In her first book, Beth Macy chronicled how the Sackler family, through Purdue Pharma, used deceptive marketing tactics to push healthcare providers to prescribe opioids. If Dopesick, now also a Hulu miniseries for which Macy served as writer and producer, offered a gripping answer to the question of how the US was plunged into the devastating opioid epidemic that persists today, her newest release, Raising Lazarus, answers the question: What do we do now?
In Raising Lazarus, Macy not only offers insight into the complex web of the Purdue Pharma case, but focuses attention on the efforts of activists who are forging new pathways to healing in their communities. The lack of coordinated national response to the opioid crisis, which has been magnified by the pandemic in irreparable ways, has forced individuals to shoulder the burden of care, often working outside established systems and the eye of the law to provide drug users resources and connection. With her trademark compassion and curiosity, Macy writes to destigmatize addiction and chronicle the trials—and the joys—experienced by communities in crisis as they work toward more hopeful futures.
I spoke with Macy over the phone about the importance of community in care, how she sees her role as a journalist, and how important it is for us to lift stigma from individuals and place shame where it belongs: on the Sacklers.
Jacqueline Alnes: Your book opens with an epigraph from Ann Pancake: “In times like these you have to grow big enough inside to hold both the loss and the hope.” There is hope in Raising Lazarus, but so many weighty subjects too: the opioid crisis, the pandemic, the violent effects of climate change, corporate greed.
Beth Macy: And there’s political toxicity. Like in Charleston, West Virginia, where it’s the worst of the worst, there’s evil on top of it.
JA: Right. What was it like writing into those different griefs as they intersect with one another?
BM: I’ll start by saying that when I finished Dopesick, I was not going to write another book about this issue. The ending of Dopesick was so dark. The person I had followed for two years, Tess, had not only overdosed, but was brutally murdered, in part because of her medical abandonment. It was so dark and unexpected. When you gather story upon story upon story and then it ends like that, it had this build-up effect of me feeling like—and my doctor thinking—I had some kind of secondary trauma. I was like literally, for my health, I’m not writing about this again. And then as I started going around talking about Dopesick and seeing how many people were stunned, like they still didn’t know this all started with OxyContin, they still didn’t know rich kids in the suburbs were getting ahold of it, they didn’t know about fentanyl—I mean this is 2018, but this is a really easy issue not to look at unless you have to. That’s part of the problem. But then, I would hear about these amazing people doing amazing things and I would start to get an inkling.
Like in my home city of Roanoke, Virginia, they finally got a needle exchange started, two years after the state said it could be started. I was at that needle exchange hanging out, and I had this teary moment where I thought, this is what Tess meant when she said urgent care for the addicted. She didn’t know what it was because she had never seen it, but she would have loved this place. People were there with their dogs, they were there just hanging out, some of them were applying for jobs. It was like a food pantry/needle exchange/you could go get Advil/you could sign up for Medicaid. I had that moment and I really dug the vibe.
The second time I went, this nonbinary harm reductionist named Lil Prosperino happened to be passing through town. There’s always one anecdote with each person that just grabs me and with Lil, it was the fact that they bought this abandoned house for thirty dollars at auction and they were going to use that for a safe consumption space. It was condemned. Lil was like, ‘We’ll use it for more than just needles, in the winter we will give out coats and I give out this homemade salve I make. They call me a hill witch.’ I thought, a hill witch, that’s fucking awesome. And then I asked to come witness it and they said, sure, come on!
When you’re with these people, you realize: no one is seeing what you’re seeing. We are seeing the unseen.
JA: How do you write about issues that are so tangled up?
BM: I try to keep it really people-centered, so that the amazing stories I’m witnessing ground the book and have enough narrative juice to keep it going. Also, when I get the opportunity, I can stop, digress, and explain the clusterfuck of why it is this way. I tried to digress often, when needed, but not for too long.
JA: When you were talking about what goes unseen, some of it was yes, me not looking, but also it seemed like there is a historical narrative of shame and harm. In our current system, for example, law enforcement often turns away, because they have to in order for healing to happen; the alternative is abiding by the law, which means putting people in jail.
BM: And oh, by the way, the jail is so far away that you are going to have to be dopesick in the foyer. I’m talking about Mount Airy, North Carolina now. That’s an unseen thing, but they let me see it. It was shocking. I was like, are they really going to let me in that jail? Someone told me, “you’re Beth Macy, you’re a bestselling author.” They are going to let you in that jail because: A) they want you to write about them, and B) because they can’t imagine that the way they’re doing it isn’t exactly perfect. They don’t see that they have their own inherent biases. That’s the way that we are trained and acculturated with Drug War thinking.
JA: You highlight throughout the book that there’s a real lack of a coordinated national response to the overdose crisis. For me, the most hopeful moments in these pages came from places where communities are coming together, sometimes unexpectedly, to provide small slivers of relief. What were some of your takeaways from writing this?
BM: I interviewed Dr. Jerome Jaffe, who worked under Nixon and set up this national set of methadone clinics on demand. The most useful thing he said is that it’s not easy to set up a system of care that the person or the patient is going to find acceptable, but also that the community is going to find politically palatable.
To tell you a story to explain, I was giving a talk in Christiansburg. I’d had some [prior] experiences with harm reductionists and they usually hate law enforcement, like Lil does. But someone named Michelle was describing how she started out of the back of a pickup truck in 2009 posing as a food pantry, and then when they realized half their population was intravenous drug users, they started handing out needles hidden in granola bar boxes. I go back on my career and the best stories are always the people who think the opposite of other people in their peer group. And also, by the way, are kicking ass. What Michelle said was, you have to meet the other side where they are, too. I had never heard a harm reductionist say that.
An example she gave was a bunch of crafters that met at a church in Hickory, North Carolina. The craft circle didn’t want to help them pass out needles, but they volunteered to crochet these bags in which to hold the needles. It reminds people who are drug users of home, because it looks like something your grandma might have made. And Michelle says, ‘Oh, by the way, I even got them to weave in iridescent thread so they could be seen in trap houses and low light areas.’ Michelle has had a ton of success in one of the most conservative areas in the nation meeting people where they are. Her group is biracial, queer, faith-based, and law enforcement loves her because she treats them like people, too. She’s able to make in-roads.
JA: This book made me think a lot about the stories we tell about addiction, and how harmful those narratives can be, right down to the language used. Would you mind talking a little bit about your decision to replace language like “affliction” or “disease” with more person-first terms like “drug users,” “patients,” and “people who use drugs”?
The best stories are always the people who think the opposite of other people in their peer group.
BM: I think it’s really important that we do this. Some journalists still use the word “addict.” When you ask them why, they’ll say, “well, that’s what they call themselves.” Some of them do, not all of them. They are not the ones we are trying to convince. We are trying to convince the general population that these are human beings worthy of care. I think the person-first [approach] is always going to be a better way to go with that.
JA: There’s a recurring theme of silence and gross, maybe feigned, ignorance from the Sackler family that especially enraged me when I read about Richard Sackler responding, “I don’t recall/remember/recollect,” something fifty-seven times during his first two hours of testimony. For you, is the role of journalist to bridge the gap in that absence of testimony? How do you see your role as a storyteller?
BM: I knew the Sacklers were never going to give me an interview, right? I’m sure their lawyers would, but I don’t want to talk to them. They are being paid $1,800 an hour just to be sycophants in my view. They are recidivist criminals. Purdue has pled guilty twice in Federal Court and now they are trying to engineer this sweetheart bankruptcy deal that would allow them to walk away with a huge chunk of their ill-gotten profits. If the treatment part of the book is about the heroes on the ground, I decided that the Sackler part of the book, if you will, would be about people like Nan Goldin and Ed Bisch because they put the pressure on. I would also include Danny Strong, from the Hulu show Dopesick, because that really helped people understand who the real criminals were—and it wasn’t your cousin who got busted for holding a little bit of dope. It’s the people who did this to the country and our so-called regulators who let them get away with it.
JA: You talk about asking your “magic wand question” to different community organizers, drug users, and healthcare providers throughout the book, so I figure it’s only right that I ask you the same: After reporting on this through the course of two books, what do you think would it take to turn the overdose crisis around?
BM: Well that’s why I wrote the epilogue the way I did. If you notice, it’s kind of tonally different.
JA: It is!
BM: My publicist at Little Brown, she did Dopesick, too, so I know her pretty well. After reading it, she goes, “Oh, Beth was in the room for that chapter!” I was like, “Yeah, I might have dropped some f-bombs. I’m pissed off. I’ve been writing about this for a decade, off and on. I give my policy magic-wand bullets near the end, but the real magic wand is the beginning of the book, where you are in the McDonald’s parking lot with Tim and he’s meeting Sam and he’s going to give him this medical help that he has never before had. He’s going to call in this discount prescription at this one particular pharmacy, which took god knows how many steps to set up. But he wants Sam to leave the meeting with two thoughts. One is: You can get better. Sam doesn’t know that, most people with OUD don’t know they can get better. They think they can’t because they’ve been treated so poorly. Forty percent of people with OUD don’t want to stop using drugs because they don’t think they can. We are not making the treatment as easy to access as the dope. That’s one.
And then the second thing Tim says is: Don’t disappear. And what he means is that if you relapse, even if you can’t make it back to the appointment here in this McDonald’s parking lot next week, text me, and I’ll come to you, wherever you are. I’ll come. And so this idea of not just meeting people where they are, not abandoning them, but embracing them. All that time I spent with Tess, and it still took me spending all that time with Tim before I realized that that’s what would have helped Tess. Having this person, this connection, this web of connections that would help her with her housing, help her sign up for Medicaid, all the social supports, and make sure she got help she didn’t have before. She struggled like hell to get that. And when she finally did, she slipped and smoked some weed and got kicked out of the program. We’ve gotta stop putting up so many hurdles for these folks.