By the time Beth Macy’s Dopesick was published in 2018, the opioid crisis had already claimed the lives of hundreds of thousands of Americans. Dopesick, which served as both an indictment and elegy, detailed how Purdue Pharma, and more specifically how the Sackler family, flooded the market with OxyContin, using deceptive marketing and sales tactics to hook an entire generation on prescription painkillers. Unfortunately, the epidemic that Macy meticulously and carefully documented has only worsened: as of 2021, the New York Times published a sobering new milestone for the opioid epidemic; more than 100,000 Americans had died from an overdose in a single calendar year, the highest toll in history.
With Raising Lazarus: Hope, Justice, and the Future of America’s Overdose Crisis, Macy doesn’t revisit the crime scene. She opted to take a different approach within a similar vein and follows the people on the front lines of this endemic. If Dopesick was a meticulous autopsy of corporate greed and regulatory failure, Raising Lazarus is a survival field guide. This time, the focus is not on the perpetrators but on the unsung heroes—harm reductionists, street-level nurses, grassroots activists, and tireless attorneys—who are fighting, often against insurmountable odds, to keep the opioid crisis from consuming another generation.
Like the biblical figure referenced in its title, the people Macy chronicles are attempting something near impossible: resurrecting hope in a country where the systems designed to help people recover are often the very institutions that fail them.
“We now have a generation of drug users that started with heroin and fentanyl. At this point, too much attention is focused on stemming the oversupply of prescription opioids.”
Beth Macy, Raising Lazarus
The crisis has metastasized. This is no longer just about Big Pharma’s malfeasance—it is about the fraying of America’s public health infrastructure, the unwillingness of lawmakers to embrace proven solutions, and the deeply ingrained cultural stigma that continues to treat addiction as a moral failing rather than a medical condition.
Harm Reduction and the People on the Frontlines
Macy’s reporting brings her to the places that most Americans, and certainly most policymakers, prefer to ignore: trap houses in West Virginia, parking lots in North Carolina, encampments beneath freeway overpasses, and mobile clinics operating out of a nurse’s Toyota Prius. She introduces us to an extraordinary cast of characters:
- Tim Nolan, a North Carolina nurse practitioner who delivers harm-reduction supplies from the back of his car, offering naloxone, wound care, and hepatitis C screenings to illicit drug users who are otherwise ignored by the healthcare system.
- Reverend Michelle Mathis, the co-founder of Olive Branch Ministry, the nation’s only biracial, queer, faith-based harm reduction group. Unlike traditional recovery programs that require abstinence, Mathis and her team meet people where they are—literally- by delivering clean syringes and fentanyl test strips to those still actively using illicit substances.
- Lill Prosperino, a 30-year-old advocate in Charleston, West Virginia, helps run a harm-reduction program serving hundreds of drug users. “I can’t imagine another disease on the planet where if somebody didn’t get better, everybody in their life would abandon them,” she tells Macy.
What unites these individuals is an unflinching commitment to harm reduction, an approach that focuses on keeping illicit drug users alive rather than forcing them into abstinence-based programs. Harm reductionists believe that people living with addiction deserve care and dignity—even if they are still using. That means providing clean needles to prevent the spread of HIV, distributing naloxone to reverse overdoses, and advocating for the decriminalization of drug possession. This philosophy is radical in its simplicity: Just. Don’t. Die.
Not everyone agrees. Throughout Raising Lazarus, Macy documents the relentless pushback against harm-reduction efforts. In Charleston, West Virginia, a city-run needle exchange program was shut down after public outcry, leading to a 1,500% increase in HIV cases. In North Carolina, Mathis’s group was forced to operate in secrecy to avoid harassment. Even those seeking treatment face enormous obstacles: America’s rehab industry remains dominated by abstinence-only programs, many of which refuse to provide buprenorphine—a medication proven to reduce opioid cravings and lower overdose deaths.
“America remains the only developed country on the planet where it’s easier to get high than it is to get help.”
Beth Macy, Raising Lazarus
The Family Sackler Legacy and the Failure of the Legal System
While Dopesick focuses primarily on Purdue Pharma and the Sackler family, Raising Lazarus revisits the question of justice. In 2021, Purdue Pharma declared bankruptcy in a controversial settlement that granted the Sackler family immunity from future lawsuits while requiring them to pay only six billion dollars in damages. That sum, spread over decades, is a fraction of what the company made from the sale of OxyContin, and the Sacklers have yet to issue a meaningful apology.
Macy profiles the attorneys, activists, and overdose victims’ families who spent years fighting Purdue Pharma in court only to see the settlement let the Sacklers walk away with their wealth largely intact. One of the book’s most compelling figures is Nan Goldin, the renowned photographer who launched a guerrilla campaign to pressure museums to remove the Sackler name from their galleries. Unlike the Justice Department, Goldin’s activism succeeded: by 2022, institutions including the Louvre, the Metropolitan Museum of Art, and the British Museum had severed ties with the Sackler Family.
“That it had taken a famous artist, of all people, to finally get under the Sacklers’ skin said as much about what captures Americans’ attention as it does about corporate influence-peddling.”
Beth Macy, Raising Lazarus
But the reality remains grim: the money from the Purdue Pharma settlement is now trickling down to the states, yet many local governments have no concrete plans for how to spend it. Public health experts fear a repeat of the tobacco settlement of the 1990s, when billions meant for smoking cessation programs were diverted to unrelated government projects. As one North Carolina harm-reduction advocate tells Macy, “The fear among public health experts is that [the money] will go to traditional drug-war modalities and not toward evidence-based care.”
The Moral Reckoning of the Opioid Crisis
If Dopesick was a story of corporate greed, Raising Lazarus is a study in moral reckoning. Macy makes it clear that the war on drugs has failed. We continue to treat substance use disorders as a crime rather than as a public health issue, and our refusal to fully embrace harm reduction has cost thousands of lives. In 2021 alone, fentanyl-related overdoses surpassed 107,000 deaths—more than gun violence and car accidents combined. And yet, as Macy points out, politicians still fear being labeled “soft on crime” if they advocate for harm-reduction programs.
Macy’s gift as a journalist is her ability to cut through the noise and humanize a crisis that has often been reduced to statistics. She forces readers to grapple with difficult questions: Would you be willing to support an overdose prevention center in your neighborhood if it meant fewer overdoses? Should healthcare providers be required to offer buprenorphine to every person living with an opioid use disorder who seeks treatment?
Ultimately, Raising Lazarus is not just a book about the opioid crisis—it is a book about who we are as a country. Are we willing to embrace policies that are proven to save lives, even if they challenge our moral assumptions? Are we capable of extending empathy to those whom society has deemed unworthy?
Or, as Macy asks:
How many more people must die before we stop punishing them for their pain?
If Dopesick was a wake-up call, Raising Lazarus is a demand for action. We can no longer say we didn’t know. The only question that remains is whether we are willing to change.
Verdict: Raising Lazarus is a searing, deeply researched follow-up to Dopesick, offering a rare glimmer of hope amid the devastation of America’s overdose crisis. It is essential reading for anyone who wants to understand the human cost of the opioid epidemic and what can still be done to stop it. 4.5 out of 5 sobees.
#QUITLIT Sobees Score: 4.5 out of 5
Reviews of other Beth Macy books
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