I

Until recently, the most remarkable thing about Big Stone Gap, Virginia and the rest of Wise County was that it is closer to the capitals of seven other states — Ohio, Tennessee, West Virginia, North Carolina, South Carolina and Georgia — plus, depending on where you are standing, Indiana, than it is to its own state capital, Richmond. (Another fun Virginia geographical fact: its westernmost tip is farther west than Detroit. Michigan.)

Two hundred miles up I-81, Roanoke was known, at least to me, as the place that gave us the pro football stars Tiki and Ronde Barber and, with the possible exception of Christian Laetner, the “Dookiest” player of all time, J. J. Redick. (Raise your hand if you thought Reddick would have a twelve-year and counting NBA career.)

Today, the most remarkable, as in “extraordinary,” “conspicuous” and “worthy of notice” thing is the toll of the opioid epidemic in that part of Virginia and all along the I-81 corridor. Last year, 1,227 people in the Old Dominion died from drug overdoses. That’s more than three people every day or one every seven hours.

Zooming in a bit, during the same period the number of overdose deaths in Roanoke, which, as journalist Beth Macy tells readers in her new book, “Dopesick: Dealers, Doctors, and the Drug Company that Addicted America,” not too long ago was the kind of place where people didn’t lock their doors, quadrupled.

As one emergency room physician put it, “Wow, that’s pretty dramatic.” Wow, indeed.

At least at the beginning, Macy’s tale resembles the story told by fellow journalist Sam Quiñones in his 2016 book, “Dreamland.” (In honor of Hispanic Heritage Month, permit me a rant: There are an estimated 57 million people of  Hispanic origin in the United States. That’s one-sixth of the population. An estimated 40 million Americans over the age of five speak Spanish at home, at least part of the time. I’m not asking anyone to learn Spanish. Really. All I’m asking is that we spell Spanish surnames correctly. By all that is holy, put the tilde over the “n” in names like “Quiñones” and “Acuña,” as in the Atlanta Braves’ Venezuelan wunderkind. It’s 2018, for Pete’s sake! We can write software that can drive a car from coast to coast but we can’t make it simpler to spell someone’s last name correctly? End of rant.)

Like “Dreamland,” Macy’s book unsparingly describes the perfidy of Purdue Pharmaceuticals, the creators of OxyContin. We read about the incentives given to sales reps to put more pills into the hands of more people with the assistance of physicians who were, at best, willing to overlook the dangers of handing out potentially-lethal painkillers like they were acetaminophen or, at worst, eager to take advantage of the incentive structures.

One doctor “was so blatantly in favor of graft that she posted a signup sheet in her office, soliciting reps to sponsor her daughter’s upcoming birthday party at  . . . an amusement park.”

And while both books combine personal stories of families devastated by the opioid scourge with a kind of narrative history of the epidemic, “Dopesick” feels far more personal. Part of the reason is that Macy’s account is largely limited to the Shenandoah Valley between Winchester and Roanoke, Virginia.

The other reason is that “Dopesick” not only tells the story of how people like Ashlyn Keikilani Kessler, a graduate of Liberty University, became addicts but also how they, successfully or, more often, unsuccessfully, sought to get off opiates. Kessler’s story, thankfully, turned out well. After serving time in federal prison, she got offs drugs, got married, got a job as a paralegal, and had a child.

II

Most of the people Macy tells us about weren’t nearly as fortunate. As awful as the stories about mothers, like Kristi Fernandez, whose kids died from overdoses, are, the ones about the parents of people like Tess, who went from being an A student and high school athlete to being an addict turning tricks to keep from getting “dopesick,” i.e., going into withdrawal, are, in some ways even worse.

While drugs are consuming the lives of people like Tess, their addictions are consuming the lives of their parents. Trying to keep an addicted child from killing himself or herself is a full-time job and then some.

In addition to the heartache and anxiety — these parents live in dread of “the phone call” informing them that their child has been found dead somewhere — there’s the Sisyphean task of getting them effective help.

If they can convince their children to seek treatment, which is no small task itself, “there is still only one treatment bed available for every five people trying to get into rehab, and at a cost far beyond the financial reach of most heroin users.”

And, as one prosecutor told Macy, “Rehab is a lie. It’s a multibillion-dollar lie.” Macy cites a 2017 New York Times report which characterizes the industry as, in her words, “unevenly regulated, rapacious, and largely abstinence-focused when multiple studies show outpatient MAT [which stands for “medication assisted treatment”] is the best way to prevent overdose deaths.” (I will get to MAT below.)

Yet families keep trying out of love and the fact that there’s really no alternative to this brutal journey. As Macy tells us, on average it takes eight years and “four or five different episodes of treatment” for an addict to remain sober for one year.

At that point, they have a fifty percent chance of relapsing. If they can make it to five years, their chances of relapse drop to less than fifteen percent. But, as Macy reminds us, most of them don’t have eight years.

III

Nearly forty years ago, the late Nancy Reagan famously told American kids to “just say no” to drugs. However well (or not) this approach may do when it comes to preventing kids from experimenting with drugs, it’s useless when it comes to dealing with addicts.

The reason is, of course, they’re addicts. Opioids and other drugs have altered their brain chemistry in ways most of us cannot imagine. Here’s an example: While “the average nonaddicted person’s perception of the future” is about 4.7 years, a heroin user’s “idea of the future . . .  is just nine days.”

That’s why, as Macy tells us, “Fewer than one-quarter of heroin addicts who receive abstinence-only counseling and support remain clean two or more years.” Art Van Zee, the country doctor who first sounded the alarm about the opioid crisis nearly twenty years ago, told Macy that “taking an opioid-addicted person and expecting them to do well in drug court . . . [without medicine-assisted therapy] is almost cruel and unusual punishment.”

So why would anyone ask them to? One answer is that the “medicines” in “medicine-assisted therapy” are themselves opioids, such as methadone and buprenorphine, and a combination of buprenorphine and naltrexone, which is used to treat alcohol and opioid addiction, known as Suboxone.

As the saying goes “You can’t fight an opioid with another opioid.” Add the fact that it is possible, albeit difficult, to abuse buprenorphine — addicts are nothing if not resourceful — and the resistance to MAT is understandably strong, especially among law enforcement and many rehabilitation clinic personnel, especially those in faith-based programs.

The problem is that, as Macy amply documents, the alternatives don’t work nearly as well. An addict’s best shot at recovery is a combination of medication-assisted therapy, counseling and community support.

IV

Scarcely a month goes by that I don’t hear of read a Christian begin a sentence with the phrase, “In a fallen world . . .” It’s become a kind of cant that serves as a rationalization for accepting some status quo or another.

But the fact remains that we do live in a fallen world, and in some instances the ideal solution isn’t on offer. We are left to choose the least-bad option. Ideally, a combination of counseling, religious instruction, and community support, especially from the Church, would be enough to keep people from dying without resorting to MAT.

It’s not. It really isn’t. And that requires us to ask what it is we hope to accomplish: convert, for lack of a better word, a relative few to a more responsible lifestyle, or save more, perhaps a lot more, by reducing the harm caused by their addiction.

I have made my choice clear: save as many as we can and pray that over time they can be weaned off the methadone or Suboxone. As one researcher told Macy, “While . . . buprenorphine, methadone, and naltrexone [are] all imperfect solutions, they remain, scientifically speaking, the best death-prevention tools in the box. “

Macy saves the best and most inspiring story for last: The director of a recovery program named Steve Loyd was explaining the science of addiction and the challenges it posed to a skeptical crowd at a town meeting “when a woman in the audience interrupted to ask, ‘Just how many chances are we supposed to give somebody?’”

As Macy recounts, “From the community center where he stood, in the heart of the Bible Belt, Steve Loyd could make out four church steeples. He had played ball and gone to Sunday school with many of the people in the room . . . In the shadow of the church steeples, Loyd let Jesus answer the woman’s question: ‘Seventy times seven,’ he said.”

Let’s go and do likewise.