If you’re trying to make sense of why an opioid epidemic is raging in the richest nation in the history of the world — and raging it is, with 174 overdose deaths a day in the United States in 2016, triple the rate from 1999, according to the Centers for Disease Control — we’d suggest you buy and read the book “Dopesick.”
Written by former Roanoke Times reporter Beth Macy, it traces the history of the epidemic and shows Virginia’s uncomfortable association with it. It was in our Appalachian coalfields, in the late 1990s, that the high-dose, highly addictive narcotic painkiller OxyContin began expanding its reach beyond terminally ill cancer patients — for whom it was developed — and started being prescribed to people with more nebulous conditions, such as lower back pain.
The state, too, proved itself particularly susceptible to heroin, which became the drug of choice among addicts once the Oxy supply began to dry up. And in a third strike for the state’s growing cadre of low income addicts, there was one more cruel twist: state legislators’ refusal, on political grounds, to expand Medicaid programs — the dreaded Obamacare — that would have increased access to treatment. The expansion will finally go into place Jan. 1, nine years after the option became available in many states.
The delay, Macy reports, cost Virginia’s 400,000 excluded participants $6.6 million a day in treatment options. “In states where Medicaid expansions were passed,” Macy writes in her book, which was published this summer, “the safety-net program had become the most important epidemic-fighting tool, paying for treatment, counseling and addiction medications, and filling other long-standing gaps in care. It gave coverage to ... users who were not poor enough for Medicaid but too poor for private insurance.”
The irony, of course, is the state’s Republicans have drawn their longest and deepest support from the communities hit hardest by the opioid epidemic. While the historical stereotype of a heroin addict is inner city and minority, the modern truth is the opposite: the addiction has ravaged rural and suburban communities, not the state’s urban core. (In an odd twist, racial profiling, for once, worked in favor of the black community: “Doctors didn’t trust people of color not to abuse opioids,” Macy writes, “so they prescribed them painkillers at far lower rates than they did whites. … By 2014, while young whites were dying of overdose at a rate three times higher than they did in 2002, the death rate for people of color was relatively unchanged.”)
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05.03.2025