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Editorial: The national opioid crisis needs national solutions

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Beth Macy’s “Raising Lazarus: Hope, Justice, and the Future of America’s Overdose Crisis.” s

“America remains the only developed country on the planet where it’s easier to get high than it is to get help.”

So writes Roanoke author and former Roanoke Times journalist Beth Macy in “Raising Lazarus,” the follow up to her New York Times nonfiction bestseller “Dopesick,” which became the basis for a Golden Globe award-winning and Emmy Award-nominated Hulu miniseries. [Macy launched the book nationally in the past week and will do a local reading at 7 p.m. Monday at Charter Hall in the Roanoke City Market Building; for ticket information visit]

“Raising Lazarus” bears the subtitle “Hope, Justice, and the Future of America’s Overdose Crisis,” and when it comes to the opioid crisis, all three of those topics prove fleeting and fragile. Anyone wanting to hear that the nation has turned some kind of corner in terms of getting the crisis under control won’t find any such news in this forward-looking but righteously angry book.

Hulu’s “Dopesick” took themes, people and incidents from Macy’s book of the same title and created composite characters and fictional narratives in order to viscerally illustrate the opioid epidemic. Those who watched it will find familiar elements in “Raising Lazarus.”

For one, the plot lines of “Dopesick” shifted backward and forward in time and hopped from setting to setting as the show wove a complex story, aiming to convey the sheer scale of the crisis and the ways the pitiless greed of OxyContin manufacturer Purdue Pharma was enabled by federal regulators and political figures, who not only looked the other way but tossed obstacles in the paths of authorities and activists trying to dam the tide of overprescriptions and overdose deaths.

In “Raising Lazarus,” Macy seemingly reports from every front line of the opioid epidemic at once. Her investigations took her from a North Carolina parking lot where a nurse practitioner brought buprenorphine, a medicine for treating opioid use disorder, to a skittish patient; to a protest mounted outside a Connecticut federal courthouse by activists who’ve lost loved ones to overdose; to encampments of the homeless in West Virginia, where new laws forbidding distribution of clean needles put harm reduction advocates at risk of arrest as they labored to offer treatment to those struggling with addiction.

Another familiar element from “Dopesick” that continues in “Raising Lazarus” is the fury at the billionaire Sackler family, former owners of Purdue Pharma, who continue to dodge lasting punitive consequences for aggressively pushing sales of OxyContin hand in glove with false claims that the opioid painkiller was nonaddictive.

Macy brings to the fore strategies that she presents as best-proven ways to help those harmed by opioids, as well as a cataloging of the forces arrayed against those strategies. You’ll have to read the book to absorb the full sweep of her recommendations — none easily achievable, given a widespread tendency among politicians and more than a few of their constituents to regard people in the grip of addiction as unworthy of aid, an attitude that does nothing to reduce the problem.

One of the things Macy calls for is making use of the money from opioid settlements to found a nationwide system of clinics for mental health and addiction care.

The suggestion sounds very much like the proposal floated by Del. Sam Rasoul, D-Roanoke, for a potential renovation of Catawba Hospital. Rasoul’s bill seeking to study the feasibility of constructing such a facility at Catawba ended up being incorporated into the new state budget. That report will be due to Gov. Glenn Youngkin and the General Assembly on Dec. 1.

Macy emphatically endorsed Rasoul’s initiative in these pages (Jan. 30, “Time to address soaring overdose crisis”), writing that it could lead to “the means for triaging the addicted and providing them the urgent care they need.”

The book is haunted by the spirit of Tess Henry, a Cave Spring High School graduate and a friend of Macy’s who became addicted because of prescribed painkillers and who dreamed of a readily available clinic for substance use disorder like the one proposed at Catawba. Henry’s addiction pulled her into a terrible spiral. She was killed in 2017 in Las Vegas after living on the street. The crime remains unsolved.

Macy champions “harm reduction,” an approach to helping people with addiction that prioritizes keeping them alive by prescribing medicine that addresses dopesickness, by providing clean needles to stop the spread of disease and by meeting people where they are rather than stigmatizing them.

“You have to make the treatments easier to access than the dope,” Macy said in a recent Roanoke Times interview.

She also emphasizes that there is no one-size-fits all treatment for addiction, and thus as many types of treatment as possible should be made available.

Often the people in the front lines of the campaign to establish and provide harm reduction know what their patients are going through from first-hand experience, having endured, and continuing to cope with, opioid addiction themselves. The stress that comes with the cause they’ve taken up is harrowing, and Macy chronicles with compassion and without judgment the toll it takes on these “warriors.”

Brave as they are, these few can’t solve this epidemic by themselves, and they shouldn’t have to. This national crisis needs national solutions.

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