Macy’s uses a Bible story to capture the work of volunteers and outreach workers dedicated to helping people with addictions. It is inspired by the story of Lazarus, who had died of an illness and was buried for four days until Jesus brought him back to life. Before acting, Jesus asked his disciples to roll away a stone that was across the entrance to the tomb. In “Raising Lazarus”, Macy calls the workers she writes about “stone rollers”.
It’s an image she borrowed from Reverend Michelle Mathis, co-founder of the Western North Carolina Olive Branch Ministry, one of the groups in the book. As overdose deaths rose in the United States — more than one million since 1996, according to the Centers for Disease Control and Prevention — these groups stepped in to try “what authorities have failed for decades to do: keep the people alive,” writes Macy.
Macy’s stone rollers view the people they treat as equals in moral weight, respect, and worth. They do not stigmatize, judge or shun these addicts. Their work is called “harm reduction” and sometimes ventures into illegal activities.
“In the wealthiest country in the world, the treatment of the sickest and most needy people fell to volunteers at risk of arrest,” Macy writes. Out of their own pockets they buy clean needles, naloxone and fentanyl test strips. They test for hepatitis C, then treat it. All manner of weather causes them to travel to homeless encampments and “trap houses” to deliver food, water, blankets and other first aid supplies. They provide safe places to shoot. They offer “unconditional positive regard” – something Macy points out is essential for people who struggle to get through it every day. Their work is funded through bake sales, t-shirt sales and GoFundMe campaigns. Often working underground, they are what Macy calls “good criminals.”
Such strategies have hardly been adopted by a nation where total abstinence, “tough love” or submission to a higher power is considered “cure”. The high costs of not doing harm reduction recur throughout the book. Macy cites many “state and local politicians who wrongly blame the suffering people for their own demise.” The lack of humanity was illustrated when a Kiwanis club leader said at a community meeting that when people relapse, “we should let them die and harvest their organs.”
The book covers all aspects of the crisis – the science of addiction, the history of the problem, the legal system which, while recognizing addiction as a disease, treats addicts simply as criminals. These are interspersed with accounts of legal battles to hold the Sackler family (owners of opioid maker Purdue Pharma) accountable for what Macy calls the “tap root of the opioid crisis.”
The shoe leather reporting took Macy to cemeteries, committee meetings, court hearings, court proceedings and protests. Death by drugs, she points out, results from a devastating convergence: the decline of meaningful work. High rate of occupational accidents. Failed drug war policies. Lack of access to health care. Deep disengagement of the recovery community from evidence-based, drug-assisted treatments. Buprenorphine (bupe), for example, has been shown in numerous studies to prevent opioid-related deaths, but many law enforcement officials dismiss its use as simply swapping one drug for another.
In Mount Airy, North Carolina, the hometown of actor Andy Griffith, who bills himself as the fictional and idyllic Mayberry of the 1960s “Andy Griffith Show,” we meet Wendy Odum. “My husband and I are now raising our four grandchildren, as well as all the grandparents we know,” she says. “All our children are dead.” Drug addiction has claimed victims there for three generations: Odum herself was addicted after being prescribed opioids after a fall. His mother also died of an overdose.
What then is the solution? The “real magic wand is to let go of the rigid notion that only one fix exists,” writes Macy. His book is a call to “radically rethink addiction care, to do more than pretend you don’t care about the disposable line – addiction is a disease – and to treat it as such.” It means adopting stone-roller tactics: needle exchanges, HIV and hepatitis C testing, safe places where people can take drugs when they need to, supportive help when they are ready to try a treatment — which should be “free and easily accessible”. She calls for a Cabinet-level drug czar and a national system of clinics that provide mental health care as well as addiction care. Treatment should not be left to “Quirks of local councils that subscribe to abstinence-only anti-drug models.”
Macy sees glimmers of hope – the Tennessee judge who, after inquiring about the benefits of bupe, now clears it with recovery housing for his addicted defendants. Fairfax County Jail, Virginia, which refers drug-addicted inmates to a bupe program and provides counseling. But they are lonely outposts of progress.
For the addiction crisis to end, we need to create an infrastructure that works. It must be at least as compelling and accessible as the opioid production and distribution network. Those who die of drug overdoses in the United States typically come close to dying nine times before the rock locks them irrevocably in their graves. There are many opportunities to roll this stone.
In July, Teva and Allergan joined the list of drug companies accepting billion-dollar settlements for their role in the overdose crisis. As opioid reduction and remediation funds trickle down to the states, that’s the task Raising Lazarus gives us. Who will join in rolling those rocks?
Nancy D. Campbell is the author of “OD: Naloxone and the Politics of Overdose.” She is a professor of science and technology studies at Rensselaer Polytechnic Institute in Troy, NY
Hope, justice and the future of America’s overdose crisis
Small, Brown. 400 pages. $30.