At the same time, it had never been within the purview of local papers like the Martinsville Bulletin to investigate what was happening with international trade in Washington or New York, much less the latest push by Big Pharma or global drug cartels. And regional newspapers like my own Roanoke Times had drastically shrunk their coverage to a mainly urban and suburban core, ignoring the increasingly distressed communities in our hinterlands just when reporting on those places was needed the most.
Those of us living highly curated and time-strapped lives in cities across America—predominantly mixing virtually and physically with people whose views echoed our own—had no idea how politically and economically splintered our nation had become. And also how much poorer and sicker and work-starved the already struggling parts of the nation truly were—because we didn’t follow that story.
We may feel more connected by our cellphones and computers, but in reality we are more divided than ever before.
In the midsized city where I live, OxyContin continued to be viewed as a rural problem into the early 2010s—a problem in the coalfields, some four hours to the west. While the Roanoke Times covered the 2007 sentencing hearing of Purdue Pharma executives, it rarely mentioned OxyContin after that. We in Roanoke had heard opioid abuse was seeping into distressed factory towns like those in Henry County, but very rarely did our newspaper report on it.
We were safe in our ignorance, or so we thought—content to stereotype drug addiction as the affliction of jobless hillbillies, a small group of inner-city blacks, and a few misguided suburban kids.
But another invisible hand was upon us.
Heinrich Dreser’s drug moved seamlessly across city and county lines, with zero regard for politics, race, neighborhood, or class.
*
I didn’t understand the connection between rural poverty, disability, and opioid addiction until I learned more about the accidental Bassett Furniture arsonist. Turned out he’d arrived at his copper heist on the outskirts of Bassett on his bicycle—a rare sight in the rolling foothills of the Blue Ridge Mountains.
“He was one of the unemployed masses; he did not have a paying job,” said the prosecutor (now a judge) in his case. “But his crime actually required work, so he wasn’t lazy so much as he was desperate.” Like so many of the region’s petty thieves, the arsonist was propelled by fear of becoming dopesick, added another local prosecutor, who told me that 75 percent of all police calls in the county now involved heroin or methamphetamine, or, increasingly, a combination of both.
Not only were rates of unemployment, disability, and opioid addiction soaring, but there was also renewed interested in methamphetamines and the practice of switching between opioids (in the form of either pills or their much cheaper cousin, heroin) and meth. “Crystal meth controls all the dockets now” in rural Virginia, a local drug task force officer told me. “If you’re addicted to painkillers, you become so lethargic you can hardly function. But meth keeps you going if you need to run the streets to go get your next dose of heroin or pills, to keep you from getting sick. It allows you to function. There’s a reason they call it ‘high-speed chicken feed.’”
I thought immediately of Spencer Mumpower’s 2010 jail mug shot. So much separated Spencer, whose mother had sent him to private school and then paid for fifteen different rehabs, from the young man who stripped copper wire out of the abandoned furniture factory. A scrawny junkie with sunken eyes and sticky-out collarbones, as Spencer described himself to me in 2012, “I looked ridiculous, like I had chicken pox. Like I’d stuck my head down a groundhog’s lair.”
But I had failed, just as the police and parents had, to connect young adults like Spencer to the rural addicted, even though Spencer told me he’d come to his heroin addiction the same way they had—through prescription opioid pills.
Our culture seems to excuse drug- and other risk-taking in white middle- and upper-middle-class kids, especially young men. The same liberties, when taken by rural poor whites or people of color—wherever they live—come across as more desperate, born of fundamental wants or needs that can’t be satisfied. But as I’ve come to learn, gauged strictly by drug use, there is no less urgency and desperation in America’s middle and upper classes today.
*
Drug epidemics unfold “like a vector phenomenon, where you have one individual who seeds that community and then the spread begins,” said Dr. Anna Lembke, an addiction-medicine specialist at the Stanford University School of Medicine and the author of Drug Dealer, MD. People whose parents or grandparents were drug- or alcohol-addicted have dramatically increased odds of becoming addicted themselves, with genetics accounting for 50 to 60 percent of that risk, Lembke explained; she noted that the correlation between family history and depression is much lower, 30 percent. Other risk factors for addiction include poverty, unemployment, multigenerational trauma, and access to drugs.
“It’s important to note, it’s really not just the unemployed and the poor who are vulnerable today; it’s really everybody, especially underchallenged youths or youths who aren’t engaged in school or other meaningful activities,” Lembke said.
At the age of thirteen, Spencer had stolen five bottles of painkillers more than halfway full—leftovers prescribed to different relatives in the aftermath of routine outpatient surgeries. By fourteen, he was taking pills regularly. Back then he used saved-up lunch money to buy weed, which he then traded for ADHD medications prescribed to his friends, or for OxyContin pilfered from their parents’ medicine chests.
“I did my first bag of heroin before I drank my first bottle of beer,” Spencer said.
In his Hidden Valley subdivision, full of sprawling ranches, trim colonial two-stories, and Arts and Crafts bungalows that were new but meant to look old, heroin was easier to get. “When we first started doing it, we didn’t worry about getting caught because cops didn’t know what heroin even looked like.
“One time I got pulled over, I had ten bags at my feet, and they didn’t know what it was so they didn’t look at it.”
*
In rural America, the opioid epidemic aged into a wily adolescence in the aughts. In the hinterlands of Virginia, it had tended to pool in families. “We’d sometimes have one overdose where the son would die, then the next day the father would die, then the next day the mother would die,” the Roanoke-based medical examiner said. “If it had been an infectious disease, there would have been widespread panic.”
Then–Virginia Tech researcher Martha Wunsch remembered the moment she went from studying overdose deaths in rural counties, funded by a National Institutes of Health grant, to hearing about it from her own teenagers, who went to high school with Spencer and Scott Roth. State health officials in Richmond had originally dismissed her research, telling her the same thing they’d said to Sue Cantrell, the rural health-department director: “This is a regional problem.”
“The issue is Interstate 81,” Wunsch told me. “The OxyContin epidemic spread from East Nowhere Jesus all up and down the Appalachian chain by way of the interstate, and suddenly my own kids were coming home from parties,” talking about pills being passed around in bowls.
Opioids infiltrated the toniest suburbs not by way of families but by peer groups. The new suburban users didn’t come to the attention of police until roughly around the time Purdue Pharma launched its 2010 abuse-resistant version of the drug, at the same time Spencer handed Scott Roth the heroin that led to his death—fourteen years after OxyContin was introduced.