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

Dopesick: Dealers, Doctors, and the Drug Company that Addicted America by Beth Macy
My rating: 4 of 5 stars

In some very tight-knit Appalachian communities heroin has become a social contagion. The epidemic has changed the region now to the point that the crisis has become ingrained in the culture itself and nearly everyone here has ties to someone who has struggled with addiction.
Opioid addiction is often described as an “equal opportunity” problem that can afflict people from all races and walks of life, but, while true enough, it obscures the fact that the opioid crisis has particularly affected some of the poorest regions of the country, especially in politically unimportant places, places such as Appalachia, a place that now feels mostly forgotten, where a huge number of Americans, many of them poor rural whites, have died in the last couple of decades of what one Princeton researcher has called “diseases of despair,” including alcoholism, suicide, and drug overdoses.
Appalachia itself is no stranger to exploitation by faraway captains of industry and Beth Macy has done an excellent job in exposing the corporate greed and regulatory failure that has played such a heavy hand in our current crisis and places the responsibility for the epidemic squarely on Purdue Frederick, makers of OxyContin, and its sales division, Purdue Pharma, which engaged in largely predatory marketing practices to sell a drug that has wreaked havoc on the lives of 2.6 million Americans. In the first section of the book, she addresses “big pharma” in telling detail, outlining how the overprescribing of pain medication created a market demand that was then met by illegal drug peddlers on the street. Section two follows the spiral of addiction as users of prescription pills, who are no longer able to afford their habit, turn to heroin, a cheaper and more lethal solution to feed their addiction and then in the last section, switches the focus to the addiction treatment industry itself.
People who are living in poverty are
especially at high risk for addiction and its consequences and if we want to be serious about reversing the opioid crisis and preventing future drug crises of this scope from happening in the future we will also need to address the economic disparities, housing instability, poor education quality, and lack of access to quality health care, including evidence-based treatment, that currently plague many of America’s disadvantaged individuals, families, and communities.
Marcia Angell, writing in The New York Review of Books, said, “As long as this country tolerates the chasm between the rich and the poor, and fails even to pretend to provide for the most basic needs of our citizens, such as health care, education, and child care, some people will want to use drugs to escape. This increasingly seems to me not a legal or medical problem, nor even a public health problem. It’s a political problem. We need a government dedicated to policies that will narrow the gap between the rich and the poor and ensure basic services for everyone. To end the epidemic of deaths of despair, we need to target the sources of the despair.”
It would however be too simplistic to blame a town’s opioid epidemic directly on the recession and loss of employment opportunities. But, nevertheless, it did create the social vacancy and desperation that we see in so many of these communities. People here no longer feel like they have a purpose. Many drug addicts are solely trying to escape the reality that the place they call home can no longer offer them anything and that’s a hard reality to live with. People are slowly becoming aware that the American Dream has been taken from them. That the American Dream is no longer theirs to dream.
The opioid crisis, as well as the national response to it, has also forced us to confront our conflicting cultural logic about whether addiction is a moral, social, or biological problem, or some combination of the three. But addiction is not something that people choose. It’s a disease and it’s one of the hardest diseases to fight. While many people have embraced this idea of addiction as a disease, a vocal cohort still dismisses this as a fantasy and regards addicts as community embarrassments. But if they had a heart problem or cancer it’d be talked about in school and with teachers, there would be support, other families would be offering to help with childcare, bringing casseroles over. However, since there is a shaming element embedded in small-town culture, and with this problem in particular, and because it is perceived to a be a problem of choice and morals, the addict is shamed. There’s no sense of community support and addicts end up becoming further and further isolated.
My own father was, and by every measure, still is, an addict and will likely be for the rest of his adult life. As Macy explains, “Opioid addiction is a lifelong and typically relapse-filled disease. Forty to sixty percent of addicted opioid users will achieve remission with medication-assisted treatment, according to 2017 statistics, but sustained remission can take as long as 10 or more years. Meanwhile about 4 percent of the opioid-addicted die annually of overdose.”
I relate this, because I know what it is like to live on the periphery of addiction, the potential danger of being neglected, taken advantage of, or even raged against and I know the real costs of addiction to families. Aside from dollars spent, addiction costs a great deal of time, energy, and emotion. Whether it is numerous stints in rehab, trips to court, or new and mounting responsibilities, addiction can dramatically change family dynamics. It can affect every facet of a person’s life and can lead to martial problems, divorce, loss of employment, and criminal charges. As these negative outcomes build, a person may fall deeper into the grips of substance abuse, using it as a means of comfort and escape, ultimately creating a self-fulfilling cycle. “Nothing’s more powerful than the morphine molecule,” Macy writes, “and once it has its hooks in you, nothing matters more … the only relationship that matters is between you and the drug.” As one user says, “It’s like shooting Jesus into your arm.”
Macy is certainly not the first to write about the opioid crisis, but she does bring a new level of humanity to a story that is too often carelessly splashed across headlines and just as easily dismissed and Dopesick, if it does nothing else, forces us to revise our image of what an addict actually looks like.
There are times when a book needs to be written, but there are also times when a book needs to be read, even though it hurts. Dopesick is one of those books.


  1. Strange to be reading this in London where the arts establishment is facing up to the realization that the Sackler foundation, having endowed our ancient and august institutions with everything from escalators to shining rooftop gallery extensions, did so with Purdue Frederick drug profits. Visiting the Royal Academy in Piccadilly now feels like going to see Ryan Adams play the Albert Hall would have done if public disgrace hadn't forced him to cancel the show. The gilded palaces of the metropolis are a world away from the Appalachian towns or British council estates where the opioids are wreaking their havoc; it feels to me that writers on the 'epidemic' derive a little too much easy ammunition from the contrast. British newspapers lament the scourge of addiction to synthetic drugs among inmates in our overcrowded Victorian prisons as if shooting down the drones that are delivering them through the cell-bars would solve the background social problems that Dopesick clearly recognizes. But if the problem is one of poverty, aren't we just looking in the wrong direction but sticking with the metaphor of disease? After all, it's not really a disease of the poor, like cholera in places without sewers. I think of Donna Tart's appealing teenage narrator in The Goldfinch. Traumatised by the sudden loss of his mother, but far from poor or uneducated, he is hugely relieved when his father gets off the see-saw of drunken irresponsibility and bad-tempered sobriety by taking up Oxycontin. The resultant leveling-out makes it easier for his son to deal with the man - and though he is too young to anticipate his own future addiction, the reader shares his relief. To a non-American, books like Dopesick might seem to play a little too easily into Trump's 'war on opioids' narrative the latest interation of a very hackneyed theme - as if he really has a more palatable palliative for the day-to-day drudgery of his rust-belt voters. Still, anyone who can write about injecting Jesus into your arm must be worth a look.

    1. This is an interesting comment/perspective on the issue. I thank you for it.

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