Author Beth Macy talks about opioid treatment in a new book

Author Beth Macy. Image via Josh Meltzer.

Roanoke-based journalist Beth Macy is One of the most famous historians of the opioid epidemic in America – first with her 2018 book, Dubcekthen adapt it to a file Hulu TV series last fall. messi new book, Lazarus breeding, addresses the question of how to treat the epidemic, and raises the emotional issue of seeing addiction not as an ethical weakness or a criminal problem but as a disease that can be treated with drugs such as methadone and buprenorphine. The book comes at a crucial moment: This year, money from massive opioid-related legal settlements is beginning to flow into local governments, who will have to decide how the money is used. Many will likely continue the path – trying to banish the problem – but Lazarus breeding It provides an alternative roadmap to more compassionate and efficient ways to use this money.

We spoke with Macy on the phone — about the opioid crisis, but also about her precarious upbringing in a small Ohio town, her efforts to tell stories of the underdog, and her anxiety about the decline of the news business, which she witnessed firsthand as a reporter for Roanoke Times From 1989 to 2014. While we were talking, she roamed her neighborhood with her dog Mavis. When asked if she had considered leaving Roanoke, she said no. If she had worked for a big city newspaper instead of Roanoke TimesShe thinks the stories in her books probably wouldn’t have been told.

I’ve spent many years writing about Americans who are suffering. What attracts you to these stories?

I think writing about strangers and vulnerable people comes from my own personal experience with others. I grew up in a small town in Ohio — Urbana. I grew up really poor; I am the first person in my family to go to college. So I always find myself motivated by the story of the person who didn’t turn everything over, especially when they are victims of these systems that are controlled by greed, like globalization. my first book, Factory man, grew out of what happened when all the jobs were gone – this happened in a lot of small towns, including my own. Back in the 1990s, and then in earlier periods, the press never told the story of globalization from the point of view of people who had lost their jobs—everyone was covering it from the point of view of CEOs and shareholders. But a lot of these people were really struggling and the government did very little for them.

Is this something you experienced growing up?

I was born in 1964, so globalization didn’t happen until after that. When I was growing up, there were jobs, but the economy was still really tough if you were poor. My dad was kind of drunk in town, and by the time I was a teenager, he was kind of not working. But my mother kept a roof over our heads, either from working at the local factory, which makes airplane lights, or she would work under the table, like a waitress or babysitting, just as the people I wrote about later did. It has taken some time in my career to discover that these are the best stories I have ever told. And they scratched that itch – they helped me write my story indirectly.

But they were also really socially relevant stories, and no one told them, because everyone I worked with in the newsrooms had grown up – I don’t want to say with everything that was handed to them, but my parents almost everyone went to college. They only saw things through a different lens. I wasn’t raised in the middle class, and I’ve always seen those stories better than the people who saw them.

I’m curious when I realized that opioids were a story you wanted to tell.

It was 2012, and I was finishing up Factory man. At the end of the report, I started hearing that crime was getting worse and that much of it was drug related. Everyone, like breaking into homes for Xanax and opioids. I lifted that away. And then I’ll be back at the Roanoke Times before the book is released and assigned to write what becomes a three-part series about these two wealthy kids who go to a private school, one of whom is about to go to federal prison for his role in the heroin sale that led to the death of his former classmate. So she merged with these two families – the child himself and the mother of the child who died. And readers, like, spit out the coffee they were drinking. They’re like, “What? Rich white kids do heroin?”

So in 2013, I met my agent and my editor. They are preparing to publish Factory manAnd they’re like, “What do you want to do next?” And I said, “I think we should look at this heroin issue.” But they’re in New York City, so they’re like, What? I couldn’t convince people in New York that this should be my next book, because they thought it was a trend and Roanoke was late getting it. Because they knew there was a heroin epidemic in the ’90s in New York.

So what did you do?

I hadn’t published a book yet – I was like Joe Blow from the Roanoke Times. I did not have the courage to defend my idea. So I found another book to write, an ethnic history book called trophin. But while I was working on it, Sam Quinones posted [his 2015 investigation of the opioid epidemic] Dream land And all of this research is starting to come out on deaths of despair and our life expectancy has been greatly reduced by opioids. So when I’m done trophinI could come back and say, ‘Do you see? I really think this is an important issue.’

Dubcek It was clearly very successful. How did it feel to see him turn into a TV show?

My first two books were selected, but only about 10 percent of the books selected were made. Almost every decent book is picked, and it’s a bit of money, and then you just pray that they’ll make it. With the first two, there were scripts written and movie stars attached, but they haven’t yet gotten the green light. but with DubcekThere was a bidding war on it. I went out to Los Angeles, met a bunch of people. The book was so personal to me, and I was so attached—especially to Tess Henry, who was the main hero in the latter half of the book—that I just wanted to make sure they didn’t screw it up.

What would the tension look like?

My goals, one of them, was that I didn’t want to stereotype Appalachia, making the Appalachians look stupid or lazy. And second, I wanted to get a really clear message about drug-assisted therapy: methadone and Suboxone. [which are used to treat opioid addiction]. It does seem a little wonky at first – you’re like, ‘We’re going to introduce this drug weed?’ But it’s really important for people to understand it. Because it’s still stigmatized – doctors still don’t want to prescribe it. Many people think that it is still just treating drug addiction with another drug. And it’s not – it should be seen as a medicine.

What should skeptics understand about drug-assisted therapy?

With drug-assisted treatment, your chance of death is reduced by 60 to 80 percent.

I think some people culturally think medication-assisted therapy is wrong. But when you see an A-list actor like Michael Keaton [who plays a doctor in Dope­sick] He gets discriminated against because he takes methadone and then Suboxone – I mean, that’s really important. Then you see it getting better. And people are getting better

With so many books, shows, and documentaries out there related to the opioid crisis, do you worry that the public will tire of it?

I think there’s a fatigue around addiction because it’s a really tough problem. We now have a third of American families struggling with it, and there is still a lot of shame and stigma they don’t want to talk about. But [Dopesick creator and showrunner Danny Strong] He knows how to make something really entertaining. He wanted to make the show a kind of procedural drama, a crime investigation story. And that makes other elements of the story palatable in some ways, because you have these good guys fighting to keep the bad guys out – which, by the way, actually happened. It’s something that people can watch and enjoy, but you sneak into learning in too.

You wouldn’t believe the hundreds of people who reached out to us to say, “I watched your show, and for the first time in three years I called my addicted kid—whom I was so disgusted with—because I finally understood he wasn’t just a bad person.” That’s the thing about prestige TV. my book [Dopesick] Really well done. It was a bestseller. I am very pleased with her. It sold better than any of my other books. But millions of people have watched Hulu — more than just reading the book. So this is an opportunity.

Dubcek Focus on the anatomy of the opioid crisis itself, but your new book is more about how to tackle this crisis. What is the situation now?

Addiction is a medical condition that affected 108,000 people last year. And most doctors don’t want to treat it, because they don’t want “these people” in their waiting room — you know, tough patients. If you are a doctor, you can prescribe OxyContin. But you do need to do special training and get a special license from the Drug Enforcement Administration to prescribe OxyContin addiction treatment. Only 8 per cent of doctors bother doing this.

The war on drugs still drives everything. We are still more likely to imprison someone with this medical condition than we are to be treated as someone with a treatable medical problem. And treating them isn’t just the nicest thing to do – it’s also a much more cost-effective way.

You point out that effective treatment is often hard to come by, though – there are plenty of legal, political, financial and ethical barriers. What can communities do to facilitate this?

What I really hope communities will take away from my book is that you can make a difference. The people you chose were innovating [ways to access] Treatment – people like the mayor in Fairfax who provide drug-assisted treatment in prison, which is still unusual. The book begins with a nurse practitioner [meeting a patient] In a McDonald’s parking lot in a dying furniture town. And it’s kind of ridiculous that this is advanced care. We are so bad at providing care for these people that we leave it to volunteers who meet people in parking lots and in their tents. And I mean this is America. I just wanted it to be really in your face, because that’s what it is.

What do you think you will work on next?

I want to write about the destruction of the media, as well as my own story – I was a paper girl in my town, and everyone read the same news and agreed on the same facts. But when my mother was on her deathbed, it was the same time they were collecting votes after the 2020 election, and my sister and I fought a major political battle while our mother was breathing her last. So I want to say, “How did this happen? Why, as a nation, can’t we have Thanksgiving dinner together anymore?” It’s kind of a memoir, but it’s also an investigation, because the press doesn’t report very well about its demise.

Sylvie McNamara

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