Roanoke, Virginia
DopesickRoanoke, Virginia, is portrayed as both a passageway and an incubator for the opioid crisis in western Virginia: a city where established heroin networks, prescription-drug use, suburban peer groups, and gaps between public institutions converged. Its position on major highways helped connect drug markets, but the crisis’s movement into affluent neighborhoods was repeatedly mistaken for an isolated episode, leaving families and responders to confront a problem that had already spread across the region.
A crossroads for drugs and people
Roanoke sits at the western edge of the northern suburbs, where I-81 runs northeast around the city and continues through the northern Shenandoah Valley. The highway links Appalachian communities in Tennessee and Virginia and intersects routes leading toward Baltimore, Washington, New Jersey, and New York. The book presents this network not as incidental scenery but as part of the city’s role in the transition from heroin to pills and then back to heroin: Roanoke was accessible enough for users to make connections, yet small enough for dealers to lie low.
The city’s existing heroin market was concentrated in its urban core, where a steady but largely quiet group of users had long gone unnoticed by much of the wider public. Roanoke’s segregation shaped how heroin was understood: it had been treated as an inner-city, Black problem, while the drug’s later arrival among white suburban users seemed to many observers to be something new. Dealers traditionally based in the city’s poorest northwest quadrant began moving toward more affluent neighborhoods such as Hidden Valley and Cave Spring, according to a heroin task officer, in part to avoid robberies and home invasions. The city’s geography thus joined old and new markets rather than separating them.
A crisis mistaken for an exception
The skin-popping incident involving local weathermen became Roanoke’s first major wake-up call, but reporters, including the book’s author, initially treated it as an anomaly. The story was so sensational that the Roanoke Times assigned two beat reporters to it, one covering courts and the other media and entertainment. It received more attention than the federal case against Purdue Pharma that ended in a settlement the following year. The contrast captures a recurring problem in the city’s public understanding: an unusual spectacle could command attention while a broader, less visible drug crisis did not.
In the 1980s and 1990s, heroin use in Roanoke was thought to involve only a few dozen people. Don Wolthuis, then an assistant U.S. attorney and later one of the federal government’s leading heroin prosecutors in the western half of the state, described a population that used the depressant drug in isolation and therefore attracted less attention than people associated with crack or methamphetamine. Among the small group of mostly African American users and dealers, heroin was understood as a drug not to sell to white people, who were believed likely to report the sellers. By the mid-2000s, the local dynamic had shifted: the more potent and dangerous the heroin, the more users sought it, as addiction researcher Warren Bickel observed while working in Baltimore.
The changing crisis remained easy to overlook when its consequences fell disproportionately on families already outside the public spotlight. In 2009, a Roanoke Times report suggested that heroin was nearing the illicit use of OxyContin and prescribed fentanyl patches in popularity, but drew little response. The following year, a regional heroin-overdose death made headlines because the person who died was the twenty-one-year-old son of a prominent white businesswoman—not because overdose was unprecedented. The attention given to that case contrasted with the earlier neglect of heroin arrests involving children of inner-city Black families. The book’s account shows how racial assumptions and class visibility influenced which local losses were treated as news.
Suburban crossings and family silence
By 2012, when the author began reporting on heroin in Roanoke’s suburbs after two decades covering marginalized families for the Roanoke Times, many families were too ashamed to speak publicly. The isolation was not only personal. Parents had no Facebook groups through which to exchange treatment advice, coping strategies, or practical and financial support. At the 2012 federal sentencing of Spencer Mumpower, Robin Roth brought a framed portrait of her son Scott to the witness stand and confronted Spencer with questions about the future Scott would never share with her. Her grief and anger made visible the burden families carried in a city where addiction was often treated as evidence of parental failure.
A Lutheran church on the outskirts of Hidden Valley became another point of connection. At a Families Anonymous meeting there, Jamie Waldrop and Drenna Banks met while their sons were struggling with addiction. Their families were established in the suburbs: Jamie was a civic leader and the wife of a prominent surgeon, while Drenna and her husband ran an insurance agency. Their sons had been friends and used drugs together, with connections that briefly crossed paths through North Cross, a private suburban school attended by Jamie’s son Christopher. Their meeting brought together parents who might otherwise have faced the crisis separately, and revealed how the epidemic moved through relationships and peer groups as well as through the city’s streets.
The author followed Tess Henry and her infant son as the Hope Initiative began taking hold in early 2016. For several months, the author drove them to Narcotics Anonymous meetings, recording interviews with Tess’s permission and walking the baby around the back of the meeting room when he cried. One meeting, held in white working-class southeast Roanoke, left Tess uneasy because people she recognized as drug dealers were gathered outside the church. She preferred meetings in Black neighborhoods, where she felt participants were funnier, had more time in recovery, and spoke more authentically. The meeting locations were not interchangeable to her; familiarity and a sense of belonging shaped whether support felt usable.
Tess also encountered stigma within recovery spaces because she was taking buprenorphine. Although Narcotics Anonymous officially accepted medication-assisted treatment, members asked to sponsor or mentor her declined. Some viewed medication as not being clean or as replacing one opioid with another. The rejection exposed another divide within Roanoke’s response to addiction: treatment could be available in principle while the people who needed it were made to feel unwelcome for using it.
Treatment efforts and their limits
Roanoke’s Hope Initiative was designed as a public-private partnership to connect people with treatment and sustain them through the difficult, often relapse-prone process of recovery. Trained volunteers, called angels, would help people navigate care while drawing on the city’s housing, mental-health, and employment resources. The program was based at the Bradley Free Clinic, a volunteer-staffed service for working people in Old Southwest, an area becoming a heroin hot spot. Its location linked a practical treatment effort to a neighborhood increasingly affected by the crisis.
The initiative’s carefully assembled resource list illustrated both its ambition and its limits. Volunteers prepared a five-page spreadsheet naming thirty-six rehabilitation and aftercare providers across the southeastern United States, with options depending on a patient’s finances and the availability of beds. The clinic opened its doors to users on the second Monday of each month, when people without outstanding warrants could be paired with trained volunteers to work through treatment arrangements. Social-service workers were available to help eligible patients apply for Medicaid. Some volunteers also arranged outpatient medication-assisted treatment, but they disagreed about its value, with some opposing the use of one drug to treat addiction despite scientific evidence supporting treatment.
The effort grew from losses close to home. Janine Underwood, executive director of the Bradley Free Clinic, attended the first Hope Initiative meeting in fall 2015 not as a physician but as the mother of Bobby Baylis, one of four people who died that June after using fentanyl-laced heroin. Bobby had struggled between rehabilitation and jail after becoming addicted to OxyContin prescribed following ACL surgery. After a three-year prison sentence, he had completed treatment, qualified as a journeyman in heating and air-conditioning, and returned to Roanoke on probation. He was working and living in his mother’s basement when he took a single dose of fentanyl-laced heroin after visiting old Hidden Valley friends. His death joined the private grief of one household to the city’s attempt to build a response for others.
Janine tried to make local officials recognize the danger in the affluent communities she had once chosen for her children’s schooling. She told the school board and county officials about her family and sought support for the county risk-prevention council, which was running on a few small federal grants. Although the Hope Initiative received almost daily calls about heroin users in Hidden Valley or nearby Cave Spring, police data showed that the problem was worse in those two communities than in less affluent areas of the county. Janine’s presentation met with silence; the school board declined to support the program, and the county provided its usual $2,000. The gap between the crisis’s reach and the public response remained stark.
Rising overdoses and unfinished work
By early 2017, fentanyl-overdose calls in the region were arriving at twice the rate recorded during the same period a year earlier. In an area of 300,000 people, emergency-room doctors were seeing overdoses daily, sometimes facing three severe opioid-related trauma cases at once. Roanoke’s treatment efforts were operating within that pressure, while people revived from overdoses could still leave the hospital and return to work, even after injecting fentanyl-laced heroin.
The following year’s totals made the worsening trend harder to dismiss: nonfatal overdoses in 2017 more than doubled the previous year’s count, and fatal overdoses nearly tripled, figures believed to be undercounts. At a sparsely attended public forum at Tess’s former school, police described seizing 4.4 pounds of fentanyl along I-81 in August 2017, an amount they said could cause one million fatal overdoses. They also reported arresting a Cave Spring High graduate who had tried to sell 700 counterfeit Xanax bars containing fentanyl, ordered through the dark web from Hong Kong. The highway that had helped make Roanoke a regional transfer point now carried a threat whose scale stretched well beyond the city.
The book closes this view of Roanoke on a contradiction: the crisis was growing, but its visibility was shrinking. Regional newsrooms had cut back, the Roanoke Times had only one reporter covering police in the Roanoke Valley, and sprawling heroin-ring prosecutions could pass with no media attention. Without sustained reporting, residents could be left with the impression that the problem had stopped. Roanoke’s story instead shows how an epidemic can become deeply established while remaining unevenly seen: moving across neighborhoods and institutions, pressing against limited treatment systems, and outlasting the public attention that might have made its scale unmistakable.
