“Dopesick,” Beth Macy’s distress rocket about the opioid crisis, is a ferocious piece of journalism distinguished by unyielding compassion.
She begins her account in 1997, when pharmaceutical giant, Purdue Pharma, makers of the new super painkiller OxyContin, targeted the small towns of central Appalachia. Like pushers with plausible deniability, Purdue’s well-heeled sales team employed go-go promotional techniques to seduce many of the region’s medical professionals, basically pitching the drug to them as a non-addictive cure-all.
But “OxyCoffin,” as it came to be known, “was a new kind of chemical,” as one public health care official put it. It rapidly hooked a portion of the population, further ravaging communities already devastated by factory closings and the downfall of coal mining. It was the beginning of what the author calls “the worst drug epidemic in modern history.”
For over 30 years, southwest Virginia has been Macy’s precinct: mostly “politically unimportant places” exploited by faraway captains of industry. One of America’s best literary, long-form journalists, her two previous, “Factory Man” (2014) and “Truevine” (2016), were set in some of the same locations as “Dopesick.”
Macy started covering the story of opioid addiction in 2012, when the epidemic had “shape-shifted across the spine of the Appalachians” into an amped-up heroin resurgence. Her research found that Connecticut-based Purdue Pharma, owned by the secretive Sackler family, “began by touting OxyContin for all kinds of chronic pain, not just cancer, and claimed it was safe and reliable, with addiction rates of less than 1 percent.”
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In truth, OxyContin’s euphoria “was immediate and intense, with a purity similar to that of heroin.” Studies indicate that the addiction rate was greater than 50 percent.
Crucially, she explains, “Opioid addiction is a lifelong and typically relapse-filled disease. Forty to 60 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.”
Among “Dopesick’s” heroic figures is Dr. Art Van Zee, a disheveled but committed “country doctor.” In the late ’90s, Dr. Van Zee made two major requests of Purdue’s leadership: “stop the aggressive marketing of OxyContin for the treatment of non-cancer pain and reformulate the drug to make it less prone to abuse.”
Purdue stonewalled, claiming, “The issue is drug abuse, not the drug.” As a result, the corporation was hit with an increasing number of lawsuits, culminating in a successfully prosecuted federal misbranding charge that led to a $634.5 million fine in 2007. (According to the Boston Globe, Purdue and the multi-billionaire Sacklers currently have 400 lawsuits consolidated against them in federal court.)
OxyContin was finally reformulated as abuse-resistant in 2010; getting prescriptions became more of a challenge; users, who will do anything to avoid becoming “dopesick,” slang for suffering the effects of withdrawal, transitioned to heroin, which was cheaper and easier to obtain.
“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 up in your arm.” Another young addict, pleading for exorcism, screams, “It’s like a demon, and I want to get it out.”
“Dopesick” is framed by the crushing testimonies of these victims and their “utterly worn out,” grieving parents, who are victims, too. Take, for instance, Tess, a potentially gifted young poet, whom Macy profiles in-depth as she spirals into prostitution and total ruin.
The writer develops personal relationships with several of her subjects. “Having grown up in an alcoholic household,” Macy confides, “I knew what it felt like to live on the periphery of addiction. … Being with Tess sometimes brought up memories of a much darker time. … There were times when journalistic boundaries blurred.”
Just as this dispatch threatens to collapse under a burden of tragedy, and a tough crusader like Macy appears on the verge of becoming overwhelmed, she pivots “Dopesick” into a first-rate true crime narrative, in which she retraces the hijinks of “commuter-dealers” along Interstate 81, the so-called “Heroin Highway,” and recalls the exploits of ATF agent Bill Metcalf as he stalks Ronnie “D.C.” Jones, the regional kingpin who transports heroin “re-rocked” into hockey-puck shapes, “camouflaged inside Pringles cans.”
“Dopesick” is at its best when Macy addresses the urgent matter of treatment, which makes this book essential reading. She’s skeptical of faith-based, abstinence-only treatments, though not dogmatically so. She’s primarily an advocate for medication-assisted treatment — “the gold standard for opioid treatment”—yet emphasizes, there’s “no perfect chemical fix.”
Macy rejects the notion that addiction is a “moral failure” that must be punished, scoffing freely at old-school, tough-on-crime advocates like Attorney General Jeff Sessions. Among “Dopesick’s” more optimistic developments, she encounters several law enforcement officials who take the more sensible position that, “We can’t arrest our way out of this epidemic.” She points to the success of Portugal, “which decriminalized all drugs, including cocaine and heroin, in 2001, adding housing, food and job assistance — and has the lowest drug-use rate in the European Union.”
When DEA agents are advised to wear hazmat suits to protect themselves from fentanyl, which is up to 50 times stronger than heroin, and the even more potent carfentanil, the ominous science fiction world of what-comes-next is already here.
“Until we understand how we reached this place,” the author of “Dopesick” believes, “America will remain a country where getting addicted is far easier than securing treatment.”