Book review of “Raising Lazarus: Hope, Justice and the Future of America’s Overdose Crisis” by Beth Macy

Macy uses a biblical story to capture the work of the volunteers and outreach workers who are dedicated to aiding addicted people. She draws on the tale of Lazarus, who had died of an illness and was entombed for four days until Jesus him brought back to life. Before Jesus acted, he asked his followers to roll away a stone that lay across the tomb’s entrance. In “Raising Lazarus,” Macy calls the workers she writes about “stone-rollers.”

It’s an image she borrowed from the Rev. Michelle Mathis, co-founder of the Olive Branch Ministry of western North Carolina, one of the groups in the book. As overdose deaths escalated in the United States — more than 1 million since 1996, according to the Centers for Disease Control and Prevention — these groups stepped in to attempt “what officials have failed for decades to do: keep people alive,” Macy writes.

Macy’s stone-rollers regard the people they treat as equals of moral weight, respect and worth. They do not stigmatize, judge or shun these drug users. Their work is called “harm reduction,” and it sometimes ventures into illegal activity.

“In the richest country in the world, treatment of the sickest, neediest people fell to volunteers risking arrest,” Macy writes. Out of their own pockets, they purchase clean needles, naloxone and fentanyl test strips. They test for hepatitis C, then treat it. All kinds of weather finds them trooping out to homeless encampments and drug “trap houses” to deliver food, water, blankets and other first-aid supplies. They provide safe places to shoot up. They deliver “unconditional positive regard” — something Macy stresses is essential for people struggling to get through each day. Their work is funded by bake sales, T-shirt sales and GoFundMe drives. Often working underground, they are what Macy calls “good criminals.”

Such strategies have hardly been embraced by a nation where total abstinence, “tough love” or submission to a higher power is regarded as “treatment.” The high costs of not doing harm reduction recur throughout the book. Macy cites numerous “state and local politicians who wrongly blame suffering people for their own demise.” The lack of humanity was exemplified when a Kiwanis Club leader commented at a community meeting that when people relapse, “we should let ’em die and take their organs.”

The book covers every aspect of the crisis — the science of addiction, the history of the problem, the justice system that, while acknowledging addiction as an illness, treats addicted people merely as criminals. These are interspersed with accounts of the legal battles to hold the Sackler family (owners of opioid-maker Purdue Pharma) accountable for what Macy calls the “taproot of the opioid crisis.”

Shoe-leather reporting took Macy to cemeteries, committee meetings, hearings, court proceedings and protests. Death by drugs, she emphasizes, results from a devastating convergence: Decline of meaningful work. High levels of occupational injury. Failed War on Drugs policies. Lack of access to health care. Profound disengagement by the recovery community from evidence-based, medication-assisted treatment. The drug buprenorphine (bupe), for instance, has been shown in multiple studies to prevent opioid deaths, but many in law enforcement dismiss its use as just swapping one drug for another.

In Mount Airy, N.C., the hometown of actor Andy Griffith, which bills itself as the fictional and idyllic Mayberry of the 1960s “Andy Griffith Show,” we meet Wendy Odum. “My husband and I are now raising our four grandchildren and so are all the grandparents we know,” she says. “All our kids are dead.” Addiction has been taking lives there for three generations: Odum was addicted herself after being prescribed opioids after a fall. Her mother, too, died from an overdose.

What, then, is the solution? The “real magic wand is to give up on the rigid notion that a single fix exists,” Macy writes. Her book is a call to “radically rethink addiction care, to do more than give lip service to the throwaway line — addiction is a disease — and to treat it like one.” That means adopting the stone-rollers’ tactics: needle exchanges, HIV and hepatitis C testing, safe places for people to take drugs when they must, supportive assistance when they are ready to try treatment — which should be “free and easily accessible.” She calls for a Cabinet-level drug czar and a nationwide system of clinics that provide mental health care along with addiction care. Treatment should not be left to the “whims of local boards who subscribe to abstinence-only anti-medication models.”

Macy sees glimmers of hope — the Tennessee judge who, after educating himself about the benefits of bupe, now allows it along with recovery housing for his addicted defendants. The Fairfax County, Va., jail that refers addicted inmates to a bupe program and provides counseling. But these are lonely outposts of progress.

If the addiction crisis is to end, we must create an infrastructure that works. It must be at least as compelling and accessible as the opioid production and distribution network. Those who die of drug overdose in the United States typically come close to dying nine times before the boulder irrevocably closes them off in their tombs. There are many opportunities to roll that stone away.

In July, Teva and Allergan joined the list of pharmaceutical companies agreeing to billion-dollar settlements for their roles in the overdose crisis. As opioid abatement and remediation funds trickle down to the states, this is the task that “Raising Lazarus” sets us. Who will join in rolling those rocks away?

Nancy D. Campbell is the author of “OD: Naloxone and the Politics of Overdose.” She is a professor of science and technology studies at Rensselaer Polytechnic Institute in Troy, N.Y.

Hope, Justice and the Future of America’s Overdose Crisis

Little, Brown. 400 pp. $30.