Dopesick

by Beth Macy

  In Roanoke, the urban hub for the western half of the state, I-81 perches at the edge of the northern suburbs. It rolls and undulates, connecting western Appalachian communities from Tennessee to Virginia as it travels northeast around Roanoke and up through the northern Shenandoah Valley, intersecting with other interstates leading to Baltimore and Washington, New Jersey and New York.

  One of the most segregated cities in the South, Roanoke had long had a steady but largely quiet group of heroin users in its urban core, which positioned it to become an ideal transfer station for the region’s transition from dope to pills, then back to dope. It was the perfect incubator for the opioid epidemic—a cultural and geographic crossroads. It was big enough for users to easily forge drug connections and yet small enough for the drug dealers to hide out.

  Some dealers, traditionally ensconced in the city’s poorest, northwest quadrant, were beginning to migrate to the more affluent neighborhoods of Hidden Valley and Cave Spring, one heroin task officer told me—to avoid robberies and home invasions.

  “As long as it was in the lower economic classes and marginalized groups, like musicians and people of ethnic minorities, it was OK because it was with those people,” said Spencer’s counselor, Vinnie Dabney, an African American who took his first sniff from a bag of heroin his sophomore year of high school, in 1968, and was a mostly functional user for thirty years. (Needle-phobic, he never once shot up.) Back then you could maintain that way because the drug’s potency was low—3 to 7 percent, compared with 40 to 60 percent today—and the police paid little attention, since white kids in the suburbs weren’t dying or nodding out in the football bleachers.

  “But the moment it crossed those boundary lines from the inner city into the suburbs, it became an ‘epidemic,’” said Dabney, shaking his head. After two drug-related jail stints, he left court-ordered treatment in the late 1990s to get a master’s in counseling and now works as a mental health and substance abuse counselor who leads support groups for users taking the maintenance drug buprenorphine, or bupe (more commonly known by the brand name Suboxone). “It’s ludicrous, this thing that’s been knocking on your door for over a hundred years, and you’ve ignored it until finally it’s like a battering ram taking your doors off the hinges.

  “It’s a monster now, but nobody paid any attention to it until their cars were getting robbed, and their kids were stealing their credit cards.” The worst of it, Dabney warned, was that people were getting hooked at even younger ages, and making the switch faster from pills to heroin.

  It took a while for the force of the battering ram to register. Unlike in the coalfields, where addicted users quickly resorted to thievery to fund their next fix, in the suburbs the epidemic spread stealthily because users had ready access to money. Many of them were teenagers selling electronic devices (then telling their parents they’d been stolen), or raiding their college savings accounts, or simply using their allowance. They were not engaging in “spot and steal,” not trading a mule for four pills, not wheeling stolen garden tillers down the street for everyone to see.

  In the wealthiest Roanoke County suburbs, illicit pill-taking commenced, shared on TruGreened lawns, next to school lockers, and in carpeted basements while clueless parents in Cave Spring and Hidden Valley were making family dinners upstairs.

  There was no widespread panic, because the teenagers and young adults had the money to keep their addictions at a low boil, and those parents who were in on the dirty little secret were too ashamed to let the neighbors know.

  From California to Florida, the parents behind Relatives Against Purdue Pharma already knew that OxyContin stood out more in rural America’s distressed hollows and towns, where reps could easily target the lowest-hanging fruit—the injured jobless and people on disability, with Medicaid cards. But OxyContin was everywhere, of course, and it had been almost since the beginning, even if the crimes associated with it hadn’t dominated the urban news.

  “The early suburban wave mostly stayed hidden…because parents there could afford to put their kids in a thirty- or sixty-day program,” said Dr. Hughes Melton, an addiction specialist and now the Virginia Department of Health’s chief deputy commissioner overseeing much of the state’s response to the crisis. “You really didn’t hear much about it until young people started dying.”

  It was the death of the funny young rapping chef, Scott Roth, with his mop of blond hair and life-of-the-party disposition, that should have put the Roanoke region on notice.

  The weekend when most of his friends were going off to college, his mother had driven him to a rehab program at the local rescue mission. She remembers leaving him by the mission door in the rain, in his plaid shorts and Nautica shirt.

  Spencer Mumpower helped me unpack the epidemic as it unfolded behind mall movie theaters and in wooded cul-de-sacs in the late aughts. But even though high school surveys showed suburban heroin use was growing in 2012 (it was then 3 percent higher in Roanoke County schools than the national average), parents and prevention workers alike underestimated Spencer’s warnings, viewing his crime as an anomaly, maybe even an outlier case of bad parenting.

  “We didn’t understand the connection between heroin and pills at least until 2014,” admitted Nancy Hans, an area drug-prevention coordinator. In 2010, her Prevention Council of Roanoke County initiated drug take-backs, events where citizens were encouraged to safely dispose of unused medications, but she wishes now that she had singled out opioids.

  At the urging of local police, Hans instead launched a campaign to warn parents about synthetic bath salts in 2012, then in the public eye because they had caused bizarre behavior, including physical scuffles with police as well as the overdose deaths of two local young women. Shortly after President Obama signed a law banning the sale of the products, Vice magazine swooped into Roanoke for a scoop. Looking back, the bath-salts blight was a red herring, problematic but short-lived—and a distraction from a much quieter, even deadlier drug.

  “That’s how it got way out in front of us,” Hans said. “And the doctors didn’t see their role in it, either. When a doctor prescribed our teenagers thirty Percocet pills for a pulled wisdom tooth, we didn’t know to complain. It was like we were all in a big fog of denial.”

  Within five years, Hans would have the numbers of multiple mothers of addicted kids programmed into her cellphone. She would find herself rushing from the funerals of heroin-overdosed twentysomethings to giving prevention talks in the auditoriums of the high schools they once attended. Spencer’s master class in drug abuse had gone unheeded, boxed away into a category of Things That Happen to Other Families.

  Andrew Bassford, the assistant U.S. attorney who prosecuted Spencer’s case, took an angry phone call from the Roanoke County school superintendent, who was mad that he’d openly addressed the accessibility of heroin and OxyContin in her schools.

  “How dare you tell the newspaper these things?” the superintendent seethed.

  Bassford, who also works as a brigadier general in the U.S. Army Reserve, was unmoved by the scolding.

  “I say these things because I know them to be true,” he said. “Your schools are a pit because your students have money, and money attracts drugs.”

  The Hidden Valley teenagers called the green 80-milligram Oxys Green Goblins. They scored them from an array of sources: a restaurant co-worker, a brother who’d had them prescribed in the wake of wisdom-tooth surgery, an Iraq war veteran who had legitimate pain but was prescribed twice as many pills as he needed and funneled the rest to the kids down the street in exchange for cash.

  “Parents didn’t really know what was going on when it was just pills,” recalled Victoria (not her real name), who tried her first OxyContin pill her senior year after a friend ratted her out to school officials for smoking weed.

  Victoria remembered the first time she tried to crush an abuse-resistant Oxy, following Purdue’s long-awaited reformulation in 2010, and it worked exactly as Barbara Van Rooyan envisioned it
would when she petitioned the FDA, demanding an opioid blocker, or antagonist, be added to the drug: “If you tried to crunch ’em, they’d gel up on you. You couldn’t even snort ’em, let alone shoot ’em. After that, the pills either went dry or were just too expensive to get. And everybody who used to deal pills starting dealing heroin instead.”

  I noticed another, lesser-known pattern among the addicted suburbanites I interviewed: The Green Goblins were typically preceded by a starter pack of a very different drug. Almost to a person, the addicted twentysomethings I met had taken attention-deficit medication as children, prescribed pills that as they entered adolescence morphed from study aid to party aid. On college campuses, Ritalin and Adderall were not just a way to pull an all-nighter for the physics exam, never mind that they were prescribed to your roommate, not you; they also allowed a person to drink alcohol for hours on end without passing out. That made them a valuable currency, tradable for money and/or other drugs.

  Between 1991 and 2010, the number of prescribed stimulants increased tenfold among all ages, with prescriptions for attention-deficit-disorder drugs tripling among school-age children between 1990 and 1995 alone. “And we’re prescribing to ever- and ever-younger children, some kids as young as two years old,” said Lembke, the addiction researcher.

  “It’s just nuts. Because if we really believe that addiction is a result of changes in the brain due to chronic heavy drug exposure, how can we believe that stimulant exposure isn’t going to change these kids’ brains in a way that makes them more vulnerable to harder drugs?” she added.

  The science is far from clear, according to a 2014 data review. Some studies show that ADHD-diagnosed children treated with stimulants have lower rates of addiction to some substances than those who weren’t medicated, while other studies suggest that exposure to stimulants in childhood can lead to addiction in adulthood.

  “A lot of us think that doctors have overdiagnosed children with ADHD, so a diagnosis is something to very carefully discern, and parents should always monitor the medicines their children and teenagers are on,” said Cheri Hartman, a Roanoke psychologist.

  Lembke pins the opioid epidemic not just on physician overprescribing fueled by Big Pharma but also on the broader American narrative that promotes all pills as a quick fix. Between 1998 and 2005, the abuse of prescription drugs increased a staggering 76 percent.

  While opioids have resulted in the direst consequences, Lembke is equally leery of benzodiazepines (prescribed for anxiety) and stimulants, both of which make teenagers—especially underchallenged kids who aren’t engaged in meaningful activities—dangerously comfortable with the notion of taking pills. Any pills. Whether the pills originated in a bottle with their name on it or came from a bowl at a so-called pharm party.

  Emergency-room administrator Dr. John Burton watched the cultural shift play out at the North Carolina YMCA summer camp he attended as a kid and returned to later as the camp doctor. Whereas very few campers took prescribed medications in the 1970s, by the mid-1990s 10 percent were taking a pill at some point during the day—most for asthma or allergy conditions, followed by a small subset of kids on behavioral medications, usually for ADHD.

  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.”

  So it went that young people barely flinched at the thought of taking Adderall to get them going in the morning, an opioid painkiller for a sports injury in the afternoon, and a Xanax to help them sleep at night, many of the pills doctor-prescribed. So it went that two-thirds of college seniors reported being offered prescription stimulants for nonmedical use by 2012—from friends, relatives, and drug dealers.

  “In the short term, kids and parents and even teachers may feel better” about Adderall’s ability to enhance memory and attention, Lembke said. “But studies show that over the long term those kids don’t do any better in school than people who don’t receive stimulants.”

  And among those whose stimulant usage becomes a gateway to harder drugs, they’re doing much worse. That was true for Spencer Mumpower, who routinely traded Adderall for marijuana, and Ritalin for cocaine. That was true for almost every addicted young adult I interviewed for this book.

  As Spencer prepared for prison in the fall of 2012, the remainder of the Hidden Valley group with whom he’d abused drugs kept on as usual to avoid becoming dopesick. Whether that meant recruiting new users at parties or taking jobs at senior moving companies with the express intent of stealing opioids from retirees, targeting the expired or leftover prescriptions so the client wouldn’t notice.

  “If it was a current medication, I’d take just a couple,” recalled a recovering heroin user I’ll call Brian, then a Hidden Valley High School student, a doctor’s son, and a member of the marching band. “If it was an old prescription, I’d take the whole bottle. Some old people would tell me, ‘Just throw it away,’ and I’d definitely take those.”

  Dependent on pills by age seventeen, Brian was twenty when a co-worker introduced him to heroin. He snorted it first from waxed-paper bags marked COLOMBIAN COFFEE and BLUE MAGIC, in wrappers so small he could hide them inside his phone case. “From the moment I did that first bag, I can tell you, looking back now, it was destined,” he said. After snorting the crushed-up Oxys, inhaling the heroin powder was easy—and the heroin was cheaper, more intense, and, increasingly, it was everywhere he went. Though he was deeply troubled by Scott Roth’s death, little else but drugs mattered anymore. Another friend taught him how to inject himself; he bought the needles at a local drugstore, telling the pharmacist he needed them for insulin.

  “It was like shooting Jesus up in your arm,” Brian said of his first IV injection. “It’s like this white explosion of light in your head. You’re floating on a cloud. You don’t yet know that the first time is the best. After that, you’re just chasing that first high.”

  Within six months, Brian had blown through the $8,000 he’d put aside for college and pawned his Xbox and video games, all without his parents’ knowledge. “I would spend six hours a day driving around Roanoke picking up drugs, waiting for phone calls, going to ATMs.”

  His parents noticed he was moodier than usual and worried about his weight loss; he’d dropped from 150 to 125 pounds. They asked him if he was anorexic.

  A counselor he was seeing for anxiety set up an intervention of sorts in his office, inviting Brian’s parents to attend and beginning with “Brian wants to tell you about a problem he’s having.”

  By then he was shooting up twenty bags a day, buying them from a host of user-dealers that had once included Spencer and Scott.

  “I’m addicted to heroin,” he told his parents.

  And while they were relieved to finally know why he’d lost so much weight—and why he sometimes stayed out until 3 or 4 a.m.—they were also gobsmacked.

  They sent him to a local hospital to detox, then to intensive outpatient treatment, where he was prescribed the opioid-maintenance drug Suboxone, with mandatory urine screenings, one-on-one counseling, and support group meetings.

  Brian was twenty-three years old and beginning to wean off Suboxone when I first interviewed him, in 2012.

  “It’s been seven days today” since his last dose of Suboxone, he said. “I have pinprickly skin, and I’m restless. It’s hard to sit still.” Still mourning Scott’s death, he noted that none of his other user-dealer friends, with the exception of Spencer, had been caught.

  “The cellphone is the glue that holds it all together for the modern drug user,” Brian told me. “In high school, I snuck out of the house a number of times to meet people at the bottom of the driveway, and my
parents had no clue. Aside from taking my cellphone away, my parents also could have looked at my text message logs and gotten a sense of what was going on.”

  At a Lutheran church on the outskirts of Hidden Valley, two moms of opioid-addicted young men met at a Families Anonymous meeting, where worried parents go for peer support. Not only would their chance meeting have lasting implications for families of the addicted in the region, but their stories would also expose how families operate inside the sizable gaps that have opened up between the two institutions tasked with addressing the opioid epidemic: the criminal justice and health care systems. While shame too often cloaks these gaps in secrecy, some doctors, drug dealers, and pharmaceutical companies continue to profit mightily from them. The addicted work to survive and stave off dopesickness while desperate family members and volunteers work to keep them alive.

  Jamie Waldrop was a civic leader, the wife of a prominent surgeon. Drenna Banks and her husband ran a successful insurance agency. Their sons had been friends and used drugs together, crossing paths briefly through friends at North Cross, a private suburban school that Jamie’s son Christopher attended.

  “I just knew [Jamie] was this cool blond-haired chick who was making me laugh at a time when I needed to laugh,” Drenna recalled. Jamie had not one but two children who’d become addicted, first to pills, then heroin. She hadn’t realized the depth of their addiction until she found them both passed out in separate incidents in her home—her oldest, breathing but slumped over in a chair from a combo of Xanax and painkillers, his cellphone fallen to the ground; her youngest, passed out on the bathroom floor, heroin needles and blood sprawled around him.

  Between the outpatient Suboxone programs (none of which worked, the family said) and multiple residential rehabs and aftercare sober-house programs (two of which, eventually, did), the Waldrops would spend more than $300,000 on treatment—not counting the drug-related legal fees or the thousands in stolen checks and credit-card bills for gift cards, which were traded to dealers for drugs. (A $200 gift card goes for $120 worth of pills, Jamie explained.) “I was a pretty bad robber,” Christopher, her youngest, said.