Dopesick: Dealers, Doctors, and The Drug Company That Addicted America Review

Below is my review as submitted to the editor for the December issue of the Sturbridge Times Town & Country Living Magazine

Please note, since the review, much has come out about how much management knew about the addictive nature of what they were selling and it is not to managements credit.

Dopesick: Dealers, Doctors, and The Drug Company That Addicted America

By Beth Macy

By now, few have not heard about the opioid crisis.  Governor, Charlie Baker, has recently signed his second piece of legislation to deal with the problem.  It is not new here in Sturbridge Country as several years ago a local doctor closed his practice due to prescription irregularities.

In an episode of his cable TV show, Anthony Bourdain spotlighted the problem, mostly in the old Massachusetts town of Greenfield.  The segment was well done in discussing what seems an epidemic.

However problematic Opioid addiction may be here in the Commonwealth, we are not the epicenter.

Beth Macy may not have found “ground zero,” but the Appalachian region she writes about should not be discounted in consideration for the dubious honor.

Macy has written Dopesick: Dealers, Doctors, and The Drug Company That Addicted America.  She chronicles the Opioid explosion that has ravaged not an inner city but the coal country that had already been blighted by economic hard times.

Actually, she might have discovered ground zero, not in the old mill towns of the Bay State or lumber camps of rural Maine or her Appalachian home region she has obvious affection for.  The subtitle, The Drug Company That Addicted America, pinpoints a successful pharmaceutical company as the origin of the plague. 

The Sackler family had built Purdue Pharma from a tiny company when they purchased it in 1952 into a powerhouse.  The company developed OxyContin and had gotten Food and Drug Administration approval in 1995.  

The Sacklers were private and more known for their philanthropy than the drug business.  That may be different since Dopesick’s publication.

It is not as if the author avers that the men were sitting around a boardroom planning to devastate rural America by hooking people on a powerful derivative of the opium poppy.  The company “touted the safety of its new opioid-delivery system everywhere its merchants went.  “If you take the medicine like it is prescribed, the risk of addiction when taking the opioid is one-half of 1 percent.” said Dr. J. David Haddox, a pain specialist who became the company’s point man for the drug.””

The Sacklers may have believed this and even that they were doing good.  Doing good was not what Purdue Pharma did best.  Selling was far and away the most important company value, or so it would seem, as they were champions at it.

Purdue Pharma is an easy and valid target, but hardly the whole story.  The region’s coal economy and factories were, like much of the industrialized US, somewhat played out.  Ms. Macy was in the right place at the right time, or maybe in the wrong place at the right time to chronicle the disaster.

Beth Macy reported for the Roanoke Times for about a decade and a half until 2014.  Since, she has been writing essays and op-eds for The New York Times as well as other venues and radio.  Harvard awarded her a Nieman Fellowship in 2010.

Before Dopesick, she had written a couple of other books.  Factory Man: How One Furniture Maker Battled Offshoring, Stayed Local --- and Helped Save an American Townwas published in 2014.  Her Truevine: Two Brothers, a Kidnapping, and a Mother’s Quest; A True Story of the Jim Crow Southcame out in 2016.  Both books garnered positive reviews.

For timeliness, however, Dopesick was, and, will be an important reporter's story.  It is happening now and will continue into the future and our ability to come to terms with the abundantly available chemicals may never happen.  From that point of view, her book’s ending can only be artificial.

Macy provides us with intimate portrayals of those dealing with or succumbing to the problem.  Some of them, such as Dr. Art Van Zee came to Appalachia because he wanted to practice in an underserved community and found one.  His match is his wife, Sue Ella Koback.  Shades of Loretta Lynn, Sue was a coal miner’s daughter from over the mountain in Kentucky.

Dr. Van Zee comes off as a hero.  She describes his struggle with the corporate interest as chronicled by another author as a “David-versus-Goliath battle.”  As the book goes on, he is always fighting that good fight.  How he avoids burn-out seems a mystery. 

Where the good doctor is somewhat mild mannered, Sue Ella seems, as the author put it, “a firecracker lawyer.”  When the abovementioned Dr. J. David Haddox told a parent meeting about a somewhat exculpatory open letter they were going to run in a local newspaper, Sue Ella blew up at him.  The letter did not run.

There are many more stories in Dopesick.  Some even hopeful, and others not. Granted, once OxyContin and drugs like it get control of a victim, the brain structure will be changed and the odds are not good.

One of the hopeful ones is Spencer Mumpower.  Spencer was not on OxyContin, but was a full-fledged heroin addict who sold a drug friend the dose that would kill him.  With some tough love from mom, she refused to bail him out, he started the turnaround.

Once out before trial, he continued the process.  Eventually sentenced, he served his time and came out clean to continue the new life.  A small triumph, but a victory nonetheless.

There is little uplift in the story of Ronnie Jones.  Even so, he comes off as a sympathetic character and that is a problem.

The TV series, The Sopranos did the same thing for the eponymous Tony.  It made a vicious criminal who murdered with impunity into a lovable teddy bear.

The author did not seem to be trying to make the criminal Jones into a Nobel prize level humanitarian.  She does document his crimes in detail.  Having a long interview with the man in prison and getting to know him does allow him to be seen as a complex character and not the sum of his crimes and that is not horrible reporting.  Even so, his wrongdoing is so large that unlike the fictional Tony Soprano, it should dwarf anything of his life that we might want to like.

Is there any optimism in the struggle Beth Macy has written about?  She endorses Drug Courts stating that they “remain among the country’s models for preventing recidivism and relapse, with intensive daily monitoring of participants---and swift consequences.”  If one successfully completes the program, charges can be dropped.

That is heartening, but there is no victory lap.  Graduates of the Drug Court program are “roughly a half or to a third less likely to return to return to crime or drugs than regular probationers.”  This means half to two thirds will. 

Still, the drug court program does offer hope.  Beth tells us parents approach one judge out shopping to beg him to place their kids in the program.

Drug court coupled with MAT or medication assisted treatment seem to work better than much else according to Beth.  MAT is not allowed everywhere; 12 Step programs don’t favor it.  Some see value according to the author, ““We’ve had thirteen babies born to mothers on MAT, and not one of those babies had NAS (neonatal abstinence syndrome),” Tazewell County judge Jack Hurley told me”

Encouraging yes, but not a solution.

The story Beth follows the longest in the book is the saddest.  The drug problems may have started in the coal camps, but more upscale areas were not left untouched.  Tess Henry lived in affluent venues as a child.  The author follows the young woman with a loving mom and a seemingly smooth life.  

Tess was subject to anxiety from an early age, but that does not seem to have been the cause of her downfall.  She experimented in college, but it was a 30-day opioid prescription of codeine cough syrup and hydrocodone at an urgent-care center to treat bronchitis that seemed to do the trick.

Her drug filled odyssey is woven into the book as the author discusses other matters as well.  Beth would come back to the young lady who was spiraling down with occasional slight glimmers of hope until the last chapter where the inevitable is reported.  Tess had been hustling as a prostitute in Las Vegas and was found by a homeless man in a dumpster.

Tess’s return home ends the book, but hardly the story.  Part Three is titled “A Broken System.”  Notwithstanding the author’s favoring of Drug Court and MAT, the system is fractured and we are not yet near any solution.  

Of course, more attempts to solve it will be made and Beth Macy will be covering the story with the same skill and clarity, we should all hope.