Chapters 10–11 Summary
Chapter 10: Liminality
Macy began to follow the journey of an addicted young woman named Tess Henry and her five-month-old son after Tess was released from prison. In a miraculous stroke of luck, Tess’s son had been born a healthy, calm baby, showing no signs of neonatal abstinence syndrome (NAS), a debilitating condition with which babies of addicted mothers are sometimes born. Buoyed by her son’s birth, Tess told Macy in 2016 that her goal was to be a “good mother” to him. Tess was enrolled in a MAT program and hopeful of a recovery. However, her mother, Patricia, noted that Tess’s visits to her addiction specialist were “cash only,” with the first visit costing a whopping $700. It was only the specialist who could prescribe Tess the steroids needed for her MAT. Not only was treatment prohibitively expensive, Macy’s research showed that even MAT drugs like Suboxone were being overprescribed, hooking users. In absence of a well-formulated MAT protocol, there were instances reported of patients “shooting up” Suboxone. Like those users, Tess, too, had found a way to abuse Suboxone. Even more alarmingly, Tess relapsed into addiction soon after her son’s birth.
One reason why the MAT drugs were abused was that doctors were wary of prescribing drugs to combat drug addiction. Therefore, drugs such as methadone, a safer painkiller that quelled opium withdrawal, were abandoned for Suboxone, an opioid antagonist, without exploring its range of side effects. Though newer MAT drugs like buprenorphine and naltrexone, with no street use potential, have now been developed, in absence of a clearly thought-out, nation-wide policy, treating drug addiction remains difficult. Macy writes,
The battle lines over MAT persist in today’s treatment landscape—from AA rooms where people on Suboxone are perceived as unclean and therefore unable to work its program, to the debate between pro-MAT public health professionals and most of Virginia’s drug-court prosecutors and judges, who staunchly prohibit its use. Those unyielding viewpoints remain, I believe, the single largest barrier to turning back overdose deaths.
Meanwhile, Tess spiraled further into her habit. Although she was trying her hardest to fight her addiction, it seemed overwhelming, and she had not seen her son—now a toddler—for over a year. Despite attempts by Patricia and the rest of the family to reach out to her, Tess had left town, going off the grid for months at a time. When she did connect with Patricia, she would vow to check into a rehab, only to cancel at the last minute. On her way out of a week-long visit home for Thanksgiving in 2016, Tess left a note for her mother: “Gone to Carilion [psychiatric ward]. Mental Breakdown. I LOVE you so much Mom. You are my everything. I want to get better & I won’t stop trying.”
Chapter 11: Hope on a Spreadsheet
Volunteers at Roanoke’s new anti-drug coalition the Hope Initiative had spent months crafting a spreadsheet listing rehab centers and MAT programs for families, which included details on bed availability. It was early 2017, and fentanyl overdose rates had doubled, so community projects such as the Hope Initiative were much needed:
In one weekend the following month, a local seventh-grader died of a probable overdose, the region’s youngest victim so far. The wife of Janine Underwood’s building manager at the clinic was getting her hair done only to be interrupted by the sound of a spectacular crash in the parking lot outside—a middle-aged professional man had passed out while driving, a heroin needle stuck in his arm, and crashed into her car.
Roanoke emergency-room physician Karen Kuel was keen to adopt Ohio’s opioid...
(This entire section contains 1197 words.)
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management protocol, where overdose patients were automatically referred to outpatient MAT programs and counseling. Along with local psychologist Cheri Hartman, Kuel had applied for a grant that would help them cross bureaucratic hurdles and make the adoption of the protocol in Roanoke easier. The grant would have been a life-saver for many families, but it was rejected.
Janine Underwood, whose young son Bobby had died of a fentanyl overdose, was on the Hope Initiative panel. Janine was crushed to learn about a young heroin user named Matthew, who hanged himself a day before he was to come to the Initiative for a counseling session. Loss and despair were the order of the day. Janine was beginning to realize that the treatment of addiction was as riddled with bureaucratic hurdles as the opioid epidemic had been spurred by profit-based policy decisions. Though many people walked into the Hope Initiative for counseling, most of them did not enroll in a MAT program. Kuel and Hartman’s push for mandatory MAT was the need of the hour but was going unheard.
Success for Janine and the Hope Initiative came months into the program and after weeks of “life-and-death” negotiations, when a young man called John (a pseudonym), a friend of Janine’s son Bobby, agreed to sign up for detox. John was in agony and running a temperature of 103 when he came to the Hope Initiative; strikingly, he wanted to “get out” of his heroin addiction. Janine made a couple of astute observations: John’s addiction was as much a disease as any other chronic illness, and John’s parents, his enablers, “had the disease too.”
Macy notes that the US could draw inspiration from Vancouver, Canada, in understanding the complexity of treating drug addiction. Public health officials in Vancouver subscribe to the idea of harm reduction, a social justice movement aimed at reducing the negative consequences of drug use without necessarily ending drug use entirely.
The basic theory being: Users can’t get sober if they’re dead, and it’s cheaper and more humane to give them clean syringes, say, than it is to pay for HIV and/or hepatitis C treatment. Vancouver officials launched supervised injection sites where nurses stood by to revive overdosed users, fostered the free exchange of used needles for clean ones, and distributed naloxone. Sites in Toronto and Ottawa were also approved.
Seattle and Massachusetts were already leaning toward the Vancouver model, finally understanding that drug addiction is, in many cases, a chronic, lifelong disorder that can be best helped with maintenance therapy. Yet the idea of “harm reduction” eluded even sincere officers like Metcalf, who insisted on seeing users as criminals rather than patients. Even Macy’s friends who had attended abstinence-led twelve-step programs like Narcotics Anonymous (NA) and Alcoholics Anonymous (AA) balked at the idea of MAT. Others supported counseling as therapy, despite evidence that it did not work.
The biggest believers in harm reduction, unsurprisingly, were mothers such as Janine and Patricia. With their effort, Tess ended up as the Hope Initiative’s fifth patient to enroll in a MAT program. If she could stay sober for five years, her chances of relapse would only be fifteen percent, Macy assured her.
Six weeks later, Patricia intercepted a Facebook exchange between a drug dealer and Tess, who was still in rehab. It was Mother’s Day 2017 when Tess promised her mother she would “find her way home.” But, Patricia notes, she ominously signed the message “using her street name: sweet T.”
