2000s

The 2000s are the decade in which the book follows an initially obscured prescription-opioid crisis becoming a national reckoning—and, in many communities, a transition toward heroin. Its defining pattern is not a single turning point but a widening chain: local reports and family losses disclosed the damage; users and dealers carried addiction through social and commercial networks; and public responses emerged unevenly, through activism, prosecution, and debates over treatment and incarceration. The book continues tracing the decade’s consequences into the years that followed, showing how the networks and policy conflicts of the 2000s persisted.

Local Warnings and a Spreading Crisis

In the spring of 2000, information traveled slowly between rural communities. A young doctor working with Art Van Zee returned from a visit to relatives in the Northeast carrying a Boston Globe story about prescription drugs and crime. Its account of Machias, Maine, described a small region where the jail population had doubled in two years, property crimes had risen, and local officials associated the change with OxyContin. The parallel with Lee County, Virginia, suggested that the trouble Van Zee was confronting was not confined to one coalfield. The newspaper story connected two places before a national account of the epidemic had taken shape.

Van Zee and his wife, Sue Ella Kobak, responded by organizing locally. Within weeks, he held public meetings through the Lee Coalition for Health, a grassroots group of ministers, social workers, and other community members. With Kobak’s editing and coaching, he wrote to Purdue Pharma about reports of injection, overdoses, abscesses, and hepatitis C, asking the company to investigate prescribing patterns. The company sent forms for reporting adverse events. At a forum for doctors and families, Van Zee brought in Yale substance-abuse specialists to explain withdrawal and the chronic, relapse-prone course of opioid addiction. The meetings joined immediate local evidence to a longer-term question: whether treatment could address an illness that was not resolved simply by stopping drug use.

By March 2001, the scale of the crisis had become harder to dismiss. The region had recorded forty-three oxycodone-overdose deaths since Purdue launched OxyContin. Some users had shifted from snorting pills to injecting dissolved powder, and the Lee County jail held seventy-nine people in a space designed for thirty-four. Nearby crimes linked to efforts to obtain pills supplied further evidence that addiction was changing everyday life as well as the work of police and courts. These reports accumulated locally before reaching a wide national audience.

From Regional News to Family Activism

A major national-media account arrived on February 9, 2001, when Barry Meier and a colleague reported on Operation OxyFest, a federal investigation in Kentucky. The operation had arrested 207 user-dealers, many of them patients who had obtained pills from doctors described as overburdened, careless, or cooperative in overprescribing. By that summer, reports of OxyContin-related deaths and crime were appearing across the country, and the drug had entered suburban settings as well as rural communities. The movement from local warning to national coverage was real, but it did not mean the crisis had been promptly understood or met with a coordinated response.

The families of people who died began to build an opposition of their own. In 2001, after his eighteen-year-old son died, Ed Bisch learned online that the death was the region’s thirtieth opioid overdose in three months. Lee Nuss, who had lost her eighteen-year-old son Randy, later connected with him through her daughter. Nuss had not known her son was using pills before his death; he had obtained an 80-milligram OxyContin tablet from a friend. Those losses became part of a wider effort rather than isolated accounts of grief.

After reading Barry Meier’s 2003 book, Pain Killer, Bisch and Nuss joined with Van Zee and Sister Beth Davies to establish Relatives Against Purdue Pharma, a grassroots nonprofit known as RAPP. Its members pressed for statewide prescription-monitoring programs that would let clinicians check patients’ prescription histories. They organized prevention workshops, displayed large photographs of their dead children outside Purdue’s headquarters, and challenged the company’s public standing. Their activism also brought them into conflict with chronic-pain patients who said the medicine allowed them to function and sleep. At a 2003 prevention conference in Orlando, RAPP members protested Purdue’s presence and Bisch read the names of 260 people memorialized on his website. The episode shows how the decade’s disputes played out both in policy arguments and in public acts of remembrance.

Enforcement and the Heroin Transition

The decade’s drug markets changed alongside public understanding. Before the Roanoke weathermen incident, heroin there was generally treated as an isolated, largely invisible drug associated with a small group of mostly Black users and dealers. In 2006, Clifton “Lite” Lee, a Philadelphia-rooted dealer, expanded the market across racial and suburban lines. Two teenagers who sold heroin to friends led investigators to evidence implicating fifty other young people, many attending Hidden Valley High School in one of Roanoke County’s wealthiest neighborhoods. A chart prepared by an investigator depicted a hierarchy in which dealers seeking money stood above users, some of whom had died of overdose. By 2008, Lee had received an eleven-year sentence; prosecutors said his network brought a thousand bags into the region two or three times a week.

Other investigations revealed how rural distribution connected to larger cities. By spring 2013, investigators had assembled a profile of a supplier known as D.C., including his vehicle and the route by which heroin entered Virginia’s I-81 corridor. Young women traveled from New York carrying drugs concealed in snack containers; the heroin had been packaged in Harlem as four-ounce disks inside Pringles cans. A shipment that might contain 200 grams contrasted with the smaller quantities brought by dealers commuting to Baltimore. In 2014, federal investigators’ case against Ashlyn Kessler included fifteen thousand text messages, which mapped connections between a New Jersey source and young people in Cave Spring and Hidden Valley. These details extend beyond the decade itself, but they make visible the distribution networks and patterns of recruitment that had taken shape during the book’s account of the 2000s.

Prosecution, Punishment, and Unequal Responses

Federal prosecution became another prominent response. John Brownlee, a young U.S. attorney in western Virginia, was pursuing a case against Purdue as early as 2003. In May 2007, he announced a settlement in downtown Roanoke: Purdue would plead guilty to felony misbranding, admitting that it had marketed OxyContin for six years as less prone to abuse and less likely to cause narcotic side effects than immediate-release drugs. The company would pay $600 million in fines; three top executives would plead guilty to misdemeanor charges, with $34.5 million in penalties paid on their behalf by the firm. The settlement did not require the executives to serve jail time. A later sentencing hearing was expected to bring them before grieving parents, who could speak in court about the drug’s consequences. The case made Purdue’s marketing conduct legally consequential, while leaving families and communities to confront losses the settlement could not undo.

The book’s retrospective also places enforcement within a racial divide. It contrasts the growing recognition that arrest alone could not end opioid addiction among mostly white users with the continued imprisonment of people such as Ronnie Jones, a Black dealer serving his third prison term. The cited national data showed that people of color were disproportionately represented among drug offenders, while research suggested that doctors prescribed painkillers to them at much lower rates than to white patients. The book treats these patterns as products of unequal prescribing and punishment, not as evidence of an inherent difference in vulnerability. At the same time, it describes a different model emerging in Winchester: a drug court designed to connect offenders with treatment, including medication-assisted treatment, as well as housing and transportation support.

The Decade’s Continuing Questions

By following the crisis from rural warnings to national reporting, family organizing, federal prosecution, and heroin distribution, the account presents the 2000s as a period of belated recognition rather than resolution. The supply of prescription pills helped create pathways into addiction; withdrawal and the need to maintain access encouraged some users to sell to others, enlarging the networks that later connected towns to distant suppliers. Enforcement disrupted parts of those networks, but individual prosecutions could not address every participant or restore treatment access to everyone affected.

The decade also leaves a question about what happens after prison. The book contrasts Ronnie Jones’s repeated incarceration with a proposed approach in which reentry workers help people find housing, employment, and harm-reduction services, while low-level drug offenders are diverted from prosecution. Bryan Stevenson argued that reducing the prison population and investing part of the resulting savings in treatment could improve people’s prospects. In this account, the 2000s are therefore not only the period when the crisis became visible: they are also when its competing explanations and responses took shape, leaving later communities to decide whether addiction would be addressed chiefly through punishment or as a public-health problem.