If you’re looking for an uplifting read, pass this one up. If you’re interested in serious anecdotal and statistical research into the opioid epidemic in this country, read it.
Macy focuses mainly on the epidemic in and around her home town of Roanoke and in some of the poorer white areas of the Appalachia’s, but the book is global in its application.
Macy interviewed and garnered the confidence of numerous users, users’ families and even a drug dealer, serving a 23-year prison sentence for heroin distribution. Interestingly, that dealer never did ‘herr-on’ as he refers to heroin. He was wise enough to know that his using would only result in his own addiction which would eat into his profits. While he might be a large fish in the dealing pond, he is hardly responsible for the epidemic. Many of the white addicts he sold to turned into dealers themselves just so they could fund their own habits. And small time players can make addicts just as quickly as big ones.
Macy has done long view research on this epidemic. And she pits its genesis back in 1996 when Purdue Pharma marketed Oxy as a less addictive drug than other opioids on the market. This has been proven to be a falsity of massive proportions. This untruth, tied in with a wave in the medical field to treat “pain as a 5th symptom”, led to massive numbers of excessive prescriptions that were largely unnecessary. Those prescriptions led to opioid addictions and when the scrips ran out, the users turned to the streets, and ultimately heroin, which is simply a cheaper version of the oxy drugs.
Ironically, Macy shows how racism in the opioid scenario actually worked to the benefit of the minorities. Why aren’t there more prescription addicted African-Americans? Because doctors don’t trust their black patients to manage the scrip appropriately so they prescribe less. But, unlike doctors, addiction is indiscriminate in its targets, and a high school football player with a knee injury who is given a three-month prescription for oxy will get hooked even if the doctor ‘expects’ him and his mom to properly manage the use.
Macy’s choice of title gets to the heart of why opioid addiction is so insidious. Pretty early into an addiction, a user’s goal is less about getting high than staving off the withdrawal, known as dopesickness. Users who have been through it can’t really liken it to anything they’ve been through because it’s worse than all of it put together. And the only thing that keeps the dopesickness at bay is using again.
Another issue that Macy addresses is how total abstinence programs to curb the epidemic are largely ineffective. Research has repeatedly shown that the greatest success opioid addicts have in recovery is through a combination of counseling, in or out patient drug treatment coupled with MAT, Maintenance Assisted Treatment. Combining rehab with therapy and sometimes years of a non-high inducing drug like Suboxone is the preferred method by most addiction treaters. This, however, becomes problematic if a provider is trying to get a patient into a rehab that only recognizes total abstinence recovery, which many of them are.
Macy shows that progress is being made in areas that treat the epidemic not as a scourge on society but as a social emergency that requires the hands-on involvement of lots of different groups – law enforcement, medical professionals, rehab facilities and educators.
Dopesick will make you think twice about judging someone’s walk through addiction, particularly one of the opioid variety. It will also, hopefully, make you think long and hard about how much pain medication you’re going to take even if it is lawfully prescribed.
Publisher: Little, Brown, and Company
Elizabeth’s rating: 4.5 stars