Dopesick

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 more 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 more 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 more 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.

Beth Macy is a marvel to me for she may be the best reporter to what has happens to the core of this country in the period of the last decade of the 20th century and the first decades of the 21st; she had the fortune to be where it was happening and the journalistic ability to tell the story. Her first publication Factory Man captures a blow by blow account of the collapse of furniture factories and surrounding garment trades in Appalachian as globalization begins in the 1990’s and workers who had know employment in a region of declining Coal production watch as their employers ship their businesses south of the border to Mexico or off to China and are pleased selling imports free of local labor cost. Macy could see the related collapse of the service industries, retail sales and social fabric of the towns, unemployment rates rose to above 20 percent, food stamp claims more than tripled, and disability rates went up 60.4 percent; but she has a hero.Her hero was John D. Bassett III, and that is a story well told; a man who saves most of his family firm and reorganizes the resistance to Asian ‘dumping’ winning compensation that enabled many to survive and restructure their trade despite resistance from all who were finding Chinese wiser and profitable.*But in this story Bassett’s factory is mentioned as a building being stripped for copper wire and burned by an individual carelessly seeking something to recycle. The area is an economic disaster but a market for an opiate to relieve pain. Do you remember your doctor or nurse asking your pain level ‘one to ten’?“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 for pain assessment and treatment that gave pain equal status with blood pressure, heart rate, respiratory rate, and temperature.” (p. 27).Macy takes the now well known opiate addiction resulting from OxyContin and other medications and moves it from ‘those poor hillbillies of Appalachian’ to the children of doctors, lawyers, and insurance salesmen of the middle class and their addiction and often deaths.Appalachia was among the first places where the malaise of opioid pills hit the nation in the mid-1990s, ensnaring coal miners, loggers, furniture makers, and their kids.“Two decades after the epidemic erupted, Princeton researchers Anne Case and Angus Deaton were the first economists to sound the alarm. Their bombshell analysis in December 2015 showed that mortality rates among white Americans had quietly raised a half-percent annually between the years 1999 and 2013 while midlife mortality continued to fall in other affluent countries. “Half a million people are dead who should not be dead,” the Washington Post, blaming the surge on suicides, alcohol-related liver disease, and drug poisonings—predominantly opioids—which the economists later referred to as “diseases of despair.” (p. 16).Macy shows that the real despair was the inability to achieve a release from addiction in the world of pills, then heroin, and finally chemically altered heroin flooding America’s landscape.Here again she has heroes the well informed who see addiction not as a crime but a sickness needing careful monitoring and public funding; a unifying of enforcement and public health –a national emergency.Dopesick: Dealers, Doctors, and the Drug Company that Addicted America is Beth Macy’s call for solutions. As she mentions even Trump has recognized the problem but has not moved toward solution. A recent article in the Times post-election recommends that the Democrats need to capture rural America for 2020 and dealing with opiate addiction highly recommended. If the nation is ready Beth Macy and ‘angels’ she covers are sources for direction.A slow presentation but possessing the very humanistic qualities she excels at.5 Stars*John Bassett did what any employer who wish to save his business could have done, and that was using the rules of competition embedded in the W.T.O. to test Chinese subsidized production and under pricing cost of production. He won compensation from his China competitor allowed under the system and survived (for a while?).

It really shows how big Pharma works and continues to work.

Thought the book would be more like the HULU series.

This book also follows the show dopesick.

Great book. Excellent work

Relato real que dá uma dimensão do problema dos opióides nos USA

I feel confident that this book could have been reduced by 50% - there are just so many individual stories, and a ton of names to keep track of - and whilst many are interesting in themselves, the connection to the overall red thread is sometimes a bit lost. Nevertheless, important investigative journalism that I am happy to have read.

Having read this book I really feel like the USA has been way too capitalised and that they really need to think about how their laws are so complicated for everything, for the common man. The opioid crisis has been covered in its full depth here, from morphine to OxyContin to heroin to fentanyl.Shocking fact from the book: 4 out of 5 heroin users are graduating from OxyContin use.

I found this book dragged on, but I persisted and was glad I did. It had so many important things to say about American society, and drugs of despair. The power of drug companies, and susceptibility of many doctors and law-makers was shocking. It made me question how a civilised society can know the magnitude of addiction, and not respond adequately. It was also apparent that beneath the despair was a loss of hope, meaning and opportunity. All democratic peoples can learn from what is happening in America, and use our votes wisely. This is a book that changed me.

Worth reading