[♪♪♪] -♪ Every day every day Every day ♪ ♪ Every day I write the book ♪ [♪♪♪] -Welcome, I'm Rose Martin, and we're in Roanoke for a special edition of Write Around the Corner with acclaimed journalist and author of the 2018 New York Times best-selling book Dopesick: Dealers, Doctors, and the Drug Company that Addicted America.

It's Beth Macy.

A dramatized adaptation of her groundbreaking book was released by Hulu as a limited series in 2021.

Hi, Beth.

Welcome to Write Around the Corner .

-Thanks for having me back.

-Oh, thank you so much for coming back and talking about this such important topic, not only the book but the series and the impact that it's had, really groundbreaking work, so thank you for doing it.

-Oh, thank you.

My goals going into the show were, one, that we are not stereotype Appalachia, and I think we did that.

And the number two was just to get the important message across ab out how people can get better if they're offered the right kind of treatment.

And so, when you see Michael Keaton's character, Dr. Finnix, you know, eventually getting better because he's offered evidence-based treatment.

I think that's real powerful.

So, so glad that we were able to get that really important message across.

-Not only the book, and the series really opened my eyes because I was thinking, how come we didn't know?

I mean, how come I didn't know that this was so pervasive, and that, you know, so many things were happening in such a way that we blindly accepted maybe these prescriptions from doctors and didn't realize how addictive, and what was happening in our communities?

-Right.

Well, I think one of the reasons we didn't know was because it started out in the coal fields and in these remote rural areas that'll, a lot of which no longer have news organizations that cover them.

So, you saw the jobs were declining, the press was declining; at the same time, this really powerful drug entered these communities.

And they purposely picked the communities in which there were high incidences of workplace injuries so that they could go to them with their FDA label, you know, that was like a golden ticket for them that they had maneuvered to get, and say, look, our drug is better than competing drugs.

And so, it's really, when you think about it that way, on top of, you know, I'm sure they had to know there were job losses and that very soon after the drug was being diverted, because people didn't have money to live on because the jobs had gone away.

So, they started selling the OxyContin as a way not just to numb their feelings but also to pay their rent.

-Well, and what really surprised me was, I found myself curious that you trust that when you go and need a prescription, that the doctors are being told the truth, too, about the effects of that medicine.

But actually, that wasn't the case because the doctors were told it was time-release and it was non-addictive, so give this to people and, you know, doctors want to really try to relieve pain.

But there was this entire other movement going on with the marketing of this highly addictive and very, very dangerous drug, right?

-Right.

And so, we dramatized that in the show, but it's based on absolute, you know, firm evidence that we have that, you know, the lobbyists, for instance, took over, and that Purdue paid all these doctors to become paid spokesmen for the company.

So, when you see Michael Keaton going to a resort in Arizona or Florida to learn more about OxyContin, he ends up giving a speech, you know, that is based on what really happened.

Purdue hired 5,000 nurses, doctors, and pharmacists to become paid spokesmen.

And they basically co-opted the hospital system such that, you know, you've seen those smiley face charts, rate your pain on a scale of one to ten.

And, you know, and you see that playing out with one of the characters in the show who's in the hospital for surgery and they want him to take OxyContin; little do they know that he's actually trying to put that company away, and he doesn't want to take it.

And then, when he digs into it and he says, why are you guys pushing this so hard, they say, well, if we get a bad rating from a customer, you know, that can hurt our accreditation.

And so, they really infiltrated all of the gatekeepers and the regulators.

-Well, and when the book was sold and to make the Hulu series, you said you wanted to make sure that they didn't stereotype Appalachia.

What were some other things that were really important to you to take this work, this important work, and take it to screen so that it was still authentic, and it still contained that message of the seriousness, entertainment value, yes, but still conveyed that message?

-I'll just start with the kind of the nicest thing I've heard about the show, and it wasn't even said to me, although I've certainly gotten people reach out via social media to tell me similar things.

One of our writers in the room was at a CVS in New York City, and he had a Hulu mask on, right after the show came out, and somebody standing behind him goes, hey, that new show, Dopesick , is really good.

And Ben goes, well, actually I worked on that show.

And they had a sweet little talk.

And then afterwards, the woman behind them goes, I watched your show, and for the first time in three years, I reached out to my addicted son.

So, like that was what we wanted.

We wanted people to understand that these people who got ensnared in this weren't bad people, they weren't moral failures, they-- legitimately many of them got addicted either because they were over-prescribed or because a relative was over-prescribed, and then all these excess meds were in the communal medicine cabinets all across America, which is true like, you know, they were giving OxyContin for 30 days for a wisdom tooth.

So, maybe a kid needed it three days or four days, and then there would be these extra meds, and then the kids would take them.

And people would break into people's houses to get them.

Everybody, you know, you want to save them in case you have an injury.

-Sure.

But the other thing I was surprised at was that there was this pseudo addiction.

So, you know, oh, well, they're not really addicted, the pills aren't working in the level that we have it, so double it or double it or double it some more.

And what impact did that actually have, and then, was that tricky to write in, you know, legally, to make sure you had all of these things in the show, in the Hulu series, that were so important to, you know, to the book, and to the impact that it was having on families and on individuals who were taking the drugs?

-Well, it's really important to get it right.

I mean, some people were still like, that really happened?

That's so dramatic.

Did that really happen?

Absolutely, it really happened, that, and worse.

I mean, we're still getting-- documents are coming out.

There's a new document repository that's going to be at UCSF, I'm actually on the advisory board for that.

All the documents that are going into these court cases in this massive opioid litigation are, you know, a lot of them haven't even been released yet.

So, everything we said in the show, I think that when everything comes out, it's going to be even worse than the show portrayed.

But everything that is in the show has been fact checked.

We have documentation, we have two sources in most cases.

And, you know, Danny, the show runner, who is really-- the show is really his vision, my book is one of the source materials.

Obviously, I was more involved than the average person.

But, you know, like a new book was coming out called Empire of Pain by Patrick Radden Keefe, literally while they were shooting the show, and we needed a second source on this anecdote we had written, which I thought we had pretty nailed down, the Hulu lawyers wanted another source.

There it was in Patrick's book and Danny-- so we were able to put it back in because we now had a second source.

Danny rewrote the scene the night before they shot it.

So, that was really exciting.

People were leaking us memos.

-During the writing of this show?

-During the writers' room, which began in March of '20, right as COVID was happening.

Yes, I can't remember it was a call or email but then I got on the phone with the person, and it was this really damning, fraud investigator memo about the Curtis Wright storyline.

So, he was the FDA investigator that stamped "Approve" on OxyContin, and then about 18 months later, went to work for Purdue, making almost 40,000 dollars a year, like way doubling, tripling his government salary.

And so, that's that revolving door that we really need to put it into, and I think the show is a really great dramatization of what happened there.

They literally rented a hotel room down the street from the FDA, and it was all in that memo.

-Wow.

And I was struck by-- each of the episodes in the show really grabbed me, and I knew it was real but there were heartbreaking moments in that show for Kaitlyn Dever's character, for example, when she, you know, you really love her, and you love her family, and she gets hurt.

But that scene where her dad takes the pills and throws them down the drain, and she, you know, just, I mean, I'm crying with them while I'm seeing that.

I mean, it had to be not only emotionally taxing for you, I mean, so much work for this groundbreaking book, and then to see that brought to life, you've been on the streets, you've been following people around and, you know, was that dramatization real?

With those things?

-Well, that scene that you said that, you know, Kaitlyn's character, Betsy, is a fictional amalgamation, but she's based on many, many people whom this has happened to.

The person I got the closest to that I write about in Dopesick was a young woman named Tess Henry.

And absolutely that has happened where she has, you know, at one point, was fighting with her mother about, you know, not having access to her drugs before her mother fully understood what the pain and suffering that she was going through, she just saw the bad behavior.

She didn't understand what was driving it and how literally, you know, the brain kind of gets hijacked by these drugs.

And so, they feel like the way we might feel hungry if we hadn't eaten in three days.

That's the way they feel for the need to get opioids to replace the amount that they've been, you know, gotten accustomed to through the illicit products.

So, yes, absolutely, I've heard a lot of stories about families fighting, and that's why that scene that you mentioned, that really tore me up almost more than any of them.

Interesting thing about Kaitlyn Dever, and I wasn't on set much, I was just on once, and she wasn't there that day.

But she is such a great actor.

They called her Little Meryl for Meryl Streep because she could get something in one tape.

But she made, she wanted to get the show so right that she made like a spreadsheet with all the qualities of dope sickness.

And then, there's a person who was in the crew just happened to be somebody in recovery, and she would check how she did with him after every scene.

So, I mean, you got to admire that level.

-Oh, absolutely.

And it was really captivating.

I mean, I found myself totally involved in the lives and, again, questioning myself to where I'm thinking, you know, this is more pervasive than I ever knew it was.

And maybe, you know, it's in the coal mines but it's also migrated into other areas that are struggling with poverty or economic decline in communities.

-It's everywhere, literally.

-Yes, it's everywhere.

-There is no socio-economic, no racial boundary.

It's, right now the numbers are highest among Black men and Native Americans.

We're also seeing a huge increase among teen overdose deaths.

And so, that's mainly fentanyl getting infiltrated in things like a teenager might be experimenting and thinking he's getting a Xanax, but it's really pressed fentanyl made to look like a Xanax.

It's very diabolical.

And so, we had a thousand teen deaths last year, which was a record rate in America.

It's not a huge number but a thousand people who weren't even addicted; most of them were just experimenting.

So, it's a really dangerous drug scene out there.

-Well, the other thing I was struck for in the show was the treatment options that were available.

So, in Michael Keaton's character, you know, him even getting addicted where he first sat with that rep who was coming in to try to push off the drug and he's like, oh, no, no, no, no, I would never prescribe this for, whatever it was, a shoulder injury or something.

But he finds himself also easily addicted.

Treatment is something that you advocate so much and so strongly for.

And you mentioned earlier that differences for the brain, how it's wired differently, and there are several treatment options, but you found some things through your experiences that are very successful.

What are they?

-So, the gold standard of care for opioid use disorder are, there are two medications, one is called buprenorphine and the brand name is Suboxone.

A lot of people call it Bupe, short for buprenorphine.

And that's something you can get in an outpatient setting.

Now that-- I mean, there's like stigma against all these levels of getting it.

So, if you don't have insurance, you're hosed, and if you're in a non-Medicaid expansion state.

A lot of doctors don't want to prescribe it; they actually have to have a special waiver to prescribe buprenorphine, an eight-hour training class, and then a lot, there's just a lot of stigma in the medical profession.

Why would we give somebody another drug if they're addicted to a drug?

Well, why would you give somebody insulin if they're diabetic?

I mean, it's a medicine for an illness.

So, that's what I'm hoping to shape the thinking around that.

And the other evidence-based medication assisted treatment is methadone.

It's a little trickier because you have to go to a federally regulated clinic every day, and then you can work your way up to take-homes, but after many months usually.

One of the good things that came out of COVID was that they loosened some of the restrictions around take-homes with methadone, and also, they made it so that, I mean, they did it mainly to protect the providers, but that like a person entering treatment for the first time could do a telehealth visit to get on buprenorphine.

So, I'm hoping that some of those special dispensations that they made for COVID will stick because it's all about making the medicine easier to get, not harder.

It's very hard to get treatment, which is why only 20 percent of people with OUD, opioid use disorder, actually get treatment.

So, I mean, that's a real, that's an epic fail right there.

-Yes, it really is.

But yet, it's treatable and it's a disease.

I think you really make sure that we realize that, you know, this is a disease, and we need to find ways that we can help our community members, our family members through that, and I believe that the series through the characters and great portrayal of each of the characters.

Were you involved in any of the casting for any of the characters for the show?

-Danny and the casting director did most of that, but he let me weigh in on the people that were real people that I knew, like he let me weigh in on Randy Ramseyer because I had met Randy, and Rick Mountcastle.

Dr. Van Zee, I knew very well, so he let me sort of pick between two people that he had picked.

And I can't remember if I weighed in on Sister Beth or not.

And the other cool thing he did, I mean, you hear all this bad stuff about Hollywood, he was just the nicest guy in the world to work with.

You know, there was a little bit at the beginning where like, we're trying to figure out how to trust each other but then, once we got there and, you know, we just both wanted the best for the show, he was so great to work with.

And so, when he would want to find out what Sister Beth would say, for instance, while she's counseling the Michael Keaton character because, you know, that happened in the show and that's what Sister Beth does, we got her on the phone, Danny and I, and we interviewed her together.

And I would have her recount things that she had already told me about the early days of OxyContin.

But then he would ask really kind of questions I wouldn't think to ask, which is like, well, what exactly would you say to somebody who, this was their first time in your office and you were, you know, and it was basically kind of how to love yourself again, right?

So, you see her doing, her character doing those exercises, that's stuff that we got directly from Sister Beth.

-I think all of these things, and you had said you didn't want Appalachia portrayed as a stereotype.

You also had Robert Gipe and some people on deck who were making sure that it was absolutely authentic.

But you also did something more for the community besides just getting people to verify that it was being authentic be cause it was important to you to have pieces shot right here.

Wasn't it?

BETH: Yes, yes.

So, we were still in LA right before COVID hit, and Danny was coming back to do-- the trip where he decides where-- he and Hulu decided where the show's going to be filmed.

And it was between Virginia and North Carolina, and they were both offering incentives.

And I was like back channeling with the guy in Virginia.

I'm like, no, we have to shoot it in Virginia.

I would just be so ashamed if we don't shoot it here, you know.

And so, I made this really impassioned pitch to Danny.

I actually got a little tearful before he left and I said, look, if there's any economic benefit that these folks can get from these hard-hit communities, well, they deserve to get them.

I mean, they were the first to experience this, they fought back really hard.

And I think they should get the benefit from it.

And he goes, wow, Beth, you really feel strongly about that.

And then, he just liked it better.

I mean, if you asked, if he was sitting right here, he would say, yes, yes, Beth moved me with her speech and the text credits are great.

I just thought Virginia looked better.

-Yes, well, I'm sure the community is grateful too because not only did you bring jobs; there were people who were able to participate in the series, right.

And then, what was the community impact from having something like, you know, the Hulu series, and all the equipment and everybody in the community?

What kind of feedback did you get from the community?

-Well, we did a little premiere up in Clifton Forge a week or two after the show came out.

And I swear, everybody in that town came and they had a little-- where it says Dopesick and all that.

And so, like I would get in the picture with them, and I'd be like, what role did you play?

Like one person like named five different roles.

I was in the scene where they were dancing and I was in like, you know, they were just dressed differently.

And they were all just so proud of it.

It was really sweet .

And just, you know, Clifton Forge had a tough time with a very high overdose rate and lost a lot of jobs.

And just to see them proud again in this beautiful, restored theater that they have downtown, it was really cool.

-Well, you had an opportunity to do a cameo also.

Did you have to try out?

Or did they just let you in there?

-Well, we were in the writing room one day when we were, it's called "breaking the story" when you're sort of outlining what's going to happen in that episode.

Danny knew kind of generally going in what he wanted to accomplish in each episode.

And then, the room was all about, which was like six of us deciding exactly what was going to happen, and we would say what's going to happen to each character in this episode, and then we'd sort of blend them together in the order that we wanted it to happen, which is really, I didn't know that was how they did it.

It was really cool.

And we were talking about that scene at the VFW where there's this community meeting, and Rick Mountcastle was going to go undercover, you know, he's wearing like the overalls like he's just a member of the community and just trying to find out, take the pulse of what's happening in the community.

And Danny's talking about, well, and we'll have a doctor, we'll have that editor from the journal PAIN, like she'll be showing for the pain.org and what should we call her?

Barbara Mullins?

And I think you should play her, Beth.

And I was like, he goes, would you do it?

And I said, why not?

I'll try it.

And I said, will you coach me?

And he said, yes.

So, I did actually have to do a little real.

-You did okay.

-Yes, Tom helped me; we did it.

My husband, Tom, helped me; we did it probably 30 times, and it was not that good.

Turns out, it's really hard to memorize all those lines.

-I bet.

-Yes.

But by the time I drove to Richmond some months later to actually do it, I just recited them in the car on the way and I had it.

But it was like, no joke, I didn't know there were going to be that many people in the room.

So, we're in this literal VFW hall that they had rented for that scene.

There's 30 extras in the audience, you know, community people, including some actors that had speaking roles as members of the community.

And then there's at least that many people in the crew.

So, it was like, bring your A game because you don't want to mess up in front of all these people.

And all the people I was sitting with, the other people who were panelists, were professional actors.

And they were so good, like they just.

-Well, you did a great job.

We watched it.

And I'm like, to my husband, watch for Beth.

You see, she's ready to come up in this part of the episode, just watch for her.

So, you did a great job.

I mean, it's such important work.

The series is a wonderful way to highlight the groundbreaking work that you've done to highlight not only the impact of this terrible tragedy of the crisis, but also for what communities and individuals need to do in order to not only heal ourselves and our communities, but what are the next steps we need to do.

So, from the series, the great feedback, and congratulations on all the awards that it's getting, and continues to get, for you and for the entire, you know, cast and crew of that.

It's amazing to constantly see that it's still, it's getting so many things.

I think that's just a reflection for the importance of the work and the message that you have.

So, what do you think Dopesick , the Hulu series, the impact of the work that you're doing right now, what do you think it's doing?

Is it changing?

Are we seeing big gains?

Is it making a difference?

-I think it's starting to bend the stigma, the stigma is really the number one problem.

And you hear it said so much, it's almost like wallpaper, you hear like stigma, stigma, stigma.

But really, you think of the fact that the doctors have to get that special waiver to prescribe the cure when they don't have to get a special waiver to prescribe OxyContin.

Like, that needs to go away.

That just, it just does, that's low hanging fruit.

And I say that in my next book, which is a follow-up to Dopesick .

But that stigma that's drug users are bad, and we're going to make their treatments extra hard to get.

And the fact that you can't, even I can't go to the health department if we had a loved one with this, and the health department, most health departments don't prescribe buprenorphine.

They should do that.

It should be as easy to get, for instance, like Tess got, Tess Henry, one of my main people that I followed in Dopesick , she got initially addicted through a 30-day prescription for two different opioids at the urgent care center here in Roanoke.

So, her treatment should have been that easy to get.

And so, the fact that you see this A list actor, Michael Keaton, struggle so hard, and it's shown to you in the context of this really entertaining, dramatic story.

And yet you're, secretly you're learning all this really great stuff that we want you to know, which is that it's really hard to get this medicine.

And until we figure out how to make the medicine and the treatments easier to access than the dope, we're still going to continue to see overdose deaths climb.

-That's the message.

-Yes.

-Would you be willing to read something for us?

-Sure.

In fact, the part I've just pulled out is, I've talked before about Tess today, but this is a section where she's really struggling and her family's struggling with, how do we deal with her?

Should we let her hit rock bottom, which is not the answer.

"A week before Christmas, Patricia, her mom, showed me a card she was mailing to Tess, with pictures of her son tucked inside."

Now, Tess had been sent to Las Vegas, a faraway treatment center.

"She'd found what she believed to be her current address from a series of Facebook exchanges between Tess and her drug dealers.

Some angry (Damn man, you stole from me) and some matter-of-fact."

You now, Tess had checked herself out against medical advice, and she was currently living on the streets, doing sex work, and middle-manning drugs in order not to be dope-sick.

"She was staying in another apartment catty-cornered from the church where I'd first taken her to NA.

Patricia wanted to tell her about a new Beck song that began, I met you at JC Penney.

I think your nametag said 'Jenny.'

It was their favorite department store, the place where she bought Tess a new wardrobe every time she left a hospital or rehab stint, only to return home, months later, with just the clothes on her back.

'It scares me now when she comes home,' Patricia admitted.

She'd locked up her shotguns; a sport shooter, she was afraid they'd end up pawned the way her laptop did.

All but two of her spoons were missing from the house, swiped for heroin mixing, she assumed.

'It's like there's a demon inside her,' Patricia said.

'I do get mad at her, and there are times I want to say, I quit.

But the truth is, and I want her to know this, I'll never give up on her.'"

-"I'll never give up on her."

And wasn't that such a powerful message not only for her mom and for Tess, for you, but for all of us, Beth.

It's an important message that you conveyed not only through this amazing work of your book, Dopesick , but in the series, the Hulu series.

I'm sure you have a favorite scene and I'm sure some of our viewers who are watching it also are going to have a favorite.

Do you want to tell anyone what yours might be?

-Well, I've probably watched it the most times because it's a pilot, and it was done first.

But that scene where Michael Keaton's Dr. Finnix is in the grand jury in the episode one, and they're asking, how many patients did you--?

Are you the doctor that prescribed OxyContin to these people?

And how many did you do that to?

And he says, and you just see like this look of shame and guilt and understanding come over his face.

And at that point, you don't know that he has been addicted and all that, and he goes, I can't believe how many of them are dead now.

And just like-- just what great acting he did in that role.

And some viewers may not know this, but he also lost a nephew to opioid overdose.

Michael Keaton did, his namesake nephew named Michael.

And so, this was really personal to him to get this right.

-Well, they did.

They did get it right.

And thank you for writing the book and for bringing it to life through the series.

And I think, as Beth has said, maybe the important message is that we don't ever give up and we constantly remember that all of us need to be involved in trying to stop this, and to support the people that we love.

Thank you so much for joining us for this special edition of Write Around the Corner for Beth Macy's Dopesick , and make sure you watch that Hulu series with her groundbreaking book.

I'm Rose Martin, and I'll see you next time Write Around The Corner .

[♪♪♪] -♪ Every day every day Ev ery day every day every day ♪ ♪ Every day I write the book ♪ ♪ Every day every day Every day ♪ ♪ Every day I write the book ♪ ♪ Every day every day Every day ♪ ♪ Every day I write the book ♪