Perkins described the weatherman as “skin-popping,” referring to the practice of injecting heroin under the skin rather than in a vein for a supposedly “safer” high.

Macy notes that Roanoke, where she moved in 1989, is a small town with an “almost Mayberry level of friendliness.” In other words, it is the last place one would expect to find rampant drug abuse. But as Dr. Jennifer Wells, a Roanoke addiction specialist, later told Macy, “The opioid epidemic is an urban story, a suburban story, and a rural story.”

Macy notes from her coverage of drug deaths that friends of overdosing users often place them in a bathtub or try to revive them with ice and cold water in order to avoid having to call 911—which could draw police, and consequently criminal charges, to the scene. Sometimes, the friends simply flee the scene. The Roanoke weatherman’s overdose was initially viewed as an anomaly, even by Macy. At that time, heroin was viewed as an “inner city (read black) drug” which, reflecting the racist attitudes of the time, was not considered a big enough problem to merit serious attention. The “mostly” Black American users and dealers in Roanoke did not sell heroin to white people, whom they believed would turn them in.

As more and more wealthy and middle-class white users began to be reported, however, Roanoke started waking up to its opioid crisis. The drugs’ spread was accelerated by Clifton “Lite” Lee, a dealer who had correctly surmised that he could double his profit margins if he imported heroin to “comparatively” staid Roanoke rather than sell solely in New Jersey and New York. Lee was soon selling heroin to high schoolers, both Black and white. Police discovered some of these teenage user-dealers attended Hidden Valley High School in Roanoke County’s wealthiest suburb, home to doctors and lawyers.

Lee was arrested in 2008, but by then he had brought tens of thousands of bags of heroin into Roanoke. Some of these bags were branded under the name “Funeral and Green” and were ninety percent pure heroin. Assistant US attorney Don Wolthius, one of the top officers investigating Virginia’s opioid crisis, told Macy that unlike bank robberies, which stop once you arrest the perpetrators, drug use is far more difficult to stop because of the “lure of the morphine molecule.” Even when dealers like Lee were arrested, they left behind already hooked users who were forced by their habit to keep looking for the next hit. Yet even then, no one was paying attention to the heroin arrests, because they concerned inner-city Black children—this despite journalists writing that heroin use was now as rampant as OxyContin and Fentanyl abuse. It was only in 2010 that Roanoke well and truly acknowledged its drug crisis, and the trigger was the death by overdose of twenty-one-year-old Scott Roth, the son of a wealthy white businesswoman.

“You think of heroin as seedy street slums, but that’s not at all how it started,” said Scott’s mother, Robin Roth, to Macy. Scott first tried heroin at a high school party attended by teenagers from wealthy families like the Roths. Though Robin Roth tried every method she could to stop Scott’s drug habit, drugs eventually claimed the life of “Vanilla Rice,” as the amiable young man had liked to call himself. Scott’s friend Spencer Mumpower, who had dealt him the drugs that claimed his life, was sentenced to prison in 2012. When Macy met Spencer, the chastened young man had begun to hold workshops from prison to teach teenage first-time users and their parents how to deal with the lure and threat of addiction, including the effects of black-market Adderall, a prescription medicine prescribed to children and adults for ADHD, or Attention Deficit Hyperactivity Disorder. Adderall could often act as a gateway drug to harder drugs for many users.

Macy notes the connection between overprescription of Adderall to American children and drug abuse. In the case of Jesse Bolstridge, the high school athlete who died of an overdose and who had been prescribed Adderall since he was a young child, the drug became a commodity he sold to his high school classmates in exchange for painkillers they’d taken from their parents’ medicine cabinets. Already addicted to Adderall, Jeff was on the lookout for the next high, which arrived in the form of OxyContin and Percocet, which he was prescribed at fifteen when he contracted Lyme meningitis.

Macy notes that while Robin Roth was initially filled with rage against Spencer Mumpower, she softened toward him over time. Meanwhile, Spencer’s mother, Ginger Mumpower, “relaxed for the first time in years—knowing that in prison, at least, her son would likely not die of a drug overdose.”