a pharmacy. Before the rule took effect, patients could have their pills refilled automatically as many as five times, covering up to six months—one reason narcotic prescriptions quadrupled from 1999 to 2010, and so did deaths.
The so-called upscheduling had been controversial, with public opinion weighing in pro (52 percent) and con (41). Chronic-pain patients complained loudly about the added cost and inconvenience. “Just because the DEA cannot figure out how to control the illegal use of these drugs should not be a reason to penalize millions of responsible individuals in serious pain,” one critic wrote in a published letter to pharmacist Joe Graedon, The People’s Pharmacy columnist.
On a website set up by the DEA for public feedback, several patients warned that rescheduling the drugs would limit their availability and drive people to street drugs—particularly heroin.
*
Tess’s dealer adapted swiftly to the switch. “He said, here, try this—it’s cheaper and a lot easier to get,” she told me. Tess took her first snort of the light brown powder, same as she’d done with the crushed-up pills. He was a serious dealer, she said, an African American who sold the stuff but was strict about never using himself. “Not to sound racist or anything, but typically black opiate dealers do not use heroin. Good dealers don’t use what they sell because they know they would just use it all,” she said.
With the legalization of marijuana in a growing number of states, drug cartels were champing at the bit to meet the demand for heroin, a market they needed to grow. “They were looking at a thirty to forty percent reduction in profits because of legalization,” explained Joe Crowder, a Virginia state police special agent and part of the federally funded High Intensity Drug Trafficking Area program that designated Roanoke a heroin hot spot in 2014. “Between the pill epidemic and the less liberal prescribing of pain meds, cartel leaders said, ‘Guess what’s purer, cheaper, and we can make it all day long?’”
Some dealers encouraged underlings to “hot pack” their product, giving superhigh potencies to new users to hook them quicker. Once the user is hooked, the product gets titrated back, forcing the person to buy more.
*
Tess said she didn’t consider herself a true addict until six months after she started snorting heroin, when she began injecting it. After three shots, though, she knew she’d never return to snorting. She showed me the scars inside her right elbow; right-handed, she learned to use her left hand to mainline the drugs into her right arm because that vein was usually a sure hit.
For a while she was able to keep waitressing at a trendy, upmarket bistro featured in the likes of Southern Living and Garden & Gun. She wore long sleeves to hide her track marks and was still able, if she concentrated hard, to remember orders without writing them down.
Around this time, a family friend told her mother, “Your daughter’s an opiate addict,” and Patricia Mehrmann had a reaction not unlike that of many other parents faced with the same accusation: She fumed, incredulous. After all, Tess never missed a day of work. “She did everything she was supposed to do,” Patricia said. We were sitting in her comfortable sunroom, surrounded by woods. Patricia was way past denying it now: She’d spent the last six months navigating treatment hurdles, and worse.
“I worked just to use, and I used just so I could work,” Tess explained. “There was no in between.” But that phase was brief, and neither Tess nor her mom had any idea what was coming next. Or that the molecule had another even higher card to play.
No matter how low Tess got, it seemed there was always a deeper and fresher hell awaiting her.
*
The addiction would out Tess eventually, as it always does. Even though she was earning $800 a week at the restaurant, even though she’d started middlemanning—recruiting and selling to new users in exchange for her cut of the drugs—she needed more money because she required ever-larger quantities of heroin to keep from feeling shaky and dopesick. She was arrested twice early on—once when officers picked her up for being drunk in public downtown and found an unprescribed OxyContin in her pocket, and again when police caught her stealing gift cards from a store. The first charge was pleaded down from a felony to a misdemeanor, and Tess was sentenced to a year’s probation and a weekend in jail. The second was treated purely as a theft. “I begged her