His next move, I learned from a sheriff’s department Facebook posting, was to get hauled back to jail on a probation violation. In his mug shot, Dennis wore an orange jumpsuit, and his eyes were so squinty you couldn’t tell they were blue. He was down to 140 pounds, from his usual 185.
I had just interviewed Dennis’s girlfriend, Courtney, the mother of his children. She was attending community college to become a paralegal; her kids went to a federally funded day care facility while Dennis’s father paid for their housing. She was working at McDonald’s in Strasburg, where Jesse bought his McNuggets on the weekend of his death. One of the low-level dealers in the Jones/Shaw ring—the guy who sold them the heroin that killed Jesse—often showed up at her drive-through window for food.
*
In 2013, Jesse’s was one of 8,257 heroin-related deaths in the nation, by far the majority of them young men, an increase of a staggering 39 percent over the previous year.
Roughly three-quarters of the dead had started down the same painkiller path that led Jesse to his death, the same path as Spencer Mumpower, Scott Roth, and Colton Banks—with a single prescription pill.
A month after Jesse’s death, the FDA approved a new high-potency, long-acting version of hydrocodone, Zohydro ER, even after its own expert panel voted 11–2 against it, noting that the drug, which lacked an abuse deterrent, could lead to the same level of addiction and abuse as OxyContin had in its original form. The FDA concluded that “the benefits of this product outweigh the risks.”
It would be four more years before the FDA would ask a pharmaceutical company to withdraw an opioid pain medication because of its potential for abuse—Opana ER, and not until 2017—and by then the annual death toll for drug overdose had climbed to 64,000.
Critics pointed out the inherent conflicts of a regulatory agency that both approves drugs and is then supposed to function as a watchdog over those drugs. The Zohydro approval was the OxyContin story all over again, said Dr. Andrew Kolodny, a doctor who lobbies for stronger painkiller restrictions.
“The most damaging thing Purdue did, it wasn’t the misbranding of OxyContin they got in trouble for. It was that they made the medical community feel more comfortable with opioids as a class of drugs,” Kolodny told me. “But had the FDA been doing its job properly with regards to opioids, we never would have had this epidemic.”
Two weeks before Jesse’s death, the FDA finally notified Barbara Van Rooyan via letter that a portion of her petition had been approved—specifically, her call to withdraw its approval of the original OxyContin. The point was by then moot, of course; Purdue had already voluntarily withdrawn it, three years after the reformulation came to market. “I think my petition did ultimately help [push the reformulation], but so many more people died while we were waiting for it,” Van Rooyan said. Months later, she said, after reading a New Yorker piece on the Sackler brothers, it dawned on her that the reformulation had almost certainly been prompted by the fact that Purdue was losing its patent on the original formulation, “not because they believed the reformulated version was safer, nor because of my petition.”
Still, the letter from the FDA disgusted and angered her and made her mourn all over again for Patrick—and the thousands of newly extinguished lives.
In the same letter, the FDA denied her secondary request, which was to have the drug limited to severe, acute, or terminal pain—and not prescribed for chronic use unless all other treatments had first been explored, guidelines most other countries in the world have adopted. Americans, representing 4.4 percent of the world’s population, consume roughly 30 percent of its opioids.
Patrick had been dead now for nine years.
It would be three more years before another federal agency would put his mother’s suggestions into practice.
PART THREE
“A Broken System”
George’s Chicken, Edinburg, Virginia
Note from Tess Henry, Roanoke, Virginia
Chapter Nine
Whac-A-Mole
By 2014, the suburban heroin-dealing scene had become entrenched in Roanoke’s McMansion subdivisions and poor neighborhoods alike. But the largest dealers weren’t twice-convicted felons like Ronnie Jones with elaborate dope-cutting schemes, multiple cars, and hired mules. They were local users, many of them female, dispatched to buy the heroin from a bulk dealer out of state, in exchange for a cut. And they were as elusive as hell to catch.
Among Roanoke’s first long-haul drug runners was a pretty brunet in her midtwenties whose name reflected her Hawaiian heritage: Ashlyn Keikilani Kessler. What distinguished Ashlyn as one of the region’s top mules, according to the prosecutor who sent her to prison, wasn’t just the volume of drugs she was transporting; it was also her body’s astonishing ability to metabolize the drug without overdosing. (“Generally speaking, there are people who overdose all the time, then there are people like me who have never overdosed,” she told me.) At the peak of her addiction, Ashlyn was using fifty to sixty bags a day. “She had a remarkable liver,” her prosecutor said.
She was an unlikely addict, a young mom and paralegal with a criminal justice degree from Jerry Falwell’s Liberty University. But her descent into drugs followed a familiar story line: After the birth of her son, in 2008, she was prescribed Lortab for mastitis, an infection not uncommon among breastfeeding mothers. She had lingering lower-back pain, too—the baby’s head had been resting on her spine throughout her last trimester. When the Lortab ran out, her obstetrician wrote her another script, for oxycodone. Within six weeks of giving birth, Ashlyn said, she was hooked. When her doctor left town after a few months and his replacement refused her refill requests, she bought black-market OxyContin through a friend of a friend. She occasionally stole Lortab from her disabled octogenarian grandfather.
She switched to Roxicodone in 2010, when OxyContin became abuse-resistant, then to heroin when the black-market Roxys became more expensive and harder to get. “It’s unreal how many people followed that same pattern: Oxys-Roxys-heroin,” she told me. “If you ask me, OxyContin is the sole reason for all this heroin abuse. If I had the choice between heroin and Oxys, I would choose Oxys.…With pills, you always knew what you were getting.”
By the time her son learned to talk, Ashlyn was doing heroin and/or heroin business with most of the Hidden Valley users. She had grown up in the north Roanoke County suburbs, but she had made lots of friends from Hidden Valley and Cave Spring. “Places like Hidden Valley are where you can get some of the best heroin because those are the kids with parents that have money,” she said.
*
From the Kentucky federal women’s prison where she was serving a seven-and-a-half-year sentence for distributing between thirteen thousand and twenty-three thousand bags of heroin, Ashlyn charted out, via email, the trajectory of heroin’s suburban sprawl, with intersecting spheres of users she knew who were now dead or doing time. She pointed out news articles I’d missed about people she’d once used drugs with, including a young mother named April who’d recently overdosed in the parking lot of a Roanoke Dollar General store, with her infant found crying in the car seat. She knew Spencer Mumpower and Colton Banks. At the height of her addiction, she’d wept through Scott Roth’s funeral Mass.