AILSA CHANG, HOST:
Journalist Beth Macy covered every facet of the opioid crisis as a reporter for The Roanoke Times in Virginia. She embedded with addicts trying to get clean. She followed families grieving after overdose deaths, interviewed heroin dealers, sifted through drug studies and court documents. And now she's written a book based on that reporting. It's called "Dopesick" in which she attempts to capture the sheer scale of the crisis.
BETH MACY: We have lost 300,000 Americans in the last 15 years to drug overdose deaths. And we're going to lose that many in just the next five.
CHANG: Macy traces the root of the current epidemic to the mid-'90s. That's when Purdue Pharma debuted the blockbuster drug OxyContin, which was aggressively marketed as an addiction-free painkiller.
MACY: It was the strongest version of an opioid painkiller that had ever hit the market. And because it was a 12-hour time release, doctors were told, you know, that this is absolutely safe. And patients were told this is absolutely safe, that addiction is, quote, "exquisitely rare," as Purdue official said.
CHANG: That turned out to be a hollow promise. As Macy saw in her reporting, dependence on OxyContin and other painkillers laid the foundation for the current heroin epidemic. She begins her story with a teenager named Jesse who made the jump from pills to heroin and didn't make it out alive.
MACY: He was one of these rambunctious kids who rarely napped. As a little boy, he would fall asleep with toys still in his hands. And early on, they put him on ADHD medication. He also had some football and snowboarding injuries when he was 15 and 16 and was prescribed opioid painkillers then. His mother isn't exactly sure at what point he became hooked, at what point he realized he was dope sick. But he knew he could trade his ADHD medicine for the opioid pills. And one thing led to another. When the pills got harder to get because of doctors cracking down on prescribing, that's when the heroin started coming in.
CHANG: His mother, Kristi, she asked you - she said she wanted to know how he got to that place. And that becomes sort of your book's underlying question. How do you try to answer a question like that?
MACY: Well, I just tried to listen to her and hear what her concerns were. I mean, she asked me to go interview the drug dealer who had landed in her town a few months before Jesse's death and who had increased the supply of heroin in that town. But her main question was, how is my gorgeous, handsome, charismatic son, 19 years old, never missed a day of work - even up until the moment he died hadn't missed a day of work - how does he end up overdosed on someone else's bathroom floor? And she says, I thought it was just pills. And I heard that over and over. She thought it was, quote, "just pills."
CHANG: What's compelling about this book is you come at it from all sides. You spend hours with a drug dealer named Ronnie Jones who ran one of the largest heroin rings in the mid-Atlantic region. How did you coax Ronnie to open up to you about why he did what he did?
MACY: He had a story to tell, too. And, you know, I also interviewed his brother, who is a very successful rap recording artist and producer. And, you know, he had tried so many times to help Ronnie when he would get out of prison and jail from his former incarceration stints. And Ronnie just could never - you know, having this early felon on his record, he could never go legit. He tells me he tried to over and over again. He tried to start his own business in this little town that he landed in to work in the chicken plant, and no one would rent to him. And, you know, he also is not quite willing to take responsibility for the deaths that his supply may have eventually caused in that community.
CHANG: That's what struck me when I was reading the section about Ronnie because he kind of rationalized his business as providing a service, that he was offering heroin at discount price. He was saving people the trip to Baltimore, which...
MACY: Which would be much more dangerous.
CHANG: Which would be much more dangerous. It was like he was doing something of value to the community is the way he looked at it.
MACY: Right. He...
CHANG: Did that surprise you?
MACY: He said, my heroin doesn't have fentanyl in it. You know, he was kind of proud of that. But Ronnie's story illustrates how little we do for felons trying to re-enter our society. You know, we don't make it easy for them to get jobs. They often come out, and they owe lots of fines. And he tries to go legit. And he ends up - you know, he starts out selling weed again, which he had been selling before. But meanwhile, since he's been in prison, this opioid thing has exploded. And somebody tells him in the break room of George's Chicken, hey, man, if you want to make the real money, you need to be bringing heroin in.
CHANG: And that's what he does.
MACY: So he finds a connection. He starts bringing it in bulk in from Harlem. And overnight, as the prosecutors tell the story - you know, I think there's a little more nuance than this. But overnight, they say, the town of Woodstock, Va., goes from having a handful of heroin users to almost hundreds.
CHANG: What do you make of the federal government's response to the crisis so far under this administration?
MACY: Yeah, so President Trump said he was going to declare a national emergency. And several months ago, he declared something that sounded like a national emergency but was actually a public health emergency, which released no new funds or no new authority. And, again, with 145 people a day dying of this...
MACY: ...We need to - as one person in the book says, with Zika, we sent helicopters. We need to send helicopters. And what I believe we need is more across-the-board access to medication-assisted treatment and - which study after study shows is the best way to help somebody with opioid use disorder prevent an overdose death. Now, it's...
CHANG: And I didn't realize there was so much disagreement about what the - what those treatments should be. I mean, you talk about buprenorphine, for example, which is an opioid itself and how it can be effectively incorporated into treatment programs. But there's a lot of resistance to that. Why is that?
MACY: Most of the treatment centers in America believe in abstinence-only care. All the people that I was following on the ground in Roanoke, Va., and elsewhere, including Jesse, my football player up in the Woodstock area - they were all being sent at great expense to their families to these very expensive abstinence-only centers. And when they get out, they're opioid-naive because they haven't been taking it. And then when they relapse, which most of them do, that's when they're the most vulnerable to overdose and die.
CHANG: Are you worried that the public and maybe even policymakers are reaching a point of fatigue when it comes to stories about opioids the way the public has reached a point of fatigue about the wars in Iraq and Afghanistan?
MACY: I have to tell you I reached a point of fatigue myself. I put a Google alert on opioid epidemic when I first started working on this book almost three years ago. And there were so many articles I couldn't even read them all. I mean, there are scores of articles...
MACY: ...Every day. But they - each of them only deal with a little piece of something going on right now. And my goal with this book was not to just show you how we got here and what it's going to take to get out of it but also to inspire people to care. And I really hope that that's what I've done.
CHANG: Beth Macy is author of the new book "Dopesick." Thank you very, very much for joining us.
MACY: Thank you so much, Ailsa.
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