gets titrated back, forcing the person to buy more.

  Tess said she didn’t consider herself a true addict until six months after she started snorting heroin, when she began injecting it. After three shots, though, she knew she’d never return to snorting. She showed me the scars inside her right elbow; right-handed, she learned to use her left hand to mainline the drugs into her right arm because that vein was usually a sure hit.

  For a while she was able to keep waitressing at a trendy, upmarket bistro featured in the likes of Southern Living and Garden & Gun. She wore long sleeves to hide her track marks and was still able, if she concentrated hard, to remember orders without writing them down.

  Around this time, a family friend told her mother, “Your daughter’s an opiate addict,” and Patricia Mehrmann had a reaction not unlike that of many other parents faced with the same accusation: She fumed, incredulous. After all, Tess never missed a day of work. “She did everything she was supposed to do,” Patricia said. We were sitting in her comfortable sunroom, surrounded by woods. Patricia was way past denying it now: She’d spent the last six months navigating treatment hurdles, and worse.

  “I worked just to use, and I used just so I could work,” Tess explained. “There was no in between.” But that phase was brief, and neither Tess nor her mom had any idea what was coming next. Or that the molecule had another even higher card to play.

  No matter how low Tess got, it seemed there was always a deeper and fresher hell awaiting her.

  The addiction would out Tess eventually, as it always does. Even though she was earning $800 a week at the restaurant, even though she’d started middlemanning—recruiting and selling to new users in exchange for her cut of the drugs—she needed more money because she required ever-larger quantities of heroin to keep from feeling shaky and dopesick. She was arrested twice early on—once when officers picked her up for being drunk in public downtown and found an unprescribed OxyContin in her pocket, and again when police caught her stealing gift cards from a store. The first charge was pleaded down from a felony to a misdemeanor, and Tess was sentenced to a year’s probation and a weekend in jail. The second was treated purely as a theft. “I begged her public defender: ‘This is not what it looks like; send her to drug court!’” remembered her father, Alan Henry, from whom Tess was sometimes estranged.

  On May 15, 2015, an employee manning the security cameras at a Roanoke Lowe’s alerted police to Tess. The camera caught her palming a copper plumbing implement and stuffing it into her purse. She’d done it before: stolen an item from one Lowe’s, then returned it to another Lowe’s, which would issue her a gift card for the value (since she lacked a receipt). But this time they caught her before she left the store.

  “I was already in withdrawal at the time” of her arrest, she said.

  At the Roanoke city jail that night, with every pore on her body aching and every muscle spasming, a female jailer greeted her with a tiny cup.

  “Here, take this,” the jailer instructed. The woman handed Tess the medicine, which had been ordered as a result of a routine urine screen.

  Inside the cup was a low dose of Tylenol with the opioid codeine. It was designed to keep the fetus growing inside Tess from going into sudden, potentially fatal opioid withdrawal. Twenty-five and five foot seven, Tess was down to 120 pounds. She hadn’t had a regular period in two years. She had no idea she was at the end of her second trimester of pregnancy.

  At least in jail, for the immediate future, she and the baby were safe.

  Six weeks later, the region’s new HIDTA task force issued a warning about a spike in opioid-overdose incidents. Between May 1 and June 23, 2015, the local drug task force would investigate eleven overdose calls, four of them fatal. The culprit was fentanyl, once a popularly diverted opioid prescribed in patch form for advanced-cancer patients that was now being illicitly imported from China and mixed with heroin or manufactured into pills. (Some arrived from China via Mexico and, to a lesser extent, Canada.)

  A synthetic opioid considered twenty-five to fifty times stronger than heroin, mail-order fentanyl had been arriving direct to residences across the United States, and so were the pill presses that local dealers used to turn the powder into pills. One quarter-ton press arrived in Southern California inside a package labeled HOLE PUNCHER. Cartel lieutenants were setting up clandestine fentanyl labs across America, mixing the powder with heroin to increase the high, in products stamped with names like China Girl, Goodfella, Jackpot, and Cash. “Some of the companies shipping this stuff from China will send you a free replacement package if it gets interdicted on the way to your home,” a prevention worker in Baltimore told me.

  News that people were dying from fentanyl-laced heroin didn’t intimidate heroin addicts, according to several I interviewed. On the contrary, the lure of an even stronger high drew them to it more.

  Later that year and again in 2017, China began banning, at the request of the DEA, the manufacture of several fentanyl analogs, which had previously been unregulated. But each time a derivative was banned, a DEA spokesman conceded, new spin-offs emerged from underground Chinese labs, some more potent than the originals. Law enforcement interdiction of the packages is tricky, because it’s hard to tell whether the shippers are illicit labs labeling the envelopes “research chemicals,” complete with phony return addresses, or legitimate companies providing the powder for pharmaceutical research.

  Back in 2015, Roanoke police chief Chris Perkins, forty-six, knew immediately fentanyl was going to be a game changer. It meant more teenagers would be drawn to the ever-potent blends, able to get high simply by snorting the drug and avoiding the stigma new users have about injecting and, later, the telltale track marks. It meant some would buy counterfeit pills that were sold to them as Xanax or oxycodone but were actually fentanyl.

  In his earliest days of working undercover drugs, Perkins had gone by the name Woody Call and wore the classic Serpico look, with a goatee and longish dark hair. It was the mid-1990s, when heroin dealers used to “step on,” or cut, their product with baby powder. He remembers finding a pair of Radford University coeds at one bust, naked on a couch in a Roanoke drug house, enveloped in a heroin fog. They’d exchanged sex for the drug, injecting it between their toes so their friends and professors wouldn’t know. Stunned, Perkins remembers calling their parents in the Washington suburbs and saying, “I can’t tell you this over the phone. You just need to come.”

  But now the cut had switched from baby powder to fentanyl, from mild to often lethal. “The market is so saturated, I can’t say it enough: There is so much heroin out there,” sold not only by former crack dealers eager to diversify their product but also by subordinates, or subdealers, Perkins said. So much that Roanoke police seized 560 grams of the stuff in 2015 alone—the equivalent of 18,666 doses or shots.

  It was Whac-A-Mole on steroids: When police took one source out, there would be a short lag until the next source presented itself. Meantime, the overdoses kept stacking up. And that was before the worst spike in fentanyl hit.

  Perkins had long championed community policing in Roanoke, wherein officers engage with teenagers in high-crime areas (often patrolling on bicycle) while always refining where they need to be, using real-time data. Violent crime in th
e city, much of it previously crack-related, had dropped 64.5 percent and property crime 39.9 percent since 2006. A 2011 program Perkins pioneered called the Drug Market Initiative offered nonviolent offenders the opportunity to bypass jail and receive job training if they agreed to leave the drug trade.

  But the cellphone had put an end to open-air drug markets, enabling the coordination of drug buys in gas-station and shopping-mall parking lots. Hotels situated along the perimeter of Roanoke on I-81 and near Interstate 581, which cuts through the city center, were also prime drug-deal spots because higher-level distributors could sell there and quickly get back on the road.

  Experienced dealers were hiring addicted middlemen like Tess to conduct street-level business for them, lowering the dealers’ risk. And shoplifting fueled by users like Tess had nearly doubled in the past five years. Violent crime was edging upward, too: A thirty-four-year-old woman was murdered at a rent-by-the-week airport motel known to be a hangout for the heroin-addicted. A woman Jamie Waldrop had been coaxing toward treatment for months was found dead of overdose at a Howard Johnson’s next to I-81.

  “She’s next on the list” to be admitted, a rehab intake counselor texted Jamie the next day.

  But it was too late. “She died in a motel last night,” Jamie wrote back.

  It was time to get nimble again.

  On the eve of his retirement, Chief Perkins vowed to do something about Roanoke’s surging heroin problem. A data geek as well as an incessant worrier—nights and weekends, Perkins had crime reports emailed to his phone every hour, one of the reasons he retired early, after twenty-four years on the force—he was eyeing a program he hoped to implement, if he could just get buy-in from the disparate health care and criminal justice agencies. “This is what I’m going out on!” he told me, almost manically, in late 2015.

  He hoped to follow the path of Gloucester, Massachusetts, police chief Joseph Campanello, who’d recently told the growing number of heroin users in his town: Turn in your drugs, and I’ll hook you up with treatment instead of handcuffs. By early 2017, the Gloucester model, called Police Assisted Addiction and Recovery Initiative, had been adopted by two hundred police agencies in twenty-eight states.

  The Hope Initiative, as the PAARI program in Roanoke would be called, was the impatient police chief’s swan song. “We want the carrot to be: We’ll treat it like a disease, and if you stay clean, we’ll go away,” Perkins said.

  The idea was to create a public-private partnership where “angels,” or trained volunteers, helped funnel addicts into treatment, mentoring them during the cumbersome and usually relapse-ridden march toward sobriety—kind of like an on-call NA sponsor, only with the skills of a social worker able to take advantage of the city’s housing, mental health, and job resources. The program would be located at the Bradley Free Clinic, a long-running program for the working poor staffed by physician volunteers and located in Old Southwest, a burgeoning heroin hot spot.

  The clinic’s executive director, Janine Underwood, wasn’t a doctor. In the fall of 2015 she attended the first Hope Initiative meeting not because she ran a nonprofit medical clinic but because her twenty-eight-year-old son, Bobby Baylis, was among the four who died of fentanyl-laced heroin that June, while Tess was in jail.

  Janine had spent the previous seven years floundering as she watched Bobby seesaw between rehab and jail after initially becoming addicted to OxyContin prescribed in the wake of ACL surgery following a snowboarding accident. He’d gotten clean—finally, she thought—during a three-year prison sentence, during which he’d participated in drug treatment and become a certified journeyman in heating and air-conditioning. On probation back in Roanoke, Bobby was excelling at his new job, living in her basement, and doing well after his release. “You could see the sparkle again in his eyes, for the first time in years,” she said. Three months after leaving prison, a visit with some old Hidden Valley friends led to a single dose of fentanyl-laced heroin. Janine discovered Bobby’s body, cold and blue, laid out on the basement floor, the evidence cleaned up and his user-dealer friends long gone from the scene.

  Still raw in her grief—Bobby had been dead only six months—Janine could draw a detailed mental map of the flaws in the treatment landscape, from health care privacy hurdles and other treatment barriers to the lack of guidance about what to do the moment you realize your twenty-one-year-old is injecting heroin: Janine had found a box of hypodermic needles hidden in a box in the back of Bobby’s closet. He’d wrapped them up in his baby blanket, sandwiched between soccer trophies and Boy Scout patches.

  What Janine did was sob. “It was the worst moment in my life. I didn’t understand yet the connection between pills and heroin. I kept thinking, ‘He’s gonna get better; it’s just pills.’

  “I’m in health care, and there were just so many things I didn’t know,” she said. “It’s almost impossible the way the systems are set up, for a parent to get good treatment for their child.”

  Janine was the first Hope Initiative angel to tell the chief, “I’m in.”

  The second was Jamie Waldrop, Christopher’s mom—the one who’d personally accompanied her addicted son to the Montana rehab. By now, so many in the Hidden Valley circle of heroin users had become intertwined: Jamie’s boys had known Bobby, Janine’s son, who’d been in the same court-ordered halfway house as Spencer Mumpower. And Jamie’s older son had at one point dated Tess.

  “It was like we had a Dementor from Harry Potter who was swirling around the households of Hidden Valley, going, ‘I want you and you and you and you,’” Jamie told me.

  The third volunteer was Terrence Engles, a former pro baseball player who’d progressed from taking injury-prescribed OxyContin to scamming pain-management doctors on Manhattan’s Upper East Side to overdosing on a Staten Island ferry in 2011. He’d just landed in Roanoke as a treatment consultant for American Addiction Centers, with three years of sobriety. He spent most of his time in Roanoke trying to persuade addicted twentysomethings to go to treatment, whether it was to one of his company’s dozen centers across the United States (for those with insurance) or to the scant few regional or charity options, most of them faith-based and abstinence-only. “I get about twenty calls a week from people in crisis,” he said.

  In Chief Perkins’s ideal world, Carilion Clinic, the region’s largest employer with nonprofit hospitals and a new research center already known for its work on addiction research, would provide much-needed inpatient treatment. No comparable treatment was available locally, only short-term detox programs and one privately owned facility that accepted only insurance and cash (a twenty-eight-day stay ran around $20,000), and it didn’t allow patients to take maintenance medications.

  Unlike Campanello’s Massachusetts, Virginia could not rely on anything close to RomneyCare, the 2006 initiative signed into law by then–Bay State governor Mitt Romney, guaranteeing insurance coverage to 99 percent of the state. Virginia’s legislature had repeatedly turned down attempts to pass Medicaid expansion in the wake of the Affordable Care Act, sacrificing $6.6 million a day in federal funds and insurance coverage for four hundred thousand low-income Virginians—a frequent source of frustration for opioid-affected families and health care advocates.

  In states where Medicaid expansions were passed, the safety-net program had become the most important epidemic-fighting tool, paying for treatment, counseling, and addiction medications, and filling other long-standing gaps in care. It gave coverage to an additional 1.3 million addicted users who were not poor enough for Medicaid but too poor for private insurance.

  But in Virginia in June 2014—one year before the first fentanyl spike—statehouse Republicans shut down the Democratic governor’s proposal to expand it in a political plot that seemed lifted from House of Cards: Democratic coalfields senator Phillip P. Puckett abruptly resigned to give the Republicans an expansion-quashing majority. Alleged motivations for his action included making his lawyer daughter eligible for a judgeship—the senate’s
policy forbids judicial appointments of relatives—and also allowing him to nab a job with the commission that oversees economic-development investments from Virginia’s slice of the tobacco settlement.

  The last Democratic legislator west of Roanoke, whose Russell County region in Appalachia remains among the state’s hardest hit by the epidemic, Puckett eventually removed himself from consideration for the tobacco post, citing “family matters,” while a six-month federal investigation into corruption claims went nowhere.

  Perkins hated political maneuvering. In his ideal world, the economics of securing help worked like this: Since addicts would be diverted from jail, the cost savings from their empty jail beds could be put toward treatment. “The problem is, it’s easier to give money to the corrections system—to the tune of one billion in the state of Virginia—than it is to take a couple of million dollars and provide inpatient treatment for our problem,” he railed, blaming politics and the tendency among jailers and sheriff’s departments to cling to bloated incarceration budgets championed during the War on Drugs, even though two hundred of the city jail’s eight hundred beds were typically empty.

  But Frederick Douglass had it right when he said, “Power concedes nothing without a demand.”

  Perkins pointed out that most addicted users return to the streets from jail with more drug contacts than they had when they arrived. “I said it all a thousand times, but I couldn’t get anybody to listen because the sheriffs are elected officials with powerful lobbyists, and a poor old appointed police chief doesn’t stand a chance,” he said.

  At the first Hope Initiative meeting, stakeholders were so focused on hurdles to treatment that Jamie worried the project would die before it ever got under way. Privately, she reached out to Police Chief Campanello in Massachusetts and asked him to do a conference call with the working group. She even suggested exactly what he should say: that if they waited till they solved all the obstacles, the program would never begin; meanwhile, people were dying every day. By the end of 2015, fifty-one thousand more Americans were dead of drug overdose—a thousand more than died from AIDS in 1995, the peak year. And the epidemic displayed no signs of trending down. In fact, HIV, spurred by the sharing of dirty heroin needles, was on the rise again, with sixty-five new cases reported that year in rural southwestern Virginia alone.