“It was like we had a Dementor from Harry Potter”: Author interview, Jamie Waldrop, Nov. 6, 2017.
a former pro baseball player who’d progressed: Author interviews, Terrence Engles, Jan. 4, 2016, and subsequent interviews.
“RomneyCare”: Kenneth Rapoza, “If ObamaCare Is So Bad, How Does RomneyCare Survive?,” Forbes, Jan. 20, 2012.
sacrificing $6.6 million a day in federal funds: “McAuliffe Pushes Virginia Medicaid expansion After GOP’s Failure to Repeal Obamacare,” CNN Wire, March 27, 2017. Republican House of Delegates speaker William Howell claimed an expansion would take state resources from education, transportation, and public safety, even though 90 percent of the bill would be footed by the federal government.
In states where Medicaid expansions were passed: Noam N. Levey, “Tens of Thousands Died Due to an Opioid Addiction Last Year. With an Obamacare Repeal, Some Fear the Number Will Rise,” Los Angeles Times, June 21, 2017.
It gave coverage to an additional 1.3 million: Sally Satel, “Taking On the Scourge of Opioids,” National Affairs, Summer 2017: 21.
political plot that seemed lifted from: Laura Vozzella, “Virginia Democratic Senator Puckett to Resign, Possibly Dooming Push to Expand Medicaid,” Washington Post, June 8, 2014. Political wrangling for favors: Jeff Schapiro, “McAuliffe, Others Pressed Puckett to Stay,” Richmond Times-Dispatch, June 10, 2014.
removed himself from consideration for the tobacco post: Puckett denied the quid pro quo, saying his talks with the Republican-controlled tobacco commission began only after he’d decided to leave. “At this point in my life, I feel that I cannot allow my political career to hamper my daughter’s future,” he said in a statement, according to Trip Gabriel, “State Senator’s Resignation Deepens Political Turmoil in Virginia,” New York Times, June 9, 2014.
while a six-month federal investigation: Andrew Cain, “U.S. Attorney’s Office Closes Puckett Probe, Will Not Seek Charges,” Richmond Times-Dispatch, Dec. 12, 2014.
a thousand more than died from AIDS in 1995: Centers for Disease Control and Prevention, as outlined in charts in German Lopez and Sarah Frostenson, “How the Opioid Epidemic Became America’s Worst Drug Crisis Ever, in 15 Maps and Charts,” Vox, March 29, 2017.
sixty-five new cases reported that year: NAS cases in Virginia had climbed from 88 in 1999 to 493 in 2013; in the Southwestern health district, there were 65 new HIV cases in 2015 and 46 in 2016, according to the Virginia Department of Health: http://www.vdh.virginia.gov/data/opioid-overdose/.
“My fear is that these are sentinel areas”: Dr. Art Van Zee’s letter to Purdue senior medical director Dr. Dan Spyker, Nov. 23, 2000.
CHAPTER TEN. LIMINALITY
Interviews: Tess Henry, Patricia Mehrmann, Dr. Hughes Melton, Dr. Lisa Andruscavage, Kim Ramsey, Dr. Cheri Hartman, Kate Neuhausen, Missy Carter, Chief Mark Mitchell, Sarah Melton, Nancy D. Campbell, Dr. Steve Loyd, Judge Jack Hurley, Anne Giles, Don Flattery, Dr. Art Van Zee, Dr. Nora Volkow, Dr. Jennifer Wells, Jamie Waldrop
Suboxone is typically the preferred MAT: Standards shifted in 2017; Virginia Board of Medicine guidelines now recommended pregnant mothers use Subutex for no more than seven days before transitioning to Suboxone. Author interviews, Dr. Hughes Melton, March 31, July 1, Oct. 3, and Oct. 28, 2017.
Subutex babies, about half of whom require: Half of babies born in Roanoke to mothers on MAT require NICU care, usually involving methadone given twice a day, for an average in-hospital period of 7.7 days, according to author interviews with neonatologist Dr. Lisa Andruscavage, May 10 and 11, 2017, and clinical nurse specialist Kim Ramsey, May 11, 2017.
“If you two wake that baby up”: Author interview and NAS unit visit with Andruscavage, May 10, 2017.
the fifty-five babies born with NAS: Carilion NAS data from Ramsey and Andruscavage; statewide NAS data compiled from Virginia Department of Health: http://www.vdh.virginia.gov/data/opioid-overdose/.
dependent babies released from the NICU: Among the 55 NAS babies born between 2015 and 2016, 37 went home with a parent, 5 with another caregiver, and 13 went directly into foster care (though 2 of the 37 eventually landed in foster care); Andruscavage and Ramsey data. Babies typically wean off their low doses of methadone within three months.
Many have been stigmatized: Author interview, Ramsey.
Access to MAT in Virginia: Author interviews, Melton and Department of Medical Assistance Services director Kate Neuhausen, July 27, 2017.
As a work-around to the Republicans’ refusal: Author interview, Neuhausen.
“When calling facilities there is rarely”: Text to author from Patricia Mehrmann, Oct. 5, 2017.
most families to continue navigating: Author interview, psychologist and Hope Initiative volunteer Cheri Hartman, Aug. 8, 2017.
“Their treatment is a video playing”: Author interview, Missy Carter, June 20, 2017.
(Nationally, roughly half of drug courts): According to the National Drug Court Institute, 56 percent of drug courts allowed MAT, 2016: https://www.ndci.org/resources/training/medication-assisted-treatment/.
“abusing it every which way”: Author interview, Lebanon police chief Mark Mitchell, May 4, 2016.
“a wonderful medicine, but we were seeing”: Author interview, pharmacist and professor Sarah Melton, July 24, 2017.
several of the nation’s top buprenorphine prescribers: Using data from a ProPublica study of Medicaid reimbursements in 2013, John Ramsey, “Clinic Operators See Benefits of Careful Suboxone Use,” Richmond Times Dispatch, Aug. 6, 2016.
Buprenorphine is the third-most-diverted opioid: Sally Satel, “Taking On the Scourge of Opioids,” National Affairs, Summer 2017: 13.
She texted me: Author interview, Patricia Mehrmann, Sept. 3, 2017.
“no one wants to tell Prince”: Monthly meeting of NAS policy board, Roanoke Memorial Hospital, Kim Ramsey, May 11, 2017.
The FBN framed methadone: Multiple interviews about the history of addiction maintenance drugs with historian Nancy D. Campbell, August and September 2017. Campbell and Anne M. Lovell, “The History of the Development of Buprenorphine as an Addiction Therapeutic,” Annals of the New York Academy of Sciences, February 2012: 124–39.
“pharmacologically perfect solution”: Campbell and Lovell, “The History of the Development of Buprenorphine,” citing the researcher P. F. Renault from 1978. First use of Vivitrol in jails in Barnstable County, MA, according to Tina Rosenberg, “Medicines to Keep Addiction Away,” New York Times, Feb. 16, 2016. Aggressive marketing of Vivitrol, with sales going from $30 million in 2011 to $209 million in 2016: Jake Harper, “To Grow Market Share, a Drugmaker Pitches Its Product to Judges,” NPR, Aug. 3, 2017.
While methadone remained on the fringes: Campbell and Lovell, “The History of the Development of Buprenorphine.”
20 percent of returning Vietnam veterans: Lee N. Robins, “The Sixth Thomas James Okey Memorial Lecture: Vietnam Veterans’ Rapid Recovery from Heroin Addiction: A Fluke or Normal Expectation?,” Addiction, August 1993.
The battle lines over MAT: My op-ed on the MAT controversy, “Addicted to a Treatment for Addiction,” New York Times, May 28, 2016.