by Beth Macy

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Dopesick Summary

Dopesick is a 2018 work of investigative journalism about the United States opioid crisis.

  • Beth Macy traces how the overprescription of OxyContin, a powerfully addictive painkiller manufactured by Purdue Pharma, began a nationwide opioid epidemic.
  • In and around her hometown of Roanoke, Virginia, Macy interviews recovering addicts, former dealers, and parents who have lost children to addiction and overdose.
  • Activist group Relatives Against Purdue Pharma (RAPP) eventually took on Purdue, leading to a successful federal lawsuit.
  • In agreement with experts and activists, Macy concludes that embracing harm reduction models and medication-assisted therapy (MAT) is the best way to address the ongoing crisis.


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Last Updated September 5, 2023.

Beth Macy's 2018 book, Dopesick, tells the devastating and often tragic story of the impact of a new generation of opioid drugs on those who became addicted or died of an overdose and the way the opioid crisis has affected the lives of the families, friends, and communities of its victims.

For much of the book, Macy focuses on the opioid which has done the most widespread damage, OxyContin, and the company that produced it, Purdue Pharma. Beginning in 1996, the company launched a $4 billion promotional campaign for what they described as a miracle drug, featuring lavish incentives for its sales representatives, such as large cash rewards and luxury vacations. Hospitals and doctor's offices across the United States were soon awash in OxyContin.

Before long, a wide array of ordinary people without previous drug issues who had been given an OxyContin prescription for the pain management of routine medical conditions or procedures found themselves addicted to the drug. What had changed? Along with its reps, Purdue Pharma had also wined and dined doctors and plied them with gifts, not only to help persuade them to prescribe OxyContin, but to convince them to do so for low-level complaints such as arthritis and backaches, as well as the most intense cancer pain. Many of these people were from middle-class suburbs or blue-collar rural areas where drug addiction was considered to be a problem of inner-city Black Americans. Thus, communities were often slow to respond to the epidemic appearing in their own backyards.

Recreational drug users quickly found a way to wring a higher high from the new drug. One of the most heavily touted features of OxyContin was its delayed-action feature, which spread its pain-killing efficacy over twelve hours. But users simply needed to scrape off the outer coating that created the delay to have a ball of oxycodone, which, when crushed and snorted or injected, had the power of uncut heroin.

Although Macy outlines the national scope of the opioid epidemic, which led to 72,000 deaths in 2017, many of her tragic tales come from the author's own town of Roanoke, Virginia. Her endless list of lives needlessly lost—including college-bound students, star athletes, devoted fathers, and gifted professionals—is heartbreaking. A number among the grieving families and friends, after recovering from their initial shock, became activists, with one group forming a nonprofit organization, Relatives Against Purdue Pharma (RAPP). US attorney John Brownlee successfully sued the company, which pled guilty to fraudulent marketing in downplaying claims about OxyContin's power to induce addiction. The company paid $600 million in fines.

Given the increased awareness of the dangers of OxyContin, doctors are supposed to be following the rigorous guidelines from the Centers for Disease Control in prescribing it for chronic pain. But after twenty years in distribution, there is an enormous amount of the drug still in existence. And as Macy points out, that doesn't include the remainder of the wide array of pharmaceutical opioids still available.

In concluding, Macy makes a strong recommendation for medication-assisted treatment (MAT) with drugs that are already proving effective in saving the lives of addicts.

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