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Dopesick: Dealers, Doctors, and the Drug Company that Addicted America
21 April 2017
Reading this book is like a descent into the hell of addiction, the pharmaceutical companies that pushed drugs using doctored data, the doctors overdosing their patients, and the government that seems to pour money into trying to find a solution that doesn t seem to have one America s approach to its opioid problem is to rely on Battle of Dunkirk strategies leaving the fight to well meaning citizens, in their fishing vessels and private boats when what s really needed to win the war is a full on Normandy Invasion Opioids are now on pace to kill as many Americans in a decade as HIV AIDS has since it began, with leveling off projections tenuously predicted in a nebulous, far off future sometime after 2020 It s a pretty sobering experience to read this book that presents where we were, where we have come from, and where we are now in the struggle to handle the opioid crisis that is sweeping this nation Who do we blame for allowing our children, our brothers, sisters, parents, and family members who have succumbed to this crisis As in everything there is enough blame to go around starting with the Purdue Pharmaceutical Company who falsified findings pushing painkillers onto an unaware public for profit Purdue Pharma L.P is a privately held pharmaceutical company owned principally by parties and descendants of Mortimer and Raymond Sackler In 2007, it paid out one of the largest fines ever levied against a pharmaceutical firm for mislabeling its product OxyContin, and three executives were found guilty of criminal charges However, try to sue a drug manufacturer and this will probably happen Unfortunately, pursuing compensation from pharmaceutical companies became a lot difficult in 2013, when the U.S Supreme Court ruled that companies making generic medications can t be held liable under state failure to warn laws Then perhaps what about the FDA Aren t they suppose to guard Americans against dangerous drugs Guess again because Government agencies, including the FDA, are protected by sovereign immunity Sovereign immunity is a legal rule that prevents the government or its subdivisions, departments, and agencies from being sued without its permission What about the doctors who pushed these pills Are they too culpable for enjoying lifestyles given to them by the drug makers for their ability to over prescribe and push medications onto an unknowing public How did this all happen As in all things the answer is money Meanwhile people are dying, people are becoming addicted, lives are lost, ruined, and the monetary toll that addiction takes on families, the economy, the moral fiber of a nation is counted daily in ERs across our nation, in homes, and in dark and dismal alleyways and flop houses Is there something anything that can be done How do we combat this when one pill, one injection can make a person a captive to a drug The author did exhaustive research on what works and what has been proven to be futile in the efforts to stem drug abuse Imprisoning offenders, residential drug treatment centers that push abstinence, tough love, and other approaches seem destine to failure The outlook is bleak and if one doesn t have the money to enter treatment programs, there is not much to be done Send them home with a shot of narcan so that when they overdose at least this time they won t die The drain on a family, on a community, on a nation as a result of this epidemic is not able to be measured Is there an answer There is no one size fits all answer Addicts can and will relapse Then there are those who so need these medications Those who have chronic pain throughout their life and need the relief that pain medications can offer, that day free of pain, that night able to sleep They, too seem to be caught up in the net of the opioid crisis Where does personal responsibility come into play The latest research on substance use disorder from Harvard Medical School shows it takes the typical opioid addicted user eight years and four to five treatment attempts to achieve remission for just a single year And yet only about 10 percent of the addicted population manages to get access to care and treatment for a disease that has roughly the same incidence rate as diabetes When you arrest one dealer, four others crop up in their place says the author Can we possibly win this war This book is a chilling look into a crisis that is sweeping our nation Americans, representing 4.4 percent of the world s population, consume roughly 30 percent of its opioids As a tragic aside Five of the students I previously taught, have died due to overdosing on drugs When does this tragedy end The informant leaned into Lieutenant Richard Stallard s cruiser This feller up here s got this new stuff he s selling It s called Oxy, and he says it s great, he said What is it again Stallard asked It s Oxy compton something like that Pill users were already misusing it to intensify their high, the informant explained, as well as selling it on the black market Oxy came in much higher dosages than standard painkillers, and an 80 milligram tablet sold for 80, making its potential for black market sales much higher than that of Dilaudid and Lortab The increased potency made the drug a cash cow for the company that manufactured it, too The informant had specifics Users had already figured out an end run around the pill s time release mechanism, a coating stamped with OC and the milligram dosage They simply popped a tablet in their mouths for a minute or two, until the rubberized coating melted away, then rubbed it off on their shirts Forty milligram Oxys left an orange sheen on their shirtsleeves, the 80 milligrams a tinge of green The remaining tiny pearl of pure oxycodone could be crushed, then snorted or mixed with water and injected The euphoria was immediate and intense, with a purity similar to that of heroin Beth Macy, Dopesick Dealers, Doctors, and the Drug Company that Addicted AmericaEvery morning at the train station, I find myself staring at the iconography of the opioid epidemic Next to me, there is an advertisement for Narcan, a naloxone nasal spray that can be used in case of an opioid overdose Across the tracks, another ad, this one for a residential treatment center focused on opioid addiction When I step on the train, I am greeted with a placard that says Stop Don t RunIt is a public service announcement, reminding users that they will be given prosecutorial immunity if they call 911 and stay with a person who has overdosed It is a law that is meant to stop users from running away and allowing a person to die in order to avoid a possession rap Day after day, it is easy to allow such things to recede into the background To become part of normal life If you are like me, you have heard the phrase opioid epidemic so often it has started to lose meaning Whether we pay attention or not, it is happening Over the past fifteen years, 300,000 Americans have died from drug overdoses Seventy two thousand died just last year It is the leading cause of death for Americans under fifty, and is deadlier than guns, car accidents, and peak HIV Beth Macy s Dopesick tells the story of the crisis by giving it details She provides the faces and the names and the unhappy endings It is a potent, at times unbearably powerful story She follows everyone cops and criminals and users prosecutors and judges doctors and nurses and treatment providers Mostly, though, this is a story of mothers A tale of mothers and their dead sons and daughters While the opioid crisis has its tentacles in every corner of the nation, Macy traces it from its origin in rural America, specifically western Virginia As a journalist based out of Roanoke, she was there at the beginning, with Perdue Pharma s introduction of OxyContin The 1996 introduction of OxyContin coincided with the moment in medical history when doctors, hospitals, and accreditation boards were adopting the notion of pain as the fifth vital sign, developing new standards of pain assessment and treatment that gave pain equal status with blood pressure, heart rate, respiratory rate, and temperature A paradigmatic shift turned patients into health care consumers Accordingly, pharmaceutical companies sent their sales reps across the country to evangelize for new medications to prescribe to these customers Macy devoted years to this story, and she begins Dopesick with the story of Perdue Pharma and OxyContin She describes how this potent drug was sold to physicians, who then over prescribed it to their patients And when I say sold, I mean that in a literal sense Sales reps were buying loyalty with free lunches and junkets and swag Physicians, for their parts, were enjoying catered lunches and filling Oxy scripts with indefinite refills At the time Oxy hit the market, unfortunately, it was not tamper resistant, meaning that this incredibly potent drug could be altered for an incredible high This high came at an even incredible cost Dopesick is the term used to describe withdrawal, and it explains why opioids are so dangerous Once your body has entertained the euphoria of opioids, it has a hard time going back Symptoms of withdrawal include aches, diarrhea, fevers, profuse sweating, stomach cramping, nausea, vomiting, anxiety, restlessness, and irritability A person undergoing this extreme manifestation of absence becomes desperate to reverse course, to feed the addiction in order to make the sickness go away An addict will do anything to get enough money for the next hit The slang junkie, after all, refers to a person who scrapped metal in order to support their addiction.Eventually, the trend that began with Oxy exploded into a rebirth of heroin, leading to a public health crisis that devastated rural communities, filling the boneyards and the prisons Macy devotes a lot of time to following the resistance, a small band of people who tried to fight City Hall, even though City Hall had been purchased by Corporate America We are introduced to a small town doctor who was the canary in the coal mine, warning of Oxy s dangers as he saw his patients dying there is a dogged ATF agent, who broke one of Virginia s largest heroin rings there is a nurse practitioner who takes her mobile health wagon into the old coalfields, where the uninsured multitudes await and there is a no nonsense Catholic nun whose activism could help remind the moribund husk of a beleaguered Church that faith without works is dead Dopesick features beautiful black white portraits of most of these people, taken specifically for the book It adds a great deal to have a face to go along with the names Perdue Pharma is an easy target It is a corporation, after all, a molten mass of money surrounded by the impenetrable layers of the mythic corporate veil, endowed by the Supreme Court with all the rights of a human person, but none of the moral responsibilities or potential legal consequences Macy, though, does not stop with them She looks at the many other contributing factors, such as an acquiescent FDA, where top officials transition directly from the agency into high paying corporate positions and physicians who failed to do their due diligence before reaching for their Perdue Pharma ballpoints to write a script and at the potency of opioids themselves, which makes recovery extremely difficult In the latter half of Dopesick, Macy turns this into a furious critique of the treatment industrial complex She advocates strongly for medication assisted treatment MAT , using drugs such as Suboxone to quell cravings and subdue withdrawal symptoms without getting the person high According to Macy, this is the only feasible way to break the epidemic However, the legal and medical systems are extremely wary of using drugs to defeat drug addiction, even though we live in a hyper medicated culture in which there is a prescription for everything Dopesick is deeply researched, nicely balancing the big picture statistics with on the ground reporting But as hard as she tries, this is not a work of objective journalism Macy was in the trenches a long time, essentially embedding herself in fraying communities To follow these lives, she became a part of those lives, to the point where she would get texts from users asking her to drive them to rehab Frankly, I do not see this as a problem If journalism requires a person to put their humanity on hold, then journalism is not worth a damn The surprising thing to me is that she was able to maintain her empathy Addicts are extremely frustrating I was a public defender for nine years, and the number of drug users I represented who maintained their sobriety was depressingly low Addicts will and do steal from the people they love the most, lie to the people they love the most, let down the people they love the most It becomes very hard, very quickly, to feel sorry for them This brings us back to the mothers Mothers are the beating heart of Dopesick, and we follow them closely as they try to save their kids It makes for dispiriting reading, as these young people trade their futures to chase a high, joining a cycle of sobriety and relapse that lasts for years, and is physically and psychologically difficult to escape From the outside, it is easy to say Cut them off Stop helping them Let them go Three strikes and you re out From the outside, it is easy to ask When is it enough But that is only what you say when it is not your child Because when it is your child, there is never a point where you quit And maybe that is the only redemption to be found in Dopesick the mothers who keep trying to save their kids.Many of them do not succeed Macy begins her book with a fitting line from Agatha Christie A mother s love for her child is like nothing else in the world, Christie writes in The Last S ance It knows no law, no pity, it dares all things and crushes down remorselessly all that stands in its path Christie was describing a mother s love, but she might have been describing opioids themselves Unfortunately, it does not seem that even love can triumph over the ruthless power of an insidious drug. An Instant New York Times Bestseller, Dopesick Is The Only Book To Tell The Full Story Of The Opioid Crisis, From The Boardroom To The Courtroom And Into The Living Rooms Of Americans Struggling To Save Themselves And Their Families Masterfully Interlaces Stories Of Communities In Crisis With Dark Histories Of Corporate Greed And Regulatory Indifference New York Times From A Journalist Who Has Lived Through ItIn This Extraordinary Work, Beth Macy Takes Us Into The Epicenter Of A National Drama That Has Unfolded Over Two Decades From The Labs And Marketing Departments Of Big Pharma To Local Doctor S Offices Wealthy Suburbs To Distressed Small Communities In Central Appalachia From Distant Cities To Once Idyllic Farm Towns The Spread Of Opioid Addiction Follows A Tortuous Trajectory That Illustrates How This Crisis Has Persisted For So Long And Become So Firmly Entrenched Beginning With A Single Dealer Who Lands In A Small Virginia Town And Sets About Turning High School Football Stars Into Heroin Overdose Statistics, Macy Sets Out To Answer A Grieving Mother S Question Why Her Only Son Died And Comes Away With A Gripping, Unputdownable Story Of Greed And Need From The Introduction Of OxyContin In , Macy Investigates The Powerful Forces That Led America S Doctors And Patients To Embrace A Medical Culture Where Overtreatment With Painkillers Became The Norm In Some Of The Same Communities Featured In Her Bestselling Book Factory Man, The Unemployed Use Painkillers Both To Numb The Pain Of Joblessness And Pay Their Bills, While Privileged Teens Trade Pills In Cul De Sacs, And Even High School Standouts Fall Prey To Prostitution, Jail, And Death Through Unsparing, Compelling, And Unforgettably Humane Portraits Of Families And First Responders Determined To Ameliorate This Epidemic, Each Facet Of The Crisis Comes Into Focus In These Politically Fragmented Times, Beth Macy Shows That One Thing Uniting Americans Across Geographic, Partisan, And Class Lines Is Opioid Drug Abuse But Even In The Midst Of Twin Crises In Drug Abuse And Healthcare, Macy Finds Reason To Hope And Ample Signs Of The Spirit And Tenacity That Are Helping The Countless Ordinary People Ensnared By Addiction Build A Better Future For Themselves, Their Families, And Their Communities An Impressive Feat Of Journalism, Monumental In Scope And Urgent In Its Implications Jennifer Latson, The Boston Globe This is a well researched nonfiction book about how the Sackler family of the privately held company Purdue Pharma, their sales reps, unethical and misinformed doctors, our pitiful healthcare system that only helps some people, and our misguided law enforcement and incarceration laws created an opioid crisis that became a heroin crisis that led to overdosing becoming the leading cause of death for young Americans.Our country needs to ensure that everyone has access to healthcare, including mental health and substance abuse care We also need to change our drug laws so tax payers aren t funding prisons for people who are low level drug users It costs a minimum of thirty thousand dollars a year to incarcerate someone In states like New York and California, the cost is seventy to than one hundred grand What if we used that money on healthcare and education and substance abuse treatment According to Macy s book, Rehab is a multibillion dollar lie It s unevenly regulated and largely abstinence focused, meaning people who are trying to get weaned off opioids aren t supposed to take drugs like Suboxone, even though it s proven to help dramatically in keeping people off drugs Most rehab centers, which are unaffordable to many, are abstinence, faith based 12 step programs 5 of the 12 steps refer to a Higher Power even though for opioid abuse, there is significant evidences that medication assisted treated for the long term is a reliable solution for sobriety When you spend that much money, you think it s going to work But it s killing people for that myth to be out there that the only true cure is abstinence Not to mention, even for people who might be able to afford barely incare treatment, there aren t nearly enough beds in residential treatment centers to meet the demand The most important thing for the morphine hijacked brain is, always, not to experience the crushing physical and psychological pain of withdrawal to avoid dopesickness at any cost To feed their addictions, many users recruit new customers Who eventually recruit new customers And the exponential growth continues until the cycle too often ends in jail or prison a grave In terms of the opioid crisis, by now we know it s a national problem that begin in small towns, places like Appalachia that were one industry towns When coal mining stopped being lucrative because of alternate sources of energy like fracking and wind turbines, there were no jobs People often had on the job injuries and were overprescribed opioids A drug that should only be used for end of life care or cancer, people were getting hooked after just two weeks and then ultimately turned to the cheaper heroin Four of five people heroin addicts now come to the drug by originally being prescribed opioids.What s the difference between our schwag and other sales reps Asked a representative for Purdue Pharma, the company that hooked our citizens on Oxycontin The Sacklers that own Purdue are one of the richest families in America The difference is that People aren t stealing from their families or breaking into their neighbors homes over blood pressure pills, said small town Dr Van Zee, a major voice to change how this drug is prescribed, which took years Doctors started prostituting themselves for a few free trips to Florida, said lawyer Emmitt Yeary, who represented the families of people who committed Oxy related crimes stealing copper from buildings to get another fix, for example We know from other countries that when people stick with treatment, outcomes can bet better than fifty percent But people in the United States don t have access to good opioid addiction treatment The state of Virginia, where many of the stories from both sides of the law that Macy reports on, is one of the states that refused to accept Medicaid expansion in the wake of the Affordable Care Act, sacrificing 6.6 million a day in federal funds for insurance coverage In states where Medicaid expansions were passed, the safety net program had become the most important epidemic fighting tool, paying for treatment, counseling, and addiction medications and filling other long standing gaps in care It gave coverage to an additional 1.3 million addicted users who were not poor enough for Medicaid but too poor for private insurance If only politicians understood that Medicaid would actually save money and lives It takes about eight years on average, after people start treatment, to get one year of sobriety and four or five different episodes of treatment for that sobriety to stick Because I m passionate about healthcare reform, justice reform, and an end to people s lives getting ruined because they had some injury and became addicted to strong opioids almost overnight, I really enjoyed this book and highlighted many, many pages We need to treat people with addictions with respect because addiction is not a moral failing of not having enough willpower, it s about how addicted brains work differently than nonaddicted brains For reviews, please visit Heartbreaking, infuriating, incredibly well researched.This is an impeccably researched overview of the US American opioid crisis, enriched by case studies of people affected Macy manages to show both the immediate, private reach of this crisis and the overarching problems in the health system that led to it. I personally know 5 families who have lost a family member s to heroin fentanyl Good, strong, well educated families It is happening all around us, in all walks of life There are plenty of heartbreaking personal accounts in this book from families who have lost a loved one, and the steps they took in an attempt to save them It can, and does, happen to anyone They aren t other , they are us, and it is heart wrenching to read.According to the author the roots of the epidemic stems from a perfect storm of factors the government mandate that physicians make adequate pain control a priority Purdue Pharma, who aggressively marketed Oxycontin to doctors as effective without causing dependency They hid evidence that this was a highly addictive drug physicians writing large amounts of the narcotic Oxycodone, often for minor procedures outdated methods of treating addicts, proven by multiple studies to be unsuccessful treating addicts like criminals again, exhaustive research tells us it doesn t work once addicted to Oxycontin, and no longer able to obtain a supply, the addicted turn to the cheaper heroin fentanyl combination according to some, this is a small percentage see below economic factors at play in a population where poverty and unemployment is the norm, the conditions are ripe for drug use addiction Appalachia was among the first places where OxyContin gained a foothold in the mid 1990s.Medicine has changed, no longer do doctors prescribe large amounts of narcotics as a matter of routine care after surgery In fact, physicians face sanctions for prescribing narcotics inappropriately and many have chosen to just stop prescribing I read this book a month ago but have hesitated to write a review because I m conflicted There is another side to the story and chronic pain patients are the unintended victims I wish the author had addressed this issue and given a balanced report Not everyone who uses Oxy will go on to become a drug addict.According to while prescription opioid misuse is a risk factor for starting heroin use, only a small fraction of people who misuse pain relievers switch to heroin According to a national survey, less than 4 percent of people who had misused prescription pain medicines started using heroin within 5 years.1 Side note I m an RN and I have a disease that causes chronic pain I m fortunate that my disease is under control through the use of biologics, and I have no need for pain medicine But I keep abreast of what is happening in the chronic pain community, and all too often those who suffer from chronic pain are the unfortunate victims of new laws and government mandates I ve personally visited pain clinics where I felt treated like a criminal even though I wasn t there for a narcotic prescription I can t imagine what it would have been like if I had needed one.Doctors are being pressured to taper chronic pain patients off opioid regimens that have been working for them for years Most chronic pain patients use the drugs in order to function but are now treated with suspicion and judgement, even if they have been using the drugs for years with no problem Many can t get their prescriptions filled at the pharmacy.Some experts claim most of the harm from opioids are from the drugs being smuggled into the country from China and Mexico, but nearly all the government s solutions are based on limiting access to pain medication for people in pain For information In 2012, author and investigative social journalist, Beth Macy began writing about the worst drug heroin epidemic in world history Dopesick Dealers, Doctors, and The Drug Company That Addicted America began in the hills and valleys of Appalachia, the mid western rust belt, rural Maine before rapidly spreading throughout the U.S In 2016, 64,000 Americans perished from drug related causes and overdoses outnumbering the total of those killed during the Viet Nam War Macy explored the terrible destructive impact on society, those who have helped and harmed, and the brave individuals sharing their own stories of tragedy and loss, casting aside stigma and shame to alert and help others.In the late 1990 s, Appalachian country doctor St Charles, Virginia Art Van Zee M.D was among the first to sound the urgent alarm how OxyContin had infiltrated his community and region Patients were admitted to hospital ER s in record numbers from drug related causes Rates of infectious disease including Hepatitis C, along with petty and violent crime had increased substantially, a police car was fire bombed addicts were desperate for cash to support their drug habit, an elderly patient had resorted to selling pills from his nursing home bed Van Zee called public meetings to advocate and alert others of the opioid health crisis, and didn t hesitate to file complaints against Purdue Pharma for aggressive marketing campaigns promoting OxyContin By 2001, he and Sister Beth Davies were attending two funerals per day of the addicted dead.In 2007, with over 2.8 billion USD earned in drug profits, Purdue Pharmaceuticals was found guilty in federal and civil criminal courts for their role responsibility for creating the opioid epidemic, for misbranding OxyContin with aggressive marketing techniques that downplayed and minimized the potential for addiction The 600 million USD fine was worth the risk for Purdue the executives charged were forced to listen to victim impact statements, and were compared to Adolf Hitler and the mass destruction of humanity, yet these men served no jail time Both Doctor Van Zee and Sister Davies were outraged that none of the fine was allocated for drug recovery and addiction programs Instead, it was appropriated for Medicaid Medicare reimbursement and for criminal justice and law enforcement Macy documents the vast suffering, heartbreak of the families, friends, medical staff and first responders, the foster parents, clergy left behind to carry on after destruction and death had taken its toll The closed down factories, lumber mills, furniture manufacturing warehouses and stores, coal mines jobs that had once sustained the middle class were grim reminders that for the average American life would never be the same again Some desperate families impacted by the disease of despair had lost life savings attempting to pay for costly drug rehabilitation programs for loved ones, only to realize addiction was a lifelong process and the likelihood of relapse might be a day away Providers of rehab facilities were not in agreement over MAT medication assisted treatment though medical experts contend that MAT is absolutely necessary to battle the intense cravings of addiction and increase the rates of successful treatment Many of the stories were harsh and brutal Too many politicians and policy makers believe addiction is a personal moral failing and criminal offense rather than a treatable disease that robs victims of their dignity and freedom of choice Macy s book easily compares to Sam Quiones outstanding award winning book Dreamland The True Tale of America s Opiate Epidemic 2015 Macy is the author of the bestselling Factory Man 2014 and Truevine 2016 With thanks and appreciation to Little Brown and Company via NetGalley for the DRC for the purpose of review. Dopesick is a semi interesting book about the opioid epidemic in America Ms Macy follows many people and families over the course of 6 years and tells their stories in this book I think I would have enjoyed it a lot had the author narrowed it down to just a couple individuals and included factual information on opioids and addiction I felt the book was disjointed, due to there being so many different people written about, and the book jumps from one person to the next and back again It just didn t flow, in my opinion There wasn t much new in this for me that I haven t read in other recent books, and living in Appalachia, I m well aware of the crisis I see people just about everywhere I go who are in the throes of addiction I did learn some about medication assisted treatment, including Suboxone, that I didn t know before so this book was not a complete washout People who enjoy human interest stories will no doubt like this than I did The author certainly did her research and writes with much insight and compassion Not a bad read by any means, just not the best for me. A problematic read for me Yes, I know awards and all that But I honestly think the awards go to the fact that Macy made Oxycontin and heroin part of a national conversation, not because this book was exemplary journalism or writing Issue 1 Macy does not feel like a competent research or investigative journalist Apparently, before the book writing gig, her newspaper job was human interest stories I can so see that And I am not the human interest kind of reader Dopesick primarily focuses on those on the front lines but not the dopesick Though it begins by talking with a major drug dealer, it quickly moves to one of the physicians who watched the crisis unfold, and then a very brief history of Oxycontin, the manufacturer Purdue Pharmaceuticals, and the family that owns the company But mostly, there are stories from the mothers Details are heart tugging and, honestly, facile She writes about how one son who died of an OD used to help his mom grow sunflowers, so now the mom plants her whole front yard full of them Another carries around the urn of her son s ashes and caused a minor disturbance in a courtroom Does this help us understand drug abuse No Does it help stir anger against Purdue Pharmaceuticals I d argue, no, because it gives the reader a sad, tragic death, only partially from system failure Macy is trying desperately to relate the individual stories to the larger issues of economics and escape, but never gels Unlike Evicted Poverty and Profit in the American City, which dispassionately used the micro stories of people to show the complexity of the issues around housing, Macy seems desperate to engage the reader through emotion.Surprisingly, for a book about dopesick, Macy largely avoids the elephant of addiction It feels like she s quick to blame the system Ann had a twisted ankle and got twenty five oxycodone before looking at individual behaviors that contribute It is clear, indirectly, that many of the mothers were in denial about the level of their teens use So it kind of ignores the web of deceptions and strategies that occur before the pill takers turn into addicts She makes it sound like people are prescribed oxycodone, get addicted, start finding someone with extra, start dealing to cover costs, then turn into heroin addicts There s a loose attempt to connect that chain with economic depression, but it doesn t work Mostly, she makes it sound like the good kids did it for fun and then, boom, their lives end Literally For me, it s the most annoying kind of journalism, because it uses stereotypical images and catch phrases to capture tragedy It s Hallmark Channel journalism Issue 2 Macy is not a good writer She uses adjectives for things she can t possibly know, but play into preconceptions see above re Hallmark Channel, and below quote about stone faced She also quotes some people saying really intriguing but largely unsupported things, and then doesn t address them later When I checked her footnotes in the back they aren t actually footnoted in the body of the book you have to skim through the notes and see if a section you are curious about is highlighted , she has lame ass citations Bylame ass,I mean one quote she uses from a guy who asserts Adderall might make the brain susceptible to addiction, then she cites a book called Drug Dealer, published in 2016 Why is this claim in the middle of writing about 2005 2007 I don t know Like I said, terrible journalism But further research has led me to thinkthat book has potential.Issue 3 Purdue Pharmaceuticals is an evil, evil corporation As a general rule, I m pretty sure most pharmaceutical companies are greedy, soul sucking entities, but Purdue seems actively evil, which Macy illustrates The topic gets a chapter or two, but is severely hamstrung by the fact that it is a privately owned corporation, by the very private Sackler family, and that one of her co workers already investigated and wrote a book about how Kermit, a town of 400, had enough pills to supply the U.S The Sackler family has doubled down by counter suing the states instead of admitting any kind of culpability The only ones that have won here are their lawyers, who have made buckets defending them since 2005 or so, when the internet exploded and people really started to get that Oxycontin was addictive I would have liked an expose of how Purdue built their empire I want of the details from the whistle blowers Some of those are included, but not in detail There s a woman who was terminated and filed a wrongful termination lawsuit, asserting she was fired because she refused to sell push drugs to two of her highest prescribing doctors Her district was Florida, naturally I wanted to know about that they must be saying that they actually tracked prescribers and numbers, and actively promoted to them Which, by implication, is basically admitting that they were being legal drug dealers Now that is unbelievably unethical, and if you have problems with kids pushing dope in schools, is because this corporation and the family that owned it ENCOURAGED IT This family has billions, made from an addictive substance they repeated promoted as not Anyway, Macy only briefly covers that case, and largely in relation to the fact that she ended up losing.Issue 4 You want compassion Talk to someone who isn t the child of police officers and a cancer nurse Macy didn t help me develop that, or make me appreciate the insidious way addiction rewires the brain, one dopamine burst at a time The last time I took care of an addict at my last hospital, we had to call a Behavioral Emergency because we had finally gotten all the unknown drug out of his system and he was pissed we messed up his high His mother was exhausted, tired of coming to the hospital and trying to talk sense into him He ripped out his IV, leaking blood everywhere Hepatitis positive, naturally and left It was super not fun Macy s stories barely even help me with compassion for the parents, seeped as they are in denial and white privilege Kristi Remembers the first time someone in town suggested her son had a pill problem Kristi defended her son, even suggesting that it had been the woman s son, not Jesse, who swiped the pills She continued to make me feel compassion and empathy for the people that love addicts, but didn t do anything for me about addicts.Which leads me to issue 5 Macy doesn t handle The Race Issue well When someone is black, she usually makes a point of saying it, and urban is often code for low class person of color She will reference sides of the town What has become clear by 2016 is that now that loads of well to do white kids are dying, it s an issue The one person I remember in the book as a person of color is black, is in prison, and who Macy seems to finger as being the person that brought dope to their middle class burbs The white twenty some old that was in jail is portrayed as reformed, living healthy and educating others before he goes to do his time in prison for providing drugs in an OD death Issue 6 The Science this is science light I really, really wanted of this Bickel went onto scientifically quantify the indifference of the typical opioid user, comparing the average non addictive person s perception of the future calculated to be 4.7 years against an addicted users idea of the future, which is just nine days I once met an addiction researcher that really educated me on brain wiring and how it changes with addiction, and it was really the first time I really started to appreciate how terrible trying to combat addiction is I was hoping Macy would talk about the changes in addicts and how they can actually be helped, but it felt like this section was science light and hope heavy She likes to blame various aspects of the system usually lack of affordable rehab beds when an addict finally says, I m ready to quit but doesn t really address the most obvious problem, that she herself notes only 50% of addicts who get into a program and on maintenance drugs stay sober for a year. That s a really shitty success rate would you go to a surgeon who was only successful 50% of the time Oh, we got most of your appendix, but not all of it Take thyroid medication or insulin if there was only a 50% chance it would work Yeah, probably not These people are desperate, so they re taking what they can get, but the most honest response to the addiction issue We don t know the best way to do it yet TL DR If you know nothing about what oxycodone is or why it s part of the national conversation, start here But if you want investigative journalism, info on Purdue, or discussion on treating addiction, go elsewhere.One and a half stars, only because I never threw it across the room.Actual semi comprehensive overview in under 20 minutes by John Oliver Shocking..just shocking I had no idea how bad things have become and who was responsible You hear news about the opioid crisis and it s getting worse and we need to do something about it..but we don t Giving out Narcan to folks so if they overdose they have the fix, not sure if I fully agree with it Aren t we just enabling it by this I remember once someone telling me at a hospital someone came in, OD d Given Narcan, revived Awesome They were given Narcan to take with them Later that same day, they were backOD d again But we need to look at the root cause, the pharma companies and doctors that over prescribe Listening into my husbands conversation recently with someone who tore a muscle at work, on the job He had to get their medical history At the ER, they were given Oxy for pain REALLY That s what you get for a torn muscle now This person was smart enough to throw out the prescription But many think I ll take just one pill, I can handle it but the sad thing is, that s all it takes You want it and And in the end, you try to stop but you get so sickdopesick So you continue to take it just to avoid the dopesickness A vicious cycle.Anyway, this book is a very detailed look at this crisis and how it came about and how fast it spread and continues to spread You get intimate details of the people hit with this, families recovering or trying to from loosing loved ones, or just trying to get a loved on straight We might think oh this is only something that happens in the downtrodden areas of the US, where people don t have jobs, have no money, and so on But it s not the case The wealthy, affluent have also been affected Big business does well to keep people hooked on these drugs, drug reps make tons of cash to have doctors peddle their drugs, even when not needed And doctors are too lenient in handing out drugs like tic tacs So if you want an in depth look at this crisis, grab this one It s heartbreaking, sad, enraging,..but a great read I listened via audio, which was read by the author She did a wonderful job but at times there were too many people and too many facts and that sort of stuff is hard to track via audio Print might have been better for me Perhaps I should now just say.rant off.