DOPESICK: Dealers, Doctors & the Drug Company that Addicted America
Beth Macy
Little, Brown and Company
© Beth Macy, 2018

There are books that need to be written, and books we need to read even though it hurts. “Dopesick” is one of those—a book that will change you.

Beth Macy tells the story of what OxyContin has done to the people of central Appalachia. A reporter for the Roanoke Times for two decades, Macy saw the effects of oxy, then heroin and fentanyl up close and personal. She got to know those who peddled and those who used and those who loved those who used. “Dopesick” takes us on that journey of personal and social and economic devastation. Read “Dopesick” and you will understand on a deep level the many consequences of the “worst drug epidemic in modern history.”

Macy tells the larger societal story by focusing on the individual stories that make up the whole. Macy’s prologue takes us to Preston County’s largest employer, the Hazelton Federal Correctional Institution in Bruceton Mills, West Virginia, where she visits Ronnie Jones, convicted for armed heroin distribution. Once, the people there worked the coal mines; now they guard prisoners.

It was a complicated path that led her to Ronnie Jones. She had gotten to know Kristi Bolstridge, the grieving mother of 19-year-old Jesse Bolstridge, “a robust high school football player barely old enough to grow a patchy beard on his chin.” Jesse’s mom, like parents throughout America, needed to know what had led her child to overdose.

Macy visits Jesse’s resting place. “It was possible to stand at Jesse’s headstone—emblazoned with the foot-high number 55, in the same font as the lettering on his Strasburg Rams varsity jersey—and look down on the stadium where he had once summoned the crowd to its feet simply by running onto the field and pumping his arms. In a small town where football is as central to identity as the nearby Civil War battlefields dotting the foothills of the Blue Ridge, Jesse loved nothing more than making the hometown crowd roar.”

Kristi Bolstridge wants/needs to know, to understand: “right now she’s obsessed with the story of her son’s swift descent into addiction—the missing details that might explain how Jesse went from being a high school football hunk and burly construction worker to a heroin-overdose statistic, slumped on someone else’s bathroom floor. If she understood the progression of his addiction better, she reasons, maybe she could help other parents protect their kids from stumbling down that same path.”

So there’s someone who sold: Ronnie Jones; someone who used: Jesse Bolstridge; and a parent, Kristi Bolstridge, who suffers the consequences of these choices. “Dopesick” demands a new way of thinking. We’ve all been programmed to imagine the villains of drug abuse and it’s not hard to see in our minds and on movie screens the black dealers of Harlem, Detroit, Baltimore; the Colombian drug lords based in Cartagena; the Mexican cartel thugs who flood the southern border with dope; and most recently, thanks to Donald Trump, the vicious MS-13 gangs of El Salvador.

But if we truly want to understand the new epidemic, we have to get to know other, less familiar villains: the pharmaceutical executives, white and very American, so greedy they are willing to lie and lie some more; the doctors willing to sell out their patients, over-prescribing and handing out OxyContin like Halloween candy in return for Caribbean holidays and kickbacks. “Dopesick” is about a drug that was sold as non-addictive, but is so incredibly addictive it is almost impossible to kick. It kills more Americans than the wars we are fighting. OxyContin is the enemy within.

Let’s go back in time: “OxyContin was the brainchild of a little-known, family-owned pharmaceutical company called Purdue Frederick, based in Stamford, Connecticut. The company was virtually unheard of when a trio of research psychiatrists and brothers—Mortimer, Raymond, and Arthur Sackler—bought it  … in the 1970s, the Sacklers acquired Scottish and British drug companies and paved the way for their entry into the pain-relief business with the development of an end-of-life painkiller derived from morphine, MS Contin, in 1984 … With annual sales of $170 million, MS Contin had run its profit-making course by the mid-1990s.

“As its patent was set to expire, the company launched OxyContin to fill the void, with the intention of marketing the new drug … a tweak of a compound first developed in 1917, a form of oxycodone synthesized from thebaine, an ingredient in the Persian poppy … They shrewdly created a separate arm to promote their product: ‘Purdue Pharma touted the safety of its new opioid-delivery system everywhere its merchants went. “If you take the medicine like it is prescribed, the risk of addiction when taking an opioid is one-half of 1 percent,” said Dr. J. David Haddox, a pain specialist who became the company’s point man for the drug … addiction, in the words of a 1996 company training session for doctors, was not just unusual; it was ‘exquisitely rare.’” (Emphasis added.)

Haddox claimed OxyContin was appropriate for all kinds of chronic pain and Purdue’s army of sales reps “fanned out to evangelize to doctors and dentists in all fifty states with this message: Prescribing OxyContin for pain was the moral, responsible, and compassionate thing to do—and not just for dying people with stage-four cancer but also for folks with moderate back injuries, wisdom-tooth surgery, bronchitis …”

Macy notes that: “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. But the opioid epidemic began in exactly the opposite manner, grabbing a toehold in isolated Appalachia, Midwestern rust belt counties, and rural Maine. Working-class families who were traditionally dependent on jobs in high-risk industries to pay their bills—coal mining in southwest Virginia, steel milling in western Pennsylvania, logging in Maine—weren’t just the first to experience the epidemic of drug overdose; they also happened to live in politically unimportant places, hollows and towns and fishing villages where the treatment options were likely to be hours from home.”

I don’t think we can really understand what is happening if we won’t acknowledge the pain, sadness and lack of purpose that so many of our neighbors, friends and relatives experience. There’s a reason painkillers predominate: because these pills and powders counteract the pain.

While we’ve learned to accept the pain of broken bones and sprained ankles, the chronic bad backs and the ravages of cancer, we’re still terrible at acknowledging pain that eludes the X-ray machine and won’t reveal itself to the MRI.

Macy comes from and writes about a place where one used to find meaning in work. A man or woman, if underpaid most of the time, was still able to support him- or herself and modestly provide for others. “Dopesick” led me to do some simple research about Appalachia at Federation of Appalachian Housing Enterprises: “poverty rates across the US was 15.6% compared to 19.7% in the combined Appalachian regions of Alabama, Kentucky, Tennessee, Virginia, and West Virginia. Even within these states there is quite a difference between poverty rates. For example, in Virginia the statewide rate is 11.5% versus an 18.8% rate for the Appalachian region. The state with the worst poverty rate in the region is Kentucky with a 25.4% rate in the Appalachian portion versus 18.9% rate for the rest of the state.” Per capita income in Appalachia is 80 percent of the U.S. level.

Macy connects the dots between poverty, pain and painkillers: “Appalachia was among the first places where the malaise of opioid pills hit the nation in the mid-1990s, ensnaring coal miners, loggers, furniture makers, and their kids. Two decades after the epidemic erupted, Princeton researchers Anne Case and Angus Deaton were the first economists to sound the alarm. Their bombshell analysis in December 2015 showed that mortality rates among white Americans had quietly risen a half-percent annually between the years 1999 and 2013 while midlife mortality continued to fall in other affluent countries. ‘Half a million people are dead who should not be dead,’ Deaton told the Washington Post, blaming the surge on suicides, alcohol-related liver disease, and drug poisonings—predominantly opioids—which the economists later referred to as ‘diseases of despair.’ (Emphasis added.)

It appears Purdue understood what was happening before almost everyone else: “From a sales perspective, OxyContin had its greatest early success in rural, small-town America—already full of shuttered factories and Dollar General stores, along with burgeoning disability claims. Purdue handpicked the physicians who were most susceptible to their marketing, using information it bought from a data-mining network, IMS Health, to determine which doctors in which towns prescribed the most competing painkillers. If a doctor was already prescribing lots of Percocet and Vicodin, a rep was sent out to deliver a pitch about OxyContin’s potency and longer-lasting action …

“Purdue reps were navigating the winding roads and hilly towns in company-rented Ford Explorers, some pulling down annual bonuses of $70,000—the higher the milligrams a doctor prescribed, the larger the bonus. And they were remarkably adept. Five years earlier, cancer doctors had been by far the biggest prescribers of long-acting opioids, but by 2000 the company’s positioning goals had been nailed, with family doctors now the largest single group of OxyContin prescribers.

“Industrywide, pharmaceutical companies spent $4.04 billion in direct marketing to doctors in 2000, up 64 percent from 1996 … In the course of five years the bonuses the sales reps received jumped from $1 million in 1996, the year OxyContin hit the market, to $40 million in 2001.”

The drugs were diabolic in so many ways. At first, the high is amazing, obliterating all discomfort. We meet Dr. Art Van Zee, who, at 29, came in 1976 to Appalachia to practice medicine in a place that desperately needed a doctor. A former coal miner patient of his explains the lure: “OxyContin had become more important to him than his family, his church, and his children. ‘It became my god,’ the man said.”

Warren Bickel, an addiction researcher, described what he had been told by a user: “Nothing’s more powerful than the morphine molecule, and once it has its hooks in you, nothing matters more. Not love. Not family. Not sex. Not shelter. The only relationship that matters is between you and the drug.”

But then what is so terribly devastating about these drugs is the reality that they work best at first, then offer a diminishing euphoria with less effect. Addicts call this “chasing the high.” Then add to it the dreadful way the drug affects the brain and body, creating a deep-seated, almost impossible-to-resist need. Then pain—great pain if you don’t take more.

Macy’s title comes from this horrifying reality. “Dopesick” is what fueled the epidemic. The misery that possessed someone who ran out of pills: “You’re throwing up. You have diarrhea. You ache so bad and you’re so irritable that you can’t stand to be touched. Your legs shake so bad you can’t sleep. You’re as ill as one hornet could ever be … And believe me, you’ll do anything to make that pain go away.”

So what was it that made OxyContin addiction so much worse than we imagined? Dr. Sue Cantrell, a former pharmacist told Macy: “The difference with OxyContin was, it turned them into nonfunctioning people.” (Emphasis added.)

“Dopesick” forces us to revise our image of the addicted. Meet Debbie Honaker, “a happily married twenty-seven-year-old mother from the town of Lebanon, two counties to the east of Van Zee, recovered from a fairly routine gallbladder surgery with a thirty-day prescription of ‘Oxy tens,’ followed by another script at her postsurgery checkup for another month’s supply, this time for Oxy forties. When she called to complain that her incision was still hurting, the surgeon gave her a third prescription, for 7.5-milligram Percocet, designed to quell her ‘breakthrough pain,’ with instructions to take it not ‘as needed for pain’ but as frequently as every two hours—concurrent with the twelve-hour Oxys. To remind her to take the Percocet, she was supposed to set an alarm for the middle of the night.

“‘The doctor didn’t force me to take them,’ Honaker said. ‘But they’re like a high-standard person, someone you’re supposed to trust and believe in. My husband and I both understood that I was supposed to take the pills every two hours.’ Within the span of three months, Honaker had mastered the classic drug-seeking emergency-room trick, beginning with an impassioned complaint about kidney stone pain. ‘I’d say, “My back’s killing me,” and [in the ER bathroom] I’d pierce my finger, then put a drop of blood into my urine sample,’ she recalled.

“She’d leave with a prescription for Percocet. She was a full-blown opioid addict when she resorted to stealing the money her husband set aside for paying the electric bill and spending it at the office of a well-known Lebanon doctor who began most of her visits to him with the question ‘What do you want?’

“Honaker went on to steal painkillers from her husband’s elderly grandmother. She bought pills from people who paid one dollar for their OxyContin prescriptions using their Medicaid cards. ‘They’ve got to choose to eat or pay their electric bill. But if they’re on Medicaid, they can sell their drugs to supplement their income,’ she said.

Honaker told Macy: “At the end of your journey, you’re not going after drugs to get high; you’re going to keep from being sick.” Another example: A physician colleague of Van Zee “treated a septuagenarian farmer who had owned land worth $500,000. Within six months, the man had sold everything he had to keep his addiction fed. ‘It’s over,’ he told his doctor. ‘The kids are gone. The wife’s gone. The farm’s gone.’”

And on the community level, there is a diabolical mathematics at work. Addiction creates addiction. Macy explains: “many users began with prescriptions, then resorted to buying heroin from dealers and selling portions of their supply to fuel their next purchase. Because the most important thing for the morphine-hijacked brain is, always, not to experience the crushing physical and psychological pain of withdrawal: to avoid dopesickness at any cost.

“To feed their addictions, many users recruit new customers. Who eventually recruit new customers. And the exponential growth continues until the cycle too often ends in jail or prison or worse … a Kaiser Family Foundation poll showed that 56 percent of Americans now knew someone who abused, was addicted to, or died from an overdose of opioids. Nationwide, the difference in life expectancy between the poorest fifth of Americans by income and the richest fifth widened from 1980 to 2010 by thirteen years. For a long time, it was assumed that the core driver of this differential was access to health care and other protective benefits of relative wealth. But in Appalachia, those disparities are even starker, with overdose mortality rates 65 percent higher than in the rest of the nation. Clearly, the problem wasn’t just of some people dying sooner; it was of white Americans dying in their prime … Put this in perspective. We lost 58,220 members of the U.S. military during the twenty years of the Vietnam War. If Case and Deaton are correct, from 1999 to 2013 we lost ten times that number to drug addiction in peacetime.”(Emphasis added.)

Dr. Van Zee was a witness to the growing epidemic: “Within two years of the drug’s release, 24 percent of Lee High School juniors reported trying OxyContin, and so had 9 percent of the county’s seventh-graders … These weren’t simply Van Zee’s patients who were showing up in the ER; they were also dear friends …

At a forum for area doctors and families, Van Zee brought in Yale University substance abuse experts to describe the sudden physical and psychological stress caused by dopesickness: “Opioid addiction is a lifelong and typically relapse-filled disease. Forty to 60 percent of addicted opioid users can achieve remission with medication-assisted treatment, according to 2017 statistics, but sustained remission can take as long as ten or more years. Meanwhile, about 4 percent of the opioid-addicted die annually of overdose.

The criminal consequences of dopesickness and an addicted community were extraordinary. In Lee County: “Sheriff Parsons reported thieves stealing everything from copper cemetery vases to wires plucked from a telephone pole that addicted users had chopped down. Parsons even had his stepson arrested for stealing his own personal checks to buy black-market OxyContin. ‘There is literally not a family in this county that has not been impacted by this drug,’ he told me in 2017, a statement I heard in every Appalachian county I visited.”

We meet Ed Bisch. After Ed Bisch watched the paramedics carry his son’s body away, he created OxyKills.com, which quickly became a repository for news about the drug and the place for parents throughout the nation to memorialize “their dead children,” what Macy describes as “a running tally of dead athletes and young mothers and former beauty queens, many no more than twenty years old.” Bisch “was answering every email, and it was consuming me … Probably ten deaths a day, sometimes a hundred emails a week.”

If the Oxy story isn’t devastating enough, Macy describes how the Oxy scourge transformed itself into the heroin and fentanyl epidemic: “If history was any indication, the moment OxyContin and other opioid pills became too expensive or too cumbersome to get, illegal drug peddlers would step in to fulfill the market demand, just as they had done a century earlier when heroin became illegal. For centuries, dealers of opium, morphine, and heroin understood that an addicted person’s fear of running out—of becoming dopesick—portended one hell of a business model …

“A crack-turned-heroin-dealer with Philadelphia roots landed in Roanoke in 2006 … Clifton ‘Lite’ Lee made heroin an equal-opportunity drug, connecting with drug users, black and white, and figuring—correctly—that he could easily double his profit margin if he imported the drug to comparatively staid Roanoke rather than continue selling it solely in New Jersey and New York. When police caught two suburban teenagers middlemanning for Lee—selling heroin to their friends and keeping some for their own use—they were stunned by what their cellphones revealed: evidence implicating fifty other kids they’d been selling heroin to. Most attended Hidden Valley High School, in outlying Roanoke County’s wealthiest neighborhood, home to insurance agents and doctors and lawyers.

“By the time Lee was sentenced to eleven years in prison, in 2008, prosecutors had pinned him with bringing a thousand bags of heroin into the region two to three times a week, paying $5,000 for twenty bricks of heroin that his network then sold for $30,000. … A 2009 Roanoke Times story suggesting that heroin was now closing in on the illicit use of OxyContin and prescribed fentanyl patches in popularity seemed to draw shrugs, even as one prosecutor publicly warned, ‘They’re skipping over pot and going straight to heroin.’”

I’ve touched on only a few of personal stories Macy offers. Let me suggest another story you should check out when you get “Dopesick”: the story of Scott Roth and Spencer Mumpower and their mothers.

“Scott Roth bought the heroin that ended his life in an apartment in Roanoke’s Grandin Village, a retail hub fifteen minutes from the Hidden Valley split-level where he was raised. A neighborhood where locals dine on regionally sourced produce, take yoga classes, watch subtitled movies, spend thousands on Stickley sofas, and crowd the weekly farmer’s market, the village is full of tree-lined streets and solid 1920s-era brick homes with expansive carports …

“When Scott Roth showed up at Spencer’s apartment to buy heroin, the two hadn’t seen each other since high school at Hidden Valley, some three years before. They were never best friends, just drug buddies who hung out in the basement of the home of a fellow partyer whose dad gave them space to get high and routinely shot up heroin in front of them, according to both Spencer and Robin Roth … Spencer played go-between in the deal, a move that resulted in death by overdose for Scott in April 2010 and prison for Spencer and his roommate dealer …

“Robin Roth felt as if she walked around Roanoke with a giant F on her forehead, branded as a parenting failure. She suffered in silence and anger, much of it directed toward the young man she held responsible for the death of her only child. At Spencer Mumpower’s 2012 federal court sentencing, Robin carried a framed portrait of Scott to the witness stand. She looked directly at Spencer, his dark mass of curly hair now neatly shorn, and leveled a litany of questions designed to make him understand the pain his actions had caused …

“As Spencer Mumpower prepared for prison for handing Scott Roth the heroin that resulted in his life-ending overdose, I spent the summer of 2012 trying to make sense of how two young men with educated, caring mothers and movie-star good looks could keep the severity of their drug habits hidden for so long. I wanted to alert readers to the growing scourge of heroin in our community, and with two teenage sons still at home, I hoped to inoculate my own family, too …

“‘You think of heroin as seedy street slums, but that’s not at all how it started,’ Robin told me. About a year after their ER visit, she found a needle and a syringe in Scott’s room and, figuring he was already in too deep, she left them there. Afraid he’d resort to sharing needles, she put him in rehab instead.

“She tried everything she could think of to help her son, from attending Families Anonymous twelve-step meetings for relatives of people suffering from addiction to driving him to weekly drug tests at a doctor’s office. She took away his car after an alcohol-fueled fender bender in her driveway, and after he turned eighteen, she kicked him out of the house whenever she found him drinking or doing drugs. She had every door inside the house removed—including the ones to the bathrooms—so he could not hide his drug use inside her home.

“When I met her, two years after her son’s death, she still had not gotten around to putting the doors back on. Racked with guilt and grief, she could no longer work.”

Macy got to know Spencer: “He was happy to school me on drug culture—how he’d once saved his lunch money to buy weed and cocaine, the way he extracted the gel out of a fentanyl pain patch and smoked it, where the best places were to find drug dealers (loitering outside Narcotics Anonymous meetings). Driving by a diabetes-supply pharmacy, he recalled once buying OxyContin off a pharmacy delivery driver. The driver was eventually arrested. But somehow he had another six hundred or seven hundred pills the next day. ‘That’s a shitload of dope,’ he said …

“With his mom’s help, he drafted a letter of apology to Robin Roth and mailed it to her therapist, who would decide when she was strong enough to read it. In it, Spencer offered, when he got out of prison, to mow her grass. From his prison cell, he would even donate to her the inheritance he received following his grandmother’s death.

“All told, Spencer had already lost twelve friends from Hidden Valley to drug-involved deaths, and every dealer he knew was either dead now or in jail. And he would soon lose several more. I called Robin the day Spencer’s mom helped him report to prison. She said knowing that Spencer was behind bars again brought her no comfort.

“’I hurt as much today as the day my son died,’ she said, choking up. ‘I pray for Spencer every day, that he’ll be strong. My heart’s breaking for that kid. But it’s the only shot he has at a normal life—to get some accountability.’”

Macy reminds us of the extraordinary growth of attention-disorder drugs like Ritalin and Adderall, with prescriptions among school-age kids tripling between 1990 and 1995 alone. She introduces us to emergency-room administrator Dr. John Burton, who works as a summer camp doctor for North Carolina: “By 2012, fully one-third of his campers were on meds, mostly ADHD medications, antidepressants, and antipsychotics. ‘What happens is, we’ve changed our whole culture, from one where kids don’t take pills at all to one where you’ve got a third or more of kids who are on pills to stay well because of what are believed to be chronic health conditions,’ Burton said. ‘They get so used to taking pills that eventually they end up using them for a recreational high.’

Macy also provides some important insight into a controversy I knew nothing about but which effects so many: the disputes between advocates of short-term and extraordinarily profitable rehab programs, 12-step programs and medication-assisted treatment (MAT programs), which offer drugs like buprenorphine, sold under the brand name Suboxone, to help wean patients off of oxy and heroin.

“Among public health officials, buprenorphine is considered the gold standard for opioid-use disorder because it reduces the risk of overdose death by half compared with behavioral therapy alone. It also helps addicts get their lives together before they very slowly taper off—if they do. One researcher recommended that MAT users stay on maintenance drugs at least twice as long as the length of their addiction, while others believe it’s too risky for long-term addicts to ever come off the drugs.” 

Let’s return to the story of Jesse Bolstridge and Ronnie Jones: “Heroin was so wildly lucrative that even mid-level dealers in the ring could make $15,000 in a single weekend … Jones had been bringing bulk heroin to Woodstock for exactly six months. During that time, not only had overdose deaths surged but so had nonfatal overdoses, the number of children entering foster care due to parental opioid abuse, and the cases of children born with neonatal abstinence syndrome—all at roughly five times the previous year’s rate …

“In 2013, Jesse’s was one of 8,257 heroin-related deaths in the nation, by far the majority of them young men, an increase of a staggering 39 percent over the previous year. Roughly three-quarters of the dead had started down the same painkiller path that led Jesse to his death … with a single prescription pill.”

Macy writes that, as she prepared for her prison visit: “I had the better part of a day to try to discern how a sleepy agricultural county nestled in the Blue Ridge Mountains, with covered bridges and lovingly preserved two-hundred-year-old log homes, had gone from having a handful of heroin users to hundreds in a few short months, and how much Ronnie Jones was to blame for it.

“Understandably guarded at first, Ronnie, thirty-nine, was gentlemanly and polite throughout the visit. During the two years he’d spent there, he said, he spent his time working out, studying Arabic and Swahili, and reading the works of Guy Johnson, Eric Jerome Dickey, and Maya Angelou. On my way to the prison, I’d been listening to the audiobook of Michelle Alexander’s New Jim Crow, I told him, the seminal book on mass incarceration that likens the War on Drugs to a system of racial control comparable to slavery and Jim Crow.

“’I’ve read The New Jim Crow twice,’” Ronnie said. He’d also read lawyer Bryan Stevenson’s majestic Just Mercy, a memoir about his work against the racial bias and economic inequities inherent in the criminal justice system, which included efforts on behalf of falsely accused death row inmates. ‘It had me crying when I read it,’ he said. These books we had both read challenged the tough-on-crime government narrative of the past forty years, one that fostered the shift in public spending from health and welfare programs to a massive system of incarceration, with a fivefold increase in imprisonment and corrections spending that soared from $6.9 billion in 1980 to $80 billion today.

“This was Ronnie’s third time in prison. He already knew that one in three black men was destined to end up incarcerated, only to find himself branded as a felon and second-class citizen the moment he got out, blocked from the mainstream economy and propelled into a dystopian loop of jail, joblessness, and back to jail. He knew that drug-involved offenders, who represent half the incarcerated population, had a recidivism rate of 75 percent. His own story was a case in point …

“Ronnie justified his heroin enterprise by declaring himself the ring’s wholesaler, far removed from the moment the needle touched the vein. He clings to the narrative that he was providing an actual service—offering the drug cheaper and in a much safer environment than Baltimore. Like Purdue Pharma announcing it had created the perfect time-release painkiller that was addictive in ‘less than 1 percent’ of cases and then reproaching the hordes of addicted people who misused its drug, Ronnie had an easy time shifting the blame …

“‘Herr-on was already there,’ he insisted, a truth confirmed in interviews with survivors of people who died of heroin overdose before Ronnie arrived in Woodstock. ‘I never introduced herr-on to the area. The only thing I did: I gave it to ’em at a cheaper price …’ (Emphasis added.)

“‘I promised myself I’d never grow up to be like my father, and while I may not have an addiction to an actual drug, I do feel my addiction,’ he said. ‘I’m addicted to that lifestyle. It wasn’t my intention. I didn’t want to do it. But no one would give me a job in the field I’d trained for, and no one would let me create my own.’

“Ronnie ended the interview with a version of the same old saw I’d heard at so many of my stops along the heroin highway: He predicted that ‘ten more dealers would pop up to take my place,’ which was accurate. It was hard to envision a future where shit in fact stopped.”

Macy writes: “It was a long drive back to Roanoke. I was too tired to stop in Woodstock, where I’d arranged to meet with Kristi. She was eager to learn what light Ronnie had shed on Jesse’s death, but I dreaded telling her just how little he seemed to think or care about the victims of his crimes. Since our last meeting, she had arranged to view the pictures police took of Jesse lying dead on the floor. He looked surprisingly peaceful. ‘What I’d been imagining was actually much worse,’ she said …

“Kristi still went by her son’s grave overlooking the football field several times a month, less often since her family moved to the other side of the county. But she still decorated it for every holiday. ‘I feel bad every day that I don’t go,’ she said.

“After a day passed, I tried to break the news gently to Kristi over the phone that Ronnie hadn’t even recognized Jesse’s name.” (Emphasis added.)

So where are we? “One-third of children in central Appalachia now lived with a nonparent adult, and 96 percent of the adopted kids weren’t orphaned—they’d been removed from their drug-addicted parents by social service workers.”

Everybody needs to read “Dopesick.”