Dopesick: Dealers, Doctors and the Drug Company that Addicted America

Dopesick: Dealers, Doctors and the Drug Company that Addicted America

Beth Macy
ARRSE Rating
4 Mushroom Heads
First, let me say, this is the saddest book I’ve read in a long while. Written by Beth Macy, a campaigning journalist who has spent her life reporting in the hinterland of rustbelt America, Dopesick chronicles the effects of corporate greed and supine regulatory bodies, alongside the corruption of many of the medical profession, metamorphosing from healers to pushers. Describing the effect of a drug company’s amoral promotion of a highly addictive painkiller, Oxycontin, the damage caused on the people detailed in her writing is heart-breaking. I found myself as I read continually identifying with the families of the victims, their shock, pain, hopelessness and despair depressingly easy to empathise with.

The copy under review is printed in standard Hardback format; at 375 pages it’s quite a lengthy read, and there are eight pages of black and white photos (which add little to the story, other than showing that a lot of Americans are rather plump). It’s retailing at £20.

The story revolves not around the company Purdue Pharma, who in the 90s began to market Oxycontin, (an extremely addictive and very strong opioid painkiller), but its effects: over-prescription fuelled by bonuses and bribery of doctors, enabling wholesale addiction starting in recession-hit small towns; the growing toll of pill addict overdoses; the battle to bring Purdue to book, and the knock on effect of reducing the efficacy of Oxycontin for recreational use, along with placing controls on its availability – the rise of Heroin use, from being an almost exclusively inner city (and black) issue to being a national epidemic which cuts across all races and classes.

The linkage made between over-diagnosis of ADHD, and the long term effect of prescribing Ritalin and Adderall – a massive increase in the likelihood of a young adult becoming a drug addict – is truly chilling. The migration of drug dealers from inner city slums, out to the suburbs and then on to smaller towns and rural areas is dealt with well, as is the background which this tragedy has played out against. One interesting fact jumped out of the page as a direct contributory factor: for every unemployed man in the US at the time of writing, there are an additional three neither working nor looking for work – basically living by drawing disability cheques. Whether this is more due to the lack of effective social security or the willingness of doctors to sign off and prescribe as a safety net for the underclass is a question for further debate.

Macy relates this multifaceted story in an engaging and pacy style; interviews with dealers, law enforcement, activists, politicians, users and their families are woven into a narrative that reads like a depressing thriller. This is coloured by her obvious anger at what is happening to communities like Roanoke, Virginia, where she lives and works. Unfortunately this anger is also the cause of the worst weakness of this book. Instead of a balanced view, what you get is an extremely slanted depiction seen through the prism of the author’s beliefs, not only of the issues, but also of the characters described. This sometimes reads like a Liberal version of Tom Clancy, if one can imagine that.

Take for example her depiction of one of the first medical professionals to notice the exploding addiction caused by Oxycontin. Dr Art Van Zee is a Democrat-voting saintly man who’s married to a former union activist, and decorates his surgery walls with pictures of former miners from the defunct coal mines which surround his town. He refuses the blandishments of big pharma salesmen, and is idolised by young doctors on attachment to his surgery as “the best physician in America”. Now this man may well be as wonderful as Macy suggests, and I mean no criticism of him specifically, but it forms a pattern. Sister Beth (a “spunky” campaigning Nun) is given a similar starry eyed treatment, as are other left-leaning activists and campaigners. Conversely, John Brownlee, a US Attorney who despite being responsible for the first successful conviction of Purdue executives, is described in a less flattering manner as an ex-serviceman over achiever with political ambitions, and someone Macy’s right-on heroes and heroines had to hold their noses to be associated with. I have the feeling that Beth Macy is not a fan of Donald Trump, or indeed of anyone who isn’t on the extreme left of the Democrats.

The strongest quality throughout this book is Macy’s depiction of the families of the addicted. The despair and helplessness of parents wondering what they can possibly do, and the devastation and loss of the loved ones of those who have died is incredibly poignant.

There is very little effort to tell the “Big Pharma” side of the story, which could leave the book open to accusations of being little more than propaganda (unfairly in my view). Despite this, I heartily recommend that if you are interested in this subject, you should read Dopesick. It’s not an easy book to read (thanks to its subject matter rather than the quality of the writing), but it’s worthwhile making the effort. A sobering and depressing, but very informative, read.

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Just to say thanks for taking the time and trouble both to read Beth Macy's book and to then write such a balanced and objective review.
You're very welcome. As I said in the review, it's the saddest book I've read in a long while - in fact, possibly the saddest I've ever read. My wife has tried to finish it several times and has been defeated by its bleakness, but agrees with me that it's something everyone should at least try to read. For all its faults, it conveys the absolute despair of addiction better than anything I've ever read.

Thanks to a severe back injury I'm on opioid painkillers and anti-inflammatories, possibly for the rest of my life; reading Dopesick has given me pause, and I've reduced my dosage to the bare minimum I can get away with and still be able to function. This experience has given me a great deal of sympathy for those who've been addicted, and even more for their loved ones.

Thanks for the kind review of my review; I enjoy doing this, but I'm glad that most of the books I get aren't quite such hard going. Having just re-read what I wrote, I don't think there is anything I would change, apart from recommending reading the book even more strongly than I did.