Reviewed books: "Dopesick: Dealers, Doctors, and the Drug Company That Addicted America" by Beth Macy & "Pain Killer: An Empire of Deceit and the Origin of America’s Opioid Epidemic" by Barry Meier
Dope-wasted in Lee County, Virginia, a disconsolate farmer told his physician that the powerful prescription drug OxyContin had destroyed his life. He had lost everything. Another Virginian, an unemployed miner, admitted OxyContin had become more important than friends, family, children or church: “It became my god.”
OxyContin — the lucrative product of Purdue Pharma of Connecticut — was touted as a pain-relief pill with a time-release mechanism for which it was difficult if not impossible to create addiction. Yet, early on even those using the medication as directed experienced withdrawal symptoms when they stopped taking it. Soon, seekers intent on circumventing medicinal guidelines discovered the drug could be tampered with, giving immediate access to oxycodone — the potent narcotic within. Purdue knew all of this but did nothing, reaping profits rather than admitting to unleashing a pandemic.
In “Dopesick,” Beth Macy offers a trenchant account of the epidemic raging throughout the U.S. In alarming detail, she portrays the anguish and deadly consequences of the worst wave ever of chemical addiction. One hundred to 200 people die each day from overdoses.
OxyContin debuted in the mid-1990s amid a promotional campaign abetted by a panoply of indoctrinated sales representatives. Purdue employed corporate propaganda and lavished gifts in an all-out effort to entice physicians to ply patients with their “wonder” product. Commissions earned by corporate reps were enormous and dampened any suspicions some might have about the dangers lurking in what they were pushing. Doctors were told OxyContin could safely alleviate all sorts of minor as well as major pains.
Not so. As overuse and illicit use of Oxy proliferated, for many it proved to be a gateway to dependence, and a costly, demoralizing and potentially terminal heroin habit. For years, prescriptions were abused or diverted to the chemical bazaar on the streets. Some conscientious doctors had been threatened with violence if they stopped prescribing. In economically depressed areas such as Appalachia, addiction exploded. Opportunistic “Pill Mills” sprouted, inundating already troubled communities with alarming quantities of drugs. Heroin is a cheaper — albeit riskier — alternative since its contents cannot be assured. It’s not uncommon for heroin to be laced with fentanyl, an extremely powerful opioid that can make a concoction lethal for an unsuspecting customer. Rising cocaine and methamphetamine consumption also contributes to the carnage.
We’ve known for centuries that the ravenous pull of narcotics can be overwhelming once the hook of addiction settles in. Macy writes: “Not love. Not family. Not sex. Not shelter. The only relationship that matters is between you and the drug.”
Communities once thought immune to the ravages of the drug scene have found there is no asylum. The fiasco’s reach afflicts all classes and ethnicities. But, as in Appalachia and parts of New England where joblessness and poverty are ubiquitous, depressed towns such as Aberdeen in Washington have been especially hard hit.
Grappling with addiction problems: The nation is in the middle of a epidemic of opioid drug abuse. What are local, state and federal officials doing to address the crisis?
“In terms of pure narcotic firepower, OxyContin was a nuclear weapon.” So writes New York Times journalist Barry Meier in his first book “Painkiller,” published in 2003. “I was the first one to tell the story of OxyContin, its maker Purdue Pharma and the company’s wealthy and secretive owners, the Sackler family.” Calling the calamity “an era of chaos,” Meier felt morally compelled to revisit the story. OxyContin sparked “the most devastating public health disaster of the twenty-first century.”
Opium’s soothing effects and dangers were learned long ago. The opium poppy grows well in many locales. There are still poppies in gardens of the American South, descendants of those grown for opium and morphine for wounded Confederate combatants. These substances were provided to the wounded of both sides. In the Civil War’s aftermath, it was evident that thousands of vets were addicted. It was called the Soldier’s Disease. By the end of the 19th Century, heroin derived from morphine had arrived. For a time, it was readily available without a prescription at the local pharmacy — good for cough, colicky babies and other ailments. By the 20th century concern mounted nationally and globally regarding narcotics and addiction. In the U.S., the Harrison Act passed in 1914; it was the opening shot in what would become the protracted War on Drugs.
Since the 1990s, more than 700,000 Americans have overdosed and died. In 2017, overdose deaths totaled 72,000, the highest yearly tally so far, due mostly to opioids. According to Macy, there are more than 2 million people in this country with opioid use disorders. Between 2006 and 2015, the makers of various opioids spent a whopping $880 million on lobbyists and political contributions. In a rare act of bi-partisanship, Congress recently passed the Opioid Crisis Response Act, which will funnel more money to address the disease, but the act falls short of the magnitude of need. Sen. Elizabeth Warren (D-Massachusetts) and Rep. Elijah Cummings (D-Maryland) are sponsoring a bill — modeled on Congress’ past response to HIV/AIDS — that would provide greater funding over a longer period.
Another troubling aspect of the epidemic is described by journalist Brian Goldstone in his essay “The Pain Refugees” (Harper’s Magazine, April, 2018). Sufferers with legitimate chronic pain can be cut off suddenly from medication when clinics and physicians — who are duly unsettled by the addiction debacle — decide to reduce or stop opioid prescriptions. Genuine persistent pain is “misunderstood, misdiagnosed, and undertreated.” These individuals become caught in an agonizing dilemma. Goldstone tells of one such patient cut off from medication who subsequently torched a doctor’s home before killing himself.
A variety of humane treatment approaches are required. While abstinence can prove successful in some cases, medication-assisted treatment (MAT) and harm reduction have great potential to help ease the misery of addiction and create salubrious options for recovery. Last year, according to Macy, Seattle followed an example set in Vancouver and became the first in this country to adopt a safe-injection program “for users of heroin and other illegal drugs, even though it was still illegal under federal law.” Evergreen Treatment Services has begun “Treatment in Transit,” a mobile program that provides swift professional intervention to users in varying degrees of crisis. Much more must be done.
The amalgam of OxyContin, heroin, meth, crack and myriad narcotics constitutes a poisonous brew that undermines and ends too many lives. Natural drugs and synthetic pharmaceuticals are integral to human history and contemporary society. Writes Macy: “Until we understand how we reached this place, America will remain a country where getting addicted is far easier than securing treatment.”
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