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Dopesick: Dealers, Doctors, and the Drug Company that Addicted America
Goodreads Choice Award
Nominee for Readers' Favorite Nonfiction (2018)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.
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.
384 pages, Hardcover
First published August 7, 2018
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March 22, 2023
A problematic read for me. Yes, I know; awards and all that. But I honestly think the awards go to the fact that Macy made Oxycontin and heroin part of a national conversation, not because this book was exemplary journalism or quality writing.
Issue 1: Macy does not feel like a competent researcher or investigative journalist. Apparently, before the book-writing gig, her newspaper job was 'human interest' stories. I can so see that. I am not the human interest kind of reader. Dopesick primarily focuses on those on the front lines... except the dopesick. Though it begins by talking with a major drug dealer, it quickly moves into history, through one of the physicians who watched the crisis unfold, and then a very brief history of Oxycontin, the manufacturer Purdue Pharmaceuticals, and the Sackler family that owns the company.
But mostly, there are stories from the mothers. Details are heart-tugging and, honestly, facile. She writes about how one son who died of an OD used to help his mom grow sunflowers, so now the mom plants her whole front yard full of them. Another carries around the urn of her son's ashes and caused a minor disturbance in a courtroom. Does this help us understand drug abuse? No. Does it help stir anger against Purdue Pharmaceuticals? I'd argue, 'no,' because it gives the reader a sad, tragic death, only partially from system failure. Macy is trying desperately to relate the individual stories to the larger issues of economics and escape, but it never gels. Unlike Evicted: Poverty and Profit in the American City, which dispassionately used the micro-stories of people to show the complexity of the issues around housing, Macy seems desperate to engage the reader through emotion but without a lot of research.
Surprisingly, for a book about 'dopesick,' Macy largely avoids the elephant of addiction. It feels like she's quick to blame the system (ex: 'Ann' had a twisted ankle and got twenty-five oxycodone) before looking at individual behaviors that contribute. It is clear, indirectly, that many of the mothers were in denial about the level of their teens' use. So it kind of ignores the web of deceptions and strategies that occur before the pill takers turn into addicts. She makes it sound like people are prescribed oxycodone, get addicted, start finding someone with extra, start dealing to cover costs, then turn into heroin addicts. There's a loose attempt to connect that chain with economic depression, but it doesn't work. Mostly, she makes it sound like the 'good' kids did it for fun and then, 'boom,' their lives end. Literally. For me, it's the most annoying kind of journalism, because it uses stereotypical images and catch-phrases to capture 'tragedy.' It's Hallmark Channel journalism.
Issue 2: Macy is not a good writer. She uses adjectives for things she can't possibly know, but play into preconceptions (see above re: Hallmark Channel, and below quote about "stone-faced"). She also quotes some people saying really intriguing but largely unsupported things, and then doesn't address them later. When I checked her 'footnotes' in the back (they aren't actually footnoted in the body of the book--you have to skim through the notes and see if a section you are curious about is highlighted), she has lame-ass citations and logic. By 'lame-ass,' I mean one quote she uses from a guy who asserts "Adderall might make the brain more susceptible to addiction," then she cites a book called "Drug Dealer," published in 2016. Yet this factoid is woven into a section during 2005-2007, a rather unfair standard. Like I said, terrible journalism (Further research has led me to think that book has potential).
Issue 3: Purdue Pharmaceuticals is an evil, evil corporation. As a general rule, I'm pretty sure most pharmaceutical companies are greedy, soul-sucking entities, but Purdue seems actively evil, which Macy illustrates. The topic gets a chapter or two, but is severely hamstrung by the fact that it is a privately owned corporation, by the very private Sackler family, and that one of her co-workers already published an investigation about how Kermit, a town of 400, had enough pills to supply the entire United States population. As of the publication date, the Sackler family had doubled-down by counter-suing the states instead of admitting any kind of culpability. The only ones that have won here are their lawyers, who have made buckets defending them since 2005 or so, when the internet exploded and people really started to get that Oxycontin was addictive (Fun fact: Rudy Giuliani was one of their corporate lawyers).
I would have liked an expose of how Purdue built their empire; I want more of the details from the whistle-blowers. Some of those are included, but not in detail. There's a drug rep who was terminated and filed a "wrongful termination" lawsuit, asserting she was fired because she refused to continue to sell/push drugs to two of her highest-prescribing doctors. (Her district was Florida, naturally). I wanted to know more about that--they must be saying that they actually tracked prescribers and numbers, and actively promoted to them. Which, by implication, is basically admitting that they were being legal drug dealers. Now that is unbelievably unethical, and if you have problems with kids pushing dope in schools, is because this corporation and the family that owned it ENCOURAGED IT. This family has billions, made from an addictive substance they repeated promoted as not. Anyway, Macy only briefly covers that case, and largely in relation to the fact that she ended up losing.
Issue 4: You want compassion? Talk to someone who isn't the child of police officers and a cancer nurse. Macy didn't help me develop empathy, or make me appreciate the insidious way addiction rewires the brain, one dopamine burst at a time. The last time I took care of an addict at my hospital, we had to call a 'Behavioral Emergency' because we had finally gotten enough of the (unknown) drug out of his system that he was pissed we messed up his high. His mother was exhausted, tired of coming to the hospital and trying to talk sense into him. He ripped out his IV, leaking blood everywhere (Hepatitis positive, naturally) and left. It was super not fun. Macy's stories barely even help me with compassion for the parents, seeped as they are in denial and white privilege: "Kristi Remembers the first time someone in town suggested her son had a pill problem.… Kristi defended her son, even suggesting that it had been the woman’s son, not Jesse, who swiped the pills."
Which leads me to issue #5: Macy doesn't handle The Race Issue well. When someone is black, she usually makes a point of saying it, and 'urban' is often code for "low-class-person-of-color." She will reference 'sides' of the town. What has become clear by 2016 is that now that loads of well-to-do white kids are dying, it's an issue. The one person I remember in the book as a person of color is black, is in prison, and who Macy seems to finger as being the lead person that brought 'dope' to their middle-class burbs. The white twenty-some-old that was in jail is portrayed as 'reformed,' living healthy and educating others before he goes to do his time in prison for providing drugs in an OD death.
Issue #6: The Science: this is very science-light. I really, really wanted more of this: “Bickel went onto scientifically quantify the indifference of the typical opioid user, comparing the average non-addictive person’s perception of the future – calculated to be 4.7 years – against an addicted users idea of the future, which is just nine days." How do you retrain those reward pathways? I once met an addiction researcher that really educated me on brain 'wiring' and how it changes with addiction, and it was really the first time I really started to appreciate how terrible trying to combat addiction is. Macy likes to blame various aspects of the system--usually lack of affordable rehab beds when an addict finally says, "I'm ready to quit"--but doesn't really address the most obvious problem that she herself notes: only 50% of addicts who get into a program and on maintenance drugs stay sober for a year. That's a really shitty success rate--would you go to a surgeon who was only successful 50% of the time? See a doctor if there was only 50% of a chance that they could identify and fix your issue? ("Oh, we got most of your appendix, but not all of it"). Take thyroid medication or insulin if there was only a 50% chance it would work? Yeah, probably not. These people are desperate, so they're taking what they can get, but the most honest response to the addiction issue? 'We don't know the best way to combat addiction yet.'
TL; DR: If you know nothing about what oxycodone is or why it's part of the national conversation, start here. But if you want investigative journalism, info on Purdue, or discussion on treating addiction, go elsewhere.
One and a half stars, only because I never threw it across the room.
Actual comprehensive book overview of the prescription drug crisis, including the impact of the federal government and health industry: Drug Dealer, MD: How Doctors Were Duped, Patients Got Hooked, and Why It's So Hard to Stop. My review: https://www.goodreads.com/review/show...
Actual semi-comprehensive overview in under 20 minutes by John Oliver:
https://www.youtube.com/watch?v=-qCKR...
Kate also has some nice thoughts about the language Macy uses: https://www.goodreads.com/review/show...
Issue 1: Macy does not feel like a competent researcher or investigative journalist. Apparently, before the book-writing gig, her newspaper job was 'human interest' stories. I can so see that. I am not the human interest kind of reader. Dopesick primarily focuses on those on the front lines... except the dopesick. Though it begins by talking with a major drug dealer, it quickly moves into history, through one of the physicians who watched the crisis unfold, and then a very brief history of Oxycontin, the manufacturer Purdue Pharmaceuticals, and the Sackler family that owns the company.
But mostly, there are stories from the mothers. Details are heart-tugging and, honestly, facile. She writes about how one son who died of an OD used to help his mom grow sunflowers, so now the mom plants her whole front yard full of them. Another carries around the urn of her son's ashes and caused a minor disturbance in a courtroom. Does this help us understand drug abuse? No. Does it help stir anger against Purdue Pharmaceuticals? I'd argue, 'no,' because it gives the reader a sad, tragic death, only partially from system failure. Macy is trying desperately to relate the individual stories to the larger issues of economics and escape, but it never gels. Unlike Evicted: Poverty and Profit in the American City, which dispassionately used the micro-stories of people to show the complexity of the issues around housing, Macy seems desperate to engage the reader through emotion but without a lot of research.
Surprisingly, for a book about 'dopesick,' Macy largely avoids the elephant of addiction. It feels like she's quick to blame the system (ex: 'Ann' had a twisted ankle and got twenty-five oxycodone) before looking at individual behaviors that contribute. It is clear, indirectly, that many of the mothers were in denial about the level of their teens' use. So it kind of ignores the web of deceptions and strategies that occur before the pill takers turn into addicts. She makes it sound like people are prescribed oxycodone, get addicted, start finding someone with extra, start dealing to cover costs, then turn into heroin addicts. There's a loose attempt to connect that chain with economic depression, but it doesn't work. Mostly, she makes it sound like the 'good' kids did it for fun and then, 'boom,' their lives end. Literally. For me, it's the most annoying kind of journalism, because it uses stereotypical images and catch-phrases to capture 'tragedy.' It's Hallmark Channel journalism.
Issue 2: Macy is not a good writer. She uses adjectives for things she can't possibly know, but play into preconceptions (see above re: Hallmark Channel, and below quote about "stone-faced"). She also quotes some people saying really intriguing but largely unsupported things, and then doesn't address them later. When I checked her 'footnotes' in the back (they aren't actually footnoted in the body of the book--you have to skim through the notes and see if a section you are curious about is highlighted), she has lame-ass citations and logic. By 'lame-ass,' I mean one quote she uses from a guy who asserts "Adderall might make the brain more susceptible to addiction," then she cites a book called "Drug Dealer," published in 2016. Yet this factoid is woven into a section during 2005-2007, a rather unfair standard. Like I said, terrible journalism (Further research has led me to think that book has potential).
Issue 3: Purdue Pharmaceuticals is an evil, evil corporation. As a general rule, I'm pretty sure most pharmaceutical companies are greedy, soul-sucking entities, but Purdue seems actively evil, which Macy illustrates. The topic gets a chapter or two, but is severely hamstrung by the fact that it is a privately owned corporation, by the very private Sackler family, and that one of her co-workers already published an investigation about how Kermit, a town of 400, had enough pills to supply the entire United States population. As of the publication date, the Sackler family had doubled-down by counter-suing the states instead of admitting any kind of culpability. The only ones that have won here are their lawyers, who have made buckets defending them since 2005 or so, when the internet exploded and people really started to get that Oxycontin was addictive (Fun fact: Rudy Giuliani was one of their corporate lawyers).
I would have liked an expose of how Purdue built their empire; I want more of the details from the whistle-blowers. Some of those are included, but not in detail. There's a drug rep who was terminated and filed a "wrongful termination" lawsuit, asserting she was fired because she refused to continue to sell/push drugs to two of her highest-prescribing doctors. (Her district was Florida, naturally). I wanted to know more about that--they must be saying that they actually tracked prescribers and numbers, and actively promoted to them. Which, by implication, is basically admitting that they were being legal drug dealers. Now that is unbelievably unethical, and if you have problems with kids pushing dope in schools, is because this corporation and the family that owned it ENCOURAGED IT. This family has billions, made from an addictive substance they repeated promoted as not. Anyway, Macy only briefly covers that case, and largely in relation to the fact that she ended up losing.
Issue 4: You want compassion? Talk to someone who isn't the child of police officers and a cancer nurse. Macy didn't help me develop empathy, or make me appreciate the insidious way addiction rewires the brain, one dopamine burst at a time. The last time I took care of an addict at my hospital, we had to call a 'Behavioral Emergency' because we had finally gotten enough of the (unknown) drug out of his system that he was pissed we messed up his high. His mother was exhausted, tired of coming to the hospital and trying to talk sense into him. He ripped out his IV, leaking blood everywhere (Hepatitis positive, naturally) and left. It was super not fun. Macy's stories barely even help me with compassion for the parents, seeped as they are in denial and white privilege: "Kristi Remembers the first time someone in town suggested her son had a pill problem.… Kristi defended her son, even suggesting that it had been the woman’s son, not Jesse, who swiped the pills."
Which leads me to issue #5: Macy doesn't handle The Race Issue well. When someone is black, she usually makes a point of saying it, and 'urban' is often code for "low-class-person-of-color." She will reference 'sides' of the town. What has become clear by 2016 is that now that loads of well-to-do white kids are dying, it's an issue. The one person I remember in the book as a person of color is black, is in prison, and who Macy seems to finger as being the lead person that brought 'dope' to their middle-class burbs. The white twenty-some-old that was in jail is portrayed as 'reformed,' living healthy and educating others before he goes to do his time in prison for providing drugs in an OD death.
Issue #6: The Science: this is very science-light. I really, really wanted more of this: “Bickel went onto scientifically quantify the indifference of the typical opioid user, comparing the average non-addictive person’s perception of the future – calculated to be 4.7 years – against an addicted users idea of the future, which is just nine days." How do you retrain those reward pathways? I once met an addiction researcher that really educated me on brain 'wiring' and how it changes with addiction, and it was really the first time I really started to appreciate how terrible trying to combat addiction is. Macy likes to blame various aspects of the system--usually lack of affordable rehab beds when an addict finally says, "I'm ready to quit"--but doesn't really address the most obvious problem that she herself notes: only 50% of addicts who get into a program and on maintenance drugs stay sober for a year. That's a really shitty success rate--would you go to a surgeon who was only successful 50% of the time? See a doctor if there was only 50% of a chance that they could identify and fix your issue? ("Oh, we got most of your appendix, but not all of it"). Take thyroid medication or insulin if there was only a 50% chance it would work? Yeah, probably not. These people are desperate, so they're taking what they can get, but the most honest response to the addiction issue? 'We don't know the best way to combat addiction yet.'
TL; DR: If you know nothing about what oxycodone is or why it's part of the national conversation, start here. But if you want investigative journalism, info on Purdue, or discussion on treating addiction, go elsewhere.
One and a half stars, only because I never threw it across the room.
Actual comprehensive book overview of the prescription drug crisis, including the impact of the federal government and health industry: Drug Dealer, MD: How Doctors Were Duped, Patients Got Hooked, and Why It's So Hard to Stop. My review: https://www.goodreads.com/review/show...
Actual semi-comprehensive overview in under 20 minutes by John Oliver:
https://www.youtube.com/watch?v=-qCKR...
Kate also has some nice thoughts about the language Macy uses: https://www.goodreads.com/review/show...
September 28, 2018
Dopesick: Dealers, Doctors, and the Drug Company Who Addicted America by Beth Macy is a 2018 Little, Brown and Company publication.
“Because the most important thing for the morphine-hijacked brain is, always, not to experience the crushing physical and psychological pain of withdrawal: but to avoid dope sickness at any cost.”
While some may remain untouched, most Americans are painfully aware of the grip opiate addiction has on our country. Like the synopsis states: “From distressed small communities in Central Appalachia to wealthy suburbs; from disparate cities to once-idyllic farm towns’, no one is immune. We see and read news reports, we see parents OD’d, passed out in their cars, with needles sticking out of their arms while their toddler sits in the back seat. Those images and the sheer volume of deaths is staggering.
Beth Macy takes us on a journey that exposes Purdue Pharma, and the Sackler Brothers, to the doctors who make big money on ‘pain management’, to the street dealers who took up the demand when patients ran of legal options, and destroyed entire towns in the process, as well all the red tape, lack of funding, political rhetoric, and the struggle to keep those addicted alive long enough to have the slim hope they’ll someday manage to kick their addiction, which tends to follow the pattern of : Oxy, Roxy, then Heroin.
“Lets’ be clear”, a Purdue Pharma spokesman said in August 2001, in a meeting with Virginia’s attorney general. “The issue is drug abuse, not the drug.” The product shouldn’t be blamed for the deaths, because in many cases the victims were also drinking alcohol and taking other drugs. Van Zee scoffed, telling a Roanoke Times reporter: “To me, that’s like somebody who was shot with a howitzer and a BB gun, and you walk up and say it’s a little hard to tell what killed him. Was it the howitzer that took off half his chest, or was it the BB gun?”
But, more importantly, the author gives the reader intimate portraits of the victims, the families, and the absolute, literal hell they have gone through. Macy pulls no punches. This book is raw, terrifying, frustrating, and made my blood boil. The government- for the past twenty years, at least, through Republican and Democratic administrations have dropped the ball. The approach is outdated, doesn’t work, and keeps people from ever having a chance at a productive life, and does very little to stymie the epidemic when they are lining their own pockets with money from Big Pharma and ‘for profit’ prisons.
“They don’t rehabilitate you in prison, and they don’t make it easy for you to get a job. I truly believe they don’t make it easy because they want you back, and they want you back because that’s the new factory work in so many places now- the prison. “You have to be very strong mentally when you get out to not make the same mistakes.”
By the end of this book, I felt weak with grief. I’d cried so hard and felt a loss so keen, for the families who lost children, or siblings, sometimes more than one, with whole families involved with opiates, either by selling or using. My heart ached for those who live with addiction, and the loved ones who must live life in a state of chronic limbo and constant worry. One parent was so desperate she even removed all the doors in her home, so her son couldn’t hide his drug use- but to no avail.
‘One woman was in the habit of kissing her husband goodbye in the morning, putting her kids on the school bus, then driving to Baltimore to buy enough to last the day before returning to Woodstock just as school bus brought her kids home.'
Those are just a couple of examples, with many even more heart wrenching. Good, ordinary people, with bright futures, who had been prescribed pain medications ended up committing felony crimes to support a drug habit, sinking to lows that are hard to imagine.
Dope sickness is so horribly agonizing some people would consider suicide to avoid it. That’s hard to fathom, and it’s hard to read about people living in such circumstances and even harder to digest that more lives are going to be destroyed if the mindset of the country doesn’t change.
This book is very well organized, presented not only by the statistics, and the history, and the various ways the opiate addiction is dealt with from law enforcement to drug companies, to doctors, to prisons, and to the government, all which bear some blame, but from the viewpoint of the families who are living with the addiction, either battling it themselves, or watching loved ones succumb, or live in agony. Their representation, their voice, is what makes the book so very powerful.
The author obviously did a lot research, but she also spent a lot of time with those who have experienced the devastation up close and personal. She’s tough in places, as balanced in presenting the facts as could be hoped for, but she’s also invested herself emotionally. I’m about as ‘bleeding heart’ as they come, and I must say this book left me feeling completely drained.
But, it is a book I highly recommend. Although this is not a book that offers pat answers or solutions, there is some proof we can staunch some of the bleeding, and maybe the more informed we are, the more we realize how easily this could be you, or one of your children, you will be more diligent, be aware of your doctor’s motives, ask for different methods of pain management, because Oxy, is so addictive one round of pain meds may be all it takes.
Don’t think the marginalized poor in the Appalachian regions are the only ones at risk. The more you know, the more power you have, and with the information provided in this book, if this country has an ounce of compassion left in its black soul, will find its hardened heart pricked with something resembling sympathy, will feel righteous indignation and refuse to look the other way, and will for once avoid passing judgements on the victims. The only people working for change seem to be the victims and their families and the stark, frank, and shocking truth is that no one seems to care- which is yet another American epidemic.
5 stars
“Because the most important thing for the morphine-hijacked brain is, always, not to experience the crushing physical and psychological pain of withdrawal: but to avoid dope sickness at any cost.”
While some may remain untouched, most Americans are painfully aware of the grip opiate addiction has on our country. Like the synopsis states: “From distressed small communities in Central Appalachia to wealthy suburbs; from disparate cities to once-idyllic farm towns’, no one is immune. We see and read news reports, we see parents OD’d, passed out in their cars, with needles sticking out of their arms while their toddler sits in the back seat. Those images and the sheer volume of deaths is staggering.
Beth Macy takes us on a journey that exposes Purdue Pharma, and the Sackler Brothers, to the doctors who make big money on ‘pain management’, to the street dealers who took up the demand when patients ran of legal options, and destroyed entire towns in the process, as well all the red tape, lack of funding, political rhetoric, and the struggle to keep those addicted alive long enough to have the slim hope they’ll someday manage to kick their addiction, which tends to follow the pattern of : Oxy, Roxy, then Heroin.
“Lets’ be clear”, a Purdue Pharma spokesman said in August 2001, in a meeting with Virginia’s attorney general. “The issue is drug abuse, not the drug.” The product shouldn’t be blamed for the deaths, because in many cases the victims were also drinking alcohol and taking other drugs. Van Zee scoffed, telling a Roanoke Times reporter: “To me, that’s like somebody who was shot with a howitzer and a BB gun, and you walk up and say it’s a little hard to tell what killed him. Was it the howitzer that took off half his chest, or was it the BB gun?”
But, more importantly, the author gives the reader intimate portraits of the victims, the families, and the absolute, literal hell they have gone through. Macy pulls no punches. This book is raw, terrifying, frustrating, and made my blood boil. The government- for the past twenty years, at least, through Republican and Democratic administrations have dropped the ball. The approach is outdated, doesn’t work, and keeps people from ever having a chance at a productive life, and does very little to stymie the epidemic when they are lining their own pockets with money from Big Pharma and ‘for profit’ prisons.
“They don’t rehabilitate you in prison, and they don’t make it easy for you to get a job. I truly believe they don’t make it easy because they want you back, and they want you back because that’s the new factory work in so many places now- the prison. “You have to be very strong mentally when you get out to not make the same mistakes.”
By the end of this book, I felt weak with grief. I’d cried so hard and felt a loss so keen, for the families who lost children, or siblings, sometimes more than one, with whole families involved with opiates, either by selling or using. My heart ached for those who live with addiction, and the loved ones who must live life in a state of chronic limbo and constant worry. One parent was so desperate she even removed all the doors in her home, so her son couldn’t hide his drug use- but to no avail.
‘One woman was in the habit of kissing her husband goodbye in the morning, putting her kids on the school bus, then driving to Baltimore to buy enough to last the day before returning to Woodstock just as school bus brought her kids home.'
Those are just a couple of examples, with many even more heart wrenching. Good, ordinary people, with bright futures, who had been prescribed pain medications ended up committing felony crimes to support a drug habit, sinking to lows that are hard to imagine.
Dope sickness is so horribly agonizing some people would consider suicide to avoid it. That’s hard to fathom, and it’s hard to read about people living in such circumstances and even harder to digest that more lives are going to be destroyed if the mindset of the country doesn’t change.
This book is very well organized, presented not only by the statistics, and the history, and the various ways the opiate addiction is dealt with from law enforcement to drug companies, to doctors, to prisons, and to the government, all which bear some blame, but from the viewpoint of the families who are living with the addiction, either battling it themselves, or watching loved ones succumb, or live in agony. Their representation, their voice, is what makes the book so very powerful.
The author obviously did a lot research, but she also spent a lot of time with those who have experienced the devastation up close and personal. She’s tough in places, as balanced in presenting the facts as could be hoped for, but she’s also invested herself emotionally. I’m about as ‘bleeding heart’ as they come, and I must say this book left me feeling completely drained.
But, it is a book I highly recommend. Although this is not a book that offers pat answers or solutions, there is some proof we can staunch some of the bleeding, and maybe the more informed we are, the more we realize how easily this could be you, or one of your children, you will be more diligent, be aware of your doctor’s motives, ask for different methods of pain management, because Oxy, is so addictive one round of pain meds may be all it takes.
Don’t think the marginalized poor in the Appalachian regions are the only ones at risk. The more you know, the more power you have, and with the information provided in this book, if this country has an ounce of compassion left in its black soul, will find its hardened heart pricked with something resembling sympathy, will feel righteous indignation and refuse to look the other way, and will for once avoid passing judgements on the victims. The only people working for change seem to be the victims and their families and the stark, frank, and shocking truth is that no one seems to care- which is yet another American epidemic.
5 stars
January 21, 2022
“The informant leaned into [Lieutenant Richard] Stallard’s cruiser. ‘This feller up here’s got this new stuff he’s selling. It’s called Oxy, and he says it’s great,’ he said.
‘What is it again?” Stallard asked.
‘It’s Oxy-compton…something like that.’
Pill users were already misusing it to intensify their high, the informant explained, as well as selling it on the black market. Oxy came in much higher dosages than standard painkillers, and an 80-milligram tablet sold for $80, making its potential for black-market sales much higher than that of Dilaudid and Lortab. The increased potency made the drug a cash cow for the company that manufactured it, too.
The informant had more specifics: Users had already figured out an end run around the pill’s time-release mechanism, a coating stamped with OC and the milligram dosage. They simply popped a tablet in their mouths for a minute or two, until the rubberized coating melted away, then rubbed it off on their shirts. Forty-milligram Oxys left an orange sheen on their shirtsleeves, the 80-milligrams a tinge of green. The remaining tiny pearl of pure oxycodone could be crushed, then snorted or mixed with water and injected.
The euphoria was immediate and intense, with a purity similar to that of heroin…”
- Beth Macy, Dopesick: Dealers, Doctors, and the Drug Company that Addicted America
Every morning at the train station, I find myself staring at the iconography of the opioid epidemic.
Next to me, there is an advertisement for Narcan, a naloxone nasal spray that can be used in case of an opioid overdose. Across the tracks, another ad, this one for a residential treatment center focused on opioid addiction. When I step on the train, I am greeted with a placard that says: Stop! Don’t Run! It is a public service announcement, reminding users that they will be given prosecutorial immunity if they call 911 and stay with a person who has overdosed. It is a law that is meant to stop users from running away and allowing a person to die in order to avoid a possession rap.
Day after day, it is easy to allow such things to recede into the background. To become part of normal life. If you are like me, you have heard the phrase “opioid epidemic” so often it has started to lose meaning.
Whether we pay attention or not, it is happening. Over the past fifteen years, 300,000 Americans have died from drug overdoses. Seventy-two thousand died just last year. It is the leading cause of death for Americans under fifty, and is deadlier than guns, car accidents, and peak HIV.
Beth Macy’s Dopesick tells the story of the crisis by giving it details. She provides the faces and the names and the unhappy endings. It is a potent, at times unbearably powerful story. She follows everyone: cops and criminals and users; prosecutors and judges; doctors and nurses and treatment providers.
Mostly, though, this is a story of mothers. A tale of mothers and their dead sons and daughters.
While the opioid crisis has its tentacles in every corner of the nation, Macy traces it from its origin in rural America, specifically western Virginia. As a journalist based out of Roanoke, she was there at the beginning, with Purdue Pharma’s introduction of OxyContin:
A paradigmatic shift turned patients into health care consumers. Accordingly, pharmaceutical companies sent their sales reps across the country to evangelize for new medications to prescribe to these customers.
Macy devoted years to this story, and she begins Dopesick with the story of Purdue Pharma and OxyContin. She describes how this potent drug was sold to physicians, who then over-prescribed it to their patients. And when I say “sold,” I mean that in a literal sense. Sales reps were buying loyalty with free lunches and junkets and swag. Physicians, for their parts, were enjoying catered lunches and filling Oxy scripts with indefinite refills. At the time Oxy hit the market, unfortunately, it was not tamper resistant, meaning that this incredibly potent drug could be altered for an incredible high.
This high came at an even more incredible cost.
“Dopesick” is the term used to describe withdrawal, and it explains why opioids are so dangerous. Once your body has entertained the euphoria of opioids, it has a hard time going back. Symptoms of withdrawal include aches, diarrhea, fevers, profuse sweating, stomach cramping, nausea, vomiting, anxiety, restlessness, and irritability. A person undergoing this extreme manifestation of absence becomes desperate to reverse course, to feed the addiction in order to make the sickness go away. An addict will do anything to get enough money for the next hit. The slang junkie, after all, refers to a person who scrapped metal in order to support their addiction.
Eventually, the trend that began with Oxy exploded into a rebirth of heroin, leading to a public health crisis that devastated rural communities, filling the boneyards and the prisons.
Macy devotes a lot of time to following the resistance, a small band of people who tried to fight City Hall, even though City Hall had been purchased by Corporate America. We are introduced to a small-town doctor who was the canary in the coal mine, warning of Oxy’s dangers as he saw his patients dying; there is a dogged ATF agent, who broke one of Virginia’s largest heroin rings; there is a nurse practitioner who takes her mobile health wagon into the old coalfields, where the uninsured multitudes await; and there is a no-nonsense Catholic nun whose activism could help remind the moribund husk of a beleaguered Church that faith without works is dead.
(Dopesick features beautiful black & white portraits of most of these people, taken specifically for the book. It adds a great deal to have a face to go along with the names).
Purdue Pharma is an easy target. It is a corporation, after all, a molten mass of money surrounded by the impenetrable layers of the mythic “corporate veil,” endowed by the Supreme Court with all the rights of a human person, but none of the moral responsibilities or potential legal consequences.
Macy, though, does not stop with them. She looks at the many other contributing factors, such as an acquiescent FDA, where top officials transition directly from the agency into high-paying corporate positions; and physicians who failed to do their due diligence before reaching for their Purdue Pharma ballpoints to write a script; and at the potency of opioids themselves, which makes recovery extremely difficult.
In the latter half of Dopesick, Macy turns this into a furious critique of the treatment-industrial complex. She advocates strongly for medication assisted treatment (MAT), using drugs such as Suboxone to quell cravings and subdue withdrawal symptoms (without getting the person high). According to Macy, this is the only feasible way to break the epidemic. However, the legal and medical systems are extremely wary of using drugs to defeat drug addiction, even though we live in a hyper-medicated culture in which there is a prescription for everything.
Dopesick is deeply researched, nicely balancing the big-picture statistics with on-the-ground reporting. But as hard as she tries, this is not a work of objective journalism. Macy was in the trenches a long time, essentially embedding herself in fraying communities. To follow these lives, she became a part of those lives, to the point where she would get texts from users asking her to drive them to rehab.
Frankly, I do not see this as a problem. If journalism requires a person to put their humanity on hold, then journalism is not worth a damn. The surprising thing to me is that she was able to maintain her empathy. Addicts are extremely frustrating. I was a public defender for nine years, and the number of drug users I represented who maintained their sobriety was depressingly low. Addicts will – and do – steal from the people they love the most, lie to the people they love the most, let down the people they love the most. It becomes very hard, very quickly, to feel sorry for them.
This brings us back to the mothers.
Mothers are the beating heart of Dopesick, and we follow them closely as they try to save their kids. It makes for dispiriting reading, as these young people trade their futures to chase a high, joining a cycle of sobriety and relapse that lasts for years, and is physically and psychologically difficult to escape. From the outside, it is easy to say: Cut them off. Stop helping them. Let them go. Three strikes and you’re out. From the outside, it is easy to ask: When is it enough?
But that is only what you say when it is not your child. Because when it is your child, there is never a point where you quit. And maybe that is the only redemption to be found in Dopesick: the mothers who keep trying to save their kids.
Many of them do not succeed.
Macy begins her book with a fitting line from Agatha Christie. “A mother’s love for her child is like nothing else in the world,” Christie writes in The Last Séance. “It knows no law, no pity, it dares all things and crushes down remorselessly all that stands in its path.”
Christie was describing a mother’s love, but she might have been describing opioids themselves. Unfortunately, it does not seem that even love can triumph over the ruthless power of an insidious drug.
‘What is it again?” Stallard asked.
‘It’s Oxy-compton…something like that.’
Pill users were already misusing it to intensify their high, the informant explained, as well as selling it on the black market. Oxy came in much higher dosages than standard painkillers, and an 80-milligram tablet sold for $80, making its potential for black-market sales much higher than that of Dilaudid and Lortab. The increased potency made the drug a cash cow for the company that manufactured it, too.
The informant had more specifics: Users had already figured out an end run around the pill’s time-release mechanism, a coating stamped with OC and the milligram dosage. They simply popped a tablet in their mouths for a minute or two, until the rubberized coating melted away, then rubbed it off on their shirts. Forty-milligram Oxys left an orange sheen on their shirtsleeves, the 80-milligrams a tinge of green. The remaining tiny pearl of pure oxycodone could be crushed, then snorted or mixed with water and injected.
The euphoria was immediate and intense, with a purity similar to that of heroin…”
- Beth Macy, Dopesick: Dealers, Doctors, and the Drug Company that Addicted America
Every morning at the train station, I find myself staring at the iconography of the opioid epidemic.
Next to me, there is an advertisement for Narcan, a naloxone nasal spray that can be used in case of an opioid overdose. Across the tracks, another ad, this one for a residential treatment center focused on opioid addiction. When I step on the train, I am greeted with a placard that says: Stop! Don’t Run! It is a public service announcement, reminding users that they will be given prosecutorial immunity if they call 911 and stay with a person who has overdosed. It is a law that is meant to stop users from running away and allowing a person to die in order to avoid a possession rap.
Day after day, it is easy to allow such things to recede into the background. To become part of normal life. If you are like me, you have heard the phrase “opioid epidemic” so often it has started to lose meaning.
Whether we pay attention or not, it is happening. Over the past fifteen years, 300,000 Americans have died from drug overdoses. Seventy-two thousand died just last year. It is the leading cause of death for Americans under fifty, and is deadlier than guns, car accidents, and peak HIV.
Beth Macy’s Dopesick tells the story of the crisis by giving it details. She provides the faces and the names and the unhappy endings. It is a potent, at times unbearably powerful story. She follows everyone: cops and criminals and users; prosecutors and judges; doctors and nurses and treatment providers.
Mostly, though, this is a story of mothers. A tale of mothers and their dead sons and daughters.
While the opioid crisis has its tentacles in every corner of the nation, Macy traces it from its origin in rural America, specifically western Virginia. As a journalist based out of Roanoke, she was there at the beginning, with Purdue Pharma’s introduction of OxyContin:
The 1996 introduction of OxyContin coincided with the moment in medical history when doctors, hospitals, and accreditation boards were adopting the notion of pain as “the fifth vital sign,” developing new standards of pain assessment and treatment that gave pain equal status with blood pressure, heart rate, respiratory rate, and temperature.
A paradigmatic shift turned patients into health care consumers. Accordingly, pharmaceutical companies sent their sales reps across the country to evangelize for new medications to prescribe to these customers.
Macy devoted years to this story, and she begins Dopesick with the story of Purdue Pharma and OxyContin. She describes how this potent drug was sold to physicians, who then over-prescribed it to their patients. And when I say “sold,” I mean that in a literal sense. Sales reps were buying loyalty with free lunches and junkets and swag. Physicians, for their parts, were enjoying catered lunches and filling Oxy scripts with indefinite refills. At the time Oxy hit the market, unfortunately, it was not tamper resistant, meaning that this incredibly potent drug could be altered for an incredible high.
This high came at an even more incredible cost.
“Dopesick” is the term used to describe withdrawal, and it explains why opioids are so dangerous. Once your body has entertained the euphoria of opioids, it has a hard time going back. Symptoms of withdrawal include aches, diarrhea, fevers, profuse sweating, stomach cramping, nausea, vomiting, anxiety, restlessness, and irritability. A person undergoing this extreme manifestation of absence becomes desperate to reverse course, to feed the addiction in order to make the sickness go away. An addict will do anything to get enough money for the next hit. The slang junkie, after all, refers to a person who scrapped metal in order to support their addiction.
Eventually, the trend that began with Oxy exploded into a rebirth of heroin, leading to a public health crisis that devastated rural communities, filling the boneyards and the prisons.
Macy devotes a lot of time to following the resistance, a small band of people who tried to fight City Hall, even though City Hall had been purchased by Corporate America. We are introduced to a small-town doctor who was the canary in the coal mine, warning of Oxy’s dangers as he saw his patients dying; there is a dogged ATF agent, who broke one of Virginia’s largest heroin rings; there is a nurse practitioner who takes her mobile health wagon into the old coalfields, where the uninsured multitudes await; and there is a no-nonsense Catholic nun whose activism could help remind the moribund husk of a beleaguered Church that faith without works is dead.
(Dopesick features beautiful black & white portraits of most of these people, taken specifically for the book. It adds a great deal to have a face to go along with the names).
Purdue Pharma is an easy target. It is a corporation, after all, a molten mass of money surrounded by the impenetrable layers of the mythic “corporate veil,” endowed by the Supreme Court with all the rights of a human person, but none of the moral responsibilities or potential legal consequences.
Macy, though, does not stop with them. She looks at the many other contributing factors, such as an acquiescent FDA, where top officials transition directly from the agency into high-paying corporate positions; and physicians who failed to do their due diligence before reaching for their Purdue Pharma ballpoints to write a script; and at the potency of opioids themselves, which makes recovery extremely difficult.
In the latter half of Dopesick, Macy turns this into a furious critique of the treatment-industrial complex. She advocates strongly for medication assisted treatment (MAT), using drugs such as Suboxone to quell cravings and subdue withdrawal symptoms (without getting the person high). According to Macy, this is the only feasible way to break the epidemic. However, the legal and medical systems are extremely wary of using drugs to defeat drug addiction, even though we live in a hyper-medicated culture in which there is a prescription for everything.
Dopesick is deeply researched, nicely balancing the big-picture statistics with on-the-ground reporting. But as hard as she tries, this is not a work of objective journalism. Macy was in the trenches a long time, essentially embedding herself in fraying communities. To follow these lives, she became a part of those lives, to the point where she would get texts from users asking her to drive them to rehab.
Frankly, I do not see this as a problem. If journalism requires a person to put their humanity on hold, then journalism is not worth a damn. The surprising thing to me is that she was able to maintain her empathy. Addicts are extremely frustrating. I was a public defender for nine years, and the number of drug users I represented who maintained their sobriety was depressingly low. Addicts will – and do – steal from the people they love the most, lie to the people they love the most, let down the people they love the most. It becomes very hard, very quickly, to feel sorry for them.
This brings us back to the mothers.
Mothers are the beating heart of Dopesick, and we follow them closely as they try to save their kids. It makes for dispiriting reading, as these young people trade their futures to chase a high, joining a cycle of sobriety and relapse that lasts for years, and is physically and psychologically difficult to escape. From the outside, it is easy to say: Cut them off. Stop helping them. Let them go. Three strikes and you’re out. From the outside, it is easy to ask: When is it enough?
But that is only what you say when it is not your child. Because when it is your child, there is never a point where you quit. And maybe that is the only redemption to be found in Dopesick: the mothers who keep trying to save their kids.
Many of them do not succeed.
Macy begins her book with a fitting line from Agatha Christie. “A mother’s love for her child is like nothing else in the world,” Christie writes in The Last Séance. “It knows no law, no pity, it dares all things and crushes down remorselessly all that stands in its path.”
Christie was describing a mother’s love, but she might have been describing opioids themselves. Unfortunately, it does not seem that even love can triumph over the ruthless power of an insidious drug.
January 6, 2019
Shocking.....just shocking!
I had no idea how bad things have become and who was responsible. You hear news about the opioid crisis and it's getting worse and we need to do something about it.....but we don't. Giving out Narcan to folks so if they overdose they have the fix, not sure if I fully agree with it. Aren't we just enabling it more by this? I remember once someone telling me at a hospital someone came in, OD'd. Given Narcan, revived. Awesome! They were given Narcan to take with them. Later that same day, they were back...OD'd again. But we need to look at the root cause, the pharma companies and doctors that over-prescribe. Listening into my husbands conversation recently with someone who tore a muscle at work, on the job. He had to get their medical history. At the ER, they were given Oxy for pain. REALLY? That's what you get for a torn muscle now. This person was smart enough to throw out the prescription. But many think 'I'll take just one pill, I can handle it' but the sad thing is, that's all it takes. You want it more and more. And in the end, you try to stop but you get so sick...dopesick. So you continue to take it just to avoid the dopesickness. A vicious cycle.
Anyway, this book is a very detailed look at this crisis and how it came about and how fast it spread and continues to spread. You get intimate details of the people hit with this, families recovering (or trying to) from loosing loved ones, or just trying to get a loved on straight. We might think oh this is only something that happens in the downtrodden areas of the US, where people don't have jobs, have no money, and so on. But it's not the case. The wealthy, affluent have also been affected. Big business does well to keep people hooked on these drugs, drug reps make tons of cash to have doctors peddle their drugs, even when not needed. And doctors are too lenient in handing out drugs like tic-tacs. So if you want an in-depth look at this crisis, grab this one. It's heartbreaking, sad, enraging,.....but a great read. I listened via audio, which was read by the author. She did a wonderful job but at times there were too many people and too many facts and that sort of stuff is hard to track via audio. Print might have been better for me. Perhaps I should now just say....rant off.
I had no idea how bad things have become and who was responsible. You hear news about the opioid crisis and it's getting worse and we need to do something about it.....but we don't. Giving out Narcan to folks so if they overdose they have the fix, not sure if I fully agree with it. Aren't we just enabling it more by this? I remember once someone telling me at a hospital someone came in, OD'd. Given Narcan, revived. Awesome! They were given Narcan to take with them. Later that same day, they were back...OD'd again. But we need to look at the root cause, the pharma companies and doctors that over-prescribe. Listening into my husbands conversation recently with someone who tore a muscle at work, on the job. He had to get their medical history. At the ER, they were given Oxy for pain. REALLY? That's what you get for a torn muscle now. This person was smart enough to throw out the prescription. But many think 'I'll take just one pill, I can handle it' but the sad thing is, that's all it takes. You want it more and more. And in the end, you try to stop but you get so sick...dopesick. So you continue to take it just to avoid the dopesickness. A vicious cycle.
Anyway, this book is a very detailed look at this crisis and how it came about and how fast it spread and continues to spread. You get intimate details of the people hit with this, families recovering (or trying to) from loosing loved ones, or just trying to get a loved on straight. We might think oh this is only something that happens in the downtrodden areas of the US, where people don't have jobs, have no money, and so on. But it's not the case. The wealthy, affluent have also been affected. Big business does well to keep people hooked on these drugs, drug reps make tons of cash to have doctors peddle their drugs, even when not needed. And doctors are too lenient in handing out drugs like tic-tacs. So if you want an in-depth look at this crisis, grab this one. It's heartbreaking, sad, enraging,.....but a great read. I listened via audio, which was read by the author. She did a wonderful job but at times there were too many people and too many facts and that sort of stuff is hard to track via audio. Print might have been better for me. Perhaps I should now just say....rant off.
January 21, 2019
This is a well-researched nonfiction book about how the Sackler family of the privately-held company Purdue Pharma, their sales reps, unethical and misinformed doctors, our pitiful healthcare system that only helps some people, and our misguided law enforcement and incarceration laws created an opioid crisis that became a heroin crisis that led to overdosing becoming the leading cause of death for young Americans.
Our country needs to ensure that everyone has access to healthcare, including mental health and substance abuse care. We also need to change our drug laws so tax payers aren’t funding prisons for people who are low-level drug users. It costs a minimum of thirty-thousand dollars a year to incarcerate someone. In states like New York and California, the cost is seventy- to more than one-hundred grand. What if we used that money on healthcare and education and substance abuse treatment?
According to Macy’s book, “Rehab is . . . a multibillion-dollar lie.” It’s unevenly regulated and largely abstinence-focused, meaning people who are trying to get weaned off opioids aren’t supposed to take drugs like Suboxone, even though it’s proven to help dramatically in keeping people off drugs. Most rehab centers, which are unaffordable to many, are abstinence, faith-based 12-step programs (5 of the 12 steps refer to a Higher Power) even though for opioid abuse, there is significant evidences that medication-assisted treated for the long term is a more reliable solution for sobriety.
“When you spend that much money, you think it’s going to work. But it’s killing people for that myth to be out there—that the only true cure is abstinence.”
Not to mention, even for people who might be able to afford (barely) incare treatment, there aren’t nearly enough beds in residential treatment centers to meet the demand.
“The most important thing for the morphine-hijacked brain is, always, not to experience the crushing physical and psychological pain of withdrawal: to avoid dopesickness at any cost. To feed their addictions, many users recruit new customers. Who eventually recruit new customers. And the exponential growth continues until the cycle too often ends in jail or prison . . . a grave.”
In terms of the opioid crisis, by now we know it’s a national problem that begin in small towns, places like Appalachia that were one-industry towns. When coal-mining stopped being lucrative because of alternate sources of energy like fracking and wind turbines, there were no more jobs. People often had on-the-job injuries and were overprescribed opioids. A drug that should only be used for end-of-life care or cancer, people were getting hooked after just two weeks and then ultimately turned to the cheaper heroin. Four of five people heroin addicts now come to the drug by originally being prescribed opioids.
What’s the difference between our schwag and other sales reps? Asked a representative for Purdue Pharma, the company that hooked our citizens on Oxycontin. The Sacklers that own Purdue are one of the richest families in America. The difference is that “People aren’t stealing from their families or breaking into their neighbors’ homes over blood-pressure pills,” said small-town Dr. Van Zee, a major voice to change how this drug is prescribed, which took years. “Doctors started prostituting themselves for a few free trips to Florida,” said lawyer Emmitt Yeary, who represented the families of people who committed Oxy-related crimes (stealing copper from buildings to get another fix, for example).
“We know from other countries that when people stick with treatment, outcomes can bet better than fifty percent. But people in the United States don’t have access to good opioid-addiction treatment.”
The state of Virginia, where many of the stories from both sides of the law that Macy reports on, is one of the states that refused to accept Medicaid expansion in the wake of the Affordable Care Act, sacrificing $6.6 million a day in federal funds for insurance coverage. “In states where Medicaid expansions were passed, the safety-net program had become the most important epidemic-fighting tool, paying for treatment, counseling, and addiction medications and filling other long-standing gaps in care. It gave coverage to an additional 1.3 million addicted users who were not poor enough for Medicaid but too poor for private insurance.” “ If only (politicians) understood that Medicaid would actually save money and lives!”
“It takes about eight years on average, after people start treatment, to get one year of sobriety . . . and four or five different episodes of treatment for that sobriety to stick.”
Because I’m passionate about healthcare reform, justice reform, and an end to people’s lives getting ruined because they had some injury and became addicted to strong opioids almost overnight, I really enjoyed this book and highlighted many, many pages. We need to treat people with addictions with respect because addiction is not a moral failing of not having enough willpower, it’s about how addicted brains work differently than nonaddicted brains.
For more reviews, please visit http://www.theresaalan.net/blog
Our country needs to ensure that everyone has access to healthcare, including mental health and substance abuse care. We also need to change our drug laws so tax payers aren’t funding prisons for people who are low-level drug users. It costs a minimum of thirty-thousand dollars a year to incarcerate someone. In states like New York and California, the cost is seventy- to more than one-hundred grand. What if we used that money on healthcare and education and substance abuse treatment?
According to Macy’s book, “Rehab is . . . a multibillion-dollar lie.” It’s unevenly regulated and largely abstinence-focused, meaning people who are trying to get weaned off opioids aren’t supposed to take drugs like Suboxone, even though it’s proven to help dramatically in keeping people off drugs. Most rehab centers, which are unaffordable to many, are abstinence, faith-based 12-step programs (5 of the 12 steps refer to a Higher Power) even though for opioid abuse, there is significant evidences that medication-assisted treated for the long term is a more reliable solution for sobriety.
“When you spend that much money, you think it’s going to work. But it’s killing people for that myth to be out there—that the only true cure is abstinence.”
Not to mention, even for people who might be able to afford (barely) incare treatment, there aren’t nearly enough beds in residential treatment centers to meet the demand.
“The most important thing for the morphine-hijacked brain is, always, not to experience the crushing physical and psychological pain of withdrawal: to avoid dopesickness at any cost. To feed their addictions, many users recruit new customers. Who eventually recruit new customers. And the exponential growth continues until the cycle too often ends in jail or prison . . . a grave.”
In terms of the opioid crisis, by now we know it’s a national problem that begin in small towns, places like Appalachia that were one-industry towns. When coal-mining stopped being lucrative because of alternate sources of energy like fracking and wind turbines, there were no more jobs. People often had on-the-job injuries and were overprescribed opioids. A drug that should only be used for end-of-life care or cancer, people were getting hooked after just two weeks and then ultimately turned to the cheaper heroin. Four of five people heroin addicts now come to the drug by originally being prescribed opioids.
What’s the difference between our schwag and other sales reps? Asked a representative for Purdue Pharma, the company that hooked our citizens on Oxycontin. The Sacklers that own Purdue are one of the richest families in America. The difference is that “People aren’t stealing from their families or breaking into their neighbors’ homes over blood-pressure pills,” said small-town Dr. Van Zee, a major voice to change how this drug is prescribed, which took years. “Doctors started prostituting themselves for a few free trips to Florida,” said lawyer Emmitt Yeary, who represented the families of people who committed Oxy-related crimes (stealing copper from buildings to get another fix, for example).
“We know from other countries that when people stick with treatment, outcomes can bet better than fifty percent. But people in the United States don’t have access to good opioid-addiction treatment.”
The state of Virginia, where many of the stories from both sides of the law that Macy reports on, is one of the states that refused to accept Medicaid expansion in the wake of the Affordable Care Act, sacrificing $6.6 million a day in federal funds for insurance coverage. “In states where Medicaid expansions were passed, the safety-net program had become the most important epidemic-fighting tool, paying for treatment, counseling, and addiction medications and filling other long-standing gaps in care. It gave coverage to an additional 1.3 million addicted users who were not poor enough for Medicaid but too poor for private insurance.” “ If only (politicians) understood that Medicaid would actually save money and lives!”
“It takes about eight years on average, after people start treatment, to get one year of sobriety . . . and four or five different episodes of treatment for that sobriety to stick.”
Because I’m passionate about healthcare reform, justice reform, and an end to people’s lives getting ruined because they had some injury and became addicted to strong opioids almost overnight, I really enjoyed this book and highlighted many, many pages. We need to treat people with addictions with respect because addiction is not a moral failing of not having enough willpower, it’s about how addicted brains work differently than nonaddicted brains.
For more reviews, please visit http://www.theresaalan.net/blog
December 4, 2018
I personally know 5 families who have lost a family member(s) to heroin/fentanyl. Good, strong, well-educated families. It is happening all around us, in all walks of life.
There are plenty of heartbreaking personal accounts in this book from families who have lost a loved one, and the steps they took in an attempt to save them. It can, and does, happen to anyone. They aren’t “other”, they are us, and it is heart-wrenching to read.
According to the author the roots of the epidemic stems from a perfect storm of factors:
- the government mandate that physicians make adequate pain control a priority
- Purdue Pharma, who aggressively marketed Oxycontin to doctors as effective without causing dependency. They hid evidence that this was a highly addictive drug
- physicians writing large amounts of the narcotic Oxycodone, often for minor procedures
- outdated methods of treating addicts, proven by multiple studies to be unsuccessful
- treating addicts like criminals – again, exhaustive research tells us it doesn’t work
- once addicted to Oxycontin, and no longer able to obtain a supply, the addicted turn to the cheaper heroin/fentanyl combination (according to some, this is a small percentage – see below)
- economic factors at play – in a population where poverty and unemployment is the norm, the conditions are ripe for drug use/addiction. Appalachia was among the first places where OxyContin gained a foothold in the mid-1990s.
Medicine has changed, no longer do doctors prescribe large amounts of narcotics as a matter of routine care after surgery. In fact, physicians face sanctions for prescribing narcotics "inappropriately" and many have chosen to just stop prescribing.
I read this book a month ago but have hesitated to write a review because I'm conflicted. There is another side to the story and chronic pain patients are the unintended victims. I wish the author had addressed this issue and given a more balanced report. Not everyone who uses Oxy will go on to become a drug addict.
According to https://www.drugabuse.gov/publication... while prescription opioid misuse is a risk factor for starting heroin use, only a small fraction of people who misuse pain relievers switch to heroin. According to a national survey, less than 4 percent of people who had misused prescription pain medicines started using heroin within 5 years.1
Side note: I’m an RN and I have a disease that causes chronic pain. I'm fortunate that my disease is under control through the use of biologics, and I have no need for pain medicine. But I keep abreast of what is happening in the chronic pain community, and all too often those who suffer from chronic pain are the unfortunate victims of new laws and government mandates. I’ve personally visited pain clinics where I felt treated like a criminal even though I wasn’t there for a narcotic prescription. I can't imagine what it would have been like if I had needed one.
Doctors are being pressured to taper chronic pain patients off opioid regimens that have been working for them for years. Most chronic pain patients use the drugs in order to function but are now treated with suspicion and judgement, even if they have been using the drugs for years with no problem. Many can't get their prescriptions filled at the pharmacy.
Some experts claim most of the harm from opioids are from the drugs being smuggled into the country from China and Mexico, but nearly all the government's solutions are based on limiting access to pain medication for people in pain. For more information:
https://www.theguardian.com/commentis...
https://www.thefix.com/other-side-opi...
http://nationalpainreport.com/enough-...
There are plenty of heartbreaking personal accounts in this book from families who have lost a loved one, and the steps they took in an attempt to save them. It can, and does, happen to anyone. They aren’t “other”, they are us, and it is heart-wrenching to read.
According to the author the roots of the epidemic stems from a perfect storm of factors:
- the government mandate that physicians make adequate pain control a priority
- Purdue Pharma, who aggressively marketed Oxycontin to doctors as effective without causing dependency. They hid evidence that this was a highly addictive drug
- physicians writing large amounts of the narcotic Oxycodone, often for minor procedures
- outdated methods of treating addicts, proven by multiple studies to be unsuccessful
- treating addicts like criminals – again, exhaustive research tells us it doesn’t work
- once addicted to Oxycontin, and no longer able to obtain a supply, the addicted turn to the cheaper heroin/fentanyl combination (according to some, this is a small percentage – see below)
- economic factors at play – in a population where poverty and unemployment is the norm, the conditions are ripe for drug use/addiction. Appalachia was among the first places where OxyContin gained a foothold in the mid-1990s.
Medicine has changed, no longer do doctors prescribe large amounts of narcotics as a matter of routine care after surgery. In fact, physicians face sanctions for prescribing narcotics "inappropriately" and many have chosen to just stop prescribing.
I read this book a month ago but have hesitated to write a review because I'm conflicted. There is another side to the story and chronic pain patients are the unintended victims. I wish the author had addressed this issue and given a more balanced report. Not everyone who uses Oxy will go on to become a drug addict.
According to https://www.drugabuse.gov/publication... while prescription opioid misuse is a risk factor for starting heroin use, only a small fraction of people who misuse pain relievers switch to heroin. According to a national survey, less than 4 percent of people who had misused prescription pain medicines started using heroin within 5 years.1
Side note: I’m an RN and I have a disease that causes chronic pain. I'm fortunate that my disease is under control through the use of biologics, and I have no need for pain medicine. But I keep abreast of what is happening in the chronic pain community, and all too often those who suffer from chronic pain are the unfortunate victims of new laws and government mandates. I’ve personally visited pain clinics where I felt treated like a criminal even though I wasn’t there for a narcotic prescription. I can't imagine what it would have been like if I had needed one.
Doctors are being pressured to taper chronic pain patients off opioid regimens that have been working for them for years. Most chronic pain patients use the drugs in order to function but are now treated with suspicion and judgement, even if they have been using the drugs for years with no problem. Many can't get their prescriptions filled at the pharmacy.
Some experts claim most of the harm from opioids are from the drugs being smuggled into the country from China and Mexico, but nearly all the government's solutions are based on limiting access to pain medication for people in pain. For more information:
https://www.theguardian.com/commentis...
https://www.thefix.com/other-side-opi...
http://nationalpainreport.com/enough-...
April 5, 2019
Dopesick is a semi-interesting book about the opioid epidemic in America. Ms. Macy follows many people and families over the course of 6 years and tells their stories in this book. I think I would have enjoyed it a lot more had the author narrowed it down to just a couple individuals and included more factual information on opioids and addiction. I felt the book was disjointed, due to there being so many different people written about, and the book jumps from one person to the next and back again. It just didn't flow, in my opinion. There wasn't much new in this for me that I haven't read in other recent books, and living in Appalachia, I'm well aware of the crisis. I see people just about everywhere I go who are in the throes of addiction. I did learn some about medication-assisted treatment, including Suboxone, that I didn't know before so this book was not a complete washout. People who enjoy human interest stories will no doubt like this more than I did. The author certainly did her research and writes with much insight and compassion. Not a bad read by any means, just not the best for me.
August 6, 2018
In 2012, author and investigative social journalist, Beth Macy began writing about the worst drug (heroin) epidemic in world history. “Dopesick: Dealers, Doctors, and The Drug Company That Addicted America” began in the hills and valleys of Appalachia, the mid-western rust belt, rural Maine before rapidly spreading throughout the U.S. In 2016, 64,000 Americans perished from drug related causes and overdoses-- outnumbering the total of those killed during the Viet Nam War. Macy explored the terrible destructive impact on society, those who have helped and harmed, and the brave individuals sharing their own stories of tragedy and loss, casting aside stigma and shame to alert and help others.
In the late 1990’s, Appalachian country doctor (St. Charles, Virginia) Art Van Zee M.D. was among the first to sound the urgent alarm how OxyContin had infiltrated his community and region. Patients were admitted to hospital ER’s in record numbers from drug related causes. Rates of infectious disease including Hepatitis C, along with petty and violent crime had increased substantially, a police car was fire-bombed—addicts were desperate for cash to support their drug habit, an elderly patient had resorted to selling pills from his nursing home bed. Van Zee called public meetings to advocate and alert others of the opioid health crisis, and didn’t hesitate to file complaints against Purdue Pharma for aggressive marketing campaigns promoting OxyContin. By 2001, he and Sister Beth Davies were attending two funerals per day of the addicted dead.
In 2007, with over $2.8 billion USD earned in drug profits, Purdue Pharmaceuticals was found guilty in federal and civil criminal courts for their role/responsibility for creating the opioid epidemic, for “misbranding OxyContin”: with aggressive marketing techniques that downplayed and minimized the potential for addiction. The $600 million USD fine was worth the risk for Purdue; the executives charged were forced to listen to victim impact statements, and were compared to Adolf Hitler and the mass destruction of humanity, yet these men served no jail time. Both Doctor Van Zee and Sister Davies were outraged that none of the fine was allocated for drug recovery and addiction programs. Instead, it was appropriated for Medicaid/Medicare reimbursement and for criminal justice and law enforcement.
Macy documents the vast suffering, heartbreak of the families, friends, medical staff and first responders, the foster parents, clergy left behind to carry on after destruction and death had taken its toll. The closed down factories, lumber mills, furniture manufacturing warehouses and stores, coal mines-- jobs that had once sustained the middle class were grim reminders that for the average American-- life would never be the same again. Some desperate families impacted by “the disease of despair” had lost life savings attempting to pay for costly drug rehabilitation programs for loved ones, only to realize addiction was a lifelong process and the likelihood of relapse might be a day away. Providers of rehab facilities were not in agreement over MAT (medication assisted treatment) though medical experts contend that MAT is absolutely necessary to battle the intense cravings of addiction and increase the rates of successful treatment.
Many of the stories were harsh and brutal. Too many politicians and policy makers believe addiction is a personal moral failing and criminal offense rather than a treatable disease that robs victims of their dignity and freedom of choice. Macy’s book easily compares to Sam Quiones outstanding award winning book “Dreamland: The True Tale of America’s Opiate Epidemic” (2015). Macy is the author of the bestselling “Factory Man” (2014) and “Truevine” (2016). ** With thanks and appreciation to Little Brown and Company via NetGalley for the DRC for the purpose of review.
In the late 1990’s, Appalachian country doctor (St. Charles, Virginia) Art Van Zee M.D. was among the first to sound the urgent alarm how OxyContin had infiltrated his community and region. Patients were admitted to hospital ER’s in record numbers from drug related causes. Rates of infectious disease including Hepatitis C, along with petty and violent crime had increased substantially, a police car was fire-bombed—addicts were desperate for cash to support their drug habit, an elderly patient had resorted to selling pills from his nursing home bed. Van Zee called public meetings to advocate and alert others of the opioid health crisis, and didn’t hesitate to file complaints against Purdue Pharma for aggressive marketing campaigns promoting OxyContin. By 2001, he and Sister Beth Davies were attending two funerals per day of the addicted dead.
In 2007, with over $2.8 billion USD earned in drug profits, Purdue Pharmaceuticals was found guilty in federal and civil criminal courts for their role/responsibility for creating the opioid epidemic, for “misbranding OxyContin”: with aggressive marketing techniques that downplayed and minimized the potential for addiction. The $600 million USD fine was worth the risk for Purdue; the executives charged were forced to listen to victim impact statements, and were compared to Adolf Hitler and the mass destruction of humanity, yet these men served no jail time. Both Doctor Van Zee and Sister Davies were outraged that none of the fine was allocated for drug recovery and addiction programs. Instead, it was appropriated for Medicaid/Medicare reimbursement and for criminal justice and law enforcement.
Macy documents the vast suffering, heartbreak of the families, friends, medical staff and first responders, the foster parents, clergy left behind to carry on after destruction and death had taken its toll. The closed down factories, lumber mills, furniture manufacturing warehouses and stores, coal mines-- jobs that had once sustained the middle class were grim reminders that for the average American-- life would never be the same again. Some desperate families impacted by “the disease of despair” had lost life savings attempting to pay for costly drug rehabilitation programs for loved ones, only to realize addiction was a lifelong process and the likelihood of relapse might be a day away. Providers of rehab facilities were not in agreement over MAT (medication assisted treatment) though medical experts contend that MAT is absolutely necessary to battle the intense cravings of addiction and increase the rates of successful treatment.
Many of the stories were harsh and brutal. Too many politicians and policy makers believe addiction is a personal moral failing and criminal offense rather than a treatable disease that robs victims of their dignity and freedom of choice. Macy’s book easily compares to Sam Quiones outstanding award winning book “Dreamland: The True Tale of America’s Opiate Epidemic” (2015). Macy is the author of the bestselling “Factory Man” (2014) and “Truevine” (2016). ** With thanks and appreciation to Little Brown and Company via NetGalley for the DRC for the purpose of review.
April 28, 2022
I found this an empathetic and informed take on the opioid crisis that took root in Central Appalachia. Beth Macy does a nice job of portraying the devastating effects of the opioid crisis both for people with substance use disorders and their loved ones. She discusses systems-level causes for the crisis too, such as corporate greed and a lack of accessible, government-funded interventions.
While I appreciate the attention this book gives to the hugely important and awful opioid epidemic, from a writing perspective I felt a little underwhelmed by Dopesick. Macy includes some information about the Sackler family’s opportunism which contributed to the opioid epidemic, stories about people who struggle/struggled with opioid use disorder, and a little space to discuss treatment. However, I didn’t feel that all these threads aligned in a cohesive way. I wanted more specific detail about the Sackler family and ways to address this crisis in a more navigable format, as well as more differentiation of the families Macy discussed.
Overall an okay intro to a serious problem in the United States. I intend to read more about this topic in the future.
While I appreciate the attention this book gives to the hugely important and awful opioid epidemic, from a writing perspective I felt a little underwhelmed by Dopesick. Macy includes some information about the Sackler family’s opportunism which contributed to the opioid epidemic, stories about people who struggle/struggled with opioid use disorder, and a little space to discuss treatment. However, I didn’t feel that all these threads aligned in a cohesive way. I wanted more specific detail about the Sackler family and ways to address this crisis in a more navigable format, as well as more differentiation of the families Macy discussed.
Overall an okay intro to a serious problem in the United States. I intend to read more about this topic in the future.
December 28, 2018
Heartbreaking, infuriating, incredibly well-researched.
This is an impeccably researched overview of the US-American opioid crisis, enriched by case studies of people affected. Macy manages to show both the immediate, private reach of this crisis and the overarching problems in the health system that led to it.
This is an impeccably researched overview of the US-American opioid crisis, enriched by case studies of people affected. Macy manages to show both the immediate, private reach of this crisis and the overarching problems in the health system that led to it.
May 12, 2020
"When a new drug sweeps the country, it historically starts in the big cities and gradually spreads to the hinterlands, as in the cases of cocaine and crack. But the opioid epidemic began in exactly the opposite manner, grabbing a toehold in isolated Appalachia, Midwestern rust belt counties, and rural Maine. Working-class families who were traditionally dependent on jobs in high-risk industries to pay their bills—coal mining in southwest Virginia, steel milling in western Pennsylvania, logging in Maine—weren’t just the first to experience the epidemic of drug overdose; they also happened to live in politically unimportant places, hollows and towns and fishing villages where the treatment options were likely to be hours from home.”
Macy opens the book with a deep dive into the history of heroin and morphine addiction, and how the drugs were reformulated over the decades into a prescription pill that has left an indelible mark on the US. A scathing indictment of Purdue Pharma follows: this the company that started with ear wax removal and shifted their focus to "pain mangement and OxyContin production in the 1990s.
Looking at the large events, Macy then "brings it home" to her corner of the world, the Interstate-81 corridor in and around Roanoke, Virginia. She creates the context of factory closings and mining towns shut down, depressed and impoverished people with little work and chronic pain, and the ripe soil when a "miracle drug" comes along, and then the desire for even more - heroin, fentanyl, etc.
Macy briefly touches on the science of addiction, and many others have done this. She chooses to focus on the faces (the largely young faces of teenagers and twentysomethings), the stories, and the rehabilitation efforts made by communities and small towns.
Impactful journalism.
Macy opens the book with a deep dive into the history of heroin and morphine addiction, and how the drugs were reformulated over the decades into a prescription pill that has left an indelible mark on the US. A scathing indictment of Purdue Pharma follows: this the company that started with ear wax removal and shifted their focus to "pain mangement and OxyContin production in the 1990s.
Looking at the large events, Macy then "brings it home" to her corner of the world, the Interstate-81 corridor in and around Roanoke, Virginia. She creates the context of factory closings and mining towns shut down, depressed and impoverished people with little work and chronic pain, and the ripe soil when a "miracle drug" comes along, and then the desire for even more - heroin, fentanyl, etc.
Macy briefly touches on the science of addiction, and many others have done this. She chooses to focus on the faces (the largely young faces of teenagers and twentysomethings), the stories, and the rehabilitation efforts made by communities and small towns.
Impactful journalism.
April 7, 2019
Reading this book is like a descent into the hell of addiction, the pharmaceutical companies that pushed drugs using doctored data, the doctors overdosing their patients, and the government that seems to pour money into trying to find a solution that doesn't seem to have one.
“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.”
“Opioids are now on pace to kill as many Americans in a decade as HIV/AIDS has since it began, with leveling-off projections tenuously predicted in a nebulous, far-off future: sometime after 2020.”
It's a pretty sobering experience to read this book that presents where we were, where we have come from, and where we are now in the struggle to handle the opioid crisis that is sweeping this nation. Who do we blame for allowing our children, our brothers, sisters, parents, and family members who have succumbed to this crisis? As in everything there is enough blame to go around starting with the Purdue Pharmaceutical Company who falsified findings pushing painkillers onto an unaware public for profit. (Purdue Pharma L.P. is a privately held pharmaceutical company owned principally by parties and descendants of Mortimer and Raymond Sackler. In 2007, it paid out one of the largest fines ever levied against a pharmaceutical firm for mislabeling its product OxyContin, and three executives were found guilty of criminal charges.")
However, try to sue a drug manufacturer and this will probably happen. "Unfortunately, pursuing compensation from pharmaceutical companies became a lot more difficult in 2013, when the U.S. Supreme Court ruled that companies making generic medications can’t be held liable under state “failure to warn” laws." Then perhaps what about the FDA? Aren't they suppose to guard Americans against dangerous drugs? Guess again because "Government agencies, including the FDA, are protected by sovereign immunity. Sovereign immunity is a legal rule that prevents the government or its subdivisions, departments, and agencies from being sued without its permission." What about the doctors who pushed these pills? Are they too culpable for enjoying lifestyles given to them by the drug makers for their ability to over prescribe and push medications onto an unknowing public?
How did this all happen? As in all things the answer is money. Meanwhile people are dying, people are becoming addicted, lives are lost, ruined, and the monetary toll that addiction takes on families, the economy, the moral fiber of a nation is counted daily in ERs across our nation, in homes, and in dark and dismal alleyways and flop houses. Is there something anything that can be done? How do we combat this when one pill, one injection can make a person a captive to a drug?
The author did exhaustive research on what works and what has been proven to be futile in the efforts to stem drug abuse. Imprisoning offenders, residential drug treatment centers that push abstinence, tough love, and other approaches seem destine to failure. The outlook is bleak and if one doesn't have the money to enter treatment programs, there is not much to be done. Send them home with a shot of narcan so that when they overdose at least this time they won't die. The drain on a family, on a community, on a nation as a result of this epidemic is not able to be measured. Is there an answer? There is no one size fits all answer. Addicts can and will relapse. Then there are those who so need these medications. Those who have chronic pain throughout their life and need the relief that pain medications can offer, that day free of pain, that night able to sleep. They, too seem to be caught up in the net of the opioid crisis. Where does personal responsibility come into play?
“The latest research on substance use disorder from Harvard Medical School shows it takes the typical opioid-addicted user eight years—and four to five treatment attempts—to achieve remission for just a single year. And yet only about 10 percent of the addicted population manages to get access to care and treatment for a disease that has roughly the same incidence rate as diabetes.”
When you arrest one dealer, four others crop up in their place says the author. Can we possibly win this war?
This book is a chilling look into a crisis that is sweeping our nation. “Americans, representing 4.4 percent of the world’s population, consume roughly 30 percent of its opioids.”
As a tragic aside... Five of the students I previously taught, have died due to overdosing on drugs. When does this tragedy end?
“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.”
“Opioids are now on pace to kill as many Americans in a decade as HIV/AIDS has since it began, with leveling-off projections tenuously predicted in a nebulous, far-off future: sometime after 2020.”
It's a pretty sobering experience to read this book that presents where we were, where we have come from, and where we are now in the struggle to handle the opioid crisis that is sweeping this nation. Who do we blame for allowing our children, our brothers, sisters, parents, and family members who have succumbed to this crisis? As in everything there is enough blame to go around starting with the Purdue Pharmaceutical Company who falsified findings pushing painkillers onto an unaware public for profit. (Purdue Pharma L.P. is a privately held pharmaceutical company owned principally by parties and descendants of Mortimer and Raymond Sackler. In 2007, it paid out one of the largest fines ever levied against a pharmaceutical firm for mislabeling its product OxyContin, and three executives were found guilty of criminal charges.")
However, try to sue a drug manufacturer and this will probably happen. "Unfortunately, pursuing compensation from pharmaceutical companies became a lot more difficult in 2013, when the U.S. Supreme Court ruled that companies making generic medications can’t be held liable under state “failure to warn” laws." Then perhaps what about the FDA? Aren't they suppose to guard Americans against dangerous drugs? Guess again because "Government agencies, including the FDA, are protected by sovereign immunity. Sovereign immunity is a legal rule that prevents the government or its subdivisions, departments, and agencies from being sued without its permission." What about the doctors who pushed these pills? Are they too culpable for enjoying lifestyles given to them by the drug makers for their ability to over prescribe and push medications onto an unknowing public?
How did this all happen? As in all things the answer is money. Meanwhile people are dying, people are becoming addicted, lives are lost, ruined, and the monetary toll that addiction takes on families, the economy, the moral fiber of a nation is counted daily in ERs across our nation, in homes, and in dark and dismal alleyways and flop houses. Is there something anything that can be done? How do we combat this when one pill, one injection can make a person a captive to a drug?
The author did exhaustive research on what works and what has been proven to be futile in the efforts to stem drug abuse. Imprisoning offenders, residential drug treatment centers that push abstinence, tough love, and other approaches seem destine to failure. The outlook is bleak and if one doesn't have the money to enter treatment programs, there is not much to be done. Send them home with a shot of narcan so that when they overdose at least this time they won't die. The drain on a family, on a community, on a nation as a result of this epidemic is not able to be measured. Is there an answer? There is no one size fits all answer. Addicts can and will relapse. Then there are those who so need these medications. Those who have chronic pain throughout their life and need the relief that pain medications can offer, that day free of pain, that night able to sleep. They, too seem to be caught up in the net of the opioid crisis. Where does personal responsibility come into play?
“The latest research on substance use disorder from Harvard Medical School shows it takes the typical opioid-addicted user eight years—and four to five treatment attempts—to achieve remission for just a single year. And yet only about 10 percent of the addicted population manages to get access to care and treatment for a disease that has roughly the same incidence rate as diabetes.”
When you arrest one dealer, four others crop up in their place says the author. Can we possibly win this war?
This book is a chilling look into a crisis that is sweeping our nation. “Americans, representing 4.4 percent of the world’s population, consume roughly 30 percent of its opioids.”
As a tragic aside... Five of the students I previously taught, have died due to overdosing on drugs. When does this tragedy end?
August 31, 2018
"But you can't put a corporation in jail; you just take their money, and it's not really their money anyway. The corporation feels no pain."Beth Macy has made a name for herself with her award-winning research and journalism, and she put her skills to good use in covering America's opioid crisis from past to present. Dopesick: Dealers, Doctors, and the Drug Company that Addicted America discusses all the warnings history has left for us concerning the addictive qualities of opiates, referencing opium, laudanum and morphine in the nineteenth century leading up to modern-day prescription drugs such as Vicodin, Percocet and Lortab. But OxyContin was supposed to fix all that. Reportedly, it was designed to discourage abuse and addiction with its time-release quality. Allegedly, big pharma took their new wonder drug and pushed it like you've never seen. This is the part of the book where Macy excels. Where did the pharmaceutical companies market OxyContin? What did they do to encourage mass prescriptions for large quantities of their drug? How did they even get it approved with safety claims? I'd like to say you'll be surprised but if you're like me you probably won't be. I believe every word.
A well-rounded piece of nonfiction, Dopesick is filled with corporate greed, criminal prosecution, science: pharmacokinetics, challenges of recovery, the segue to heroine, the noteworthy timing of media coverage/public intervention, and in-depth interviews with and about the users who have ridden this nasty roller coaster.
Dopesick is a must read for anyone who has been impacted by the opioid crisis in some way, which is pretty much every tax payer in America. If you know someone who is recovering (or not) from opiates/opioids, this book may also help you understand why the process seems insurmountable. Now we need to see this kind of victim-sensitive coverage on cocaine/crack cocaine.
Quote:
“What happens is, it takes about eight years on average, after people start treatment, to get one year of sobriety...and four to five different episodes of treatment for that sobriety to stick. And many people simply don't have eight years.”
Note: If interested in learning what being "dope sick" entails, I found some information on this recovery website.
June 15, 2019
A few weeks ago, a beloved member of my community—husband, father, celebrated musician—was found in his car in the hospital parking lot, unconscious. He'd been driven there by a drug dealer and abandoned after two attempts to revive him with Narcan failed. ER intervention was too late, as well. He was pronounced dead soon after he was admitted. Forty-three, dead of an overdose. The autopsy would reveal habitual opioid use.
Just one more casualty in the crisis that Beth Macy chronicles with astonishing depth and power in Dopesick: Dealers, Doctors, and the Drug Company that Addicted America. The Center for Disease Control released a study several months after the publication of Macy's book that showed a record 72,000 Americans died of drug overdoses in 2017, more than HIV at its peak, more than car crashes or gun violence. Corresponding to Macy's research and the humanity she reveals behind the statistics, what began as a deliberate scheme by prescription drug manufacturers to hook and debilitate people seeking relief from temporary or chronic pain became a road to abuse of cheaper and more accessible heroin, and is now a war against the manufacture and distribution of synthetic opioids (fentanyls). The numbers are staggering.
Dopesick, centered in Appalachia where the opioid crisis began in the late 1990s with the release of OxyContin and where it remains the most virulent, delves deep into the circumstances of opioid abuse and addiction through intimate portraits of the victims, their families, the dealers, cops, and health care providers and activists. She explores every angle, revealing the blatant corruption of Big Pharma and the sickening failure of U.S. regulatory bodies to recognize and respond to criminal behaviors. By the time three sacrificial executives of Purdue Pharma were convicted and fined in 2007, legions of addicts had been created. When pharma recalibrated its meds to make them more addiction-resistant, it was too late. The addicts had turned to heroin. And then synthetics hit the market—more potent and all the more deadly.
There are glimmers of hope in escaping this cycle: extensive research bears out medically-assisted treatment (MAT) as a means to combat addiction; states are responding aggressively without waiting for the Federal government—which continues to thwart access to healthcare; a public health campaign that's addressing the stigma of addiction and decriminalizing user behavior, directing energy and resources to treatment, not incarceration.
In my community, the wagons quickly circled and the denials of a problem were vehement. I wondered how many in that crowd of mourners at the memorial service were one bad hit away from the same fate, how many were in need of the support and intervention that might have saved the one whose death came as such a shock to so many. I can only hope that those who loved him turn their grief into action to save the next vulnerable life.
What remains unresolved for me is our dependency on medication to solve our emotional, mental health and physical problems, and our complete trust in the medical system and Big Pharma to have our best interests at heart. Dopesick makes this point time and again, but even the public shaming of the Sackler family and the lawsuits against pharmaceutical manufacturers, which roll through every day in the headlines now, don't seem to sway average America from reconsidering what's in their medicine cabinet. From Adderall to Ambien, we are hooked.
Just one more casualty in the crisis that Beth Macy chronicles with astonishing depth and power in Dopesick: Dealers, Doctors, and the Drug Company that Addicted America. The Center for Disease Control released a study several months after the publication of Macy's book that showed a record 72,000 Americans died of drug overdoses in 2017, more than HIV at its peak, more than car crashes or gun violence. Corresponding to Macy's research and the humanity she reveals behind the statistics, what began as a deliberate scheme by prescription drug manufacturers to hook and debilitate people seeking relief from temporary or chronic pain became a road to abuse of cheaper and more accessible heroin, and is now a war against the manufacture and distribution of synthetic opioids (fentanyls). The numbers are staggering.
Dopesick, centered in Appalachia where the opioid crisis began in the late 1990s with the release of OxyContin and where it remains the most virulent, delves deep into the circumstances of opioid abuse and addiction through intimate portraits of the victims, their families, the dealers, cops, and health care providers and activists. She explores every angle, revealing the blatant corruption of Big Pharma and the sickening failure of U.S. regulatory bodies to recognize and respond to criminal behaviors. By the time three sacrificial executives of Purdue Pharma were convicted and fined in 2007, legions of addicts had been created. When pharma recalibrated its meds to make them more addiction-resistant, it was too late. The addicts had turned to heroin. And then synthetics hit the market—more potent and all the more deadly.
There are glimmers of hope in escaping this cycle: extensive research bears out medically-assisted treatment (MAT) as a means to combat addiction; states are responding aggressively without waiting for the Federal government—which continues to thwart access to healthcare; a public health campaign that's addressing the stigma of addiction and decriminalizing user behavior, directing energy and resources to treatment, not incarceration.
In my community, the wagons quickly circled and the denials of a problem were vehement. I wondered how many in that crowd of mourners at the memorial service were one bad hit away from the same fate, how many were in need of the support and intervention that might have saved the one whose death came as such a shock to so many. I can only hope that those who loved him turn their grief into action to save the next vulnerable life.
What remains unresolved for me is our dependency on medication to solve our emotional, mental health and physical problems, and our complete trust in the medical system and Big Pharma to have our best interests at heart. Dopesick makes this point time and again, but even the public shaming of the Sackler family and the lawsuits against pharmaceutical manufacturers, which roll through every day in the headlines now, don't seem to sway average America from reconsidering what's in their medicine cabinet. From Adderall to Ambien, we are hooked.
October 19, 2018
Compelling, informative, compassionate, and harrowing. Dopesick is a comprehensive account of America's opioid crisis that has plagued disparate rural areas throughout the country, though Beth Macy mainly narrows down her research to her local Appalachia. She pieces together interviews with doctors, advocates, addicts, and individuals who have lost family members to the drug, to weave some kind of narrative out of the onslaught of factors which have contributed to the epidemic.
While the reality of the opioid crisis was not lost on me before this (a friend of mine from high school died of an overdose about a year ago, which spurred my interest in this subject in the first place), Dopesick fills in the disturbing details. How Purdue Pharma saturated the market with Oxycontin in the 90s and continuously shifted blame from the addictive nature of the drug to the addicts themselves; how doctors have been made to prescribe these highly addictive painkillers at the drop of a hat (mainly to white patients, due to racial stereotyping that they are less likely to get addicted, which is why the opioid epidemic has hit white communities the hardest); how the government has essentially turned a blind eye and continues to deny adequate funding to address this issue; how MAT (medication-assisted treatment) has been stigmatized to the extent that many rehab programs require patients to be clean before checking in; and how feeling 'dopesick' is so miserable that addicts will do anything to quell the incredibly painful withdrawal symptoms.
Beth Macy fuses thorough research with unfailingly compassionate anecdotes shared with her by mothers who have lost children to the drug. Their individual stories litter Macy's larger narrative, most of them following the exact same trajectory: being prescribed oxycodone for a minor injury, developing a dependency, being cut off from their supply, turning to illegal means of obtaining the drug, trying to get clean, failing to get clean, overdosing. There's one statistic that Macy repeats a few times throughout this book that stayed with me - on average it takes an addicted person eight years of recovery before they've gone a full year without relapsing. That is how impossible it is to quit this drug.
Since this crisis isn't going anywhere any time soon, between a lack of funding, the refusal to acknowledge MAT as a legitimate rehabilitation technique, and incarceration of drug users and dealers as the primary tool being used by the government as a band-aid solution, Dopesick is well worth reading as a starting point, for anyone wondering how this crisis has reached such a critical state with so little government intervention.
While the reality of the opioid crisis was not lost on me before this (a friend of mine from high school died of an overdose about a year ago, which spurred my interest in this subject in the first place), Dopesick fills in the disturbing details. How Purdue Pharma saturated the market with Oxycontin in the 90s and continuously shifted blame from the addictive nature of the drug to the addicts themselves; how doctors have been made to prescribe these highly addictive painkillers at the drop of a hat (mainly to white patients, due to racial stereotyping that they are less likely to get addicted, which is why the opioid epidemic has hit white communities the hardest); how the government has essentially turned a blind eye and continues to deny adequate funding to address this issue; how MAT (medication-assisted treatment) has been stigmatized to the extent that many rehab programs require patients to be clean before checking in; and how feeling 'dopesick' is so miserable that addicts will do anything to quell the incredibly painful withdrawal symptoms.
Beth Macy fuses thorough research with unfailingly compassionate anecdotes shared with her by mothers who have lost children to the drug. Their individual stories litter Macy's larger narrative, most of them following the exact same trajectory: being prescribed oxycodone for a minor injury, developing a dependency, being cut off from their supply, turning to illegal means of obtaining the drug, trying to get clean, failing to get clean, overdosing. There's one statistic that Macy repeats a few times throughout this book that stayed with me - on average it takes an addicted person eight years of recovery before they've gone a full year without relapsing. That is how impossible it is to quit this drug.
Since this crisis isn't going anywhere any time soon, between a lack of funding, the refusal to acknowledge MAT as a legitimate rehabilitation technique, and incarceration of drug users and dealers as the primary tool being used by the government as a band-aid solution, Dopesick is well worth reading as a starting point, for anyone wondering how this crisis has reached such a critical state with so little government intervention.
January 28, 2019
Disheartening deep dive into the opioid crisis in America, from its inception twenty years ago via OxyContin prescriptions to today’s desperate consumption of heroin and synthetic opioids. Big Pharma and corporate greed play a huge role, as does public policy. Still, history is interesting and informative, but what is needed are solutions. I’m wondering if there are any, given that there is actually no “cure” for opioid addiction - it is a chronic lifelong condition that can be treated and managed only. The addiction changes the psychology and the neural circuits of the brains of individuals who are addicted. Treatment and management is expensive, time consuming and unlikely to work without medication assisted treatment (MAT) using methadone, buprenorphine or naltrexone. Access to treatment programs that use MAT is extremely limited. And so it goes....and grows, with no real end in sight. The drugs become stronger and more dangerous, the addicts more desperate, the safety nets more shredded and scarce.
The author weaves in many personal stories of people impacted by this epidemic - addicts and their families, law enforcement, doctors and social workers - as well as lots of historical information, statistics and pages of footnotes. Very interesting but a bit of a choppy reading experience. Because public policy plays a big role in the management of this epidemic, there is a definite political slant to this book, so beware if that is an irritant.
As I sit here writing this review, there is actually a television ad for Treatment Centers of America running right now. Such bitter irony. At least they offer MAT....if you are lucky enough to live near one of their seven outpatient centers in Georgia and Florida.
The author weaves in many personal stories of people impacted by this epidemic - addicts and their families, law enforcement, doctors and social workers - as well as lots of historical information, statistics and pages of footnotes. Very interesting but a bit of a choppy reading experience. Because public policy plays a big role in the management of this epidemic, there is a definite political slant to this book, so beware if that is an irritant.
As I sit here writing this review, there is actually a television ad for Treatment Centers of America running right now. Such bitter irony. At least they offer MAT....if you are lucky enough to live near one of their seven outpatient centers in Georgia and Florida.
February 27, 2019
This book is about the opioid crisis. It’s an extremely well-researched, comprehensive look at how it started, how it spread, and some of the lives it has affected/ destroyed/devastated. Another story about hardworking Americans being led to their demise by a greedy American corporation (that flat out did not care about the havoc it was unleashing), in this case Purdue Pharma. The facts within are devastatingly sad and often inconceivable. I need a few more days to put some quotes down, but I’m not sure I can review this well. I literally do not have the DNA to understand how people (in medicine, no less) can knowingly do this to unsuspecting people. It is unconscionable. It is criminal. It is a national crisis. I have more to say...hold, please*.
*Through what I’m sure is 100% my error, I cannot for the life of me find the audiobook in which I bookmarked many important statistics. I will continue to look, but in the meantime I remember three points that shocked me, all of which are paraphrased:
1. OxyContin was just introduced in 1996 and just twenty three years later, overdose is the leading cause of death in Americans over 50.
2. The average addict takes 8 years to achieve a single year of sobriety.
3. There was staggeringly horrid statistic about a pharmacy in a town of under 400 people writing thousands of prescriptions in a year. How is this allowed to happen?
This book opened my eyes and broke my heart.
So did: If You Love Me: A Mother's Journey Through Her Daughter's Opioid Addiction. Reading both books paints a vivid picture of the devastating personal toll opioid addiction takes on families and its victims, combined with the evidence that Purdue Pharma knowingly unleashed a monster for massive financial gain at the cost of American families. 5 stars
*Through what I’m sure is 100% my error, I cannot for the life of me find the audiobook in which I bookmarked many important statistics. I will continue to look, but in the meantime I remember three points that shocked me, all of which are paraphrased:
1. OxyContin was just introduced in 1996 and just twenty three years later, overdose is the leading cause of death in Americans over 50.
2. The average addict takes 8 years to achieve a single year of sobriety.
3. There was staggeringly horrid statistic about a pharmacy in a town of under 400 people writing thousands of prescriptions in a year. How is this allowed to happen?
This book opened my eyes and broke my heart.
So did: If You Love Me: A Mother's Journey Through Her Daughter's Opioid Addiction. Reading both books paints a vivid picture of the devastating personal toll opioid addiction takes on families and its victims, combined with the evidence that Purdue Pharma knowingly unleashed a monster for massive financial gain at the cost of American families. 5 stars
December 27, 2018
Dopesick is a very informative and well-written book about the opioid epidemic. Unfortunately, I listened to the audiobook, and I really hate to whine about this, but the author narrates it, and her voice reminded me so much of that of Sarah Huckabee Sanders. This isn't anyone's fault, of course, but I do wonder whether a different performer might have brought more life to the narration. That being said, the author tells an important series of stories and does so in a compassionate way I fund compelling. I learned a lot, and finished the book feeling rather depressed about the state of things in this country, so to cheer myself up I'll read a murder mystery next;-) In all seriousness, though, I was deeply moved and disturbed by the story this book tells and it opened my eyes to a terrible reality with which so many people live and are unable to escape.
Find more reviews and bookish fun at http://www.princessandpen.com
Find more reviews and bookish fun at http://www.princessandpen.com
February 20, 2022
This book really tells the story of Opioid addiction in America. It tells the facts not a story as the mini series did. Must better information about Opioid Crisis. It is a crisis! Sadly, it isn’t getting better.
December 27, 2018
Dopesick was very well done and thought provoking. But it took me a long time to listen to the audio because it felt like I could only listen to so much bleak information about the opioid crisis at any given time. Beth Macy looks at opioid addiction from many perspectives, including its causes and the failing efforts to implement a solution that works. But what makes this one especially difficult and compelling are the stories of individual addicts and their families. Macy got very close to several of her subjects. This made for a powerful, and sometimes almost unbearable, listening experience.
Recommended and important, but brace yourself for the experience.
Recommended and important, but brace yourself for the experience.
September 4, 2018
3.5 Stars - 4 for the importance of the subject matter, 3 for the quality of the writing. I felt like there were just too many players to keep track of in the narrative. Someone introduced on page 30 by their full name is going to be unforgettable when introduced by their first name after there have been 40 or so other people introduced during the ensuing pages. Such fragmented storytelling proved to be frustrating to this reader. Nevertheless, an important book about a problem that will not soon go away.
October 27, 2022
In Dopesick, Beth Macy addresses the exponentially increasing issue of opioid addiction. Drug overdose has taken 300,000 Americans over the past 15 years and experts predict that 300k more will die in the next five years.
It is now the leading cause of death for Americans under age 50. It kills more people than guns or car accidents and at a rate higher than the HIV epidemic at its peak.
Macy shares the story of carfentanyl being distributed in a small rural Appalachian town that resulted in 26 deaths in one day. Carfentanyl is used as an elephant tranquilizer and should not be used on humans. It is 100 times more potent than fentanyil and 10,000 times more potent than morphine.
Opioid addiction started in small rural towns rather than in big cities which is the inverse of what has happened with drug addiction in the past. Macy shares poignant stories of addicted teenagers and adults and the impact it has on their families, loved ones and friends. Teenagers and young adults attend "pharming/farming" parties where various pills are passed around. In many instances, when someone has overdosed, rather than call 911, friends disappear and don't want to be around when medical personnel and police arrive on the scene.
It is an addiction that cuts across race, gender, and socio-economic class. Many families are ashamed to talk about it until the need for survival trumps shame. Drug addiction is a disease of despair.
Macy also shares the statistics about young children, as young as two years old, being put on Ritalin or Adderall. Starting children on meds early on can lead to a perspective that pills aren't dangerous.
Very sobering overview that highlights the need for collaborative solutions across healthcare, mental health, schools, police, judges, prisons, and rehab facilities.
It is now the leading cause of death for Americans under age 50. It kills more people than guns or car accidents and at a rate higher than the HIV epidemic at its peak.
Macy shares the story of carfentanyl being distributed in a small rural Appalachian town that resulted in 26 deaths in one day. Carfentanyl is used as an elephant tranquilizer and should not be used on humans. It is 100 times more potent than fentanyil and 10,000 times more potent than morphine.
Opioid addiction started in small rural towns rather than in big cities which is the inverse of what has happened with drug addiction in the past. Macy shares poignant stories of addicted teenagers and adults and the impact it has on their families, loved ones and friends. Teenagers and young adults attend "pharming/farming" parties where various pills are passed around. In many instances, when someone has overdosed, rather than call 911, friends disappear and don't want to be around when medical personnel and police arrive on the scene.
It is an addiction that cuts across race, gender, and socio-economic class. Many families are ashamed to talk about it until the need for survival trumps shame. Drug addiction is a disease of despair.
Macy also shares the statistics about young children, as young as two years old, being put on Ritalin or Adderall. Starting children on meds early on can lead to a perspective that pills aren't dangerous.
Very sobering overview that highlights the need for collaborative solutions across healthcare, mental health, schools, police, judges, prisons, and rehab facilities.
December 2, 2019
Find all of my reviews at: http://52bookminimum.blogspot.com/
The fact that this one didn’t even make it to my “Currently Reading” list probably says everything that needs to be said about how much I enjoyed it. I picked this up during Nonfiction November as a challenge to myself to break away from my usual “nonfiction” selections which generally take form as comedic memoirs. I knew Dopesick had won a bunch of awards and I will admit I was hoping for a reading experience like I had with Evicted. Unfortunately, that didn’t happen. What I got instead was the Lifetime Television forWomen Mothers version of the opioid epidemic which centered around the addiction and/or death that they discussed regarding their children (one who only took ONE PILL and it killed him because – yeah, that sounds legit). While the history of Oxy was barfed out like a high-school term paper and there was a dealer or two thrown in for good measure, they were but blips on the radar. Nope - Dopesick wants to pull on the heartstrings and sadly for it . . . . .
The fact that this one didn’t even make it to my “Currently Reading” list probably says everything that needs to be said about how much I enjoyed it. I picked this up during Nonfiction November as a challenge to myself to break away from my usual “nonfiction” selections which generally take form as comedic memoirs. I knew Dopesick had won a bunch of awards and I will admit I was hoping for a reading experience like I had with Evicted. Unfortunately, that didn’t happen. What I got instead was the Lifetime Television for
May 8, 2020
As author Beth Macy states, most of us know someone who has been affected by the opioid epidemic. For me, it is a nurse former co-worker, whose son died from a methadone overdose. And then there was my nurse friend, who lost her nursing license because she became addicted and started diverting patient medications. And also my brother-in-law’s brother, who went to prison because he was selling “pills.”
During the early to mid-eighties, I worked as a Licensed Practical Nurse and my job on a surgical unit at our local hospital was ‘pill-pusher’ and ‘shot-giver.’ If you had just had a surgical procedure, I was your favorite person. Loaded up with a syringe full of your favorite pain relieving narcotic, I administered relief. This seemed reasonable then and still does to me, in service of eradicating acute pain. Although the opioid epidemic that Macy writes about didn’t come into being until 1995, when Oxycontin was marketed, addiction to pharmaceuticals was occurring even back then, in the 1980s. However it was nothing like the scale that occurred when Oxycontin came on the scene. A pill that would give pain relief over 12 hours, it was heavily marketed, and because it was slow release, the claim was made that this would hamper drug abusers from achieving a drug high. This was not the case. It was also marketed as having an addiction rate of “less than 1 percent.” The truth was that it was highly addictive, as are all opioids. When a patient was released from the hospital with a thirty day supply of prescription oxycontin, now we have a problem. It was a problem that would grow by leaps and bounds and as Macy, points out, the crisis began in the rural Appalachian area where people were suffering the loss of manufacturing and textile jobs. Some sought relief from socio-economic distress by taking pills; others just needed to make money, and often that money was to support their drug habit.
I learned so much from reading Macy’s book. I had an internalized prejudice against medication-assisted treatment (MAT) which uses drugs like Methadone and its successor, Suboxone, to “stave off dopesickness, reduce cravings, and, if prescribed appropriately and used correctly, doesn’t get you high.” Now, I understand that this type of treatment is essential. Macy takes the reader into the lives of addicts, many of them young, and the lives of their parents. What a struggle! To get addicts to agree to treatment, find the funds to pay for it, find a place that will accept them, and have all this come together while the addict is still in the frame of mind to go. The fear of getting dopesick can change the mind of an addict in the blink of an eye. MAT has a much better success rate than abstinence treatment.
There is so much heart in this book. At first, I felt a little confused because quite a few people are introduced at the beginning and I had difficulty keeping them straight. But soon, I was in deep enough to care about the young people who lost their lives to opioid overdose, some of them before their parents even knew they had a problem. Macy talks about harm reduction strategies like needle exchange sites and injection sites, which do not offer drugs, but have medical people there for supervision. The principles of harm reduction “work to minimize the harmful effect of drugs rather than simply ignore or condemn them.” (1). Addiction can happen to anyone; to someone you know and love, or to me and you. Macy helps to break the stigma that engulfs the addicted. She helps the reader understand why the war on drugs hasn’t worked and how community and compassion can provide a way forward. An important book and highly relevant for our times.
https://harmreduction.org/about-us/pr...
During the early to mid-eighties, I worked as a Licensed Practical Nurse and my job on a surgical unit at our local hospital was ‘pill-pusher’ and ‘shot-giver.’ If you had just had a surgical procedure, I was your favorite person. Loaded up with a syringe full of your favorite pain relieving narcotic, I administered relief. This seemed reasonable then and still does to me, in service of eradicating acute pain. Although the opioid epidemic that Macy writes about didn’t come into being until 1995, when Oxycontin was marketed, addiction to pharmaceuticals was occurring even back then, in the 1980s. However it was nothing like the scale that occurred when Oxycontin came on the scene. A pill that would give pain relief over 12 hours, it was heavily marketed, and because it was slow release, the claim was made that this would hamper drug abusers from achieving a drug high. This was not the case. It was also marketed as having an addiction rate of “less than 1 percent.” The truth was that it was highly addictive, as are all opioids. When a patient was released from the hospital with a thirty day supply of prescription oxycontin, now we have a problem. It was a problem that would grow by leaps and bounds and as Macy, points out, the crisis began in the rural Appalachian area where people were suffering the loss of manufacturing and textile jobs. Some sought relief from socio-economic distress by taking pills; others just needed to make money, and often that money was to support their drug habit.
I learned so much from reading Macy’s book. I had an internalized prejudice against medication-assisted treatment (MAT) which uses drugs like Methadone and its successor, Suboxone, to “stave off dopesickness, reduce cravings, and, if prescribed appropriately and used correctly, doesn’t get you high.” Now, I understand that this type of treatment is essential. Macy takes the reader into the lives of addicts, many of them young, and the lives of their parents. What a struggle! To get addicts to agree to treatment, find the funds to pay for it, find a place that will accept them, and have all this come together while the addict is still in the frame of mind to go. The fear of getting dopesick can change the mind of an addict in the blink of an eye. MAT has a much better success rate than abstinence treatment.
There is so much heart in this book. At first, I felt a little confused because quite a few people are introduced at the beginning and I had difficulty keeping them straight. But soon, I was in deep enough to care about the young people who lost their lives to opioid overdose, some of them before their parents even knew they had a problem. Macy talks about harm reduction strategies like needle exchange sites and injection sites, which do not offer drugs, but have medical people there for supervision. The principles of harm reduction “work to minimize the harmful effect of drugs rather than simply ignore or condemn them.” (1). Addiction can happen to anyone; to someone you know and love, or to me and you. Macy helps to break the stigma that engulfs the addicted. She helps the reader understand why the war on drugs hasn’t worked and how community and compassion can provide a way forward. An important book and highly relevant for our times.
https://harmreduction.org/about-us/pr...
March 10, 2022
Let's start off with this: the book gets a 3 because the first half was entertaining to read. However it is not at all what I had hoped it would be.
As someone who works in the harm reduction space for injecting drug use and blood borne viruses I have a lot to critique Macy on. Firstly, the language she uses to describe people who have drug dependence is appalling and so outdated. This book was published in 2018 so she has no excuse. She uses terms like "junkie", "addict", "abusers", "clean","full blown heroin junkie", "battered womens shelter" and so on. For someone whose aim was to get the reader to feel empathy and understanding, she did neither. She wanted to destigmatise people who use drugs but does the complete opposite by using stigmatising and discriminatory language. Macy only focuses on white America and there is casual racism more than once in this book. I was so let down. She instead goes for shock value, demonizing drug users instead of the drugs themselves. There were so many opportunities and case studies in this book to debunk stereotypes but she doesn't, I find it so irresponsible.
From reading others reviews on this book I also agree that I was left unsatisfied with the little time she spent on the Pharmaceutical company Purdue who made and marketed Oxycontin. What she did write though was fascinating,amount prescription coupons, free trips offered for doctors etc. I was happy she spent some time talking about different types of opioid substitution therapy and how abstinence based treatment doesn't work.
I thought the court case chapters were boring and hard to follow, at times she is a lackluster writer.
Interesting points:
- A non user's (she uses addicted) perception of the future is about 4.7 years whereas someone who uses drugs is about 9 days
- Americans 4.4% of the worlds population, consume about 30 % of the world opioids
- The OxyContin epidemic became a heroin epidemic, which lead to increased deaths in HIV and Hepatitis C
- I liked the way she wrote this, " denying opioid dependent people their medicine OST that they have been legitimately prescribed is akin to denying diabetics their insulin on the grounds they're fat, (most rehabs in America do not do OST)
My overall thoughts are that at times its interesting but I can't recommend it due to how problematic it is. I think going down a googling rabbit hole of Purdue Pharma and OxyContin might be better.
As someone who works in the harm reduction space for injecting drug use and blood borne viruses I have a lot to critique Macy on. Firstly, the language she uses to describe people who have drug dependence is appalling and so outdated. This book was published in 2018 so she has no excuse. She uses terms like "junkie", "addict", "abusers", "clean","full blown heroin junkie", "battered womens shelter" and so on. For someone whose aim was to get the reader to feel empathy and understanding, she did neither. She wanted to destigmatise people who use drugs but does the complete opposite by using stigmatising and discriminatory language. Macy only focuses on white America and there is casual racism more than once in this book. I was so let down. She instead goes for shock value, demonizing drug users instead of the drugs themselves. There were so many opportunities and case studies in this book to debunk stereotypes but she doesn't, I find it so irresponsible.
From reading others reviews on this book I also agree that I was left unsatisfied with the little time she spent on the Pharmaceutical company Purdue who made and marketed Oxycontin. What she did write though was fascinating,amount prescription coupons, free trips offered for doctors etc. I was happy she spent some time talking about different types of opioid substitution therapy and how abstinence based treatment doesn't work.
I thought the court case chapters were boring and hard to follow, at times she is a lackluster writer.
Interesting points:
- A non user's (she uses addicted) perception of the future is about 4.7 years whereas someone who uses drugs is about 9 days
- Americans 4.4% of the worlds population, consume about 30 % of the world opioids
- The OxyContin epidemic became a heroin epidemic, which lead to increased deaths in HIV and Hepatitis C
- I liked the way she wrote this, " denying opioid dependent people their medicine OST that they have been legitimately prescribed is akin to denying diabetics their insulin on the grounds they're fat, (most rehabs in America do not do OST)
My overall thoughts are that at times its interesting but I can't recommend it due to how problematic it is. I think going down a googling rabbit hole of Purdue Pharma and OxyContin might be better.
July 26, 2020
This book was equal parts devastating and infuriating. Beth Macy has written a meticulous account of the opioid crisis our country has faced over the past two decades. Mostly localized to her native Virginia, Macy uses her investigative skills to trace back this epidemic to its roots and follow it to its inevitable, disastrous end. The casualties, measured in both deaths and lives completely shattered, are almost too large to comprehend. So while relaying important facts and statistics about addiction and overdose, the author weaves in human stories of real people who have struggled and who are still struggling currently in order to give us something more to grasp on to than cold numbers.
Though it may be presented as something more academic or anthropological, what Dopesick is over anything else is a call to action. It’s a call for the pharmaceutical companies and their overseers who over-produce and supply these drugs to the general public. It’s a call to doctors in small towns who are overprescribing and letting themselves be influenced by the sales reps who are pretty brazenly offering bribes. It’s a call for police and other law enforcement to change the way they pursue and classify addicts as criminals first and people second. It’s a call to legislators to seem reluctant to enact any programs to help the already addicted find their way back to society. And it’s a call to the communities affected, the ones who believe that by not acknowledging these problems they will simply go away. But unfortunately by the time anyone has really started to listen, it’s usually far too late for far too many.
I can hear the weariness in Macy’s writing and her interviews with the families of those affected. Everyone just seems so tired. Hell, I was tired too. But it’s even harder to treat an already difficult problem when everyone is walking around like Sandra Bullock in Birdbox. I guess I, like Macy and the rest of her subjects, are just wondering if and when this will be taken seriously like the absolute crisis it is.
Though it may be presented as something more academic or anthropological, what Dopesick is over anything else is a call to action. It’s a call for the pharmaceutical companies and their overseers who over-produce and supply these drugs to the general public. It’s a call to doctors in small towns who are overprescribing and letting themselves be influenced by the sales reps who are pretty brazenly offering bribes. It’s a call for police and other law enforcement to change the way they pursue and classify addicts as criminals first and people second. It’s a call to legislators to seem reluctant to enact any programs to help the already addicted find their way back to society. And it’s a call to the communities affected, the ones who believe that by not acknowledging these problems they will simply go away. But unfortunately by the time anyone has really started to listen, it’s usually far too late for far too many.
I can hear the weariness in Macy’s writing and her interviews with the families of those affected. Everyone just seems so tired. Hell, I was tired too. But it’s even harder to treat an already difficult problem when everyone is walking around like Sandra Bullock in Birdbox. I guess I, like Macy and the rest of her subjects, are just wondering if and when this will be taken seriously like the absolute crisis it is.
March 28, 2018
This was ridiculously excellent. Macy is a fantastic writer, and she is so good at getting you to care about the people and issues in this book. I read Dreamland: The True Tale of America's Opiate Epidemic but didn't think it was particularly good, in terms of helping me understand WTF was going on with the opioid crisis. Macy's book is just SO. MUCH. BETTER. at that aspect of this, while including narrative and biography.
(Abandon Hope All Ye Who Enter Here. This is not at all hopeful, and there's not much redemption to be found in its pages, sadly.)
Thanks to the publisher for the ARC! (Picked up at PLA.)
(Abandon Hope All Ye Who Enter Here. This is not at all hopeful, and there's not much redemption to be found in its pages, sadly.)
Thanks to the publisher for the ARC! (Picked up at PLA.)
May 11, 2019
DNF - I'm only a little ways into the book, but I can already see this isn't the read I'm hoping for. It seems heavy on stories from mothers who don't believe their children can actually be addicts, with lots of emotional, heart-tugging vignettes. But it's light on the science of how addiction happens and why it's so hard to break out of it, which is what I'm hoping to understand.
Please see carol's review of this book, which pretty much encompasses my feelings on this book.
Please see carol's review of this book, which pretty much encompasses my feelings on this book.
July 8, 2024
This was incredibly well researched and written. The author plunged headfirst into the gritty world of addiction to bring about this book and to be a voice, especially for the victims in Appalachia. We are raised to trust doctors and believe that they know better than us, but the dirty little secret is that they trade their morals for bribes from drug reps. The amounts of pills that the doctors in this book shoveled out is astonishing, and SO much blood is truly on their hands. They should all somehow be held accountable. Of course, there is certainly a measure of common sense that the patients ignored in favor of their doctor, but they were naive and were fooled, and they were the ones to suffer the consequences.
August 3, 2019
America ... please ... read ... this ... book.
I'm late to the party, and I'm not saying you're going to enjoy it, but ... in addition to being very well done, the book provides an important, valuable public service in opening eyes ... and, hopefully, hearts and minds ... to the scourge and the scale and the complexity and the abject horror of the nation's pain-killing (opiods ... oxycontin ... heroin ... fetanyl, you name it) epidemic.
If you've read or followed or are at least dimly aware of the litigation against Perdue Pharma and the Sackler family, the book fills in a lot of the holes and provides (no pun intended) painstaking detail and context. If you haven't been keeping up, you may find the book ... I dunno ... stunning, disorienting, ... and overwhelming. But read it. It's powerful stuff.
Full disclosure: I like to think of myself as relatively well-read and cognizant of current events - I read ... a lot, and I'm a voracious consumer of news and commentary ... and I have been aware of much of the litigation against Perdue Pharma and the Sackler family.... But ... I ... truly ... had ... no ... idea, and I'm grateful that the book came into my hands. I realized I need to read more after a recent international business trip with a (disabled veteran) colleague who - unlike most - managed to pull himself out from the grips of the painkillers, land on his feet, do great things professionally ... and (and this is no small thing) devote himself to speaking to and helping others who face the scourge. I was taken aback by how superficial my cognizance was of the scale, the enormity, the ... significance of the crisis. Again, I was clueless. So, thanks, Beth Macy, for your informative book (and your Herculean efforts to bring the project to fruition).
I won't belabor my disgust with the Sacklers and Perdue Pharma, nor my disdain for the doctors, who, frankly, conspired to unleash this seemingly unspeakable hell upon the public, in part, because they're highlighted in the title, and they're the star of the show. And, as for the dealers, well, there will always be a criminal element ... and I agree with the author that our criminal justice system does us few favors in providing alternatives, and ... and this is one of the book's crowning achievements, I hadn't fully grasped the (in retrospect, obvious) link between factory closings (and offshoring) with the poverty and despair that opened the door to these markets.
No, the must frustrating revelation for me was the ... far from obvious ... impediment that the faith-based (abstinence only, think AA or 12-step) community has become to dealing with a problem that ... and this is no small thing ... is simply not analogous to alcohol (or many prior addictive drugs). It's particularly troubling reading this today ... in light of the mountains of medical evidence ... again creating a situation where a well-intentioned, important (high-profile? dominant?) community ignores/rejects science and, in so doing, inflicts harm upon legions of individuals, the public, and our futures. (I don't want to get distracted by vaccinations or climate change here, but it's hard to ignore the analogies.) The passages articulating that recurring, predictable conflict are as frustrating and painful as they are maddening and heart-breaking.
To be clear, I'm not saying this book is better than many of the other books that have attempted to explain the epidemic (crisis?) to the public .... the author, in particular, mentions Painkiller, Dreamland, Drug Dealer MD, and The Big Fix in her acknowledgements... it's just newer, and it's the one I decided to start with.
I'll end where I began: read the book or one of the others (noted above). It's not an easy read, and, frankly, I could only consume it in very small doses. You'll be glad you did. And, who knows, maybe you (or we) can help make a difference.
I'm late to the party, and I'm not saying you're going to enjoy it, but ... in addition to being very well done, the book provides an important, valuable public service in opening eyes ... and, hopefully, hearts and minds ... to the scourge and the scale and the complexity and the abject horror of the nation's pain-killing (opiods ... oxycontin ... heroin ... fetanyl, you name it) epidemic.
If you've read or followed or are at least dimly aware of the litigation against Perdue Pharma and the Sackler family, the book fills in a lot of the holes and provides (no pun intended) painstaking detail and context. If you haven't been keeping up, you may find the book ... I dunno ... stunning, disorienting, ... and overwhelming. But read it. It's powerful stuff.
Full disclosure: I like to think of myself as relatively well-read and cognizant of current events - I read ... a lot, and I'm a voracious consumer of news and commentary ... and I have been aware of much of the litigation against Perdue Pharma and the Sackler family.... But ... I ... truly ... had ... no ... idea, and I'm grateful that the book came into my hands. I realized I need to read more after a recent international business trip with a (disabled veteran) colleague who - unlike most - managed to pull himself out from the grips of the painkillers, land on his feet, do great things professionally ... and (and this is no small thing) devote himself to speaking to and helping others who face the scourge. I was taken aback by how superficial my cognizance was of the scale, the enormity, the ... significance of the crisis. Again, I was clueless. So, thanks, Beth Macy, for your informative book (and your Herculean efforts to bring the project to fruition).
I won't belabor my disgust with the Sacklers and Perdue Pharma, nor my disdain for the doctors, who, frankly, conspired to unleash this seemingly unspeakable hell upon the public, in part, because they're highlighted in the title, and they're the star of the show. And, as for the dealers, well, there will always be a criminal element ... and I agree with the author that our criminal justice system does us few favors in providing alternatives, and ... and this is one of the book's crowning achievements, I hadn't fully grasped the (in retrospect, obvious) link between factory closings (and offshoring) with the poverty and despair that opened the door to these markets.
No, the must frustrating revelation for me was the ... far from obvious ... impediment that the faith-based (abstinence only, think AA or 12-step) community has become to dealing with a problem that ... and this is no small thing ... is simply not analogous to alcohol (or many prior addictive drugs). It's particularly troubling reading this today ... in light of the mountains of medical evidence ... again creating a situation where a well-intentioned, important (high-profile? dominant?) community ignores/rejects science and, in so doing, inflicts harm upon legions of individuals, the public, and our futures. (I don't want to get distracted by vaccinations or climate change here, but it's hard to ignore the analogies.) The passages articulating that recurring, predictable conflict are as frustrating and painful as they are maddening and heart-breaking.
To be clear, I'm not saying this book is better than many of the other books that have attempted to explain the epidemic (crisis?) to the public .... the author, in particular, mentions Painkiller, Dreamland, Drug Dealer MD, and The Big Fix in her acknowledgements... it's just newer, and it's the one I decided to start with.
I'll end where I began: read the book or one of the others (noted above). It's not an easy read, and, frankly, I could only consume it in very small doses. You'll be glad you did. And, who knows, maybe you (or we) can help make a difference.
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