Dopesick - Beth Macy Page 0,51

year of high school, in 1968, and was a mostly functional user for thirty years. (Needle-phobic, he never once shot up.) Back then you could maintain that way because the drug’s potency was low—3 to 7 percent, compared with 40 to 60 percent today—and the police paid little attention, since white kids in the suburbs weren’t dying or nodding out in the football bleachers.

“But the moment it crossed those boundary lines from the inner city into the suburbs, it became an ‘epidemic,’” said Dabney, shaking his head. After two drug-related jail stints, he left court-ordered treatment in the late 1990s to get a master’s in counseling and now works as a mental health and substance abuse counselor who leads support groups for users taking the maintenance drug buprenorphine, or bupe (more commonly known by the brand name Suboxone). “It’s ludicrous, this thing that’s been knocking on your door for over a hundred years, and you’ve ignored it until finally it’s like a battering ram taking your doors off the hinges.

“It’s a monster now, but nobody paid any attention to it until their cars were getting robbed, and their kids were stealing their credit cards.” The worst of it, Dabney warned, was that people were getting hooked at even younger ages, and making the switch faster from pills to heroin.

*

It took a while for the force of the battering ram to register. Unlike in the coalfields, where addicted users quickly resorted to thievery to fund their next fix, in the suburbs the epidemic spread stealthily because users had ready access to money. Many of them were teenagers selling electronic devices (then telling their parents they’d been stolen), or raiding their college savings accounts, or simply using their allowance. They were not engaging in “spot and steal,” not trading a mule for four pills, not wheeling stolen garden tillers down the street for everyone to see.

In the wealthiest Roanoke County suburbs, illicit pill-taking commenced, shared on TruGreened lawns, next to school lockers, and in carpeted basements while clueless parents in Cave Spring and Hidden Valley were making family dinners upstairs.

There was no widespread panic, because the teenagers and young adults had the money to keep their addictions at a low boil, and those parents who were in on the dirty little secret were too ashamed to let the neighbors know.

From California to Florida, the parents behind Relatives Against Purdue Pharma already knew that OxyContin stood out more in rural America’s distressed hollows and towns, where reps could easily target the lowest-hanging fruit—the injured jobless and people on disability, with Medicaid cards. But OxyContin was everywhere, of course, and it had been almost since the beginning, even if the crimes associated with it hadn’t dominated the urban news.

“The early suburban wave mostly stayed hidden…because parents there could afford to put their kids in a thirty- or sixty-day program,” said Dr. Hughes Melton, an addiction specialist and now the Virginia Department of Health’s chief deputy commissioner overseeing much of the state’s response to the crisis. “You really didn’t hear much about it until young people started dying.”

It was the death of the funny young rapping chef, Scott Roth, with his mop of blond hair and life-of-the-party disposition, that should have put the Roanoke region on notice.

The weekend when most of his friends were going off to college, his mother had driven him to a rehab program at the local rescue mission. She remembers leaving him by the mission door in the rain, in his plaid shorts and Nautica shirt.

*

Spencer Mumpower helped me unpack the epidemic as it unfolded behind mall movie theaters and in wooded cul-de-sacs in the late aughts. But even though high school surveys showed suburban heroin use was growing in 2012 (it was then 3 percent higher in Roanoke County schools than the national average), parents and prevention workers alike underestimated Spencer’s warnings, viewing his crime as an anomaly, maybe even an outlier case of bad parenting.

“We didn’t understand the connection between heroin and pills at least until 2014,” admitted Nancy Hans, an area drug-prevention coordinator. In 2010, her Prevention Council of Roanoke County initiated drug take-backs, events where citizens were encouraged to safely dispose of unused medications, but she wishes now that she had singled out opioids.

At the urging of local police, Hans instead launched a campaign to warn parents about synthetic bath salts in 2012, then in the public eye because they had caused bizarre behavior, including physical scuffles with police as well as the overdose deaths of two