Dopesick - Beth Macy Page 0,82

at his new job, living in her basement, and doing well after his release. “You could see the sparkle again in his eyes, for the first time in years,” she said. Three months after leaving prison, a visit with some old Hidden Valley friends led to a single dose of fentanyl-laced heroin. Janine discovered Bobby’s body, cold and blue, laid out on the basement floor, the evidence cleaned up and his user-dealer friends long gone from the scene.

Still raw in her grief—Bobby had been dead only six months—Janine could draw a detailed mental map of the flaws in the treatment landscape, from health care privacy hurdles and other treatment barriers to the lack of guidance about what to do the moment you realize your twenty-one-year-old is injecting heroin: Janine had found a box of hypodermic needles hidden in a box in the back of Bobby’s closet. He’d wrapped them up in his baby blanket, sandwiched between soccer trophies and Boy Scout patches.

What Janine did was sob. “It was the worst moment in my life. I didn’t understand yet the connection between pills and heroin. I kept thinking, ‘He’s gonna get better; it’s just pills.’

“I’m in health care, and there were just so many things I didn’t know,” she said. “It’s almost impossible the way the systems are set up, for a parent to get good treatment for their child.”

Janine was the first Hope Initiative angel to tell the chief, “I’m in.”

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The second was Jamie Waldrop, Christopher’s mom—the one who’d personally accompanied her addicted son to the Montana rehab. By now, so many in the Hidden Valley circle of heroin users had become intertwined: Jamie’s boys had known Bobby, Janine’s son, who’d been in the same court-ordered halfway house as Spencer Mumpower. And Jamie’s older son had at one point dated Tess.

“It was like we had a Dementor from Harry Potter who was swirling around the households of Hidden Valley, going, ‘I want you and you and you and you,’” Jamie told me.

The third volunteer was Terrence Engles, a former pro baseball player who’d progressed from taking injury-prescribed OxyContin to scamming pain-management doctors on Manhattan’s Upper East Side to overdosing on a Staten Island ferry in 2011. He’d just landed in Roanoke as a treatment consultant for American Addiction Centers, with three years of sobriety. He spent most of his time in Roanoke trying to persuade addicted twentysomethings to go to treatment, whether it was to one of his company’s dozen centers across the United States (for those with insurance) or to the scant few regional or charity options, most of them faith-based and abstinence-only. “I get about twenty calls a week from people in crisis,” he said.

In Chief Perkins’s ideal world, Carilion Clinic, the region’s largest employer with nonprofit hospitals and a new research center already known for its work on addiction research, would provide much-needed inpatient treatment. No comparable treatment was available locally, only short-term detox programs and one privately owned facility that accepted only insurance and cash (a twenty-eight-day stay ran around $20,000), and it didn’t allow patients to take maintenance medications.

Unlike Campanello’s Massachusetts, Virginia could not rely on anything close to RomneyCare, the 2006 initiative signed into law by then–Bay State governor Mitt Romney, guaranteeing insurance coverage to 99 percent of the state. Virginia’s legislature had repeatedly turned down attempts to pass Medicaid expansion in the wake of the Affordable Care Act, sacrificing $6.6 million a day in federal funds and insurance coverage for four hundred thousand low-income Virginians—a frequent source of frustration for opioid-affected families and health care advocates.

In states where Medicaid expansions were passed, the safety-net program had become the most important epidemic-fighting tool, paying for treatment, counseling, and addiction medications, and filling other long-standing gaps in care. It gave coverage to an additional 1.3 million addicted users who were not poor enough for Medicaid but too poor for private insurance.

But in Virginia in June 2014—one year before the first fentanyl spike—statehouse Republicans shut down the Democratic governor’s proposal to expand it in a political plot that seemed lifted from House of Cards: Democratic coalfields senator Phillip P. Puckett abruptly resigned to give the Republicans an expansion-quashing majority. Alleged motivations for his action included making his lawyer daughter eligible for a judgeship—the senate’s policy forbids judicial appointments of relatives—and also allowing him to nab a job with the commission that oversees economic-development investments from Virginia’s slice of the tobacco settlement.

The last Democratic legislator west of Roanoke, whose Russell County region in Appalachia remains among the