And now from the University of Chicago Institute of Politics and CNN Audio, The Axe Files with your host, David Axelrod.

You may not know the name Beth Macy, but you should because she’s one of our country’s most compelling and impactful journalists. Her book, “Dopesick” and the widely praised mini series on Hulu that was based on it, shined a bright light on the scourge of opioid addiction in America and on the predatory practices of a family owned pharmaceutical company, Purdue Pharma. That helped ignite it. Now best written a follow up book, “Raising Lazarus,” to share the stories of valiant efforts across the country to confront the drug crisis with effective, patient centered answers. Her brilliant work is infused with humanity and insights that flow from her remarkable story. I’m telling you, I love this conversation, and I hope you will, too. Here it is. Beth Macy, it’s good to see you.

Good to see you. Thanks for having me.

You grabbed me in an airport in Nashville. We were both waiting for a plane from Chicago. And I was so happy that you did because you’ve been so impactful as a journalist and as a as someone who grew up in journalism myself, I really appreciate what great journalism can do. So it’s a pleasure to meet you. But before we get into the stories that you’ve written, I really want to talk about your story because it seems so fundamental to the work that you’ve done. We’re all informed by our personal journey. So tell me about growing up in Urbana, Ohio, 45, 47 miles west of Columbus, Ohio, and about your life and your family.

Well, that’s a nice question. Yeah, I grew up in Urbana. It was a it was a manufacturing town when I was growing up. I’m 58. So what, in the sixties and seventies? And my dad was kind of dysfunctional. And from four generations of addiction, he was an alcoholic. And my mom kept the family together. She worked at the airplane light factory called Grimes Manufacturing, which sort of dominated the whole town. And then when she would get laid off because the economy would tank, she would pick up under the table jobs, just like the people I wrote about in “Factory Man” did. And so I’ve always had an eye for the underdog and the marginalized groups and, you know, probably throw working at newspapers before I realized that those are the stories that I wrote the best. And then, you know, by about 40, I had kind of the social capital at the paper where I then worked to pretty much just do those stories. And I had some really good editors. But I just want to say a minute about small towns because and also about the power of the Pell Grant. I was the first in my family to go to college. And I went solely on need-based financial aid, a few scholarships, you know, like the Kiwanis, you know, gave me a couple hundred bucks. But I had great teachers in a small town and school, and the library were places where a poor kid, you know, really gets a fair shake and is judged for for their merit. And, you know, in a small town, you know all kinds of people. I had a lifeguard job in my teenage years, and I was buddies with the judge who came to do his laps, you know, every day. And his wife was the librarian at the library down the street. And I had really great teachers that brought language alive for me.

Not to interrupt you, but in a great bit of foreshadowing, you also had a newspaper route.

Oh, yeah. Yeah, that was my first way to make money. Well, my grandma used to pay me to, she lived next door. She owned our house, which is like, probably the only thing that kept us from being homeless. She owned our house. And she worked at this dress shop downtown. And when dress me in these frilly clothes that he didn’t like. And so I was like, I’m going to buy my own clothes, I’m going to get paper route. And I did that for years. And then I worked my way up to lifeguarding at the city pool. And then I worked at that little newspaper when I was in college in the summers.

So before you advance your own story here. Talk to me a little bit about your dad and the impact of his alcoholism, because he, I guess he was a veteran when he worked he worked as a painter, but he didn’t work very much, apparently.

Not- by the time I came along they were like in their late thirties when they had me, which was quite unusual then. Everybody else’s parents were much younger. You know, he wasn’t home a lot. He wasn’t particularly mean drunk, although I certainly had some traumatic episodes from my childhood. But they’re kind of few and far between, mostly he was just absent and I was raised by my mom, who was this gritty, feisty, funny as hell person who could, like, stretch a dime like you would not believe.

And apparently you would go over to the VFW bar when your dad was working because your mom wanted to grab his check before.

He drank it up. So as a as a little girl, what, how did you process that?

Well, it was in a good mood and invite us in. And I would get a Coke and cashews, which I thought was really cool. But no. Like by the time I was old enough to get how shitty it was and how, you know, my other friends parents were like the freakin Brady Bunch. I was pretty resentful. I was kind of a wild teen and I was very embarrassed like one of my boyfriends saw him staggering home once from the bar and you know I’ve shared a lot of shame with it and I just wanted to get the hell out of there. And I did.

It’s interesting. And we’ll talk about this summer when we talk about “Dopesick.” But you obviously know a lot more about addiction now than you did then. And so much of what you’ve written and so much of what you’ve said is about how we think about people who are addicted. And we tend to think of it, and I think of this also in the mental health, mental illness realm, we tend to think of it as a stigma, as a mark on care of character or bad character. But it’s an illness.

It is. When you’re a kid, it’s hard to see that.

Of course. Of course. Well, it’s also hard to see if everybody around you believes that it’s a mark of bad character as well.

Yeah, I just felt like he wasn’t taking care of us, you know? And I knew there were times when he tried to get better. There were the little AA devotionals would appear in the house. And then one time he went away to treatment. And I didn’t even remember that. But after my mom died, I found this letter that she had written in Batesville, Indiana, where he had gone to dry out for a month or so. And that must have been like one of the times that the AA devotionals showed up afterwards. But I was just, wow, I didn’t know. Like, I don’t even know how they managed that. Whether my grandma bought it or his boss bought it, probably his boss was a good friend. He would give us money when we were really low and stuff like that.

You were the first to go to college in your family?

Yeah, I’m way younger than everyone else. They’re like 16, 13 and nine years older.

Uh huh. And what what moved you to go?

Well, I had really good teachers, and all my friends were going, and I was, like, none of them are smarter than me. And then I had this guidance counselor that told me there was this thing called the Pell Grant, which many years later, I would learn the story about how the Pell Grant came to be, which I’m still fascinated about this era when we cared about poor kids going to college, you know, in the sixties, LBJ and Senator Pell and you know, I got to meet him in his later years and testified before Congress. But I was just like, what? I can go for free? I mean, my grades were there. I was lucky, if they had told me earlier in my childhood that I could go for free if I got really good grades, I would have been a 4.0. But I wasn’t. I could’ve been, but I didn’t know.

But you went off to, so you went off to Bowling Green. How did you adjust to it? Did you feel comfortable there right away? Did you feel like you belonged?

It took me a minute. I’m one of these people that’s really lucky. I can drink a couple of beers and stop because I was kind of wild teenager. And I’m just lucky that I’m not an alcoholic. You know, it was a party school. The classes were great. I had a couple teachers that really kind of took me under their wing. I published my first national magazine piece.

Yeah I want to ask you about that. Youhad taken a course on magazine writing, did you know when you took that course, did you know? Yeah, I think I want to be a writer. I think I want to be a journalist. Or were you just kind of sampling different things?

No, I had already picked feature writing. And if you wanted to do feature writing, you met you majored in magazine.

And why did you pick that?

Cause I just thought there were, I liked news, but I really liked the stories that took you deeper into a story. Like, I didn’t really care about the breaking news, but the the issues that drove the breaking news were more interesting to me. And I also like being able to write, which I don’t now really get to, but being able to write about a variety of different things.

But why did you pick journalism writ large? Why was that appealing to you?

Because some teachers told me I was a really good writer and I liked reading and I really liked engaging with people one on one. My husband saysa fence post will talk to me if I talk to them long enough. Though I just, I was lucky. I picked it. I never changed and it just suited me.

Uh huh, yeah. You mentioned this essay you wrote, and you entered some sort of essay contest for Seventeen magazine and you wrote about your dad.

Yeah. And I had this teacher, Vicky Hesterman, who edited. It wasn’t a contest, actually, it was just a submission for this like point-of-view essay type thing. But she really wanted me to get them to accept my piece, which we didn’t said that much about the alcoholism. You know, she just really helped me with that. And I saw her last week they gave me an alumni award and she came to the ceremony. It was so moving to see those people that made such an influence.

I actually tried to find the piece that you wrote in Seventeen magazine. I didn’t find it, but what did you write, if you didn’t write about your dad’s alcoholism, what did you write?

Well, I did, I think I did write a little bit about it. But I remember her saying, let’s not go too much into this because everybody stigmatized it. Right. So I wrote about it a bit and I wrote about him getting lung cancer, the fact that we had a difficult relationship, and that I never told him I loved him. And I wrote about this last moment. I came to visit him. He had, this was early days of hospice. And the nurses were at our house. And I brought him, he was really, really skinny and this brown square from the radiation on his chest. And we had this really moving, almost like goodbye. And I gave him this Bowling Green Dad sweatshirt and he thanked me. And it was a sweet moment, but it was this idea of forgiveness and how I hadn’t really come around to it yet. It’s hard to forgive that.

Yeah, that’s also a hard thing for a young person to write.

Yeah, I would have been more honest, I think. But I remember she was holding me back. And again, that’s probably because of the stigma.

Mm hmm. And you went back and you worked in Columbus for some suburban newspapers around Columbus?

Yeah. Covering schools and the growth areas. And cops. And then I went down to Savannah to be a feature writer. And then I moved Roanoke. And I was never going to stay in Roanoke because I was going to move up to bigger and better place. And, like, it just got me. First time I went to the grocery, the lady at the checkout goes, “what are you gonna fix with this?” You know, they’re just so friendly in Roanoke, and it’s a great place to raise a kid.

Talk about how you said you really gravitated to longform writing because you wanted to dove in deeper. How did you develop your journalism? How did you develop this? Because, you know, one of the things that animates your work is just how close you get to your subjects. I mean, to the point where you bring them to life. Tell me how you evolved as a, as a writer.

The first piece I ever wrote. Ironically, now that I think about, I never thought about like this before. It won a national award. It was a profile of a recovering alcoholic who had been a sportswriter at the paper. And he was this just wild, larger than life person who had become a developer downtown at the time that downtown was turning from this kind of seedy place, and it was reinventing itself. And, you know, he got fired when he got caught covering a sports game from the local bar watching it on TV. And so there were all these and no one thought he was worthy in the newsroom because they knew him as this crazy guy. And I was like, I saw him as this guy with this great, you know, second chance story. His name’s Dave Mudcat Saunders. He became a political consultant.

Crazy, isn’t he? So with the material, like they didn’t want me to do the story. And I’m like, this guy is pure gold. Like, everybody’s written about him now. But that was the first piece I ever-

Yeah. And I love bringing people to life. I mean, the lead of that story I just had fun with and I was able to get my own voice in and some of the exchanges that, he would call me all the time. Did you call Governor Wilder about me yet? What did he say? You know, and just he was so rich as a as a person to write about. I just, really funny and uh, I remember-

Smart as hell and he will call his mother, he was like the first person I knew that had a car phone and call his mother on the way over to her house and said, will you fix me a hamburger? And I just love stories like that. Like that just makes me like really understand that person.

Let me just say parenthetically, as someone who filed a few pieces from saloons, that should not exclude someone from working in journalism, some of the best stories ever written were dictated from a from a saloon somewhere. So. But he found, he found a better use for himself anyway I think.

Yeah, he sure did. He’s helped a lot of people too. He prefers to go to the AA meetings in town that are of the poorer neighborhoods. You know, he keeps it real. I run in to him from time to time.

It took a while for you to move to books. You got a Nieman Fellowship and you went off to Harvard and you came back with a resolve to to write a book. And the book you wrote the first book you wrote is called “Factory Man: How One Furniture Maker Battled Offshoring, Stayed Local – and Helped Save an American Town.” But the larger sort of motif, light motif of this is about what what’s happened to small towns in America and talk about that and what the whole offshoring of jobs did to towns. And I don’t know whether your town was affected by that, Urbana where you grew up, but.

Yeah, it was it was affected like in the earlier round. It got, Grimes eventually got bought out by Honeywell, you know, this big international conglomerate. And the people that did my mom’s jobs, which she soldered airplane lines like that was then done by machines and it just employed far fewer people.

And but Urbana was kind of one of those. Also, rural towns. I think rural places that have more than one industry end up doing better. Post globalization, I mean, it’s doing okay. Okay. It’s not like Martinsville, Virginia, which is the town that inspires factory man. And I really I was working with this freelance photographer who had been at the paper and he self fit seeing himself to to document the aftermath of globalization and Martinsville and and we met at a bar and we decided to pair up together and I got my editor of the paper on board to let us work together, which is very unusual. He was being funded by some journalism foundation at the time and he had already made a bunch of connections down, it was about an hour away, so we just started going down there to say, What’s it like when half of the jobs go away? Not just the textile and the furniture jobs, but all the little places where those folks show the money before the diners and mom and pops?

I don’t think that’s well understood. You know, there’s a whole chain affected when a factory goes down or when jobs go away. And so the diner and the stores and everything downstream gets affected as well.

Absolutely. And when I started interviewing them, it reminded me of when my mom would get laid off and have to pick up under the table jobs. You know, when I was little and a person would give me their cell phone number and they’d be like, oh, it’s about to get cut off. Here’s my mom’s cell phone number instead. And so I tell students that when your, when your own values and your own story sort of intersect what you’re trying to write about, that’s when I think your writing most comes alive. And there’s this moment, I don’t know if you’ve read “Factory Man,” at the end where I’m taking one last pass or Bassett, Virginia, the town that only existed because of that company. And now it’s just basically old folks there and no businesses at all. Well, maybe one Bassett Industries building and a bank and this guy is putting a bunch of bricks into a culvert and the bricks are the bricks from Bassett Superior Lines and people are coming back and they’re taking souvenir bricks. And that’s what it that’s what it meant to those people. And the bricks are still warm from the sun. And it reminded me of those people and my mom. And it’s this really complex story where nobody ends up mining the back room of this new global store. Right. You know, it’s oh, it’s going to be good. It’s a win-win. President Clinton said, you know, it’ll, everybody will benefit. But in fact, in that, in Martinsville and Bassett in that county, you know, they had had the highest unemployment rate for a dozen years. Food stamps tripled. Disability rates had gone up to 64.1% just since China joined the WTO. And it wasn’t a win-win. It’s, I don’t know if it’s ever going to be a win-win. And at the end of that, my research, heroine related crime started going through the roof. And that’s when I got the clue that like, oh, this has taken over these small towns.

We’re going to take a short break and we’ll be right back with more of The Axe Files. And now back to the show. These places also became kind of a hub of Trumpism. And talk to me about that and about sort of the sense of abandonment that made these folks so receptive to Trump and how it’s changed our politics.

Yeah, I mean, I go into quite a bit of deep, depth in that in “Factory Man,” of course that’s pre-Trump on that came out in ’14. But you saw these communities just really implode. Crime going up and people are blaming the victims. Basically, these are the same areas where Purdue and other companies.

Yeah. The maker of OxyContin targeted and proliferating with pill mills. And so that desperate people are still going to have to survive. And so a lot of people started doctor shopping and using the sales of the pills they were getting because so many people were addicted as a way to pay their other bills. And I want to talk about the TAA, which is super wonky, Trade Adjustment Assistance.

Yeah, right. That was offered as a panacea somehow for all of these massive dislocations that globalization was causing. And it didn’t.

It didn’t. Only a third of the dislocated workers even took them up on it.

This was supposed to be aid to help workers make the conversion to something else when their jobs went away, essentially.

Yeah, but like a lot of people took like, oh, I’ll become a paralegal and there was maybe one paralegal job in that town. And everybody says, why don’t they just moved to Roanoke or moved to a better place or move to Greensboro? They don’t want to move. And they’ve got family members and kids and elderly relatives that people, all over the world where that’s happened, people haven’t moved. And it was like they had never interviewed a dislocated worker. Whoever was running that program, I mean, it was, you had to be in school full time to do it. There were all these really onerous things and how are you going to work even at a gas station and pay your rent if you were going to school full time? It was really crazy. And so-

And also people I mean, I hear it in focus groups all the time, people saying, you know, trade for what? Where am I going to go? It’s your point. Where am I going to get a job like that around here? And, you know, they were really, really bitter about it.

Very bitter. And, you know, a lot of that was done under the Clinton administration and China joining the WTO. And just a lot of anger. And one of the first places I went when I was hanging out with that photographer, Jared Soaries, is he took me to a food pantry and they were dispensing the food on what I was like, what is that? It looked like a conveyor belt and it was an old textile mill conveyor belt that they had converted in a food distribution device. And I thought, what? That says it all, doesn’t it? And you could tell what people used to do by their disfigurements. Women who had spent years over sewing machines making sweatshirts were hunchback, and some of the men were missing fingers who had worked in furniture factories. And it was the last, last place to come and get a box of old food.

Yeah. I think one of the things that’s happened in our politics and in our society is you do have a hard division between sort of metropolitan college educated folks and people in small towns and rural areas who’s, a bunch of whom haven’t didn’t go to college, work with their hands, work with their backs, doing stuff that in pandemics we call essential work, but we don’t respect most of the other most of the rest of the time. And they know that. They sense that. So just finish the point on this, because we got to get to the, I want to get back to the heroin and, you know, and OxyContin scourge. But how, what then is the appeal of sort of right wing populism, Trumpism, to the folks that you covered and probably to some of the folks you left behind in Urbana?

Yeah. Yeah, you’re right. I mean, I think they really believed him that he was going to, you know, stop the coal mines closing, stop the bring offshore jobs, bring them back. And he didn’t. And he also did a lot of kind of racial dog whistling that appeal to some folks. That’s just, you know, which has been going on since the start of our country. And that’s just so sad. And and yet, when you look at their towns and how they have changed and disintegrated, you really do go, oh, what the hell, Democrats? Like what did you do for these people? You know, in a lot of small towns, I report on for “Raising Lazarus,” you know, the media-

That’s your latest book, yeah.

Yeah. It’s about the solutions. And it’s the median has declined, so nobody’s really telling the stories. Then you’ve got social media coming in and people are only reading things they already agree with, which aren’t necessarily right. And my own relatives called The New York Times the fake news. And I’m like, I have written for The New York Times. You would not believe the fact-checking at The New York Times.

Right, yeah, I have as well.

You say your mom’s name’s Sarah Macy, they’re going to, like, want to see your birth certificate. Practically everything is fact checked. And they and yet they believe these things that are not fact-checked.

Yeah. This issue of I wanted to ask you about journalism, local journalism, because you worked for you know, you’ve spent your life and working for local news. It’s a desperate situation in many communities in this country. Local newspapers have died. And, you know, people are getting their information primarily from sites on the Internet. It’s it’s a tragic situation.

It really is. And I don’t think we were reporting on ourselves very well either. My next book, if I want to, I want to write a memoir next, but I want to analyze that decline. And, you know, you go to a small town like where I’m from. I mean, it was never very big paper, but all that’s left is crime and sports. So when you have just crime, I mean, even The Roanoke Times, it’s a lot of crime court because it’s easy stuff to get and they’re not reimagining for a while we had a really great website and then we got bought by venture capitalists and all this kind of stuff that just wanted the building, the downtown building, and there’s just nobody telling it other than, you know, there’s some nonprofit startups. And I’m involved in them one of them and that’s a good sign. And they point out that in all of Virginia, there was no full time education reporter west of Richmond, which is half the state. There is no full time health reporter. Education reporter. It’s really dire because we don’t even know what we’re missing.

Yeah. Yeah. And we’re not. I mean, as with television and so on, we’re so fractionated that we’re just having different conversations. You know, when, when you have a hometown newspaper and everybody’s reading it, then you can discuss what’s in that paper and you have some basis for a common understanding. There’s, there’s not that. I just wanted to underline that because I think it’s something that is not just a threat to journalism. I mean, what you said before, all the downstream damage of a changing economy, this is one of those that’s not just a threat to journalism. It’s actually a threat to democracy. It’s you know, and it’s one that that we need to urgently address. We also need to urgently address the addiction issue and talk to me about how that evolved. I was curious. I read that you had actually gone to your publisher and pitched a book on the whole issue of addiction and how it was ravaging communities, and they were reluctant. You wrote an intermediate intervening book because when you first pitched the idea, it was like, I don’t know.

Yeah, it was my gatekeepers in New York. It was both my then-agent and my then-editor. And I told them both because they had just briefly gone back to the Roanoke Times and I did this three part series on the fact that heroin was taking over, not the inner city, but the the wealthy suburbs and readers kind of split their copy out. And I was as I was talking, because there’s a one year gap between when you turn a book in and when it comes out. I was trying to pitch in because I wanted to sell that second book, so I had quit my job altogether and I eventually did. But it wasn’t the one I saw happening, which was like, it’s heroin is in not just Martinsville, Virginia, but it’s also in Hidden Valley, which is the cover of “Dopesick” is this beautiful cookie cutter McMansion type neighborhood. Like, we got a problem here. And I knew because I remember that the prosecutor interviewed who was sending the one kid away to federal prison for five years for his role in his private school, classmates dead that those two kids alone were using and dealing with 50 different kids in that neighborhood. And so it wasn’t it was like that was just the tip of the iceberg that made the front page, the paper that there is this huge iceberg underneath. And I knew it wasn’t an easy fix. Kids weren’t going to just stop using that. This fear of withdrawal that first. Yet. I interviewed the one who was going to prison, taught me the word dope sick he said, if you’re dope, if you’ve got X amount of heroin and your dope man isn’t coming out next Thursday, you’re going to pass it out with a little bit each day until you get to see him again. Because the worst thing in the world is to be in withdrawal. It’s like the worst flu times 100. You’re on the toilet, you’re you’re so sick, you can’t even imagine. And he came he came to the premiere of the Hulu show, our little independent movie theater in Roanoke. And he’s like, I taught you that word.

This raises the issue of I mentioned earlier about you getting close to your subjects. It’s very obvious that, you know, you lived this with people. You tried to get as close to it as you could, and you got close to some of the young people, some of whom lived and some of whom didn’t. You did an audio book about one of them, Tess Henry, who was a subject in in “Dopesick.” And you were in her mother, I guess, did an audio book together about what happened to her. Talk a little bit about about her.

Yes. It was an audible original podcast called “Finding Tess” and I met her in 2015. Once I finally got the agent and editor on board with the fact that we were in the middle of this heroin crisis. You know, three years later, I met her and she dad was a surgeon. Raymond, the hospital nurse should have had every, you know, thing to help her get better. And she was just struggling. She just had a baby, learned she was pregnant while in jail because she was stealing stat in order to buy heroin. And I just asked her if I could hang out with there because I knew I’d learn a lot about her. And she told me how she had gotten originally addicted to it at an urgent care center by two 30 day prescriptions.

Well, it was different opioids, actually, in in her case. And then she quickly found OxyContin on the streets. And when the OxyContin got hard to get, her drug dealer showed her how to snort heroin, which is just like how she snorted oxy and then or hydrocodone. And then she started injecting when that when the snorting didn’t keep her from me nurse sick and she just was somebody that had all kinds of barriers. She couldn’t get on Matty. There was a waiting list. It cost $500 for the first visit. Virginia hadn’t yet passed Medicaid. You know, one place would only see her if she tried their counseling first and failed, would only then let her get on her buprenorphine, which is medication assisted treatment, the gold standard of care. But there’s a lot of stigma around it. And so I knew she might eventually end up overdosed, but and rather instead, as a sort of a last ditch effort, her grandfather paid for her to go to an abstinence only rehab in Las Vegas. And when she bombed out of that because she couldn’t withstand the cravings without buprenorphine, she was then homeless and doing sex works on the streets of Las Vegas. And she was murdered on Christmas Eve in 2017. And talk about like giving a call. Her mother didn’t find out till Christmas Day. I got a call on the day after. I think she’d just found out that morning. Actually, it took a while to identify her body, and here’s her mother crying. And every detail that came in that day was worse than the last note. Her body’s found in a dumpster. Her body had been burned. She was naked. I mean, it was just like, oh, my God. And I had already finished the book. But, you know, I had time to rewrite the end, and kind of as a journalist I had never been in that situation. And I called a friend of mine who had-

You you’re leaving out one detail. Didn’t she text you and ask you to go and ask you to come in and help her get out of there?

No, she had earlier when she had been on the streets in Roanoke, she had texted me and asked me to pick her up at a trap house.

Yeah. And my husband said- I always want to do that. Like when I needed her to get her material, I would driver in another meeting, but when she needed me my husband said, “You can’t do that. It could be dangerous.” And I didn’t do that. But I called her mother and her peer support person instead. But no, she, we had been texting maybe two weeks before her death about how hard she was trying to get home. She had already called ahead to the methadone clinic to sign up. That’s another gold standard medicine. She wanted to get custody of her son back. I mean, she’s a real, like, warrior, you know, she’s tough, street smart. Even though she had grown up with everything handed to her. She really had been on the streets for a long time at that point. And she was like, I’m looking forward to reading your book. Can I get an early copy? You know, I’m like, I’m rooting for you. And then she’s murdered. And it was just like, Oh my God. What do you do? What do you do? I just put my notebook down and. I mean, I was at the funeral helping your mother pick out an urn. I was at the funeral home when she said goodbye to her battered body, which they had. You know, they had done her up so her mom can say goodbye and her granddad. It was just three of us. And that’s the last image of the book. Her mother, like, tucking in pictures of her son and her favorite dogs. I think a lock of the dog hair, something she loved to rescue dogs. That was actually how I met her. A friend of mine just found her dog loose one day and called me and said, I return this dog to this woman. And she she didn’t know how to tell her it was her mother’s and had been taking care of the dog and she had to go to work and she didn’t know if she could leave her heroin addicted daughter at home, alone with her son. She didn’t know if she could trust her, take care of her baby son. And that’s how I met her.

What I wanted to ask you is I did a podcast with a friend of mine named Alex Kotlowitz, who wrote a book, “There Are No Children Here.” And he wrote a book about, he’s been very focused on violence in Chicago. And he, you know, was hanging around on the streets with gang bangers and people who were involved in in shootings and who were who were shot. And he told me that when he was writing the book and when he finished the book, he was deeply, deeply depressed. And he went to a therapist and the therapist said, you’ve got secondary PTSD. You’ve gotten so close to this that you’re experiencing it as if you were, you know, part of this. And you get, you know, stories like Tess’s make me, you know, have to ask you, how did you deal with all of that?

Obviously, you’re obviously a very feeling person.

Yeah. And, yeah, my blood pressure went way up. I went to my doctor. He thought I had PTSD, sent me to a psychiatrist who said it’s probably secondary trauma. And I work with this group called the Dart Society for Trauma Journalists, I’ve done their programs. And so I knew about it. And then the psychiatrist said, you have probably secondary, but you’re just depressed and anxious, you know, and for some medication. And, you know, also said you should write about this some happier things, which I used to be able to do it. I was a feature writer. And though it was, I had to go around talking about the book. My blood pressure came down to stop that madness. And then I started hearing about really good things that were happening and innovative things that were happening in the addiction realm and even law enforcement. And I wanted to, that felt like a helper story. You know, Mr. Rogers says find the helper, find the helpers when you’re scared. And so the new book was much easier to write because I was writing about the people that I was one generation removed you know from the the pain.

So yeah. So therapeutic for you in a way.

Totally. Yeah. I feel like, especially at the time when the settlement money is coming down and a lot of communities don’t even know what to do with it, I’m worried that it’s going to go to abstinence only treatment, all the things that failed test incarceration, first models. And so it seems like a time for the nation to see like they’re outliers. They’re all outliers. It’s few and far between. But people who really have figured out how to reach this really hard to reach population that has been stigmatized for so long. They’re most of them aren’t in our health care systems or any of our systems other than criminal justice and how to help them not die.

We’re going to take a short break and we’ll be right back with more of The Axe Files. And now back to the show. Part of your reporting led you to this this pharmaceutical company, Purdue Pharma. Tell me how that how you unravel that and what you what you learned.

Yeah. So the first third of “Dopesick,” the book is I always want to go back, just like I did in “Factory Man.” I want to go back to these community meetings and let’s see how they’re doing now. And so I took our former reporter who had covered OxyContin. I want at first bubbled up as a real problem with crime and the coalfields of Virginia, you know, and across the border in Kentucky and West Virginia. And his name was Lawrence Hammonds. I took him up for coffee when I started working on “Dopesick” and they said, I read, reread the stories, tell me who you think I should talk to. And he’s like, Well, you have to go back to this Catholic nun activist who was like, took Purdue on and fire away. You know, she’s like four feet ten and in her eighties and she’s still counseling every day for 12 hours a day. And you’ve got to call this doctor, Dr. Art Van Zee. He was the four from Lee County, which is the westernmost county in Virginia. And you’ve got to call him because he was the first person to actually pick up the phone to Purdue and say, look, I know it says you drug is virtually non addictive, but I’ve got kids I immunized in my practice who are overdosing in the library at high school and that farmers who’ve been they’ve had competing opioids before because of injuries but they get on on second they lose everything. They lose their truck, their family, their farm, everything. They say that drug became my god, and they just blew him off as some kook from Appalachia. They you know, there’s this scene in Dan Strong’s Hulu show, the show I worked on based on “Dopesick.”

“Dopesick,” wonderful series.

Where Richard can’t even get West Virginia and Virginia right. You know, it’s just like he’s so looking down his nose at it and there’s a doctor and nun from Appalachia.

Richard Sackler from Purdue Pharma.

Yeah. Who really was the driving force behind this this lie that OxyContin was safe. So I and I love a battle story. So I go back to Sister Beth, Doctor Van Zee other some of the first parents of the dead are a big part of the book. And I play that story out and you see that that’s the part of the story that really gets the most attention. And the Hulu show is the fight against Purdue, as well as like the Michael Keaton character. He’s, that’s based on a doctor-

Who just just won an Emmy for his performance in Dopesick. Phenomenal, phenomenal performance.

So good to see an A-list actor like Mike Michael Keaton. And this is his is kind of part Dr. Van Zee part this doctor I found a Tennessee named Steve Lloyd who actually did get addicted. And then to see him with his social capital, the character struggled to get on buprenorphine, struggled to get on methadone and then come back as a guiding force. It’s it’s a lot like what Dr. Steve did and and also like, you know, Dr. Van Zee. So that was really cool and getting to recreate the scenes like the sentencing hearing in 2007. And that was another thing Lawrence had told me about. He was there that the reporter and he goes, there was this moment I’ll never forget. I’m like getting teary just telling you. But there’s this parent that brought, snuck, smuggled her son’s ashes into the courtroom that and like you know waved at the executives and said, this is this is your drug and this is what you did to my son and just very moving. And I was so glad we were able to really put the onus on who the criminals are in the in the show. And a lot of people read the book. It won an award. It was on the bestseller list. But millions of people watched the show and some of them reached out to say, you know, I called my addicted son for the first time in three years. And and that was really moving because we got to we’re going to knock the stigma down.

Yeah. And put the onus where it belongs. Do you think Purdue Pharma ultimately agreed to a $6 billion settlement and then used bankruptcy as a tool to- go ahead, talk to me. You’re shaking your head.

Did they file for bankruptcy? First, they agreed to a $3 billion settlement. Then they filed for bankruptcy to get themselves out of the super wonky, which they love to get them out of this multidistrict litigation in Cleveland. They’ve filed for bankruptcy, not in Connecticut, where they’re based, but in this one jurisdiction in white Plains, New York, because there’s one judge, bankruptcy judge, who’s known to favor third party releases, which is the great loophole that they use to be able to retain large part of their wealth and to wipe out all the 4000 civil lawsuits against them. It doesn’t protect them from criminal suits. So a lot of the parents are still very hopeful that the DOJ will bring justice because they’re now recidivist criminals. After ’07 Which is where our show ends, you know, these three executives who like basically took the hit for the Sacklers and were paid richly for it. You know, they doubled down. They hired McKinsey to teach them how to go around the rules that they said they would abide by. And they, their best sales year was the year after the settlement. And then so they get them again. The Justice Department gets them again for another settlement in 2020. That’s. And so that’s kind of wrapped up in the bankruptcy. The hope is because the bankruptcy is currently on appeal. The judge said the sacklers and they said the bankruptcy judge doesn’t have a right to tell Ed Bish and other parents of the dead that they can’t sue the sacklers that that’s unconstitutional. And now it’s at the Second Circuit Court for second appellate level, and the next level would be the Supreme Court. So, you know, a lot of the communities need this money. They need the $6 billion. So they’ve set up this site, a Sophie’s Choice between like justice and abatement. But unless somebody goes to jail, like what’s going to keep another millionaire from wanting to become a billionaire and do the same thing, knowing they could just pay a fine and come out of it? I really hope the DOJ indicts the Sackler might let them say that.

Yeah, well, you’ve it’s a you’ve got a First Amendment rights yourself, you know. So as long as you are talking talking about the law. You mention that you were prescribed medication when you needed it. There are appropriate uses for pain medications and so on. How do we balance those two things? How do we balance the need for, you know, and the utility of some of these medications and the sort of predatory practices and untruths that surrounded this drug that has created so much havoc but is still out there.

Yeah. Yeah. I mean, opiate opioids and even OxyContin are totally appropriate for cancer, end of life, post-surgery. But the thing that Purdue did is they said, oh, it’s it’s available. It’s safe to take long term for moderate pain. And so then you had kids getting it for wisdom, teeth, surgeries and, you know, back pain and all manner of things. And it wasn’t just the narrative around Oxy was narrative around all opioids because they infiltrated, you know, the the Jayco that, you know, the the governing body for hospitals. That said, unless you treat a person’s pain, you might lose your Medicare or Medicaid reimbursements. You know, they they changed the whole system by buying you know, buying people off, basically. I mean, at the root, that’s what they did. And but yeah. And then in ’16 the CDC writes a new guideline saying, you know, opioids should be a last stitch effort for moderate pain. Very last stitch. And so then a lot of doctors overreacted and took stable chronic pain patients who weren’t misusing the drug were using more, needing more every month. And, you know, a lot of those folks got just yanked off their meds and then they’re because they’re dependent, just like Tess was, and they’re going to go to the black market and get central and or commit suicide. And I hear from a lot of those folks every time I do an interview that they kind of come out angrily at me. And I’m trying to understand that. But the main thing is our doctors haven’t been trained how to deal with pain and addiction.

Is that too benign an attitude toward the doctors themselves who are prescribing? Because by now the pernicious effects of opioids are pretty well known. I mean, laymen know it. Doctors certainly know it. I mean, how much of a responsibility do doctors have in this whole sordid mess?

Well, it’s huge. They were lied to, of course, just like the Michael Keaton character was lied to. Well, what I say, cause I speak to them a lot in talks and I’ll say, I know not every one of you took a free trip to Arizona, Florida, to become a paid spokesman for Purdue Pharma. But you participated in a system that now has 7 million people, Americans, addicted to opioids. You, by golly, you oughta participate in the system to get them better. And and that’s that’s something we could talk about now to there’s this MAD Act up before Congress, which will basically take the waiver requirement of buprenorphine and, which we know is the gold standard of treatment. Only 8% of American doctors have bothered to become waivered because they don’t want these difficult patients in their waiting room. And that’s a real crime.

And you’ve said that it’s harder, that there are more obstacles to getting trained up to administer the treatment for addiction, then it’s much easier just to prescribe and walk away.

Yeah, and it’s much easier for the patient to go get dope than it is to get the treatment much easier. And I was talking to Dr. Gupta, the drug czar, on Friday, and he said of the 8%, only about 20% of them even actually prescribe like they get a waiver. And then they don’t do it because they really they don’t want the difficult patients. So hospital systems need to change. And you know, I profile in the new book this and in the finding test podcast, the head of our ED in our big hospital system in the western Virginia, it’s called Carilion. You know, he at the beginning, he thinks it’s just treating a drug with another drug. It’s not as jobs import tests have been in to his head numerous times for abscesses and overdoses. And now he got all, in one week because the person in power changed his mind, got all of his docs waiver. And now when you get, somebody like Tess goes in there, they get connected with a peer, they get on buprenorphine, they get connected to an outpatient, counseling and it’s happening and you should hear his voice in the way he’s changed. He’s not hopeless about it.

Yeah. And you, you have a series of stories in your new book about hopeful things that are being done all over the country. How do you, how do you bring these to scale?

Well, that’s what I was trying to get with Dr. Gupta. I think the first thing is make the MOUD, the medications for opioid use disorder, scale that up. The first thing is to get rid of that waiver requirement, which is, you know, designed, it’s stigmatized drug users all over and the prescriber.

Explain the waiver and what it requires.

Yeah the waiver requires of physicians and nurse practitioners to get eight or 16 hours of training to get a special DEA dispensation. And then they’re only allowed to see a certain number of patients until they’ve been doing it for a couple of years. And then still they’re capped at 275, right? So getting this mainstreaming addiction treatment, this MAT Act that’s currently in the Senate would take that requirement away. And so just like any doctor can prescribe OxyContin now, any doctor, if this passes, will be able to prescribe buprenorphine, which would be a huge thing. And then I think we need to get a lot of money to harm reduction groups that are already on the ground, that are meaning people in ten encampments and McDonald’s parking lawns to get them into systems of care because the largest group of people, 40% with OUD, don’t want to stop using. They don’t trust the system. So they’ve been treated like dirt when they have gone to the hospital and the harm reductionists these are people that do mobile needle exchanges and give out safe use kits, Narcan, they begin to build trust. And we know the people that work with them are five times more likely to enter treatment than folks that don’t. So I’m really hoping that the settlement monies goes first to the the groups on the ground that are doing that as well as to like, you know, the law enforcement innovators who aren’t just putting people in jail because we know that doesn’t work. They’re just going to come back.

Yeah. I mean, this is a huge issue, that sort of criminalization of addiction. We’ve got prisons filled with people who have addiction issues and rather than getting diverted to treatment programs, they wind up in prison and end up on the streets again, just repeating the same behavior.

With a more poisoned drug supply, you know, and they come out and they’re opioid naive and then they get heroin and go back to their old dosage and now has fentanyl in it or it’s just all fentanyl and they die there, too. I forget how many times, it’s it’s many, many more times likely to die when they come out of prison.

Yeah. So I want to ask you just I want to return to the beginning of our discussion about your dad. Once you started delving into this world, did you have greater insight into your dad’s own addiction, alcoholism, or are there things that you would have liked to have known then? Are there things that you would have liked to have done then? Are there things you would have told him?

Hmm. Well, you’re getting deep, Axe.

And I guess I would have liked to have had some support around that. You know, there’s just this town of Huntington, West Virginia, has which has been just socked by this crisis. They have a recovery themed high schools now. And if a kid is having a bad day because their parent is addicted and they’re struggling, like they can just kind of check themselves out and go talk to people. I would have been a wonderful thing I didn’t know Liam Neath. I just thought he was a loser who didn’t take care of his family. I mean, he embarrassed me when he did talk to me. He wasn’t very nice. I mean, I think there were years probably that we didn’t even talk to each other in the same house. I just viewed him as a nonentity, which is really sad. I mean, my husband is the best dad in the world. And there were moments when the kids were little and I was like, wow, this is what a good dad does. And it would just piss me off all over again, you know, and any of that. And this amazing uncle who was was a former editor of the newspaper that hired me, we just had his celebration of life on Saturday. He was more of a father to me than my own dad ever was. Back then, I mean, that was when the drug war was really kicking up. There was really no sympathy. And to see that letter that my mom wrote after she died, you know, it was so lovely and. You know, just a little bit. It’s on how the kids were doing and, you know, and then he wrote her back and he had dropped out of high school or junior high. And, you know, his spelling was atrocious. And to see that, like he was trying too, he was trying to get better, he just didn’t have the tools. You don’t have the access.

Well, Beth, one thing that I’m sure of is that the things you’re doing are going to make a big difference in other people’s lives, other kids, other parents. And the reason I was so excited to have you is I believe so deeply in journalism as a force to bring about change. Yeah. And you’ve you are doing that the work that you’ve done, your book, the Hulu series that flowed from it. It is raising people’s consciousness. It is changing the dialog. It is creating movement. And that’s journalism at its best.

Thank you. That means a lot.

It’s an honor to be with you. And I look forward to reading this book, but also to your memoir and to you doing what you can to make sure that there are other journalists down the line in small towns and rural areas who will shine a bright light that we need show.

Yeah. Thank you. Thank you for the great questions.

Thank you for listening to The Axe Files brought to you by the University of Chicago Institute of Politics and CNN Audio. The executive producer of the show is Allyson Siegal. The show is also produced by Miriam Fender Annenberg, Jeff Fox and Hannah Grace McDonald. And special thanks to our partners at CNN, including Rafeena Ahmad and Megan Marcus. For more programing from the GOP, visit politics.uchicago.edu.