reducing its budget by $364 million, despite Trump’s campaign vow to combat the nation’s growing opioid epidemic, and backed health care changes that would have put the most vulnerable users at risk. After a backlash, Trump rolled back his proposal to relatively modest trims. But more than a year after his inauguration, the office still lacked a permanent director, Trump remained more focused on law enforcement than public health strategies, and a comprehensive list of recommendations written by his own presidential commission remained a work in progress or unaddressed.
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Harm reduction remained slow to catch on in most of the Bible Belt, including Roanoke. When I told Janine about an idea hatched at an opioid brainstorming session in Boston—to segregate users on a boat in international waters, where they could legally inject under medical supervision, ideally then transitioning to counseling and MAT—she was repulsed. “That’s crazy! We’ve created this problem, and now we decide we’re just going to continue to let it happen, and that’s the answer?”
And yet she was miles ahead of most leaders in her conservative community. She’d told her son’s story recently to the local school board and county officials, hoping to raise money for the county’s risk prevention council, which was currently running on fumes and a few small federal grants. She’d explained how she’d pulled strings to get her kids into the Hidden Valley school zone because she considered it a superior place to raise children. But the affluence she believed would protect her family had instead allowed the festering of shame and inaction. Almost daily the Hope Initiative took a call about a heroin user from Hidden Valley or nearby Cave Spring, and police data showed that the problem was worse by far in those two communities than in other, less affluent areas of the county.
“I was just a mom trying to make them aware of what’s happening here, that they should be aware. But there was dead silence in the room,” Janine said. “Nobody asked me a question. I just spoke, and I sat down.”
The school board declined to support the program, and the county gave its usual $2,000.
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Of the fifty-seven people who came seeking treatment in the Hope Initiative’s initial months, the volunteers had persuaded only two people to begin residential treatment. About fifteen were referred to MAT outpatient programs—seven of whom were still in recovery a year later. Neither Tess nor her friend Joey was among the successes, though both were regularly in touch with Hope volunteers.
Tess seemed to be nowhere close to accepting help, Patricia told me, in early 2017. We sat next to each other at a drug-prevention forum put on at Tess’s alma mater, Cave Spring High, as judge after cop after grieving parent talked about rising overdose calls (thirty in the first six weeks of the year), more than a doubling of Narcan administrations, and increasingly potent seizures of fentanyl-spiked heroin.
Janine told Bobby’s story publicly for maybe the twelfth time. She finished by describing a recent visit to an urgent-care center with her teenage daughter, who’d sprained her thumb playing softball. After an X-ray and an exam to rule out a break, the doctor wrote her fifteen-year-old a prescription for a twenty-five-day supply of oxycodone.
“I tore it up,” Janine said. She also called clinic official Dr. John Burton, who said of the incident: “This was a provider who was still doing things the way we used to do them five years ago, and he didn’t get the memo.” A come-to-Jesus ensued, with Burton reminding the doctor of the hospital system’s ER policy of no more than three days’ worth of oxycodone or hydrocodone per prescription, sans refills.
During the Q&A at the end, Patricia stood in the audience and described Tess’s descent from Cave Spring honor-roll student and athlete to heroin addict and prostitute, preyed on by a growing network of drug dealers and pimps.
“I never saw it coming,” she told the crowd. “And I don’t know what the answer is, but I know it’s important we take heroin out from under a dirty rug. We should be talking about it the same way we talk about cancer.”
At the moment, Tess was back in the psych ward of a local hospital, Patricia said later. Hope volunteers Jamie and Terrence Engles were trying to coax her into a long-term rehab center in Nevada, but they were concerned, again, about the problem of the fleeting liminal phase—having a bed available the moment Tess was released from the hospital, not to mention