'Dopesick': Nonfiction

The 2018 book about the opioid epidemic hasn't lost any of its relevancy.

I usually enjoy learning new words, but not the one I learned while reading “Dopesick”: iatrogenic. It means caused by doctors or medical treatment or procedures.

Beth Macy’s book, a years-long work of investigative journalism that tells the story of the opioid epidemic from its epicenter in Virginia, argues convincingly and shatteringly that the epidemic is to a significant degree an iatrogenic event, exacerbated by economic and societal factors.

Though “Dopesick” was published in 2018, it remains heart-breakingly relevant. In fact, I pulled it from my to-read list this month partly because of the CDC’s Nov. 3 announcement that it had updated its guidelines for prescribing opioids for pain. In “Dopesick,” pain prescriptions pave the path to addiction for far too many people. And while I was finishing the book this week, Walmart agreed to pay $3.1 billion to settle thousands of lawsuits over its pharmacies’ roles in the opioid crisis.

The power of Macy’s book lies in the human connection, in her stories of people who find themselves destroying their own lives in pursuit of what she calls the morphine molecule: high school standouts who never make it to college, a farmer in his 70s who loses everything he worked his whole life for, a mother who uses the hours her kids are in school to make drug-buying trips, a doctor who manipulates his own peers.

Then there are those whose lives orbit addiction: grieving parents-turned-activists, doctors, prosecutors, police. Macy even interviews a drug trafficker imprisoned for ruining countless lives; his product scared him to the point where he wouldn’t use it, but he shows no remorse for contributing to others’ misery.

The shadow behind all these stories is, of course, Purdue Pharma, the company that developed OxyContin. Macy exposes how relentlessly the company marketed the drug to doctors and pharmacists even as it became clear that OxyContin was killing people and communities. She reports how company lawyers held fast to their stance that “the enormous benefits of OxyContin far outweigh its risks.”

***

Are people with addictions better served by being imprisoned and forced to stop using, or by being offered medication-assisted treatment, which shifts them to a combination of therapy and less potent drugs? Many of those in “Dopesick” wrestle with this question, which comes down to whether you see people with addictions as criminals or as patients, and which turns out to have some interesting historical roots.

I didn’t know that in the late 19th century, America experienced a drug epidemic much like today’s opioid epidemic. Macy writes:

By the late 1870s, injecting morphine was so popular among the upper classes in Europe and the United States that doctors used it for a variety of ailments, from menstrual pain to inflammation of the eyes. … Daily users were not socially stigmatized, because reliance on the drug was iatrogenic.

Macy tells of Civil War veterans who became addicted to morphine after doctors gave it to ease pain from wounds; these veterans were easily identifiable because they wore leather bags around their necks that held needles and morphine tablets. Many of their family members became addicted, too, using morphine to cope with the trauma left by war.

By the early 20th century, heroin was illegal. People had to turn to criminal drug networks for their supply; they became known as “junkies” because they collected and sold scrap metal to finance their purchases:

The “respectable” upper- and middle-class opium and morphine addicts having died out, the remaining addicted were reclassified as criminals, not patients.

Which brings us to our current situation, limned so well by Macy in “Dopesick.” The title, by the way, refers to the most common reason people who are addicted to opioids continue to use them: not so much to get another high as to avoid the terrible physical symptoms that come with withdrawal. They’re not voting for a candidate they support. They’re voting against a candidate they dread.