Macy recalls how the families of addicted people that she followed in Roanoke seem to age in fast motion. After visiting her son, Spencer, almost every weekend since 2012, Ginger is there when he gets out in February 2017. Seven years sober, Spencer has picked up a healthier addiction to martial arts. He plans to attempt the “geographic cure,” moving to a new city to work for a martial arts studio.
For the epilogue, Macy checks back in on the lives of some of the people she profiled in previous chapters. Spencer is a case study in how someone can recover from addiction. Though Macy is careful to avoid falling into “personal responsibility” arguments about the causes of addiction, she shows how with luck, support, and hard work, someone like Spencer can turn his life around. Spencer also proves that people aren’t condemned to their addictions—despite the difficulties some of them will turn their lives around.
Scott Roth’s mother, Robin, still regularly texts with Macy and has been mourning her son’s death for eight years. She recently moved from her old house to a smaller apartment, but some sunflowers still grow on her old property, as if as a memorial to Scott and to the other victims of the opioid epidemic.
On the other hand, Robin Roth shows that some people can’t escape the effects of the opioid crisis, even years after the death of their loved ones. Robin’s long mourning period emphasizes how the impact of the epidemic is much more profound than raw overdose statistics.
In the fall of 2017, Macy again speaks with Bobby’s mother, Janine Underwood. Bobby’s old friends continue to show up at the Hope Initiative regularly, tired of their addicted lifestyles, but also unable to give them up.
Macy shows how the Hope Initiative has not been a silver bullet in its community and addiction still persists as a problem. This does not mean the initiative has failed, however; as Macy noted earlier, the recovery process often takes many years and reform is often an incremental process.
In 2017, both fatal and nonfatal overdoses explode in Roanoke. Ronnie Jones was correct in his prediction that heroin distribution wouldn’t stop with him in jail, but these heroin rings receive less press due to severe cutbacks at local papers, leading some Virginia residents to falsely assume there is less heroin on the streets. A major addiction researcher receives money to expand MAT in Virginia, but despite the expansion, long waitlists remain a problem in Roanoke.
One of the recurring themes in Dopesick has been how the changing media landscape affected the opioid epidemic. While Macy at times criticized the sensational coverage of opioids in local papers, she finds that any coverage at all is better than nothing, which is unfortunately all some papers can afford in 2017.
From Las Vegas, Nevada, Tess texts about going back into rehab. Her mother, Patricia, has tried to get Tess into MAT in Virginia, but the limited resources in Roanoke mean that enrollment is currently limited to pregnant women. In Nevada, Tess herself has applied for Medicaid in an attempt to seek MAT treatment.
Some things haven’t changed in the epilogue: Tess still faces bureaucratic hurdles that make it harder for her to get treatment, even during moments when she’s most willing.
Tess has made some troubling phone calls home where she seems to be high on meth and paranoid about “gang stalkers” out to kill her. She may or may not actually be involved with gangs, but she does seem to have a pimp. By December 2017, Tess seems better, making vague plans to come back to Roanoke for a stay at an abstinence-only treatment center. She hears about an early copy of Dopesick and asks to see it.
Tess’s family has no way of knowing whether Tess’s paranoid calls have any basis in fact or if they are brought on by drugs, once again showing how addiction keeps families in the dark. Even when she reaches her lowest points, however, Tess seems to have the ability to bounce back and suddenly decide she wants treatment. Macy portrays how the life of a heavy drug user is not necessarily one downward spiral, but often interspersed with moments of hope and clarity.
In the days leading up to Christmas, Tess sends Patricia scattered text messages, still vaguely promising to come home. She keeps putting off picking up her ID, which she’ll need to come home to Roanoke.
Tess’s behavior seems to be encouraging. The fact that she is communicating with Patricia at all is a good sign. Unfortunately, as Macy has shown previously, sometimes people struggling with addiction hit their lowest moments right when they are on the brink of a change.
The morning after Christmas, Patricia gets a call from the Las Vegas police department. Someone has discovered Tess’s body, naked and in a plastic bag, with blunt head trauma. The body and plastic bag are partially burned. The sensational nature of the death causes it to make national news. Just like the U.S. itself is divided in its response to the opioid crisis, Tess’s grieving family is also divided, despite everyone’s good intentions.
Tess’s death is shocking, both for its suddenness and for its violence. Like many of the deaths chronicled in Dopesick, it raises questions that may never be answered, particularly about the circumstances leading up to Tess’s death. Macy does not pretend to have these answers; she sets forth the information available while acknowledging that in some ways the stories of people like Tess will remain incomplete.
Police investigate potential gang connections to Tess’s death. Tess’s body finally comes home to Roanoke on December 30, 2017. It takes two days to make the body presentable for a viewing, in part because her head was shaved in order to collect evidence. Patricia sees the body on January 2nd, which would have been Tess’s 29th birthday. Inside her daughter’s vest, she puts a picture of her son, some of her dog’s hair, and a sand dollar.
Macy ends the epilogue by showing Patricia standing over the body of her dead daughter—perhaps the starkest illustration so far of the awful human toll of the opioid epidemic. The end of the epilogue is significantly less hopeful than the ending of the final proper chapter, although the two sentiments don’t necessarily contradict each other. Arguably, the solemnity and grief that end the epilogue only provide greater urgency to the call to action in the final chapter.