Raising Lazarus: Beth Macy’s Follow-Up Reporting on the Opioid Epidemic

Raising Lazarus: Hope, Justice, and the Future of America’s Overdose Crisis, by Beth Macy
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Journalist Beth Macy, who has been on the forefront of chronicling the opioid epidemic in the US for years, recently released her follow-up to 2018’s Dopesick. I haven’t really seen this new book get as much attention yet as I think it deserves, so I hope that changes soon.

The tack Macy takes in Raising Lazarus is to focus on harm reduction methods; the scientific research that supports their use and successful outcomes as opposed to previously used methods, like abstinence rehabs, prison, or just ignoring the problem; and the people who are doing that work in their communities, often illegally. This is shocking:

In the richest country in the world, treatment of the sickest, neediest people fell to volunteers risking arrest to give out homemade tinctures discovered in the Middle Ages.

The title refers to the biblical act of raising Lazarus from the dead: Jesus did it, but it was Lazarus’s friends and family who did the tough, unpleasant work of removing his burial shroud and wrappings, helping to usher him back into life.

Macy uses this as a metaphor for the difficult but necessary work that many — but not nearly enough — people are performing of harm reduction on local, community levels. Macy identifies harm reduction as opposed to previous governmental stances or policies as being the tactics backed by science to have the most impact in helping Americans overcome the still-crippling opioid epidemic, which has been back-burnered in the Covid era.

This is also quite a thorough study, weaving in a vast range of economic and social aspects around addiction and treatment as well as some of the legal battles to hold the Sackler family responsible for their role in knowingly pushing Oxycontin despite awareness of its dangers.

And as in Dopesick, Macy’s puts human faces on this epidemic, of both users and the people doing the exhausting, thankless work mitigate harm, to intense emotional affect. She acknowledges how tough it is, showing how many people have been affected by it, not only due to their own addiction but through family members and loved ones who have fallen victim, or those who have been victimized through theft, for example. That makes it difficult sometimes to have sympathy, but Macy shows exactly why empathy matters in ultimately conquering this epidemic. She addresses the widespread misunderstandings that we still hold about addiction thanks in part to Reagan-era War on Drugs policies, likening the social media comment sections on mugshot posts to “an updated version of Shirley Jackson’s “The Lottery”.

This is an incredible work of compassion, on Macy’s part to chronicle it and of all the people who are doing what they can in harm reduction work to help community members who have been horribly failed by medical professionals, big pharma, the government, law enforcement, and anyone else who could’ve pointed this in a different direction any earlier.

If I live to be 100, I will never forget the image of Brooke Parker, sitting at the infected feet of a calmly weeping man while police officers went about the business of stapling up eviction notices. It was like we weren’t even there, like the earth that we, too, walked on belonged solely to the politicians and bureaucrats and people who were still falling for Richard Sackler’s “hammer the abusers” scam.

A helpful companion read is Brian Alexander’s The Hospital: Life, Death, and Dollars in a Small American Town, a book I haven’t reviewed but really appreciated. A thread running throughout Raising Lazarus is the responsibility that the US for-profit healthcare system has in not better mitigating the epidemic, and The Hospital makes abundantly clear how dangerous, overbloated, and unwieldy this system is, to the detriment of all of us.

I agree with economist Paul Krugman, quoted in Macy’s book, that “I still run into people who are sure that we have the world’s highest life expectancy, when we actually die a lot younger than people in other rich countries.” This is American exceptionalism at its worst: we do continue to believe our healthcare system is vastly superior to other countries, particularly looking down on those with universal socialized medicine, when the reality is that the opioid epidemic would’ve never played out as it did without our healthcare industry prioritizing profit and pharmaceutical money over patients themselves.

As per economists Anne Case and Angus Deaton: “Other countries have a range of other ways of organizing healthcare, all have their strengths and weaknesses, but none are killing people. None are supporting the brazen subordination of human need to human profit.”

This is hard-hitting and emotional — I get tearful even remembering one section where several newly-in-treatment opioid users shared their short-term goals — but it’s outstanding: excellently written, even page-turning, and such an important journalistic work. Please read this if you still think that the “they have to be allowed to hit rock bottom” approach to drug use is correct.

published August 16, 2022 by Little, Brown. I received an advance copy courtesy of the publisher for unbiased review.