Nursing Book Club

Dopesick: Dealers, Doctors and the Drug Company That Addicted America by Beth Macy

An origin story for the opioid crisis

In her new book, Dopesick, journalist and author Beth Macy traces the history of a public health crisis that now kills more Americans under the age of 50 than guns or car accidents, and whose grim toll exceeds even the worst years of the HIV epidemic.

Macy began following the opioid crisis and its impact on marginalized families back in 2012, as a reporter for Virginia’s Roanoke Times. By the time her book was finished five years later, several of the people she’d interviewed had already died.

None of this book is sugarcoated, and some of the stories she shares are just astounding. A single batch of heroin in West Virginia stopped the breathing of 26 people in a single day. There were so many deaths in that state that the indigent-burial assistance program ran out of money five years in a row. One young man Macy interviewed became an EMT after two teens behind him in his high school classroom fell out of their chairs because they’d overdosed during class.

The book’s title, Dopesick, refers to the physical symptoms addicts experience when trying to wean themselves from opioids. However, Macy does not focus only on the individuals, families and healthcare providers caught in the web of opioid addiction, but also on the larger issues of how these medications have been licensed and abused in the U.S.

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Wellspring of an Epidemic

The oldest opioid drug is opium, which has been used for pain relief for thousands of years in some parts of the world. Refined derivatives like morphine and heroin were first developed in the 19th century and saw widespread medical use despite their potential for abuse, which led the U.S. to completely outlaw heroin in 1924.

However, Macy traces the history of this current epidemic to the 1995 FDA approval of OxyContin, a semi-synthetic narcotic containing an opium derivative called oxycodone. The manufacturer, little-known, family-owned Purdue Pharma of Stamford, Conn., assured the FDA that the probability of abuse was low. Until 2001, the drug’s label even claimed that it was less likely than other opioids to be abused because of its delayed absorption.

While oxycodone was not new (it was developed in 1916), Macy notes that the commercial introduction of OxyContin in 1996 coincided with “the movement in history when doctors, hospitals and accreditation boards were adopting the notion of pain as the fifth vital sign.” Purdue Pharma sold $44 million of OxyContin in its first year alone.

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The company quickly doubled its sales staff and began aggressively promoting the drug, extravagantly rewarding prescribing physicians and even handing out coupons for free trial prescriptions. These were minor expenses for a drug whose annual sales topped $1 billion by 2001.

Along the way, some patients became addicted. When their prescription medications were cut off or became too expensive, some abusers switched to more readily available illicit drugs like heroin and, more recently, powerful synthetic opioids like fentanyl. It’s all easily understandable and yet almost unbelievable.

I’ve seen the full-page ads that Purdue Pharma has taken out in the New York Times to inform the public of the steps they are now taking to address the monstrous problem they were instrumental in creating. Frankly, I’m not impressed.

This book is a must-read for anyone who wants to be well informed about this difficult subject. Sadly, for some, it is already too late.

Dopesick: Dealers, Doctors and the Drug Company That Addicted America by Beth Macy (Little, Brown & Co., 2018)

Editor’s Note: Hulu has adapted Dopesick as an eight-episode miniseries, which will air in 2021

Christine Contillo, RN, BSN, PHN, is a public health nurse with more than 40 years of experience, ranging from infants to geriatrics. She enjoys volunteering for medical missions.


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