Dopesick

by Beth Macy

  Several interventions later, including a visit with her at the emergency room, the women persuaded Joey, battered and with bruises around her neck, to move away from the dealer. As Jamie helped her pack up, they found some of Tess’s clothes.

  Cheri Hartman talked her psychiatrist husband into taking Joey on again as a Suboxone patient. (He’d once prescribed her Vivitrol, during an earlier period of sobriety, before she turned twenty-six.) Joey’s divorced parents shared the cost of the prescription, visits, and lab work, and uninsured Joey applied to the hospital-run clinic for charity care.

  But Joey bumped into treatment barriers in March 2017, just as Tess had with waiting lists and funding hurdles: The only inpatient facility willing to accept her at the moment was a free, faith-based program in Charlotte that did not permit the use of Suboxone or any other drugs.

  To get into the rehab, Joey decided to wean herself off MAT, even though she knew the dangers. And while Jamie tried to be encouraging, privately both she and Cheri worried. “She was so motivated and wanted to do it, and we all felt like it would really be a good fit,” Cheri said, even though the MAT tapering presented a catch-22.

  “Her addiction was so severe, I don’t think she was fighting withdrawal symptoms as much as she was fighting her mental illness demons,” including bipolar depression and probably PTSD, Cheri said. In her experience, those who have serious psychiatric problems on top of their addictions and who also use multiple drugs (not just opioids) are the very hardest cases to treat, even with MAT. In an ideal world, Joey would have gone from Vivitrol, which lasts about a month, directly to rehab, with the shot providing a bridge to fight her cravings, Cheri said.

  Jamie worried, too, telling Joey’s dad, “I don’t know what makes her think she can do it now when she couldn’t do it before. We’re just doing the same old thing here.” Her dad pointed out that Joey had never had much tolerance for pain. “She felt she couldn’t get off anything unless she was on something else, but that’s what a lot of drug addicts do; it’s the addictive personality,” Danny Gilbert said. “I think it’s asinine to tell a drug addict you’ve got to be clean before you can come to my facility.” (In the treatment center’s defense, it couldn’t afford to have medical staff on hand to supervise detox and/or medications, Jamie said.)

  Joey had two halves of a Suboxone pill left. She was trying to stretch them out, self-weaning in preparation for rehab. The next day, Danny Gilbert was traveling in northern Virginia with his wife when he took a frantic call from Joey. She and her boyfriend had had another fight, and she felt her resolve slipping.

  “Daddy, I don’t want to die!” she told him. They argued on the phone.

  A few hours later, she texted her father:

  I just left goodwill, can you please transfer $4 so I can get a pack of cigarettes please?

  Eight minutes later he texted Joey back:

  Say what you want but everyone loves you…we want you back!!!! Get Cigarettes but get your life back, not more BS.

  The next morning, Cheri phoned Jamie but had a hard time choking out the news: Joey had lain inside a Roanoke County house for almost eight hours before 911 was called. Police were investigating, but the so-called friends she was using with had cleaned up the scene, fearing prosecution, after Joey passed out. She died of an overdose of illicit methadone on March 26, 2017, the nineteenth lethal overdose in the Roanoke County suburbs so far that year. She was twenty-seven years old.

  “She fought hard against the demon of addiction and God has delivered her to a place of unconditional love, laughter and no more pain,” her mother wrote in her obituary. “Watch over us, Jo, and smile down on us until we can hold you in our arms again.”

  Two days later, the moms of the Hidden Valley fraternity of users—only a few of their sons and daughters now among the living—took their seats among the memorial service pews. Patricia wept, marveling at how much the Gilbert family loved their troubled daughter. Even with all the sorrow she’d caused them, they had tried so hard to keep her safe.

  “I was thinking to myself, ‘If this was Tess, how would you feel right now, family?’” She firmly believed that Tess still had the potential to recover, to become a loving mother to her son. Patricia was still showing her grandson family pictures, coaching him to say “Mama” when she pointed to Tess. But new custody issues were emerging that Patricia kept secret from Tess—and she knew that Tess could die before they were resolved. She had already chosen the spot where she would sprinkle her daughter’s ashes if it came to that: at a confluence of the Cape Fear River and the ocean where they had loved walking the dogs and searching for sand dollars, not far from the family’s old beach house.

  Six weeks later, Patricia intercepted a Facebook message between a Las Vegas drug dealer and Tess, now communicating through her rehab roommate’s phone.

  She was still at the facility the next day, when Patricia fired off a letter expressing her disappointment to her daughter. “If she fails, she is on her own,” she told me.

  It was Mother’s Day 2017. Tess wished Patricia a happy one, via text. “I love you,” Tess wrote. “But this [is] bullshit all of it,” especially being away from her son.

  “I’m going to [find] a way home,” she said.

  She signed the text to her mother ominously, using her street name: Sweet T.

  United States Penitentiary, Hazelton, Bruceton Mills, West Virginia

  Chapter Twelve

  “Brother, Wrong or Right”

  In The Odyssey, Homer described a drug that would “lull all pain and anger and bring forgetfulness of every sorrow.” A Victorian poet said taking opium felt as if his soul was “being rubbed down with silk.”

  In Virginia’s coalfields, a long-addicted OxyContin user spoke in hyperbolic terms about the first time she crossed paths with the molecule, back in 1998. “I thought, that’s all I need from here on out. I will live life like this,” Rosemary Hopkins, in recovery and on MAT under the care of Van Zee since 2009, told me in a counseling room at Sister Beth Davies’s office.

  Rosemary had a theory about the way corporations had been allowed to unleash a flood of painkillers, a notion I heard more than once as I traversed Appalachia’s former factory and mining towns: “For that strong of a drug, for it to be everywhere you looked, it was like the government was controlling it, trying to get rid of the lowlifes.”

  She laughed when she said it, but I could see what she was getting at. Although her hypothesis was somewhat different, it was a version of what federal prosecutor Andrew Bassford meant when, quoting President Garfield, he proposed that governments fail their citizens “not because of stupidity or faulty doctrines, but because of internal decay and rigidification.”

  “I used to do eighty cases in a good year, but in recent years it’s been twenty-six, forty, whatever,” Bassford said in April 2017. “So the amount of cases being done does not match the problem, and we have found ways to make it more difficult to do cases—more boxes that have to be checked, more things to do in the service of perfection.”

  When I offered that I was leaving his office after our third interview depressed—again—he said, “Well, you should be. Rehab is a lie. It’s a multibillion-dollar lie.”

  An annual $35 billion lie—according to a New York Times exposé of a recovery industry it found to be unevenly regulated, rapacious, and largely abstinence-focused when multiple studies show outpatient MAT is the best way to prevent overdose deaths. “I’m afraid we don’t have good data on outcomes from residential programs,” said John Kelly, the Harvard researcher. While research supports users remaining in their home environments on outpatient MAT, desperate families continue to grasp for “cures” offered by companies marketing abstinence-only rehabs. “Part of it is, when you spend that much money, you think it’s going to work,” Cheri Hartman said. “But it is killing people for that myth to be out there—that the only true cure is abstinence.”

  I hoped the stories of Ronnie Jones and his victims wou
ld illuminate the ruts in both a criminal justice system that pursues a punishment-fits-all plan when the truth is much more complicated and a strained medical system that overtreats people with painkillers until the moment addiction sets in—and health care scarcity becomes the rule.

  I hoped, too, that my interview with Jones would help answer Kristi Fernandez’s questions about what led to her son Jesse’s premature death. Was Ronnie Jones really the monster that law enforcement officials made him out to be? Had the statewide corrections behemoth that returns two thousand ex-offenders a year to Virginia’s cities, counties, and towns played a role in his revolving door of failures?

  I had come to interview Ronnie Jones expecting I would have two hours, no recording devices allowed. On the day of our meeting, though, the visit stretched from morning into late afternoon, with the prison handler monitoring our visit from the other side of a glass wall and inexplicably allowing us to talk for more than six hours.

  I had the better part of a day to try to discern how a sleepy agricultural county nestled in the Blue Ridge Mountains, with covered bridges and lovingly preserved two-hundred-year-old log homes, had gone from having a handful of heroin users to hundreds in a few short months, and how much Ronnie Jones was to blame for it.

  Understandably guarded at first, Ronnie, thirty-nine, was gentlemanly and polite throughout the visit. During the two years he’d spent there, he said, he spent his time working out, studying Arabic and Swahili, and reading the works of Guy Johnson, Eric Jerome Dickey, and Maya Angelou. On my way to the prison, I’d been listening to the audiobook of Michelle Alexander’s New Jim Crow, I told him, the seminal book on mass incarceration that likens the War on Drugs to a system of racial control comparable to slavery and Jim Crow.

  “I’ve read The New Jim Crow twice,” Ronnie said. He’d also read lawyer Bryan Stevenson’s majestic Just Mercy, a memoir about his work against the racial bias and economic inequities inherent in the criminal justice system, which included efforts on behalf of falsely accused death row inmates. “It had me crying when I read it,” he said. These books we had both read challenged the tough-on-crime government narrative of the past forty years, one that fostered the shift in public spending from health and welfare programs to a massive system of incarceration, with a fivefold increase in imprisonment and corrections spending that soared from $6.9 billion in 1980 to $80 billion today.

  Whereas Bill Metcalf, the ATF agent largely responsible for Jones’s twenty-three-year prison sentence, took inspiration for his life’s work from the image of the brain frying like an egg and Nancy Reagan’s “Just Say No” slogan, Alexander and Stevenson saw fearmongering and institutional racism in mandatory minimum sentences, three-strikes sentencing laws, the abolishment of parole, and “stop and frisk” policing.

  This was Ronnie’s third time in prison. He already knew that one in three black men was destined to end up incarcerated, only to find himself branded as a felon and second-class citizen the moment he got out, blocked from the mainstream economy and propelled into a dystopian loop of jail, joblessness, and back to jail. He knew that drug-involved offenders, who represent half the incarcerated population, had a recidivism rate of 75 percent. His own story was a case in point.

  “We can’t arrest our way out of this problem,” I’d heard again and again, from everyone from police chiefs to public health providers. But that sentiment seemed to apply only to the mostly white group of opioid users who were dealing or committing property crimes to stave off dopesickness—not to people like Ronnie, in prison for armed heroin distribution, or to the majority of other black and brown people arrested for selling the drugs, even though they were statistically less likely to use or to deal. (Three-quarters of federal drug offenders are black or Hispanic while 57 percent of state-imprisoned drug offenders are people of color.)

  Why had blacks failed to become ensnared in opioid addiction? That question was addressed in 2014 data issued by the Centers for Disease Control and Prevention: Doctors didn’t trust people of color not to abuse opioids, so they prescribed them painkillers at far lower rates than they did whites. “It’s a case where racial stereotyping actually seems to be having a protective effect,” marveled researcher Dr. Andrew Kolodny of Brandeis University. Put another way: By 2014, while young whites were dying of overdose at a rate three times higher than they did in 2002, the death rate for people of color was relatively unchanged.

  If, as Shannon Monnat had proposed, the hollowing out of the predominantly white working class was the kindling in the heroin epidemic, and the mounds of opioid pills in America’s communal medicine chest was the spark, I was beginning to wonder whether the fragile transition of ten thousand prisoners a week from state and federal prisons into U.S. communities fanned the flames of the fire.

  At the same time that Ronnie and I were speaking, the city of Winchester was launching the region’s first drug court just a half hour north of the heart of Ronnie’s Woodstock heroin ring. It was designed not only to connect offenders to treatment, including MAT, but also to help them access free housing and taxi vouchers to get to work (a serious barrier in rural areas), the latter paid for by grants from the local Rotary Club.

  While the government’s response to the opioid crisis had been molasses-slow, mired in bureaucracy, funding woes, and slow-to-close treatment gaps, here was an example of volunteers stepping in to patch up the holes. Winchester was becoming a magnet for people in recovery across the state, including ex-offenders who came for treatment and ended up staying because of its multitude of halfway houses—fourteen in a city of just twenty-seven thousand people—and of newly announced jobs.

  Amazon was soon to open a warehouse and distribution center in the county, and Procter and Gamble was building a Bounce fabric-softener factory twenty minutes north. The fastest-growing church in town was led by an ex-offender and opioid addict, a charismatic pastor who held Sunday services at the downtown mall—in a bar.

  What if Winchester’s Rotarians and drug-court champions had been around to assist Ronnie Jones when he got out of prison, instead of one probation officer responsible for keeping up with 104 ex-offenders on her rolls?

  “Right away they run into issues of having a paycheck that doesn’t cover rent, utilities, and food, not to mention their court fines and child-support arrears—and that’s when the issues really start,” said Ronnie’s probation officer, who asked not to be named because she wasn’t authorized to speak. “That’s usually when they commit new crimes.” In 2016, the Woodstock office had two probation officers tasked with doing monthly check-ins, field visits, and drug screening for 204 people, though an additional officer was scheduled to join the team.

  Many ex-offenders have no driver’s license and no way to get one until they pay back the thousands they owe in court fines and child-support arrears. In some states, people with drug charges are permanently barred from getting food stamps, a holdover from a 1996 federal ban. (Virginia is one of twenty-six states that have eased some restrictions on the ban.)

  “Think about it: You can do without a roof, but you can’t do without food,” said Mark Schroeder, a repeat drug-dealing offender and recovering crack addict who successfully opened his own garage-door-hanging business in the Shenandoah Valley in 2016 after a ten-year federal prison stint. He and hundreds like him were given reduced sentences following the 2015 decision Johnson v. United States, a U.S. Supreme Court ruling that redefined the status of “armed career criminals.”

  “To feed yourself, you’re either going to rob somebody, or you’re going to go back to dealing or prostitution,” Schroeder said. “I’ve been there and done it myself.

  “The whole thing is designed for you to come back.”

  What if Ronnie’s reentry had been managed not by an overburdened and apathetic system but instead by workers from Bryan Stevenson’s Equal Justice Initiative, which sends clients to felon-friendlier cities like Seattle? There, jobs and harm-reduction measures are more plentiful, and police diver
t low-level drug and prostitution offenders who are addicted from prosecution before they’re booked, assisting with housing, case management, and employment services. Such a two-pronged approach not only addresses the need of former drug dealers to find legitimate work but also works to dry up the demand for drug dealing.

  “It makes a huge difference,” Stevenson told me. “If we reduced our prison population by twenty-five percent, that’s twenty billion dollars we could save. And if we invested half of that in treatment, we could really increase people’s likelihood of success.”

  In the 1970s, America decided to deal with drug addiction and dependence as a crime problem rather than a health problem, “because it was popular to find a new community of people to criminalize,” Stevenson explained. “And everybody was preaching the politics of fear and anger.”

  As that narrative of addicts as criminals further embedded itself into the national psyche, the public became indifferent to an alternative response that could have eased treatment barriers, he said. As an example he cited Portugal, which decriminalized all drugs, including cocaine and heroin, in 2001, adding housing, food, and job assistance—and now has the lowest drug-use rate in the European Union, along with significantly lowered rates of drug-related HIV and overdose deaths. In Portugal, the resources that were once devoted to prosecuting and imprisoning drug addicts were funneled into treatment instead.

  Ronnie Jones’s story was tough to fit into a neat arc of redemption, but it seemed to turn on poor decision making fueled by family instability and quick-fix desires. His rap sheet began with a felony grand larceny charge the summer before his senior year of high school. He’d borrowed a car from a girlfriend, then used that car to meet up with another girl, resulting in a catfight and, ultimately, his arrest and conviction for theft. While he was on probation for that offense, he nabbed another felony for driving another car, sans license, that contained stolen goods.