The first time Ed Bisch heard the word “OxyContin,” his son was dead from it.
Journalist Beth Macy is a longtime reporter with the Roanoke Times. Beginning in 2012, from her vantage point within the Roanoke community, she observed the swiftly worsening opioid crisis as it engulfed her region of the western half of Virginia. Her interviews and forged connections with the parents and families of survivors and victims was the genesis for this book, as she movingly documents how OxyContin went from being a virtual unknown to the unfortunate household name it now is.
Macy follows the stories of several of these locals, mostly mothers, who try to help their surviving addicted children or make the tragic deaths of those who succumbed to addiction meaningful in the larger scope of the epidemic. While telling these affecting stories, she weaves in context of how the crisis came to be, and at such magnitude.
Putting faces and stories to the statistics is a heartbreaking but powerful way to understand how easy addiction can take hold. The near-unbelievable scope of addicted users described here, ranging from high schoolers doing heroin to the elderly both involved in the drug trade and dying of addiction, is almost too great to comprehend but Macy manages to distill these stories into something completely impacting and devastatingly heartfelt.
Out of the three books I’ve read about the epidemic, Dopesick feels the most sharply personal. All of the book-length reporting on the epidemic includes those intimate, heartwrenching stories that show just how high the human toll of this crisis is, and that its victims are not only the ones who lose their lives. But Macy forms a particularly strong bond with several families, most of them interconnected with each other within Roanoke’s small-feeling community and following their stories and setbacks is what makes this such an emotional punch to the gut.
It does cover, out of necessity, some similar ground as previous works, but Macy has a knack for setting the storytelling in a helpful narrative that doesn’t feel redundant despite what you may already know. She draws elements of previous reportage like Dreamland into that narrative and builds on it helpfully.
One such topic that always deserves underscoring is the 2007 trial of Purdue executives, eventually sentenced for criminal misbranding, which she describes including the perspective of a grieving but ferociously fighting mother who refuses to accept the explanation that they didn’t know what was happening so far down the chain of command.
She had wanted the men to apologize, to admit that they had understood all along that OxyContin wasn’t a novel way of fighting pain but simply a different and more potent way of dispensing nature’s oldest drug.
If the Sacklers’ lieutenants had legitimately not known about the flood of pills unleashed by sales reps toting around bad data and free shrubbery twenty-five rungs down the corporate ladder from them, maybe it was because they had not cared to look.
She also covers the claim much-loved and trumpeted by pharmaceutical reps that “… opioid analgesics caused addiction in less than 1 percent of patients,” and the sheer insanity of the bonus system doctors enjoyed for prescribing products like OxyContin, pitched to them with everything from free meals served quick in respect of their busy schedules to branded goodies and even shrubbery:
The source of this claim was a one-paragraph letter to the editor of the New England Journal of Medicine written in 1980. The letter was never intended as a conclusion on the risks of long-term opiate use, one of the authors would much later explain, yet it was trotted out repeatedly during OxyContin’s first decade.
At Dine ’n’ Dash gatherings and in doctors’ offices from the coalfields to the California coast, this letter about an unrelated initiative was repeated and tweaked until its contents no longer resembled anything close to the authors’ intention, like an old-fashioned game of telephone gone terribly awry.
One of the most interesting aspects covered here is the long and frequently setback-filled road to recovery faced by addicts who have the money, resources and support to seek treatment – already a significant hurdle to clear. In addition to taking an average of eight years of recovery work before addiction is more securely beat, this includes combating the widespread stigma in rehabilitation programs against using MAT (medication-assisted treatment). These are drugs like Suboxone and methadone, which allow addicts to wean off of opiates without the shock and higher relapse danger of a cold turkey approach.
As Macy details, they can also be abused to some extent, but treatment plans that employ some sort of drug are more successful than those that enforce strict abstinence (often connected to religious-based rehabs), adding yet another frustrating layer to the story of how we’re making this situation worse.
No matter where I turned in central Appalachia, the biggest barriers to treatment remained cultural. Stigma pervaded the hills and hollows, repeating itself like an old-time ballad, each chorus featuring a slightly different riff.
Dopesick has a particularly accessible feel in the way Macy, a talent at blending past and present narratives, tells the personal, painful stories of the addicted and their families who struggle to help them, sometimes successfully, often not.
The writing is excellent for the most part, I had a qualm with an occasional anthropomorphism attributed to the morphine molecule, as in lines like “the molecule had another even higher card to play“, but this small complaint is far outweighed by the emotional impact of the stories told and data related.
Like in American Overdose, Macy acknowledges that there’s no easy solution to the crisis, and neither will it end soon, but she hits on some key points offering hope. Not only are many dedicated organizations doing difficult but extraordinary work in rehabilitation, but she helps chip away at some of the stigmas, including of MAT therapy, and emphasizes how long the road to recovery for an addict to successfully shake the drug’s hold is. These aren’t easy truths, but they’re important ones to know and accept if we’re going to come anywhere close to resolving what’s become a massive public health crisis with long-term repercussions to come.
Excellent, crucial reportage on a heavy and heartbreaking topic but one we can’t afford to ignore or be misinformed about.
Dealers, Doctors, and the Drug Company that Addicted America
by Beth Macy
published August 7, 2018 by Little, Brown