by Beth Macy

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Last Updated September 5, 2023.

In Dopesick, Beth Macy examines both the human dimensions and the broader social issues of the opioid crisis in the United States through focusing on southwestern Virginia. Her approach is primarily that of a journalist, basing her accounts on many interviews with people who are directly affected. The author also uses a number of research techniques to situate the individuals and families within their communities and to draw a larger picture of the Appalachian region, which has been especially hard hit. Macy also looks both at corporate responsibility and the need for accountability and reviews possible solutions. Her work draws on social science and interdisciplinary approaches, incorporating sociology, economics, and policy studies.

Locating her in-depth analysis in and around Roanoke, Virginia, Macy brings home the devastating effects of opioids in various forms. Noting that rural areas, not just urban and suburban areas, have been heavily affected, she examines the patterns of drug sales, both legal and illegal, that put these powerful narcotics into people’s hands, often beginning when they were just teenagers. Macy charts the efforts of numerous individuals and organizations to stem the tide, both in aiding addicts with recovery and providing needed services to their families. Those involved include medical professionals, religious workers, and heartsick parents. Beyond dealing with the immediate impact, Macy shows the activist positions that a diverse array of people have deployed, taking the Food and Drug Administration to task and participating in lawsuits against Big Pharma.

At the broadest level, Macy addresses the medical and social system that is intended to serve and assist people with substance abuse problems—a system that has failed so badly that nonprofits must step in to fill the gap. The contradictory positions of different agencies and lack of communication among them are some factors working against effective treatment in the short term and formulation of effective policy in the long run. Macy often adopts the stance of a crusader, whose moral outrage is coupled with pragmatic candidness about the benefits to multiple stakeholders. Macy encourages the reader to question who profits from the pain of others, and her subjects’ candor makes it clear that their stories could become anyone’s story if the system is not fundamentally changed.

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