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

by Beth Macy

Compared with the New Zealand hospitals where Davis worked earlier in his career—often prescribing physical therapy, anti-inflammatories, biofeedback, or acupuncture as a first-line measure—American insurance companies in the age of managed care were more likely to cover opioid pills, which were not only cheaper but also considered a much quicker fix.

Little did Davis or the other ER docs understand that the routine practice of sending patients home with a two-week supply of oxycodone or hydrocodone would culminate by the year 2017 in a financial toll of $1 trillion as measured in lost productivity and increased health care, social services, education, and law enforcement costs.

But the results of that investigation would end up sealed in the Senate Finance Committee’s office, where they remain buried, despite periodic calls for their disclosure.

But why?

Alerts—Wood had been sending out regular compilations of OxyContin-related news articles and overdose statistics via email to law enforcement agents, prosecutors, and other interested parties. Recipients who spotted any OxyContin news in their localities should “let me know,” Wood urged at the top of every update, which Van Zee nicknamed the Wood Reports. “Never assume I already know!” Wood enthused.

This book is so weirdly written.

Was it really possible the small-town lawyers had compiled enough evidence to indict both the company and its top executives on a host of felony charges, not just for misbranding the drug but also for mail fraud, wire fraud, and money laundering? It seemed so, according to a memo written by the federal prosecutors to Brownlee at the time.

I don't know, this is the first time you've mentioned money laundering and fraud. This book is really not very good.

Another fact highlighted the claim sales reps made to some doctors that oxycodone was harder to extract from OxyContin for IV use than other pain medications—when Purdue’s own study showed that a drug abuser could recover 68 percent of the drug from a single pill.

You've repeated this fact 3 times now and this is the first time it's been given any context.

Mortimer may have inherited his toughness from his older brother, Arthur,

Weird use of "inheritance" here.

Bickel went on to scientifically quantify the indifference of the typical opioid user, comparing the average nonaddicted person’s perception of the future—calculated to be 4.7 years—against an addicted user’s idea of the future, which is just nine days.

But what was the addicted user's perception of time before they started using?

who leads support groups for users taking the maintenance drug buprenorphine, or bupe (more commonly known by the brand name Suboxone).

Which you've mentioned before, so why not put the explanation there?

Unlike in the coalfields, where addicted users quickly resorted to thievery to fund their next fix, in the suburbs the epidemic spread stealthily because users had ready access to money. Many of them were teenagers selling

There was no widespread panic, because the teenagers and young adults had the money to keep their addictions at a low boil,

Literally saying the same thing twice on the same page.

Victoria (not her real name), who tried her first OxyContin pill her senior year after a friend ratted her out to school officials for smoking weed.

How do those two things relate to each other?

they also allowed a person to drink alcohol for hours on end without passing out.

YOU SAID THIS ALREADY. Jesus, this book is so badly written.

Like many black heroin users and dealers, D.C. pronounced his product “herr-on,” as in: None of my friends or close associates does herr-on. I wouldn’t even know where to put the needle.

??? How class that quote explain anything? I'm beginning to really dislike this book.

briefly took buprenorphine (more commonly known by the brand name Suboxone),

I KNOW. YOU KEEP REPEATING IT.

medication-assisted treatment, or MAT,

Why explain MAT now when you've been using the contraction already for ages? Why is this book so terribly written?

Harvard researcher John Kelly told me. “What happens is, it takes about eight years on average, after people start treatment, to get one year of sobriety…and four to five different episodes of treatment” for that sobriety to stick. And many people simply don’t have eight years.

Or the money for it.

Subutex is the monoproduct version of buprenorphine; lacking the added naloxone blocker,

You literally said this 7 pages ago. Is this book just, like, a bunch of previous articles mashed together and barely edited for repetition or something?

as liberally as doctors could prescribe opioid painkillers up through 2016, they remained regulated as hell when it came to treating opioid addiction with methadone and buprenorphine—

it takes the typical opioid-addicted user eight years—

Already mentioned, in chapter 8.

Danny Gilbert said. “I think it’s asinine to tell a drug addict you’ve got to be clean before you can come to my facility.” (In the treatment center’s defense, it couldn’t afford to have medical staff on hand to supervise detox and/or medications, Jamie said.)

Campbell, who documented Kolb’s work, has written: “Perhaps the day will come when more sensible views prevail—that relapse is the norm; that drug addiction should be treated as a chronic, relapsing problem that affects the public health; and that meeting people’s basic needs will dampen their enthusiasm for drugs.”

“You can fix it upstream, when it’s affordable, or you can wait till they present back in the ER with stage-four cancer or cirrhosis, and they still need extended hospital stays,” Tyson said. “It’s a drain on the system no matter what, so why can’t we fix it upstream?”

But part of the problem now is, we’re so hopeless…that we don’t try very hard.”

Dr. Hughes Melton, set up practice in 2000 because he wanted to treat the underserved. Melton was helping direct the state’s response to the opioid crisis; among his initiatives was a new statewide push for syringe exchange and some tighter controls on MAT prescribing. His wife, Sarah Melton,

Again, both of these people have already been introduced.

as an individual disease phenomenon or a moral failing, the easier it is to obfuscate and ignore the social and economic conditions that predispose certain individuals to addiction,” Avruch said.

The fix isn’t more Suboxone or lectures on morality but rather a reinvigorated democracy that provides a pathway for meaningful work, with a living wage, for everybody.

“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.”

ill-designed training for displaced Americans: Trade Adjustment Assistance is outdated, with poor participation and efficacy, according to Beth Macy, “The Reality of Retraining,” Roanoke Times, April 22, 2012.

Gotta love it when someone cites themselves.

Sister Beth Davies was a plucky activist nun who

Why "was"? She's still alive, I just checked.

We can see in the shifting data what works. We just aren’t doing enough of it. If you’re addicted, where you live in the United States can determine whether you live or die.