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'Dopesick' author turns her attention to the citizen volunteers combatting addiction


This is FRESH AIR. I'm Dave Davies, in today for Terry Gross. The Centers for Disease Control and Prevention estimates that more than a million Americans have died from drug overdose since 1996. Our guest, journalist Beth Macy, writes that addiction has become the No. 1 destroyer of families in our time. Her last book, "Dopesick," which was adapted into an eight-part series on Hulu, detailed the dimensions and impact of the opioid crisis, particularly on rural communities. Macy returns to the subject in a new book, noting that given the scale of the opioid epidemic, the nation is sorely lacking in effective treatment programs, often due to the indifference of state and local officials or their hostility to treating people they regard as parasites or criminals.

Macy's new book highlights the work of citizens who have made it their business to help those struggling with addiction, sometimes working with small nonprofits or churches, sometimes driving their own cars to drug houses or makeshift encampments to offer clean needles, hepatitis testing and treatment, medications that ease withdrawal symptoms, and plenty of empathy and understanding.

Also with us today is one of those activists who's had a meaningful impact. Reverend Michelle Mathis is co-founder of Olive Branch Ministry, which now provides services to people in nine counties in North Carolina. She's also program coordinator for the Gaston County, N.C., Opioid Overdose Response Team. She serves on the board of several statewide organizations, including the North Carolina Harm Reduction Coalition. And she's the advisory board chair of the National Faith in Harm Reduction Movement. She's also an important character in Macy's new book, which also chronicles ongoing lawsuits and protests targeting the owners of Purdue Pharma. That book is called "Raising Lazarus: Hope, Justice, And The Future Of America's Overdose Crisis."

Well, Beth Macy, Michelle Mathis, welcome to FRESH AIR. Beth, I thought we'd begin with you to remind us of kind of where this opioid crisis came from. You know, a lot's happened in the last few years. We've had a pandemic. We've had, you know, a lot of political division and controversial stuff involving the former president. Remind us how it is that prescription opioids were introduced and became so widely abused back in the '90s.

BETH MACY: Yeah. Well, in 1996, Purdue Pharma, which was based in Connecticut under the direction of its owners, the Sackler family, introduced a drug called OxyContin. And they also funded a lot of pain orgs. And at the same time that the drug came out, they did this massive marketing campaign to show that, while for a hundred years we knew that opioids were addictive and only to be used in cases of cancer, end of life, severe pain, now they were flipping the narrative and telling a lot of doctors and sending them on fancy trips to learn to be paid speakers for the company, that their drug was virtually non-addictive.

And so it flipped from only using opioid pills. And this was really a national movement. And other companies soon joined in because they saw how Purdue was cashing in. But they basically flipped the narrative by convincing doctors that opioids were safe. And right away, the drug started being misused. It was being massively overprescribed. And so you had people who legitimately would have workplace injuries because, by the way, Purdue targeted those areas, particularly distressed areas in communities like the furniture belt of North Carolina or coalmining areas in western Virginia. And they went there. They targeted doctors who were already prescribing competing opioids like Percocet or Vicodin. And they targeted those doctors by saying, look, the FDA allows us to say this drug is virtually non-addictive. And it really took off like wildfire.

DAVIES: Right. There's been a lot of legal action in which Purdue Pharma had to admit to criminal misbranding of its pharmaceuticals. But they got out there. They were ubiquitous. What was the impact on so many of the communities that you've written about?

MACY: Yeah. In the communities that I cover - and it's largely southern Appalachia, rural communities - you've seen disability go through the roof. You've seen food stamps and food insecurity go up, foster care tripling, workforce participation rate, particularly among middle-aged men who haven't gone to college, way, way down. And when you tally up all the deaths, it's more than 1 million dead of drug overdose since 1996, the year OxyContin came out.

DAVIES: Michelle Mathis, you've been doing this work full-time since 2018, I believe, with your wife, Karen Lowe. I understand that before that, in the '90s, you worked with survivors of sexual abuse and then worked with - in HIV prevention and treatment. Tell us about the early days of when you got into working on people who were struggling with opioid addiction before you had, you know, funding and an organization.

MICHELLE MATHIS: Well, let me start off by saying that I did not come to this work easily. When I first heard about harm reduction, which is the work of reducing the negative consequences of high-risk behaviors, especially around the areas of sex work and people who use drugs, I saw the work as enabling. And it wasn't until I got into the trenches and began to meet people who were impacted daily by substance use that I realized that I had to change my thinking, that we were enabling people to have a second and third and fourth chance at life, that we had an opportunity to enable people to take positive steps and to find safe space.

So that was a good portion of the beginning of my work, really, was changing my mindset to embrace the work at hand. I was introduced to harm reduction while doing some HIV outreach and education and testing one evening, and met a man who was handing out some wound care kits in a parking lot. And he was involved in harm reduction. And through that, he began to mentor me. When we started, Karen and I, we had a decision to make. Were we going to go into this full force while working our regular jobs, or were we going to kind of take a more relaxed approach? And we wanted to make sure that we gave it our full effort. So we would spend evenings and weekends delivering food to individuals under the auspices of having a kind of mobile food exchange, whereas we were actually delivering syringes and condoms and alcohol wipes underground, if you will.

So we came to it in a kind of an unusual way, but what we found was the word spread very quickly. We didn't advertise, obviously, because it wasn't legal in North Carolina at the time, but we didn't have to advertise because when you provide a service that is desperately needed, the customers find you. So one would bring another and then another And then another. And we had one participant. She said, I get tired of giving people y'all's number and then people lose it. You need to print up some business cards and have your phone number on it and make it so nobody knows what you're doing.

So we already had Olive Branch Ministry. We put our phone numbers on there. So that way, when people found the card, whether it was a parent or a friend or a child, whoever, they would think someone was involved in a ministry. And, you know, being in the South, that's a really good thing. But it allowed us to spread the word effectively.

DAVIES: So you're providing clean syringes, which helps people because dirty syringes can spread disease and cause infections. But it's not just that, especially as the work went on in time. I mean, you made connections with this folk. What kinds of other services did you end up providing and connecting people to?

MATHIS: When we started, of course, it was syringe services. I mean, we did that for four years, but in the midst of that, we began to do unofficial peer support. So we were able to work with individuals, provide peer counseling, if you will, in an unofficial capacity. We met people simply where they were, and we listened because so often people who are stigmatized have no place to even share their thoughts, share their anger, share their grief because we were losing people left and right to overdose - so just providing safe space. And that's one of the biggest things that we provide. And as time has gone on, we provide overdose education and prevention. We provide naloxone, the medication that can reverse an opioid overdose. We provide that free of charge. We provide community education both to the regular community, the public, and to faith communities, because we are a faith-based organization. We provide low-barrier hepatitis C medication through an unusual partnership with a federally qualified health clinic in our area and a nurse practitioner named Tim (ph), who is an angel. And along with that, we also provide, through his help, low-barrier medication-assisted treatment through the Suboxone program that we have.

DAVIES: Right. That's the drug which helps people - it combats withdrawal symptoms, right?

MATHIS: That's correct. Yes. And then we also do simple things like provide food. We provide a sofa for somebody to take a nap if they've had to be up all night on the streets, so they were walking around to make sure that they were safe and that nobody attacked them. There's a lot of nuanced kind of things that we do in this work. Our mission statement is to extend hope and to extend life. And that's the goal of everything that we do.

DAVIES: It strikes me the enormous patience and empathy that it takes to deal with folks whose lives are in disarray and who, you know, have been dismissed, you know, and treated rudely at times when they've sought help. Was it hard for you to do that, to embrace people where they are?

MATHIS: That's a tricky question. Meeting people where they are is the key to harm reduction. And so if you're going to do this work, then you have to go into it with a mindset of you're going to meet all types of people from all walks of life because this disease does not discriminate. And if you're willing to meet the person who makes six figures a year where they are, you also have to meet the person who hasn't been able to hold down a job in 20 years where they are. It doesn't matter what they look like, what they smell like, where they come from, what they had for breakfast. You treat everyone with no judgment, no stigma, and with love. Love bears all things. Doesn't mean that our work is easy, but what it means is that if you truly enter into this work with a mindset of love and you want the best possible outcome for this individual and that they have a say in what that outcome is because they're the expert in that journey, then you're along for the ride. You're there to hold space with them, and you make that commitment from the time they walk through your door or you see them in a parking lot or in a tent city. From the first time you engage with them, you make that commitment to be with them.

DAVIES: Beth Macy, there's a moment that you describe in the book where a man who is, you know, struggling with addiction is in the presence of Michelle Mathis, our other guest here. And he's embarrassed. He hasn't bathed. He thinks he smells. Do you know the moment I'm talking about?

MACY: Yeah, they're in a Roses department store, and I believe Michelle was there to meet him, to give him clean supplies. And he told me the story. She didn't tell me. I reached out to him after I saw on Facebook that he was talking about how he had brought somebody back using Narcan that he'd gotten from Olive Branch. And so I just picked up the phone and called him, and he was - this is somebody that was initially prescribed OxyContin. He was a veteran and had had an injury in Kuwait and, you know, the typical journey. And he was in the middle of a four-day binge, as he said it, and he was there to get his needles. And Michelle stopped, and she looked at him, and she said, can I give you a hug? And he will never forget that moment. That was a pinnacle moment for him.

DAVIES: Michelle Mathis, do you remember this?

MATHIS: Absolutely. Absolutely. And he - it was then, as he is now, an amazing individual who has, through lots of hard work and his own determination, made many positive steps in his life. But I will never forget the moment that we met - never.

DAVIES: We need to take a break here. Let me reintroduce you both. Michelle Mathis is co-founder of Olive Branch Ministry, which provides services to people struggling with addiction in rural North Carolina. Also with us - Beth Macy. Her new book is "Raising Lazarus: Hope, Justice And The Future Of America's Overdose Crisis." We'll continue our conversation in just a moment. This is FRESH AIR.


DAVIES: This is FRESH AIR. We're speaking with journalist Beth Macy, author of the book "Dopesick," about the opioid epidemic. Her new book, "Raising Lazarus," is about grassroots organizations and citizen volunteers working to help people struggling with addiction, often in rural communities. Also with us is Reverend Michelle Mathis, co-founder of Olive Branch Ministry, which provides a variety of addiction-related services in nine counties in North Carolina.

You know, it makes a difference when you're doing this work, whether you have some cooperation and support from the ruling authorities in the area - the politicians, the mayor, especially police and courts, because people who are addicted get arrested, and that's an opportunity to intervene and provide services and treatment. It's a juncture in their lives. But you can't if the local sheriff has no interest in this kind of thing. And I thought we would talk about efforts in Surry County, N.C. This is different from Michelle Mathis's home county. Beth Macy, tell us a little bit about this county. It's an interesting place on its own.

MACY: Yeah, it's - the county seat is Mt. Airy - or the best-known little town is Mt. Airy, N.C. That was Andy Griffith's hometown and the inspiration for "The Andy Griffith Show" in Mayberry. And if you drive down Main Street, you'll see all kinds of references to the show, from Aunt Bee's diner to - you know, you can pay a little money and take a ride in Andy Griffith's old police cruiser.

And the town has sort of built itself up on having this really wholesome image - I mean, images of Andy and Opie everywhere, which is awesome but not awesome when you cling so rigidly to that narrative that you're not willing to see that you have - when I first started going down there, they had the second-highest overdose rate in the nation.

DAVIES: Is there any common ground between harm-reduction groups and those in law enforcement agencies that pursue the war on drugs? I mean, has the war on drugs had any positive effect?

MATHIS: The war on drugs is the war on people who use drugs. And I just have to say that. It's not a war on drugs themselves. And I feel really strongly about that. That being said, I'm a little different than some harm reductionists in that I do believe in strong relationships with local law enforcement. Law enforcement has the ability and the option to divert charges. There is actually national programs called Law Enforcement Assisted Diversion, which allows an officer to make a decision in that moment - are they going to arrest the individual, or are they going to divert those charges in order to assist the individual getting treatment?

That is a powerful relationship that we can have if we have the trust of the law enforcement community. It prevents people from catching charges, from having a record, potentially, especially if it's their first time, from destroying their employability, from destroying their family life. There's a lot of unintended consequences with one single arrest.

DAVIES: I mean, one of the things was that people who were addicted would get arrested. What was the county jail like?

MACY: It was twice as full as it was supposed to be. They let me tour it. There was an intake area where people who had been recently arrested were laying on urine-soaked mattresses with buckets to catch their vomit. Many of them were dope sick, in serious withdrawal. And, you know, I got the full tour. This is a county that has to spend a lot of money sending - busing inmates elsewhere to the other side of the state, so then their families can't visit them. And it was just really bad circumstances.

And they were pretty open about letting me see it, largely because they wanted to buttress their argument for a bigger, more expensive jail, which they are building presently. But when I would ask, like, here's a little nurse's office - why can't you do buprenorphine here? You know, they just kept coming back to this argument - we don't have enough room; we don't have enough staff. And I got to see that sort of attitude begin to shift because of Mark Willis, with Michelle's help, and this effort to create this pretty large network of peer-recovery specialists, and that's people in recovery who are going out, they're responding to overdoses, they're meeting people at the hospital and linking them, when they're ready, to care.

DAVIES: Yeah, you mentioned Mark Willis. He's this ex-Marine who'd done work overseas and took this job as the opioid response coordinator. So over time, this work in Surry County, the home of Andy Griffith, which prides itself on being, you know, the Mayberry of America - have overdoses declined? Have things visibly improved?

MACY: Not yet, to my knowledge. The last time I checked, no. I mean, they still have hundreds of people - job openings that they can't fill because people can't pass a drug test. But they have this huge infrastructure now, which is so important for every community to have now that this opioid litigation money is starting to filter down to communities. I mean, when I first asked Michelle what her hope was for this litigation money, she was very cynical. She said, I don't know, I think it's probably all going to go to drug war programming and abstinence-based treatment models.

But now you have, in the basement of the courthouse, where Mark Willis has his five or six peer-support people - he has community outreach. He has a data guy. I mean, it's like command central. And every person who has an overdose gets a response from his team. He has somebody stationed at the hospital that works with folks when they're ready to enter treatment. And I think we're going to start to see change there. And it's just - it's gotten the community excited. I mean, one of the things they did was they - you know, they did this garden outside of the courthouse. They're trying to make it appealing. They're trying to send a message that we care about everybody in our community.

DAVIES: Let me reintroduce you. We're going to take another break here. We're speaking with Beth Macy. Her new book is "Raising Lazarus: Hope, Justice And The Future Of America's Overdose Crisis." Also with us is Michelle Mathis. She is co-founder of Olive Branch Ministry, which provides services to people struggling with addiction in rural North Carolina. They'll be back to talk more after a break. I'm Dave Davies, and this is FRESH AIR.


DAVIES: This is FRESH AIR. I'm Dave Davies, in for Terry Gross. We're speaking with journalist Beth Macy, who spent several years reporting on the opioid crisis in America. Her new book, "Raising Lazarus," tells the story of citizen volunteers and grassroots organizations that are working to help people struggling with addiction often in rural communities. The book also chronicles ongoing lawsuits and protests targeting the owners of Purdue Pharma. Also with us is Rev. Michelle Mathis, co-founder of Olive Branch Ministry, which provides a variety of addiction-related services to people in nine counties in North Carolina.

You know, Michelle Mathis, one thing that comes through in reading about this is how stressful this work can be, I mean, for folks - some who don't get paid for it. But, you know, when somebody calls you at the end of the day and they're really in need of something, you drive over there, and you do it. And you just - you can work around the clock. And then, there's the fact that there are tragedies, right? I mean, people who seem to be doing well disappear, or they die of overdose. How do you cope with all that emotionally?

MATHIS: This work is high-stress. You know, that kind of goes, I guess, without saying. You develop relationships with individuals, and then, they may pass away from an overdose. Or, like you said, they may disappear, and you don't know what's happened to them. And sometimes, it's because coming back to a syringe services program or reengaging with harm reduction may be triggering for them on their new journey. And so even reaching out to say I'm OK may be too much for them. You have to accept that and kind of live in the moment, if you will.

But, you know, I'll never forget the first death that we experienced in doing this work and the fact that - and it still haunts me to this day - that when she passed, she had, during the time we'd known her, saved dozens of lives through the administration of naloxone and had reversed overdoses. She had prevented disease from many people because she encouraged us to order special syringes from the U.K that were color-coded so that people would know who their own - you know, which syringes applied to them, you know, were theirs. She'd done everything she could do. But because of shame and stigma, she ended up dying alone having overdosed.

And the grief for us came obviously in her death, but also the fact that we could never share with her family the fact of - the - all the great work she had done in the midst of her addiction. And that is a tragedy for us. So it's not only the tragedy and the stress of losing individuals, but also losing the truth of their stories and not being able to tell them. So when we talk with people who are in the trenches doing this work, we say often, you can't fill someone else's cup unless you keep yours filled. Do what you have to do. Step away. Take care of yourself so you'll be able to take care of someone else tomorrow.

DAVIES: You know, one gut punch that hit me as I read this - I mean, when we were talking about the efforts in Surry County, the place where, you know, Andy Griffith's hometown was. And there was this guy, James Stroud, who was a former banker who was really active in this. At one point, he used his own money to get somebody out of jail, just pushed himself and pushed himself. And then, you learn, at some point, he's gone back to using meth again. It's just tough to see folks who are doing the work just overwhelmed by it. Is he better now? Do we know?

MACY: He tells me he is doing better now, and I don't know that he's back working with Birches. But, you know, I saw that kind of peer stress every - in every community that I visited, people with many years of sobriety relapsing. And it's just this irony or something that the people who are most qualified to do this work, the peers I'm talking about, are sometimes the most vulnerable, too. But I think it's important to show the issue fully in the round, warts and all, because that's what people are dealing with. And they need help. We need to scale what they're doing. Especially as this litigation money comes in, we need to offer this kind of help at a scale that actually matches the scale of the epidemic.

DAVIES: That actually leads me to my next question. You know, at the end of the book, I mean, it's inspiring to see how hard all of these people are working and the impact they're having. But it's one at a time, and it's hard. And you write that, you know, their work is simply not sustainable. Individuals, no matter how inspiring or selfless, cannot solve a systemic problem without sustained institutional and governmental support, bigger changes.

MACY: Yeah, and I think the government, they owe them that because, you know, they presided over this massive, overprescribing problem that led to this epidemic, where we are now, by, you know, impotent regulators who are using the revolving door to get better jobs with industry and on and on. There's a lot of - there were a lot of bad players. And I just really - I mean, whenever I talk to groups, I always say, you know, if you're somebody that has social capital in your community, if you know judges, if you know sheriffs, if you know emergency department directors, tell them about these examples of folks who have figured it out.

Because once - I mean, what I really love is when I'm interviewing somebody - and maybe I've talked to them two years ago, and they were totally against Suboxone, and now they got all their doctors waivered and are prescribing it in the emergency room - and you say, well, how's that feel? You're, like, potentially saving 30 lives this month. And they are so excited about it because they're not just seeing the same problem cycle back over and over. And then, they become evangelists for whatever progressive, new thing they're doing. And they go and teach other emergency room doctors in other places. Or sheriffs go and spread the word of what they're doing with other sheriffs. Because I think, you know, we'll hear change from somebody who's like us more likely than we'll hear it from somebody who isn't.

DAVIES: Yeah. You mention doctors getting waivered. That's essentially getting them the qualifications to write prescriptions for Suboxone, right?

MACY: Right.

DAVIES: Right, right.

MACY: Right. And there's no special DEA certification that you need to prescribe OxyContin, but there is - you have to have this special waiver and training. And only 8% of doctors have bothered to get it. And even a lot of those don't want to do this treatment because, you know, they'll say, well, the patients are too difficult or, you know, I don't want those people in my waiting room. Well, guess what? They're already in your waiting room.

DAVIES: We need to take another break here. Let me reintroduce you. We're speaking with Beth Macy. Her new book is "Raising Lazarus: Hope, Justice, And The Future Of America's Overdose Crisis." Also with us is Michelle Mathis, co-founder of Olive Branch Ministry, which provides services to people struggling with addiction in rural North Carolina. We'll continue our conversation after this short break. This is FRESH AIR.


DAVIES: This is FRESH AIR. And we're speaking with journalist Beth Macy, author of the book "Dopesick" about the opioid epidemic. Her new book, "Raising Lazarus," is about grassroots organizations and citizen volunteers working to help people struggling with addiction, often in rural communities. Also with us is Reverend Michelle Mathis, co-founder of Olive Branch Ministry, which provides a variety of addiction-related services in nine counties in North Carolina.

There's been a lot of litigation that grew out of the opioid epidemic aimed at pharma companies. And one that you write about is against the Sackler family and Purdue Pharma, their company, which gave us OxyContin. And there's been more than one civil action against them. But in this one, you write about a protest movement, which sort of grew up in conjunction and parallel to the lawsuit, which sought to raise certain issues in the litigation. You want to just describe who these folks were, what the issues they were raising were?

MACY: Sure. In 2019, Purdue filed for bankruptcy, which got them out of this giant multidistrict litigation that also included other opioid makers and pharmacies and distributors. And they filed for bankruptcy in White Plains, N.Y., which is not where they're located. They filed there because there was a judge that favored what's called a third-party nonconsensual release. And what that did was it allowed them to hold on to a lot of their wealth, to basically walk away with a lot of their wealth sucked in offshore accounts. They have to give up the company. I think they're at $6 billion right now. But in the meantime, this grassroots group called the Ad Hoc Committee on Accountability, which was sort of fronted by the famous artist Nan Goldin, who has done all this protest to take the Sackler name down successfully - you know, in places like the Met and the Guggenheim and the Louvre - started getting really interested in following what was happening in the bankruptcy court. They wanted to make sure that the victims' voices were heard.

And interestingly, they partnered up - Nan herself is in recovery and on Suboxone for her opioid use disorder, which began with an OxyContin prescription. But many of the folks in this group are parents of the dead. I talk a lot about Ed Bisch - I profiled him as well in "Dopesick" - and, you know - which is - you couldn't get more opposite of Nan Goldin than Ed Bisch, who was this salt of the Earth IT worker in Philly. But suddenly, every Thursday night, they're all meeting on Zoom. And they're saying, how are we going to make sure that the public understands this very untransparent process - and what Ed calls the bankruptcy scam - that's going to allow them to walk away from this after already pleading twice in federal court to, you know, fraudulent marketing and the like, that's going to allow them to walk away a third time? And so they are still working on that.

DAVIES: Right. And so one of the things they wanted to deal with was that in addition to keeping a lot of their fortune, they would get this immunity from any future civil lawsuits, this - what's the expression? - third-party...

MACY: The nonconsensual releases.

DAVIES: Nonconsensual releases. You know, an unseen future person can no longer sue because the Sacklers committed this money. Tell us what happened and where it stands.

MACY: So they got up to $6 billion, the Sacklers giving up the company and a lot of public pressure was applied, a lot of media stories, a lot of legal filings by the Ad Hoc Committee's pro bono lawyer Mike Quinn. And currently, the bankruptcy is on appeal. The first judge that looked at it said - Judge Robert Drain, the bankruptcy judge, doesn't really have a right to tell Ed Bisch and other relatives of the dead that they can't sue the Sacklers civilly. And so that's - then the Purdue appealed that. And it's currently now sitting at the second appellate level. In the meantime, Ed Bisch and other members of this group, you know, staged a protest in front of the Department of Justice, begging Attorney General Garland to indict them criminally. And they've had follow-up meetings. And, you know, I report on kind of how that goes near the end of the book. And we don't know what's happening with that yet. But we do know that Garland came out very forcefully in favor of that first appellate judge's ruling. And so, you know, we wait and see what happens next on that.

DAVIES: So if there is $6 billion paid as a result of this litigation, does that go to people who need treatment? Does it go for compensations for families of victims? Can it be diverted to other spending by state legislatures or county governments?

MACY: It's all a patchwork, just like the whole addiction system in America is. Some states have set up really great guidelines - Massachusetts, New York, for instance - and other communities haven't really said what they're going to do with it. I know in North Carolina, which is where a lot of "Lazarus" takes place, only the half - only half of the counties have even appointed an opioid person, an opioid response point person to address with that. So the fear is - and Michelle's the first one that pointed this out - that the money is just going to come down and it's going to go to drug war policing, and that not enough of it is going to be actually spent to help people get better. There was a small settlement pot for personal injury victims, but many of them didn't know or they didn't have the capacity to apply. And so I think the average award is going to be for those who did is between - starts at $3,000 and goes up. I can't remember what the top number is, but it's not a lot of money. As Ed Bisch, a parent that I profile in both "Dopesick" and "Raising Lazarus," says, it wouldn't even cover the cost of a funeral.

DAVIES: You know, Beth Macy, your last book, "Dopesick," about the opioid crisis was made into an eight-part series on Hulu, you know, starring Michael Keaton. It won a Peabody Award, a lot of Emmy nominations. Michelle Mathis, did you see the series?

MATHIS: I did.

DAVIES: Yeah. What'd you think? What was your reaction?

MATHIS: I watched the first one with great anticipation. And then I had to take a break before I watched the next. We actually spent some time in our Hickory office watching together and crying with each other and holding each other, sitting on the sofa. It was triggering in a lot of ways. But it was also an affirmation of the necessity of the work that we do and that we're not fighting against a pharmacist, you know? We're fighting against big pharma and the destruction that they have left us with. And so for that, it was inspiring for us.

DAVIES: If it's not too personal, what in that first episode was hard for you or triggering?

MATHIS: In our day-to-day, we're in the trenches. And so we are working with folks that we know individually. And so we know an individual story here, an individual story there. But when you take a step back and you look at the big picture, as you see in a different community - but you see how this pure evil has affected not only the individuals that you know, but the story is so much bigger. And you know this in the back of your head. But you get so focused on the day-to-day of what you do that taking a step back and seeing truly the impact that it has had and the devastation of millions of lives - that was overwhelming in that moment.

DAVIES: Beth Macy, you know, the last time you and I spoke about your last book, we spoke briefly about alcoholism in your family, you know? Your dad struggled with it through your childhood. And recently, you wrote a piece about it in Oprah Magazine and said that your work on, you know, opioid addiction in recent years and all your reporting had made you rethink your attitude towards your father. Can you share some of that with us?

MACY: Yeah. I wrote about - you know, I was kind of the - I was the fourth child of much older parents. I was kind of like the midlife accident. And by the time I came along, my dad was really in advanced stage alcoholism. He couldn't work. He would sit at the VFW all day. And we were really poor. And it ticked me off. And it made me mad. It made me protective of my mother. And he died of lung cancer when I was in college. I was 19. And he was just really not a part of my life. So you know, he didn't attend any of my events, didn't come to my graduations. Nothing. And I was kind of relieved when he died. And I know that sounds really harsh.

But in getting to know these folks - and I know alcoholism and opioid use disorder are different - it began to hit me that he, too, had a disease, his disease of alcoholism. And while I didn't know him when he was healthier earlier in his years, I realized that if I'm going to be kind of giving this message that this is a treatable medical condition, which is so important to emphasize, that it's treatable - and that we need to extend grace and love to these folks, many of whom were victims of Purdue Pharma and others, and that I needed to extend some grace to him, too. And that was a tough piece to write.

DAVIES: Well, Beth Macy, good to talk with you again. Thanks so much for spending some time with us.

MACY: Thanks, Dave.

DAVIES: Michelle Mathis, good luck in your work. Thank you for speaking with us also.

MATHIS: It's been an honor, Dave. Thank you.

DAVIES: Beth Macy is the author of the book "Dopesick" about the opioid crisis, which has been adapted to a series on Hulu. Her newest book about grassroots efforts to help people with addiction is called "Raising Lazarus: Hope, Justice, And The Future Of America's Overdose Crisis." We also spoke with Michelle Mathis, co-founder of Olive Branch Ministry, which provides services to people struggling with addiction in nine counties in North Carolina. Coming up, TV critic David Bianculli reviews the final episode of the AMC series "Better Call Saul." This is FRESH AIR.


Dave Davies is a guest host for NPR's Fresh Air with Terry Gross.

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