"Raising Lazarus: Hope, Justice, and the Future of America’s Overdose Crisis" by Beth Macy; Little, Brown (373 pages, $30)
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It was historic — and alarming — news when in August the National Center for Health Statistics announced that, for the second year in a row, life expectancy for Americans had declined, dropping to a level last seen three decades ago.
One factor in that drop was, of course, the COVID-19 pandemic. But another lethal factor has been having an impact for much longer, as journalist Beth Macy writes in her new book, “Raising Lazarus: Hope, Justice, and the Future of America’s Overdose Crisis.”
Macy writes, “The Centers for Disease Control and Prevention estimates that more than a million Americans have died from drug overdose since 1996, the largest factor by far in decreasing life expectancy for Americans. In the past two decades, overdose deaths have quintupled. If life-expectancy declines persist, experts predict it will take more than a century to recover.”
Overdose deaths affect Americans at every income and educational level, of every race, in every part of the country. They outnumber gunshot deaths and car crash deaths combined.
The overwhelming majority of those overdose deaths are caused by opioids, both legal and illegal. Much of the enormous growth in those numbers can be traced to one legal opioid, OxyContin, and the company that makes it, Purdue Pharma.
Macy laid out that deadly connection in her deeply reported 2018 book, “Dopesick: Dealers, Doctors, and the Drug Company That Addicted America.” The book was the source for the 2021 Hulu miniseries “Dopesick,” which was nominated for multiple Emmys and won one for Michael Keaton for best lead actor. (Macy was involved with the show as a writer and executive producer.)
In “Dopesick,” Macy wove together two major storylines. One spotlighted the lives of individual victims of overdose and the devastated families they left behind; the other related how the Sackler family, the owners of Purdue, not only developed OxyContin but created a marketing method that essentially peddled the drug as a safe, nonaddictive painkiller — and relentlessly targeted sales at communities vulnerable to it.
It’s a story to make your blood boil. In “Raising Lazarus,” Macy shifts the perspective somewhat. The story of Purdue, the Sacklers and the massive legal attempt to hold them responsible continues in this book. But Macy also turns her attention to people who are trying to do something about addiction and overdose deaths — heroes you never heard of who are saving lives one at a time.
The book’s title comes from the New Testament story, as explained by the Rev. Michelle Mathis. She heads the Olive Branch Ministry in western North Carolina, which offers boots-on-the-ground help for opioid users.
When Jesus heard his friend Lazarus had been dead for four days, Mathis says, he mourned with others close to him. “Then Jesus instructed his followers to roll away the stone from Lazarus’s tomb, and he commanded Lazarus to come forth, telling the mourners to unbind him from his burial cloths.
“Jesus had already performed the miracle; now, it was up to the community to do the stinky, messy work of pulling the burial shroud off Lazarus.”
Those are the people Macy shows us: the ones doing the messy work.
For decades, people who were addicted to drugs were stigmatized as morally deficient or criminal rather than sick. The most popular solution to the problem, promoted by politicians and law enforcement, was the 1980s-vintage War on Drugs strategy to “arrest their way out” of it by imprisoning users — a solution that has seen little success.
Macy writes about newer ways to treat addiction that, if not quite miracles, have shown much more promise. One of them is buprenorphine, or bupe, as she calls it, a prescription drug that treats opioid addiction by reducing withdrawal and cravings — the “dopesickness” that so often drives people into relapse. And relapse immediately after prison or rehab, when the user is clean, is when overdose is most likely.
The use of bupe in tandem with other forms of treatment, including counseling and job and housing assistance, have helped countless users recover, Macy writes.
You might think a treatment like this would be offered enthusiastically in every community in America. Instead, the struggle to get bupe is, for many people, far more difficult than just relapsing to street drugs. Macy writes about speaking to a group of sheriffs about the benefits of treating users with bupe while they’re in jail, so they can make an easier transition to life outside and (as studies show) be much less likely to re-offend.
When she’s done, she writes, a single sheriff sarcastically slow-claps while the others sit in stony silence. They refuse to be seen as “coddling” criminals.
So people like Nikki King pick up the slack and get the work done. King grew up in a small town in Kentucky and was already at work creating a program to treat addiction when she was a graduate student. Seven years after she had graduated from high school, Macy writes, King “could tick off the names of twenty former classmates who were dead from suicide or drug- and alcohol-related car wrecks, disease or overdose.” She was tired of seeing them fall through the cracks.
Energetic and fearless, King takes a job in rural, conservative Ripley County, Indiana, where there are “no drug-treatment centers or detox facilities, not a single full-time psychiatrist, and addiction medicines were just about impossible to get.” But by 2019, the opioid crisis there had reached a level its leaders couldn’t ignore — so many people were using drugs that the county’s child abuse and neglect rate quintupled in five years.
As much as the community needed help, King ran into resistance to her methods at every turn. But, Macy writes, she wanted to create a program for “marginalized rural people with high rates of childhood trauma and comorbidities. By 2021, she had dubbed her team the Avengers of Mental Health. It had grown so fast that she had to move her own desk into the supply closet.”
King is just one of the real-life problem-solvers Macy chronicles. Some of them have lost family members to overdose, like Ed Bisch, who had never heard of OxyContin until the day his son died from it. Some have survived addiction themselves, like photographer Nan Goldin, who turned her brilliant career into a crusade against the Sacklers.
They are inspiring and admirable, every one of them. But they are, Macy makes clear, a scattered army of Davids facing a national Goliath.
Drug use is still highly politicized, as in the current attempts to tie immigration at the southern border to the flood of illegal fentanyl into the U.S., as if cartels might be inefficient enough to smuggle their product in the hip pockets of random people walking across the desert rather than, as Macy notes, “carried in via legitimate ports of entry on land and water, hidden in tractor trailers, cars, and shipping containers.”
And users themselves are still blamed and stigmatized. Mathis, the minister, recalls attending a community meeting in Mount Airy, North Carolina (the model for Mayberry in “The Andy Griffith Show”), where “the Kiwanis leader vented, ‘I think when they relapse. we should let ‘em die and take their organs!’”
But addiction is a problem we ignore at our peril, as “Raising Lazarus” makes clear. The heroes Macy writes about, and Macy herself, keep rolling away the stone.
