With Drug Overdoses on the Rise, Churches Need an All-Hands-on-Deck Attitude

What would the parable of the Good Samaritan look like today?

In the United States, the man lying beside the road may well be dying from an overdose of fentanyl.

Over the course of the pandemic, social isolation combined with a flood of super-potent synthetic fentanyl pushed overdose deaths in the US to unimaginable levels, from 70,000 in 2019 to 107,000 in 2021. Will we, like the Levite and priest in Luke 10:25–37, keep our distance?

Journalist Beth Macy’s book Dopesick chronicled the current opioid crisis, inspiring a widely viewed Hulu miniseries. More recently, in Raising Lazarus: Hope, Justice, and the Future of America’s Overdose Crisis, Macy searches out possibilities of hope amid mounting deaths of despair.

The title of Macy’s book comes from her conversations with Rev. Michelle Mathis, who cofounded Olive Branch Ministry, a faith-based organization in Hickory, North Carolina, devoted to reducing harm and death associated with drug and opioid use. Mathis offers a compelling account of Jesus raising Lazarus from the dead that focuses on an overlooked element in the story:

Nobody was a miracle worker except for Jesus … but even in the end after the miracle had been performed, nobody could see it because Lazarus was still bound, so Jesus told people to go forth and unbind him—those folks had a role to play. Those that were willing to unbind Lazarus were able to look the miracle in the eye and be face to face with this new creation that God had brought forth.

As Macy describes Mathis’s telling, “Jesus had already performed the miracle; now, it was up to the community to do the stinky, messy work of pulling the burial shroud off Lazarus.”

This “stinky, messy work” is always done locally. Throughout the book, Macy joins on-the-ground organizers in overlooked places like Batesville, Indiana, and Charleston, West Virginia, as they cultivate connections between suffering people and support in their communities. Macy finds no top-down formula for local responses to substance-use issues. Instead, healing in each location seems to require close and attentive care sustained over time, which means patiently and persistently meeting people right where they are.

All hands on deck

Over the past several years, I have studied religious responses to the opioid crisis in southern Appalachia and across North Carolina through projects funded by the Greenwall Foundation and The Duke Endowment. Using mixed methods—interviews, listening sessions, and a statewide survey—our research teams have listened carefully to faith leaders responding to the opioid crisis. We discovered the work of remarkable people, including Mathis, and we built the Churches Promoting Recovery project to share practical resources inspired by their wisdom and witness. Much as Macy describes them, these modern-day Good Samaritans spend their days on our own roads to Jericho, bandaging wounds and connecting people with networks of care.

For the most part, they are not culture warriors. They do not have large media platforms. They may or may not fit into typical political or religious boxes. They are not wealthy. They often have personal stories of hard-lived experience, grace encounters, and hard-won healing. They see the men and women on the road and do not pass by on the other side.

Opioid and drug overdose is not a red-state or a blue-state problem. It is not a problem that affects only one racial or ethnic group. It is rather an all-hands-on-deck problem that affects every community—but responses must be tailored to the needs of each particular community.

As we learned in a study of faith leaders in North Carolina, pastors’ needs and interests vary, differing by whether their congregations are predominantly Black, Hispanic, or white and also by cultural expectations and theological commitments. What works for one conservative Baptist congregation may not work for the progressive Presbyterian church down the road. Mathis gets this, and against the grain of many progressive activists, she makes a point of meeting conservative Christians and their communities where they are.

Recognizing the importance of differences among clergy and churches, the Churches Promoting Recovery project highlights stories of faithful and creative witnesses from diverse Christian leaders and communities. Mathis and Olive Branch Ministry are one such story. When we spoke with her, she conveyed the urgency of the contemporary crisis for Christians: “If the church does not engage people who use drugs where they are,” she said, “we’re going to lose those lives one way or the other—whether it’s a physical loss or a spiritual loss. Can we really afford that as people of faith?”

One size never fits all

When Christians get involved in responding to the opioid crisis, they encounter a fault line. On one side are those who emphasize opioid-use problems as medical issues, for which medication-assisted treatment (MAT) with drugs like buprenorphine is the fitting strategy. On the other side are those who emphasize opioid-use problems as spiritual issues, for which abstinence programs like Narcotics Anonymous offer the only pathway to genuine healing.

Advocates for these alternative approaches often view each other with skepticism and distrust. Both have witnessed their approach transform lives; both can point to deaths that they believe were caused by the inadequacies of the other side. Fierce competition for local, state, and federal funding further hinders collaboration. It also spills out into fights along politically polarized lines, with conservatives advocating abstinence-only responses and progressives pushing for MAT and other harm-reduction strategies like syringe-exchange programs.

How might Christians find a way through this impasse? Macy offers two helpful recommendations. First, she counsels giving up “the rigid notion that a single fix exists” and acknowledging “that one size never fits all when it comes to addiction.” She describes buprenorphine (“bupe” for short) as only “a critical first step.” “What bupe does best,” she continues, “is to create a window of reprieve from the daily hustle of avoiding dopesickness, thereby allowing people the chance to engage in all the equally difficult next steps of trying to build back their lives without drugs.” In the end, conservatives and progressives alike have to discern what is best for particular people through the slow, patient work of walking alongside them.

Macy’s second recommendation flows from observing that communities are transformed when their members hold personal change and social change together. The stories she tells display how changing hearts and minds goes hand in hand with reforming structures, and vice versa. As with treatment strategies, there is no formula for this kind of work; it must be discovered locally through the on-the-ground efforts of caring and committed people. Macy observes, “Change happened by way of one forward-thinking sheriff, one frazzled peer, one grieving mother at a time. It came by way of a purple-haired minister [Rev. Mathis] obsessed with doing s— rather than talking about it.”

A lesson in neighbor love

The progressive evangelical leader Tony Campolo often remarked that his evangelical audiences were bothered more by his use of profanity to describe the deaths of children from malnutrition than they were by the deaths themselves, and Macy’s Raising Lazarus includes quite a bit of profanity. Evangelicals may be put off, as well, by characters like the purple-haired Rev. Mathis (who cofounded Olive Branch Ministries with her partner Karen Lowe). Many see syringe-exchange programs and other harm-reduction strategies as enabling substance abuse.

Our studies in North Carolina found that pastors of evangelical churches were much more likely to say that their congregations oppose syringe-exchange programs than pastors in mainline Protestant churches. More were open to distributing naloxone, the life-saving medication that reverses opioid overdoses, but still fewer than among mainline Protestants.

Perhaps Mathis, however, has something to teach her evangelical sisters and brothers. Like the Samaritans of Jesus’ time, she and her colleagues at Olive Branch Ministry would be dismissed by some evangelicals for what they see as problematic politics and theology. And yet there she is, walking along the Jericho road, looking for people struck down by substance-use issues, meeting them where they lie, and doing what she can to keep them alive, form relationships with them, and hope for their healing and transformation.

Perhaps Mathis’s ministry is less a scandal than a lesson in neighbor love, inviting us to “go and do likewise,” to discover God’s resurrection power in “the stinky, messy work of pulling the burial shroud off Lazarus.”

Brett McCarty is associate director of the Theology, Medicine, and Culture Initiative at Duke University, where he holds faculty appointments in the Divinity School and the School of Medicine’s Department of Population Health Sciences.