Interstate 85, referred to in the book as I-81, is a transport corridor whose importance lies in how it connects places with different drug markets, communities, and patterns of opioid use. The narrative describes the interstate as part of the route by which the crisis spread through Appalachia and into Virginia’s suburbs: a physical link that helped make a regional epidemic out of local networks.

Route and Regional Setting

The book places I-81 at the edge of Roanoke’s northern suburbs. It follows the western Appalachian communities from Tennessee into Virginia, curves northeast around Roanoke, and continues through the northern Shenandoah Valley. Along the way, it intersects with other interstate routes leading toward Baltimore, Washington, New Jersey, and New York. The road’s geography gives Roanoke a position between rural Appalachian communities and larger northeastern drug markets.

That position mattered because Roanoke already had a longstanding, comparatively quiet population of heroin users in its urban core. The city was large enough for users to make drug connections, yet small enough for dealers to hide. In the book’s account, this combination made Roanoke a transfer point in a broader movement from heroin to prescription pills and then back to heroin. Dealers who had traditionally operated in the city’s poorest northwestern neighborhoods were also moving into more affluent areas such as Hidden Valley and Cave Spring.

A Corridor for the Epidemic’s Spread

The interstate gave the crisis a regional geography. Researcher Martha Wunsch described OxyContin’s spread along the Appalachian chain by way of I-81, while observing that pills had begun circulating among teenagers in her own community. The shift into affluent suburbs did not necessarily follow family lines; peer groups became conduits, carrying opioid use into social settings where it had been less visible. The road connected these communities, but the book also stresses the human networks that carried drugs between and within them.

Heroin shipments illustrate how that wider geography could be joined to local distribution. By spring 2013, investigators were tracking a supplier whose product was said to enter Virginia’s I-81 corridor in plastic shopping bags, carried from New York by young women riding the Chinatown bus. The heroin had been packaged in Harlem as four-ounce, hockey-puck-shaped disks hidden in snack containers, including Pringles cans. A shipment routinely brought 200 grams to the Shenandoah Valley, far more than the smaller quantities carried by dealers commuting to Baltimore. In Woodstock, local dealers broke the supply into tenth-gram bags for sale.

From Commuting to Local Networks

The corridor’s role was not limited to bulk shipments. After Purdue Pharma introduced an abuse-resistant version of OxyContin in 2010, a small group of mostly young white men began making near-daily, two-hour drives to Baltimore, a longstanding heroin center. They bought enough for themselves and extra to sell to friends, using the proceeds to pay for the next purchase and the gas for another trip. Police called them commuter-dealers: users whose travel helped extend a distant market into local circles of supply and demand.

The book places those journeys within a longer East Coast trafficking geography. Baltimore had served for decades as a staging area for drugs moving along the coast, with Interstate 95 connecting it to cities from Miami to Bangor. For Roanoke-area users, the drug market was therefore neither simply local nor organized around one road. I-81 connected western Virginia to Appalachian and northeastern routes; travel to Baltimore and the relationships formed around resale linked users to another established market.

Local Consequences and Visibility

By late September 2013, federal agents and local police from seven counties were targeting leaders of a major heroin ring. Several arrests had already occurred, but the investigation had not yet appeared in the local press. The region’s pill problem had become a full heroin epidemic within a few months, while, outside the addicted population, only a handful of police officers knew its scale. The contrast between the reach of the supply networks and the narrow circle of public awareness underscores how an epidemic could spread across connected communities before it was widely recognized.

Interstate 85’s significance in the account is thus relational rather than deterministic. The road linked rural and suburban Virginia to markets and routes beyond the region, while local dealers, commuters, friends, and peer groups turned that access into repeated exchanges. The narrative treats transportation infrastructure as one part of a larger system: a corridor through which drugs could travel, and through which a crisis already embedded in social networks became harder to contain within any single town.