Beth Macy

An interesting, readable, and useful -- if not definitive -- account of the United States' ongoing opioid epidemic. The author's account of how early small-town cops caught on to the fact that a new product called OxyContin could become a problem for law enforcement is positively uncanny, and she does a good job of tracing the spread of opioid and heroin abuse from truly hopeless corners of Appalachia to wealthier zip codes. Other parts of "Dopesick" aren't quite as strong. The account of show more how Purdue pharma developed OxyContin and the actions it took in response to evidence that patients were abusing it gets the main points across but also feels somewhat cursory.

To be perfectly honest, it was difficult to read "Dopesick" without comparing it to "Dreamland", Sam Quinniones's book on the origins of our current drug epidemic. While Quinnionnes appraised this material with an investigative reporter's eye and devoted lots of space to a structural analysis of the epidemic, Macy's book puts more focus on the human element. She describes how the sudden deaths of a handful of teenagers brought home the epidemic's seriousness to a small city in a mostly rural corner of Virginia and provides affecting accounts of their short, unfinished lives. Her descriptions of how mothers and public health professionals living at the epidemic's ground zero have tried to contain its effects is both illuminating and heartbreaking. She describes the personal sacrifices made by people who've lost loved ones to opioid addiction at length, highlighting just how unprepared the health system in these regions was for a problem of this scale. We hear about frantic phone calls to faraway treatment centers and midnight drives to get addicts addicted to detox, and, of course, about overdoses that happen despite everyone's best efforts and the lasting pain of losing a son or daughter to drugs. I found "Dopesick" to be an emotionally trying read.

Lastly, while Quinniones's dealers were, by design, eminently replaceable cogs in a machine, Macy takes the time to get to know some of the people personally responsible for trafficking an enormous amount of heroin from Baltimore to a rural area of Virginia in which it was, if not completely unknown, relatively uncommon. She illustrates how most long-term users are also dealers, balancing sales with use to keep from getting sick. Her portrait of Ronnie, a more-or-less big time distributor that serviced many of the addicts we meet in "Dopesick" is interesting in its own right. He seems intelligent and talented. He'd trained as a computer technician and obviously ran a well-oiled operation. He ducks personal responsibility for much of the damage he caused in the pocket of Appalachia in which he operated, pointing out that he didn't introduce the drug to his territory and often did little more than save his customers a drive to the big city. It's revealing though, that even as his was in full swing he knew that his run was unlikely to last more than six months. Predictably, his arrest did relatively little to stop the flow of drugs into the area where he used to sell.

On balance, I'd recommend readers take a look at Quinniones's book first, though both of these accounts have their strengths and weaknesses. In the final analysis, though, what's especially dispiriting is that much of what Macy describes here is still happening, and by almost all accounts it's gotten worse. Overdose are much higher now than they ever were during the period described in "Dopesick." Sadly, I have no idea how any of this ends. Macy's description of a community doctor's efforts to educate people about opioid addiction and her descriptions of the family-led grassroots efforts to get addicts care prove that there's still some hope to be found, but all-encompasing solutions to this crisis still seem to be in short supply. show less

Beth Macy continued her advocacy, research, and investigative journalism after Dopesick in Raising Lazarus: Hope, Justice, and the Future of America’s Opioid Crisis.

Throughout the book, we watch the Sackler family bankruptcy case play itself out through the court system: their attempt to pay a pittance to shield themselves from future and further liability, implicitly recognizing while officially denying their significant role in today’s opioid crisis.

By today, of course, very few are show more still on OxyContin. But many are still feeling the effects of the OxyContin pill mills of the past, and now are addicted to opioids. Throughout the book the author profiles the various people, particularly in parts of Indiana, West Virginia, Kentucky, and North Carolina, who serve on the ground to try to do whatever they can in order to get people the help they need. Most of them have some kind of personal background with opioids or something similar. The story is one full of relapses, even, and sadly perhaps even especially, among these helpers.

There is hope and promise: there are ways forward for people. Bupe (Buprenorphine) can help those addicted to opioids to better manage their condition. Some people are able to find a way out through addiction recovery programs without such medication. Slowly but surely, many are coming around, moving away from the previous posture of incarceration and castigation and understanding how opioid addiction is not like many of the drugs of old, cannot be managed the way former forms of drug addiction were managed, and with appropriate medicine and care, those addicted to opioids can find a way forward.

But it is incredibly time-intensive and expensive, and it always seems easier to judge and condemn those addicted for perceived moral fault. The Sacklers relied on this kind of discrimination and prejudice to make their case. Plenty of citizens and their elected representatives manifest little patience with those addicted in their midst; and probably not a few find the whole thing quite embarrassing. Often the areas in which the situation is the worst are those areas in which there is the greatest resistance to change and management.

This book is a hard and emotional read. It’s gutting to read how most of the women on the streets of Charleston, West Virginia, had previously been faithfully married with children before whatever circumstances led to their addiction; one was even a pastor’s wife. Those of us who are not among the addicted want to find some justification or reason to consider those who are addicted as culpable, as the “other,” so that we might not imagine that we would ever suffer this “contagion.” Yet it is only by the grace of God that perhaps we did not suffer some injury, or go through some similar experience, for it is haunting and horrifying to imagine we could become as them very easily and ourselves be dopesick and on the streets.

If we, as a society, are best judged in how we treat the least of those among us, then our judgment will not go well for us, and those who have suffered greatly in the opioid crisis rightly condemn us. We can, and should, do much better. show less

Back in 2016, I went to the library to find out what the big to do was about the newest, hottest book around, “Hillbilly Elegy” by an upstart Yale-educated hillbilly named J.D. Vance. He wrote about his hometown of Middletown, Ohio, which is not far from where I live. Western Ohio, like much of the Midwest has been darkly affected by the influx of drugs, drugs which addicts lean on in the absence of education, employment, and an otherwise rewarding life. Beth Macy’s book is about show more another Ohio town, Urbana, similarly affected by the same things that transformed Middletown. The difference in the two books is Beth Macy is the real deal. J.D. Vance is a phony. it’s really too bad Macy didn’t beat the Yalie to the punch and get “Paper Girl” out first. I think it might have had more of an impact than it has. Macy wrote this book at the beginning of the second Trump administration, presumably before much of the end of first year damage had been done. Her anger at the end of her book is evident, and that anger would have been multiplied had the book come out a few months later. My only regret in reading “Paper Girl” is my own anger was amplified as I read her account of Urbana and the social and political disaster that this country has become. And the saddest thing is, like most of America, I’m just worn out and am becoming numb to it all. show less

Summary: A memoir about growing up in Urbana, Ohio and how the town changed in ways that reflects the struggles of rural America.

Beth Macy grew up in Urbana, Ohio, the county seat of Champaign County, about an hour west of where I live. She grew up in a family with a mostly absentee father. As the title suggests, to supplement the family income and have some spending money, she delivered the daily paper to a section of the town and got to know those families well. With the support of her show more mother, older siblings and teachers, she managed to do well in school. Then she learned of the Pell Grant program, that enabled her to complete journalism studies at Bowling Green State University. From there, she went on to a career in journalism and published several best-selling books.

Her mother remained in Urbana and as her health declined, Macy spent more time there and noticed the dramatic changes in her former home. It came home to her when she met Silas James, a talented graduate from her high school from a similar poor background. She describes his struggle to find hope and his efforts to scrape together the means to enroll in a two-year welding course and cobble together transportation to get there. She wonders why the investment in her education was no longer available for someone like Silas.

And she began to notice other changes. Declining graduation rates. Confederate flags in what was once a Union stronghold and underground railroad stop. Local companies sold to outside or foreign interests followed by layoffs. The paper she delivered and later interned with was down to two issues a week and barely hanging on. Talking to counselors at the high school, she learned of stunning amounts of abuse. There were changes among former classmates and family as well. A former boyfriend, a one-time radical, was deep into QAnon.

This book is both a memoir of growing up, with lots of memories of siblings and friends, and an exploration of the cultural changes and political divides she was encountering. Rather than simply cut off contact with those she disagreed with, including families, she interviewed a number of them as a good reporter. This was not always easy. For example, one sister told her the idea of her son marrying another man was an “abomination.” But she learns about the church and political beliefs that led to these differences. She showed up for homecomings and reunions.

More than that, she weighed how broader changes in the country contributed to the changes in her town. She looks at the gutting of the Pell Grant program, so helpful to her, that resulted in making it so much harder for students like Silas to get an education. She lays blame on both parties for forgetting rural America, except to harvest their votes. NAFTA led to the offshoring that closed factories that were the backbone of small towns throughout Ohio. Drugmakers made huge profits on addictive drugs that destroyed lives and families. And media echo chambers engendered distrust of other media, science, and education.

As she listens, and sometimes argues, she also wrestles with her own contribution to the divides. The last part of the book is titled “Showing Up.” Despite the hits, she keeps showing up with aging sisters, recalling family memories, particularly when her mom passes. And she grieves the death of her ex-boyfriend, who lacked health insurance. He delayed going to the hospital for too long with a case of pneumonia. Through all the discouragement of the 2024 election and its aftermath, she doesn’t give up. Recalling her rural roots, she contends that “We must scramble for hope fiercely, the way a farm girl wrestles with a muddy sow.”

The city where I live is a government/business/education/tech center and has boomed. Politically, it is a blue island. A majority of Ohio’s 88 counties struggle with the same issues as Urbana. I grew up in Youngstown (and was a paperboy). While Youngstown was and still is much larger (59,000 vs. Urbana’s 11,000), I’ve seen the same kinds of changes Macy describes. She helped me understand rural Ohio. Not only does she model a posture of grace for how we show up. She also models the fierce hope we need to lean into. And she makes the urgent case for forgotten rural America. show less