PORTSMOUTH — Investigative reporter Beth Macy tried to end her book, “Dopesick,” with some hope.

When the book was finished and edited in November 2017, it was three pages shorter, and ended with the mother of 26-year-old Tess Henry going to sleep with a phone in her hand, waiting for her daughter to call, to come home to Roanoke, Virginia, to take another shot at treatment and recovery.

But on Christmas Eve, Tess’ mother, Patricia Mehrman, instead got a call from the Las Vegas police who said her beautiful, optimistic daughter, the mother of an 8-year-old son, had turned to prostitution to feed her heroin addiction and had been murdered, her battered body found in a dumpster.

“That was not the ending I intended but, of course, that had to be the final word,” Macy said in an interview this week, ahead of her Tuesday, Aug. 21 appearance at The Music Hall Loft in Portsmouth. “This is the world people wind up in when they fall through the cracks.”

When she learned of Tess’ death, Macy put down her reporter’s notebook and instead, “I made a pot of soup and took it up the mountain to her mom. There would be time for notes later.”

In “Dopesick: Dealers, Doctors and the Drug Company that Addicted America,” Macy sets out to answer the simple, painful question she heard over and over as a reporter on the heroin beat for the Roanoke Times. The question, mostly from mothers who had lost a child to prescription opioids or street heroin and fentanyl: How did this happen to my beautiful child?

This week, the Centers For Disease Control and Prevention reported an estimated 72,000 Americans died of drug overdoses in 2017, the most since records have been kept.

The death toll is driven by an increased use of narcotics and the potency of the synthetic opioid fentanyl, which is far stronger than heroin and often cut into street dope to intensify the high. If it wasn’t for the overdose antidote Narcan, the death toll would be far greater, public health officials say.

That’s what’s happening. Macy’s book ambitiously sets out to answer why it's happening.

The book begins with Macy trying to answer the question for Kristi Fernandez, the mother of Jesse Bolstridge, a high school football star who died of a heroin overdose.

“I had been dispatched to prison by a specific grieving mother, clutching a portrait of her 19-year-old son,” Macy wrote. “I wanted to understand the death of Jesse Bolstridge, a robust high school football player barely old enough to grow a patchy beard on this chin.”

“What exactly, his mother wanted to know, had led to the death of her only son.”

In prison, she interviewed Ronnie Jones, found guilty of running the biggest heroin dealing operation in the Roanoke area.

In the interview with Jones and with virtually every subject in this book, Macy finds the answers to the opioid epidemic are nuanced, and, as one Johns Hopkins doctor tells her, “Our wacky culture can’t seem to do anything in a nuanced way.”

Yes, Ronnie Jones sold heroin that killed Jesse Bolstridge and so many others. But after a felony car theft conviction in his youth, he emerged for his first prison stint owing $5,000 in medical bills and $20,000 in court fines and restitution and few job options as a convicted felon. And the money from drug dealing was dazzling. It allowed him to live a big life.

“I promised myself I’d never grow up to be like my father, and while I may not have an addiction to an actual drug, I do feel my addiction,” Jones told Macy. “I’m addicted to that lifestyle.”

Macy doesn’t excuse Jones’ actions, and she introduces us to his highly successful brother, who grew up in the same circumstances and was able to achieve success in the music industry.

“It was a long drive back to Roanake,” Macy wrote of her drive home from the prison interview. “I was too tired to stop in Woodstock, where I’d arranged to meet with Kristi. She was eager to learn what light Ronnie had shed on Jesse’s death, but I dreaded telling her just how little he seemed to think or care about the victims of his crimes.”

While dealers like Ronnie Jones are part of the problem, much of the book focuses on the pharmaceutical companies that flooded Appalachian communities with prescription opioids in the 1990s and 2000s, particularly Perdue Pharma, makers of Oxycontin.

“A lot of people came to their addiction through prescribed pharmaceuticals that were oversupplied in America’s communal medicine chest,” Macy said during our interview.

The heroes in "Dopesick" are the doctors, activists, police officers, prosecutors and heartbroken parents who sounded the alarm in the 1990s when they saw the devastation Oxycontin was causing in their communities. For nearly a decade, their pleas fell on deaf ears until, in 2007, Perdue Pharma and three top executives were fined $634.5 million for misleading the public about the addictive risks of Oxycontin. None of the executives were sentenced to prison.

“When it’s white collar crime and no one goes to jail, the corporation feels no pain and business continues as usual,” Macy said. “There were so many times in the arc of this epidemic when things could have been done to stop the progression.”

Today, Perdue and other opioid makers, distributors and pharmacies are facing more than 500 lawsuits in federal court, Macy said.

But the toll in damaged lives and deaths continues, despite many well-meaning efforts.

“We lost 300,000 people to drug overdoses in the past 15 years and we’re supposed to lose that many again in the next five,” Macy said. “And now that I’ve examined the viral nature of the drug, where user-dealers recruit new user-dealers, it’s kind of scary. We have so many people in foster care now, too. In these distressed coal field communities, about a third of kids are being raised by their grandparents. We’re talking about generations to turn it around.”

After reporting on the heroin crisis since 2012 does Macy ever feel frustrated that despite so many people working so hard to stop the death and destruction so many people, families and communities continue to suffer?

“Jesus Christ, yes,” Macy said.

Beth Macy will appear at The Music Hall Loft, 131 Congress St., Portsmouth on Tuesday, Aug. 21 at 7 p.m. Tickets are $42 ($40 for members) and include an autographed copy of "Dopesick: Dealers, Doctors, and the Drug Company that Addicted America" ($28 hardcover), bar beverage, reserved seat, author presentation, Q&A and book signing meet-and-greet. Packages can be purchased online at TheMusicHall.org, by calling (603) 436-2400 or at the Historic Theater box office, 28 Chestnut St.