Born in upper-crust black Chicago—her father was for years head of pediatrics at Provident, at the time the nation’s oldest black hospital; her mother was a socialite—Margo Jefferson has spent most of her life among (call them what you will) the colored aristocracy, the colored elite, the blue-vein society. Since the nineteenth century they have stood apart, these inhabitants of Negroland, “a small region of Negro America where residents were sheltered by a certain amount of privilege and plenty.”   Reckoning with the strictures and demands of Negroland at crucial historical moments—the civil rights movement, the dawn of feminism, the fallacy of postracial America—Jefferson brilliantly charts the twists and turns of a life informed by psychological and moral contradictions. Aware as it is of heart-wrenching despair and depression, this book is a triumphant paean to the grace of perseverance.

    From distressed small communities in Central Appalachia to wealthy suburbs; from disparate cities to once-idyllic farm towns; it's a heartbreaking trajectory that illustrates how this national crisis has persisted for so long and become so firmly entrenched. Beginning with a single dealer who lands in a small Virginia town and sets about turning high school football stars into heroin overdose statistics, Macy endeavors to answer a grieving mother's question-why her only son died-and comes away with a harrowing story of greed and need. From the introduction of OxyContin in 1996, Macy parses how America embraced a medical culture where overtreatment with painkillers became the norm. In some of the same distressed communities featured in her bestselling book Factory Man, the unemployed use painkillers both to numb the pain of joblessness and pay their bills, while privileged teens trade pills in cul-de-sacs, and even high school standouts fall prey to prostitution, jail, and death.Through unsparing, yet deeply human portraits of the families and first responders struggling to ameliorate this epidemic, each facet of the crisis comes into focus. In these politically fragmented times, Beth Macy shows, astonishingly, that the only thing that unites Americans across geographic and class lines is opioid drug abuse. But in a country unable to provide basic healthcare for all, Macy still finds reason to hope-and signs of the spirit and tenacity necessary in those facing addiction to build a better future for themselves and their families.