definitively protects the addicted from overdose death and leads to reduced crime and better health. “Holy mackerel, this is such an old study, but people still aren’t aware,” he said.
The community services board in Roanoke had recently added MAT treatment for twenty-one patients, but only if they first engaged in counseling. Carilion still had a three-week wait for its outpatient MAT. When I floated the idea at a Carilion-sponsored forum that every doctor who’d accepted a Purdue Pharma freebie should feel morally compelled to become waivered to prescribe Suboxone as a way to beef up treatment capacity, the response among the doctors in the room was…crickets.
As Philadelphia edged closer to launching the nation’s first supervised safe-injection facility, efforts to start a syringe-exchange program in Roanoke remained sluggish and mired in politics—even as the rural health department director Dr. Sue Cantrell finally won permission to open one in Wise, in the most conservative part of the state. The Virginia General Assembly seemed on the verge of passing a Medicaid expansion, finally, but with a provision that the “able-bodied” be required to work.
*
The changes weren’t trickling down fast enough for Tess. When I told her mom about the limited MAT expansions in the fall of 2017, paid for via state and federal grants, she called the community services board office and was told that only pregnant women were being accepted at the time. Soon after, Tess messaged me at 4 a.m. from someone else’s phone, saying she planned to enter another Nevada rehab and asking if I’d send her more books when she got there.
I texted back that I already had the new David Sedaris book ready to send.
“Oh, awesome!” she said, thanking me for my “positivity” and support. She didn’t have an address where she could receive the book, but she would let me know when she checked herself into a rehab. Her elderly grandfather had agreed to fund another round of treatment, even though Tess had recently talked him into wiring her $500, allegedly to pay a friend to drive her back to Roanoke. “He knew he was being played, but he loves her so much, and he was probably thinking, ‘What if she’s hungry?’” said Patricia, who learned about her dad’s cash transfer after the fact. Though the ploy was likely another con for drug money, Patricia was buoyed by Tess’s having reached out to her family and me, and updating her Facebook page with pictures of her son. Unknown to us at the time, Tess had applied for Medicaid in Nevada, which expanded access in 2014 under the ACA—another indication that she was actively seeking treatment and MAT.
“The problem is, we don’t even know where she is” or, worse, what pimp and/or drug dealer she was now beholden to. In a November 2017 phone call, Tess was hopped up on crystal meth, Patricia believed, and paranoid that “gang stalkers” were trying to kill her. As she walked down the streets of Las Vegas, she thought people in passing cars were flashing their lights at her. She thought strangers were shouting her son’s name.
“All Tess has to do is tell us where she is, and the treatment people will come and pick her up.”
Of the 132 addicted users who had come to the Hope Initiative in its first year, fewer than ten had gone to residential treatment and stayed sober.
But Patricia still slept with her cellphone every night, waiting and praying that Tess would one day be among them.
*
In early December, Tess seemed better, judging from sporadic text messages and calls to her mom. She’d decided to make her way home to Roanoke, though her plans for the journey were vague. Patricia lined up a bed at an abstinence-only treatment center fifteen minutes from her home, Tess’s grandfather agreed to cover the flight and rehab, and Patricia spent a week navigating the Department of Motor Vehicles bureaucracy to get Tess a temporary ID that would allow her to board an airplane.
But where to send the ID? Tess was still homeless, and another week passed before she called Patricia with an address via a borrowed phone, possibly belonging to a current or former pimp. “Are you in danger?” her mom asked, and Tess claimed she was not, repeating a line she often said: “I’m a soldier, Mom. I’ll be fine.”
“Yes, love,” Patricia responded. “But sometimes even soldiers fall.”
On December 9, Tess may have used that same borrowed phone to respond to one of my Facebook posts, about an early reading