Dopesick

by Beth Macy

  A journalist and former colleague of mine: Tonia Moxley email, with X-ray, to author, July 24, 2017.

  gabapentin, which is increasingly sought: Carmen Heredia Rodriguez, “New on the Streets: Gabapentin, a Drug for Nerve Pain, and a New Target of Abuse,” Kaiser Health News, July 6, 2017.

  two employees charged with drafting it: Told to me privately by a Centers for Disease Control and Prevention program analyst at the Poynter Institute’s “Covering the Opioid Crisis,” Washington, D.C., Sept. 26, 2016.

  residency programs in the field of addiction medicine: Author interview, Campbell, and David E. Smith, “The Evolution of Addiction Medicine as a Medical Specialty,” AMA Journal of Ethics, December 2011. As of 2014, the list of residency programs: http://www.abam.net/wp-content/uploads/2013/04/ABAMF-Accredited-Program-Summaries-2013-14-1.pdf.

  “because Big Pharma’s going to keep”: Author interview, Caroline Jean Acker, June 15, 2017.

  largest free medical outreach event: Author interviews, Teresa Gardner Tyson, Feb. 23, July 6–7 (on Health Wagon), and May 24, 2017 (Health Wagon event that was precursor to Remote Area Medical event), and follow-up interviews by phone and text over the summer of 2017.

  hadn’t used illicit drugs in more than: Author interview, Craig Adams, July 25, 2017.

  state of health of RAM patients: Higher overdose death rates in rural America as outlined in these CDC statistics: https://www.cdc.gov/mmwr/volumes/66/ss/ss6602a1.htm?s_cid=ss6602a1_e.

  “In Central America, they’re eating beans”: Quote by RAM volunteer Dr. Joseph F. Smiddy, in Trip Gabriel, “When Health Law Isn’t Enough, the Desperate Line Up at Tents,” New York Times, July 23, 2017.

  “On the other side of the cities”: Author interview, Dr. Art Van Zee, Sept. 24, 2016.

  For decades, black poverty had been concentrated: Caroline Jean Acker, Creating the American Junkie: Addiction Research in the Classic Era of Narcotic Control (Baltimore: Johns Hopkins University Press, 2002), 225.

  same counties where Donald Trump performed: Shannon Monnat, “Deaths of Despair and Support for Trump in the 2016 Presidential Election,” Pennsylvania State University, Department of Agricultural Economics, Sociology, and Education Research Brief, Dec. 4, 2016. (Monnat now works at Syracuse University.)

  “when one of us makes a mistake”: Author interview, Wendy Welch, May 22, 2017. Welch is the director of the Graduate Medical Education Consortium and author of Fall or Fly: The Strangely Hopeful Story of Adoption and Foster Care in Appalachia (Athens: Ohio University Press, 2018).

  founded in 1980 by a Catholic nun: The Health Wagon was started by a Massachusetts native who’d served as a midwife in Africa before volunteering in Appalachia. Sister Bernie Kenny regularly got carsick on the twisty roads: “Every scratch on the old RV, Sister Bernie put it there,” Tyson said, grinning.

  school district depopulation and austerity: Sara Gregory, “Final Bell Tolls at Coalfields School—Wise County, the Beacon of the Coalfields School Divisions, Closes Another School,” Roanoke Times, May 28, 2017.

  The fifty-four-year-old teacher hadn’t had insurance: Author interviews, Brenda Bolling, St. Paul Health Wagon stop, July 6 and 24 (telephone follow-up), 2017.

  recent death of a forty-two-year-old patient: Author interviews, Tyson and patient’s father, Tony Roberts, March 28, 2017.

  Reggie Stanley, forty-five, who died: Author interview, Tyson.

  “He was a great guitar player”: Written on his Mullins Funeral Home guest book, July 5, 2017.

  Cantrell had been holding town-hall: Author interview, Dr. Sue Cantrell, Aug. 8, 2017.

  every legislator in the coalfields had voted: Author interview, Sarah Melton, July 24, 2017. No substantive crime increase in needle-exchange areas: Melissa A. Marx et al., “Trends in Crime and the Introduction of a Needle Exchange Program,” American Journal of Public Health, December 2000: 1933–1936, available at: https://www.researchgate.net/publication/12217407_Trends_in_crime_and_the_introduction_of_a_needle_exchange_program.

  Across the border in West Virginia: Early results from Huntington needle exchange were positive, according to Christine Vestal, “Early Results of W.Va. Towns’ Needle Exchange Program Show Progress,” PBS NewsHour, June 6, 2016. Even bare-bones exchanges operating on as little as $10,000 annually were found to be cost-effective, considering that the cost to treat a single hepatitis C infection ranged from $65,000 to $500,000. In other localities, needle-stick injuries to police officers were reported 66 percent less often; Tessie Castillo, “Law Enforcement Lead West Virginia Efforts to Implement Syringe Exchange Programs,” Huffington Post, Dec. 15, 2015.

  IV drug users in the region: Author interview, Melton.

  like many of the returning Vietnam soldiers: Among the 20 percent of American servicemen in Vietnam who became hooked on heroin, only 20 percent went on to abuse the drug once they returned to their hometowns. Some attributed this low rate to the fact that the people and places associated with prior heroin use were powerful triggers to reuse: Lee N. Robins et al., “Vietnam Veterans Three Years After Vietnam: How Our Study Changed Our View of Heroin,” American Journal on Addictions, April 2, 2010.

  “I won New Hampshire because”: Donald Trump explaining why he won the Republican primary in New Hampshire (though he did not win the state’s general election), from Liam Stack, “Trump Called New Hampshire a ‘Drug-Infested Den,’ Drawing the Ire of Its Politicians,” New York Times, Aug. 3, 2017.

  most Americans support federal financing: “Public Ranks Children’s Health Insurance, Marketplace Stabilization Higher Priorities Than ACA Repeal,” Kaiser Family Foundation poll, Sept. 22, 2017. The poll found that Medicaid and Medicare buy-in ideas are more popular than single-payer, which was affirmed by 54 percent of those polled. Data analysis from Eric Levitz, “America Is Not a ‘Center-Right Nation,’” New York Times, Nov. 1, 2017.

  to court nonwhite voters, including Hispanics: U.S. Census Bureau, “Voting and Registration in the Election of November 2016,” released in May 2017.

  “You’ve got too many leaders just not responding”: Author interview, Bryan Stevenson, July 12, 2017.

  “really bad for you”: Aubrey Whelan and Don Sapatkin, “Advisers: Trump Won’t Declare Opioid Crisis a National Emergency,” Philadelphia Inquirer, Aug. 9, 2017.

  A few days later, he seemed to change his mind: Brianna Ehley, “Trump Says He Will Declare Opioid Crisis a ‘National Emergency,’” Politico, Aug. 10, 2017.

  the so-called emergency was retrumpeted: In ninety-day increments, federal agencies could more freely use existing money to mitigate the crisis, and Trump’s aides pledged that eventually Trump would release more money for treatment: Julie Hirschfeld Davis, “Trump Declares Opioid Crisis a ‘Health Emergency’ But Requests No Funds,” New York Times, Oct. 26, 2017.

  seven Americans were dying of overdose: Zachary Siegel, “Where Are the Opioid Recovery Activists?,” Slate, Oct. 29, 2017.

  The Obama administration had also been slow: Author interview, Acker.

  One-third of children in central Appalachia: Lori Gates-Addison, area prevention council director, quoting Kids Count data, presentation for Taking Our Communities Back, Big Stone Gap, VA, May 23, 2017; and author interview, Gates-Addison, May 23, 2017.

  96 percent of the adopted kids: Author interview, Welch.

  “Repeats”: Author interview, Giles Sartin, May 24, 2017.

  DEA recommended that first responders wear: http://iaclea.org/visitors/PDFs/Fentanyl_BriefingGuide_June2017.pdf.

  “already happened here to us”: Gates-Addison, presentation for Taking Our Communities Back.

  study forecasting the epidemic’s spread: Jeanine M. Buchanich, Lauren C. Balmert, and Donald C. Burke, “Exponential Growth of the USA Overdose Epidemic,” https://doi.org/10.1101/134403. The study is critically lauded though not yet peer-reviewed, as outlined in Jeremy Berg, “Modeling the Growth of Opioid Overdose Deaths,” Science, June 5, 2017.

  “more disturbing is the pa
ttern”: Author interview, Don Burke, May 30, 2017.

  predicting the toll would spike to 250 a day: Max Blau, “STAT Forecast: Opioids Could Kill Nearly 500,000 Americans in the Next Decade,” STAT, June 27, 2017.

  “Don’t mess with this shit”: Author interview, Robert Pack, Aug. 25, 2017.

  2.6 million Americans who are already addicted: Of the 20.5 million Americans with a substance use disorder in 2015, 2 million had prescription opioid-use disorder, and 591,000 were addicted to heroin: Results from 2015 National Survey on Drug Use and Health at https://www.samhsa.gov/data/.

  residents of two rural Virginia towns: CDC statistics ranked Martinsville, VA, first for opioid prescribing and Norton, VA, second, using 2015 statistics. Andrew Joseph, “More Opioids Were Prescribed Here Per Person Than Anywhere Else in the U.S.,” STAT, July 7, 2017, using data from this CDC report: https://www.cdc.gov/mmwr/volumes/66/wr/mm6626a4.htm?s_cid=mm6626a4_w.

  It was in their Highpower clinic: Among the patients who explained the practice to me were Crystal Street and Debbie Honaker; author interviews, March 16, 2016, and in follow-up phone calls.

  “Our wacky culture can’t seem to do”: Author interview, Dr. Marc Fishman, May 9, 2017.

  a slim minority of opioid addicts: Ibid. Half of buprenorphine patients drop out within six months of beginning MAT, and poor outcomes often follow dropout, according to Kathleen M. Carroll and Roger D. Weiss, “The Role of Behavioral Interventions in Buprenorphine Maintenance Treatment: A Review,” American Journal of Psychiatry, Dec. 16, 2016.

  only three had managed not to become: Author interview, Susan (real name withheld to protect job prospects), May 22, 2017.

  “The loss is tremendous”: Email to author from Sister Beth Davies, Oct. 13, 2017.

  Van Zee told me his greatest fear: Author interview, Van Zee, June 25, 2016.

  I stood in the low light: Author interviews, maintenance director Tim Allen and Dr. Jessie Gaeta, Boston Health Care for the Homeless Program medical director, who designed SPOT over the objections of several community groups; June 23, 2017.

  Judge Michael Moore’s hair had turned: Author interviews, drug court judge Michael Moore, March 16 and April 1, 2016, and June 20, 2017.

  studies showed kids were more likely to use: Multiple studies showed that DARE was ineffective, including a GAO report: Christopher Ingraham, “A Brief History of DARE, the Anti-Drug Program Jeff Sessions Wants to Revive,” Washington Post, July 12, 2017.

  Neil Smith thought they were the grandchildren: Author interview, Russell County bailiff Neil Smith, June 20, 2017.

  “The more we talk about the epidemic”: Author interview, David Avruch, Nov. 1, 2017.

  “The answer is always community”: Author interview, Sue Ella Kobak, March 13, 2017.

  former nursing home into a rehab: Author interview, Bob Garrett, July 5, 2017.

  treatment clinic called Overmountain Recovery: Author interviews, Pack, Dec. 16, 2016, and July 5, 2017, and follow-ups via email and phone.

  a mighty resistance on its march: Dr. Stephen Loyd, as featured in the documentary The Gray Area, by David Floyd, available at https://www.youtube.com/watch?v=qGQy0NcnK2Q&feature=youtu.be.

  Loyd knew exactly how to explain himself: Author interview, Loyd, Aug. 25, 2017.

  via an app on his cellphone: The app prompts Loyd to check in daily for the possibility of a random drug screen. He is drug-tested at least four times a year.

  repeated overdose reversals were: Corky Siemaszko, “Ohio Sheriff Says His Officers Won’t Carry Narcan,” NBC News, July 7, 2017.

  Epilogue. Soldier’s Disease

  Interviews: Ginger Mumpower, Robin Roth, Danny Gilbert, Wendy Gilbert, Britney Gilbert, Skyler Gilbert, Janine Underwood, Nancy Hans, Joe Crowder, Warren Bickel, Steve Ratliff, Dr. Sue Cantrell, Tess Henry, Patricia Mehrmann, Mark Sharp, Lindsey Turner, Kathleen Quirk, Louis Mehrmann, Dr. Alan Henry, April Henry, Sergeant Brian Kowalski

  “That’s OK,” Ginger hollered: Author interviews, Ginger Mumpower, Sept. 18 and Oct. 22, 2017.

  onetime father figure was arrested: “Karate Instructor Pleads No Contest to Sex Crimes,” WDBJ-7, April 18, 2016; Rikk Perez, owner of Perez Kenpo Karate, pleaded no contest to taking indecent liberties with a minor and carnal knowledge of a minor.

  Scott Roth’s mom, Robin: Text exchanges between author and Robin Roth, 2012–2017.

  her family firmly believes, she’d be alive today: Author interview, Danny, Wendy, Britney, and Skyler Gilbert, Sept. 22, 2017.

  Bobby’s old friends continued showing up: Author interviews, Janine Underwood and Nancy Hans, Sept. 22, 2017.

  Nonfatal overdoses had more than doubled in 2017: Community forum, Virginia State Police special agent Joe Crowder, Cave Spring High School, Jan. 22, 2018. Of the 334 overdose calls police in the region responded to in 2017, 36 people died and 298 were nonfatal.

  4.4 pounds of fentanyl…arrested a Cave Spring High graduate: Ibid.

  nabbed a $1 million grant: Author interview, Dr. Warren Bickel, Dec. 12, 2017.

  only if they first engaged in counseling: Author interview, Steve Ratliff, division director of adult and family services, Blue Ridge Behavioral Healthcare, Jan. 26, 2018.

  Dr. Sue Cantrell finally won permission: Author interview, Dr. Sue Cantrell, Jan. 26, 2018.

  only with a provision that the “able-bodied”: Laura Vozella, “Virginia House Passes Medicaid Work Requirements at Session Midpoint,” Washington Post, Feb. 13, 2018.

  “Oh, awesome!”: Text exchange between author and Tess Henry, Sept. 12, 2017.

  Patricia still slept with her cellphone: Author interviews, Patricia Mehrmann, Aug. 11, Sept. 14, and Nov. 28, 2017, with numerous text exchanges in between.

  A construction laborer and former heroin user: Author interview, Mark Sharp, Dec. 29, 2017.

  “Our poet”: Text to author from Patricia Mehrmann, Dec. 22, 2017.

  “I am going to die”: Journal entry by Tess Henry, sometime between November 2016 and February 2017.

  possible that Tess had in fact been: Author interviews, Lindsey Turner, Dec. 29 and 30, 2017. Turner, assistant director of the We Care House in Las Vegas, where Tess lived in the spring of 2017, had been one of Tess’s counselors.

  “They make your life miserable”: Author interview, Kathleen Quirk, Jan. 8, 2017. Quirk operates a street-level ministry doing well-being checks on Las Vegas sex workers under the name Cookies and Hope. “If you take cookies from me, I get to talk to you. I walk around where I used to work in brothels, strip clubs, and on the streets,” she told me. Quirk was profiled in Kimberly De La Cruz, “Former Prostitute Fights Sex Trade with Cookies,” Las Vegas Review-Journal, April 13, 2015.

  was struggling to grasp the violent nature: Author interview, Patricia and Louis Mehrmann, Dec. 27, 2017.

  “Her body has arrived”: Text to author from Patricia Mehrmann, Dec. 31, 2017.

  Photos

  After the death of her nineteen-year-old son, Jesse Bolstridge, Kristi Fernandezbecame obsessed with the story of his swift descent into addiction, including finding any missing details that might explain how he went from high school hunk and burly construction worker to heroin-overdose statistic.

  From the small sliding-scale clinic where he practices in Virginia’s westernmost county, Dr. Art Van Zee was among the first U.S. physicians to warn people about the dangers of OxyContin. The overdose victims showing up in the ER in the late 1990s weren’t simply his patients; they were also dear friends, many of them descendants of the coal miners whose pictures line his exam-room walls.

  Sister Beth Davies was a plucky activist nun who had already spent decades standing up to coal-mining operators, and she refused to be swayed by Purdue Pharma’s marketing or its offers of “blood money.” Executives at the company might have been able to intimidate people up north, where their philanthropy held sway, but it didn’t work with Sister Beth.

  “Mark my words: This is the beginning of a disaster for us,” Pennington Gap, Virgini
a, pharmacist Greg Stewart told Sister Beth Davies in the late 1990s. He had already been the victim of two robbery attempts, including one by the OxyContin-addicted son of a hair-salon owner who crawled in through the ceil-ing vents connecting the salon to Stewart’s store.

  The first time Big Stone Gap lieutenant Richard Stallard heard about the new painkiller, a confidential informant told him it was already available on the streets: “This feller up here’s got this new stuff he’s selling. It’s called Oxy, and he says it’s great.”

  “We enabled her,” said Ashlyn Kessler’s grandmother, Lee Miller, who is raising Ashlyn’s young son while Ashlyn finishes a federal prison sentence for heroin distribution. A paralegal with a degree from Jerry Falwell’s university, Ashlyn was one of the region’s top drug mules, making the trek from Roanoke to New Jersey three, sometimes four, times a week.

  Jamie Waldrop, a surgeon’s wife and a recovery coach, had two children who became addicted, first to pills, then to heroin. “Until they go off to rehab, you don’t realize just how dysfunctional your life has become.”

  When her twenty-eight-year-old daughter, Tess, checked herself out of a Nevada treatment program, Roanoke nurse Patricia Mehrmann tried desperately to track her movements, including via Facebook Messenger, to prostitution websites featuring her daughter. “There is no love you can throw on them, no hug big enough that will change the power of that drug.”

  Still raw in her grief—her son Bobby had been dead only six months—Janine Underwood could draw a detailed mental map of the treatment landscape, from health care privacy hurdles to instructions on what to do the moment you realize your twenty-one-year-old is injecting heroin. “I’m in health care, and there were just so many things I didn’t know,” said Underwood, the administrator of a free clinic for the working poor.