Hidden Valley High School, Roanoke County, Virginia

Chapter Six

“Like Shooting Jesus”

An hour south of Roanoke, in a part of the state once dominated by unfettered industry, Martinsville, Virginia, was stuck in an economic morass. In 2012 the small city of thirteen thousand laid claim to having the highest unemployment rate in Virginia for twelve years. For most of the twentieth century, it had been the state’s industrial powerhouse, packed with textile and furniture factories, home to more millionaires per capita than any other city in the nation. But nearly half its jobs went away when the millionaires sent the textile work to Honduras and Mexico in the wake of NAFTA in 1994, and the furniture jobs to China after that.

Bill Clinton had predicted that China’s 2001 entry into the World Trade Organization would eventually create a “win-win” for workers. American companies would theoretically be able to export products to China’s growing consumer class, an argument Wall Street championed when stock prices climbed with every new plant-closing announcement. Corporate shareholders and CEOs ate up Clinton’s prediction, a cheery best-case version of Adam Smith’s eighteenth-century “invisible hand.” As the economists described it, Chinese peasants would better their lot by making chairs in factories, while dislocated American workers would retrain for more fulfilling, advanced jobs.

But with ill-designed training for displaced Americans based on a lumbering federal program created in the 1960s, the second part of that equation very rarely came to pass. Only a third of workers who qualified for Trade Adjustment Assistance even went back to school, and the majority of those who did found themselves with new certifications and associate’s degrees yet earning much less than they had in the factories, if they were working at all. The ones I met who were coping the best worked part-time at Walmart, supplementing their pay with food stamps, food pantry donations, and small vegetable gardens.

Consumers all got cheaper jeans, yes, but what did that matter to the people who had once stitched them if they were now out of work and couldn’t afford new clothes? The global economy created winners and losers, Bassett Furniture CEO Rob Spilman told me, explaining the dismissal of some eight thousand furniture workers from his payroll. “It was that or perish,” he said. “At the end of the day, we are not a social experiment.”

In rural counties decimated by globalization, automation, and the decline of coal, the invisible hand manifested in soaring crime, food insecurity, and disability claims. In Martinsville and surrounding Henry County, unemployment rates rose to above 20 percent, food stamp claims more than tripled, and disability rates went up 60.4 percent.

What those numbers looked like on the ground, as I began reporting on the recession in 2008 for the Roanoke Times and later for my first book, Factory Man (published in 2014), could be distilled in two images I observed but did not fully, at the time, comprehend:

The first was of adults—black and white, old and young—arriving at area food pantries two hours before the doors opened, the older among them clutching canes or leaning on walkers. The second was the smoldering remains of an abandoned furniture factory in the town of Bassett, near Martinsville. An unemployed thirty-four-year-old was attempting to rip out copper electrical wires to resell on the black market when he inadvertently sparked a fire that burned the shuttered factory down. In his police mug shot, you could see the burns on his face.

It was easy to understand the connection between joblessness and hunger, to get that hunger fueled some of the crime. It was growing clearer, too, that the federal disability program was becoming a de facto safety net for the formerly employed, a well-intentioned but ultimately disastrous way of incentivizing poor people to stay sick, with mental illness and chronic pain—conditions that are hard to prove and frequently associated with mental health and substance use disorders—prompting the majority of disability awards.

That same pattern was playing out in the Lee County coalfields, where some parents coaxed their children’s doctors toward ADHD diagnoses, knowing that such behavioral problems could help make them eligible for Social Security disability when they became adults. “Ritalin is a pipeline to disability here,” one Lee County health care manager told me, describing the federal program as a coping mechanism for poverty and workplace uncertainties.

A hospital administrator I know from nearby eastern Kentucky recalled a Drug Abuse Resistance Education officer asking her high school classmates what they wanted to be when they grew up.

“A drawer,” one young man said.

“You mean an artist?”

“No, a draw-er.”

Someone who draws disability checks. It was the only avenue he could imagine for himself, the only way to get himself and his family fed. Well over half of Lee County’s working-age men—a staggering 57.26 percent—didn’t work. (The trend line was somewhat better among women, around 44 percent.)

If OxyContin was the new moonshine in rural America, disability was the new factory work. By 2016, for every unemployed American man between the ages of twenty-two and fifty-five, an additional three were neither working nor looking for work. Having dropped out of the workforce entirely, they had numerically vanished from the kind of monthly jobs reports touted by politicians and reporters.

Many turned up instead in disability statistics, which were largely ignored in headline-grabbing economic reports. Disability claims nearly doubled from 1996 to 2015. The federal government spent an estimated $192 billion on disability payments in 2017 alone, more than the combined total for food stamps, welfare, housing subsidies, and unemployment assistance.

For people who have not ventured recently into rural America, the jaw-dropping and visible decline of work comes as a shocker, an outgrowth of the nation’s widening political and cultural divide. Before the 2016 election of Donald Trump, that disconnect was maintained by a national media that paid little attention to rural, predominantly white places like St. Charles or Bassett, where the country’s much-hailed economic recovery had definitely not trickled down.

At the same time, it had never been within the purview of local papers like the Martinsville Bulletin to investigate what was happening with international trade in Washington or New York, much less the latest push by Big Pharma or global drug cartels. And regional newspapers like my own Roanoke Times had drastically shrunk their coverage to a mainly urban and suburban core, ignoring the increasingly distressed communities in our hinterlands just when reporting on those places was needed the most.

Those of us living highly curated and time-strapped lives in cities across America—predominantly mixing virtually and physically with people whose views echoed our own—had no idea how politically and economically splintered our nation had become. And also how much poorer and sicker and work-starved the already struggling parts of the nation truly were—because we didn’t follow that story.

We may feel more connected by our cellphones and computers, but in reality we are more divided than ever before.

In the midsized city where I live, OxyContin continued to be viewed as a rural problem into the early 2010s—a problem in the coalfields, some four hours to the west. While the Roanoke Times covered the 2007 sentencing hearing of Purdue Pharma executives, it rarely mentioned OxyContin after that. We in Roanoke had heard opioid abuse was seeping into distressed factory towns like those in Henry County, but very rarely did our newspaper report on it.

We were safe in our ignorance, or so we thought—content to stereotype drug addiction as the affliction of jobless hillbillies, a small group of inner-city blacks, and a few misguided suburban kids.

But another invisible hand was upon us.

Heinrich Dreser’s drug moved seamlessly across city and county lines, with zero regard for politics, race, neighborhood, or class.

*

I didn’t understand the connection between rural poverty, disability, and opioid addiction until I learned more about the accidental Bassett Furniture arsonist. Turned out he’d arrived at his copper heist on the outskirts of Bassett on his bicycle—a rare sight in the rolling foothills of the Blue Ridge Mountains.

“He was one of the unemployed masses; he did not have a paying job,” said the prosecutor (now a judge) in his case. “But his crime actually required work, so he wasn’t lazy so much as he was desperate.” Like so many of the region’s petty thieves, the arsonist was propelled by fear of becoming dopesick, added another local prosecutor, who told me that 75 percent of all police calls in the county now involved heroin or methamphetamine, or, increasingly, a combination of both.

Not only were rates of unemployment, disability, and opioid addiction soaring, but there was also renewed interested in methamphetamines and the practice of switching between opioids (in the form of either pills or their much cheaper cousin, heroin) and meth. “Crystal meth controls all the dockets now” in rural Virginia, a local drug task force officer told me. “If you’re addicted to painkillers, you become so lethargic you can hardly function. But meth keeps you going if you need to run the streets to go get your next dose of heroin or pills, to keep you from getting sick. It allows you to function. There’s a reason they call it ‘high-speed chicken feed.’”

I thought immediately of Spencer Mumpower’s 2010 jail mug shot. So much separated Spencer, whose mother had sent him to private school and then paid for fifteen different rehabs, from the young man who stripped copper wire out of the abandoned furniture factory. A scrawny junkie with sunken eyes and sticky-out collarbones, as Spencer described himself to me in 2012, “I looked ridiculous, like I had chicken pox. Like I’d stuck my head down a groundhog’s lair.”

But I had failed, just as the police and parents had, to connect young adults like Spencer to the rural addicted, even though Spencer told me he’d come to his heroin addiction the same way they had—through prescription opioid pills.

Our culture seems to excuse drug- and other risk-taking in white middle- and upper-middle-class kids, especially young men. The same liberties, when taken by rural poor whites or people of color—wherever they live—come across as more desperate, born of fundamental wants or needs that can’t be satisfied. But as I’ve come to learn, gauged strictly by drug use, there is no less urgency and desperation in America’s middle and upper classes today.

*

Drug epidemics unfold “like a vector phenomenon, where you have one individual who seeds that community and then the spread begins,” said Dr. Anna Lembke, an addiction-medicine specialist at the Stanford University School of Medicine and the author of Drug Dealer, MD. People whose parents or grandparents were drug- or alcohol-addicted have dramatically increased odds of becoming addicted themselves, with genetics accounting for 50 to 60 percent of that risk, Lembke explained; she noted that the correlation between family history and depression is much lower, 30 percent. Other risk factors for addiction include poverty, unemployment, multigenerational trauma, and access to drugs.

“It’s important to note, it’s really not just the unemployed and the poor who are vulnerable today; it’s really everybody, especially underchallenged youths or youths who aren’t engaged in school or other meaningful activities,” Lembke said.

At the age of thirteen, Spencer had stolen five bottles of painkillers more than halfway full—leftovers prescribed to different relatives in the aftermath of routine outpatient surgeries. By fourteen, he was taking pills regularly. Back then he used saved-up lunch money to buy weed, which he then traded for ADHD medications prescribed to his friends, or for OxyContin pilfered from their parents’ medicine chests.

“I did my first bag of heroin before I drank my first bottle of beer,” Spencer said.

In his Hidden Valley subdivision, full of sprawling ranches, trim colonial two-stories, and Arts and Crafts bungalows that were new but meant to look old, heroin was easier to get. “When we first started doing it, we didn’t worry about getting caught because cops didn’t know what heroin even looked like.

“One time I got pulled over, I had ten bags at my feet, and they didn’t know what it was so they didn’t look at it.”

*

In rural America, the opioid epidemic aged into a wily adolescence in the aughts. In the hinterlands of Virginia, it had tended to pool in families. “We’d sometimes have one overdose where the son would die, then the next day the father would die, then the next day the mother would die,” the Roanoke-based medical examiner said. “If it had been an infectious disease, there would have been widespread panic.”

Then–Virginia Tech researcher Martha Wunsch remembered the moment she went from studying overdose deaths in rural counties, funded by a National Institutes of Health grant, to hearing about it from her own teenagers, who went to high school with Spencer and Scott Roth. State health officials in Richmond had originally dismissed her research, telling her the same thing they’d said to Sue Cantrell, the rural health-department director: “This is a regional problem.”

“The issue is Interstate 81,” Wunsch told me. “The OxyContin epidemic spread from East Nowhere Jesus all up and down the Appalachian chain by way of the interstate, and suddenly my own kids were coming home from parties,” talking about pills being passed around in bowls.

Opioids infiltrated the toniest suburbs not by way of families but by peer groups. The new suburban users didn’t come to the attention of police until roughly around the time Purdue Pharma launched its 2010 abuse-resistant version of the drug, at the same time Spencer handed Scott Roth the heroin that led to his death—fourteen years after OxyContin was introduced.

*

In Roanoke, the urban hub for the western half of the state, I-81 perches at the edge of the northern suburbs. It rolls and undulates, connecting western Appalachian communities from Tennessee to Virginia as it travels northeast around Roanoke and up through the northern Shenandoah Valley, intersecting with other interstates leading to Baltimore and Washington, New Jersey and New York.

One of the most segregated cities in the South, Roanoke had long had a steady but largely quiet group of heroin users in its urban core, which positioned it to become an ideal transfer station for the region’s transition from dope to pills, then back to dope. It was the perfect incubator for the opioid epidemic—a cultural and geographic crossroads. It was big enough for users to easily forge drug connections and yet small enough for the drug dealers to hide out.

Some dealers, traditionally ensconced in the city’s poorest, northwest quadrant, were beginning to migrate to the more affluent neighborhoods of Hidden Valley and Cave Spring, one heroin task officer told me—to avoid robberies and home invasions.

“As long as it was in the lower economic classes and marginalized groups, like musicians and people of ethnic minorities, it was OK because it was with those people,” said Spencer’s counselor, Vinnie Dabney, an African American who took his first sniff from a bag of heroin his sophomore year of high school, in 1968, and was a mostly functional user for thirty years. (Needle-phobic, he never once shot up.) Back then you could maintain that way because the drug’s potency was low—3 to 7 percent, compared with 40 to 60 percent today—and the police paid little attention, since white kids in the suburbs weren’t dying or nodding out in the football bleachers.

“But the moment it crossed those boundary lines from the inner city into the suburbs, it became an ‘epidemic,’” said Dabney, shaking his head. After two drug-related jail stints, he left court-ordered treatment in the late 1990s to get a master’s in counseling and now works as a mental health and substance abuse counselor who leads support groups for users taking the maintenance drug buprenorphine, or bupe (more commonly known by the brand name Suboxone). “It’s ludicrous, this thing that’s been knocking on your door for over a hundred years, and you’ve ignored it until finally it’s like a battering ram taking your doors off the hinges.

“It’s a monster now, but nobody paid any attention to it until their cars were getting robbed, and their kids were stealing their credit cards.” The worst of it, Dabney warned, was that people were getting hooked at even younger ages, and making the switch faster from pills to heroin.

*

It took a while for the force of the battering ram to register. Unlike in the coalfields, where addicted users quickly resorted to thievery to fund their next fix, in the suburbs the epidemic spread stealthily because users had ready access to money. Many of them were teenagers selling electronic devices (then telling their parents they’d been stolen), or raiding their college savings accounts, or simply using their allowance. They were not engaging in “spot and steal,” not trading a mule for four pills, not wheeling stolen garden tillers down the street for everyone to see.

In the wealthiest Roanoke County suburbs, illicit pill-taking commenced, shared on TruGreened lawns, next to school lockers, and in carpeted basements while clueless parents in Cave Spring and Hidden Valley were making family dinners upstairs.

There was no widespread panic, because the teenagers and young adults had the money to keep their addictions at a low boil, and those parents who were in on the dirty little secret were too ashamed to let the neighbors know.

From California to Florida, the parents behind Relatives Against Purdue Pharma already knew that OxyContin stood out more in rural America’s distressed hollows and towns, where reps could easily target the lowest-hanging fruit—the injured jobless and people on disability, with Medicaid cards. But OxyContin was everywhere, of course, and it had been almost since the beginning, even if the crimes associated with it hadn’t dominated the urban news.

“The early suburban wave mostly stayed hidden…because parents there could afford to put their kids in a thirty- or sixty-day program,” said Dr. Hughes Melton, an addiction specialist and now the Virginia Department of Health’s chief deputy commissioner overseeing much of the state’s response to the crisis. “You really didn’t hear much about it until young people started dying.”

It was the death of the funny young rapping chef, Scott Roth, with his mop of blond hair and life-of-the-party disposition, that should have put the Roanoke region on notice.

The weekend when most of his friends were going off to college, his mother had driven him to a rehab program at the local rescue mission. She remembers leaving him by the mission door in the rain, in his plaid shorts and Nautica shirt.

*

Spencer Mumpower helped me unpack the epidemic as it unfolded behind mall movie theaters and in wooded cul-de-sacs in the late aughts. But even though high school surveys showed suburban heroin use was growing in 2012 (it was then 3 percent higher in Roanoke County schools than the national average), parents and prevention workers alike underestimated Spencer’s warnings, viewing his crime as an anomaly, maybe even an outlier case of bad parenting.

“We didn’t understand the connection between heroin and pills at least until 2014,” admitted Nancy Hans, an area drug-prevention coordinator. In 2010, her Prevention Council of Roanoke County initiated drug take-backs, events where citizens were encouraged to safely dispose of unused medications, but she wishes now that she had singled out opioids.

At the urging of local police, Hans instead launched a campaign to warn parents about synthetic bath salts in 2012, then in the public eye because they had caused bizarre behavior, including physical scuffles with police as well as the overdose deaths of two local young women. Shortly after President Obama signed a law banning the sale of the products, Vice magazine swooped into Roanoke for a scoop. Looking back, the bath-salts blight was a red herring, problematic but short-lived—and a distraction from a much quieter, even deadlier drug.

“That’s how it got way out in front of us,” Hans said. “And the doctors didn’t see their role in it, either. When a doctor prescribed our teenagers thirty Percocet pills for a pulled wisdom tooth, we didn’t know to complain. It was like we were all in a big fog of denial.”

Within five years, Hans would have the numbers of multiple mothers of addicted kids programmed into her cellphone. She would find herself rushing from the funerals of heroin-overdosed twentysomethings to giving prevention talks in the auditoriums of the high schools they once attended. Spencer’s master class in drug abuse had gone unheeded, boxed away into a category of Things That Happen to Other Families.

Andrew Bassford, the assistant U.S. attorney who prosecuted Spencer’s case, took an angry phone call from the Roanoke County school superintendent, who was mad that he’d openly addressed the accessibility of heroin and OxyContin in her schools.

“How dare you tell the newspaper these things?” the superintendent seethed.

Bassford, who also works as a brigadier general in the U.S. Army Reserve, was unmoved by the scolding.

“I say these things because I know them to be true,” he said. “Your schools are a pit because your students have money, and money attracts drugs.”

*

The Hidden Valley teenagers called the green 80-milligram Oxys Green Goblins. They scored them from an array of sources: a restaurant co-worker, a brother who’d had them prescribed in the wake of wisdom-tooth surgery, an Iraq war veteran who had legitimate pain but was prescribed twice as many pills as he needed and funneled the rest to the kids down the street in exchange for cash.

“Parents didn’t really know what was going on when it was just pills,” recalled Victoria (not her real name), who tried her first OxyContin pill her senior year after a friend ratted her out to school officials for smoking weed.

Victoria remembered the first time she tried to crush an abuse-resistant Oxy, following Purdue’s long-awaited reformulation in 2010, and it worked exactly as Barbara Van Rooyan envisioned it would when she petitioned the FDA, demanding an opioid blocker, or antagonist, be added to the drug: “If you tried to crunch ’em, they’d gel up on you. You couldn’t even snort ’em, let alone shoot ’em. After that, the pills either went dry or were just too expensive to get. And everybody who used to deal pills starting dealing heroin instead.”

I noticed another, lesser-known pattern among the addicted suburbanites I interviewed: The Green Goblins were typically preceded by a starter pack of a very different drug. Almost to a person, the addicted twentysomethings I met had taken attention-deficit medication as children, prescribed pills that as they entered adolescence morphed from study aid to party aid. On college campuses, Ritalin and Adderall were not just a way to pull an all-nighter for the physics exam, never mind that they were prescribed to your roommate, not you; they also allowed a person to drink alcohol for hours on end without passing out. That made them a valuable currency, tradable for money and/or other drugs.

Between 1991 and 2010, the number of prescribed stimulants increased tenfold among all ages, with prescriptions for attention-deficit-disorder drugs tripling among school-age children between 1990 and 1995 alone. “And we’re prescribing to ever- and ever-younger children, some kids as young as two years old,” said Lembke, the addiction researcher.

“It’s just nuts. Because if we really believe that addiction is a result of changes in the brain due to chronic heavy drug exposure, how can we believe that stimulant exposure isn’t going to change these kids’ brains in a way that makes them more vulnerable to harder drugs?” she added.

The science is far from clear, according to a 2014 data review. Some studies show that ADHD-diagnosed children treated with stimulants have lower rates of addiction to some substances than those who weren’t medicated, while other studies suggest that exposure to stimulants in childhood can lead to addiction in adulthood.

“A lot of us think that doctors have overdiagnosed children with ADHD, so a diagnosis is something to very carefully discern, and parents should always monitor the medicines their children and teenagers are on,” said Cheri Hartman, a Roanoke psychologist.

Lembke pins the opioid epidemic not just on physician overprescribing fueled by Big Pharma but also on the broader American narrative that promotes all pills as a quick fix. Between 1998 and 2005, the abuse of prescription drugs increased a staggering 76 percent.

While opioids have resulted in the direst consequences, Lembke is equally leery of benzodiazepines (prescribed for anxiety) and stimulants, both of which make teenagers—especially underchallenged kids who aren’t engaged in meaningful activities—dangerously comfortable with the notion of taking pills. Any pills. Whether the pills originated in a bottle with their name on it or came from a bowl at a so-called pharm party.

Emergency-room administrator Dr. John Burton watched the cultural shift play out at the North Carolina YMCA summer camp he attended as a kid and returned to later as the camp doctor. Whereas very few campers took prescribed medications in the 1970s, by the mid-1990s 10 percent were taking a pill at some point during the day—most for asthma or allergy conditions, followed by a small subset of kids on behavioral medications, usually for ADHD.

By 2012, fully one-third of his campers were on meds, mostly ADHD medications, antidepressants, and antipsychotics. “What happens is, we’ve changed our whole culture, from one where kids don’t take pills at all to one where you’ve got a third or more of kids who are on pills to stay well because of what are believed to be chronic health conditions,” Burton said. “They get so used to taking pills that eventually they end up using them for a recreational high.”

So it went that young people barely flinched at the thought of taking Adderall to get them going in the morning, an opioid painkiller for a sports injury in the afternoon, and a Xanax to help them sleep at night, many of the pills doctor-prescribed. So it went that two-thirds of college seniors reported being offered prescription stimulants for nonmedical use by 2012—from friends, relatives, and drug dealers.

“In the short term, kids and parents and even teachers may feel better” about Adderall’s ability to enhance memory and attention, Lembke said. “But studies show that over the long term those kids don’t do any better in school than people who don’t receive stimulants.”

And among those whose stimulant usage becomes a gateway to harder drugs, they’re doing much worse. That was true for Spencer Mumpower, who routinely traded Adderall for marijuana, and Ritalin for cocaine. That was true for almost every addicted young adult I interviewed for this book.

*

As Spencer prepared for prison in the fall of 2012, the remainder of the Hidden Valley group with whom he’d abused drugs kept on as usual to avoid becoming dopesick. Whether that meant recruiting new users at parties or taking jobs at senior moving companies with the express intent of stealing opioids from retirees, targeting the expired or leftover prescriptions so the client wouldn’t notice.

“If it was a current medication, I’d take just a couple,” recalled a recovering heroin user I’ll call Brian, then a Hidden Valley High School student, a doctor’s son, and a member of the marching band. “If it was an old prescription, I’d take the whole bottle. Some old people would tell me, ‘Just throw it away,’ and I’d definitely take those.”

Dependent on pills by age seventeen, Brian was twenty when a co-worker introduced him to heroin. He snorted it first from waxed-paper bags marked colombian coffee and blue magic, in wrappers so small he could hide them inside his phone case. “From the moment I did that first bag, I can tell you, looking back now, it was destined,” he said. After snorting the crushed-up Oxys, inhaling the heroin powder was easy—and the heroin was cheaper, more intense, and, increasingly, it was everywhere he went. Though he was deeply troubled by Scott Roth’s death, little else but drugs mattered anymore. Another friend taught him how to inject himself; he bought the needles at a local drugstore, telling the pharmacist he needed them for insulin.

“It was like shooting Jesus up in your arm,” Brian said of his first IV injection. “It’s like this white explosion of light in your head. You’re floating on a cloud. You don’t yet know that the first time is the best. After that, you’re just chasing that first high.”

*

Within six months, Brian had blown through the $8,000 he’d put aside for college and pawned his Xbox and video games, all without his parents’ knowledge. “I would spend six hours a day driving around Roanoke picking up drugs, waiting for phone calls, going to ATMs.”

His parents noticed he was moodier than usual and worried about his weight loss; he’d dropped from 150 to 125 pounds. They asked him if he was anorexic.

A counselor he was seeing for anxiety set up an intervention of sorts in his office, inviting Brian’s parents to attend and beginning with “Brian wants to tell you about a problem he’s having.”

By then he was shooting up twenty bags a day, buying them from a host of user-dealers that had once included Spencer and Scott.

“I’m addicted to heroin,” he told his parents.

And while they were relieved to finally know why he’d lost so much weight—and why he sometimes stayed out until 3 or 4 a.m.—they were also gobsmacked.

They sent him to a local hospital to detox, then to intensive outpatient treatment, where he was prescribed the opioid-maintenance drug Suboxone, with mandatory urine screenings, one-on-one counseling, and support group meetings.

Brian was twenty-three years old and beginning to wean off Suboxone when I first interviewed him, in 2012.

“It’s been seven days today” since his last dose of Suboxone, he said. “I have pinprickly skin, and I’m restless. It’s hard to sit still.” Still mourning Scott’s death, he noted that none of his other user-dealer friends, with the exception of Spencer, had been caught.

“The cellphone is the glue that holds it all together for the modern drug user,” Brian told me. “In high school, I snuck out of the house a number of times to meet people at the bottom of the driveway, and my parents had no clue. Aside from taking my cellphone away, my parents also could have looked at my text message logs and gotten a sense of what was going on.”

*

At a Lutheran church on the outskirts of Hidden Valley, two moms of opioid-addicted young men met at a Families Anonymous meeting, where worried parents go for peer support. Not only would their chance meeting have lasting implications for families of the addicted in the region, but their stories would also expose how families operate inside the sizable gaps that have opened up between the two institutions tasked with addressing the opioid epidemic: the criminal justice and health care systems. While shame too often cloaks these gaps in secrecy, some doctors, drug dealers, and pharmaceutical companies continue to profit mightily from them. The addicted work to survive and stave off dopesickness while desperate family members and volunteers work to keep them alive.

Jamie Waldrop was a civic leader, the wife of a prominent surgeon. Drenna Banks and her husband ran a successful insurance agency. Their sons had been friends and used drugs together, crossing paths briefly through friends at North Cross, a private suburban school that Jamie’s son Christopher attended.

“I just knew [Jamie] was this cool blond-haired chick who was making me laugh at a time when I needed to laugh,” Drenna recalled. Jamie had not one but two children who’d become addicted, first to pills, then heroin. She hadn’t realized the depth of their addiction until she found them both passed out in separate incidents in her home—her oldest, breathing but slumped over in a chair from a combo of Xanax and painkillers, his cellphone fallen to the ground; her youngest, passed out on the bathroom floor, heroin needles and blood sprawled around him.

Between the outpatient Suboxone programs (none of which worked, the family said) and multiple residential rehabs and aftercare sober-house programs (two of which, eventually, did), the Waldrops would spend more than $300,000 on treatment—not counting the drug-related legal fees or the thousands in stolen checks and credit-card bills for gift cards, which were traded to dealers for drugs. (A $200 gift card goes for $120 worth of pills, Jamie explained.) “I was a pretty bad robber,” Christopher, her youngest, said.

Jamie and her husband can’t pinpoint the most frenzied moment in their journey. Maybe it was when they were scheduled to attend a medical conference at the Greenbrier, a storied five-star resort, but had to bring their grown sons along because they couldn’t trust them to stay home alone. Before the conference was over, they discovered a sizable drug stash hidden in a potted plant in their room.

Maybe it was when Jamie’s surgeon husband had to drive to the roughest part of the city to pay off one son’s drug-dealer debt. Or maybe it was the daily jewelry shuffle Jamie initiated in the wake of discovering her diamond necklace gone, along with her husband’s Rolex: She’d take what remained of her best jewelry, “the handed-down stuff,” and rotate it between an oatmeal container, the freezer, and the dirty-laundry hamper—the last places her children would look. “We lived like that for years; it was our new normal. Until they go off to rehab, you don’t realize just how dysfunctional your life has become.”

In the beginning, Jamie and Drenna had, like most parents, isolated themselves—until it dawned on them, at the Families Anonymous meeting, that they were living a very similar nightmare. “I stayed away from my other friends because what do you say when people ask you, ‘How are your kids doing?’” Jamie said.

*

Christopher was two weeks into his first residential-treatment stay when word reached him that a good friend had fatally overdosed on 30-milligram oxycodone pills and other narcotics. It was Colton Banks, Drenna’s son.

“It tore me up pretty good,” Christopher remembered. “Colton was the nicest guy ever. You could call him up in the middle of the night and ask him for a ride, and he’d get out of bed and come and get you.”

Christopher recognized the location of his friend’s death immediately. His body was found at the home of a middle-aged man, an opioid addict who’d been prescribed hundreds of the pills from a Roanoke pain clinic three days before. All but twelve of the pills were missing, a police search warrant confirmed, in a painkiller-selling scheme that placed Colton, nineteen, on the campus of Radford University, where he was selling the pills to pay back a drug debt from the day before.

“We got most of our pills from him,” Christopher said of the middle-aged addict. “He’d get four hundred thirties [Roxicodone], then some fifteens [Roxicodone], Xanax, and Klonopin all prescribed to him at once by the same crooked doctor. You can use a lot and still make five thousand dollars a month off that, if not more.”

The weekend of Colton’s death was supposed to be his last hurrah before getting clean. He had an appointment with an addiction specialist lined up for Monday—he’d stuck not one but two Post-it notes on the dashboard of his car reminding him to go.

Colton died at eleven-thirty on the morning of November 4, 2012, All Saints Sunday, while his parents were in church. A few hours later, when a policeman showed up on their stoop to say that Colton had “expired,” they were initially confused. Expired? No, their younger son was dead.

To add insult, no charges were filed against the middle-aged dealer, because it’s impossible to pin blame on a single batch of pills when an autopsy rules “multiple toxicity,” as it did in Colton’s case, the police chief confirmed.

The Bankses fumed, then and now, about that. “I want to go kill the bastard,” Drenna told her husband, but he persuaded her to stop and think about their other son.

And she did, though she sometimes sat outside the man’s house in her car, her gun on the seat next to her, anguishing and hating and praying for her son.

*

Two years before Colton’s death, a family friend in Fredericksburg, Virginia, lost his son to a heroin overdose, and Drenna remembered thinking, “Why can’t you control your kid?” She apologized, later, for having judged. She had monitored Colton’s Adderall when she learned he was abusing it at age seventeen. She’d grounded him soon after, when she found pot hidden in a briefcase under his bed. She’d sent him to a twenty-eight-day rehab at nineteen after he progressed to pills.

“At first you’re just so embarrassed,” Drenna said. “You think you’re doing right as a parent, but then these drugs take over their life, and nobody talks about it because it’s this dark, hidden secret.”

At the funeral-home visitation, Drenna had Colton presented in an open casket, wearing a flannel shirt she’d just bought him from Kohl’s, pants, hat, and his favorite boots, the ones he wore four-wheeling. His hands were arranged so they clutched a necklace he’d recently borrowed from his older brother, a silver fish medallion with the inscription wwjd.

She remembered her handsome bearded boy borrowing it from his brother’s nightstand, telling her, “I may not be as good-looking as Kevin, but I do pretty well with the girls.” And they both laughed.

She would remember that moment every day for the rest of her life—especially when she stopped by Burger King on his birthday to order his favorite meal (a cheeseburger with fries and sweet tea), and when she poured dressing on her salad (“He’d use ranch, and he’d think the bottle had a small hole when it didn’t, and invariably it’d go all over the place”).

“I wanted his friends to see this person they knew who was no longer here. This was the star athlete, the kid who stood up to bullies. Colton was everybody’s protector, everybody’s friend. He had a good home life. He really had it all,” she recalled, tearing up.

“They think they’re invincible.”

Three months after Spencer left for prison and two years after Scott Roth’s death, the Bankses used their nineteen-year-old son’s funeral to send a message to his opioid-addicted friends and their parents.

Though Christopher Waldrop was away at rehab and not allowed to come home, Jamie made a point of sitting next to one of his high school friends at the service, in an increasingly familiar role.

She and a handful of other local moms were preparing to out themselves and their families, understanding, finally, that survival had to trump shame. Jamie pledged to help her son’s friend find a bed at a treatment facility the moment he was ready to go. “His parents were in total denial,” she said.

She would tell Christopher later how Drenna Banks stood at her son’s funeral, her voice quavering, and begged her audience to let Colton’s death be the last:

“For the longest time, I didn’t know what God wanted me to do, but now I know,” she told the mourners, chucking her prepared remarks in favor of an impromptu call for treatment. “There are so many families struggling with the same thing Colton has been struggling with. It’s insidious, and it’s evil, and it’s not just pot.…And I know there’s a social stigma attached to this, but don’t hide. Don’t hide from it.

“I know there are at least three other boys here that I know Colton wants me to help. And you know who you are.…I know now that I’m supposed to be here for you boys, and we’re gonna make it through.”

*

The following Mother’s Day, Jamie called Drenna and asked her to come over because her husband was out of the country, and she didn’t know what else to do. Christopher was close to relapsing, Jamie suspected, if he hadn’t already. He was at home visiting her, having checked himself out of an Asheville, North Carolina, aftercare program—against his counselor’s advice. After four months of sobriety, “I was tired of all the rules,” Christopher told me later. “I wanted to drink again.”

Jamie begged Drenna to talk some sense into her son. And Drenna tried, telling him that Colton would not want him to be using again; that it wasn’t fair for his mom to have to wonder every second of every day if she would be going to his funeral as she did Colton’s. He insisted that he wasn’t using heroin and that he hoped, eventually, to make Colton proud.

But the drinking would lead to poor choices, as it usually did, and before long the usual signs presented themselves in the form of stolen checks and pawned laptops; in Christopher continuing to lie through his teeth to his mom, over the phone from Asheville, that he was not doing drugs.

Drenna advised Jamie to drive the four hours to her son’s apartment and show up on his doorstep, unannounced. “You’ve got to go down there,” she implored her friend. “You’ve got to go look at him and pull up his sleeves!”

Jamie arrived at her son’s apartment to find cases of beer and a bong in the middle of the living room.

“Hand me your phone,” she said.

Her stomach sank the moment she clicked on his text log and found scores of messages to and from drug dealers. There was no need to pull up Christopher’s sleeves—the needles and bags of heroin were right there near the beer, tucked into his shoes.

“I was like, shit, here we go again,” Christopher remembered.

*

What he needed, said his counselor, whom Jamie had called in for advice, was “another fucking spiritual experience, and I have the perfect place”: an abstinence-based rehab in the Montana wilderness.

“I’m not going anywhere,” said Christopher. “I hate the wilderness.”

“Then you can join the Asheville transient society,” the counselor said.

Christopher pleaded for help from his mom. Surely she could not abide him becoming homeless.

But Jamie said she would no longer help Christopher finance an apartment, a car, a cellphone, or even food. “We’re not enabling you anymore,” she said.

Instead, she spent a week in an Asheville hotel room with her dopesick son as he detoxed, toggling between a hot shower and the toilet, prepping for his return to rehab.

A day into the detox, Christopher decided he was ready for another fucking spiritual experience. He was twenty years old.

“I felt terrible,” he remembered. “From Colton dying, and I knew I’d hurt my family a ton.” He was tired of trawling for purses in mall parking lots when most of the car doors were locked. “I was not having enough money to get high, I’d been stealing too much, and I hated it. This time, I wanted it [sobriety] for myself.”

As of this writing, Christopher has remained sober four years. At twenty-four, he’s back in college, this time in Dallas, the city where he landed after Montana to live in a sober house for young men transitioning from rehab to recovery. Offered a drink on his twenty-first birthday, Christopher told a waitress, “I’m allergic to alcohol.”

He was spending a lot of time “giving back” to the recovery community, mentoring young people who are newly sober, helping them work the twelve steps—and worrying about his mom as she increasingly devoted herself to helping other addicted people access treatment, calling rehabs, picking them up off the streets, and taking them to homeless shelters. His surgeon dad has even been known to give Jamie’s cellphone number out to addicted patients he meets in the ER.

“There’s a lot of emotional investment in it for her, but she’s not an addict and doesn’t totally understand, still, that some of the people she deals with are going to die. And the small percentage of people who do end up getting better may end up” relapsing, Christopher said, especially those who can’t afford multiple rehabs and aftercare.

How many addicts, after all, have moms who can afford not just to send their dopesick son to a second $30,000 rehab but also to accompany him on his flight to Montana so he won’t, at the last minute, back out?

Christopher knows he’s in a rarefied position: Fewer than one-quarter of heroin addicts who receive abstinence-only counseling and support remain clean two or more years. The recovery rate is higher, roughly 40 to 60 percent, among those who get counseling, support group, and medication-assisted treatment such as methadone, buprenorphine, or naltrexone.

“We know from other countries that when people stick with treatment, outcomes can be even better than fifty percent,” Lembke, the addiction specialist, told me. But most people in the United States don’t have access to good opioid-addiction treatment, she said, acknowledging the plethora of cash-only MAT clinics that resemble pill-mill pain clinics as well as rehabs that remain staunchly anti-MAT.

All told, Christopher had lost four close friends to opioid overdose, including Colton Banks and Scott Roth. For Brian, the number was also four.

None of the recovering users I interviewed had been in the military, but they tallied their losses with the sorrowful stoicism of veterans who’d been to war.

Near the tail end of Spencer Mumpower’s prison sentence, he had lost twelve friends, and five others were now in prison or jail. “He’s had very few friends get clean, either through going to rehab or jail, but the ones who didn’t are either dead, or they have parents who enable them, and they continue to do drugs,” Ginger Mumpower said. “Most of his friends have never seen jail; they either talk their way out, or their parents buy their way out.”

When Colton Banks died, in 2012, for every one opioid-overdose death, there were 130 opioid-dependent Americans who were still out there, still using the drugs.