Raising Lazarus by Beth Macy and what compassion looks like as policy

The following are some quotes taken from the book Raising Lazarus by Beth Macy. You may be familiar with her book Dopesick or the Hulu series by the same name. I believe that Raising Lazarus is a needed starting point for people who want to do healing and create new policy paths in our communities and in the United States. The crises of substance use disorders and opioid use disorders are linked to other social crises as well. The problems our families and communities are facing every day are linked to one another, making these crises systemic. But if we going to wait to become experts ourselves, or depend on so-called experts and leaders, before taking action things are going to get much worse. Raising Lazarus gives us the starting points that we need. Think of this book as a compass.

One of our primary problems is in our lack of compassion for people who suffer with substance use disorders and opioid use disorders and their families. Many of us hold to the ideas that someone has to hit bottom before they will want or deserve help, that some people are beyond help, that there should be high barriers to people seeking help, that these disorders are moral failings, and that imprisonment is the best and most socially beneficial form of treatment. Macy makes a good point in her book that when we talk in these terms it is often our own trauma speaking and that the decades-long war on drugs and that trauma are costing us our compassion. This trauma and our lack of compassion, then, excuse us from helping others and saving lives. 

Here are some quotes from the book with page numbers given from the hardback edition (Little, Brown and Company; New York, 2022).

Page xiii: Within the first pandemic year, the overdose count was 29 percent higher than the year before, and the numbers kept climbing. By late 2021, it was clear that addiction had become the No. 1 destroyer of families in our time, with almost a third of Americans reporting it as a serious cause of family strife, and drug overdoses claiming the lives of more than 100,000 Americans in a year---more than from car crashes and guns combined.

Page xvii: in a country that spends five times more to incarcerate people with (substance use disorder) than it does to treat their medical condition, progress was stagnant. In 2019, an estimated 18.9 million Americans in need of treatment didn't receive it. That's a treatment gap of roughly 90 percent. Among the lucky few who do get treatment, Black patients were far less likely than Whites to have access to lifesaving buprenorphine...a medicine that blocks opioid cravings...

Page xv: In Charleston, West Virginia, complaints about vagrancy and needle litter outside the public health department's needle exchange led to its closure in 2018, sparking a 1,500 percent increase in HIV.

Page 13: At one community meeting Mathis attended...a historic-district leader complained repeatedly that her neighborhood had been overtaken by people engaging in around-the-clock drug deals. "We need to tear down those houses and abolish the Fourth Amendment so police can do what they need to do," the woman said.

Mathis listened patiently to a range of stigma-inflicted comments. But at the mention of of abolishing the Fourth Amendment she stood..."Y'all, I just have to ask: Do you know the song, 'They Will Know We Are Christians by Our Love'? Well, I'm not feeling the love in this room right now."

Mathis reminded them that that Jesus tended first to people's physical needs because he understood that folks who were tired, hungry, and hurting "wouldn't have ears for what he needed to say." When the civic leader persisted, Mathis politely suggested she fix her neighbors a casserole---people who use drugs sometimes forget to eat, she explained.

Page 72: Fentanyl was present in more than 60 percent of the 2020 overdose deaths reported by the CDC, a quadrupling of the portion it accounted for in 2015. By June of 2021, mortality kept rising as fentanyl and other synthetics were involved in a whopping 87 percent of opioid deaths and 65 percent of all drug overdose deaths.

Page 89: Between 1999 and 2019, the gap between rural and urban death rates almost tripled, growing from 62 per 100,000 to 169.5. That death-rate disparity was bigger now than the disparity between Black people and White people, which academics pinned not just to deaths of despair but also to poor nutrition, lack of exercise, smoking, and uneven access to quality medical care.

Whether they meant to or not, people were literally killing themselves as the hyper-polarized government they hated stood by, and politicians who professed to lead them were engulfed in culture wars about transgender bathroom rights, Stonewall Jackson statues, and critical race theory. "People are making a virtue of going it alone and not depending on anyone, almost as a kind of self-protection," Silva told me.

Or as Nikki put it: "Rigid thinking is what it is, and that's a trauma response."

Page 256: But anyone with walking-around sense now understood that shipping 100 million opioid doses to a county with a population of just 90,000 was not acting in the best interests of that community. Huntington (West Virginia), a small city an hour west of Charleston, had the highest overdose-death rate of any community in the nation.

In 2016, Huntington-based EMS workers had responded to twenty-six heroin overdoses in less than four hours. One in five babies born at the local hospital was exposed to addictive substances. Foster-care placements doubled, and the school system had to install a twenty-four-hour hotline so that the police and schools could communicate about students living in homes where parents had (substance use disorder). The high school now has a dedicated space where traumatized teens can go if they need to talk to an adult or just be alone, no questions asked.

Page 275: People with (substance abuse disorders) are still ignored by policy makers when they often have the most knowledge to offer about their conditions, said Baltimore addiction specialist Yngvild Olsen, who cited a recent survey of 900 people with (substance abuse disorders). Their top three goals, in order, were: staying alive, reducing harmful substance use, and improving mental health. 

Macy provides a few pages of needed policy and political changes at the end of the book. None of them will solve all of the problems quickly, but they all fit together like a jigsaw puzzle. When that puzzle has been put together we will see one another and what is within us more clearly. Policy is a test of faith. Can we raise people from the tombs we have consigned them to or not? Is resurrection possible or is it a fable? Macy and the stone-rollers who she writes about believe in resurrection. Do you?