Opioid withdrawal

Opioid withdrawal is the state the book calls dopesickness: an urgent consequence of losing access to opioids that can shape decisions about survival and treatment. It is not presented as an isolated medical episode. Its pressure runs through the stories of people trying to get care, families trying to keep them alive, and a fragmented system in which effective treatment may be costly, delayed, or stigmatized.

Meaning and Language

The book gives withdrawal a historical vocabulary as well as a contemporary one. In discussing the term yen, it notes that opioid-addicted people in China had used it for both the craving for drugs and the restless sleep associated with withdrawal. The paired meanings capture a condition that is at once bodily and compelling: the distress of stopping and the pull toward relief are difficult to separate.

In the modern Virginia accounts, dopesickness names a practical danger as much as a symptom. Families and volunteers work to keep people alive while those affected try to survive and stave off withdrawal. The term helps explain why the search for drugs can dominate immediate choices, without reducing addiction to a matter of will or overlooking the conditions that make care hard to reach.

Family Pressure and Unequal Resources

When the reporting began in 2012, families in the suburbs of Roanoke, Virginia, were often too ashamed to speak on the record. Parents in different parts of the state had no Facebook groups through which to share advice about rehabilitation, coping, or practical support. The book places that isolation beside the daily effort to keep loved ones alive as they moved through treatment, relapse, and the criminal justice system.

A meeting of Families Anonymous brought together Jamie Waldrop and Drenna Banks, whose sons had been friends and used drugs together. Their encounter opens onto a wider divide: criminal justice and health care were both expected to address the epidemic, yet families often had to navigate the gaps between them. In that setting, withdrawal was not simply a clinical concern. The immediate need to stave it off met families’ uneven ability to pay for care or find an available place.

That inequality appears clearly in the different treatment options available to families. Kristi Fernandez had previously sent Jesse Bolstridge to a ten-week rehabilitation program in Jacksonville, Florida, involving counseling and medical detox. He briefly received buprenorphine, but still owed $25,000 for the stay despite being insured; his payments were automatically deducted from his account at $25 a week. After three weeks, he was weaned off the medication, a short-term approach that later became increasingly controversial as the evidence and practice of longer-term medication-assisted treatment gained prominence.

Medication and Barriers to Care

The book describes buprenorphine as a medication that can prevent dopesickness and reduce cravings, theoretically without producing a high. Tess Henry reported that it made her feel normal. Her experience also shows how treatment could remain financially difficult even when medication itself was partly covered: insurance paid 80 percent of its cost, but her addiction doctor required $700 up front and charged $90 to $100 for each follow-up visit, which could occur as often as four times a month. Other treatment providers had waiting lists.

Access depended not only on money but on the limited capacity and rules of the treatment system. At the time described, federal rules restricted doctors certified to provide medication-assisted treatment to 100 patients each; that cap later rose to 275 in response to the crisis. In 2017, state efforts broadened access, including changes to Medicaid reimbursement intended to encourage clinics to accept insurance and cover counseling and care coordination. The book notes that these changes did not quickly meet the scale of need in most communities.

A five-page spreadsheet compiled by volunteers at Roanoke’s Hope Initiative listed 36 rehabilitation and aftercare providers. Volunteers contacted them according to a patient’s finances and whether a facility had a bed. Some also helped arrange outpatient medication-assisted treatment, but the volunteers themselves were divided about its value, with some opposing the treatment of addiction with another drug. The spreadsheet makes the work of access visible: a route to care had to be assembled from available beds, personal finances, program eligibility, and disagreement over what treatment should count.

Pregnancy and the Stakes of Continuity

Tess Henry’s treatment during pregnancy shows why stopping opioids abruptly could carry stakes beyond withdrawal itself. She left jail in June 2015 nearly seven months pregnant and later entered the Life Center of Galax, one of the few Virginia facilities then accepting patients receiving methadone or buprenorphine. She took Subutex, a form of buprenorphine then recommended for some pregnant patients. The book cites federal guidance that abruptly discontinuing opioid use during pregnancy can result in premature labor, fetal distress, or miscarriage.

Tess had spent the first half of her pregnancy addicted to heroin and the second half taking Subutex. She worried that her baby might experience neonatal abstinence syndrome, a withdrawal condition that can require extended hospital care. Her treatment was made possible in part by private insurance and a $6,500 deductible paid by her father from the remainder of her college-savings fund. The episode presents continuity of care as a matter with consequences for both mother and child, while showing how family resources can determine whether a specialized program is within reach.

Stigma and the Larger System

Medication could prevent withdrawal and reduce cravings, yet people receiving it could still face suspicion from recovery communities. Tess had attended twelve-step meetings before and felt stigmatized for taking buprenorphine, which some participants regarded as not being clean or as substituting one opioid for another. Although Narcotics Anonymous officially accepted medication-assisted treatment, members asked to sponsor or mentor her declined. The book follows this cultural divide widening over the two years it tracked her story; access to a prescription did not guarantee acceptance or steady social support.

The barriers surrounding withdrawal sit within a broader account of the epidemic. The book links rural distress—including unemployment above 20 percent in Martinsville and surrounding Henry County, more than tripled food-stamp claims, and a 60.4 percent rise in disability rates—to a wider collapse of work. It also identifies the expanding supply of painkillers, promoted by pharmaceutical companies and approved by regulators, as part of the conditions fueling the crisis. Withdrawal itself is not offered as a complete explanation of addiction; rather, it is one point where these larger forces meet a person’s immediate need for relief and a family’s effort to find care.

By placing dopesickness alongside treatment costs, waiting lists, pregnancy, and the stigma attached to medication, the book shows how the threat of withdrawal can narrow the space in which people seek help. Its account makes continuity and access central: treatment has to be available, affordable, and socially supported before it can reliably interrupt that pressure.