Beth Macy's "Raising Lazarus" highlights those on the front lines of harm reduction

Author Beth Macy’s latest book, “Raising Lazarus: Hope, Justice, and the Future of America’s Overdose Crisis,” documents those who are on the ground working in harm reduction across the United States. Woven throughout these profiles, Macy also dives into the intricacies of the litigation aimed at holding Purdue Pharma and the Sackler family accountable. 

WFDD’s Bethany Chafin spoke with the author prior to her appearance at the WFDD Book Club.

Interview Highlights

On how opioids affect the brain:

"So opioids are different from other classes of drug in that we all make natural opioids. ... And what prescribed opioids do — they're called exogenous opioids — is they flood the opioid receptors with way more opioids than is naturally made in the body. And so when oxycontin or heroin flood those receptors, what happens is the body quickly gets used to having that receptor being flooded, and so if you don't have them, basically, your normal amount of opioids that we make in the body don't work anymore. And so if they don't have them, what they have is not only crushing anxiety and depression but also this physical withdrawal, which every person I've interviewed describes as like the worst flu times 100; it's diarrhea, nausea, restless leg, vomiting. And they're not going to die from it generally, but it becomes this outsized fear of withdrawal."

On what the treatment landscape looks like:

"Basically, we have an 87% treatment gap, which means that only 13% of people have been able to access any treatment at all in the last year. Now we know that buprenorphine and methadone are the gold standard of care for people with opioid use disorder. But because addiction was always kind of a stepchild, not held within our healthcare system, because we don't have universal healthcare ... Many rehabs, in fact, most rehabs still don't allow people to be on MAT, medication-assisted treatment, which is buprenorphine or methadone. Most drug courts don't allow participants to be on MAT. Most jails and prisons, which have been our country's de facto response to addiction, don't allow inmates to be on MAT. And so most hospitals, when somebody shows up for an overdose, or an abscess, or some other injection-related disease, don't have a way to put people on MAT. These are all the places where we could be touching this huge group of American citizens who are suffering from this treatable medical condition, but we're just simply not doing it."

On how "Raising Lazarus" came to be following "Dopesick":

"I didn't want to write about it ever again. I just kind of wanted a break from the crisis, personally. And then as I went out, talking about the book, I started hearing about these really exciting innovations that were occurring in unexpected places like Hickory, North Carolina; Fairfax County, Virginia; Batesville, Indiana. And I was like, 'I want to shine a light on these innovations that, by the way, are working,' with the idea that if people understand what works, then perhaps one day we can scale up the treatments to match the scale of the problem.

And so I pitched a book about solutions. And if "Dopesick" was about the problem and all the barriers, this book would be about the solutions. Now, we put the word 'hope' in the subtitle, because all these people represent hope. But they're all working as kind of outliers along the fringes of these systems, which still largely are ignoring this population. So it was aspirational. I am hopeful about the people I met because they're amazing. And they gave me hope every single day. In fact, I just heard from Tim Nolan, the nurse practitioner who begins the book this morning, with an update on 'our peeps' — that we call them. These are people that I met when I was shadowing him, some of whom are getting better for the first time in their lives because they finally have treatment. And that's so heartening."

Listen to the audio of this story for more on some of the harm reduction workers highlighted in "Raising Lazarus." 

*Editor's Note: This transcript has been lightly edited for clarity.