Meet the Virginia Reporter Who Helped Hulu’s “Dopesick” Get the Details Right

Beth Macy on the power of dinner around the table, handmade quilts, and rooting for Southern underdogs

Photo: Portrait by Klein Davis

Beth Macy developed a giant web of sources—coal miners, activists, small-town lawyers, moms, and daughters—over her nearly thirty-year career as a reporter at the Roanoke Times and throughout the South. “There’s a lot to be proud of in Appalachia, but unless we dig beneath the surface, you don’t really know what it’s all about,” she says. Her deeply reported and empathetic dive into America’s opioid crisis—and especially its grip on the mountain South—became the 2018 bestseller Dopesick, and her work now forms the backbone of the riveting Hulu series of the same name (the season finale of Dopesick airs Wednesday, November 17 at 12 a.m.) We chatted with Macy about her affinity for underdogs, what it was like to switch to screenwriting, and how she plans to bring family memory into her holiday season—hint: There are recipes.

You wrote a Good Dog column for us a ways back—what’s your dog situation now?

Ha, you must have just heard them in the background. Whenever the mail gets delivered, they go crazy. I have two—Mavis and Charley. They’re rescue dogs. Mavis is what we call a wire-haired terrorist, and Charley, who I think I wrote about then, is part Belgian Malinois, the type of dog that took down bin Laden. He’s blind now. They’ve been funny as we’ve all worked from home over Zoom—they’re always here and barking.

photo: Courtesy of Beth Macy
Macy’s two dogs, Charley and Mavis; Mavis lays over Dopesick edits.

You’ve been a newspaper reporter for decades—and your first job was in Savannah?

That was my first daily newspaper job. I was a feature writer; I wrote about food, sometimes about crime, and I was lucky enough to cover it all. I was in my first writing group there, too, with poet Rosemary Daniell. We had the author of Midnight in the Garden of Good and Evil come and speak to us. Savannah was such a colorful and interesting place to work. It taught me how to be a better writer. I had a coworker who was a great interviewer, Aida Rogers, and I learned so much about reporting from her. And empathy. All of that has come in handy when I write about people who experience trauma.

Then onto Roanoke? 

In 1989, I went to Roanoke and the paper was much, much bigger then—we had over 120 newsroom employees. I always gravitated toward social issue stories. I grew up poor, and I was the first of my family to go to college. It took me awhile in my career to realize that stories about underdogs and outsiders were the ones I wrote the best. Once I got some seniority at the paper and had a bit of leeway, that’s when I started pitching stories that were in that wheelhouse and that would become my books. 

Could you tell immediately when a topic was going to be book-worthy?

I was lucky enough to get a fellowship at Harvard in 2010 that put me in contact with people who had written books—so I met agents and editors, and it was sort of in the back of my mind. When I went back to my newspaper after a year away, I thought bigger. It occurred to me that you didn’t have to live in a big city to do big journalism. 

I started to approach my work with more confidence—I wasn’t more aggressive, but I just wouldn’t limit myself to the Virginia expert on something or other; I would find the expert on something in the nation. I was in my mid-forties then, and I had this great editor, Carole Tarrant, who was exactly my age, and she kicked my butt in terms of editing. I think that’s rare, to be in our forties, at the same place for so long, and to be really challenged together. She made me want to go deeper.

The first big series I wrote after the fellowship was the profile of a little town that had been decimated by globalization. All the factories had shut down except for this little furniture maker who had not closed his factory. The three-part series became the basis of my first book, Factory Man. Because I had more confidence and a wider lens to approach my stories, I could see this was a story that started in rural Virginia, but then it goes to China and Vietnam. At its heart was really a story about the people that America has forgotten. They reminded me so much of growing up in this little factory town in Ohio. When you write about things that resonate with your own story, you do a better job. I put what I knew about what it was like growing up on the margins—I had a mom who lost her job because of technology and globalization—and I could go deeper into that story.

What led you to start working on Dopesick?

Dopesick grew out of Factory Man in some ways. I started hearing about heroin in these little tiny towns, and I was shocked. I didn’t really understand that the heroin epidemic grew directly out of Oxycontin. We didn’t really know that as a nation until around 2014 when, for the first time in American history, our life expectancy dropped. I had all these connections to the story because I’ve lived in the same place for thirty years now. I took the reporter who had been covering Oxy out for coffee, and I had him retell the stories I had read from his work. He helped me piece together details about parents who had lost their children.

photo: Antony Platt/Hulu
Kaitlyn Dever as Betsy in Dopesick.

What was it like transitioning to TV writing?

I realized quickly that the Hulu crew knew how to tell a story for television and I knew how to tell a story for print and they’re so different. But it’s much more collaborative. I’m used to just me at my desk. But for screen, we’re a group all together, writing for scenes. But you do miss that great tool in print of being able to tell history, so you have to somehow show history through dialogue. 

The showrunner Danny Strong knew he wanted to tell the story of this coal mining community and he wanted to tell victim stories through composite characters and combining elements of different people. He’s a master at this. Danny and I would get on the phone together and re-interview people from my book to help the characters he was developing. I remember when we talked to the Sister Beth character, I wanted to know all about her activism and how she saw her community, but Danny instead asked her, “How do you talk to a patient? What are the things you say to get someone talking?”

Wow, yes…there’s that really powerful scene where she asks Michael Keaton’s character, a doctor, about what it felt like to deliver babies before the town—and his own life—was ravaged.

That’s Danny for you, man. Getting those details. And I’m really glad that two of the veteran TV writers were from small towns. They knew the rural activities that people actually do. We had a person in the room who was in recovery and had spent time in a methadone clinic. We fact-checked everything, and we also hired a consultant from eastern Kentucky to say what was authentic to the story that happened there. Kudos to Danny for being open to all of that. I’m now hearing from people I’ve interviewed right and left saying they like the show, but for some people who have struggled, it’s really tough for them to watch. But they also feel seen and heard in a big way, which is gratifying.

photo: Gene Page/Hulu
photo: Antony Platt/Hulu
Michael Keaton as Dr. Samuel Finnix in Dopesick.

It’s apparent that you lent the show a richer understanding of the South. Some of the major heroes of the book and show are small-town lawyers, coal miners, church leaders…

Somebody said the other day that when they read there was going to be a show set in coal country, they thought that yet again the houses would be portrayed in ramshackle fashion. No—look at the details. In the character Betsy’s room, she has a sweet little lamp made out of a tree. That was such a warm detail I’m glad they included. She loved to quilt, and there are quilts in so many scenes. Her family eats dinner together. These are all beautiful things rendered with authenticity and love, and we wanted to make it absolutely crystal clear that the reason these towns might look distressed when you drive through them isn’t because bad people live there or because lazy people live there. 

There’s been a lot of stereotyping of Appalachia that we didn’t want to repeat. We wanted to show, with history, how out-of-state companies came in without giving back, and how Oxy targeted the areas where the jobs were already going away, targeting people who were already hurting. They bought the data that showed them which doctors were prescribing opioids, which happened to be places that had workplace injuries. Any time you know the backstory, you can be more empathetic. Betsy’s quilts are Appalachian, and she loved being a coal miner and she was proud of being the first female on her crew. It’s a reminder that there’s a lot to be proud of in Appalachia.

And you’re working on a follow-up to Dopesick?

I’m doing edits on my new book, about solutions to the opioid crisis. It’s called Raising Lazarus: Hope, Justice and the Future of America’s Overdose Crisis, and it comes out next August.

You’ve written about your family, and how you all have different political opinions, but you stay connected in your own ways, like online games. My dad and his sister stay in touch over online Scrabble, so I loved learning that about you. We’re heading into the holidays—any advice on smooth family interactions?

I think really Thanksgiving is just about being grateful for what you have. Listen to each other and share family traditions that transcend politics and ugly school board meetings and all the other stuff we’re hearing about. Ask about food—where did you get this recipe from; or why didn’t we make mom’s sweet potato casserole this year? 

This year, I’m figuring out what I’m going to make. I have some mushrooms we foraged that are called chicken of the woods—I have a bunch of those in the freezer I might do something with. For several years I made these cranberry stuffed yeast rolls, but they are pretty labor-intensive. I always make Susan Stamberg’s cranberry relish, and I recently saw a cauliflower gratin that looks good.

photo: Courtesy of Beth Macy
Macy’s family cookbook; a potato recipe with her mother’s handwriting.

A while back, I did a cookbook for my family of my mom’s recipes. It was my therapy after she died. She had neat handwriting and it was very distinct. Food is a really important thing in our family—a bonding thing. Growing up, we had dinner together every night, and none of us ever went hungry. But my mom was someone who saw poverty, someone who was surrounded by addiction for much of her life. So I think in some ways, my recent projects have been honoring my mom.