by Beth Macy

Hardcover, 2018





New York, NY : Little, Brow and Co., 2018.


An instant New York Times and indie bestseller, Dopesick is the only book to fully chart the devastating opioid crisis in America: "a harrowing, deeply compassionate dispatch from the heart of a national emergency" (New York Times) from a bestselling author and journalist who has lived through it In this masterful work, Beth Macy takes us into the epicenter of America's twenty-plus year struggle with opioid addiction. 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. "Everyone should read Beth Macy's story of the American opioid epidemic" -- Professor Anne C Case, Professor Emeritus at Princeton University and Sir Angus Deaton, winner of the Nobel Prize in Economics… (more)

User reviews

LibraryThing member zmagic69
I read Dreamland a year ago and was afraid this would be a bit of a rehash of that book, but was not the case at all. This is a phenomenal book that needs to be read and discussed. This country has a serious drug problem and a government who first played the role of complacent dope dealer, and now can’t figure out what to do about it.
One thing I especially appreciated was the author kept politics out of most of the discussion, except where it couldn’t be avoided.
Make no mistake, this isn’t a Democrat or Republican issue. This isn’t a liberal or conservative issue. This is an epidemic that needs to be fixed, and it is going to take money and comprises by everyone to get it done.
Read this book!
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LibraryThing member Darcia
I can't properly express the importance of this book. As a person who lives with multiple chronic pain conditions, including Lyme disease and fibromyalgia, I know all too well how easy it could be to fall into the trap of addictive prescription medications. Doctors hand out the pills, because that's what they were taught to do and, really, what else is there to do for a patient in chronic pain? And up until recently, few doctors and patients understood how horribly addictive medications like Oxycontin really are. So no one was warned. In fact, the opposite happened; doctors were told it was absolutely safe, and consequently they helped create an epidemic of addiction.

Too many people remain in their bubble, thinking addiction only affects the poor or the weak or someone else's kids. Until addiction strikes someone close to them, and their world is tipped upside down. We've cultivated a society in which people believe prescription medications are safe, and that Oxy isn't dangerous like heroin, when Oxy really is just heroin wrapped up in a prettier package.

This book takes on the myth of Oxycontin's safety, and how it leads to heroin use because that's the cheaper option. We see exactly how the drug's manufacturer intentionally downplayed the addiction factor and specifically targeted their marketing strategy at vulnerable areas of the country. These pharmaceutical companies are more dangerous than the drug dealers importing heroin and cocaine, and yet they continue getting rich off the addicts they create.

Beth Macy shows us exactly where and how opioid addiction began, how it evolved, and where it led. We meet addicts, many of whom are middle class kids and young adults from good homes, and not the stereotypical gangbanger or disenfranchised poor. We see the destruction and the desperation through their eyes.

The point here is not to label all opioids as evil, but to educate on their use and abuse. I really hope everyone reads this book.

*I received an advance ebook copy from the publisher, via NetGalley, in exchange for my honest review.*
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LibraryThing member msf59
“Drug overdose had already taken the lives of 300,000 Americans over the past fifteen years, and experts now predicted that 300,000 more would die in only the next five. It is now the leading cause of death for Americans under the age of fifty, killing more people than guns or car accidents, at a rate higher than the HIV epidemic at its peak.”

“Americans, representing 4.4 percent of the world’s population, consume roughly 30 percent of its opioids.”

“America’s approach to its opioid problem is to rely on Battle of Dunkirk strategies—leaving the fight to well-meaning citizens, in their fishing vessels and private boats—when what’s really needed to win the war is a full-on Normandy Invasion.”

Beth Macy is an award-winning reporter, based in Roanoke VA. In this gut-punch of a book, she zeroes in on the opioid crisis, that has wreaked havoc, in her small city, devastating families from both sides of the tracks. This is just a snapshot of central Appalachia and other rural towns throughout the country. Macy effectively focuses on several individuals and their loved ones, following them through the harrowing trials of addiction. This also reminds us that the family pays as dearly as the loved one, with the “problem”. It turns out, I had no idea how deep and destructive the opioid crisis is. It is so under-reported. I guess we would rather worry about “rapist” immigrants and Russiagate, than deal with this horrifying plague, delivered by the gods at Big Pharma. I will add this one to the Must Reads, like Evicted, Just Mercy and Ghettoside, if you want to know what is happening in the Great U.S. of A.

I realized, after I started Dopesick, that I had read her earlier book Truevine. Another very interesting book. A talented author.
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LibraryThing member Dreesie
Thanks to NetGalley and Little, Brown, and Company for providing me with this galley in exchange for an honest review.
This book is both fascinating and infuriating. Macy looks at the history of opium and its various iterations over the last 200+ years. She then traces the origins of Oxycodone, the drug that began the current opioid epidemic ravaging our country. She examines Purdue Pharma's marketing of the drug: claiming it was not addictive, claiming it was needed because too many people were suffering from pain, having sales reps push the drug to doctors who then prescribed it to anyone. Its use in the "left behind " (her words) towns of Appalachia and Maine, as jobs dried up and people went on disability and were given Oxycodone for "pain".

She continues down this timeline--how doctors created addicts, and then cut them off. In their desperation to avoid dopesickness (diarrhea, the shakes, pain--it's physical and very real and very miserable), they went underground. To stealing pills, stealing and selling anything, buying pills on the black market, and finally heroin. And the overprescribing spread across the country, as doctors and law enforcement and judicial systems and govt offices refused to listen to sufferers and their survivors. They still believed the drug company.

And while the drug company did finally lose a case in court, the epidemic has continued. Who in this country cannot name someone who has died of an opioid overdose? (Usually because of fentanyl, now being imported from China per Macy.) Macy follows the trajectories of addicts, dealers, parents, recovery workers, doctors, and more in the Roanoke area as she looks at where this epidemic is might be going and what might be done to slow or stop it.

Apparently the final print version of this book has pictures--these were not in my Galley. I would love to see them.

I did have some issues with this book and had a few questions that were not addressed.
• Macy has a chip on her shoulder regarding poor people in Appalachia. She thinks this epidemic happened because the government does not care about poor white people. I would argue that the government cares more about corporations (Purdue Pharma) than ANY citizens. It was not until heroin became big (it's cheap) and the production and selling was therefor completely illegal that the government did anything--punishing regular people. Punishing users and small-time dealers and occasionally slightly bigger dealers. But still not punishing the corporation that started it all with their lies and marketing--they are still legally selling the legal version.
• How did people in these small towns get on disability so easily? Where I am at it is incredibly difficult and takes years--and they are constantly reviewing to kick people off. How did these people get on and just get handed so many drugs? Were the doctors trying to scam the government? I would have liked more info on this.
• In chapter 12 she suggests sending released felons to "friendlier" places with more services, like Seattle, where low-level drug and prostitution offenders are diverted from prosecution. I have SO MUCH I could say about this (none of it nice), but first she complains about "left-behind towns" (again, her words) where people survive on disability and various charities (churches, the health wagon, etc) because there is no work (yet those still there choose to stay and be "left behind"), and now she thinks released felons should be shipped to out-of-state cities to take advantage of the programs in other jurisdictions, that other people in other states pay taxes for? Just wow. Maybe Virginia should start such programs if they are so successful. She does not actually go into why felons should be shipped out of state rather than have such programs started in-state. Perhaps other people should be the ones to pay for them?
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LibraryThing member strandbooks
Impossible to read this book without feeling anger, frustration and sadness. It’s eye-opening on the trajectory of the opioid crisis and how the end is nowhere in sight with our current solutions. This quote by Tim Kaine sums it up “Beth Macy writes about our opioid epidemic, but Dopesick is not about drugs. It’s a book about kids and moms and neighbors and the people who try to save them. It’s about shame and stigma and desperation. It’s about bad policy, greed and corruption.… (more)
LibraryThing member brianinbuffalo
Macy's exceptional work should be required reading for every public policy professional, medical expert and citizen who might be contemplating taking opioids for any type of malady. "Dopesick" deserves its spot on so many lists of best non-fiction books of 2018. Macy is an author who understands that the four most important words in journalism are "tell me a story." The harrowing tales in this book are heart-breaking, yet they graphically illustrate the severity of the nation's opioid crisis and the critical need to embrace narcotic-assisted treatments. As someone whose family was ravaged by long-term drug addiction that ended in the overdose/suicide of my older brother, "Dopesick" was torturous to read -- but such an important step for me.… (more)
LibraryThing member SABC
Beth Macy shares America's twenty plus year struggle with opioid addition.
LibraryThing member cmt100
Outstanding. Very readable, which is good, since every American needs to read it.
LibraryThing member Susan.Macura
I am an educated, well-read adult who is up to date on current events. I thought I had a grasp on the opioid epidemic and what it means for our country. I was so wrong. This book has absolutely terrified me. The author has done an amazing job of discussing the history of opioid abuse through history, how Purdue Pharma took advantage of a number of factors to become the producer of OxyContin, how so many people became addicted and how so many moved on to the cheaper alternative - heroin. Purdue Pharma knew how addictive their product was, but pushed it anyway, all the while touting the "fact" that it was not addictive despite the evidence they had to the contrary. Along the way the owners of this small company became rich beyond anyone's wildest dreams. It did not matter the cost to lives, and the cost was great, beyond my imagination. The author pulls no punches here and introduces the reader to many of those who lost it all in the search of the ultimate high, or in the alternative, the search to avoid dopesickness. The author looks at treatment, why so many methods fail, as well as what is working. This is a must read for all of us, because any one of us could either become addicted or be affected by someone else who does. Most importantly, this is a book for every lawmaker out there because we are not treating this addiction in the best way possible. If we do not deal with this soon in the right way, the results will be even more catastrophic than they already are.… (more)
LibraryThing member shazjhb
Excellent book. Just one small part of the country. Made it personal by focusing on families
LibraryThing member Narshkite
Essential reading for everyone I know. I don't know where to start in reviewing this book. Macy has drawn together the threads of of the opioid crisis to provide the clearest picture I have yet read of its genesis, growth, and impact. Though filled with personal stories, one more gutting than the next, Macy also shares the science of opioid addiction, and tells the story of of the politics and back door dealing that left Perdue Pharma free to continue to lure people into addiction years after the effects of its drugs were well documented. She also explores the political and sociological reasons addicts are kept from potential cure. (If you hate Obamacare, you are not going to like what she has to say about states that did not accept Medicaid expansion and how you, the anti-ACA person, are killing people every day.) She explores the costs of looking at addiction as a choice or moral failing and the reasons opioid addiction has been largely limited to white people. (This is the first time I can recall that racism worked to the benefit of black people.)

This is great reporting, and in a week where the President of the US celebrated the murder and assault of reporters, actually laughed about it, I am reminded that the press is core of our society.
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LibraryThing member mrsgrits
Read this book. It's not a fast read, but it is most certainly worth your time. It will open your eyes and break your heart and enlighten you in unexpected ways about the opioid epidemic in America.
LibraryThing member dougcornelius
It will make you mad. It will make you sad. Ms. Macy pulls together many different strands to show the reader what happened and how we are failing to deal with the opioid crisis.
LibraryThing member breic
While I learned a few things, it was not nearly enough to justify an entire book. I suppose the problem with reading a book about current events, written by a journalist, is that it is likely to repeat the newspaper articles that I've already read and that are fresh in my memory.

I also have trouble trusting an author who can't compute percentages.

> … Prosecutors had pinned him with bringing a thousand bags of heroin into the region two to three times a week, paying $5,000 for twenty bricks of heroin that his network then sold for $30,000. The growth in heroin users was as exponential as its 600 percent profit margin.
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LibraryThing member over.the.edge
Dopesick: Dealers, Doctors and The Drug Company That Addicted America
By Beth Macy
Little Brown

I picked this up at the library. I never realized how little I knew or was aware of opioids, beyond their highly destructive and addictive properties. What I learned....
Opioids are one of the most addicting and insidious drugs, whose devastation and destruction has ruined lives, relationships, families and entire communities. Its unrelenting. Its unapologetic. Its harrowing effect and addictiveness has me both sad and angry. Pharmaceutical companies put profit over health. It's made me sad, then mad!

The opiod crisis can be traced back to 1952, when Purdue Frederick sold his family-owned pharmaceutical company to the Sackler Brothers. As Purdue Pharma this small operation grew to a massive conglomerate worth millions. One of the companies original goals was the manufacture of MS Contin, an end of life pill for the terminally ill, to make general public more accepting of this drug and life choice option. It was aggressively marketed as a pain reliever. Especially in areas where pain reducing narcotics were requested most, and prescribed liberally. Samples were also liberally given to Drs with a cash incentive and offers of travel and vacations as incentives, if they offered the samples and prescribed the pill. They were told it was non- addictive due to a special "time release capsule" inside the pill, and the incentives to prescribe were so good, no one really paid attention to what they were prescribing.
When small towns with populations around 400 were being sent 8 million pills a year, it became obvious that the drugs non addictive qualities were questionable. Oxycontin was being abused, as drugs like percocet and dilaudid were no longer a high enough potency to "work". Desperate addicts would pop oxys in their mouth until the coating was gone, take the middle and crush it to powder, which they would then snort or inject. Sad. Really sad!

Eventually, the Purdue Frederick company pled guilty to the felony charge of "mis labeling", but the company has never admitted responsibility for the 100, 000s of deaths due to oxys being prescibed as non addictive. Many families and friends, co workers and community leaders were there in the courtroom telling of the devastation the mislabeling has done to them personally, to their futures and their inability to ever fully recover from its addiction. Still, they did no jail time, paid a fine and continued selling their products for several years.
This is a fantastic and thoroughly researched history of opioids as well as an insight into their addiction. This should be required reading for everyone. As I made me sad....then it made me mad.
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LibraryThing member SamSattler
Horrifying account of what is happening to small town America while no one seems to have the answer to the problem. But I really wanted to hear more about the drug company behind the epidemic and what price was paid by the white collar criminals in charge there. This is mostly the relatively short biographies of a few of that company's victims, and sad as their story is, it didn't leave me feeling satisfied that I had learned all there was to be learned about the opioid problem in this country.… (more)
LibraryThing member angiestahl
Covers the opioid crisis.

Does a very good job of balancing a sense of the epidemic scale of addiction (from rural Appalachia to tony suburbs) and how opioid addiction 'equalizes' poor and affluent, as well as humanizing it through the individual grief and cost to families.

Tees up thoughtful discussion on opioid roots: the over-prescription of pain meds and pharma profit and sales incentives, as well as how we might begin to counter it through decriminalization and investing in Narcan/other treatments for first responders.

As others have said, its thoroughness does bog the narrative down a bit and becomes repetitive in parts. At times, it feels like drinking through a firehose. The stats are mindblowing though. A few that stood out to me:

1) Opioid addition has about the same incident rate as diabetes.
2) It takes the typical opioid addict 8 years and 4-5 treatment attempts to achieve remission for a single year. But, only about 10% of addicts get access to care and treatment at all, much less multiple rounds.
3) Even one-time opioid use can permanently alter the brain.

Scary and sad stuff. Recommended for those who want to know more about opioid addiction or those who want a better understanding of issues facing Appalachia.
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LibraryThing member SABC
Beth Macy shares America's 20+ years struggle with opioid addition. This is 9 CD's read by the author Beth Macy.....10.5 hours of listening.
LibraryThing member reader1009
nonfiction (opiate crisis personal stories connected with)

I really hope something happens to the Sackler family and the doctors who (continue to) overprescribe; it's really easy to become addicted (even "normal" people) just by following your doctor's instructions; odds for recovery really dismal; MAT (medication-assisted therapy) is not perfect but is basically the best option for not relapsing/dying--5 years of MAT or more (along with other guided support/therapy) gives you OK odds at recovery, but it's not readily available or affordable.
This book was great at explaining the crisis and promoting empathy for the addicted and their families. Highly recommended for everyone, since by now everyone knows someone who is affected.
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LibraryThing member Tytania
This was a really hard book to get through. There was no narrative arc - even a work of nonfiction should have narrative; but this was just one bad thing after another. I chalked up seeming non-sequiturs to my lack of ability to focus; but by the end I was spotting them for sure. For example, on page 264 there's a paragraph about how "Female user-dealers are incentivized to lie in their quest for what the government calls substantial assistance," which comes out of nowhere and goes nowhere. The chapter isn't about females, it's about Ronnie Jones.

There are no happy endings here. I get that that's reality. There's no cure for addiction, just struggling every day to avoid the likely relapse. The closest we get to any hopeful notes in the book are the nods to medically assisted treatment, or MAT, as the best evidence-based route available to clean and sober living. So OK - couldn't we read a story about someone holding down a job and family with the help of MAT? Just one little success story, one thread of hope, could make the difference in a reader coming away inspired to act to be supportive of addicts and MAT in their communities, vs. finishing the book horrified and hopeless.
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LibraryThing member Whisper1
This book was difficult to get through, yet I read it in two days. The sheer statistics packed full in this book are staggering. If you have ever visited the Metropolitan Art Museum in New York City, you probably visited one of the main highlights of the Museum. The Temple of Dendur acquisition was funded by Dr. Arthur Sackler. Rescued when the Aswan dam in Egypt was going to be flooded, the temple was brought to the museum with strict instructions regarding space and temperature controllment.

This very same man owns a large pharamaceuticall firm called Purdue Pharma. In this very well researched book, the author traces the beginning of the American opioid crisis from the poor, destitute but beautiful Appalachian mountains where the crisis can directly be placed at the foot of Pharma, through today and the large landscape of addicted children, parents and new-born infants who, too often, land in the morgue.

Dopesick is the tem for addicts constant need of acquiring ever increasing amounts of the drugs in order to avoid the dreaded dope sickness of withdrawal.

Phara introduced Oxy-Contin to one of the poorest areas in the United States. Giving their drug representatives free reign to sell as much of the drug to the local doctors, without the warning that it is highly addictive. The reps. pushed the drug to doctors at unGodly amounts, and exorbitant mgs; they swore it was safe and should be used for pain..any pain...large or small.

As the daughters and sons of the previous coal miners died, in a short period of time as the drug consumption became a huge problem that spanned out from thee Appalachian area, to the Northern Shenandoah Valley, then from urban to suburban and then on to large cities.

While his drug company enabled Dr. Arthur Sackler to advance, in 2015, to the top of America's most wealthy, his wealth from "oxy," created billions upon billions for him, and more than that in the track lines scattered throughout the United States and the broken, addicted dead who previously tried in vain to find a way out of the powerful addiction.

While more and more die of overdose, many addictions can be placed to the very first high-level dosage of Oxy-Contin.
Then, more and more offshoots were produced including dilaudid, and then, for those heavily hooked on drugs, heroin is the cheaper and more potent way of getting increasingly addicted to the point of no return.

In 1996, when the drug first pushed and was consumed in large quantities, through today when 56% of Americans now know of someone who abused or was addicted to and/or died from overdose of opioids, wherein Sackler's company unleashed a drug they knew was highly addictive, contrary to what they made reps. told doctors.

Finally, the company was held in court for accountability. Focusing on the statistic of those who died from the drug, and the fact that the company did indeed know the potency of the drug, the lawyers who won the case noted that no amount of money could undo what was unleashed on the unsuspecting population. Winning a very large billion dollar judgement against Pharma was a large accomplishment, still, the company continued to thrive, and people continue to search for the high just like that first hit of heroin.
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LibraryThing member addunn3
If you want a clear picture of what the opioid epidemic looks like in America, read this book.
LibraryThing member delphimo
Dopesick by Beth Macy provides an interesting discussion about the prescribed drug epidemic, but too much information given like a textbook. Macy shows that drugs have invaded the population and have gotten out-of-control. The drug OxyContin manufactured by Purdue Pharma, who targets the poor souls in Appalachia. The stories are heart wrenching as the crisis spreads to other areas.… (more)
LibraryThing member moekane
Outstanding delineation of the hold narcotics obtained in Appalachia, including antecedents through current issues, illustrated through the lives of individuals with OUD and their families. The number of dead adolescents and young adults is heartbreaking and appalling.
LibraryThing member write-review
Death Along I-81

People should read Dopesick for many good reasons, among them to understand how this current drug addiction crisis evolved, to see how a needed drug for a limited population morphed into an epidemic with aggressive sales tactics promoting it beyond its purpose, to witness how lax government regulatory enforcement encouraged bad actors, to learn how an entrepreneurial medical profession was coopted, yet again, by a cunning pharmaceutical company, and to discover methods for helping addicts get and stay off drugs.

But beyond these reasons, most of all, people should read Dopesick to see that the addicted are human beings, just like we readers, who, often through no fault of their own, find themselves hooked on a drug prescribed to ease their pain. Macy takes us into the lives of the addicted, parents of the addicted, law enforcers trying to stem the trade, and all manner of doctors, nurses, and researchers looking for effective methods of breaking addiction and keeping it broken. Because the book teems with heartbreak, most will not find it easy to get through.

This exploration of opioid addiction begins in the mountains of western Virginia, West Virginia, Kentucky, Tennessee, and northwestern North Carolina: Appalachia; and in Connecticut, home of Purdue Pharma, developers and distributors of OxyContin (a synthesized pain reliever similar to morphine) and its derivatives. It details Purdue’s aggressive marketing and sales approach to pushing out the drug, including the medical profession’s adoption of pain as the fifth vital sign (you’ve seen the ten degrees of pain in doctors’ offices).

Prescribing became common, even for pain that could easily be managed with over the counter analgesics, and those scripts often included thirty-day supplies. Once hooked, users implored and tricked doctors into extending their scripts. Then they resorted to any means of raising funds. Finally, when Oxy became too expensive, they turned to something that was not only cheaper but easier to get, that also delivered the intense high they sought, heroin. To fund their addictions, many turned into low-level dealers. And because the body adapts to opioids, users constantly needed to up their dosages not just to achieve the initial highs but to stave off the sickness engendered by dope deprivation. Which is why you hear of addicts flocking to suppliers whose customers have died of overdoses.

When you drive I-81 through the Appalachians, you enjoy some of the most beautiful scenery in the U.S. What you don’t see is the poverty and depression along the route. Beth Macy takes you off the highway into the byways where began and stills rages one of America’s worst health crises. It’s a difficult and often harrowing journey worth you time.

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