Dopesick - Beth Macy Page 0,120
if he relapsed and/or made a critical medical error while treating a patient. He still checks in daily for the possibility of a random drug screen, via an app on his cellphone, even though he’s now Tennessee’s assistant commissioner for Substance Abuse Services. The daily routines of his life as a recovering addict and physician keep him committed to recovery, just as the scar on his left ankle reminds him how desperately low the drug-addicted can go.
Though Loyd’s treatment was too expensive to be replicated to scale—he paid $40,000 cash up front (limited coverage is now available to those with insurance, but it would cost almost twice that today)—he believes the five-year treatment model, common for addicted doctors and airline pilots, is ideal. It’s why they tend to have opioid-recovery rates as high as 70 to 90 percent.
“There’s nothing scientific at all about twenty-eight days of [residential] treatment,” Loyd said of the kind heralded in movies and on reality TV. “It takes the frontal lobe, the insight and judgment part that’s been shut down by continued drug use, at least ninety days just to start to come back online and sometimes two years to be fully functioning.”
But most users don’t have access to ninety days of treatment, much less two years. Only one in ten addicted Americans gets any treatment at all for his or her substance use disorder—which is why there’s such a push for outpatient MAT and, increasingly, programs that divert the addicted from jail to treatment.
While drug courts rightly provide not only intensive monitoring but also the threat of a swift jail sentence, Loyd believes that all people in recovery, especially those who relapse, should be allowed MAT, even if they have to sue to get it. “The judges who don’t allow it are in violation of the Americans with Disabilities Act. They just are!” he said. Denying opioid-addicted participants medicine they have legitimately been prescribed is akin to denying diabetics their insulin on the grounds that they’re fat.
If 90 percent of people with diabetes were unable to access medical treatment, there would be rioting in the streets.
*
Loyd made his MAT argument repeatedly as he tried to sell the idea of Overmountain to the doubters in Gray, ten minutes down the road from his Boones Creek hometown. The crowd was tougher than he anticipated.
To intimidate him, they filmed him as he spoke. They yelled, “Put it in your neighborhood!” and placed condemning signs in the hands of their ten-year-old children as they marched.
At one meeting, Loyd tried to explain the science behind addiction—that it was a chronic brain disease, and relapses were to be expected—when a woman in the audience interrupted to ask, “Just how many chances are we supposed to give somebody?”
He tried to appeal to the group’s humanity, as Gaeta had done in Boston, pointing out that addiction already was in their neighborhood. Simply turning their heads away out of fear or sanctimonious denial was equivalent to enabling the spread of overdose deaths—quite possibly, even, in their own families.
From the community center where he stood, in the heart of the Bible Belt, Steve Loyd could make out four church steeples. He had played ball and gone to Sunday school with many of the people in the room.
There were leaders here and elsewhere who agreed with the woman, he knew, including an Ohio sheriff who’d recently proposed taking naloxone away from his deputies, claiming that repeated overdose reversals were “sucking the taxpayers dry.”
Loyd thought immediately of the answer Jesus gave when his disciple asked him to enumerate the concept of forgiveness. Should it be granted seven times, Peter wanted to know, or should a sinner be forgiven as many as seventy times?
In the shadow of the church steeples, Loyd let Jesus answer the woman’s question: “Seventy times seven,” he said.
*
If the federal government wouldn’t step in to save Appalachia, if it steadfastly refused to elevate methods of treatment, research, and harm reduction over punishment and jail, Appalachia would have to save itself.
Epilogue
Soldier’s Disease
Back in my adopted hometown of Roanoke, where I’d been following families for going on six years, the addicted people I came to know were in widely ranging states of wellness, some far more fragile than others. Their relatives were worn out. Many seemed to age before my eyes, like a video on fast-forward.
The day his mother arrived to pick him up from the Petersburg, Virginia, penitentiary in February 2017, Spencer Mumpower was exuberant when he spotted her walking toward him. “I want to