According to politicians and the media, such as award-winning journalist Beth Macy, we are in the midst of the worst drug crisis in American history. Sparked first by oxycodone and broadening into heroin and fentanyl, opioid addiction is indeed ravaging communities across the nation, largely in economically depressed areas in Appalachia as well as the Midwest and Great Lakes regions. Ms. Macy painstakingly details the misery of those ravaged communities and identifies reasons for the addiction crisis in her book Dopesick: Dealers, Doctors, and the Drug Company that Addicted America.

Chronicling the Crisis

After the Civil War, Southern whites had the highest opium addiction in the country, possibly the world. Morphine addiction was a scourge in the 1930s. In 1970 and 1971, more adolescents in the metropolitan area of New York died of heroin overdoses than any other cause. In the 1980s, the crack cocaine epidemic eviscerated inner-city communities from Los Angeles to New York, driving the most massive wave of imprisonment in U.S. history. Even if the current crisis is the worst (and the numbers make a good case), we’ve been here before in other social iterations.

It took Ms. Macy 5 years to complete her book, and her journalistic skills are in full display as she chronicles the opioid addiction crisis that first caught her attention as a reporter for The Roanoke Times. She begins in the coal fields in a remote area of Virginia and marches on through backwater towns in Appalachia. Her interviews are compelling, and she uses them as the substance and heartbeat of the narrative. People down on their luck trust Ms. Macy, and they open up about the pain of seeing loved ones taken from them by drug overdose.

A Zero-Sum Game Approach

As the title implies, Ms. Macy identifies those she considers the villains in this tragedy: dealers, doctors, and a drug company (namely Purdue Pharma, the producer and distributor of OxyContin).

In a chapter aptly named, “The Corporation Feels No Pain,” Ms. Macy does what amounts to a psychological autopsy of the 2007 John L. Brownlee federal case against Purdue Pharma in a plea agreement under which the company admitted fraudulently marketing OxyContin for 6 years, contending that its drug was less likely to abuse than faster-acting versions of the drug. The presentencing phase, where families who had lost loved ones to overdoses read from a 50-page list of dead names, was very emotional. Two of these family members, Ed Bisch and Lee Muss, lost sons to overdose and founded a nonprofit organization, Relatives Against Pharma Purdue.

Not a Simple Issue

According to a 2016 national survey by the Substance Abuse and Mental Health Services Administration, about 87 million U.S. adults used a prescription opioid sometime during the previous year, and only about 2% developed a “pain reliever use disorder,” which includes behaviors ranging from overuse to overt addiction.

Moreover, it’s easy to blame unscrupulous doctors, who, according to the author, prescribe pain pills for free meals or other perks, for the addiction crisis. It’s even easier to lay convict a pharmaceutical company that puts profit over societal well-being, again according to the author’s perspective. However, this opioid overdose crisis is multifactorial, and one of the book’s shortcomings is putting emotion over subjectivity.

“The opioid crisis has killed far too many young Americans…. Ms. Macy’s fine book has documented the tragedy on both personal and societal levels.”

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For instance, studies reported in the media have indicated there is a direct correlation between the factories and jobs that went overseas, resulting in unemployment, and the worsening of the opioid crisis. A timeline illustrates that it began when whole swaths of the country, especially the upper Midwest, were gutted as industries moved overseas and China exported its excess capacity to the United States. In short: Despair and hopelessness, and unemployment, represent a fertile ground for those seeking the euphoric escape of opioids.

Ms. Macy also delves into the sociopolitics of the addiction crisis. She points out that in her home, Roanoke, Virginia, “No one was paying attention to heroin arrests when they only concerned the children of inner-city black families. When white people in the suburbs started using and dying, the media took notice.” Then she turns to what she refers to as the inadequate action of the U.S. Food and Drug Administration, the shortage of affordable drug treatment facilities, and the role of prescription drugs as a gateway to heroin.

There’s a lot of blame, and Ms. Macy does a good job at finding those to blame. Much of her book is bleak. Riveting first-person stories from distressed small communities to wealthy suburbs illustrate the tragic depth of this national crisis and why it has persisted for so long.

Unintended Consequences

There are also unintended consequences in response to the opioid-overdose epidemic, an issue not addressed in Dopesick. The Surgeon General and the Centers for Disease Control and Prevention have issued strict guidelines for opioid prescribing. Although most guidelines exempt patients with cancer, there has been a marked decrease in the use of morphine for patients with cancer and, more alarming, a shortage of parenteral opioids for the treatment of cancer pain.

The opioid crisis has killed far too many young Americans, leaving families and communities in perpetual mourning. Ms. Macy’s fine book has documented the tragedy on both personal and societal levels. This book walks a fine line between hard journalism and polemic, but its strengths far outweigh its flaws. This book is recommended for readers of The ASCO Post. ■