In Beth Macy’s 2018 book “Dopesick,” she details how the opioid crisis devastated families and communities in Southwest Virginia.

“When a new drug sweeps the country, it historically starts in the big cities and gradually spreads to the hinterlands, as in the cases of cocaine and crack,” Macy wrote in the book. But the opioid epidemic began in exactly the opposite manner, grabbing a toehold in isolated Appalachia, Midwestern rust belt counties, and rural Maine.”

The book also documented how Purdue Pharma, the makers of OxyContin, perpetuated opioid misuse and addiction, and the legal actions governments took against the company – including a lawsuit filed by former Virginia Attorney General Mark Herring months after the book’s release.

Purdue and its owners – members of the Sackler family – settled more than 2,000 lawsuits in 2022, committing $6 billion to be distributed to various governments in the U.S.

Virginia has already received some of its $80 million share for addiction treatment and prevention.

Now, Macy explores some of the ways agencies can use settlement money to address the opioid crisis in her new book, “Raising Lazarus.”

She spoke with WVTF’s Jeff Bossert about some of those ideas.

This interview has been edited for length and clarity.

 

Jeff Bossert: Where's the argument at in terms of harm reduction and what some people are catching on to and many others are not? Where do you think the sense of optimism is now?

Beth Macy: My sense of optimism is that there are a lot of really amazing people doing incredibly - heroic is not too strong a word to describe their work - to help the most marginalized among us.

My frustration is that particularly in distressed rural areas - where the epidemic, by the way, has lasted the longest, where it began, where they have the fewest resources to address it - many of those areas are perhaps not inclined. For instance, Charleston, West Virginia, which is having right now this huge spike in HIV cases. They basically outlawed needle exchange in many of the communities there, or they regulated it to a point where it's practically outlawed. And that's really concerning when the CDC says it has the most concerning outbreak in the nation.

So there's a lot of education that needs to happen.

J.B:  The pandemic forced many people into isolation and certainly hurt this issue. So how much has COVID-19, the last couple of years and maybe the political divide stolen headlines from this crisis?

B.M: Right. And a lot of people think there's opioid fatigue, as they call it. There's a lot of articles out practically every week about this morass of super complex opioid litigation. That's a hard thing to follow. I try to break that down.

About a third of the book is about the quest for accountability told through these the lens of these activists that are trying to hold Purdue Pharma's feet to the fire.

And then we know that overdose deaths, every time they announce a new tally, they've gone up from the year before. And a lot of that is COVID-related. People were using drugs with no one there to Narcan them or were simply so depressed by job losses and whatnot. You know that many people in long-term recovery even return to use.

J.B:  What hope is there left to try to hold the Sackler family accountable after bankruptcy court and paying billions to gain immunity from future litigation?

B.M: Well, that's perfectly put, Jeff. They have given up their company, Purdue Pharma, and have pledged to give $6 billion to help solve the opioid crisis.

That sounds like a lot of money. Well, they've made more than $13 billion. They've stocked a lot of it away in offshore accounts that people like attorney generals of Massachusetts and New York can't get their hands on.

And they're rich enough that they've been able to hire $1,800 an hour lawyers to protect them, PR consultants to teach them, help them break the rules that they agreed to abide by when they pleaded guilty to fraudulent marketing in (2007) and again in 2020.

This is what we call billionaire justice, alas. But there are still people working to hold their feet to the fire. And there's also talk of criminal indictments for the first time in years.

J.B: You mention a couple of times in the book President Biden's drug czar. He's had a mixed record regarding needle exchange programs but claims to now back harm reduction. And I saw recently that he was now behind such programs, admitted to mistakes as the health commissioner in West Virginia.

B.M: Dr. Gupta? I mean, I thought it was great when he admitted that he had been wrong. What I say at the end of the book, where I really do give some policy prescriptions based on my ten years of covering this issue off and on, that the drug czar's office should be elevated to a cabinet level position, as it was prior.

Back in the early seventies under President Nixon, believe it or not, before he invented the war on drugs, he actually had a system of care for returning veterans who were from the Vietnam War who were addicted to heroin so that anyone in any community could go to a walk in clinic and get on methadone if they needed, and also get help with their housing and social supports. And that's what we need to get back to.

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