Dopesick: Dealers, Doctors, and the Drug Company that Addicted America

Dopesick: Dealers, Doctors, and the Drug Company that Addicted America

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...

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Title:Dopesick: Dealers, Doctors, and the Drug Company that Addicted America
Author:Beth Macy
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Dopesick: Dealers, Doctors, and the Drug Company that Addicted America Reviews

  • Ang

    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

    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

    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

    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.)

  • lp

    An emotional, powerful, important must-read. This book wasn't trying to do what HILLBILLY ELEGY was trying to do, but it did it, anyway. It did a great job getting close to answering those big questions. I got a huge understanding of the cycle of addiction and struggle in Appalachia. Beth Macy writes with her heart and her skill. Both are enormous.

  • Geoffrey

    (Note: I received an advanced electronic copy of this book courtesy of NetGalley.)

    Beth Macy has crafted a work that expertly utilizes both a grander narrative and the personal tragic tales of numerous figures and families, all to great effect to show how the ongoing epidemic came to be.

    This is a work that will tear out your heart before filling you with a ferocious fury. Fury at the shameless drug companies who targeted economically depressed communities with their painkillers. Fury over the co

    (Note: I received an advanced electronic copy of this book courtesy of NetGalley.)

    Beth Macy has crafted a work that expertly utilizes both a grander narrative and the personal tragic tales of numerous figures and families, all to great effect to show how the ongoing epidemic came to be.

    This is a work that will tear out your heart before filling you with a ferocious fury. Fury at the shameless drug companies who targeted economically depressed communities with their painkillers. Fury over the countless warnings from men and women about the new and growing crisis that went ignored until addiction crept from devastated rural areas and into the suburbs and cities. Fury over the absurdly patchworked American healthcare system that makes it so difficult for the addicted to get the care they need. Fury over a system that punishes the victims of the epidemic far more than the perpetrators ever could be. Fury over the countless parade of tragedies that affect the families covered in this work. "Dopesick" just will not stop filling you with rage alongside your new knowledge until you've reached the very last page.

    In other words, Macy has done her job incredibly well here. If you want to better understand the opioid epidemic that still burns on, this is THE book to read.

  • Stephanie

    If you want to know the backstory of America's opioid epidemic, look no further than Beth Macy's meticulously researched book. The personal vignettes bring a face to the stories we read about in the paper. I know many people will compare it to Hillbilly Elegy, which I learned a great deal from, but this book raised more questions for me. I think it would be a fantastic book club discussion. It points out a broken health care system that will continue to let people down if we don't make changes s

    If you want to know the backstory of America's opioid epidemic, look no further than Beth Macy's meticulously researched book. The personal vignettes bring a face to the stories we read about in the paper. I know many people will compare it to Hillbilly Elegy, which I learned a great deal from, but this book raised more questions for me. I think it would be a fantastic book club discussion. It points out a broken health care system that will continue to let people down if we don't make changes soon.

    I received an advanced electronic copy of this book courtesy of NetGalley. Thank you for the opportunity to read it.

  • Michelle

    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 terri

    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.

  • Rachel

    Compelling, informative, compassionate, and harrowing.

    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

    Compelling, informative, compassionate, and harrowing.

    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),

    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

    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

    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,

    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.

  • Matt

    - Beth Macy,

    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:

    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

    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 Perdue 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

    with the story of Perdue 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

    , 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

    .

    (

    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).

    Perdue 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 Perdue Pharma ballpoints to write a script; and at the potency of opioids themselves, which makes recovery extremely difficult.

    In the latter half of

    , 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.

    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

    , 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:

    ?

    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

    : 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.

    Christie writes in

    .

    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.

  • Julie

    Dopesick: Dealers, Doctors, and the Drug Company Who Addicted America by Beth Macy is a 2018 Little, Brown and Company publication.

    While some may remain untouched, most Americans are painfully aware of the grip opiate addiction has on our country. Like the synopsis states:

    Dopesick: Dealers, Doctors, and the Drug Company Who Addicted America by Beth Macy is a 2018 Little, Brown and Company publication.

    While some may remain untouched, most Americans are painfully aware of the grip opiate addiction has on our country. Like the synopsis states:

    , 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.

    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.

    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.

    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

  • Jennifer

    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.

    discusses all the warnings history has left for us concerning the addictive qualities of opiates, referen

    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.

    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,

    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.

    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.

    Note: If interested in learning what being "dope sick" entails, I found some information on

    .

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