51 pages • 1-hour read
Dopesick: Dealers, Doctors, and the Drug Company that Addicted America
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Part 3, Chapters 9-11Chapter Summaries & Analyses
Chapter 9 Summary: “Whac-A-Mole”
Macy illustrates why it was so hard to stop drug trafficking in Roanoke during the 2010s. Ashlyn Keikilani Kessler was an “unlikely addict, a young mom and paralegal with a criminal justice degree from Jerry Falwell’s Liberty University” (190) who became addicted after her doctor prescribed opioids for a breast duct infection after her pregnancy. She used drugs and carried drugs back and forth between her community and wholesalers, making it difficult to put a stop to drug trafficking because people like her are virtually invisible to law enforcement.
The problem is that the legal system is “not nimble enough to combat heroin’s exponential growth. The drug’s too addictive, the money too good” (194). Macy describes the day when agents arrested Ashlyn with over 700 bags of heroin and her abandoned “Narcotics” Anonymous book stashed in her car. Ashlyn ended up in prison, having been a major source for drugs in her community. However, arresting her did nothing to stop the flow of heroin into Roanoke; there were many others like her. Ashlyn lost custody of her son as a result of her conviction.
Although the FDA finally cracked down on Purdue Pharma for its role in normalizing opioid abuse, communities still had to deal with multiplying problems like addiction-driven crime and illnesses like hepatitis C and HIV that circulated more freely among those who injected heroin using needles.
Then came fentanyl, an even more potent opioid imported from China with little regulation. Medication-assisted treatment worked, but in Virginia, the Medicaid programs that could have funded treatment were not allowed because the state chose not to expand Medicaid eligibility with the passage of the Affordable Care Act (commonly known as “Obamacare”).
Chapter 10 Summary: “Liminality”
Macy recounts the efforts of the Hope Initiative, a private-public partnership between volunteers and law enforcement, to divert people with addictions from the criminal justice system to rehabilitation programs. Trained volunteers helped drug-addicted people get into rehabilitation programs and gain access to social support services. Neither the volunteers nor their law enforcement partners supported medication-assisted treatment (MAT).
Macy grounds this chapter with the story of Tess Henry, a pregnant woman with an opioid addiction. Macy got personally involved with Tess, sometimes taking her and her crying baby to 12-step program meetings and keeping in touch with Tess’s mother. This close relationship revealed the impact of prejudice against MAT.
Henry spent most of her pregnancy on Subutex, a drug for MAT that people with addictions sometimes divert and abuse. Most of the treatment options for pregnant people didn’t allow use of her medication. After the birth of her son, Tess got a referral to a MAT program at a methadone clinic, but she relapsed. Tess’s mother paid cash to get her into another medication-assisted program. Family members argued over whether tough love (allowing Tess to deal with the consequences of addiction alone), 12-step programs, or MAT was the answer. Tess eventually participated in “Narcotics” Anonymous, a 12-step program. The meeting Tess attended was one where members saw medication-assisted treatment for addiction as “simply replacing one opioid with another” (216). Tess was unable to get a sponsor (a mentor who is in recovery and helps the new member stay sober).
Tess had a brief moment when it seemed like things would work out for her, what Macy describes as the “liminal phase” (227) during which the person with addiction is open to treatment and has the opportunity to get some. However, that moment passed and she was unable to get the help she needed in time.
Macy argues that this bias against MAT is “the single largest barrier to turning back overdose deaths” (219). When these drugs are available, patients are frequently weaned off of them quickly, leading to relapses like Tess’s. Although Tess’s son was not born with “dopesickness in miniature” (210), i.e., neonatal abstinence syndrome, he ended up in the custody of his grandmothers as Tess’s addiction worsened.
Chapter 11 Summary: “Hope on a Spreadsheet”
The Hope Initiative relied on a volunteer-created spreadsheet of programs to find places in rehabilitation programs for people like Tess, but such slots were scanty. Faith-based, 12-step programs dominate the facilities available for rehabilitation. There aren’t enough beds for MAT approaches, and Medicaid funding is inadequate for providing more. Tess’s mother was resigned to the fact that Tess would likely die. By 2017, the Hope Initiative finally found a bed for Tess in a Nevada facility. Tess made it to the facility, but she was already communicating with her drug dealer using her roommate’s phone.
Part 3, Chapters 9-11 Analysis
Macy deepens her analysis of exactly how the structural response to the opioid epidemic is broken by examining specific systemic failures in law enforcement, rehabilitation, and healthcare. This chapter includes relatively dense discussions designed to help the reader understand the ins and outs of Medicaid and approaches to rehabilitation, but Macy again illustrates these with stories about specific people.
Macy notes elsewhere that law enforcement has built its drug interdiction efforts (efforts to disrupt drug trafficking) to catch people dealing drugs in urban communities. In Chapter 9, Macy includes details about Ashlyn Kessler—her color-matched accessories, her car, her handbag, her degree from a conservative Christian university—to show that the focus on urban men and people of color as targets in the War on Drugs is misguided. Beneath Ashlyn’s respectable appearance was a body with an “astonishing ability to metabolize the drug [heroin] without overdosing” (189). The War on Drugs is a game of “Whac-A-Mole” because the system isn’t designed to catch people like Ashlyn Kessler, a member of the comfortable suburban communities in Roanoke. Class, race, and gender biases hobble the efforts of law enforcement and the criminal justice system.
These biases are not present in law enforcement alone. Macy’s account of Tess Henry’s struggles to beat her addiction adds emphasis to the cost of stereotypes of who gets addicted and how to help them. Like Ashlyn, Tess was a woman who dealt with addiction during and/or after pregnancy. The rehabilitation industry became an impediment to recovery even when Tess was in that liminal stage because of biases against MAT and because that system didn’t know how to deal with women with children. Macy’s description of driving Tess to NA meetings with a baby in tow also shows that Macy was willing to engage with a subject on a subjective, personal level instead of maintaining her objectivity as a journalist.
Macy also shows that another element of the broken system is the way insurance works in the United States. Pregnant people in many states are eligible for medical care through Medicaid, a federal and state healthcare program for people with low income. Under the Affordable Care Act, states like Virginia could have extended Medicaid benefits to help people like Tess, those with too much income to qualify for Medicaid but not enough to afford their care. Through this explanation, Macy reveals how the lack of political will to expand Medicaid in Virginia meant Hidden Valley residents like Tess and other impoverished urban individuals alike didn’t get the care they needed for recovery.
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