Dopesick

by Beth Macy

  A construction laborer and former heroin user now working in Portsmouth, Virginia, Sharp said he offered to fly out and drive her back in a rental car, but Tess told him not to worry; her mother was making arrangements to fly her home.

  “For a drug addict trying to be clean, Vegas is really no place to be,” Sharp said. Tess was aware of Las Vegas gangs, but she wasn’t mixed up in them, to Sharp’s knowledge. “She wasn’t afraid to go into the wrong part of town, though,” he added. “She really weren’t scared of nothing.”

  Tess gave Sharp the same line she gave her mother: She was a soldier, not to worry, she would make it home.

  In the days leading up to Christmas, Tess sent her mother scattered texts with mixed messages, telling her she loved her, thanking her for looking after her son and her beloved dog, Koda. She’d be home soon, she insisted, though she had yet to pick up her ID.

  “Our poet has been begging for money, saying she is sick but no trip to ER,” Patricia texted me on December 22.

  The next day, Tess wrote to say she’d just gotten on Suboxone, to prevent her from becoming dopesick during her trip. But she still hadn’t picked up her ID.

  “I am thankful for my dad and have peace of mind knowing that when she is ready I can make something happen quickly,” Patricia said, the day before Christmas Eve. “It is for the angels to watch over her.”

  The morning after Christmas, Patricia got the call. Las Vegas police had traced Tess’s identity through her fingerprints and her tattoos—the Tree of Life on her shoulder and another on her side that said “God forgive me my sins.”

  On Christmas Eve, in the Dumpster of a central Las Vegas apartment complex, a homeless man foraging for cans discovered Tess. She was naked, inside a plastic bag, and there were partial burns on her body and the bag, as if whoever murdered her had tried to erase the evidence of her death. The cause of death was blunt head trauma.

  The story made national news, and Patricia, determined that people should understand both the disease of addiction and her daughter’s incredible strength, spoke to every reporter who contacted her. The attention made some family members uncomfortable.

  I saw a family riven by Tess’s death as it had been throughout the last five years of her life, some members second-guessing each other’s actions and still debating enabling versus helping and the meaning of tough love. “As my son is fond of saying, ‘Whenever Tessy was presented with choices, she was expert at making the very worst choice,’” said her father, Alan, enumerating the many times that he and Tess’s siblings had tried to help, paying for rent, rehab, or food. But those efforts were primarily in the earlier years of Tess’s addiction.

  By the time Tess left for Nevada, as she wrote in her journal around that time, “I was stealing, robbing, selling my body, and anything else I could do to make money for drugs. I was beaten, raped, robbed, and malnourished. I ended up in the hospital with my mom’s help where I detoxed and got on medication and where I am writing this now. I am going to die if I keep living the way I am.”

  She was dead now, her grieving family a perfect microcosm of the nation’s response to the opioid epidemic: well-meaning but as divided as it was helpless, and utterly worn out.

  Police were investigating, but Alan Henry theorized that Tess “had gotten crosswise with somebody she owed something to,” possibly a drug dealer or a pimp—an argument Patricia rejected outright as blaming and unjust “when we have no idea of what happened to her.”

  A former counselor of Tess’s who works with addicted and sex-trafficked women in Las Vegas said it was entirely possible that Tess had in fact been a victim of gang stalking. Addicted women who do sex work are sometimes threatened with rape or murder if they refuse to join a gang trying to “turn them out,” or coerce them into prostituting themselves on the gang’s behalf.

  Another rehab worker who knew Tess and had herself been a heroin-addicted sex worker from 2003 to 2010 told me that four of her prostitute friends had been murdered by gangs and left in Dumpsters and, in one case, the air-conditioning ducts of a motel. “These gangs will stalk you and hurt you and block you from making money,” said Kathleen Quirk, who does street-level counseling with addicted prostitutes in Las Vegas, offering cookies she bakes in her home as a way to forge an initial bond. “They make your life miserable until you do what they say—or you end up dead.”

  The scenarios were almost beyond comprehension for those at home closest to Tess.

  Her grandfather, a retired auditor for IBM, was struggling to grasp the violent nature of Tess’s death. As Patricia relayed the details in the booth of a steakhouse chain, where they stopped after making arrangements for Tess’s cremation, his eyes welled with tears and he said, “Oh…That means somebody hit her.”

  Tess finally made her flight home the night of December 30. It was unseasonably cold in Virginia, the winds howling and furious. The snow flurries reminded Patricia of all the cold nights she’d spent worrying about Tess. She was still sleeping with her cellphone, awaiting Tess’s transport to Roanoke. Just after midnight, she texted me:

  Her body has arrived.

  It took funeral-home technicians two days to make Tess presentable enough for Patricia to view her body. Her head had been shaved in Las Vegas, for the collection of evidence, and Tess’s older sister had picked out an outfit from one of Tess’s favorite shops, including an embroidered vest, leggings, and a bright silk-cashmere headscarf with a boisterous, smiling Frida Kahlo.

  In a windowless nook of a downtown Roanoke funeral parlor, not far from where Tess once roamed the streets, Patricia caressed the back of the scarf, as if cupping a baby’s head, and told her poet goodbye.

  It was January 2, Tess’s birthday. She would have been twenty-nine.

  Patricia tucked the treasures of her daughter’s life inside the vest—a picture of her boy and one of his cotton onesies that was Tess’s favorite, some strands of Koda’s hair, and a sand dollar.

  Acknowledgments

  This book stands on the shoulders of several important works about the opioid crisis that came before it: Barry Meier’s Pain Killer, Sam Quinones’s Dreamland, Anna Lembke’s Drug Dealer, MD, and Tracey Helton Mitchell’s Big Fix. My take on the epidemic as I witnessed it landing in the western half of Virginia began with reporting I did in 2012 for the Roanoke Times, and I remain grateful to my former newspaper for giving me the time and guidance to see the epidemic unfolding before me, particularly editors Carole Tarrant and Brian Kelley. Longtime reporter Laurence Hammack not only unearthed the devastation caused by rampant overprescribing in Virginia’s coalfields as early as 2000, he was also the first in the nation to write about the heroics of Dr. Art Van Zee, Sue Ella Kobak, and Sister Beth Davies, whose insights were invaluable to me throughout my reporting.

  My agent, Peter McGuigan, helped frame my initial reporting into the idea for this book, and Vanessa Mobley, my editor at Little, Brown, shaped my further reporting with razor-sharp analysis and offered masterful guidance on structure and theme while never letting me forget that, above all, it was America’s grieving families who were being left to figure a way out of this mess. John Parsley gave critical early advice to cast my reporting net wide and to be patient.

  If I ran my own journalism action-figure factory (#LifeGoals), I would fashion caped likenesses of my most intrepid and generous journalist pals: Martha Bebinger, Andrea Pitzer, Carole Tarrant, and Brian Alexander, along with my photojournalist collaborator of many years, Josh Meltzer, who shot the portraits for this book.

  I’m thankful, too, for the generous legal, medical, journalistic, and historical insights offered in multiple conversations with Dr. Anna Lembke, Dr. Molly O’Dell, Dr. Steve Huff, Dr. Art Van Zee, Sister Beth Davies, Robert Pack, Dr. Steve Loyd, Sarah Melton, Dr. Sue Cantrell, Dr. Hughes Melton, Dr. Jody Hershey, Dr. Karl VanDevender, Teresa Gardner Tyson, Tammy Bise, Don Wolthuis, Andrew Bassford, Nancy D. Campbell, Elizabeth Jamison, John Kelly, Caroline Jean Acker, Sergeant Chad Seeberg, Agent Bill
Metcalf, Sergeant Brent Lutz, Lieurenant Richard Stallard, Christine Madeleine Lee, Heath Lee, Dean King, Andy Anguiano, Barbara Van Rooyan, Cheri Hartman, Nancy Hans, Janine Underwood, Jamie Waldrop, Wendy Welch, Bryan Stevenson, Danny Gilbert, Thomas Jones III, Drenna Banks, Dr. Karen Kuehl, Dr. Lisa Andruscavage, Kim Ramsey, Dr. Jennifer Wells, Ed Bisch, Lee Nuss, Barry Meier, Laura Hadden, Lisa Wilkins, Marianne Skolek Perez, Isaac Van Patten, Chris Perkins, Jeremiah Lindemann, Richard Ausness, Vinnie Dabney, Laura Kirk, Warren Bickel, Aaron Glantz, Rob Freis, Judge Michael Moore, Missy Carter, Emmitt Yeary, Shannon Monnat, Nikki King, Sue Ella Kobak, Dr. Martha Wunsch, Destiny Baker, Kristi Fernandez, Ginger Mumpower, Robin Roth, David Avruch, and with the patients (named and unnamed) of Dr. Art Van Zee, Dr. Hughes Melton, Sister Beth Davies, and Ron Salzbach. For the insights they shared from behind prison walls, I offer heartfelt thanks to Ronnie Jones, Ashlyn Kessler, and Keith Marshall.

  Portions of this book were written and rewritten at the Virginia Center for the Creative Arts and Rivendell Writers Colony; their fishponds and wooded lands were a balm of beauty, quiet, and support. As usual, my librarian pro team of Piper Cumbo, Edwina Parks, and Belinda Harris cheerfully augmented my research. I’m also grateful for the creative support of Sheila Pleasants, Mason Adams, Amy Friedman, Kim Cross, Kirk Schroder, Richie Kern, Mim Young, Doug Jackson, Chloe Landon, Chris Landon, Mary Bishop, Anna Quindlen, Mary-Chris Hirsch, Kate Khalilian, Mindy Shively, Max Landon, and Will (“You Got This, Ma”) Landon. Special thanks to my friend Elizabeth Perkins, who introduced me to Patricia Mehrmann and Tess Henry in November 2015, after rescuing a dog of theirs that had gotten loose, and who “had a feeling” I needed to know their story.

  At Little, Brown, I’m lucky to have the spirited backing of publishers Reagan Arthur and Terry Adams, copyeditor Deborah P. Jacobs, production editor Pamela Marshall, jacket designer Lauren Harms, editorial assistant Joseph Lee, and the fabulous publicity/marketing team of Sabrina Callahan, Alyssa Persons, Lena Little, and Pamela Brown.

  As always, I thank my secret ingredient, Tom Landon, who supports everything I do, from first-line editing and technical assistance to hashing out story lines with tough questions and cheerful reminders to be patient with my interviewees and myself.

  In my thirty-two years of journalism, I have never known a source to be as open and unvarnished about hard truths as Patricia Mehrmann, who let me into her life over the course of hundreds of text messages and scores of emails, phone calls, and visits, and whose courage to confront the stigma of addiction is astonishing. May our poet rest in peace.

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  Notes

  Prologue

  Interviews: Ronnie Jones, Don Burke, Kristi Fernandez

  I walked along the manicured entranceway: Author interview, Ronnie Jones, Hazelton Federal Correctional Institution, Bruceton Mills, WV, Aug. 11, 2016.

  the prison had taken over: Hazelton is the largest employer in Preston County, according to the Preston County Economic Development Authority website and Hazelton management, via email to author, July 13, 2017.

  “Exactly who have you spoken to”: Email to author via CorrLinks federal prison monitored email: July 18, 2016.

  a single batch of heroin was about to land: “26 Overdoses in Just Hours: Inside a Community on the Front Lines of the Opioid Epidemic,” Andrew Joseph, STAT, Aug. 22, 2016.

  West Virginia’s indigent burial-assistance program: Christopher Ingraham, “Drugs Are Killing So Many People in West Virginia That the State Can’t Keep Up with the Funerals,” Washington Post, March 7, 2017.

  Drug overdose had already taken: Jeanine M. Buchanich, Lauren C. Balmert, and Donald C. Burke, “Exponential Growth of the USA Overdose Epidemic,” https://doi.org/10.1101/134403 (extrapolates 300,000 more opioid deaths in the next five years, based on graphs studied from 1979 to 2015); other forecasts using similar data are outlined in Max Blau, “STAT Forecast: Opioids Could Kill Nearly 500,000 Americans in the Next Decade,” STAT, June 27, 2017.

  It is now the leading cause: Josh Katz, “Fentanyl Overtakes Heroin as Leading Cause of U.S. Drug Deaths,” Global NAIJA News, Sept. 3, 2017.

  Kristi Fernandez and I stood: Author interview, Kristi Fernandez, May 23, 2016.

  When a new drug sweeps the country: Author interview, historian David Courtwright; the advent of the opioid epidemic was masterfully chronicled for the first time in Paul Tough, “The Alchemy of OxyContin,” New York Times Magazine, July 29, 2001.

  the German elixir peddlers at Bayer: Martin Booth, Opium: A History (New York: St. Martin’s, 1996), 69; David Courtwright, Dark Paradise: A History of Opiate Addiction in America (Cambridge, MA: Harvard University Press, 2001), 47; Courtwright, “Preventing and Treating Narcotic Addiction—A Century of Federal Drug Control,” New England Journal of Medicine, Nov. 26, 2015. Per capita consumption of opiates tripled in the 1870s and 1880s.

  Chapter One. The United States of Amnesia

  Interviews: Lt. Richard Stallard, Nancy D. Campbell, Dr. John Burton, Dr. David Davis

  young parents can die of heroin overdose one day: Kristine Phillips, “A Young Couple Died of Overdose, Police Say. Their Baby Died of Starvation Days Later,” Washington Post, Dec. 25, 2016. The deaths occurred in the Kernville neighborhood of Johnstown, Pennsylvania, sixty miles east of Pittsburgh.

  “Half a million people are dead”: Lenny Bernstein and Joel Achenbach, “A Group of Middle-Aged Whites in the U.S. Is Dying at a Startling Rate,” Washington Post, Nov. 2, 2015.

  “diseases of despair”: That wording became a shorthand for Case and Deaton’s work in the wake of a subsequent study by the pair, published in March 2017, according to Joel Achenbach and Dan Keating, “New Research Identifies a ‘Sea of Despair’ Among White, Working-Class Americans,” Washington Post, March 23, 2017.The language is also used in a follow-up story, Jeff Guo, “The Disease Killing White Americans Goes Way Deeper Than Opioids,” Washington Post, March 24, 2017.

  Kaiser Family Foundation poll: Bianca DiJulio, Jamie Firth, Liz Hamel, and Mollyann Brodie, “Kaiser Health Tracking Poll: November 2015,” http://kff.org/health-reform/poll-finding/kaiser-health-tracking-poll-november-2015/.

  Nationwide, the difference in life expectancy: Steven Rattner, “2016 in Charts. (And Can Trump Deliver in 2017?),” New York Times, Jan. 3, 2017.

  in Appalachia, those disparities are even starker: A 65 percent higher overdose mortality rate in Appalachia: Michael Meit et al., “Appalachian Diseases of Despair,” prepared for the Appalachian Regional Commission, Walsh Center for Rural Health Analysis, August 2017.

  people hadn’t yet begun locking: The early history of the modern-day epidemic shows that some of the largest concentrations of overdose deaths were in Appalachia, the Southwest, and New England, according to Lauren M. Rossen et al., “Drug Poisoning Mortality: United States, 2002–2014,” National Center for Health Statistics, Centers for Disease Control and Prevention, Aug. 25, 2016.

  Stallard was sitting in his patrol car: Author interview, Big Stone Gap police lieutenant Richard Stallard (now retired), April 29, 2016.

  snorters overcame their aversion to needles: Paul Tough, “The Alchemy of OxyContin,” New York Times Magazine, July 29, 2001.

  “Delayed absorption, as provided by OxyContin”: Attachment B to Plea Agreement, United States v. The Purdue Frederick Company, Inc., and Michael Friedman, Howard R. Udell, and Paul D. Goldenheim, filed in the U.S. District Court for the Western District of Virginia, Abingdon Division, from lawsuit’s “Agreed Statement of Facts” outlining the company’s original claims, 6; last modified May 8, 2007.

  The company was virtually unheard of: Michael Moore, “Lodi Plant Owners Known for Wealth, Philanthrophy,” Hackensack Record (NJ), April 27, 1995.

  As its patent was set to expire: Stacy Wong, “Thrust Under Microscope, Stamford Drug Company’s Low Pr
ofile Shattered by Controversy Over Abuse of Painkiller OxyContin,” Hartford Courant, Sept. 2, 2001.

  launched in the nation’s best-known corporate tax haven: Leslie Wayne, “How Delaware Thrives as a Corporate Tax Haven,” New York Times, June 30, 2012. Because corporations can lower their taxes by shifting royalties and other revenues to holding companies in Delaware, where they are not taxed, the state is particularly appealing to shell companies.

  “If you take the medicine”: Barry Meier, Pain Killer: A “Wonder” Drug’s Trail of Addiction and Death (New York: Rodale Press, 2003), 43.

  “exquisitely rare”: Ibid., 190.

  at the end of Alexander Hamilton’s ill-fated duel: John C. Miller, Alexander Hamilton and the Growth of the New Nation (New Brunswick, NJ: Transaction Publishers, 2004; originally published in 1959), 574. Hamilton recovered from a 1793 bout of yellow fever after taking laudanum, 380.

  one of Boston’s leading merchants: Opium money made by Thomas S. Perkins helped spawn the Industrial Revolution, according to Martha Bebinger, “How Profits from Opium Shaped Nineteenth-Century Boston,” WBUR, July 31, 2017.

  the opioid-addicted in China had long referred to as “yen”: Thomas Nordegren, The A–Z Encyclopedia of Alcohol and Drug Abuse (Parkland, FL: Brown Walker, 2002), 691. “Yen” refers both to restless sleep during withdrawal and to the craving for drugs.

  (What modern-day addicted users): William S. Burroughs, Junkie (New York: Ace Books, 1953), 155.

  “I consider it my duty”: Martin Booth, Opium: A History (New York: St. Martin’s, 1996), 69.