Journalist Beth Macy returns to chronicle the opioid epidemic in RAISING LAZARUS, a follow-up to her previous reportings on the number-one killer of Americans that also serves as a message of hope. Her 2018 book, DOPESICK --- the inspiration for Hulu’s Peabody Award–winning series --- took readers into the epicenter of the opioid crisis. She profiled not only the labs and marketing departments of pharmaceutical companies, but also the distressed communities of Central Appalachia and even the wealthy suburbs where abuse of narcotics made a slow but devastating creep.

With the Purdue-owning Sackler family fresh in readers’ minds (thanks to the media’s coverage of the settlement case that finally put the Sacklers firmly in the hot seat, as well as books like Patrick Radden Keefe’s EMPIRE OF PAIN), RAISING LAZARUS is a natural progression of Macy’s reportage, a “where are we now” of the efforts being made to curb the opioid epidemic now that we seem to have reached a nationwide agreement about who was originally responsible. While many Americans may feel that justice has been served, masks have been ripped off and a sense of normalcy can resume, Macy proves in her skewering yet inspirational book that we are nowhere close to ending the epidemic that has cost us well over a million lives.

"RAISING LAZARUS confirms Beth Macy as our nation’s best hope at chronicling the opioid epidemic...by highlighting not the criminals behind the deaths but the ones who can no longer speak for themselves and the heroes working against all odds to ensure that no others join their ranks."

Beginning with the title, Macy alludes to the biblical story of Lazarus, whom Jesus raised from the dead, asking his followers to do the heavy work of removing the large stone of his entombment despite their fears of meeting death. As she explains, the work Americans still must do to end the opioid epidemic is much like this: dirty, messy and often uncomfortable work that will allow the miracles of recovery and the end of a public health crisis to occur. Macy did not interview Jesus himself as she prepared to write RAISING LAZARUS, but she does encounter some true miracle-makers: the unsung heroes working at ground zero of the epidemic, often through illegal if not frowned-upon means, to meet people with substance abuse and opioid use disorders where they are --- and not where we, our politicians or least of all the Sacklers want them to be.

Macy’s search for hope begins with nurse practitioner Tim Nolan, who runs a portable exam room out of his Prius, delivering clean needles, hepatitis medication, wound care supplies and, most important of all, support to people living with substance abuse disorders. As she watches, Nolan meets with users still high, or fixing to get high, asking each of them to promise “not to disappear.” His street exam room is coordinated by Reverend Michelle Mathis, cofounder of Olive Branch Ministry, the nation’s only biracial, queer, faith-based harm reduction group. Despite her connection to faith, Reverend Mathis herself is a bit of a pistol with her colorful hair, booming voice and unapologetic BS-detector. As Macy goes on to profile others working with Mathis and Nolan to keep Appalachia clean, one thing becomes drastically clear: unlike forced incarceration and rehabilitation, the only approach that actually stands a fighting chance is harm reduction.

Likely a new term for most readers, harm reductionists believe that people suffering from and succumbing to addiction do not need to be stigmatized, jailed or forgotten, but rather met where they are --- truly where they are, as Macy often reports from trap houses, bandos (abandoned homes where people use and sell drugs) and encampments. They should be given not lectures and sentences but access to clean needles, safe injection sites, basic needs like food and shelter, and finally, health care in the form of both medication and therapy. This approach may sound childishly hopeful to some and willfully obtuse to others, yet the statistics prove that it works.

As Macy continues to introduce other colorful characters both living through addiction and fighting against it (and no, the two states are not separate from one another and often overlap), readers are exposed to and educated on several different ways that grassroots advocates are battling addiction in their communities and helping others do the same, while also advocating for policy reform that will allow them to save even more people. The work is tiring, draining, triggering and often unrewarding, but these heroes have been granted a firsthand look at the opioid epidemic and have emerged with grace, compassion and fight.

The statistics Macy quotes are staggering, from the 1,500% increase in HIV cases in one West Virginia town after public outrage forced its needle exchange to close, to the 80% of Americans who say they would not want to befriend, date, marry or live near someone with a substance abuse disorder. (This is even more shocking when you learn that 50% of Americans claim to believe that addiction is a disease. As Macy wonders, would we feel the same way about cancer or even alcoholism?)

Although RAISING LAZARUS is full of shocking statistics like these, and even more heartbreaking stories, there is a through line of hope here, one that comes with uplifting stories and action items. Macy talks to the truly progressive people who want to see all drugs decriminalized, but she also speaks with people like Reverend Mathis, who are meeting NIMBYs (“not in my backyard-ers”) and asking them what level of outreach and aid they are comfortable with, even if it means enlisting a group of crocheters against handing out clean needles to craft colorful Narcan bags (yes, that’s a real story from this book). In accordance with meeting her readers where they are, Macy even makes the case that more conservative approaches, based on cost-effectiveness rather than science or humanity, will still win from harm-reduction policies, for which every dollar saves $9 in public health and social costs.

If there is one negative to the book, it is that Macy devotes perhaps too much time covering the Sackler bankruptcy trial and the Purdue litigation. While her portrayals of characters like Nan Goldin and gumption-filled lawyer Michael Quinn are evocative and lively, much of the legalese of the case feels recycled and distracts from the overarching narrative.

This small complaint aside, RAISING LAZARUS confirms Beth Macy as our nation’s best hope at chronicling the opioid epidemic --- how we got here, the reality of where we are now, and where we go from here --- by highlighting not the criminals behind the deaths but the ones who can no longer speak for themselves and the heroes working against all odds to ensure that no others join their ranks.