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The drugs - pills, heroin, fentanyl - are pretty similar wherever you go, but each region seems to have its own particular opioid narrative. Sam Quinones captured Ohio's opioid economy in full throttle in 2015's 'Dreamland.” Beth Macy's 'Dopesick,” published last year, chronicled Appalachian Virginia's reeling survivors and groundbreaking prosecutors as finger pointing over the epidemic moved to courtrooms. And the recent 'Hope & Heartbreak: Beyond the Numbers of the Opioid Epidemic” focuses largely on the pained parents and ragged recoveries of Westmoreland County.
It comes as southwestern Pennsylvania tentatively leads the way toward what may be the epidemic's slow denouement. Overdose deaths are down steeply here. Addiction, relapse and mourning, though, still seem to be near historic highs. This is the eighth book for Scott Brown, of Greensburg, and it is distinct from the rest of the opioid canon because of the title's first word: hope. Though it contains a numbing parade of devastated parents and fragile 12-steppers, it also captures some of the grassroots activism that likely contributed to the region's 40% plunge in fatal ODs last year.
The book is strongest when it spends some time with a single character, such as Carmen Capozzi, the grieving father who founded Sage's Army and marched on policymakers from here to the nation's capital but shrinks from TV shows about grandparents because he'll never be one. Or when it lingers on Dona Cardiff, a 70-year-old woman with custody of two great granddaughters, who slowly won their trust by repeating, 'I love you with all my heart, to the moo-oon and back.”
Brown also brings us glimpses into the alien logic of addiction and recovery. We meet a mother who took her son to buy heroin and then watched him shoot up. Why? Because it seemed a better option than seeing him suffer withdrawal and go on the lam while they waited for a rehab bed to open up.
Then there's this observation, from a preacher: 'One of the things I love about heroin addicts is that in many ways, they understand what our relationship with God is supposed to be like better than anyone else. They love their god, heroin, with all their heart, soul and mind. ... When those people find a way to step back from that addiction and turn that same commitment and devotion toward God, it tends to be very effective.”
Brown's account is heavy on stories of recovery built on spirituality, and largely devoid of accounts of the many people who stabilized their lives with the help of methadone, Vivitrol or buprenorphine, aka Suboxone. That focus on faith reflects the author's apparent take on the root of the epidemic, summarized by a Catholic counselor: 'The problem with addiction isn't the drug, because there will always be drugs,” the counselor tells Brown. 'The issue is the lack of connection, the lack of meaning, the inability to feel part of a family, community, spirituality.”
The policy prescriptions offered by Brown's sources are agnostic: create more sober-living homes, allow recovering users to drive so they can work, and take on the stigma that makes it so difficult for people in the grip of heroin to ask for help.
One wonders whether, as the deaths decline, the impetus to address these problems will fade. Brown's book makes the case that there's much to be done, but even his main protagonist has doubts about whether the momentum can be sustained. 'My biggest fear,” Capozzi tells the author, 'is people are just tuning it out.”