Excerpt from Dopesick by Beth Macy, plus links to reviews, author biography & more

Kristi used to think that maintaining Jesse's grave was "the last thing we can do for him," she told me, choking back tears. But right now she's obsessed with the story of her son's swift descent into addiction—the missing details that might explain how Jesse went from being a high school football hunk and burly construction worker to a heroin-overdose statistic, slumped on someone else's bathroom floor. If she understood the progression of his addiction better, she reasons, maybe she could help other parents protect their kids from stumbling down that same path.

"I just want to be able to say, 'This is what happened to Jesse,' so I can be educated, so I can help others," Kristi says. "But in my mind, the story doesn't add up, and it drives me crazy."

Maybe a mother's questions about a child's death can never be totally answered, and yet Kristi's pain sits there between us, no less urgent today than it felt on the day he died. To comprehend how she was left with these questions—and how our country came to this moment—I needed to widen the scope of my investigation both in geography and in time. I would fold in questions from other mothers, too, who wanted to understand why their addicted sons were imprisoned now instead of in treatment; why their addicted daughters were still out on the streets, God only knew where.

* * *

When a new drug sweeps the country, it historically starts in the big cities and gradually spreads to the hinterlands, as in the cases of cocaine and crack. But the opioid epidemic began in exactly the opposite manner, grabbing a toehold in isolated Appalachia, Midwestern rust belt counties, and rural Maine. Working-class families who were traditionally dependent on jobs in high-risk industries to pay their bills—coal mining in southwest Virginia, steel milling in western Pennsylvania, logging in Maine—weren't just the first to experience the epidemic of drug overdose; they also happened to live in politically unimportant places, hollows and towns and fishing villages where the treatment options were likely to be hours from home.

Jesse Bolstridge was born in the mid-1990s, when opioid addiction first took root. His short life represents the arc of the epidemic's toll, the apex of which is nowhere close to being reached.

If I could retrace the epidemic as it shape-shifted across the spine of the Appalachians, roughly paralleling Interstate 81 as it fanned out from the coalfields and crept north up the Shenandoah Valley, I could understand how prescription pill and heroin abuse was allowed to fester, moving quietly and stealthily across this country, cloaked in stigma and shame.

Set in three culturally distinct communities that represent the evolution of the epidemic as I reported it, Dopesick begins in the coalfields, in the hamlet of St. Charles, Virginia, in the remote westernmost corner of the state, largely with the introduction of the painkiller OxyContin in 1996.

From there, the scourge not only advanced into new territories but also arrived via a different delivery system, as the morphine molecule shifted from OxyContin and other painkillers like Vicodin and Percocet to heroin, the pills' illicit twin, and, later, even stronger synthetic analogs.

As the epidemic gained strength, it sent out new geographic shoots, moving from predominantly rural areas to urban and suburban settings, though the pattern was never stable or fixed. Heroin landed in the suburbs and cookie-cutter subdivisions near my home in Roanoke in the mid-2000s. But it wasn't widely acknowledged until a prominent jeweler and civic leader, Ginger Mumpower, drove her addicted son to the federal prison where he would spend the next five years, for his role in a former classmate's overdose death.

I covered Spencer Mumpower's transition from private-school student to federal inmate at the same time I witnessed the rise in overdose deaths spread north along I-81 from Roanoke. It infected pristine farm pastures and small northern Shenandoah Valley towns, as more users, and increasingly vigilant medical and criminal justice systems, propelled the addicted onto the urban corridor from Baltimore to New York. If you live in a city, maybe you've seen the public restroom with a sharps container, or witnessed a librarian administer Narcan.

Excerpted from Dopesick by Beth Macy. Copyright © 2018 by Beth Macy. Excerpted by permission of Little Brown & Company. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.