By 2014, suburban heroin dealing has become prevalent in both the rich and poor neighborhoods of Roanoke. One of Roanoke’s top mules is Ashlyn Keikilani Kessler, a young woman of Hawaiian heritage who has the ability to take extreme quantities of drugs without overdosing. She first got addicted after being prescribed OxyContin for back pain that lingered after the 2008 birth of her son. When OxyContin is reformulated in 2010, she eventually switches over to heroin.
Ashlyn is serving a seven-and-a-half-year sentence in a federal women’s prison in Kentucky when she begins emailing Macy. She knows about Spencer Mumpower and Colton Banks, and she was even there at Scott Roth’s funeral mass. Two years into her addiction, she got fired from her job as a paralegal and started stealing valuables to buy drugs, including heirloom jewelry from her Hawaiian-born grandmother.
Ashlyn’s involvement with other local heroin users shows how tight-knit communities like Roanoke can be. Her story of how drugs caused problems with work, which led to crime, is similar to the story of many other OxyContin-turned-heroin users across the country. Macy has largely focused on the experience of younger white men using heroin (and they are a major demographic), but she makes it clear that they aren’t the only ones affected by the epidemic.
Soon after getting fired, Ashlyn connects with a dealer who approaches her about driving back and forth from New Jersey to run drugs. She agrees. By 2014, however, DEA agents have recovered 15,000 text messages from her phone that paint a clear picture of addiction in her local area. Police pull her over and arrest her on Interstate 81, just north of Roanoke, discovering 722 bags of heroin.
Both the number of text messages and the amount of heroin Ashlyn was carrying suggest that she had gotten deep into the world of dealing it. This change in her life happened within a relatively short span of time, showing how quickly the effects of addiction can take place.
Andrew Bassford is the man in charge of prosecuting Ashlyn’s case. He keeps a portrait of James Garfield on his desk because he admires the Ohio-born president’s work ethic. Bassford has a high-and-tight haircut and often wears cowboy boots; he tries to talk in one-liners like characters from TV shows like Dragnet.
Bassford’s portrait of Garfield and his cowboy boots show that he tries to be eccentric. Once again, Macy returns to the theme of how fictional depictions of law enforcement provide a distorted view of the reality: while Macy doesn’t state it outright, she implies that Bassford isn’t nearly as smooth as the cops from TV that he idolizes.
Bassford despairs that the current law enforcement system for dealing with heroin isn’t very effective. Because the drug is so wildly available and cheap, if you get rid of one dealer, more just show up, like Whack-A-Mole. Despite Van Zee’s prediction that OxyContin would be recalled once rich kids in suburbs started dying, he is dismayed to see himself proven wrong—the response (or lack of response) remains the same.
Bassford’s comparison to Whack-A-Mole is evocative and easy to understand, which is why Macy uses it in the chapter title. The comparison to Whack-A-Mole could suggest that maybe the approach of arresting and imprisoning dealers is flawed from the premise, since more will just pop up, but Bassford and others might disagree with that interpretation.
Tess Henry is a 26-year-old waitress that Macy meets in 2015. She is the daughter of a local surgeon and a nurse. Although she was a star high school athlete and an honor-roll student, she started a $200-a-day heroin addiction in college. She identifies herself not as a drug runner or mule but as a “middleman” who knew many of the other users and dealers from Hidden Valley.
Although she is introduced somewhat late in the book, Tess will become one of the most important subjects Macy profiles, in part because Macy goes into greater depth with her story than any of the others. Part of what makes Tess’s story interesting is that, as a “middleman,” her experience is fairly average, and she was in regular contact with both users and dealers. But Macy is careful not to reduce people to stereotyped labels like “addict,” and Macy goes deep on the specifics of Tess’s life in order to demonstrate how all people struggling with addiction are more than just a statistic or a label.
Tess’s family has a history with addiction: she has alcoholic relatives on both sides. A routine visit to the urgent-care center for bronchitis leads to two 30-day opioid prescriptions (one for codeine cough syrup and another for hydrocodone to ease throat pain). Soon after, she begins looking for dealers to supply her with more. New government regulations in October 2014 reclassified some common painkillers, making them harder for doctors to prescribe, but Tess’s dealer suggests replacement drugs she can use instead.
Tess’s story has some parallels with Ashlyn and with countless others: her family history made her vulnerable but ultimately it was a chance medical problem that caused her to first discover opioids. The government makes an effort to solve the problem of over-prescribed painkillers, but as is often the case in Dopesick, the response is too little, too late, particularly for Tess.
Tess believes she became truly addicted when she started snorting heroin. Though she was able to hide her addiction and hold on to her job as a waitress at first, eventually it becomes impossible to hide. After a couple arrests, she is caught on May 15, 2015, stealing copper from a Lowe’s hardware store. In jail, she learns that she is in the second trimester of a pregnancy and is given a Tylenol to stop her fetus from having opioid withdrawal.
Tess’s trajectory follows that of many other people with opioid addictions, with the addiction leading to crimes that she likely wouldn’t have otherwise committed. Tess’s story also shows how normal life events, like pregnancy, don’t stop because of an addiction and how by the time Tess is arrested, her unexpected pregnancy is so common among opioid users that jails have protocols in place to deal with it.
Six weeks later, there is a spike in opioid overdoses, due to the synthetic opioid fentanyl, which is 25 to 50 times more potent than heroin. Despite the deaths, many users continue to seek heroin, with some even being intrigued by the prospect of a greater high.
The fact that so many drug users deliberately seek out fentanyl helps to underscore just how self-destructive some people can act when they are motivated by an addiction.
In 2015, Chris Perkins, the 46-year-old police chief, knows that fentanyl is going to change the whole opioid epidemic, for the worse. Catching user-dealers becomes harder as open-air markets are made obsolete by cell phones. Perkins, nearing retirement after 24 years on the force, wants to implement one final program to go out on. He hears about a program in Gloucester, Massachusetts, where police are allowing heavy users to turn in their drugs and receive treatment instead of going to jail.
The flexibility and ingenuity that Perkins uses when looking for a solution to addiction provide a contrast with the more rigid solutions proposed by the federal government. Macy is an advocate for people in their own communities helping to fill in the gaps in the federal response to the opioid crisis, and Perkins represents a case study for one way to do this.
Perkins helps create the Hope Initiative, which aims to establish a clinic for recovering opioid users like the one in Gloucester, Massachusetts. Janine Underwood is the executive director. Janine’s son, Bobby, died of fentanyl in June of 2015, after several years of going in and out of treatment and prison. Janine is the first to tell Perkins she wants in on his idea. Jamie Waldrop (mother of Christopher) is the second to join Perkins’s initiative.
As with RAPP, from previous chapters, many of the most passionate activists for change are people who have watched family members die of opioids. Macy shows how one of the silver linings of grief is that it can motivate people to seek out positive change, although she is careful not to sugarcoat the harsh reality that many parents of opioid victims face.
Virginia, however, doesn’t have the same public health measures in place as Massachusetts, and its legislature turns down attempts to pass Medicaid expansion as part of the Affordable Care Act, denying a potential $6.6 million in federal funds to low-income Virginians. In Virginia in 2014, one Democratic senator resigns under unusual circumstances, giving the Republicans a majority to shut down the Democratic governor’s proposal to expand Medicaid. The stakeholders in Perkins’s new clinic despair about the obstacles they will face but remain convinced of the urgency of their cause.
Macy shows how the federal government’s decision to leave many aspects of healthcare up to individual states has made things complicated for activists. What works in one state might not be possible in another, hindering progress. Healthcare reform, such as Medicare for All on the left and the movement to repeal the Affordable Care Act on the right, are an important context for this passage, but Macy largely avoids mentioning specific political platforms, perhaps because healthcare is such a contentious issue and because she wants to maintain some objectivity.