Even if opioid addiction is no longer leading every newscast and headline, Macy’s message is that the crisis continues.
“If people think the crisis is over, they’re wrong. We had the highest number of deaths from opioids just last year, almost 108,000. We haven’t really improved our treatment. We still have almost 7 million people out there with Opioid Use Disorder (OUD),” she said.
Macy recently provided a presentation and participated in a book signing in Urbana, her hometown. She delivered her remarks to a packed house in the Champaign County Library. Attendees included former teachers, former classmates and acquaintances, and some of those serving on the front lines in addressing substance abuse issues locally.
During her 45-minute program, Macy highlighted possible solutions for the opioid epidemic that she so graphically detailed in her earlier book, “Dopesick,” which she also helped to adapt into an award winning television series.
“Dopesick” shone a light on Purdue Pharmaceutical and the Sackler family who owns it. The story says the Sacklers exploited the medical system and government agencies in peddling what may be the most addictive drug ever created. While executives of the company pleaded guilty to federal criminal charges in connection with their actions, Sackler family members have not been charged.
Credit: Jae C. Hong
Credit: Jae C. Hong
In “Raising Lazarus,” Macy updates efforts to hold the family accountable and argues for new approaches to end the ongoing calamity of drug addition in the United States.
Macy calls the Sacklers “a family of millionaires who wanted to become billionaires, and they got the FDA (Food and Drug Administration) to approve a special insert that said their drug (oxycontin) was less prone to abuse than their competitors because it had a time release mechanism. But they knew from studies they’d done that people were abusing this drug. They were crushing it, snorting it, chewing it up.”
Thousands upon thousands of those prescribed oxycontin eventually became addicts, and when their drug of choice was unavailable, they turned to heroin. A landslide of addiction resulted.
Opioid addiction has fueled Macy’s writing for over a decade. She recalls first reporting on the issue as a journalist for the Roanoke Times in Virginia, where she worked for 25 years.
“I first reported on it in 2012 when two wealthy kids from the fanciest suburb outside of Roanoke had their lives upended by heroin. I did a three-part series about their story. They were private school classmates. One died and the other was about to go to federal prison for selling him the heroin.”
Readers were in disbelief, Macy said, that heroin had infiltrated the supposedly safe, secure suburban neighborhood.
“It was several years later that the whole nation came to know that we now had this heroin crisis.”
‘Festering and growing’
In 2015, for the first time since being tracked, the life expectancy of Americans went down.
“That was largely because of opioids, liver disease from alcoholism and suicide, what economists call ‘deaths of despair,” according to Macy.
Her experience has led her to the conclusion the opioid crisis is “festering and growing, and taking advantage of long-standing fissures in American society, where we are seeing the person who is addicted as a moral failure and a criminal instead of seeing them as a person with a treatable medical condition. This is treatable.”
One of the signs of hope Macy has identified and writes about is the concept of “harm reduction.” In “Raising Lazarus” she explained that “the idea that drug users are worthy human beings — that they are in fact, equals — is harm reduction in a nutshell.”
“It means meeting people where they are, even if it means they are still using drugs, and saying I’m going to treat them with love and non-judgment.”
With the legal settlements requiring Purdue Pharma and pharmacy retail distributors of the medications driving the opioid addiction now requiring economic accountability for their role, Macy believes it’s time to change the treatment approach.
“The research is clear we can fix this if we try,” she asserted.
She credits a woman named Tess whose life was lost to addiction as saying, “‘We need urgent care for the addicted.’” But she didn’t know what that meant until she saw it in action. Visiting a needle exchange center was an eye-opening experience for her.
“The first time I went into one, I thought ‘This is it, this is what Tess meant by urgent care for the addicted.’ It’s a place where you can go and get connected to care. You could get food, you could get clean needles, clothes, you could take your dog with you.”
Drug users have multiple needs that require attention. Many have diseases as a result of their drug use, such as HIV or hepatitis. Many fall into homelessness, become victims of sexual and physical assault or become involved in criminal activities to afford feeding their addiction.
The impact of facilities that tackle each of the problems along with addiction can be profound, according to Macy, and speaks to the efficacy of the approach.
“We don’t need millions of dollars to do it,” she said. “We just need people who will look at the research.”
Peers gain trust
Peer recovery specialists are another critical component in successful care.
“A peer recovery specialist is a person in recovery that will help other addicts. They will meet with those still using drugs in hospitals if they’ve overdosed, or in jail, will help them with housing,” Macy explained.
Because they are themselves in recovery, they gain trust from other users. In her book Macy writes, “We need to listen not just to on-the-ground helpers but also to the people they are seeking to help. It took me more than a decade to fully grasp this, but people who use drugs are the real experts.”
One peer recovery worker she talked about staffs the front desk because when people come in they are scared. As the receptionist, she tells people she’s in recovery. It opens the door for many users to overcome their fears and seek help.
When she mentioned this to a public health researcher in West Virginia, he told her he’d done a recent study that found one of the key things to a person staying in recovery wasn’t the attitude of the nurse, the doctor or the probation officer — it was the attitude of the person running the front desk.
Grassroots efforts
Another of Macy’s highlighted heroes in “Raising Lazarus” is an advance practice nurse who works during the day in a healthcare facility and voluntarily began meeting with addicts in North Carolina evenings, offering needle exchanges to help prevent them from sharing needles and contracting disease. He soon suspected that many of those he met already had Hepatitis C.
“At the suggestion of one of his patients, he started doing “Hepatitis C testing pizza parties” in the homes of addicts,” according to Macy. “They invite their friends, and he sets up a lab on the kitchen counter.”
Across the country, such grassroots efforts are having an impact in addressing addiction and they need to be nationally replicated, Macy writes.
New federal initiatives intended to prevent death permit doctors to now prescribe buprenorphine, which Macy writes is “scientifically proven time and time again to be a crucial act of mercy in reducing overdose deaths.” But Macy notes that “bupe” as it’s also known, is not a panacea, and most addicts released from jail or treatment centers require interventions that address basic human needs such as housing and food.
As the impersonal headcount of opioid related deaths continues to rise and the dollars of legal settlement money begin to flow to the communities impacted by the opiate epidemic, Macy says she wrote “Raising Lazarus” to ensure that the harm reduction approach to treatment grows and the victims of the opioid crisis receive the humane, nonjudgmental care they deserve.
She writes, “The opioid-litigation money is a once-in-a-generation opportunity. The Sacklers willfully created the opioid crisis. They shamelessly lied to the health care community and enlisted their aid in carrying out a murderous rampage that has victimized hundreds of thousands of people in this country. History will judge them for that…But how we respond to the horrors that have resulted will determine how we are judged.”
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