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

by Beth Macy

(Although the word “opiate” historically refers to drugs derived from the opium poppy and “opioid” to chemical versions, the now more widely accepted term “opioid” is used in this book for both forms of painkillers.)

Drug overdose had already taken the lives of 300,000 Americans over the past fifteen years, and experts now predicted that 300,000 more would die in only the next five. It is now the leading cause of death for Americans under the age of fifty, killing more people than guns or car accidents, at a rate higher than the HIV epidemic at its peak.

Because 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.

“We were impressionable young doctors, fresh meat with a lifetime of prescribing ahead, and they flocked to us,” he told me. “They took us golfing. It was standard to have a free lunch most days of the week because the drug companies were always buying, then you’d have a short educational seminar going on [about their drugs] while you ate.”

Jobs in coal mining, once the number-one industry in central Appalachia, were cut in half between 1983 and 2012,

In an Appalachian culture that prides itself on self-reliance and a feisty dose of fatalism, peddling pills was now the modern-day moonshining. Some passed the trade secrets down to their kids because, after all, how else could they afford to eat and pay their bills?

“At the end of your journey, you’re not going after drugs to get high; you’re going to keep from being sick.”

In a place where people had once left keys in cars and didn’t bother locking their homes, a forty-one-year-old resident told the Globe reporter, he now kept a loaded gun inside the house. A quarter of his former high school classmates had developed addictions to Oxy. Van Zee’s co-worker distributed copies of the Boston Globe story to others in the clinic, marveling: “That’s us!”

from Maine, it dawned on Van Zee and his wife that they were not alone.

Forty to 60 percent of addicted opioid users can achieve remission with medication-assisted treatment, according to 2017 statistics, but sustained remission can take as long as ten or more years. Meanwhile, about 4 percent of the opioid-addicted die annually of overdose.

It would not come to light for nine more years that FDA regulators and Big Pharma executives had been quietly holding private meetings at expensive hotels at least annually since 2002,

The meetings led to the development of “enriched enrollment,” an aptly named practice that allowed drug companies to weed out people from their studies who didn’t respond well to their drugs, therefore tipping the balance toward FDA approval of new drugs—and away from science.

It might have been easier If OxyContin swallowed the mountains, and took The promises of tens of thousands of young lives Slowly, like ever-encroaching kudzu. Instead, It engulfed us, Gently as napalm Would a school-yard. Mama said As hard as it was to bury Papa after the top fell in the mine up Caney Creek, it was harder yet to find Sis that morning cold and blue, with a needle stuck up her arm. Top of her class, with nothing but promise ahead until hi-jacked by the torment of needle and spoon.

“Fifteen rehabs had not convinced Spencer that it was not in his best interests to get high. It took time in jail and a friend dying before he could decide he wanted to change.”

If OxyContin was the new moonshine in rural America, disability was the new factory work.

Disability claims nearly doubled from 1996 to 2015. The federal government spent an estimated $192 billion on disability payments in 2017 alone, more than the combined total for food stamps, welfare, housing subsidies, and unemployment assistance.

“If you’re addicted to painkillers, you become so lethargic you can hardly function. But meth keeps you going if you need to run the streets to go get your next dose of heroin or pills, to keep you from getting sick. It allows you to function. There’s a reason they call it ‘high-speed chicken feed.’”

But I had failed, just as the police and parents had, to connect young adults like Spencer to the rural addicted, even though Spencer told me he’d come to his heroin addiction the same way they had—through prescription opioid pills.

Our culture seems to excuse drug- and other risk-taking in white middle- and upper-middle-class kids, especially young men. The same liberties, when taken by rural poor whites or people of color—wherever they live—come across as more desperate, born of fundamental wants or needs that can’t be satisfied. But as I’ve come to learn, gauged strictly by drug use, there is no less urgency and desperation in America’s middle and upper classes today.

“When we first started doing it, we didn’t worry about getting caught because cops didn’t know what heroin even looked like. “One time I got pulled over, I had ten bags at my feet, and they didn’t know what it was so they didn’t look at it.”

“The issue is Interstate 81,” Wunsch told me. “The OxyContin epidemic spread from East Nowhere Jesus all up and down the Appalachian chain by way of the interstate, and suddenly my own kids were coming home from parties,” talking about pills being passed around in bowls.

Back then you could maintain that way because the drug’s potency was low—3 to 7 percent, compared with 40 to 60 percent today—and the police paid little attention, since white kids in the suburbs weren’t dying or nodding out in the football bleachers.

Almost to a person, the addicted twentysomethings I met had taken attention-deficit medication as children, prescribed pills that as they entered adolescence morphed from study aid to party aid.

Between 1991 and 2010, the number of prescribed stimulants increased tenfold among all ages, with prescriptions for attention-deficit-disorder drugs tripling among school-age children between 1990 and 1995 alone.

Lembke pins the opioid epidemic not just on physician overprescribing fueled by Big Pharma but also on the broader American narrative that promotes all pills as a quick fix.

Lembke is equally leery of benzodiazepines (prescribed for anxiety) and stimulants, both of which make teenagers—especially underchallenged kids who aren’t engaged in meaningful activities—dangerously comfortable with the notion of taking pills. Any pills.

Critics pointed out the inherent conflicts of a regulatory agency that both approves drugs and is then supposed to function as a watchdog over those drugs.

“The most damaging thing Purdue did, it wasn’t the misbranding of OxyContin they got in trouble for. It was that they made the medical community feel more comfortable with opioids as a class of drugs,” Kolodny told me. “But had the FDA been doing its job properly with regards to opioids, we never would have had this epidemic.”

Americans, representing 4.4 percent of the world’s population, consume roughly 30 percent of its opioids.

“If you ask me, OxyContin is the sole reason for all this heroin abuse. If I had the choice between heroin and Oxys, I would choose Oxys.…With pills, you always knew what you were getting.”