Dopesick: Dealers, Doctors, and the Drug Company that Addicted America
© 2018 Beth Macy
384 pages

More people are expected to die from accidental drug overdoses in the next five years than have died in the previous fifteen, part of an overall spike in what is sometimes called ‘diseases of despair’, including suicide and alcohol-linked deaths: in 2021,  overdose deaths broke records with over a hundred thousand lives cut short –  and most of these deaths owed to opioids.   The opioid crisis is particularly troublesome because it’s a manufactured one,   largely being the direct byproduct of an aggressive marketing campaign for OxyContin by Purdue Pharma in the late 1990s.   The promotion of opioids for chronic pain was a seed of despair that found fertile ground in regions of the country increasingly destitute, left behind by globalization.  In Dopesick, Beth Macy offers a history of the opioid crisis, an investigation into its roots, and an exposure of the human costs of not only government policy, but the apathetic response of the American public – a response created both by disinterest in the suffering, and by an increasing feeling that the problem is too pervasive to tackle. There is hope, though, and the book ends in Macy’s argument for an approach centered in healthcare rather than punitive measures. 

Most drug problems begin in the cities, where there are concentrated markets.  The opioid crisis, however, began in rural areas like backwoods Maine and Virginia.  These were not places marked by white-collar work: instead, men and women  worked long hours in mines and factories, pushing their bodies to the limit and looked for relief from their pain from professional men in white coats who they were supposed to trust.  In the mid-1990s,  pain was being recast as a ‘fifth vital sign’,   something that merited immediate treatment – and as luck would have it, there was suddenly a new effective painkiller on the market, one that a weak study declared was not an addiction risk for those suffering chronic pain.  It was aggressively marketed to doctors, who were told over cozy dinners and in offices filled with new OxyContin-branded  equipment that it was perfectly safe.    The pills were potent enough that physical addiction followed quickly, and those doctors who paid attention and became wary about subscribing them were  bypassed by new addicts to figure out ways to game the system – -getting prescriptions from multiple docs, for instance,   or faking pain from kidney stones.  Less scrupulous doctors embraced their increasingly compulsive repeat customers – and some became addicts themselves,  writing fake scrips to increase their access to pills.    Increasingly desperate opioid addicts  sank to criminality to feed the new monster in their head –  stealing and pawning goods, for instance, or  becoming dealers in the burgeoning non-pharmaceutical heroin market. (Sam Quinones covered the link between Oxy addicts and the increase of cheaper,  more readily available heroin in his book Dreamland, but it’s addressed more broadly here.)  Heroin dealers, well aware of the addictive potential of their product, often ‘hot-load’ initial samples by giving newcomers especially potent doses of the drug — enough to hook with one bite.

Although the opioid wave began as an irresponsible remedy to physical pain,  Macy notes that it quickly evolved.    As coal mines and factories closed,  selling pills and later heroin on the side became a viable source of income to people whose other options were relocating (difficult to do with no income) or becoming perpetual ‘draw-ers’, those who lived off of  frequently fraudulent disability claims or other forms of state handouts.    The growing market embraced its more natural customer base –  young people of wealthier classes with plenty of disposable income and a party-prone lifestyle, who had been groomed to be pill poppers by a lifetime of exposure to Ritalin and other stimulating prescriptions. Those, too, were overkill – prescribed by doctors too eager to diagnose bored boys as having an attention disorder, and too sure that neuroactive drugs were the only solution.  Wherever opioids went, they left death and sorrow in their wake – -and as Macy’s many extensive interviews showed here,   even those most primed to succeed in life could be destroyed by it.   Opioid addiction rewires the brain more quickly and more comprehensively than other drugs, and time and again readers witness people in this book going through rehab, valiantly putting their life together, and then –   as if they were possessed –  succumbing to temptation or crumbling under pressure and finding themselves in the gutter again. The story  with which Macy closes the book is especially effective at conveying the awful drama of addiction, recovery, and self-destruction. Despite the misery that saturates this book, her interviews with recovery specialists and those who have made the journey themselves indicates that Medication-Assisted Therapy, which uses opioid-like drugs to help wean addicts off of the real thing, is the most promising path forward. Macy also maintains that more government support (via Medicaid and food assistance) is needed to bouy addicts up so that they don’t resort to using their old contacts and selling drugs just to get by. Being convicted of a felony (exceedingly easy to do in Police State USA) is often the first step into a mire of unhirability and poverty that effectively forces the convicted to become perpetual clients of the welfare state or (for those with imagination or ambition) actors in criminal or black market economies.

Related:
Unstitched: My Journey to Understand Opioid Addiction, Brett Ann Stanciu
Dreamland: The True Sale of America’s Opiate Epidemic, Sam Quinones