Editor’s Note: This interview first appeared in Path Finders, an email newsletter from the Daily Yonder. Each week, Path Finders features a Q&A with a rural thinker, creator, or doer. Like what you see here? You can join the mailing list at the bottom of this article and receive more conversations like this in your inbox each week.

Beth Macy is the author of Dopesick: Dealers, Doctors, and the Drug Company that Addicted America, as well as the forthcoming Raising Lazarus: Hope, Justice, and the Future of America’s Overdose Crisis. She was also an executive producer and co-writer on Hulu’s TV adaptation of her book, which premiered in 2021 and stars Michael Keaton and Rosario Dawson. We talked with her in 2019 after the book release of Dopesick, and were fortunate to chat with her again after Hulu’s Dopesick adaptation.

Enjoy our conversation about her time as a paper girl, the state of local journalism, and doing right by Appalachia on the small screen, below.

Olivia Weeks, The Daily Yonder: First I’d love to hear a little bit about you. How’d you get your start as a reporter? And can you tell me about your relationship to your hometown paper?

Beth Macy: So I’m from this small town of about 14,000 people in the middle of the cornfields in Ohio called Urbana. Not very urban, though, and I grew up in a pretty poor family where I learned early on if I wanted anything, I was going to have to buy it myself. So I got a paper route. I was the only girl that delivered papers, and you know, delivering the paper taught me a lot of my journalism skills. It didn’t occur to me until years later that that was what was happening, but you know, you learn how to deal with all kinds of people. People don’t want to pay you for their subscription. So you learn negotiating skills. You have to get your paper to your customers every day or they’re gonna flip out, so you really learn work ethic. After that I worked concessions at the municipal pool and then I saw the lifeguards made more money for less work so I figured out how to swim better. 

I was from a quiet family that a lot of people didn’t pay attention to and you know, kind of marginalized class of people, factory workers, unemployed people, a lot of people who didn’t have the same opportunities that I ended up having. And so I decided early on, or I don’t even know if it was much of a decision, that I just wanted to do really well in school, so that I would have more opportunities available to me.

Beth Macy is the author of the book Dopesick. (Photo by Stephanie Klein-Davis.)

DY: How’d you find yourself in journalism?

BM: I was a good student. I became the first person in my family to go to college in 1982 which was the early Reagan years, before college tuition started going up so high and financial aid started going down. I was able to go to a decent State University, where all of my tuition was paid. I even got money to pay for books and for room and board, something that wouldn’t have been possible for me had I been born 15 years later. I often think of that and just feel so lucky. But also I feel pissed off. That other promising poor kids don’t have those opportunities. It’s just wrong.

DY: After college, how did you find yourself in Virginia doing the sort of opioid reporting that you ended up becoming very successful at?

BM: My third newspaper job was at the Roanoke Times. I went there in 1989. I thought I was only going to be there a few years, and I still live in Virginia today. 

All of my books have grown out of journalism that I initiated at the Roanoke Times and a lot of those big pieces and projects that I wrote grew from my effort to shine a light on social issues and on marginalized groups. Growing up I realized my best work is when my personal values and my personal story sort of intersect with the things I’m writing about.

I started writing about addiction on an assignment in 2012 when heroin broke out in a wealthy white suburb in the county where I live. Kids were overdosing and going to federal prison for selling heroin to their private school classmates and people went “What? Holy shit. I had no idea white people were doing heroin,” and of course, they had been for some time, it’s just it never made the news. So I parsed out how this happened, going back to the painkillers that were unleashed on the country with the introduction of Oxycontin. A lot of the kids had gotten their start by swiping pills from their parents’ and grandparents’ medicine cabinets. So we did this three part series in 2012. And then I became a book writer and my first book, Factory Man, is about the aftermath of globalization in a distressed community in Southside, Virginia. As I was wrapping up the reporting on that book, I realized that the communities where the jobs had gone away were the communities that were being besieged by things like heroin and methamphetamine. And that was a story I also wasn’t seeing reported very much, because a lot of those little towns had lost their media or their papers had been severely shrunk. Even the Roanoke Times which was, in its heyday, a pretty aggressive paper, no longer bothered covering communities like that anymore. They were too far out of our circulation area. So those stories weren’t being told in a meaningful way.

DY: So, in some sense, your reporting on the opioid crisis really grew out of that first work on factory closures.

BM: Absolutely. I just continued finding new stories that helped me illustrate what was happening as it went from Oxycontin and the painkiller epidemic, to heroin and now the meth and poly-substance epidemic that we have to call the overdose crisis, because in so many overdoses, there are multiple drugs involved.

DY: And what do you think it was about your third book, Dopesick that really struck a chord with people, so much so that it was made into a TV show?

BM: A new Gallup poll just came out a couple months ago showing that nearly one third of Americans have had serious addiction issues in their family. I don’t think there’s anyone who doesn’t know somebody. I recently tallied up all the deaths going back to the introduction of Oxycontin, which we never do, we always start in 1999. In 1996, this idea that pain is a fifth vital sign was introduced. So why don’t we go back to 1996? Well when I added up all the deaths, it’s actually well over a million. And that’s not counting all the addiction-adjacent deaths, like suicide, hepatitis and HIV. It’s far worse than we think.

Dopesick was published by Little, Brown & Co. in 2018. (Image provided.)

So I was thrilled when they bought Dopesick and they were going to make it into this entertaining but super educational story that would help with the stigma against addiction but also help people learn about this very slow brewing story that occurred over 25 years, in this really riveting eight hour format. It’s condensed down, you know, with fancy A-list movie stars that people want to watch, but then they see, “Oh, that’s like my cousin.” And the audience is much larger than people who read serious nonfiction. I mean, it’s great for my career and all that, but really the best thing is that people know the story now who didn’t know it before.

DY: Given the gravity and the real darkness of these events in your subjects’ lives, were you nervous about the TV adaptation? How did it feel to see your factual reporting dramatized?

BM: I was nervous, to be honest. I worried that I would stereotype Appalachia, I worried that there was too much emphasis on the Sacklers and not enough on the people who were the real victims. Richard Sackler said “Blame the abusers.” I think the nation has followed his words to a tee. But I quickly realized that the person adapting the book had done a full on study on his own. He had a great writers room and I got to be a part of it. So I knew I wasn’t voiceless in it. There was also a person in recovery who had spent a year going to methadone clinics every morning. The other two TV writers were seasoned TV writers who grew up in small towns. So all those things helped prevent us from stereotyping. Danny Strong, the showrunner, took me up on my suggestion to hire Robert Gipe, who’s a wonderful novelist from Kentucky, to give feedback on all the scripts. We really wanted the show to be authentic, and you know as well as I do that Roanoke, Virginia is really different from the coalfields of Virginia. I’ve never lived in the coalfields. I’ve never lived in one of these really distressed small towns. And so having Robert available to brainstorm was great. We also worked with Dr. Stephen Lloyd who used to be the Opioid Czar in Tennessee. He came in for a whole afternoon with the team one day to talk on Zoom about how he had gotten addicted to Oxycontin, and then recovered from that because he had access to great treatment. Now he runs several treatment clinics, and he helped us really strengthen that storyline. He’s in the book Dopesick, too. Because I had done this book, I had access to all these experts across the nation. So we brought some of them into the room and the story was still unfolding with the Sackler storyline, so we’d get people to leave us documents and do interviews with former employees at Purdue Pharma. I really understood that Danny [Strong] wanted to make it authentic, wanted to do something that he could be really proud of. He wanted it to shift stigma away from the people who were victimized, and onto the people who caused this problem.

I think it’s very lucky. Such a good first TV experience. Because you don’t know who is buying your rights.

DY: My last question – what are you working on now?

I just finished a book that’s coming out in August. It’s called Raising Lazarus: Hope, Justice and the Future of America’s Overdose Crisis. It’s about solutions. It’s slightly more upbeat than the last one. Although we know solutions are not anywhere near matching the scale of the problem. But it’s still really interested in telling the stories of people who’ve been marginalized and how that marginalization contributes to the rural-urban divide, and toxic politics of today.

This interview first appeared in Path Finders, a weekly email newsletter from the Daily Yonder. Each Monday, Path Finders features a Q&A with a rural thinker, creator, or doer. Join the mailing list today, to have these illuminating conversations delivered straight to your inbox.

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