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

by Beth Macy

As journalist Sam Quinones theorized in his 2015 book, Dreamland, maybe the addiction-prone people who would have succumbed to alcohol addiction in late middle age—had opiates not appeared—were the same people who were now prematurely dying of heroin in their early adulthood.

“What you sell up in the city, you can double down [your profits] here,” said an investigator on the case. “You don’t have the competition in the small towns, and you don’t have people shooting at you.”

“The drug dealer’s dilemma is always: How do I market myself and remain invisible simultaneously?”

“You can’t blame Ronnie for everything,” Marie told me. “We’re the ones who stuck the needle in our arms.

By arresting Jones, Metcalf was not only doing his job; he was atoning for the sins of his father. His wife, though, was starting to complain about his obsession with Jones—he routinely worked till midnight or later, leaving her stranded at home with their four kids. With every new conspiracy chart, he promised he’d request a desk job “after this case.”

In 2013, Jesse’s was one of 8,257 heroin-related deaths in the nation, by far the majority of them young men, an increase of a staggering 39 percent over the previous year.

It would be four more years before the FDA would ask a pharmaceutical company to withdraw an opioid pain medication because of its potential for abuse—Opana ER, and not until 2017—and by then the annual death toll for drug overdose had climbed to 64,000.

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

“Most human organizations that fall short of their goals do so not because of stupidity or faulty doctrines, but because of internal decay and rigidification. They grow stiff in the joints. They get in a rut. They go to seed.”

“We’ll score a huge drug bust that we’ve been working on for maybe a year, and all that does is create a vacuum in the market that lasts maybe five to seven days,”

But Frederick Douglass had it right when he said, “Power concedes nothing without a demand.”

By the end of 2015, fifty-one thousand more Americans were dead of drug overdose—a thousand more than died from AIDS in 1995, the peak year.

Overprescribing among doctors specializing in addiction treatment was rampant, according to several rural MAT patients I talked to who unpacked how Suboxone doctors prescribed them twice as much of the drug as they needed, fully knowing they would sell some on the black market so they could afford to return for the next visit.

Critics compared the British makers of Suboxone with Purdue Pharma because of their zest for market saturation and noted that clinic operators have a financial incentive not to wean someone off the drug.

It had been that way since the birth of methadone, a synthetic painkiller developed for battlefield injuries that was discovered in—or rather, recovered from—German labs shortly after World War II.

American researchers soon learned that methadone quelled opioid withdrawal, but the Federal Bureau of Narcotics (precursor to the DEA) was rabidly against using drugs to treat drug addiction.

Such controversies continue to this day and illustrate the blurry line between lethal and therapeutic, between the control of pain and suffering and the pleasure of a cozy high.

“There’s a reason why some people think NA and AA are cults,” said Mitchell, who used methadone, needle-exchange programs, and a secular support program called LifeRing to treat her heroin addiction. “They can’t take in any other information because it throws a different light on their own personal recovery.”

In The Odyssey, Homer described a drug that would “lull all pain and anger and bring forgetfulness of every sorrow.” A Victorian poet said taking opium felt as if his soul was “being rubbed down with silk.”

“I’ve read The New Jim Crow twice,” Ronnie said. He’d also read lawyer Bryan Stevenson’s majestic Just Mercy, a memoir about his work against the racial bias and economic inequities inherent in the criminal justice system, which included efforts on behalf of falsely accused death row inmates.

one that fostered the shift in public spending from health and welfare programs to a massive system of incarceration, with a fivefold increase in imprisonment and corrections spending that soared from $6.9 billion in 1980 to $80 billion today.

Doctors didn’t trust people of color not to abuse opioids, so they prescribed them painkillers at far lower rates than they did whites.

Put another way: By 2014, while young whites were dying of overdose at a rate three times higher than they did in 2002, the death rate for people of color was relatively unchanged.

his 2017 book, Locked In, Fordham Law School professor John F. Pfaff argues that it’s politically safer and economically cheaper to charge a person with a felony, which sends them to prison—on the state’s dime—than it is to incarcerate someone locally or put them on probation, paid for by local budgets.

At the time, he owed $5,000 in medical bills and $20,000 in court fines and restitution. Jurisdictions across the country increasingly inhibit ex-offenders’ ability to reenter society by assessing hefty court fines and fees, requiring them to pay thousands or face more jail time.

Kolb changed his beliefs about addiction after his colleagues proved to him that “normal” people, including the 10 to 15 percent of patients who were health care professionals, could become addicted, too, if they were opioid-exposed.

Did a president who bragged about winning a swing state—telling the president of Mexico, “I won New Hampshire because New Hampshire is a drug-infested den”—win because voters genuinely thought he could fix it, or because too many people were too numbed out to vote?

Finding a balance between treating and perpetuating addiction had been pursued in the United States since the 1800s, when doctors used morphine to wean patients from laudanum, then later used heroin to get patients off morphine. Soldier’s disease had sparked a period of stern prohibition in the Harrison Act and, eventually, the War on Drugs.

“There’s nothing scientific at all about twenty-eight days of [residential] treatment,” Loyd said of the kind heralded in movies and on reality TV. “It takes the frontal lobe, the insight and judgment part that’s been shut down by continued drug use, at least ninety days just to start to come back online and sometimes two years to be fully functioning.”

Ronnie Jones was right again: Shit had not stopped at all, but with continued regional-media cutbacks—the Roanoke Times was down to just a single Roanoke Valley police reporter, and there were now sprawling heroin-ring prosecutions that received zero media attention—the public was left to believe that it had.