Raising Lazarus: Hope, Justice, and the Future of America's Overdose Crisis

Raising Lazarus: Hope, Justice, and the Future of America's Overdose Crisis by Beth Macy, Little Brown and Company 

Beth Macy’s Dopesick is one of those books that never leaves you. The book’s ending, especially—when one of the people stricken with opioid use disorder, who we get to know well in the book, is found dead in a Las Vegas dumpster—is forever seared in my memory. It is a tragic human ending, but also a literalization of the way our society has discarded drug users over the last two decades as the opioid epidemic devastated so many communities.  

There have been too many who have died, so many families affected, and so much pain and suffering. Macy does not keep any of it at arm’s length. Her empathy is deep, her feelings raw, her anger righteous, and her reportage in-depth and personal. In her new book, Raising Lazarus, she speaks about the individual who was literally discarded in that dumpster at the end of Dopesick as “my friend.” It seems she almost never writes her name without that preface. It is a reminder to us that she died not at the end of a book, but in real life, leaving behind friends and family who loved her dearly, after trying so hard to save herself in a country where finding long-term help is much more difficult than finding a short-term fix.  

As COVID hit, this now generations-old epidemic that we’ve tried to keep confined to the shadows for so long slammed into one that dominated every headline, with catastrophic consequences: 

Within the first pandemic year, the overdose count was 29 percent higher than the year before, and the numbers kept climbing. By late 2021, it was clear that addiction had become the No. 1 destroyer of families in our time, with almost a third of Americans reporting it as a serious cause of family strife, and drug overdoses claiming the lives of more than 100,000 Americans in a single year—more than from car crashes and guns combined.  

One million Americans have died of overdose since 1996, and that “is predicted to double by decade’s end.” But there is hope. There are people out there who have been battling the opioid epidemic on the frontlines for years. Perhaps I should be careful about using words like “battling” or “frontlines” and other war metaphors, though, because as Macy shows us in detail: 

The War on Drugs is a war on Black people and the poor. … It should be abolished.   

The racial disparity remains true even though White people use heroin and fentanyl “at far higher rates than Black people.” And what started as an epidemic in economically distressed Appalachia has since spread into nearly every zip code in America, afflicting even the affluent.  

The people who are making a real difference aren’t those going to war with drug users, but those providing services to them. They are meeting drug users where they are, and members of the broader community where they are, trying to change hearts and minds, trying to heal. They are handing out clean needles and test kits for fentanyl, HIV, and Hepatitis C. They are advocating for safe consumption sites and other spaces where those with opioid use disorder (OUD) can be reached, for counseling programs and treatment in prisons. In a tough love world, it is an approach backed by evidence: 

People who go to needle programs are five times more likely to enter treatment—because their needs are triaged by trusted workers who can help them enter treatment if and when they are ready. They’re also three times more likely to reduce or stop IV drug use. 

They are “peers”—former drug users turned counselors, advocates, and activists. They are parents who have lost their children, sisters who have lost their brothers. They are doctors, public health professionals, and religious leaders who have found their calling. They are members of law enforcement who know that, while they must hold people accountable for crimes they commit when they are in the desperate throes of addiction, they can also offer some assistance when they hold people in their jail cells—that they can treat their withdrawal symptoms and attempt to release them into treatment rather than back into a trap house. They are people not only building bridges between the addicted and the services they need but building bridges in the community to help heal relationships that were once adversarial. They do so with the understanding that stigmatization, punishment, and pushing people ever further into the shadows is not the solution. 

The idea that drug users are worthy human beings—that they are, in fact, equals—is harm reduction in a nutshell. 

They are people like the mother whose son was struggling with OUD at the same time that her best friend’s daughter was diagnosed with a brain tumor. She noticed how the community stepped up in support of her friend’s family, and she even led a cancer awareness campaign for a local Girl Scout troop on their behalf herself. When her son was hospitalized due to a life-threatening seizure he experienced as a result of Xanax withdrawal, there was no such support network. Instead, most of the advice to parents like her was to practice tough love or cut ties until their children were “ready” to get better. Noting how her friend “had not been told to let her daughter ‘hit rock bottom’ before taking to her to an oncologist,” she decided to take a more proactive approach based on harm reduction and care rather than tough love and stigmatization, and both her son and her friend’s daughter are considered “NED—no evidence of disease”—six year later.   

They are people like Reverend Michelle Mathis and her wife Karen Lowe, a biracial, lesbian couple who started Olive Branch Ministries in conservative, rural North Carolina. They “started out offering food and hygiene supplies to the region’s homeless from the back of their card in 2009” and have since built one of the most successful outreaches to those struggling with addiction, in part by enlisting the communities—including law enforcement—that surround them in the effort. 

As the Reverend Michelle Mathis … described it: Those who get close enough to people who use drugs may get to personally witness the miracle of wellness—but only if they first answer the call. As with the disciples who unwrapped a raised-from-the-dead Lazarus at Jesus’s command, Rev. Mathis explained, “It doesn’t always smell like flowers, and you might get a little something on you. But the people who are willing to work at the face-to-face level get to see the miracle and look it in the eye.” 

It seems so straightforward. People are more likely to try to save themselves if they feel loved and valued—if others are actively trying to save them, as well. If this attitude were to become more systematic, it would go a long way to getting people off the streets and out of trap houses and into treatment. One of the reasons it isn’t already is hidden in the last paragraph. Xanax is, of course, a patented pharmaceutical that is regularly abused. And the makers of the drug that is most responsible for igniting the opioid epidemic, OxyContin, ran a very effective campaign to place the blame for abuse of their highly addictive drug on patients rather than on the fact that their drug was, in fact, highly addictive.  

For a fuller story of how the epidemic started and the many ways in which the makers of OxyContin—Purdue Pharma, and the Sackler family that owned it—are responsible for it, Macy’s Dopesick is a must read (or a must watch, as it has been turned into a Peabody Award winning television series starring Michael Keaton and Rosario Dawson, if you prefer it that way). What it reveals is that, even if they found ways to make it legal, Purdue Pharma may be the biggest drug pusher in US history, responsible for a generation of misery after its murderous campaign of pushing pills on rural Appalachian Americans who had worked physically debilitating jobs that were disappearing and leaving economic pain to compound the physical pain they were experiencing from that hard work.   

Given that the US government was also trying to recover the $12 billion that Joaquin “El Chapo” Guzman had made in illicit heroin sales, why shouldn’t it also redistribute the $12 billion made by the Sacklers to taxpayers harmed by OxyContin? 

It should also be noted that kingpins like El Chapo would not have nearly as large a market to push heroin and other drugs into were it not for Oxycontin and other perfectly legal drugs being pushed by large pharmaceutical companies that got people hooked on opioids. At first, people only turned to heroin when they could no longer find or afford Oxy. Twenty years into the epidemic, we now have a generation of Americans who started on heroin. And, unfortunately: 

Whether we realize it or not, most of us continue blaming the victims rather than the corporations, politicians, and impotent regulators who allowed the wealthy to poison our nation. 

But blame won’t take us very far even if properly appointed. People should be held accountable for the harm they’ve caused, but blame is punitive, and we need to shift the paradigm to harm-reduction. We need to address the epidemic as the public health issue that it is. If Gavin Newsom had read Raising Lazarus when it was released last week, I think there is zero chance he would have vetoed the bill this week that would have allowed for safe injection sites in California. Reading the news as I was in the middle of the book, I found it to be a tragic, depressing decision.  

Macy tells us in the Epilogue of the book that she “was so depressed” when she finished Dopesick that a minister friend of hers was compelled to remind her that “not everyone is a heroin user, Beth.” I am already prone to melancholy myself, but I have to admit that I was depressed for days myself after just reading the book. Things felt, and feel, bleak because they are, and it is time we stop blaming the victims of this crisis for it. This is a public health issue, and it is time we support—with public dollars—the compassionate, service-oriented individuals who have been doing the work on the ground and back and evidence-based programs with proven success. We need to get public policy to follow in the footsteps of people like Sister Beth Davies, who we first got to know in Dopesick.  

Since the crisis began, Sister Beth Davies has epitomized the best of what a servant-leader should be. Hers should be one of the most stable organizations in the entire recovery movement. But she is eighty-eight years old, works too many fucking hours, and is in danger of getting her lights cut off while the Sacklers’ light bill is paid for a thousand years in advance.  

Her supporters have taken to starting a GoFundMe campaign in support of the center’s work. It echoes the all-too common GoFundMe campaigns we all see when someone in our community is stricken with a terminal disease or surprise medical expense. That we need to so often crowdfund money in the world’s wealthiest country when our friends get sick is not only an odd paradox, but a national disgrace. Macy notes another:  

It is a worrisome paradox that our nation, which leads the world in medical research spending, has among the world’s worst outcomes for addiction and mental health.  

We can do better. Raising Lazarus gives us examples of people working with a mindset and set of proven practices for exactly how we can do better and concludes with some ways we can level up those successes systemically. I hope it gets turned into a television series that acts as a follow up and companion to Dopesick. But, more importantly, I hope it gets turned into legislation.