pinwheels, an American flag, and a brand-new 55 metal sculpture painted in school colors. Over the next year, Kristi would hatch plans for a memorial five-kilometer race for opioid awareness that she envisioned meandering past Jesse’s old football field and the Shenandoah River. Photos of overdose victims, including another friend of Jesse’s who had recently died, would be placed along the runners’ path; the money raised would benefit the area’s substance abuse coalition.
In one week in October 2016, nineteen people in the northern Shenandoah Valley region would overdose, seventeen of them brought back with Narcan. Baltimore dealers continued to hot-pack their heroin with fentanyl, an area naloxone trainer told me, because when someone dies, customers flock to his or her dealer, chasing a better high. “It’s like, ‘I might lose three of my customers, but in the long run I’ll gain ten of yours,’” theorized the trainer, a mom who’d lost a son to fentanyl-laced heroin. The fentanyl-packing strategy is also sometimes employed with known snitches or suspected confidential informants, the goal being to kill them.
*
After a day passed, I tried to break the news gently to Kristi over the phone that Ronnie hadn’t even recognized Jesse’s name.
In that respect, Ronnie Jones was no different than the drug reps in their tailored suits and SUVs: He had failed to see the harm his drugs had caused.
And why should he be any different?
A few months before I sat down with Ronnie, Purdue Pharma executive J. David Haddox gave a speech urging members of the Richmond Academy of Medicine not to be swayed by the narrative taking shape around the opioid epidemic. His company was working to create new and “safer” painkillers, he said. The assembled doctors were unimpressed. What can we do, they wanted to know, when our patients need pain relief but we don’t want them to become addicts? Haddox could only suggest using local pain specialists—including the friend of his who’d invited him down to deliver the speech. But there weren’t enough pain specialists, and the doctors were increasingly aware of studies showing that long-term opioids in fact created more pain in many patients, a condition known as opioid-induced hyperalgesia.
Eight years after the 2007 sentencing of the company and three top executives for criminal misbranding, more lawsuits were being filed against Purdue and/or other opioid makers and distributors by the month, and they would grow to include such plaintiffs as the city of Everett, Washington; the state of Ohio; Cabell County, West Virginia; and Virginia’s tiny Dickenson County, not far from Lee. Purdue had followed Big Tobacco’s playbook when it downplayed the risks of its drug, and now some of America’s best legal minds were trying to make it and other pharmaceutical companies pay for the “public nuisance” burdening their communities. The states of West Virginia and Kentucky had already garnered modest settlement payments from Purdue, to the tune of $10 million and $24 million, respectively, victories that brought to mind the civil litigation brought by forty-six states and six other jurisdictions against the tobacco industry in 1998. Cigarette companies then agreed to pay billions to the states, in perpetuity, for the funding of prevention and public health programs.
But painkillers aren’t tobacco, and the cases differ partly because opioids have legitimate medical benefits when prescribed and used correctly, and the companies who make them use as fall guys the out-of-work coal miners and furniture makers and underchallenged youth who have illegally abused and diverted their drugs. “The cigarette companies finally caved, but only because the litigation costs were eating them alive,” said legal scholar Richard Ausness at the University of Kentucky. He foresaw the possibility of such a settlement being forged with opioid makers, but to a much smaller degree. “It’s a tough call because you want to punish them, but you may not want to put them out of business, because then you’re largely forgoing the right to any future claims,” he said. Tightening new opioid prescriptions through physician monitoring programs, then shifting the government’s focus to treatment and prevention, were more effective strategies than litigation, Ausness believed.
*
Haddox punctuated his talk with slides touting the work Purdue was undertaking to create new, “safer” painkillers. When his thirty-minute speech was over, the general practitioners in the audience grumbled a bit. Despite Haddox’s great slides and optimistic plans for new and improved opioids, the doctors were still slogging it out in the trenches. They knew they’d be the ones left holding the prescription pads when it came time to juggle