Andrew Vachss - Pain Management

Amazon.com Review
When last encountered (2000's 
), career criminal Burke was on the rebound from a nearly successful assassination attempt, lying low and licking his wounds in Portland, Oregon. Severed from his connections in NYC, Burke survives on jobs--"violence for money" mostly--brokered by his live-in lover, Gem, an Asian beauty with a painful, larcenous past and a present to match.
At hand is a task Burke has done before: the recovery of a runaway, a 16-year-old girl named Rosebud. But Burke, an assassin with scruples, knows when things aren't right. Rosebud's father, Kevin, has a '60s-era contempt of "The Man" that doesn't jibe with his obvious wealth. Mother Maureen limps through life on pharmaceutical crutches. Younger sister Daisy and best friend Jennifer know things but won't share. As his search spirals out from Portland's mean streets, Burke encounters a mysterious young woman, Ann O. Dyne, who offers to help for a price. Her raison d'être is pain management--securing and dispensing medications vital to the terminally ill but held beyond their reach by a largely uncaring cadre of doctors, lawyers, and politicians. Eventually, of course, this plot line connects with Rose's whereabouts.
Andrew Vachss's MO here, as usual, is a mystery (Rosebud's disappearance) plus an actual cause célèbre (humane pain management). It's a risky formula that aims both to entertain and to enlighten. With its believably unbelievable characters, Vachss's spare noir, and steely pacing that counterpoints a bolt-upright climax, Burke's 13th outing is every bit as satisfying as the dozen that came before.