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
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!
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.*
“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.
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?
By Beth Macy
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 said....it made me sad....then it made me mad.
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.
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.
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.
I learned a lot reading this book. Not being within the subculture of drug addiction I did not realize how deep it goes. Listening to the news and hearing about Perdue Pharmaceuticals then reading this I realize why the attorney generals of the states opposing the settlement are taking their actions. There is so much destruction that has occurred over the two decades this medication, as well as others, has been on the market. How it spread shocked me and what was done to get it into the hands of patients disgusted me.
I liked the interviews with the addicts, the dealers, the doctors, and those left behind. It showed a story that very few of us hear or live (although maybe more live it than I realize. I admit to being a little sheltered.) I wish that treatment were more humane instead of the all or nothing approach that is taken by many programs. The treatment seems more a punishment. I also wish those who created the problem would be accountable for their actions rather than the little guy who gets caught using or selling.
Much more needs to be done to stop the drugs (even those prescribed by your doctor) from being abused. More needs to be done to help those addicted recover and go on to live their lives but this is a start, being aware of what is happening around us of which we are blind.
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.
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.