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

by Beth Macy

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.

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.

No one in federal government would take seriously the concerns of a country doctor until opioid abuse took hold in the cities and suburbs. “If it’s a bunch of poor folks up in the mountains, it doesn’t affect them personally,” he said.

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. “And we’re prescribing to ever- and ever-younger children, some kids as young as two years old,” said Lembke, the addiction researcher. “It’s just nuts. Because if we really believe that addiction is a result of changes in the brain due to chronic heavy drug exposure, how can we believe that stimulant exposure isn’t going to change these kids’ brains in a way that makes them more vulnerable to harder drugs?” she added.

By 2012, fully one-third of his campers were on meds, mostly ADHD medications, antidepressants, and antipsychotics. “What happens is, we’ve changed our whole culture, from one where kids don’t take pills at all to one where you’ve got a third or more of kids who are on pills to stay well because of what are believed to be chronic health conditions,” Burton said. “They get so used to taking pills that eventually they end up using them for a recreational high.” So it went that young people barely flinched at the thought of taking Adderall to get them going in the morning, an opioid painkiller for a sports injury in the afternoon, and a Xanax to help them sleep at night, many of the pills doctor-prescribed. So it went that two-thirds of college seniors reported being offered prescription stimulants for nonmedical use by 2012—from friends, relatives, and drug dealers.

Among Bassford’s favorite Garfield quotes: “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.”

In rural America, where overdose rates are still 50 percent higher than in urban areas, the Third World disaster imagery is apt, although the state of health of RAM patients was actually far worse. “In Central America, they’re eating beans and rice and walking everywhere,” a volunteer doctor told the New York Times reporter sent to cover the event. “They’re not drinking Mountain Dew and eating candy. They’re not having an epidemic of obesity and diabetes and lung cancer.”

“You’ve got too many leaders just not responding to problems,” Stevenson said. “Think about with HIV, with smoking, with Zika, you had this energetic leadership from people who were saying, ‘We’re going to win this.’ The mind-set of ‘This is unacceptable’ has to be brought into the way we think about addiction and the opioid epidemic. But part of the problem now is, we’re so hopeless…that we don’t try very hard.”