The Opioid Crisis Through the Lens of Government, Medicine, and the Personal

Book review: American Overdose, by Chris McGreal
Book Depository

A former head of the Food and Drug Adminsitration has called America’s opioid epidemic, “one of the greatest mistakes of modern medicine.” It is neither a mistake nor the kind of catastrophe born of some ghastly accident. It is a tragedy forged by the capture of medical policy by corporations and the failure of institutions in their duty to protect Americans.

Guardian journalist Chris McGreal’s American Overdose is the latest narrative look at the opioid epidemic overwhelming the US, and it’s a well researched, emotionally intense one that combines personal perspectives from users and families with medical industry background and lawmakers’ inaction to give a timeline of the crisis progression and where its responsibility lies, at least in part. It shows how frighteningly easy it is for addiction to take hold and how politicians and government have been lobbied and financially influenced by drug companies, allowing addiction to burgeon unchecked.

In comparison to an excellent previous book on the epidemic, Dreamlandthis focused more on the culpability of pharmaceutical companies, Purdue with its deceptive, selective statistics and aggressive marketing of OxyContin in particular; the unscrupulous doctors running pill mills; and the politicians, especially in Congress, willing to look the other way when supporting drug companies benefited them financially. We see some of the extreme lobbying on behalf of the pharma industry that goes into this as well, which is horrifying. Especially when juxtaposed with the voices of the people affected – sometimes of users and former users, and very affectingly, from families when loved ones didn’t survive.

In contrast, Dreamland focuses more on the Mexican cartels who moved in when they saw opportunity multiplying in the opiate market. American Overdose better explores how the problem exploded in the first place. It also covers territory like the drug companies’ continued development of prescription opioids, including stronger ones despite knowledge of abuse. McGreal also covers the dangerously skewed research that was cited claiming the drugs’ safety.

They homed in on the statistic showing that only two of the patients became addicted and probably because they had previously abused drugs.

[ArtVan Zee] was among the first doctors to raise the alarm, but he struggled to be taken seriously against the arrayed forces of the opioid makers’ money, a Congress unwilling to challenge the industry, and a federal medical establishment that showed little interest in addressing its wider responsibilities to the public health.

The book reads somewhat like a magazine article. A well written and extensively researched one, but not as cohesive or consistently compelling as I’d prefer. The sections detailing maneuverings in Congress and other government bureaucratic measures and missteps were tough to slog through, as important as these failures of policy were, and there are a plethora of figures that make it a bit disorienting.

Some stories stuck out though, like this one:

After sporadic legislation to tax and limit opium imports, the US Congress passed the Harrison Act in 1914 to restrict distribution to prescribing physicians. Because the law involved taxation, the Treasury Department was left to enforce it. Drawing on its absolute lack of medical expertise, the Treasury made a moral judgment that addiction was not a disease but a human failing. It ruled that doctors would not be permitted to prescribe narcotics to people who were hooked even if it was to help them shake their addiction. The Supreme Court upheld that position, and it prevailed for half a century.

It explains so much.

But the policy stories also left me with questions. There are several mentions of the Obama administration, and Obama himself, being uninterested in addressing the opioid crisis. But not enough explanation of why; I wanted to understand more of that.

When breakthroughs are made, such as strides in recognizing addiction as disease, it’s often tangled with other thorny issues like the crack epidemic, which was criminalized and disproportionately affected African American communities. Now that a drug problem is affecting white people, it’s labeled a public health crisis and beginning to receive political attention instead of criminalization.

I thought the reporting was strongest when the people affected spoke for themselves, because the impact of their stories and the trajectory of how they occurred is what really unmasks the ugliness and horror of this pharmaceutical-sponsored epidemic. It exists because of a perfect storm of drug companies pushing their product through aggressive, persuasive pharmaceutical reps, doctors and insurance companies more willing to treat symptoms than root causes (not to mention unscrupulous doctors who saw profit opportunity and ran with it), and legislation unwilling to address medical regulation or insurance issues. It is, in one word, infuriating.

A story that gets central attention here is the bizarre one of Henry Vinson, a former mortician arrested in a prostitution scandal in Washington, D.C. He eventually made his way to Williamson, West Virginia and opened a clinic, employing doctors Diane Shafer and Katherine Hoover, who would make thousands of dollars a day, cash, writing opioid prescriptions. Patients were encouraged to not even see the doctors during appointments. These two illustrate a sadly not uncommon story of extreme greed and absence of ethics, which is heartbreaking (and eyebrow-raising as Shafer’s case spirals into the soap operatic) but also a deep-dive look at how pill mills function and affect the towns where they take root.

McGreal also does excellent work in showing that addiction knows no socioeconomic boundaries, period. That should go without saying at this point and yet there are those who persist in believing it’s a choice, not to mention gut-wrenching stories from parents who, thanks to long-entrenched prejudices, understood too late the depth and seriousness of what their children were suffering. He interviews people across the spectrum who suffered opiate addiction, including doctors themselves. The slippery slope from trying to manage pain enough to live normal, everyday life into full-fledged, all-consuming addiction is not nearly as lengthy or rare as many still believe.

The stories from grieving parents are the hardest. To know the story behind why this is happening – how many legislators and medical professionals who were supposed to have human best interest at the core of their work and who instead have created, allowed, and added gasoline to the flames of this epidemic is tragic. American Overdose covers the details but it doesn’t offer much hope – only the reality that there is no easy or quick solution.

American Overdose:
The Opioid Tragedy in Three Acts
by Chris McGreal
published November 13, 2018 by PublicAffairs (Perseus)

I received an advance copy courtesy of the publisher for unbiased review.

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Book Depository

26 thoughts on “The Opioid Crisis Through the Lens of Government, Medicine, and the Personal

  1. Truly a fantastic review! I love how you read very interesting and important books and this one is no exception. I find the topic of the book to be very interesting and something that plagues society.. It’s interesting how the author included different aspects from politicians to families affected. Again, fantastic and very detailed review.

    Liked by 1 person

    1. Thank you so much! I try, sometimes more successfully than other times, to vary my reading and learn about issues and this one is just so important. I knew the origins of the opioid problem were awful but I didn’t realize just how reprehensible until reading this. I really recommend it, it’s eye-opening. Thanks again for such a kind compliment!

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    1. Thanks so much! I felt the same, but the books were opposite in my case. I recently got a copy of Dopesick though, I do want to read it as I’ve only heard excellent things about it, just bracing myself. This one was great but felt pretty bleak.

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  2. I am thinking about reading this, but didn’t want to read Dreamland over again, which is what this book sounded like. I may pick this up now, because it seems like this book takes another angle of the issue (Dreamland does discuss the pharma industry, but focuses a lot more on cartels). Great review!

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    1. Thanks so much! It was the same for me – I read Dreamland last year so hesitated about something potentially too similar. This does cover some of the same territory out of necessity (especially the development of prescription opioids, Purdue, etc.) but focused more on the medical industry, exploitative doctors, and failures to enact meaningful legislation. The Mexican cartels aren’t mentioned at all, so actually the two books complement each other really well.

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  3. Amazing review! This is a topic I really want to read more books on soon, having only read features and articles about it online. I’ll add this to the list, alongside Dopesick, Dreamland, and Pain Killer. It sounds like this one offers an interesting perspective, in spite of the writing feeling magazine-ish at times.

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    1. Dreamland was excellent and focuses on a different aspect of the crisis than this one does, so I was glad to have the varied perspectives. As exhausted and upsetting as the topic is I’m still interested in it and I keep hearing only excellent things about Dopesick, so I may read that one too when I feel up to it. Would love to hear your thoughts if you read one of these!

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  4. There seem to be several books out about this subject right now and with good reason. I’ve read that over the counter medication is usually just as effective as the prescription ones dealing with pain, yet doctors still push this stuff. Several clinics were raided here a few weeks ago and some people were really up in arms about it. I need to read more about the subject and will have to decide which book to pick up.

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    1. Some of the doctors mentioned here did exactly that, prescribed opioids so loosely or allowed refills when they weren’t necessary, etc. Doctors were influenced by pharmaceutical reps who claimed opioids weren’t an addiction danger, so I guess at least in part some doctors didn’t realize the severity of what they were doing, but I’m also skeptical about that. It was a way to manage the symptom instead of addressing root causes in many cases, some insurance companies were more willing to pay a prescription instead of physical therapy, things like that. The whole thing is maddening. I definitely recommend this one as a deep dive into the medical industry/legislative side of the story.

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  5. Great review. When I drove for Uber when I took a year off, I talked to a surprising number of opioid addicts or recovering addicts. It’s truly an epidemic and there are so many people getting rich off the misery and death.

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  6. Great review! I did enjoy Dreamland but I’m not ready to read another book about the opiod crisis quite yet, so I’ll put this one on my list for later. Lately I’ve started reading books about incarceration and I need to mix in some happier topics.

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    1. I know what you mean, I felt pretty depleted after this one. I also got a little stuck on incarceration and/or wrongful conviction books for awhile and had to temper it with some lighter and brighter topics, that seems to be the best way to cope. This one is a worthwhile read when you feel braced for it. I hope you have some good, happier reads soon!

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