Galax, Virginia, is presented in Dopesick as a small Virginia city with two sharply connected roles in the opioid crisis: it ranked among the country’s highest opioid-prescribing localities, and it housed the Life Center of Galax, a treatment facility that could accept some patients receiving medication-assisted treatment. Through Tess Henry’s care there, Galax becomes a point where high regional exposure to opioids meets the limited, expensive and difficult-to-sustain pathways into treatment.

Setting and the prescribing landscape

In 2017, residents of Galax had been prescribed more opioids per person than residents of all but one locality in the country; Martinsville ranked first, and Galax fourth. The comparison placed two rural Virginia communities near the top of a national measure of prescribing, linking Galax to the broader history of the crisis rather than depicting opioid harm as confined to large cities. The book also notes that Martinsville and Galax are small cities where Factory Man was largely set.

That ranking sits in tension with the treatment options available to people already dependent on opioids. Galax appears not simply as a place named in prescribing data, but as a community where specialized care was scarce enough that the Life Center’s willingness to treat a patient on medication-assisted treatment mattered.

The Life Center and pregnancy care

In June 2015, nearly seven months pregnant, Tess Henry left jail and stayed with her mother, Patricia. After a difficult attempt to make a life with the baby’s father, the family found a private treatment center two hours away that would accept Tess during the final month of her pregnancy: the Life Center of Galax. Private insurance covered most of the roughly $20,000 bill, while Tess’s father paid the $6,500 deductible using the remaining money in her college-savings fund.

The facility was among the few in Virginia that accepted patients receiving medication-assisted treatment with methadone or buprenorphine. Tess was taking Subutex, a buprenorphine medication then recommended for some pregnant patients. The distinction mattered: Subutex did not contain naloxone, unlike Suboxone, and was considered safer for the baby at that time, though more liable to misuse. After spending the first half of pregnancy addicted to heroin and the second half taking Subutex, Tess feared that her child might experience neonatal abstinence syndrome. The book notes that the condition could require extended hospital care and that about half of so-called Subutex babies required neonatal intensive care and methadone treatment to manage withdrawal from the medication.

Relapse and return to care

Tess relapsed not long after giving birth. Patricia realized something was wrong when a man came to her mailbox claiming he owed Tess thirty dollars; she recognized him as a likely drug dealer. Tess returned to treatment in Galax for another month while the grandmothers cared for the baby, then about six weeks old. Her return shows that the first treatment stay had not ended the need for care, and that family members were central to keeping the infant safe while Tess sought further treatment.

After that month, Tess came home hoping to move into sober living or a halfway house. Many such facilities did not permit medication-assisted treatment, and none of those available to her would allow her to bring her baby. She therefore returned to Patricia’s home while continuing medication-assisted treatment. Galax had provided a rare opening for treatment during pregnancy, but it could not by itself resolve the obstacles that followed discharge: finding a setting that accepted her medication and allowed her to remain with her child.

Costs and wider significance

Tess’s treatment in Galax depended on an expensive private-care arrangement, substantial insurance coverage and family funds. Later, buprenorphine made her feel normal and insurance covered 80 percent of the medication, but appointments with her addiction doctor required cash: $700 up front and $90 to $100 for each follow-up, potentially four visits a month. Patricia objected to cash-only medication-assisted treatment practices, while also appreciating that a local prescriber had accepted Tess when other area providers had long waiting lists.

The book places these difficulties alongside broader shortages in access to medication-assisted treatment and the mismatch between treatment needs and available facilities. Galax’s significance is therefore double-edged: it was both a place associated with exceptionally high opioid prescribing and a rare source of treatment for a pregnant patient who could not easily find another facility. Tess’s repeated passage through the Life Center, followed by the barriers she faced after discharge, makes visible how treatment availability, affordability, family resources and rules about medication and children could determine whether care continued.