— Dopesick: Dealers, Doctors, and the Drug Company that Addicted America, by Beth Macy (Little, Brown and Company, 2018)
Part of my day job over the last few months consisted of writing hundreds of fliers for political campaigns across the country. While researching the programs of the different candidates, I noticed a recurring topic among their priorities. Along with traditional kitchen-table issues like health care and jobs, the vast majority of candidates had something to say about—and a plan of action to tackle—the opioid epidemic.
How prevalent is this issue in our society that it has become a staple in political campaign platforms? According to the Centers for Disease Control and Prevention, drug overdose deaths in America, driven by the opioid epidemic, reached 72,000 in 2017. The spike in recent deaths is dramatic considering nearly 300,000 people died of overdoses in the last 15 years. Drug overdoses are now the leading cause of death in people under 50.
Just a few weeks ago, Indiana sued Purdue Pharma, the makers of OxyContin, a narcotic analgesic usually prescribed to relieve pain, for its alleged responsibility in fueling the state’s opioid crisis. In early November, the Food and Drug Administration (FDA) approved a new opioid that is said to be 5 to 10 times more potent than pharmaceutical fentanyl, a synthetic opioid which in turn is 80 to 100 times stronger than morphine. Doctors, consumer groups, and legislators criticized the decision for its potential to worsen the drug epidemic.
In this context, award-winning journalist Beth Macy’s Dopesick: Dealers, Doctors, and the Drug Company that Addicted America comes as a timely, in-depth look at America’s opioid crisis that tells the stories of its victims and traces the social and economic roots of the epidemic.
The Irruption of OxyContin
Twenty-eight states have filed lawsuits against Purdue Pharma so far. Founded as Purdue Frederick in 1952 by brothers and physicians Mortimer, Raymond, and Arthur Sackler, the company entered the pain-relief sector in the mid-80s. Ten years later, it introduced the potent OxyContin to the market and eventually hired pain specialist Dr. J. David Haddox, who worked to assuage public concern about the new drug. Some of Haddox’s bold claims were that “the risk of addiction when taking an opioid is one half of one percent” and that it is “exquisitely rare.”
Macy situates the origins of the opioid epidemic in rural America, and the practice among certain doctors of excessively prescribing pain-relieving drugs. Data-mining company IMS Health identified these physicians and provided the information to Purdue Pharma, which in turn deployed an army of sales representatives to target these doctors and push their product on them.
Dopesick surveys Purdue Pharma and other drug companies’ aggressive tactics across rural communities in Virginia, West Virginia, Maine, and rust-belt states affected by decaying manufacturing and mining industries. According to Macy, “… the real perfect storm fueling the opioid epidemic had been the collapse of work, followed by the rise in disability and its parallel, pernicious twin: the flood of painkillers pushed by rapacious pharma companies and regulators who approved one opioid after another.”
The approval of OxyContin by the U.S. Food and Drug Administration in 1995 coincided with an increase in the advertising spending of pharmaceutical companies, which jumped from $360 million that year to $1.3 billion in 1998. Purdue Pharma bonuses for its representatives grew from $1 million to $40 million between 1996 and 2001.
Dr. Art Van Zee, an internist practicing in Lee County, VA, one of the poorest towns in the state, was one of the first medical professionals to alert county, state, and federal authorities on the opioid epidemic in rural America. Macy recounts how Van Zee witnessed the rapid deterioration of community life caused by the flood of pain pills. He noted that two years after OxyContin’s release, one quarter of Lee High School juniors reported having used the drug. Neighbors began robbing one another to sustain their Oxy habit as 80-mg pills were typically sold for $80 on the streets.
Van Zee attempted to educate his neighbors and petitioned the FDA to withdraw OxyContin from the market. The FDA eventually negotiated with Purdue to add a black box warning to the drug’s packaging, a measure that a company spokesman dismissively referred to as “an exercise in graphic design.”
By the early 2000s, Macy claims, the havoc wreaked by OxyContin in western Virginia was “legend.” This climate prompted John Brownlee, a young, ambitious federal prosecutor in Roanoke, VA, to sue Purdue Pharma over its fraudulent claims about OxyContin’s safety and effectiveness. The company hired Rudy Giuliani to fight the lawsuit. In spite of immense backstage lobbying to drop the lawsuit, Brownlee prevailed. Giuliani negotiated a settlement through which Purdue-owned holding company, Purdue Frederick, paid $640 million in damages while three executives pled guilty to misdemeanors and were fined a total of $34.5 million.
The settlement remains the harshest penalty received by Purdue Pharma to date, but the human cost is irreparable. As Macy tells the stories of families ravaged by addiction, medical professionals, first responders, and those who died from drug abuse—a high school football star, a “happily married twenty-seven-year-old mother,” a recovering addict trying to turn her life around—she can only conclude that OxyContin’s “lure” has proven to be “so intractable, that those who were already addicted were likely to be ruled by it for the rest of their lives.”
An Urgent Reminder
The situation has worsened since the widespread arrival of high-grade heroin and fentanyl. It is estimated that four out of five people who abused these substances had been on an oral opioid, either prescribed or acquired illegally.
When it comes to recovery, Macy is adamant that one of the best options is medication-assisted treatment (MAT), the use of medications in combination with counseling and behavioral therapies. Although Macy states that “every significant scientific study supports” MAT, it is resisted by those who favor abstinence-focused approaches, those concerned with the drawbacks of so-called maintenance drugs, and many drug-court prosecutors and judges.
But while the debate over policy and treatment approaches proceeds, the number of opioid overdose deaths continues to grow. With its painstaking research and vivid testimonies, Dopesick is an indispensable overview of America’s opioid crisis and an urgent reminder that much more needs to be done in the form of treatment, research, and harm reduction to turn this problem around.
— Gonzalo is a writer born in Texas, raised in Chile, and currently living in Shepherdstown. His books have been published in Spain and Chile, and his fiction has appeared in Boulevard, Goliad, and The Texas Review, among others.Review by Gonzalo Baeza