Dealers, Doctors, and the Drug Company That Addicted AmericaBook - 2018
In this masterful work, Beth Macy takes us into the epicenter of America's twenty-plus year struggle with opioid addiction. From distressed small communities in Central Appalachia to wealthy suburbs; from disparate cities to once-idyllic farm towns; it's a heartbreaking trajectory that illustrates how this national crisis has persisted for so long and become so firmly entrenched.
Beginning with a single dealer who lands in a small Virginia town and sets about turning high school football stars into heroin overdose statistics, Macy endeavors to answer a grieving mother's question-why her only son died-and comes away with a harrowing story of greed and need. From the introduction of OxyContin in 1996, Macy parses how America embraced a medical culture where overtreatment with painkillers became the norm. In some of the same distressed communities featured in her bestselling book Factory Man , the unemployed use painkillers both to numb the pain of joblessness and pay their bills, while privileged teens trade pills in cul-de-sacs, and even high school standouts fall prey to prostitution, jail, and death.
Through unsparing, yet deeply human portraits of the families and first responders struggling to ameliorate this epidemic, each facet of the crisis comes into focus. In these politically fragmented times, Beth Macy shows, astonishingly, that the only thing that unites Americans across geographic and class lines is opioid drug abuse. But in a country unable to provide basic healthcare for all, Macy still finds reason to hope-and signs of the spirit and tenacity necessary in those facing addiction to build a better future for themselves and their families.
"Everyone should read Beth Macy's story of the American opioid epidemic" -- Professor Anne C Case, Professor Emeritus at Princeton University and Sir Angus Deaton, winner of the Nobel Prize in Economics
From the critics
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- America’s approach to its opioid problem is to rely on Battle of Dunkirk strategies—leaving the fight to well-meaning citizens, in their fishing vessels and private boats—when what’s really needed to win the war is a full-on Normandy Invasion.
- If my own child were turning tricks on the streets, enslaved not only by the drug but also criminal dealers and pimps, I would want her to have the benefit of maintenance drugs, even if she sometimes misused them or otherwise figured out how to glean a subtle high from the experience. If my child's fear of dopesickness was so outsized that she refused even MAT, I would want her to have access to clean needles that prevented her from getting HIV and/or hepatitis C and potentially spreading them to others.
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When a new drug sweeps the country, it historically starts in the big cities and gradually spreads to the hinterlands, as in the cases of cocaine and crack. But the opioid epidemic began in exactly the opposite manner, grabbing a toehold in isolated Appalachia, Midwestern rust belt counties, and rural Maine. Working-class families who were traditionally dependent on jobs in high-risk industries to pay their bills — coal mining in southwest Virginia, steel milling in western Pennsylvania, logging in Maine — weren’t just the first to experience the epidemic of drug overdose; they also happened to live in politically unimportant places, hollows and towns and fishing villages where the treatment options were likely to be hours from home.
Dope sick begins in the coalfields, in the hamlet of St. Charles, Virginia, in the remote westernmost corner of the state, largely with the introduction of the painkiller OxyContin in 1996.
You live in a city, maybe you’ve seen the public restroom with a sharps container, or witnessed a librarian administer Narran.
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 dope sickness at any cost.
In the 1820s , one of Boston’s leading merchants masterminded an opium - smuggling operation off the Cantonese coast , spawning millions for Boston Brahmins with the names of Cabot , Delano ( as in FDR ) , and Forbes . This money would go on to build many of the nation’s first railroads, mines, and factories.
In a region where few businesses dare to set up shop because it’s hard to find workers who can pass a drug test, young parents can die of heroin overdose one day, leaving their untended baby to succumb to dehydration and starvation three days later. Appalachia was among the first places where the malaise of opioid pills hit the nation in the mid - 1990s, ensnaring coal miners, loggers, furniture makers, and their kids.
Nationwide, the difference in life expectancy between the poorest fifth of Americans by income and the richest fifth widened from 1980 to 2010 by thirteen years. For a long time, it was assumed that the core driver of this differential was access to health care and other protective benefits of relative wealth. But in Appalachia, those disparities are even starker, with overdose mortality rates 65 percent higher than in the rest of the nation. Clearly, the problem wasn’t just of some people dying sooner; it was of white Americans dying in their prime.
As the Virginia writer John C. Tucker described it in May God Have Mercy: “For a miner who avoids being crippled, burned or buried alive, the usual question is which will give out first — his lungs, his back, or his knees.”
The term “hipster,” in fact, drew from the Chinese opium smoker of the 1800s, who’d spent much of his time smoking while reclining on one hip.
When 20 percent of American soldiers came back from Vietnam with symptoms of heroin dependence, researchers were initially puzzled by the fact that most didn’t go on to become heroin addicts — possibly some theorized, because they returned to spread-out social networks in rural areas and small towns where heroin didn’t exist. It may have helped, too, that many were detoxed in Vietnam before they came home, with the veterans who continued to struggle with addiction typically being the ones who already had drug problems before serving.
Barry Meier’s 2003 book, Pain Killer.
Bill Clinton had predicted that China’s 2001 entry into the World Trade Organization would eventually create a “win - win” for workers. American companies would theoretically be able to export products to China’s growing consumer class, an argument Wall Street championed when stock prices climbed with every new plant - closing announcement. Corporate shareholders and CEOs ate up Clinton’s prediction, a cheery best - case version of Adam Smith’s eighteenth - century “invisible hand.” As the economists described it, Chinese peasants would better their lot by making chairs in factories, while dislocated American workers would retrain for more fulfilling, advanced jobs. But with ill - designed training for displaced Americans based on a lumbering federal program created in the 1960s, the second part of that equation very rarely came to pass.
“But his crime actually required work, so he wasn’t lazy so much as he was desperate.” Like so many of the region’s petty thieves , the arsonist was propelled by fear of becoming dope sick , added another local prosecutor , who told me that 75 percent of all police calls in the county now involved heroin or methamphetamine , or , increasingly , a combination of both .
Before the 2016 election of Donald Trump, that disconnect was maintained by a national media that paid little attention to rural, predominantly white places like St. Charles or Bassett , where the country’s much - hailed economic recovery had definitely not trickled down .
If OxyContin was the new moonshine in rural America, disability was the new factory work. By 2016, for every unemployed American man between the ages of twenty - two and fifty - five, an additional three were neither working nor looking for work.
“I stayed away from my other friends because what do you say when people ask you, ‘How are your kids doing? ’ ”
Nothing’s more powerful than the morphine molecule, and once it has its hooks in you, nothing matters more. Not love. Not family. Not sex. Not shelter.
“If you have a guy doing a chain of bank robberies, you catch him and the robberies stop.” But the problem with heroin is the lure of the morphine molecule. Herr - on is my girlfriend.
“We can’t arrest our way out of this epidemic.” That sentiment illuminated the folly of the decades - long War on Drugs, in which drug users are arrested four times more often than those who sell the drugs.
From California to Florida , the parents behind Relatives Against Purdue Pharma already knew that OxyContin stood out more in rural America’s distressed hollows and towns , where reps could easily target the lowest - hanging fruit — the injured jobless and people on disability , with Medicaid cards .
Lutz thought he had seen everything at George’s Chicken , a plant manned by dislocated factory workers , young locals who lived just north of the poverty line , immigrants who’d managed to land a work visa ( or a passable version of one ) , and an increasing number of workers whom Lutz referred to simply as “ diversion , ” as in : “ Most of the trouble we get around here is from diversion . ” A Virginia Department of Corrections initiative, the program aims to divert nonviolent felons from prison to employment, and to help them gain work experience that will ease the transition back to their communities after their sentences are complete.
On average, every person enrolled in Medicare Part D in Lee County had been handed a whopping 10.23 opioid prescriptions in 2013, compared with just 2.96 in Shenandoah County.
The real perfect storm fueling the opioid epidemic had been the collapse of work, followed by the rise in disability and its parallel, pernicious twin: the flood of painkillers pushed by rapacious pharma companies and regulators who approved one opioid pill after another. Declining workforce participation wasn’t just a rural problem anymore; it was everywhere, albeit to a lesser degree in areas with physicians who prescribed fewer opioids and higher rates of college graduates. As Monnet put it: “When work no longer becomes an option for people, what you have at the base is a structural problem, where the American dream becomes a scam.”
Another trafficking artery was Interstate 95, which connected Baltimore to cities from Miami to Bangor, Maine, with nicknames that transitioned over time, depending on the drug of choice, from Reefer Express to Cocaine Lane to the Heroin Highway, also called the Highway to Hell.
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Macy, along with help from doctors, lawyers, the families of the addicted, and others, shines a very bright and very harsh light on the reality of opioid addiction in America. Every single page is fact-filled, and by the end of the first couple chapters, you'll see the role big pharma has played in turning the opioid use in the United States into a full-blown epidemic. You'll discover how and why our current systems do not work, and you'll discover some of the amazing efforts taking place in small cities and towns (particularly in Appalachia) to help those who are addicted instead of punishing them.
You'll get to know families coping with addiction. Some of these people will remind you of a friend, a family member, or even a neighbor coping with addiction. These days, we all know someone who's addicted, and if you've ever found yourself wondering how or why - why people would choose a drug over a job, a spouse or even a child - this book will help you understand it just a little more clearly.
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