America faces no shortage of challenges. One of them, the opioid crisis, is only getting worse. And it’s time to ask the question: what does recovery require? What will it take to bring a decades-old epidemic to an end and communities across America back to life?
To discuss that I spoke to Beth Macy. Better than anyone, Macy has chronicled the origins of the opioid crisis and how the greed and corporate malfeasance of Purdue Pharma wrecked communities and destroyed thousands of American lives. Macy discussed her 2018 book Dopesick and her journalism career in previous interviews with The Daily Yonder. This time we talked about her most recent book, Raising Lazarus, which was released last fall.
In Raising Lazarus, Macy reports on the efforts to hold Purdue accountable and she takes readers into some of the country’s hardest-hit places to witness the devastating personal costs. What struck me reading Raising Lazarus is that it’s a story all too familiar. Much of it takes place only a few miles from where I live in the foothills of North Carolina. Often, it’s the next county over.
This issue is also personal. My generation in Appalachia was devastated by the opioid crisis and I wasn’t immune. From 2007 to 2011 I battled addiction until the day I hit bottom. Thanks to a support system of family and friends I managed to move on. After law school, I came back home and represented hundreds of folks dealing with the same issues. The only difference between us was a lack of resources and support. And that made me one of the lucky ones.
That’s what I wanted to discuss with Macy: how do we give more Americans another chance in life?
First, we must understand that recovery is hard and that it doesn’t happen overnight. “It’s a chronic relapsing disease,” Macy said in our conversation. “Relapses are to be expected.” According to John Kelly [an addiction researcher] at Harvard it takes an average person five to six treatment attempts over eight years to get just one year of sobriety. “You were lucky to come out of that. You were also lucky not to be using at a time when fentanyl was in the drug supply.”
Recovery begins in the darkest depths of despair, in jail cells, group homes, and on the streets, where it can be hard to find treatment. “We still have an 87% treatment gap in our country,” said Macy. “Last year only 13% of folks with opioid use disorder managed to access evidence-based care.”
As a result, the chapters in Raising Lazarus are full of DIY recovery. They’re about folks bringing food, needles, clothing, and testing kits to parking lots and trailer parks.
Mark Willis is a former Marine-turned-opioid response director in Surry County, North Carolina, with a staff full of peer support setup in the basement of the county administration building.
Tim Nolan is a nurse practitioner driving around the streets of nearby Hickory in a Toyota Prius to treat people where he can find them. “If the patients couldn’t find a ride to the nearest truck stop or Burger King, Tim took his mobile clinic to them,” Macy wrote in the book. “Absent a cohesive system of care to treat the affected, he created his own.”
Raising Lazarus is full of those stories. “If you are lucky enough to live in Hickory, Michelle Mathis and her wife Karen Lowe have started this amazing harm-reduction group called Olive Branch, and they will help you get connected to discount [medication-assisted treatment],” said Macy. “But these are outliers in rural America. If you don’t live in a state that has expanded Medicaid, it’s going to be harder for you to access good treatment.”
Medication-assisted treatment (to taper off the use) and needle exchange programs are controversial and often discouraged but they’re also a way of meeting people where they are. “We know that people who visit needle exchanges are five times more likely to recover,” Macy told me. “That’s why harm-reduction is so important, [those dealing with substance use disorder] don’t trust the system because they’ve encountered so many barriers. Until we begin to reach out through harm-reduction, which evidence says works, we’re not going to begin to work on that treatment gap.”
Until there is enough state and federal funding for treatment, recovery in America is a story of small victories and people who won’t give up on their neighbors. “That’s why I started the book in a McDonald’s parking lot [with Nolan delivering supplies including clean needles, prescriptions, and treatment for infections],” Macy said. “A lot of these groups are run by people in recovery themselves, mothers who have lost people, sisters who have lost people.” Better than anyone they understand the cost of doing nothing.
An example of that is Nikki King. “When I profiled Nikki King in Raising Lazarus among her first memories as a little girl was going to a friend’s birthday party and the friend’s mom passing out from OxyContin ruining the birthday cake, dropping it,” said Macy. “When I met her, she was this young professional having to ration her vacation time so she could go home for funerals. She’d lost so many of her classmates.” After growing up surrounded by the opioid crisis in Kentucky she has dedicated her life to being part of the solution.
What’s standing in the way of recovery the most now is the stigma of addiction. “We say addiction is a disease, but we don’t really believe it,” Macy told me. “We’ve grown up with a drug war mentality. Drugs are bad. Drug users are bad. These are moral failures. They’re criminals.”
But they’re also students, parents, neighbors, classmates, coworkers, and childhood friends. We could make the country great again if we’d only give them a chance. We’d be amazed by the results.
“I profile a woman who was running a trap house and now she’s a peer recovery coach after being in active addiction her whole adult life,” Macy said. “She’s got a job. She’s got her kids back. She’s productive. She’s helpful. She’s funny. And she’s so proud of herself. When you see a person come out of that and become a helper … a lot of these peers that I profile, they are like us times ten. You’re one of them too. They are so strong. It’s like that scar tissue that’s tougher than the rest of your skin.”
That’s certainly been true in my life. Recovery wasn’t easy but it was also a lesson in building resilience. And I’m better off because of that.
That’s why Raising Lazarus can be a frustrating read at times, because of local politicians who are unwilling to confront their biggest challenge or bring their own people out of the shadows. If not for moral reasons, at least for economic ones, it’s in the interests of towns across America to embrace a redemption story. “All these jobs in all these communities that I’ve been reporting from remain unfilled because people can’t pass a drug test,” Macy told me. “Mt. Airy [North Carolina] went from having 500 jobs they couldn’t fill to 1,800 in like a year.”
For someone who’s spent years reporting on such a tragic subject, Macy does feel some optimism because she’s seen what works. “When I first went down to Mt. Airy, I went to a community meeting [where] somebody said, ‘I think when they relapse, we let them die and take their organs,’” Macy told me. “Now, they’re diverting people from jail into treatment. Every person who overdoses gets a visit from an overdose response peer to try to get them into recovery.”
Through her work now in Indiana, Nikki King has moved mountains to implement workplace trauma programming and evidence-based treatment and they had “zero overdoses in the first eighteen months of the program,” according to Macy. “Look at how she did that. There are little pockets out there that are moving ahead, that are not waiting for the government, which is so hampered by politics, to figure this out. They’re forging ahead. That’s why I wanted to write this book.”
An important part of this story is the role of place. According to the author Johann Hari, “The opposite of addiction isn’t sobriety – it’s connection.” That comes across in Raising Lazarus in a powerful image in the epilogue where the words “What happened to community …!” are spray painted on the wall of a building in West Virginia. There’s a reason why substance use disorder and overdoses went up during the pandemic. That’s because Americans were isolated at home and away from family and friends. There’s a reason why so much of Raising Lazarus takes place in rural settings where folks are naturally more disconnected to begin with. That’s a challenge.
We can all do our part to help, especially in places that lack resources. “We can all carry Narcan because you never know if somebody is going to come into your house and have an overdose. We should all be calling our local harm reduction group and volunteering.”
In my hometown, a classmate named Devin Lyall dealt with addiction, managed to get into treatment in a nearby city, got her life back, and then opened our community’s first recovery center. Now they have housing, a farm and a thrift store, a Recovery Friendly Workplace initiative, and harm-reduction outreach. They also do weekly spiritual gatherings, meetups for young people, and yoga. They’ve learned that the best way to keep people alive is to give them a reason to live.
We’re going to need more programming like that to address this crisis in a holistic way. “There’s a community I write about, Huntington, West Virginia, where they’ve had to do trauma-informed schooling,” said Macy. [Students] can check themselves with no questions asked and go and talk to a counselor. We’re going to be seeing more of that. I hope we are because we’re losing generations in some of these distressed communities. I was in Columbus, Ohio, and they have a whole high school that’s just recovery high school.”
Is that a comprehensive national solution? No. But it’s a start. “My hope is that I can generate enough hope,” said Macy. “I always encourage people to use your social capital. That’s how minds get changed. It’s not through using the data. It’s from hearing these stories.”
That’s why I decided to open up about my own struggle too. I was one of the lucky ones. But I shouldn’t be, my story should be the norm.
Michael Cooper is a journalist and attorney from the foothills of North Carolina. He has contributed to The Week, The New Republic, and National Affairs. He serves as the Senior Director of Advocacy for NC Child.