The Human Toll of the Opioid Crisis is Painfully Felt in ‘Dopesick’

Book review: Dopesick, by Beth Macy (Amazon / Book Depository)

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.

Dopesick:
Dealers, Doctors, and the Drug Company that Addicted America
by Beth Macy
published August 7, 2018 by Little, Brown

Amazon / Book Depository

29 thoughts on “The Human Toll of the Opioid Crisis is Painfully Felt in ‘Dopesick’

  1. Wonderful review! I know we’ve discussed this book ad nauseum so I won’t go on and on, but you highlighted so many of the things that I loved about it, like Macy’s skill at blending the personal with the professional and the clear agenda of destigmatizing MAT. So happy you read this one!

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    1. Thank you for giving me the push I needed to read it! I can’t believe I almost passed it by because I ended up learning so much from this one, especially about how stigmatized MAT is, which still just blows my mind when her research demonstrates clearly how beneficial it is compared to the abstinence-only rehab. I’ve loved discussing this one with you, I’m so glad you motivated me to read it!

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      1. The fact that so many clinics require patients to be clean BEFORE checking in was definitely one of the more eye-opening details that I got from that book. How are we still insisting on these practices that don’t even work?!

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      2. YES that was astounding to learn! I know there’s not an easy fix to this crisis whatsoever, but it just seems like we’re digging ourselves even deeper into a hole with some of the ridiculous policies and practices around it. It all just seems so counterintuitive to solving the problem with lasting effect.

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      3. It’s definitely one of those ‘has America actually moved past Puritanism?’ moments. I’d never realized how many stigmas against drug users I had internalized, the whole ‘say no to drugs’ rhetoric they raise us on made it seem like drug use is a very black and white choice that you can opt in or out of. It’s so infuriating to think that our society can’t even get our heads around the fact that addicts need help, let alone everything else that needs to be accomplished.

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    1. You didn’t tell me but that’s such a fantastic idea and I hope you get a grant for it in future. (Is there a possibility of contacting the publisher for discounted rates, maybe something like that could be helpful?) This book was so accessible and so very impacting, I can’t believe the benefit in that wasn’t recognized. One of the parts of this that shocked me (maybe I’m naive) was how young some of the people were when they first started experimenting with opioids. Something as eye-opening as this seems incredibly important for kids that age to be aware of.

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  2. Great review! I’m just finishing up American Overdose, which I’ve enjoyed for the most part, and it sounds like this addresses the emotional toll of the epidemic in interesting ways. The focus on MAT also seems intriguing—I was a bit disappointed that American Overdose didn’t much cover the recovery process or changes in attitudes toward addiction.

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    1. That’s a good point, I felt like American Overdose was better for understanding the political maneuverings that have done a part in it getting so wildly out of control, and that insane pill mill doctor story! This one takes a much more personal approach, including with Dr. Art van Zee’s story, which I forgot to mention in the review but had more significant coverage here and was very moving. I have to say I preferred Dopesick overall, I know it’s hard to read so much about this topic but it shed light on a lot of things I still wondered about having read the others, it’s definitely worth your time!

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  3. Another awesome review! I’ve been thinking about reading this one . I feel like I should try at least one book about the opioid crisis. This one feels like one I could connect with. Not exactly fun reading but such an important topic.

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  4. Immediately adds to wishlist, I can’t cope with all your recommendations! This is another topic that interests me, I remember in my crim degree, I did an essay on ‘the war on drugs’, and it was so interesting once you get into the nitty gritty of topics such as these.I will definitely be buying this one!

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    1. This one is important, and reading more about the opioid epidemic and how it’s been handled so differently than the crack epidemic in the US has been so eye-opening for me. I also had a lot of prejudices I guess I didn’t even realize related to growing up under the “war on drugs” and books like this one have made me see things differently. To know how complicit the drug companies and some doctors were just continually astounds me. I think you’d really get a lot from this one, it’s well written but packs in a lot of statistics and data very readably. Hope you’ll read it, would love to hear what you think!!

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  5. What an insidious drug! I had three surgeries and each time, I was sent home with a full prescription of opiates when I only needed enough for two days. I never took more than one or two of the pills. One prescription was for Oxy and, fortunately for me, I had a respiratory reaction to the drug after one pill. It’s unbelievable how irresponsibly the medical community dispensed this drug.

    Thanks for your thorough and informative review. I never hear anything about MAT in the same conversation with rehabilitation. Granted I’m not as up to date on those discussions but the few I’ve read or watched in media make to mention. This crisis really frightens me.

    Liked by 1 person

    1. The scenario you’re describing, about having a procedure and being sent home with way more opiates than reasonable, is such a frighteningly common one in the stories I’ve read, including ones here. Just chilling, really. And a common refrain from the people addicted – they took them because a doctor prescribed them, it’s a medical professional and you’re just doing what they tell you. Now I think many people are much more conscious of that but it’s too late, frankly. The damage that’s already been done is massive and long-term enough. One story profiled here that’s especially wrenching (as the author follows the girl quite closely) begins with her being prescribed opiates for bronchitis! And that was it – it was a fast, slippery slope from there.

      The crisis frightens me too, and as much as I want to understand more about it, reading about it can be tough because it’s not looking hopeful as things stand now. The stigma against using MAT in treatment has got to go, because abstinence-only programs and the discrimination in these programs against people using those drugs to wean off is only worsening long-term recovery prospects. And I think doctors and pharma companies need to take more responsibility in trying to solve this, the author lays out how they’re not really bothering much with that either. It’s just so upsetting.

      Liked by 1 person

  6. I always find myself a little nervous to pick up books on recent events, I think from a fear that they’ll be less objective than books that cover historical events. I’ve been interested in the many books on the opioid crisis though and your description of this makes me want to give it a try.

    Liked by 1 person

    1. That’s so interesting, I hadn’t even considered the possibility of a lack of objectivity with events being so fresh. One of the stories here is from Dr. Art van Zee, who has been treating patients with addiction and trying to get lawmakers and drug companies to listen to him, for many years now, I think he was one of the first to raise the alarm about how bad this was/is getting. So it does have some short-term perspective, in that sense. It was very eye-opening, and having already read two books about the crisis (I’m done now though – they are draining) I was impressed that she managed to find an angle that didn’t feel repetitive. What she does very well here is show, both statistically and anecdotally, that stigma is a major factor in this not only remaining unsolved but worsening. It was excellently done, I really recommend it if you feel up for it.

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