Poured Over: Beth Macy on Raising Lazarus

“And so, then I thought, Who do I most admire? Who taught me the most, and also, they’re doing it for completely selfless reasons, right? And I thought, Oh, that moment and the parking lot. So, I thought, I’m going to start a book in the parking lot of a McDonald’s dumpster in a dying town and show you how, in the most unlikely places, magic is happening.” Beth Macy’s 2018 bestseller Dopesick and the Emmy-nominated Hulu streamer it inspired have helped changed our national conversation about Opioids and addiction. Her new book, Raising Lazarus, takes a new approach to our ever-growing crisis, focusing on solutions and the people bringing those solutions to our communities. Beth joins us on the show to talk about harm reduction, meeting people where they are, organizing at a local level, the lawsuit against Purdue Pharma and the behavior of the Sackler family, activism, and more with Poured Over’s host, Miwa Messer. And we end this episode with TBR Topoff book recommendations from Marc and Becky.

Featured Books (episode)

Raising Lazarus by Beth Macy

Dopesick by Beth Macy

Empire of Pain by Patrick Radden Keefe

Featured Books (TBR Topoff)           

Undoing Drugs by Maia Szalavitz

Death in Mud Lick by Eric Eyre

Poured Over is produced and hosted by Miwa Messer and mixed by Harry Liang. New episodes land Tuesdays and Thursdays (with occasional Saturdays) here and on your favorite podcast app.

Full transcript for this episode:

B&N: I’m Miwa Messer, I’m the producer and host of Poured Over and Beth Macy has been on the show before. Her book Dopesick from 2018 is the basis for the Hulu streamer of the same name that now has 14 Emmy nominations, which is really exciting to see. Her new book, Raising Lazarus: Hope, Justice in the Future of America’s overdose crisis is a follow up to dope sick, it is also a book about solutions. It’s a book about where we need to go from here. And Beth, my friend, I am so happy to see you even though we are going to talk about complicated sad stuff. But we need to do this.

Beth Macy: I’m so happy to see you too. And it is something we should all be talking about. So thanks.

B&N: So I want to set folks up. Dopesick came out in 2018. And I want to set us up with some stats, because here we are four years later, the crisis is getting worse, in many cases not better and certainly was exacerbated by COVID. And can you give us some numbers just to give us a little perspective?

BM: Yeah. And that’s a great question. Because I remember in 2015, when I was writing the book proposal for Dopesick, there was this data that came out, showing that the epidemic was expected to crest in 2018. And I actually put it into the proposal thinking that would make the book timely. But golly, you know, it has only gotten worse. And of course, COVID exacerbated the overdose deaths, because people were using along with no one to Narcan them, and they were losing their, you know, weren’t able to see their go to the groups and the therapists at the beginning. And you know, also the drug supply just got way more dangerous. So now you have every year since COVID, it has gone up and it’s gone up, it breaks records every year, we have lost 1 million people to drug overdose deaths since 1996. The year oxycodone came out. And the epidemiologist who I think best tracks that, a guy named Don Burka, University of Pittsburgh, because he’s always been right when he’s predicting the curve. And he says we will be at 2 million by 2029. You know, which is so soon. So that’s how fast it’s a curve that looks, you know, almost straight up.

B&N: Yeah, that’s seven years. That is the way time has been passing recently. 2029 will be here, before we know it. And there’s something else I want to raise. You grew up in a very tiny town in Ohio. And at one point in Raising Lazarus to say this could have been my story, except I got to go to college. And I got to change my trajectory. So part of this is your relationship to the people and the land. And the place that you’re not just coming in solely from an outsider’s perspective. I mean, certainly you were on the ground reporting for three years before dopes that came out. And then you were reporting during COVID, as well, which changes sort of how the stories get told. When did you start figuring out who needed to be featured in Raising Lazarus because there are a couple of different storylines that happen.

BM: Yeah, so what I do something like this, because you don’t this is the hardest book by far, because it’s happening in real time. Whereas even Dopesick, most of the action had happened prior to me coming along. So with this, I just cast my net wide as, as I you know, just would for a magazine or a newspaper story, and then kind of land on the stories that I think best exemplify where we need to go. So harm reduction is a big theme in this book. I mean, it’d be easy to go to San Francisco, New York and follow a harm reductionist, but harm reduction in Appalachia, that’s a whole nother thing entirely, because they have a whole nother set up cultural barriers and financial barriers. And oh, by the way, this is the place that has been struggling with epidemic for the longest because of how Purdue targeted. So I say we’re about to have all this money come down from the litigation dollars, the settlement funds, a lot of communities aren’t going to know what to do with it. And unless we start educating the public about what actually works, i.e medication assisted treatment and harm reduction, the money’s just gonna go to the same old, same old drug war policing modalities. And so I looked at this as an attempt to really educate so I just had to find people that were doing really innovative things going back to factory man, I love a badass who figures out a way. And it’s not necessarily what all his or her peers are doing. But they figure out a way to do what needs to be done. They do the right thing, and they win. And I just love that. I mean, there are a lot of losses in this book, and I’m talking about olive branch ministry, Michelle and Karen, Tim, these are people who are doing the Lord’s work from you know, the most marginalized places and figuring out how to do it and I think if they can do it, then there’s no excuse why Dubuque, Iowa can’t do it also, or Austin, Texas, or Nebraska or where have you.

B&N: I mean, you’re really talking about people digging into their own communities?

BM: Yeah, it took me a couple times to get the prologue right. My editor Vanessa Mobley, she said, Well, I don’t think the beginning is right yet. And I forget what I had initially. But at one point, she said, you know, you do your best writing, when you really admire the person you’re writing about which you would think I would already know that, but it’s kind of like, That’s me and my writing, and I can’t really know how I do it. And so then I thought, Who do I most admire who is the who taught me the most, and also, they’re doing it for completely selfless reasons, right? And I thought, oh, that moment in the parking lot, you know, so I thought, I’m going to start a book in the parking lot of a McDonald’s dumpster in a dying town and show you how, in the most unlikely places, magic is happening.

B&N: Tim Nolan is a registered nurse practitioner in a very tiny town.

BM: In a very tiny town. And he is getting people on life saving medicine, and treating them with respect and non judgmental, and he’s telling them that because I think it’s so important, the theme of the book is like he says, he’s gonna give them this discount medication that he’s never before been offered. And it’s been two years of addiction. And he says two things. One, you can get better. I know you’ve written yourself off. I know, the whole American public has written people like you off, but you can get better I’ve seen it happen. And two, and this is key, don’t disappear. So even if you go out and you use again, this week, still come back to our appointment in this parking lot next week, and text me if you can’t, and I’ll come to you because he knows that these people disappear. Another worker calls it ditch and dodge by doesn’t even want to see them because so hard to deal with all the trauma they have going on their lives. And some people might go, Well, how many chances are you supposed to give these people but look, nothing we’re doing is working other strategy. And we now have a third of American families dealing with this. And it’s going to come for you if you think it’s not sorry to be the bearer of bad news. But we have got to start making the treatments easier to access than the dope.

B&N: Harm reduction. You describe it as counterintuitive. There are some people to put it politely they find it counterproductive. And again, as you just mentioned, we need to change the conversation. People are dying at alarming rates, their children are ending up in foster care, they can’t pass drug tests when they are alive in the world, and they can’t get jobs. And that’s just the very, very tip of the visible iceberg. And one of the things I want to stress and you certainly stress this through both books is people who become desperately addicted aren’t using to get high they’re using to not get sick. The phrase dopesick is a physical condition. Can you describe that for listeners?

BM: And they all say the very first person I ever interviewed taught me that word back in 2012. He was someone then in recovery for heroin addiction, he was about to go to federal prison for his role in a write about him and who is on power. And he said, You’re not doing it to get hot, you’re doing it so as not to have this excruciating pain of withdrawal. And it just becomes this huge monkey on your back. It’s physiological, it’s psychological. And you’ll do anything. I mean, you’ll let your kids go, you’ll do sex work, you’ll do anything not to feel that feeling. And it’s almost like this overblown in their minds feeling most people don’t die from it. It’s like another parent told me she said, once you finally figured it out, somebody said, it’s like you haven’t been offered food in 30 days, and somebody sets a plate of delicious food in front of you, and tells you not to eat it, every pore of your body is going to want that food. And that’s the way they feel.

B&N: And that’s a white kid from the suburbs of Virginia who’s telling you about being dopesick, and what it felt like for him. And that’s part of where the story changes for a lot of Americans because for a long time, drugs were not something you saw in comfortable suburbs or so people thought and suddenly the language changes from must incarcerate must punish must this too. Now we’re starting to talk more about rehab and recovery. And yet here we are in 2022, sort of slingshotting back to, well lock everyone up. And that doesn’t seem to be the most productive solution for communities. It’s certainly profitable for some people, but it’s not helpful. Can we talk about where harm reduction fits into a larger community picture?

BM: Yeah. And so, harm reduction is this idea of meeting people in active use chaotic use where they are and maybe just giving them a sandwich to start with because they’re hungry, right, building that little thread of trust, and then maybe they’re gonna come back the next time and they’re gonna get clean use supplies, and eventually when they’re ready, if and when They’re ready. Maybe you can triage them into treatment. But another form you could say this goes broadly under the umbrella of harm reduction is meeting people where they are including in jails, and most jails in America won’t allow the life saving medications buprenorphine or Suboxone or methadone. I mean, that’s slow, very slowly starting to change. So when I lighted upon this harm reduction group that was work had had managed to help offer really cutting edge treatments inside a detention center in Fairfax, Virginia. I thought that’s something I want to know more about. So that’s young woman who had lost her brother. And a lot of these people were doing these innovations are women, Sisters of the Dead, Mothers of the Dead, she starts this. Her name is Ginny at would love it, she loses her brother, she starts doing things like changing laws in Virginia before she’s barely old enough to drink. And then she’s creates this harm reduction group, she sends her peer recovery specialists that that are people in recovery themselves. They all have criminal records, she’s allowed to send them into this jail to do counseling in trauma work with these folks, they are getting MAT because the sheriff is progressive and has done our homework. And then the most important thing is when people come out of jail, we know about 80% of people have an Sud substance use, it’s you’re in jail, that’s when they’re most likely to relapse and die, because at that point, they’re opioid naive so that it’s going to hit him harder. Plus, the supplies probably gotten worse while they were in jail. So Jenny’s folks actually pick them up at that point, they have their prescription, which is very rare for their buprenorphine, Jenny’s folks going to drive them to the pharmacy to pick it up. And then also take them to the next place that they together have pre arranged to go like to a sober living, or maybe they found a relative that they’ve been able to get back with. And then they follow them, and they keep up with them. And it’s this, it’s not even the most expensive kind of treatment. It’s high touch, low tech, social supports. I mean, many of them have been abandoned by their families, because they’ve hurt their families. I mean, it’s not like their families dumped them, because there’s a lot of harm and trauma around that. And one of the best things I’m singing ahead a little bit, but I keep thinking of this. One of the best things anybody’s ever said about the book, or the show that the dope sick and Hulu show is that before I read your book, or watch your show, I thought my loved one was just a terrible person. I understand that I’ve been blaming the wrong people. I’ve been blaming my loved one when when actually it was Richard Sackler and Purdue Pharma. I should have been blaming all the bottle of doctors that participated. The kneecap DEA, the FDA that participated and our failed regulatory system,

B&N: A lot of what you write about is power, who has it, who doesn’t who we stigmatize who we ascribe shame, too. I mean, shame apparently does not work. When your bank accounts hit a certain amount. It’s only something that we assign to people who are poor in this country and then expect them to change because we’ve decided that their their stigma, essentially the stigma of treatment, or the stigma of their using or whatever has happened in the stigma of their poverty is really what’s at issue. And, you know, certainly you’ve been writing about the Sacklers for a while Patrick Radden Keefe did Empire of Pain. I mean, the two of you are not the only writers who have been working on these these stories, but you follow one of the lawyers who is working pro bono for Nan Goldin, the artist who is very, very much at the forefront of getting the Sacklers names removed from art galleries around the world. I have to say I was quite happy when I saw her actions at both the Met and the Guggenheim, those were pretty exciting moments.

BM: And I took a couple years, but by golly, they got results.

B&N: So let’s bring Nan and Martin Quinn into the story for a second because there’s someone else I want to come to but let’s set up the systemic stuff.

BM: Yeah, I was living in New York, the fall of 2019. Like I had a writer’s residency at Baruch College. And one of the editors at Little Brown, Judy Klain, said, you know, my good friend is in this group with Dan Goldin. They meet on Thursdays at Nan’s apartment, and you know, I had read Patrick’s amazing article about the Sacklers. And it was influential in dope sick and also, you know, going forward in the show, and in the latest book in his beautiful book, Empire pain, just incredible reporting. So I went to Nan’s apartment and you know, did a little research on her and saw that they were really just like ordering pizzas on Thursday night and brainstorming. They saw the way this was going down that the Sacklers were going to walk away on scape. How can we keep the pressure up? You know, in the beginning, it was all the museums. It was all about heaping shame on the Sacklers and then then, shortly after that, the Sacklers manage to file for bankruptcy in the middle of this massive super complicated multi district litigation which is in Cleveland. Now they pull out and fought Purdue files for bankruptcy in White Plains, New York, which is where Oh, so you might think, oh, that’s where produce located No, they’re in Stamford, Connecticut, they find the place where there’s only one judge, and he’s known to favor it sounds wonky, because it is third party releases non consensual third party releases, which allows the Sackler family and their wealth to be protected through this bankruptcy scheme, even though they are nowhere near bankrupt. So Nan’s group, eventually they get tied up with other parents of the dead, relatives of the dead. And they meet and then and then COVID happens. And then they’re all relegated to Zoom’s. So they can’t even protest in front of the bankruptcy court all eventually they do, which is story. And I just thought, you know, if I’m telling the harm reduction stories through the gritty people on the ground, I need to also tell the story for accountability through the gritty people on the ground. And at some point, Nan meets Mike Quinn, and Mike Quinn is this corporate lawyer himself, or he has been in the past and firm, you know, some legit firm, he just gets swept away in the unfairness of it. And so in between his real job and often at night, and on the weekends, he’s writing these kind of outrageous briefs and filing them in the bankruptcy court. And Judge Robert drain is just getting so furious at him. And he, at one point, he threatens to find him with contempt. And, you know, he shouts at him, it’s really telling of how a system in which you have enough bajillion dollars that you can afford lawyers who make $1,790 An hour and McKinsey consultants to help you break the rules that you promised to abide by the first time you were in trouble and PR flacks that you can get away with anything. And you know, Patrick, I know was very cynical at the end of his book is like, I don’t know, he’s a lawyer. He knows way more about this stuff than I do. He’s like, I don’t know. It’s like the emperor’s new clothes. Nobody’s gonna call him on it. And what I love about Mike Quinn as he calls him on it, yeah, they’re very sort of like, nobody’s listening to us. Nobody’s listening to us. Oh, and then all of Mike’s arguments eventually become like, you see that Overton window of thinking, beginning to shift. And so at first, the sack was only going to pay 3 billion and give up the company. Now it’s up to six. Now it’s in appeal, and the first appellate judge cited against the Sacklers. So, I think the show probably helped with that, too. I think people started to understand who the real bad guys were.

B&N: And I think one of the things I really appreciate about your books specifically, is the way that you connect with the people you’re writing about. And this is hugely important. You have this trust with the people you’re writing about that is so deep and genuine, and that they will just let you in. And there’s a woman called Nicky King, who I would like to meet in real life some day.

BM: You would love Nicky King, man. You wouldn’t want her to go all holler on you, but you’d love to. Oh, no. Yeah, so I met her, like somebody I know here in Roanoke had been to this rural health conference, and I had heard her speak. And he knew I was working on it, dope, sick, that book, a book about the opioid crisis season, you’ve got to meet this woman, like, why he didn’t know he just had a feeling. And I start calling her and talking to her. And I’m just captivated by her story. You know, she grew up in Appalachia and eastern Kentucky, she had to run away to go to college, which is amazing story. She now has her PhD. And she’s an addiction and mental health expert at the age of like 2627. She helps this nonprofit hospital in a community with a terrible overdose crisis. She helps him collaborate with the court system, which by the way, does not want to treat people with Su DS initially as an only wants to treat them as moral failures and criminals. And she helps them come up with a new way of thinking about it that really has great results. I mean, until COVID happened, they didn’t have a single death in the group. And so what they did is they stopped the cycle of people getting out of jail, relapsing, then having a dirty screen, drug screen and having to go back to jail. They started and people started getting better. And then they started, you know, then the probation officer who were so skeptical, they started going, oh, there is a different way to do this.

B&N: So part of why I mean beyond the fact that I really want to meet Nick in real life. You’ve got all a branch ministry, on the ground in their community, meeting people where as you say, where They are whatever that might mean. You’ve got Nan Goldin, Martin Quinn, fighting in a different way. All of these people are dug in locally in their communities. They’re seeing what’s happening, man, you know, famously overdosed and had significant problems with heroin and pills because of a wrist injury and surgery she had, and she is one of the greatest photographers that we’ve had. We’ve got to start locally, we’ve got to start locally. And that is part of the hiccup though, this idea of starting locally is that there are some jurisdictions where abstinence is sort of the thing that everyone wants to pursue. And frankly, abstinence doesn’t work for the majority of people.

BM: For the majority. But it does work for some. Absolutely, well, percent. When I was starting this, I was all like, only I’m at only MIT. And then you know, I myself have to check my blind spot. So because I see this woman, I meet her, she’s running a trap house, a place where pee rising and selling drugs, she starts becoming a harm reduction as herself by she’s giving clean needles to the people who come to buy drugs. And then a couple of weeks later, I’m checking in with the group that introduced me to her and they’re like, oh, Billy’s got arrested. Because of the way these harm reduction has had been able to make change in their community that got one good cop on board with what they were doing. And instead of going to jail, which Billy has been in and out of jail, her whole adult life, he gets offered treatment and her treatment of choice because she is a Christian through and through. And she had herself misuse suboxone many, many times she goes to an abstinence only now she has celebrated 14 months of recovery. And a lot of people might poopoo that, but by golly, it works for her right as somebody and because I was like, What am I missing here and I remember calling the great harm reduction as Tracy Helton Mitchell and she said you can’t write about harm reduction in the south without writing about Jesus. And that works in certain communities. Yeah. So I guess the important takeaway once I figured out my blind spot for me was everything has to be offered from MAT to abstinence only to rehabs that allow a mentee, I mean, the important thing is people need to know these statistics before they make the choice if they get to make the choice about what they’re going to do for their substance use disorder. And, you know, I find I’ve even found myself in the uncomfortable place of telling people that I was following that, you know, that modality doesn’t work as well as the science is totally clear. And they’re like, I don’t care. I don’t I don’t want to do it’s not going to work for me. I mean, that’s not my job to tell somebody want to do for their drink, but but I’ve just wanted to make sure they knew

B&N: Part of the knowing, too. And part of why we are where we are with the opioid crisis in America. It’s who we are. It’s the death of local journalism. It is the death of community, we have become a very hard people. And I think in some places, we were always leaning towards being hard people. But now compassion seems to be in very short supply, we are ascribing this morality. And this sort of, we’ve decided that if you’re an addict, you’re somehow not a person. I mean, actually, I will go there. It’s it’s we’re denying people their humanity. And I’m not saying that addicts have not hurt people. I’m not saying that at all. I’m simply saying we need to open up the conversation. And part of what’s missing from the conversation, though, is the fact that local news outlets don’t exist anymore. Yeah, they’ve either become part of broadcast networks that have really wild agendas, or they’ve simply been bought by private equity, who then discovers that newspapers are not profitable.

BM: I mean, that’s part of how this crisis gets so mad as we don’t, you know, I having written for kind of a big paper in a small area, we, in the 90s, we stopped even covering those small areas. So and then papers there started folding, and in all people get his the crime news. That’s about it. And so that’s not the totality of life is the crime that’s happening, but even our paper now it’s shrunk so much. It’s like, the paper I used to work for it was 125 people in the newsroom when I went there in 1989. Now there’s like eight or nine. And we miss these big in depth stories. Also, people in the cities don’t really understand how bad it is in lands. I mean, I was at the Sydney Writers Festival. And the questions I get from interviews, why have you stayed in Roanoke so long? And I’m like, Well, have you ever been to Roanoke? It’s really cool. It’s a great place to raise a family and oh, by the way, do you think any of these books I’ve written would have even been possible had I not stayed in Roanoke for so long? And that’s part of the divide if this very important national story. I mean, we have more rural areas than we have cities in America. We’re a very large country, and people in the cities are just miss Seeing it because the stories aren’t being told, I get so pissed off when people say, Why have you stayed there so long? I’m just like, Come hang out with me. You’ll see.

B&N: I mean, that’s become a huge piece of the American conversation as well. If you don’t like it, they’re just leave. Why should we leave our communities behind? Right? Why? Why? I mean, we’ve seen the good that can come out of it when you dig into your own community, and you stay. And again, this comes back to meeting people where they are. Right, like, how has that become a controversial idea? I know. And I think it’s because we’ve layered in so many other pieces of it, where I’m just like, you know, people are messy, and life is difficult. And there are not enough jobs right now, for folks who are not in very specific parts of the country. And that’s on us. Yeah, that’s, and when I say us, I mean, all of us. I mean, when you look at all of the jobs that have left certain parts of the country, I mean, you know, the textile business is gone, the furniture businesses, so much is gone. And all of these things where you could actually, you know, raise your family and have vacation and own your house and own your car and have a life. And now, I mean, is it any wonder that addiction is off the charts in places that were targeted? Because produce on opening doesn’t make a lot of money off of communities that don’t have a lot of money.

BM: Right. There’s just been forgotten in there’s so much animosity now. And both ways. So that’s why I thought, one of the reasons I thought like let’s celebrate these people that have figured out ways to make connection, in this time when we have crisis layered upon crisis, the climate crisis COVID, the undergrowth, just one thing after another, and there are heroes out there among us, let’s like tell their stories, and hopefully begin to shift that Overton window of thinking about these issues.

B&N: You have a great detail. And I think it’s from the riff that you have on the olive branch ministry, but one of the women who runs it, went to a local knitting group and said, Will you help us and they were like, we’re not going to pack needles for you. And listen, that’s fair, the knitting group said fair enough, we’re not going to cross that line. But they do now crochet bags that the ministry gives out with supplies and the but they also use dayglo yarn so that folks can see their bags in low light situations. And the knitting group is actually very happy to participate this way.

BM: There is something that all of us can do. I know. And that’s the thing that Michelle figures out the woman, she runs the nation’s first queer, biracial, faith based harm reduction. There’s a lot of qualifiers. And she’s the first person I ever hear say, we have to meet the naysayers where they are too, right. Because just like we have to meet the drug users, where there are people who use drugs, if we’re going to change the way we deal with this and improve our communities, we have to bring along the other folks too, because there isn’t just a magic wand, how I wish there was a magic wand, but there isn’t one. And it really is a political or societal psychological shift that needs to take place. That’s how we’re going to make change. I mean, the first time I interviewed the nation’s first drugs are Jerome Jaffe, you know, he was appointed drugs are under Nixon, this is before the war on drugs. And he because we have all these heroin addicted folks coming back from Vietnam, gives him the power to create this nationwide system of walk in methadone clinics with social supports. It’s exactly what I call for at the end of this book, right? We’ve been here before we know how to do it. But when I’m interviewing Dr. Jaffe, a year or so ago, he says, it’s not easy. And I thought it was a throwaway line. And then I kept coming back on he was right, he says, it’s not easy to come up with new addiction treatments that are acceptable to the people who are going to be taking them and politically acceptable to the communities in which they’re going to be taken. And I was like, that’s the rub. It’s a political problem is what it is.

B&N: It’s a political problem that can be to a certain extent addressed by local organizing, coalition building actually, is a phrase that kept popping up in my head as I was reading, raising Lazarus. And again, it’s what you just described, it’s meeting everyone where they are, whether they are in support or against harm reduction, but if we don’t start changing the conversation, and also this idea that it has to impact you personally, in order to care, that seems not helpful. Yeah, that seems just entirely unhelpful because it is impacting all of us. It is impacting families, and it is impacting communities. And, you know, in some cases, the legal system is overburdened, and we could, there’s so many ways that if we just step back from our fear and our judgment and our snottiness for a second, we might be Look at our communities and say, Hey, I know you. And part of why I’m using plural. Now is because I genuinely believe and I think raising Lazarus does this, that if we all just find the place where we can contribute somehow whatever that level of contribution is, then we can make some progress. But if we continue to stand in our corners and say, This is disgusting, I don’t want to deal with it. I don’t see it. These people aren’t people, then we’re never going to get anywhere. And it’s just going to get worse and more people are going to die.

BM: Yeah, absolutely. What I love is over and over in the book is you see people begin to change their mind. Yep, and start to open them up. And then where I think it really gets great is when people in power who do that then admit they were wrong before like a guy who’s running all these emergency departments for this mega hospital system here where I live, he’s like, buprenorphine is just treating a drug addiction with another drug. That’s not our job. And yet, that’s who’s getting the people with overdose, When else would you be able to touch them, and so not that long ago, he says, all my Doc’s are gonna get waiver to do buprenorphine in the end. And then we’re gonna have this bridge program where we give them a couple of days, we set them up with a peer, and then we’re gonna get them into the outpatient clinic. And I said, Dr. Burton, what happened? You were totally against it two years ago, and he goes, Well, we read your book dopes it, because and then we looked at the research went up, and I had called them out in me, public forums and stuff. I mean, it wasn’t ugly about it. But I was just like, there’s so much great research about this, can we look at it, and that, but the important thing is that now he’s a leader. And he’s telling other hospital systems how to implement this. And he loves his job for the first time in a long time, because he’s seeing not the same people cycle in and out. So that happens, you see that happening with Judge Sloane, the rural judge in Tennessee, who is now the Supreme Court gave him an honorary award for being so innovative. You see that happening with places like what Nikki’s doing Niki would be called upon to teach other communities how to do that. So that’s apparently how it’s got a spread, since we can’t seem to get leadership in this country on board. And I was so frustrated with that. And then finally, somebody who’s like PhD in public health, he goes, public health is run on a local level, it’s run by the states in the communities. I think this is not a red issue. It’s not a blue issue. It really doesn’t look at any of that it can get you anywhere and in any stripe of persuasion. And so I think it’s a point actually, that it could be a great connecting point, believe it or not.

B&N: No, I do believe that because I mean, here’s the thing, I’m going to ask you a question that you have asked all of your interview subjects over both books, Dopesick, Raising Lazarus, which is what would it take to turn the crisis around? And I think you’ve just outlined a couple of points. But let’s sit here for a second with that idea. And certainly harm reduction on a local level. Absolutely. We need some sort of federal presence. Let’s bullet point it.

BM: Yeah. Well, let’s get back to Dr. Jaffe. Okay, so many one nationwide system of walking clinics, right? Anyone without an appointment, could walk in and get help, they could get signed up for Medicaid, I’m talking about what it would look now we have about two one of these in America now. 20. That’s all we have declining life expectancy getting worse. Every year, we have 20 of these kinds of places. And at those places, you would get connected with housing, you would get on Medicaid, if you’re a state that it expanded it. That’s another bullet point. We need Medicaid expansion in universal health care. I mean, all of these things are not only humane, but they’re also cost effective. So we need more education around that fact, that we spend so much money on the drug war, and there’s so many people employed by that we really need to peel back the layers on that and say not defund the police but maybe have a larger social work mental health and some communities are doing that they’re sending social workers out when it’s a an addiction related call, instead of police. I think President Biden could go a long way by Re-elevating the drugs, our position, that’s the leader of the office. Oh, MDCP to a cabinet level that would say, I really think this is important. And he said while he was campaigning, that this was going to be a top issue. And granted, he has a lot to deal with. But we still have a lot of there was a longtime federal ban on the federal funding of syringes. That’s one of the biggest running needle exchange because actually buying the syringes. So I think there’s still some restrictions around that. It’s not a full ban anymore, but it’s still kind of muddied waters. And then you see health department some health departments don’t want to do anything about this. Right? So like they think giving out condoms is edgy, and yet like There are some health departments in Appalachia that will prescribe MAT. Very rare though. So we need state leadership. I say at the end, I interviewed Dr. Josh Sharfstein at Johns Hopkins. And he’s like, we are still spending millions of dollars to federal funding of graduate medical education pumping out doctors who still don’t know how to recognize addiction, right? What it’s going to be in your practice, at some point, guaranteed, furthermore, how to treat it. So that’s another bullet point. And another big bullet point. And this is such low hanging fruit get rid of that damn ex waiver, which is this eight hour doctors have to get a special certification training and a DEA waiver to prescribe the medicine, they don’t have to get it for to prescribe Oxycontin, but they have to get it to prescribe buprenorphine. So I mean, these are kind of the low hanging fruits of where I think we need to go. And why wait around for the federal government to do these things. I mean, when the best place to start is right here in our local communities. Whenever I speak about this issue, which is a lot, I always, you know, have a slide where I showed Nicky or Tim or one of those, I say, Look, if you know, a judge, if you have social capital on your community, if you know, judges, if you know, doctors, if you know of probation officers, all these gatekeepers, hospital CEOs, talk to them about what’s working elsewhere, show them examples, because they’ll get big kudos or, and they’ll feel really good about themselves are my kind of like, take my journalist hat on. And I just become an activist, right, which feels a little naughty.

B&N: I mean, essentially, Beth, what you’re saying is just invest in ourselves. I mean, if we invest in our communities, we are investing in ourselves. We’re investing in our children, our families, our neighbors, our friends, we’re investing in the places we call home, because as you said, this is everywhere. Yeah, this is everywhere. And for the longest time, people in you know, places, there were plenty of people in places who didn’t have to say, Oh, this isn’t my problem. And then it came home and it sat on their front step. And now it’s not going away, because we’re playing peekaboo with a crisis. That’s right. I mean, we talk about pulling ourselves up by our bootstraps all the time, which that’s a whole nother conversation to have. But I’m gonna go really simple for a second, why don’t we just pull ourselves up by our bootstraps and save ourselves? Yeah. And everything that you lay out and Raising Lazarus gets us up to that point. So I’m just gonna borrow someone else’s language that bootstraps. I mean, bootstraps come in different sizes, there’s accessibility issues to bootstraps. But I’m just going to steal that phrase for a second and just say, All right, let’s pull ourselves up by our bootstraps. Does that work for you? Do you hear now? Yeah, but your communities are saying to you.

BM: And before I can find examples in the US, or in the regions where I was recovering, I was like, you know, I call up Vancouver, because that was the first place that I had supervised consumption in Africa. And they’ve been dealing with this longer and more humanely The United States has. So I find the drug users union, which was started not by a drug user, but actually just an activist in the community where they had a terrible heroin issue. And I interviewed the folks that started it. I was telling about West Virginia, which were they outlawed syringe exchange at a time they’re having this huge HIV crisis, the most concerning, like in the nation, and I’m telling them about it, and they’re like, they have to get drug users involved. You cannot fix a problem. Unless you get the people who are experiencing the problem involved in the solution. We got to ask them what they want. Not us. People who don’t use drugs, deciding what they want. Every time they were surprised at what they wanted. It wasn’t necessarily stop using drugs. It was to end police brutality. It was a place to sleep where the police weren’t kicking them out of their homeless again. I was wrong on that, too. We all have blind spots. Yeah.

B&N: But if we sit and listen for a minute, and if we read Dopesick, and if we read Raising Lazarus or go back and just watch dope sick on Hulu, it’s a starting point. No one’s asking anyone to fix it tomorrow because it’s much more complex than that. But we have places to start. Yeah, we have places to start. You say it and Raising Lazarus. Baby steps.

BM: Baby steps.

B&N: Beth Macy, thank you so much for joining us on Poured Over. Raising Lazarus is out now. Dopesick is still on Hulu, so please, if you haven’t seen it yet, go watch it. 14 Emmy nominations is pretty great. But I would appreciate seeing Emmy Award winner next year.

BM: Yeah, that’d be awesome. I’m so proud of the show. I mean, Davey did such a great job with it. The cast was fully involved. Yeah, they brought their A game. I mean, I’ve just like it’s changing the conversation and there’s nothing is a journalist that makes you happier than that.

B&N: And booksellers, too, I should add. Alright, Beth, I adore you. It’s so good to see you.

BM: Thank you. Yeah, thanks, Miwa. Give everyone at Barnes and Noble my love.