The Paul Wells Show - Dopesick author on hope and the future of the overdose crisis

Episode Date: October 19, 2022

Beth Macy is one of the leading chroniclers of crisis in the American heartland. Working in Roanoke, Virginia, she wrote Factory Man, an influential book about outsourcing in American industry. Then she wrote Dopesick, an account of the opioid overdose crisis. Dopesick became an award-winning TV series. Now Macy has written a sequel, Raising Lazarus, looking for hope and a path forward on overdoses. Please take five minutes to complete this podcast survey for a chance at a $100 gift card.

It's a big world out there and sometimes it seems like it's breaking. I'm talking to the people who are trying to fix it. This week, journalist Beth Macy on hope in America's heartland. She's trying to get the church ladies to help him hand out needles, and they didn't want to. But they had a little knitting circle, and they said, well, how about we crochet bags for drug users that go to your clinic so that they

can put their needles and their wound care kits in there. And she was like, great! I'm Paul Wells. Welcome to The Paul Wells Show. Did you see Dope Sick? That amazing miniseries about the billionaire Sackler family Did you see Dope Sick? That amazing miniseries about the billionaire Sackler family who ran Purdue Pharma and the opioid crisis that shook Middle America? It ran on Disney Plus in Canada, which is weird because it's a horrifying thing to watch.

But Disney picked it up from Hulu in the US, who produced it. Michael Keaton played a Virginia doctor who becomes addicted to the pills he's prescribing. He took home an Emmy, a Golden Globe, and a Screen Actors Guild Award. Here's why I ask. Dope Sick was adapted from a book of the same name by Beth Macy, this week's guest. When I heard that Beth Macy had written a sequel to Dope Sick, it's called Raising Lazarus, Hope, Justice, and the Future of America's Overdose Crisis. I knew I had to read it. And I knew I had to talk to Beth Macy and invite you to listen in.

There are two things going on in this week's interview. Two subjects I wanted to illuminate. The first, obviously, was the crisis Macy's depicting. The terrible flash fire opioid crisis, which is estimated to have killed more than 70,000 people in the United States in the year 2021 alone. And a total of more than 30,000 people in Canada since 2016, by the way. My second subject is Beth Macy. When she started writing books not quite a decade ago, she was a feature writer at the Roanoke Times, a not particularly renowned newspaper in Virginia, a not particularly noteworthy part of the United States. But Virginia turned out to be the epicenter for two American

crises, deindustrialization and the outsourcing of American industry to China, and the opioid catastrophe. Macy wrote about both of them. Her book Factory Man is about a family-owned furniture company that faced brutal competition from China. Dope Sick is about the drug crisis. This instinct to notice that the local story is a global story is hardly common in journalism. The pressure in our line of work runs entirely the other way, to divorce the day's headline from any broader context. People who bring you the news for a living can sometimes be pretty good at missing forests for trees. In his 2005 commencement address at Kenyon College, the one everybody was quoting when he died, the late novelist David Foster Wallace talked about fish who were so busy swimming they never noticed water. He wasn't talking about journalism, but he could have been. Beth Macy's a rare fish because she writes about the

water. She tells me that when she finished writing Dope Sick, the last thing she wanted to do was to tell another story about drugs. What changed? The most unexpected thing. She started to find hope. Raising Lazarus is about that hope. Tentative, always struggling. About the possibility of giving dignity and a chance to people who'd been running out of hope for either. I hope you enjoy our talk. Beth Macy, thanks for joining us today. Thanks for having me. Where are you joining me from? I live in Roanoke, Virginia, where I've been a reporter from this region.

It's in the Blue Ridge Mountains near Appalachia for over 30 years. I very much want to come back and ask about Roanoke as a place to do news gathering, because to be up here in Ottawa sounds like the middle of nowhere, but it turned out to be the middle of everything. But let's start with the subject at hand, which is your new book, Raising Lazarus, which is your second book about the opioid crisis. And I've covered some aspects of this story. And it seems to me that you cannot, when you finish Dope Sick, have wanted to write a second book about the opioid crisis? You are exactly right about that. I wanted to run Screaming from the Building.

I promised my husband I wouldn't write about it again. I was kind of a mess. My main person that I've been following for two and a half years is brutally murdered. The book ends with her mother saying goodbye to her in the funeral home, her battered body, because she had been denied evidence-based care over and over and over. My doctor thought I had PTSD. I mean, I don't think I had PTSD. I think I had depression and secondary trauma from it. It's nothing compared to what the families go through. But I was not going to write about this again.

I was like, oh, I did my piece. But as I traveled around the country talking about it, I started to hear and see some really good things happening. And I realized that this was kind of like the secret sauce to how we, if we are going to turn back our deaths of despair and overdose deaths, more people need to be doing what these innovators and outliers are doing. So I decided to celebrate them, the helpers, as Mr. Rogers calls them, in hoping that it's kind of beautifully timed with the beginning of the opioid litigation settlement money coming down. Like,

here's the best ways we could be spending it. You know, we know how to fix this. We're just not doing it yet to the scale to match the scale of the crisis. It's a hellishly complicated story, though. I mean, because the solutions are partial. There is pushback against almost all of them. And a lot of people come to these crises with opioids because they've had some other crises on the way. And so their lives themselves are complicated. Absolutely. And so I'm trying to tease out how did we get here? So there's a

whole chapter on the war on drugs that, you know, goes back to 1914 and the Harrison Narcotics Act and how a lot of people who were using drugs then were forced to go to the black market. And I take a detour to tell the really important story, I think, of a time in America when we actually offered evidence-based care with social supports to people who had heroin addiction in the early 70s before the drug war. Nixon actually appointed the first drug czar, a really crusty psychiatrist named Jerome Jaffe. He's in his 90s now, but I tracked him down. And he was really difficult to interview. I wanted him to talk about how we could do now what he did then, which was to have a standalone 300 methadone clinics that veterans could go to for free and get wraparound services.

And he said, and I thought it was a throwaway line. We were both annoying the hell out of each other. And he said, it's not easy to develop new medicines, a new way to stop treating people that are acceptable to both the people themselves and the political leaders at large, which really underscores like, this is so much a political problem. You know, a lot of sheriffs are elected. A lot of judges are elected. They're afraid they'll lose their power and their position if they appear to be hug a thug or soft on crime. And so I just tried to unwind that back to a time in the early 70s

before the drug war when, you know, we put most of our addiction money toward treatment instead of criminal justice, that it's actually flip flop. Now we put way more money toward criminal justice, which was initially, you know, a war on black and brown people and poor people, which is still playing out today. So I really think there's roles for the president to play, I really think there's roles for the president to play, Congress to play, state governors, local officials. At the beginning, I was really frustrated. You see, I'm asking everybody I interview, what is the magic wand?

What do you think? All these people who know more about it than I do because they deal with it every day. Everybody had a little bit different answer. But I kept thinking, well, if we could just wave this federal wand, then it could be solved. But public health is actually run by the state and by the communities. And so you can have 57 needle exchanges in Kentucky, for instance, and three in Virginia, you know, which you would think is a more progressive place than Kentucky. But I mean, it just so depends on the politicians in charge and the way the laws have been written. It's a really sticky wicket to kind of tease apart to figure out like where it went

awry and how we can get it back. Now, you've mentioned a few times the term evidence-based care. That comes down to safe supply and supervised injection sites, health authorities providing narcotics to users and giving them a place where they can use. Even in Canada, where there's a number of safe injection sites in Ottawa, where I live, where this idea has made a lot of progress. As you can imagine, there's just a hell of a lot of resistance and a lot of regret about the effect of these policies on the neighborhoods where those sites are. There's a lot of well intentioned nimbyism about all of this. I mean, and you've encountered that and more, I think,

in your own reporting. Yeah. I mean, but the US, like Canada is so far ahead of the US, like it's apples and oranges. Like we have two safe consumption sites in America and they're gets people connected to some kind of systems of care where they can begin to make little micro improvements in their lives. And when they're ready, reach out for help to enter recovery. But right now we're still fighting to get needle exchanges. West Virginia, which has the highest overdose rate in the nation, which is severely restricted needle exchange in the middle of the most concerning HIV outbreak. So that's a politics problem. It's a huge politics problem. Some communities in West Virginia are figuring out end runs around it. There's some underground work happening. There's a lot of underground work happening. I think those people are heroes. But first we've got to have the needle exchanges, and then we've got to have the low barrier

buprenorphine and methadone, access to low barrier buprenorphine and methadone. I really think Congress needs to do what they did with the Ryan White Act, which made treatment on demand available to people with HIV and AIDS and really, really turned the corner with that. Biden ran on this platform of it's not going to just be these one-time only grants. We're going to really put big money to this problem. It hasn't happened yet. He's starting to talk about harm reduction. He's the first president that's ever used that phrase. So that's good. But I mean, because you guys have national health care, you're so far ahead of us in so many ways. Let's back up a little bit. When did you, looking around, start to think, boy, this opioid stuff is a major story that I'm going to have to start devoting time to.

It was 2012. At the time, I was a newspaper reporter at the Roanoke Times. And we're a community of about a quarter of a million. We're not quite Appalachia, but we're really close to it. So we're close to those communities where OxyContin first broke out, like in the coal fields. But it's about four hours away. But we had covered that story when it happened. In 2010, we had a growing heroin epidemic here, and it wasn't in the inner city, which was where everybody thought it would be. It was in the wealthy suburbs. And there was this one story that I got onto, which was the fact that these two wealthy private school kids, their lives have been upended by heroin. One was overdosed and dead, and the other was about to go to federal prison for five and a half years for having sold him the heroin that he died on. I mean, they were using, you know, they were user dealers,

all of them. So I spent the summer with this guy named Spencer Mompower, the kid who was about to go to prison. And I wrote about the two families in hopes to put the community on alert that this is out there because I knew because I'd interviewed the prosecutor who went after Spencer, they were using and dealing with 50 other kids. Like they had their phones. They knew this was just the tippy tip of the iceberg. And because Spencer taught me the word dope sick, he would say, my dope guy wasn't coming until next Thursday. And I only had X amount of dope. You better believe I would parse it out so that I still had some on Wednesday, because the worst thing in the world is to get dope sick. You're on the toilet, you have diarrhea, you're crushing anxiety and depression. And he just made it sound like monsters were inside of his blood. So that's where I got that idea. So I did this series, 2012. Then I wrote my first book,

Factory Man. At the end of that, that's about the aftermath of globalization in these small communities in Appalachia. And I started to hear about drug crime. I started hearing about heroin in tiny Martinsville, Virginia, which at one time had the highest number of millionaires per capita in the nation because it was this furniture powerhouse. But all those jobs had gone away. And crime breaking out in these small little once idyllic towns. and crime breaking out in these small little once idyllic towns. And I filed that away. I put that in that book. And then I did this heroin series.

And I actually pitched this to my agent and my editor in New York. I said, I think we've got a heroin thing is really big. And I told them about the story I'd just done. And they both said, we had heroin here in new york in the 90s um we think you're just late getting it like it was a trend you know like fashion or something and i was like i was thinking about all those 50 kids in that one suburb using and dealing with spencer and you know in 2015 deaton and Case come out with Deaths of Despair. And for the first time in American history since World War I, our life expectancy is going down. And that has continued as overdoses have gone up.

That's the number one factor. And then the book Dreamland came out around that time, too. And by then I was able to convince them that I really was seeing something. And by then I was able to convince him that I really was seeing something. And that, you know, at the time I had been sort of on the cutting edge of it, but not really understanding until I did the research how connected it was to Oxy. And by that point, you know, of course, the supply was being hit with fentanyl pretty hard, too. This is one of the things that really fascinates me about your career. You talked in passing about your book, Factory Man, which is about a guy whose furniture factory is pushed to the brink of going out of business. And he ends up going over to China to see the factories that are undercutting his business.

He goes out to see outsourcing. And then you did the opioid thing. At some point, Virginia starts to look like the center of everything instead of, as I said, the center of nothing. Now, you come to Virginia from outside. What was Virginia like when you first got to know it? I actually came here to work at the Roanoke Times in 1989. And it was just a really great place to raise a family. And it was one of these communities that was transitioning from, it had been a big railroad town, you know, quite booming, but like a long time ago. And then the railroad kept cutting back,

and then it finally cut ties all together. And now it's rebuilding itself as a healthcare town. And we've got a medical school, we've got a big, non-profit hospital system called carillion that has a lot of sway and i was like a feature writer and i gravitated towards stories of outsiders and underdogs because i guess i consider that i was one am one and those are the stories I always told the best. So I did a lot of work on immigration, racial history, and race issues. And then this heroin thing caught my attention. Well, the aftermath of globalization too. And that was a story like, I never thought I was going to write books. But when you meet this guy, this guy John Bassett factory man like he's just like oh my god the hair stood up in the back of my neck here's a guy whose story is a global story it's also the history of industry in the south it's a

family feud story I mean that really got me excited because I'm basically a heart of feature writer. I love a good yarn. And you can chase the story all the way to China, Vietnam, Washington, where he files the largest anti-dumping petition on record. And oh, by the way, he wins when everybody else in his industry is closing their factories. He's going to China and saying, industry is closing their factories he's going to china and saying f you it's on and he wins his suit he proves that they're illegally dumping underpriced furniture in our market to take the jobs away and that absolutely paralleled the opioid crisis because purdue in the 1996 they concentrated on places where uh there was a people who doctors who are already prescribing a lot of competing opioids and those happen to be places with workplace injuries and they also happen to be places where the jobs were going away and so that not only were people being over prescribed like massively over prescribed for little things

like back pain, who doesn't have that TMJ, you know, wisdom tooth, but also people without jobs were getting themselves prescribed. And then they were selling it on the black market for a dollar a milligram. So it became a side hustle and a way to make money to pay your other bills that you couldn't pay because you didn't have a job anymore. And the selling of diverted pills was even a bigger factor than the prescribed pills. Like my friend Tess was that I write about in Dope Sick, the main person, she was actually initially prescribed opioids at an urgent care center. But then quickly, she was able to buy them on the black market because pill mills were just like, giving these things out like candy. So these two stories, industrial outsourcing,

the decline of industrial middle America, and the rise of opioids, they're about the middle of America kind of breaking. Yeah, and that people in the cities don't see it as much. I mean, we're just so all siloed. And a third thing that I would add in there that I probably I'm going to write about next is how the decline of the media added to that. So like, when I first came to the Times in 1989, we had a bureau in Martinsville, we had a bureau in the coal fields, like those quickly closed within a few years. We had 125 people in our newsroom. Now there's about eight. So stories simply aren't being told. That's why people are gravitating to their silos

on Facebook and whatever else and Fox News. And I mean, it's really threatening to rob us of democracy. You mentioned that more than once in Raising Lazarus, that one reason this crisis was able to get so far down the field before it drew the attention of public authorities was that a lot of these towns are news deserts, where local papers aren't around to tell much besides kind of cheerleading stories, if they even exist. And so when suddenly entire high school classrooms were starting to use hard drugs, there was no reporter there to say, hey, what's up? No. OxyContin comes out in 1996. Dr. Van Zee, who is the doctor I profile, and he's also profiled in the Hulu show, makes his first call or writes his first letter to Purdue, begging them to take it off the market till it can be reformulated to be resistant to abuse.

In 1999, 2000, crime is going through the roof. We don't send a reporter four hours away to cover the whole thing until 2001. And we're among the first to cover it. And I love this story in Dope Sick because it's so telling. So Dr. Manzi and Sister Beth, the drug counselor that he works with, are just like, they think they're the only ones that are

dealing with it because it's pre-internet. And they have this intern that's working with Dr. Manzi one summer and he goes home to Boston. And all of a sudden, the Boston Globe has sent a reporter to Maine to report on the exact same thing. Crime on a level that they had never seen before. And it's blue collar, it's massive overprescribing, it's fishing workers and fishermen and mill workers. And that intern carries back a Boston Globe hard copy of a news story and shows it to Dr. Bansi and Sister Beth and we're like, because it hadn't even made national news yet. And they're like, we're not the only ones.

That's when he really starts advocating. We'll come back to my conversation with Beth Macy in a minute. Macy in a minute. I want to take a moment to thank all of our partners, the University of Toronto's Munk School of Global Affairs and Public Policy, the National Arts Centre, our founding sponsor, TELUS, our title sponsor, Compass Rose, and our publishing partners, the Toronto Star and iPolitics. When did you decide that the story was just too big to be contained between the covers of your newspaper? And did you get resistance from editors? Well, I told you that one story, I thought it would be my second book. They said, no. I mean, I have to deal with gatekeepers, you know, even though I'm on my own and writing out on my kid's former

bedroom, my grandkids' former bedroom, you know, I have to convince them and I couldn't convince them. And so I did another, I did a racial history story for my second book. But really one is, they've all grown out of reporting that I initially did for the Roanoke Times. But they're, you know, they're microcosms. They're stories that stand in for Peoria, Illinois, or Western Ohio, or little towns outside of Ottawa. It's happening everywhere. It's just not being reported to the extent that I think it should be. Your story takes you to a lot of strange places, surprising places. A clinic next to a McDonald's dumpster in North Carolina. First of all, tell me about that character.

Tell me about Tim Nolan. Well, so that's how I began the book, next to a McDonald's dumpster in a dying furniture town, a former furniture town. And I got to him through this harm reduction group called Olive Bridge Ministry that I just met by accident. I was speaking somewhere and I heard this woman on a panel before me talking about harm reduction, which I knew about, but she was saying, you know, we have to meet both sides where they are. And she told this great story about the church that loaned them space that they were running

a needle exchange out of. They were out in a double wide behind the church and she was trying to get the church ladies to help them hand out needles. And they didn't want to. But they had a little knitting circle. And they said, well, how about we crochet bags for drug users that go to your clinic so that they can put their needles and their wound care kits in there? And she's like, great. Well, you add some reflective threads so they can see them in uphouses and low light areas.

And they got so into it. Would he add some reflective threads so they can see them in trop houses and low light areas? And they got so into it, you know, they now call themselves the Hickory Hookers, which is hilarious. So when I first took me a while to get her to let me come down and visit, you know, she runs, she and her wife run the nation's only queer biracial faith based harm reduction coalition. Like my story Spidey sense went up there a little. And, and when I said, well, what's your goal right now? And they had started out illegally posing as a food pantry out of the back of their pickup truck in 2009. That is badass. And I said, what's your goal now? You have three needle exchanges, you know, for, for her, then the Holy grail would be low barrier buprenorphine, which is like, we're going to drug users where they are, because we know they don't have the capacity to come to us.

Then I met Tim, who is her volunteer. He's a nurse practitioner who does this low barrier work for them. And so I'd started the book with another anecdote. And my editor said, I don't even remember what it was. But at at some point maybe a third of a way through the writing of it she goes you know you do your best writing when you're writing about somebody you really admire and I just like tucked that away because neither one of us thought the beginning was the right beginning and then I thought oh this has got to be about Tim because here's like a person he's worked all day and then at 90 volunteers he starts out just doing needle exchange meeting people in truck stops and fast

food and then he notices that a lot of them are sick with um hepatitis c so then he starts testing them curing them of hepatitis c and then uh he starts doing the low barrier buprenorphine. So going to them where they are. So I began at a McDonald's dumpster with Tim getting for some participant, a discount prescription. And he says two things to him. And this is why I started the book with Tim. He says, one, Sam, you can get better. Sam doesn't think he can get better because he's been fighting this for over 10 years. He's been in and out of jail the whole time. He's never been able to access treatment, really, not anything steady.

And Americans think they can't get better. They've sort of written this population off. So one, you can get better. And two, and maybe even more importantly, just don't disappear. And that means even if Sam goes out, he picks up his discount bube at Walgreens and he returns to use two days later, Tim is still going to meet him the next week in that parking lot. And if he can't make it to the meeting, he's going to text him and he'll come to him. He's not giving up on a person just because they have relapsed. This is a chronic relapsing disease. And that is really the crux of what I think it's going to take to turn this around. A lot of it is about treating your neighbor like your neighbor, right? So not only the people who are involved in harm reduction,

treating the substance users as people with hope, people with a chance and a future, but also people like your Olive Branch members who are almost certainly Biden voters who are trying to get their work done in communities where just about everyone is a Trump voter. And step one is you need to understand and be understood. And that must have been also part of the strange optimism of this

book is talking about places where that's even still possible in America. Yeah. And like harm reductionists in New York or Chicago or wherever. And I remember hearing from them in my early days of like writing about the crisis. They didn't think I was pushing the edge enough. And they would, maybe not now, but there was a time when they would have dismissed what Michelle at Olive Branch is doing as unloke or, you know, not with it. One of the things Michelle says is we have to meet the other side where they are too, One of the things Michelle says is we have to meet the other side where they are too, because that's her community. And if she can make the DA like her, she can help her people get their charges reduced.

And so if she can do this cutting edge care, and this really is low barrier care, really is cutting edge for America. In a red state that hasn't even passed the Medicaid expansion, we need to celebrate her and learn from her because that's a much heavier lift than New York City even opening a overdose prevention site. It just is. So how does she do that? Well, she treats the cops like human beings too. I gave this a version of this story at a talk i was giving in west virginia and there was a harm reductionist there who got so mad when i said you need to meet the other side where they are that she got up and walked out huh like right in the middle of my talk and i was like huh what if i just said something that ticked her off and she told me later it was and i was just

like and of course there they're just fighting it's like an all-out war but where michelle is like it's got to be appropriate to the culture michelle's figured out a way to make it work i mean i met some guy that had i just saw it on facebook he had narcan somebody with narcan that he got from olive branch in a mcdonald's parking lot i think it was actually the same one believe believe it or not, where Tim sometimes works. And he was saying on Facebook how much he loved Olive Bridge or whatever. So I called him up and he's like, yeah, I've been sober and on methadone for three years now. I'll never forget when Michelle met me at a Rose's department store to give me clean needles. And I'd been on a four-day bender he

said i was dirty i stunk and she said can i give you a hug i mean that was what it was it wasn't the needles it was like i know it sounds sappy but it was it, but it was that love. And to me, that's what Christianity is. Or goodness, whatever you want to call it. I'm not a religious person at all. But that's where this special sauce happens. And they make those connections. Even now, as people listen to us, some people are going to be saying, well, this is the world gone crazy.

us, some people are going to be saying, well, this is the world gone crazy. As long as we're going to give addicts their drugs and a place to use them and the equipment to shoot up and care if they get into trouble, why would they ever stop? Well, it's more than that. It's making the connections. And when people start to feel like somebody cares about them, it's the story I tell where a guy goes into a needle exchange in New York City and says, at the front desk, they say, how can I help you? He says, I'm hungry. And the front desk woman gives him a sandwich. And he's still using for a few months, but then he starts going there and step by step, things get better. So it's the connections. It by step things get better so it's it's the

connections it's not just the needles it's not just the safe supply it's the connections and when they start making these improvements in their life that's when they start getting better and and sometimes it takes a while i tell the story at the end of Dope Sick where this doctor, Steve Lloyd, he's the doctor that the Michael Keaton character is based on in the show. And we don't tell this part of the story, but it's in the book Dope Sick. And he's trying to talk a community into letting him open a nonprofit methadone clinic. And there's like hundreds of protesters calling them drug lords and all this kind of shit. And some woman stands up and says, how many chances are we supposed to give these people?

And he said, you know, I looked around the room and he was from that community. He said, I played ball, gone to school with most of the people, gone to church with them. And he said, he thought of the disciples asking Jesus, how many times should a sinner be forgiven? Should he be forgiven 70 times or 70 times? So Dr. Steve said what Jesus said, which is 70 times 7. And he didn't meet 490. He met as much as it takes.

What was it like making that TV series? That must have been surreal. You've got Michael Keaton. You've got Michael Stuhlbarg as the patriarch of the Sackler clan. Large amounts of money. And the Sacklers trying to scare you off with their lawyers while it was happening. Well, luckily, Hulu's owned by Disney. That has even more money than the Sacklers.

So that felt good. You know, that wasn't just me and my my grown kids former bedroom. It was this huge machine. Of course, the driving special sauce of that show was the showrunner, Danny Strong, who was just absolutely outraged by what had happened and felt like people didn't really understand it. And he was so right. You know, my book did well, it was a bestseller, it sold a couple hundred thousand copies, but 10 million people or more by now have watched this show. And suddenly they're understanding that it's not just their addicted loved ones fault for all the strife it's caused in their family, that it's not just their addicted loved ones fault for all the strife it's caused in their family,

that it's much higher above them. It was done for greed. You know, the best feedback we've gotten from the show has been like family members reaching out and saying, I watch your show. And I called my addicted son for the first time in three years. Did you struggle early on with trying to figure out how close emotionally to get to this story or to these people? Every rule of thumb that we have as journalists is we watch, we don't participate. In Dope Sick, there was a moment where Tess Henry, the young woman I've talked about, reaches out to me late at night and asked me to come pick her up from trap house and I was just like what do I do what I do my husband said you can't go there you know you

don't know what to say and so I forwarded it on to her peer that she was working with at the time and her mother but then I was like I felt bad about it because it's like when I need her I'll take her to an NA meeting because that's my opportunity to talk to her. But when she needs me, I'm not available. So, you know, Walt Harrington, the great journalist, Washington Post magazine writer, he's retired now. He wrote a book called Intimate Journalism. And he says, you're not doing your job unless you're getting right on the line. You try not to cross it. Whenever I think I might be crossing it or my toe is hanging over the edge, I tell the reader. I told the reader about that story. I was doing taxes with my niece that night. It was February. And I didn't see her text right

away. Usually I'll see a text pretty soon, but it took me a while. And this was my thinking. This is why I did it. But I've struggled a little bit with that. And in the new book, because I'm mostly writing about the helpers, this is a much more positive book. It's more there is this moment in the epilogue. And I had written the whole thing and I showed it to my I call him my Appalachian sensei. He's a he's a novelist from Kentucky and an activist named Robert Geig. And he's just, he's been my guide through two books now. And I just adore him. He's like the smartest, big hearted person I know. Big heartedest. And he goes, dude, you've written two books about

this now. I'm tired of hearing what you're saying. I want you to tell me what you think. So at the end of the book, I take off my Beth the journalist hat, and I put on my Beth the pissed off journalist, tired of saying same old, same old, same old hat. And does it swerve into activism? Maybe. But I got to call a spade a spade. I got to show people

really what's happening, what happened when they were looking and, um, you know, how this started, but also how our government, which allowed this man-made crisis to,, how they're not doing anything about it or not enough about it. And so, you know, there's a little tonal shift at the end and I'm willing to take the hits for it. The Sackler family, owners of Purdue Pharmaceuticals, who marketed OxyContin and its derivatives with extraordinary skill and complete disregard for the human cost of it. They're a huge character in both of the books. If the Sacklers hadn't been around, would this crisis have happened anyway in a country where the bottom had fallen out of the Midwest, where simply being in the working class was physically painful for so many people and where to some extent,

nobody was looking, nobody in positions of authority was looking. Would something else have gotten sucked into that pit if the Sacklers hadn't been so eager to provide a product? You know, there's really no way to, to know for sure. I do know that like they were the taproot of this. And once they did it and got away with it, then you had all these other opioid makers and distributors going, oh, wow, we can cash in on this too. You know, so you're starting to see them having to end up in court with these settlements coming down now, even Walgreens and CVS and distributors, generic makers.

But the Sackler started it using the techniques of the patriarch who was dead when OxyContin came out. His side of the family always wants you to say that because he had nothing to do with it, but they were basically using Arthur Sackler 101, which is can't market directly to the consumer, but you can market to the doctors. So they pretty much just took his playbook and they went with it with this really powerful narcotic. And then when the others saw how they were cashing in and how the FDA had sort of laid

down and the lobby had gotten so huge. And, you know, there's this famous quote that came out in recent documents where Richard's bragging, I can get any congressman or senator on the phone in 45 minutes if I want to. It wasn't just them, but them and their paid sycophants are really who did this to our country. You still live in Virginia. Yep. are really who did this to our country. You still live in Virginia.

Yep. Do you picture a future where it sort of comes back to the place that you moved to in 1989? Yeah, well, so I live in a city and it really is doing good. But if you go an hour outside, you see these communities that I first wrote about in Factory Man. And, you know, the cities are reverting to counties and people are moving away.

Anybody that was a middle manager above has long gone, right? And so what you have are poor, elderly, minority folks left. And then the opioid crisis sort of on top of that. And when you look at these communities now, I mean, in far Southwest, like in these hollers where, you know, they have one little road going out to a closed coal mine and, you know, burned down houses that are still there. And I mean, it's poverty like, like I've been in Northern Haiti and it's northern Haiti, and it's worse than that. And I don't know that these communities will ever come back from that.

But I know there's still some really good people there trying to help, and we need to be supporting them at a greater scale. Thank you so much for taking the time to talk to me. I really appreciate it. Thanks, buddy. Appreciate it. Thanks for listening to The Paul Wells Show. The Paul Wells Show is produced by Antica in partnership with the National Arts Centre and the University of Toronto's Munk School of Global Affairs and Public Policy. It's published by the Toronto Star and iPolitics. Thanks to our founding sponsor, TELUS,

and our title sponsor, Compass Rose. Our senior producer is Kevin Sexton. Our associate producer is Hayley Choi. Our executive producer is Lisa Gabriel. Stuart Cox is the president of Antica. Remember that you can find a lot more of my writing at my newsletter, paulwells.substack.com. If you're enjoying the show, spread the word.

We'll be back next Wednesday.