Cover of 'Dopesick: Dealers, Doctors, and the Drug Company that Addicted America' by Beth Macy. Graphic: Little, Brown and Company

By Jessica Bruder
31 July 2018

(The New York Times) – In 2000, a doctor in the tiny town of St. Charles, Va., began writing alarmed letters to Purdue Pharma, the manufacturer of OxyContin. The drug had come to market four years earlier and Art Van Zee had watched it ravage the state’s poorest county, where he’d practiced medicine for nearly a quarter-century. Older patients were showing up at his office with abscesses from injecting crushed-up pills. Nearly a quarter of the juniors at a local high school had reported trying the drug. Late one night, Van Zee was summoned to the hospital where a teenage girl he knew — he could still remember immunizing her as an infant — had arrived in the throes of an overdose.

Van Zee begged Purdue to investigate what was happening in Lee County and elsewhere. People were starting to die. “My fear is that these are sentinel areas, just as San Francisco and New York were in the early years of H.I.V.,” he wrote.

Since then, the worst drug crisis in America’s history — sparked by OxyContin and later broadening into heroin and fentanyl — has claimed hundreds of thousands of lives, with no signs of abating. Just this spring, public health officials announced a record: The opioid epidemic had killed 45,000 people in the 12-month span that ended in September, making it almost as lethal as the AIDS crisis at its peak.

Van Zee’s prophecy and other early warnings haunt the pages of Dopesick: Dealers, Doctors, and the Drug Company That Addicted America, a harrowing, deeply compassionate dispatch from the heart of a national emergency. The third book by Beth Macy — the author, previously, of Factory Man and Truevine — is a masterwork of narrative journalism, interlacing stories of communities in crisis with dark histories of corporate greed and regulatory indifference.

Macy began investigating the drug epidemic in 2012, as it seeped into the suburbs around her adopted hometown, Roanoke, Va., where she worked for 20 years as a reporter at The Roanoke Times. From there, she set out to map the local onto the national. “If I could retrace the epidemic as it shape-shifted across the spine of the Appalachians, roughly paralleling I-81 as it fanned out from the coalfields and crept north up the Shenandoah Valley, I could understand how prescription pill and heroin abuse was allowed to fester, moving quietly and stealthily across this country, cloaked in stigma and shame,” she writes.

The word “allowed” is a quiet curse. The further Macy wades into the wreckage of addiction, the more damning her indictment becomes. The opioid epidemic didn’t have to happen. It was a human-made disaster, predictable and tremendously lucrative. At every stage, powerful figures permitted its progress, waving off warnings from people like Van Zee, participating in what would become, in essence, a for-profit slaughter. Or as Macy puts it: “From a distance of almost two decades, it was easier now to see that we had invited into our country our own demise.”

Particularly grotesque is the enthusiasm with which Purdue peddled its pills. In the first five years OxyContin was on the market, total bonuses for the company’s sales staff grew from $1 million to $40 million. Zealous reps could earn quarterly bonuses as high as $100,000, one former salesperson told Macy, adding, “It behooved them to have the pill mills writing high doses.” Doctors were plied with all-expense-paid resort trips, free tanks of gas and deliveries of Christmas trees and Thanksgiving turkeys. There were even “starter coupons” offering new patients a free 30-day supply. As sales rocketed into the billions, noxious side effects began to emerge. Chief among them was the creation of a legion of addicts who, desperate to stave off withdrawal, made the leap to cheap heroin and, later, fentanyl. (“Four out of five heroin addicts come to the drugs … through prescribed opioids,” Macy notes pointedly.) [more]

The Worst Drug Crisis in American History

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