In her mobile Health Wagon, nurse practitioner Teresa Gardner Tyson and her grant-funded staff of twenty are largely left to tend to the health needs of the uninsured in Virginia’s coalfields. During repeated attempts to gut the Afford-able Care Act in 2017, Tyson grieved for her patients who were dying due to untreated hepatitis C caused by IV injection of opioids and Virginia’s repeated failures to expand access to Medicaid.
Of his 1993 Lee County (Va.) High graduate class of two hundred students, A. J. McQueen said more than half were either in prison or battling addiction. “We have to wear rubber gloves now when we make arrests,” the drug detective said.
In 2017, public health professor Robert Pack and Dr. Steve Loyd led a coalition to open Overmountain Recovery, a center offering methadone and other treat-ments in the conservative rural community of Gray, Tennessee, where opposition was fierce. This collaboration among a university, a regional nonprofit hospital, and the state’s mental health agency represented one of the strongest models I witnessed for thwarting governmental rigidity and indifference to turning back the crisis.
Acknowledgments
This book stands on the shoulders of several important works about the opioid crisis that came before it: Barry Meier’s Pain Killer, Sam Quinones’s Dreamland, Anna Lembke’s Drug Dealer, MD, and Tracey Helton Mitchell’s Big Fix. My take on the epidemic as I witnessed it landing in the western half of Virginia began with reporting I did in 2012 for the Roanoke Times, and I remain grateful to my former newspaper for giving me the time and guidance to see the epidemic unfolding before me, particularly editors Carole Tarrant and Brian Kelley. Longtime reporter Laurence Hammack not only unearthed the devastation caused by rampant overprescribing in Virginia’s coalfields as early as 2000, he was also the first in the nation to write about the heroics of Dr. Art Van Zee, Sue Ella Kobak, and Sister Beth Davies, whose insights were invaluable to me throughout my reporting.
My agent, Peter McGuigan, helped frame my initial reporting into the idea for this book, and Vanessa Mobley, my editor at Little, Brown, shaped my further reporting with razor-sharp analysis and offered masterful guidance on structure and theme while never letting me forget that, above all, it was America’s grieving families who were being left to figure a way out of this mess. John Parsley gave critical early advice to cast my reporting net wide and to be patient.
If I ran my own journalism action-figure factory (#LifeGoals), I would fashion caped likenesses of my most intrepid and generous journalist pals: Martha Bebinger, Andrea Pitzer, Carole Tarrant, and Brian Alexander, along with my photojournalist collaborator of many years, Josh Meltzer, who shot the portraits for this book.
I’m thankful, too, for the generous legal, medical, journalistic, and historical insights offered in multiple conversations with Dr. Anna Lembke, Dr. Molly O’Dell, Dr. Steve Huff, Dr. Art Van Zee, Sister Beth Davies, Robert Pack, Dr. Steve Loyd, Sarah Melton, Dr. Sue Cantrell, Dr. Hughes Melton, Dr. Jody Hershey, Dr. Karl VanDevender, Teresa Gardner Tyson, Tammy Bise, Don Wolthuis, Andrew Bassford, Nancy D. Campbell, Elizabeth Jamison, John Kelly, Caroline Jean Acker, Sergeant Chad Seeberg, Agent Bill Metcalf, Sergeant Brent Lutz, Lieurenant Richard Stallard, Christine Madeleine Lee, Heath Lee, Dean King, Andy Anguiano, Barbara Van Rooyan, Cheri Hartman, Nancy Hans, Janine Underwood, Jamie Waldrop, Wendy Welch, Bryan Stevenson, Danny Gilbert, Thomas Jones III, Drenna Banks, Dr. Karen Kuehl, Dr. Lisa Andruscavage, Kim Ramsey, Dr. Jennifer Wells, Ed Bisch, Lee Nuss, Barry Meier, Laura Hadden, Lisa Wilkins, Marianne Skolek Perez, Isaac Van Patten, Chris Perkins, Jeremiah Lindemann, Richard Ausness, Vinnie Dabney, Laura Kirk, Warren Bickel, Aaron Glantz, Rob Freis, Judge Michael Moore, Missy Carter, Emmitt Yeary, Shannon Monnat, Nikki King, Sue Ella Kobak, Dr. Martha Wunsch, Destiny Baker, Kristi Fernandez, Ginger Mumpower, Robin Roth, David Avruch, and with the patients (named and unnamed) of Dr. Art Van Zee, Dr. Hughes Melton, Sister Beth Davies, and Ron Salzbach. For the insights they shared from behind prison walls, I offer heartfelt thanks to Ronnie Jones, Ashlyn Kessler, and Keith Marshall.
Portions of this book were written and rewritten at the Virginia Center for the Creative Arts and Rivendell Writers Colony; their fishponds and wooded lands were a balm of beauty, quiet, and support. As usual, my librarian pro team of Piper Cumbo, Edwina Parks, and Belinda Harris cheerfully augmented my research. I’m also grateful for the creative support of Sheila Pleasants, Mason Adams, Amy Friedman, Kim Cross, Kirk Schroder, Richie Kern, Mim Young, Doug Jackson, Chloe Landon, Chris Landon, Mary Bishop, Anna Quindlen, Mary-Chris Hirsch, Kate Khalilian, Mindy Shively, Max Landon, and Will (“You Got This, Ma”) Landon. Special thanks to my friend Elizabeth Perkins, who introduced me to Patricia Mehrmann and Tess Henry in November 2015, after rescuing a dog of theirs that had gotten loose, and who “had a feeling” I needed to know their story.
At Little, Brown, I’m lucky to have the spirited backing of publishers Reagan Arthur and Terry Adams, copyeditor Deborah P. Jacobs, production editor Pamela Marshall, jacket designer Lauren Harms, editorial assistant Joseph Lee, and the fabulous publicity/marketing team of Sabrina Callahan, Alyssa Persons, Lena Little, and Pamela Brown.
As always, I thank my secret ingredient, Tom Landon, who supports everything I do, from first-line editing and technical assistance to hashing out story lines with tough questions and cheerful reminders to be patient with my interviewees and myself.
In my thirty-two years of journalism, I have never known a source to be as open and unvarnished about hard truths as Patricia Mehrmann, who let me into her life over the course of hundreds of text messages and scores of emails, phone calls, and visits, and whose courage to confront the stigma of addiction is astonishing. May our poet rest in peace.
Notes
PROLOGUE
Interviews: Ronnie Jones, Don Burke, Kristi Fernandez
I walked along the manicured entranceway: Author interview, Ronnie Jones, Hazelton Federal Correctional Institution, Bruceton Mills, WV, Aug. 11, 2016.
the prison had taken over: Hazelton is the largest employer in Preston County, according to the Preston County Economic Development Authority website and Hazelton management, via email to author, July 13, 2017.
“Exactly who have you spoken to”: Email to author via CorrLinks federal prison monitored email: July 18, 2016.
a single batch of heroin was about to land: “26 Overdoses in Just Hours: Inside a Community on the Front Lines of the Opioid Epidemic,” Andrew Joseph, STAT, Aug. 22, 2016.
West Virginia’s indigent burial-assistance program: Christopher Ingraham, “Drugs Are Killing So Many People in West Virginia That the State Can’t Keep Up with the Funerals,” Washington Post, March 7, 2017.
Drug overdose had already taken: Jeanine M. Buchanich, Lauren C. Balmert, and Donald C. Burke, “Exponential Growth of the USA Overdose Epidemic,” https://doi.org/10.1101/134403 (extrapolates 300,000 more opioid deaths in the next five years, based on graphs studied from 1979 to 2015); other forecasts using similar data are outlined in Max Blau, “STAT Forecast: Opioids Could Kill Nearly 500,000 Americans in the Next Decade,” STAT, June 27, 2017.